Understanding cultural aspects of health through photography.

Photography is used as a means to teach nursing students of varying learning styles and levels of cultural awareness about cultural aspects of health.

Posttraumatic stress disorder and pregnancy complications.

OBJECTIVE: To assess the associations between specific pregnancy complications and posttraumatic stress disorder based on neurobiologic and behavioral characteristics, using Michigan Medicaid claims data from 1994-1996. METHODS: Two thousand, two hundred nineteen female recipients of Michigan Medicaid who were of childbearing age had posttraumatic stress disorder on the basis of International Classification of Diseases, 9th Revision (ICD-9) codes. Twenty percent (n = 455) of those recipients and 30% of randomly selected comparison women with no mental health diagnostic codes (n = 638; P <.001) had ICD-9 diagnostic codes for pregnancy complications. We used multiple logistic regression to investigate associations between specific pregnancy complications and posttraumatic stress disorder, controlling for demographic and psychosocial variables. Obstetric complications were hypothesized based on high-risk behaviors and neurobiologic alterations in stress axis function in posttraumatic stress disorder. RESULTS: After controlling for demographic and psychosocial factors, women with posttraumatic stress disorder had higher odds ratios (ORs) for ectopic pregnancy (OR 1.7, 95% confidence interval [CI] 1.1, 2.8), spontaneous abortion (OR 1.9, 95% CI 1.3, 2.9), hyperemesis (OR 3.9, 95% CI 2.0, 7.4), preterm contractions (OR 1.4, 95% CI 1.1, 1.9), and excessive fetal growth (OR 1.5, 95% CI 1.0, 2.2). Hypothesized labor differences were not confirmed and no differences were found for complications not thought to be related to traumatic stress. CONCLUSIONS: Pregnant women with posttraumatic stress disorder might be at higher risk for certain conditions, and assessment and treatment for undiagnosed posttraumatic stress might be warranted for women with those obstetric complications. Prospective studies are needed to confirm present findings and to determine potential biologic mechanisms. Treatment of traumatic stress symptoms might improve pregnancy morbidity and maternal mental health.

Extending the extended family for homeless and marginally housed African American women.

Young homeless African American women and elderly marginally housed African American women have health, housing, and personal concerns specific to their age cohort, yet they also have parallel and complementary needs. The young struggle to find affordable housing, while the old may have difficulty in maintaining their homes. This article reports select findings from a pilot study designed to describe these two groups of women. The preliminary study was conducted preparatory to the development of a larger study to explore factors that would facilitate or hinder linking the two groups of women for mutual assistance in housesharing arrangements. Interviews and housing history findings revealed contrasts and similarities among the women and between both cohorts that reflected individual differences, common yet divergent life courses, and collective responses to family life situations, societal trends, and policies. Advantages and disadvantages of housesharing were delineated with 56.3% of the homeless women and 81.3% of the elderly women viewing coresidential living as an option worth considering. Housesharing arrangements should be further investigated by nurses and colleagues. Findings from this study are foundational for establishing alliances that may be a means to promote health and strengthen "family" in both populations.

Linking African American mothers across life stage and station through photovoice.

Homeless young African American women and low-income, elderly African American women have housing needs specific to their age cohorts, yet they also have parallel and complementary housing, health, and personal needs. The young struggle to afford decent housing, while the old may have difficulty maintaining their homes. In this pilot study, intergenerational contact was established between young homeless women and elderly independently housed women through photovoice. Over six months, five African American women discussed photographs they had taken that focused on their current living arrangements and activities. Although the women spanned three generations, had different life experiences, and resided in a variety of home settings, the sharing of photographs revealed many commonalities. In the process of discussing photographs, the women established mutual respect, exercised reciprocal affirmation, and built alliances. The preliminary study is preparatory to exploring the feasibility of establishing house-sharing arrangements for mutual assistance between these cohorts.

Physical activity and postpartum well-being.

OBJECTIVE: To describe reported patterns of postpartum physical activity and to identify benefits or risks associated with postpartum physical activity at 6 weeks postpartum. DESIGN: Secondary analysis of longitudinal data collected prenatally and postpartum in a study of obstetric outcomes at a midwestern tertiary-care center and its ambulatory satellite and hospital clinics. PARTICIPANTS: One thousand three women completed a questionnaire at the 6-week postpartum clinic visit. Mean age was 29.7 years, and mean education level was 15.3 years. VARIABLES OF INTEREST: Participation in vigorous exercise, change in postpartum activity level, postpartum weight retention, infant feeding method, maternal postpartum adaptation, and participation in activities for fun. RESULTS: Nearly 35% reported doing vigorous exercise with a modal frequency of three times per week. More active women had retained significantly less weight (8.6 lb [3.9 kg]) than their less active counterparts (11.3 lb [5.1 kg]). Vigorous exercisers demonstrated a consistent pattern of better scores on measures of postpartum adaptation and were more likely than nonexercisers to participate in fun activities, such as socializing, hobbies, and entertainment. Breastfeeding was not adversely affected by vigorous exercise. CONCLUSIONS: These exploratory results indicate that physical and psychologic benefits may accrue to postpartum women who are able to exercise vigorously and avoid decreasing their usual level of activity. A prospective randomized test of this relationship is warranted. Although positive outcomes of physical activity have been demonstrated in the population at large, exercise has rarely been an element in postpartum care plans. Nurses who care for women after childbirth should assess women's exercise goals and support them in their desired activities.

Early adolescents' sexual behaviors.

The purpose of this study was to analyze changes in early adolescents' intimate behaviors and the initiation of sexual intercourse over a one-year time period. The changes are interpreted within the context of recent progress in understanding the development of early adolescents. Public school students in sixth and ninth grades of selected schools in a midwestern industrial city were studied in two waves of data collection. A total of 106 students provided data for the second year, allowing comparisons of their Time 2 with their Time 1 responses. Five of eight intimate behaviors studied increased in frequency during the year. Also, the adolescents' perceived benefits of having sexual intercourse increased and perceived costs decreased during the follow-up year. Increases in the frequency of intimate behaviors but not changes in their perceptions of the benefits and costs predicted whether or not students had initiated sexual intercourse during the follow-up period. These findings support current understanding of early adolescence as a time of incremental learning about intimacy and about sexual relationships. The findings suggest that preventing early sexual intercourse may require understanding the specific behavioral competencies related to healthful development of intimacy. Pediatric nurses can be leaders in providing the necessary counseling and education to young adolescents, their families, and their communities.

Poverty and procreation among women. An anthropologic study with implications for health care providers.

In this article, select findings from a 5-year ethnographic study of homeless, pregnant women in Southern California pin-pointed the contextual constraints, along with individual factors, that framed the women's reproductive options and actions. The women had very little choice in the timing, the place, the partner, and the circumstances surrounding conception. Factors contributing to their becoming pregnant were the woman's victimization, economic survival, lack of access to contraceptives, uncertain fertility, desire for intimacy, and hope for the future. Findings suggest that even if the women were able to establish reproductive goals and had the wherewithal to acquire and effectively use contraceptives, situational constraints (homelessness, pregnancy, poverty, contraception, fertility patterns) might still prevent their success.

PIP: This 5-year ethnographic study describes the ability of 15 women living in Southern California to manage their reproductive goals while they were homeless. Data were collected through participant observation spanning a few months to 1 year; from information offered by scores of other homeless, pregnant women; from interviews with ancillary people in the lives of the subjects; and from focused observations of the environment and resources offered by the community. This report focuses on the circumstances that led the women to become pregnant. It was found that conception usually occurred in less then desirable conditions and that the women had little choice in the timing and place of conception or in selection of their partner. Most of the women became pregnant while homeless and attributed this to a desire for intimacy, to victimization, to a bid for economic survival, to a lack of access to contraceptives, to uncertainty about their fertility, and to a hope for the future that made being pregnant their sole source of joy. It is concluded that it is unjust that society expects impoverished women with few resources to be more able to control their reproductive lives than women with more resources, especially since preventing pregnancy requires consistent, diligent use of the most effective methods of contraception. Further study of this situation is needed.

Special health care needs of homeless pregnant women.

As women and families join the ranks of the homeless in increasing numbers, many women find themselves confronting both pregnancy and homelessness. When pregnancy accompanies the precarious state of homelessness, the need for adequate shelter is not being met during one of the most critical periods of a woman's life. This article focuses on the unique health needs of homeless pregnant women. Detailed accounts of the daily life experiences of African American, Anglo, and Latina homeless pregnant women were derived from an ethnographic study conducted in a large metropolitan area in southern California. Their pregnancies were difficult because normal physiological changes of pregnancy often became pathological, signs of potential complications went unnoticed or unattended, and minor discomforts of pregnancy were exacerbated by the women's environment. Nursing therapeutics that support health maintenance and coping strategies of the women while on the streets or in shelters were explicated.

Dissection of cross-reactivities using a panel of H-2Ld alloreactive T cell hybridomas.

In order to explore the role which class I structure plays in alloreactivity, we have generated Ld-reactive T cell hybridomas by fusion of a dm2 anti-BALB/cJ MLR with the BW5147 cell line and examined their stimulation by the following class I molecules (alpha 1/alpha 2/alpha 3): Lq, Dq, dm1, Ld/Ld/Dd, Lq/Dq/Ld, and Q10/Q10/Ld. We found that their specificities differed in their patterns of cross-reactions and were reasonably representative of those present in the bulk population of MLR-generated CTLs. Ld/Ld/Dd and Q10/Q10/Ld stimulated the majority of the hybridomas, Lq and dm1 were recognized by over half of the panel, and Lq/Dq/Ld stimulated only modestly, while Dq was not recognized by any hybridoma. Correlation of these observed reactivities with class I structure suggests that putative TCR contact residues may play a significant role in recognition when compared to the polymorphic amino acid residues which control pocket specificity and peptide binding. Specifically, Lq and Dq possess very similar or identical pockets, in contrast to those of dm1 and Q10. However, Q10 has identical TCR contact residues to Ld, both on the alpha 1 and alpha 2 alpha helices, unlike Dq which is mismatched on both helices. Lq and dm1 are mismatched compared to Ld on only one helix. Thus, a molecular rationale for the cross-reactions observed in this study involves the direct participation of residues of class I molecules in allorecognition.

Immunogenicity and tolerogenicity of self-major histocompatibility complex peptides.

Mechanisms involved in self-antigen processing and presentation are crucial in understanding the induction of self-tolerance in the thymus. We examined the immunogenicity of determinants from major histocompatibility complex (MHC) molecules that are expressed in the thymus and have tested peptides derived from the polymorphic regions of class I and class II molecules. We found that two peptides corresponding to NH2 termini of the class II alpha and beta chains (Ak alpha 1-18 and Ak beta 1-16) could bind to self-Ak molecules with high affinity and, surprisingly, were immunogenic in that they could elicit strong proliferative T cell responses in B10.A mice (Ak, Ek). Neonatal injection of peptide Ak beta 1-16 resulted in complete unresponsiveness to this peptide at 8 wk of age showing that these T cells were susceptible to tolerance induction. We have also tested certain class I MHC peptides and showed that some can interact efficiently with class II MHC peptides to induce an autoreactive T cell proliferative response. Among these class I peptides is one (Dd 61-85) that has the capacity to bind to self-Ia without being immunogenic, and therefore represents an MHC determinant that had induced thymic self-tolerance. We conclude that some self-MHC molecules can be processed into peptides that can be presented in the context of intact class II molecules at the surface of antigen-presenting cells. Autoreactive T cells recognizing optimally processed self-peptide/MHC complexes are eliminated during development, whereas other potentially autoreactive T cells escape clonal inactivation or deletion. Incomplete tolerance to self-antigens enriches the T cell repertoire despite the fact that such T cells may eventually become involved in autoimmune disease.

Self-perceptions and personal sources of support among Creole Belizean parents of mentally retarded children.

A modified version of the Kuhn-McPartland Twenty-Statement Test, a projective technique to measure self attitudes, was administered to six Creole Belizean mothers of mentally retarded children in Belize, Central America. Other methods of measurement included participant observation over a 13-month period, focused observations, formal, unstructured interviews, and daily calendars maintained by the parents. A central finding of the entire ethnographic study was that mothers relied almost exclusively on themselves and personal sources of support, like religion, for coping, rather than social support from others.

Origin of the fourth component of complement related Chido and Rodgers blood group antigens.

We have reviewed the relationship between C4 and its related blood group and discussed the mechanisms whereby a fragment of C4 could become attached to erythrocytes (E). We hypothesize that there is chronic fluid-phase activation of C4 by either C1 to form C4b or spontaneous cleavage of the thioester to form iC4. These activated molecules bind to E. Proteolytic degradation of the bound C4b or iC4 would leave a covalently attached fragment of C4 on E and thereby give rise to the Ch and Rg blood group antigens. This system is of further immunopathologic interest since this 'normal' activation or turnover of C4 is closely regulated. In patients deficient in regulatory proteins, this spontaneous or normal turnover of C4 and C3 may initiate a pathologic condition.

The C4 and Slp genes of the complement region of the murine H-2 major histocompatibility complex.

Recent analyses, at the protein and DNA levels of structure, of the murine complement components C4 and the closely related sex-limited protein, Slp have led to new insights into the H-2/S region-linked C4 and Slp genes and their products. The primary products are 200 000 Da precursors which are cleaved, intracellularly and extracellularly, into the the mature alpha-beta-gamma-subunit molecules of plasma. Precursor order of subunits is beta-alpha-gamma; a complementary DNA clone spanning the alpha-gamma junction has been extensively analysed. The C-terminal of the alpha-chain is of particular interest because of post-secretion processing which differentiates 'secreted' and 'plasma' forms of C4, both apparently functional, and because allelic variants of C4 and the Slp protein, which differ substantially in molecular masses, owe their differences principally to different levels of glycosylation of the alpha-chain. Allelic variations in rate of C4 synthesis (C4-high compared with C4-low) have been analysed in cultures of hepatocytes and macrophages. Three distinct modes of genetic regulation of the expression of the Slp protein have been identified.

Purification of Fc gamma receptor from rabbit alveolar macrophages that retains ligand-binding activity.

The Fc gamma receptor of rabbit alveolar macrophages was purified by affinity chromatography by using rabbit gamma-globulin (Rab gamma G) coupled to Sepharose. Macrophage preparations were efficiently labeled with 125I by using a modified lactoperoxidase method. After incubation of NP-40 cell lysates with Rab gamma G-Sepharose, elution at 4 degrees C with 0.5 N acetic acid containing 1% NP-40 and rapid neutralization allowed recovery of active Fc gamma receptor. Purified Fc gamma receptor retained its ligand-binding activity, since approximately 41 to 72% of labeled material specifically rebound to Rab gamma G-Sepharose. Active receptor also rebound to human IgG- and rat IgG-sepharose. Active Fc gamma receptor did not bind to Sepharose coupled to rabbit Fab, rabbit F(ab)'2 or human F(ab)'2 fragments, nor to Sepharose coupled to chicken IgG. Analysis of Fc gamma receptor by SDS polyacrylamide gels demonstrated a broad peak of radioactivity in the apparent m.w. range of 50,000 to 70,000 in 5.6% acrylamide gels and 35,000 to 55,000 in 9% gels. Labeled receptor with similar structural characteristics and ligand-binding activity was also obtained from highly purified adherent cell populations and from macrophages biosynthetically-labeled with [14C]glucosamine in culture.

Improved cell surface radioiodination of macrophages.

Rabbit alveolar macrophages at high cell concentrations are inefficiently radiolabeled by the usual lactoperoxidase-catalyzed iodination method. Soluble macromolecules secreted by macrophages were found to inhibit the radioiodination of macrophages and other cells. A modified procedure is described which minimizes the presence of such inhibitory material and thereby considerably improves the radioiodination efficiency for both alveolar macrophages and the macrophage-like P388D1 cell line.