Bone resorption levels by age and menopausal status in 5,157 women.

OBJECTIVE: The purpose of this study was to describe bone resorption activity using a biochemical marker according to the categories of age, menopausal status, and selected drug/supplement use in middle-aged and elderly community-based women. DESIGN: This was a cross-sectional study that assessed urinary cross-linked N-telopeptide of type I collagen (NTx) and used self-report data to group women as premenopausal (Pre), perimenopausal (Peri), postmenopausal without hormone replacement therapy (Post), and postmenopausal with hormone replacement therapy (HRT). RESULTS: Mean NTx values were found to be significantly different by group and controlling for age (p = 0.001), with post hoc tests showing all pairwise group comparisons as significantly different (p = 0.001), except that the Pre and HRT groups were not significantly different. Both the Peri and the Post NTx levels were significantly higher than the Pre and the HRT groups'. NTx values in the Peri group varied with age-the youngest Peri women were similar to Pre women, and the oldest Peri women were similar to Post women. Significantly lower NTx levels were found only in the Post (p = 0.009) and HRT (p < 0.001) groups using diuretics compared with nonuse and only in the HRT group using calcium supplements compared with nonuse (p = 0.006). No differences by thyroid use were found. With a biochemical marker, the results showed that bone resorption activity differences could be demarcated in women according to age, estimated menopausal stage, and selected drug/supplement use. CONCLUSIONS: These results support the usefulness of NTx assessment for indicating bone resorption activity and therefore the potential for osteoporosis or for monitoring the efficacy of antiresorptive therapies.

Psychophysiological responses after sudden cardiac arrest during hospitalization.

A sample of 21 sudden cardiac arrest (SCA) survivors were interviewed every 48 hours during hospitalization to determine emotional, cognitive, and physiological parameters of recovery. On the average, SCA survivors were not excessively anxious, depressed, angry, or confused during hospitalization, but they did report high levels of denial and uncertainty. The two most predominant cognitive impairments at the time of hospital discharge were loss of short-term memory and construction ability. Both the number of cardiac arrhythmias and the types of interventions used to manage them decreased as hospital discharge approached.

Symptoms and self-care strategies in women with and without dysmenorrhea.

We compared the self-reports of women who reported either none-mild (N = 34) or moderate-extreme (N = 27) pain from uterine cramping regarding, (a) gastrointestinal, perimenstrual, and other symptoms during the 5 days before and after the beginning of menstrual flow; (b) smoking, alcohol use, exercise behaviors, and number of reported stressors; and (c) self-care strategies used for symptom management. Although there were significant differences between the two groups in reported symptoms, there were no significant between groups differences in smoking, alcohol use, exercise behaviors, and number of stressors reported. Despite the number of symptoms reported, relatively few self-care strategies were used. The most commonly reported strategy was the use of medication for cramping pain. The results confirm prior observations that dysmenorrhea is associated with a variety of symptoms and extend our understanding of how women manage these symptoms.

Menstrual cycle factors related to increased gastric contractile response to tube feeding.

Evidence exists that the ovarian hormones have a modulating effect on gastrointestinal (GI) motility, yet details are sketchy and little attention has been paid to the effect that fluctuating hormone levels might have on women who are receiving enteral feedings. This study compared gastric motility indices in response to tube feedings at two points in the menstrual cycle, concurrently measured ovarian hormone levels, and described three potentially related factors (ie, GI symptoms, uterine cramping pain, reports of daily stressors). Intragastric motility responses to enteral feedings were obtained on 28 women (aged 19-37) during menses and midfollicular phases of two menstrual cycles. Intragastric pressure changes were monitored by an open-tipped cannula method at rest, during and after tube feeding (Ensure, 240 ml at 8 ml/min). Serum estradiol and progesterone levels were measured by radioimmunoassay. Women completed a daily diary of symptoms and stressors throughout the two menstrual cycles. Results showed that intragastric pressure amplitudes and frequencies were higher at menses compared with midfollicular recordings. At menses, prefeeding and feeding gastric pressure amplitudes were positively correlated with uterine cramping pain and GI symptoms (ie, nausea). At menses, postfeeding contraction frequencies were also correlated with uterine cramping pain. At midfollicular phase, progesterone levels correlated with gastric motility indices; number of stressors indirectly correlated with gastric motility indices. These data suggest that gastric responses to enteral feeding are influenced by menstrual cycle phase.

Sleep patterns related to menstrual cycle phase and premenstrual affective symptoms.

An ovulatory menstrual cycle is characterized by fluctuating levels of progesterone. Progesterone, a gonadal hormone known for its soporific and thermogenic effects, is present in negligible levels prior to ovulation and in high levels after ovulation. To describe and compare sleep patterns in relation to ovulatory cycles and premenstrual mood state, sleep was monitored in healthy women at two phases of the menstrual cycle. Results indicated that rapid-eye-movement (REM) latency was significantly shorter during the postovulatory (luteal) phase compared to the preovulatory (follicular) phase, but there was no significant difference in latency to sleep onset or the percentage of REM sleep. While there were no menstrual cycle phase differences in the percentages of various sleep stages, the women with negative affect symptoms during the premenstruum demonstrated significantly less delta sleep during both menstrual cycle phases in comparison with the asymptomatic subjects.

Nursing research opportunities in enteral nutrition.

The concepts of individual adaptations, environmental, and person factors have been suggested as components of a framework for considering existing and potential investigations of enteral feeding as a therapeutic modality. Much of the work regarding adaptations to enteral feeding have described the pathophysiological and experimental responses of individuals--that there is less emphasis on the physiological and behavioral responses is evident in the literature. Also, little investigation has been focused on the environmental risk factors or the person vulnerability factors that are associated with less than optimal adaptations to enteral feeding. However, it is the understanding of all three of these aspects that will lead to comprehensive strategies for promoting satisfactory adaptations. To date, the majority of clinical therapeutic studies have focused on obviating or managing untoward reactions to enteral feeding by manipulating environmental physical factors. Certainly, more needs to be done, particularly with respect to temporal and rhythmicity considerations. However, there is an obvious lack of information about manipulating social circumstances or person factors (such as, knowledge deficit) for therapeutic ends. Examination of the multiple dimensions of patient responses to enteral nutrition modalities, the interaction of these various dimensions (concentrating on the social and person), and the physical elements is congruent with the holistic and caring nature of nursing practice and should guide future study.

Gastrointestinal symptoms and bowel patterns across the menstrual cycle in dysmenorrhea.

Gastrointestinal (GI) functional indicators and symptoms across the menstrual cycle were examined in three groups of women: dysmenorrheic (n = 15), non-pill-taking nondysmenorrheic (n = 10), and nondysmenorrheic taking birth control pills (BCPs) (n = 9). Group assignment was based on the reported presence or absence of moderate to severe menstrual cramps in a GI Health Diary which subjects kept for two menstrual cycles. Stool consistencies and frequencies and GI symptoms were also recorded in this diary. Menstrual cycle phase significantly, p = .03, influenced stool consistencies for the sample as a whole with the loosest stools at menses. Reports of stomach pain were higher, p less than .001, at menses than at other cycle phases in all groups, and nausea, p less than .001, and decreased food intake, p less than .01, were more frequently reported by dysmenorrheic women at menses. More dysmenorrheic women had a history of menses-related GI symptoms. Both cycle phase and group differences were significant, p less than .05, for menstrual distress, with negative affect, pain, behavior changes, and autonomic reactions reported more frequently at menses by dysmenorrheic women.

Adrenalectomy and pentagastrin effects on gastrointestinal cholinergic enzyme activities.

The present study examined the effects of pentagastrin and adrenalectomy on choline acetyltransferase (ChAT) and acetylcholine esterase (AChE), enzymes which synthesize and degrade acetylcholine in the rat gastrointestinal tract. Adrenalectomized and non-adrenalectomized rats, 14 and 21 days old, were treated with either pentagastrin (250 micrograms/kg i.p.) or saline for 7 days. Rats were sacrificed at 21 and 28 days of age. Adrenalectomy- and pentagastrin-treated 21-day-old rats had greater ChAT activities than those treated with pentagastrin alone, while AChE activities were higher in the pentagastrin-treated group. Adrenalectomy- and pentagastrin-treated 28-day-old rats had lower levels of activity as compared to pentagastrin-treated rats. The adrenal gland does appear to influence the response of cholinergic enzyme activities to pentagastrin.

Pentagastrin on neurotransmitter enzyme activities in the rat gastrointestinal tract.

The effects of three doses (5, 100, and 250 micrograms/kg) of pentagastrin on the activities of choline acetyltransferase (ChAT) and acetylcholine esterase (AChE), the neurotransmitter enzymes that synthesize and degrade acetylcholine, and monoamine oxidase (MAO), the degradation enzyme for catecholamines, were investigated. Enzyme activities were assayed in 6 gastrointestinal segments of 21- and 28-day-old and adult rats. All animals were injected intraperitoneally for 7 days with pentagastrin, and the results were compared with age-matched controls receiving saline for 7 days. Plasma and adrenal corticosterone levels were measured. No consistent differences in adrenocortical variables existed between pentagastrin- and saline-treated animals. Similarly, no consistent pentagastrin dose responses of ChAT, AChE, and MAO activities were evident. However, at the highest dose pentagastrin generally produced increases in ChAT activities in 21- and 28-day-old rats, while producing decreases in AChE and MAO activities in 21-day-old rats and increases in 28-day-old animals. There were few significant differences in enzyme activities in adult rats receiving pentagastrin as compared to saline.

Concordance of perimenstrual symptoms across two cycles.

The prevalence of perimenstrual symptoms usually is based on reports for one menstrual cycle; the consistency of symptoms across cycles is ignored. The purpose of this investigation was to determine perimenstrual symptoms reported concordantly for two menstrual cycles in a group of 63 presumably healthy women reporting symptoms in health diaries over 2 months. There were only nine symptoms for each of the menstrual and premenstrual phases reported by the same woman across both cycles. Furthermore, concordance of perimenstrual symptom reporting across the two cycles was significant only for backache (kappa = .636, p less than .0001), headache (kappa = .849, p less than .001), and cramps (kappa = .899, p less than .001) in the menstruum and for backache (kappa = 0.123, p less than .0001), cold sweats (kappa = .500, p less than .0001), fatigue (kappa = .135, p less than .0001), depression (kappa = .268, p less than .0002), and tension (kappa = .320, p less than .0001) in the premenstruum. Several symptoms showed high prevalence during the remainder of the cycle which might contribute to the lack of concordance. These data imply that prevalence estimates based on only one menstrual cycle may be inaccurate overall and inadequate as baseline or followup estimates by which to evaluate therapeutic intervention.

The basic mechanisms of fever: considerations for therapy.

In response to threat, particularly the invasion of microorganisms, body temperature rises, a condition called fever. This occurs as phagocytic cells in the body are activated to secrete substances which generate a multitude of host defense responses. Evidence is presented that this response is likely adaptive for the individual and fever acts to synergistically support the responses. Implications for practice are that the attenuation of fever by clinical interventions could limit the defense mechanisms for the individual and a more effective therapeutic goal might be to keep body temperature within certain limits. Developing knowledge about the host defense response and fever mechanisms will suggest supportive therapeutic options for testing.