Objective
We sought to extend our prior observations and histopathologically characterize key metabolic enzymes (CYP1A1) with markers of oxidative damage in placental sections from smokers.
Study Design
Placental specimens were collected from term singleton deliveries from smokers (n=10) and non-smokers (n=10), and subjected to detailed histopathologic examination. To quantify the extent of oxidative damage, masked score-graded (0–6) histopathology against 4-hydroxy-2-nonenal (4-HNE) and 8-hydroxydeoxyguanisine (8-OHdG) was performed. Minimal significance (p<0.05) was determined with Fisher’s-exact and two-tailed T-test as appropriate.
Results
We observed a significant increase in the presence of syncytial knots in placentas from smokers (70% versus 10%, p=0.02). These gross observations were accompanied by significant aberrant placental aromatic hydrocarbon metabolism (increased CYP1A1, 4.4 vs. 2.1, p=0.002) alongside evidence of oxidative damage (4-HNE 3.4 vs. 1.1, p=0.00005; 8-OHdG 4.9 vs. 3.1, p=0.0038).
Conclusions
We observe a strong association between maternal tobacco use and aberrant placental metabolism, syncytial knot formation, and multiple markers of oxidative damage.
This evaluation study measured the effect of respite on family caregivers of the elderly. The specific aims were: (a) to learn the effect of respite on the evaluation variables of caregiver quality of life, mood, and response to caregiving; (b) to learn relations between the demographic variables and the evaluation variables; and (c) to examine respite to identify benefits other than those being directly measured. Subjects were 130 caregivers, with 6- and 12-month data on a small subsample of the 130. Interviews with caregivers and satisfaction surveys supported respite as an effective intervention. Quantitative analysis showed that none of the evaluation variables changed statistically. The caregiver mood variable evidenced positive changes; other variables changed negatively. Research issues, such as the short time subjects were in the respite program and the lack of sensitive measurement tools, are discussed. Clinical implications for community health nurses are also discussed.
OBJECTIVE
We sought to evaluate the frequency of, and factors associated with, the use of 3 evidence-based interventions: antenatal corticosteroids for fetal lung maturity, progesterone for prevention of recurrent preterm birth, and magnesium sulfate for fetal neuroprotection.
STUDY DESIGN
A self-administered survey was conducted from January through May 2011 among obstetricians from 21 hospitals that included 30 questions regarding their knowledge, attitudes, and practice of the 3 evidence-based interventions and the 14-item short version of the Team Climate for Innovation survey. Frequency of use of each intervention was ascertained from an obstetrical cohort of women between January 2010 and February 2011.
RESULTS
A total of 329 obstetricians (74% response rate) who managed 16,946 deliveries within the obstetrical cohort participated in the survey. More than 90% of obstetricians reported that they incorporated each intervention into routine practice. Actual frequency of administration in women eligible for the treatments was 93% for corticosteroids, 39% for progesterone, and 71%formagnesiumsulfate. Provider satisfaction with quality of treatment evidence was 97% for corticosteroids, 82% for progesterone, and 57% for magnesium sulfate. Obstetricians perceived that barriers to treatment were most frequent for progesterone (76%), 30% for magnesium sulfate, and 17% for corticosteroids. Progesterone use was more frequent among patients whose provider reported the quality of the evidence was above average to excellent compared with poor to average (42% vs 25%, respectively; P < .001), and they were satisfied with their knowledge of the intervention (41%vs 28%; P = .02), and was less common among patients whose provider reported barriers to hospital or pharmacy drug delivery (31% vs 42%; P = .01). Corticosteroid administration was more common among patients who delivered at hospitals with 24 hours a day–7 days a week maternal-fetal medicine specialist coverage (93% vs 84%; P = .046),
CONCLUSION
Obstetricians in Maternal-Fetal Medicine Units Network hospitals frequently use these evidence-based interventions; however, progesterone usewas found to be related to their assessment of evidence quality. Neither progesterone nor the other interventions were associated with overall climate of innovation within a hospital as measured by the Team Climate for Innovation. National Institutes of Health Consensus Conference Statements may also have an impact on use; there is such a statement for antenatal corticosteroids but not for progesterone for preterm prevention or magnesium sulfate for fetal neuroprotection.
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