RESUMEN
Effective treatment of maternal antenatal depression may ameliorate adverse neurodevelopmental outcomes in offspring. We performed two follow-up rounds of children at age 2 and age 5 whose mothers had received either specialized cognitive-behavioural therapy or routine care for depression while pregnant. Of the original cohort of 54 women, renewed consent was given by 28 women for 2-year follow-up and by 24 women for 5-year follow-up. Child assessments at the 2-year follow-up included the Parenting Stress Index (PSI), Bayley Scales of Infant Development (BSID-III) and the Child Behaviour Checklist (CBCL). The 5-year follow-up included the Wechsler Preschool and Primary Scales of Intelligence (WPPSI-III) and again the CBCL. Treatment during pregnancy showed significant benefits for children's development at age 2, but not at age 5. At 2 years, intervention effects were found with lower scores on the PSI Total score, Parent Domain and Child domain (d=1.44, 1.47, 0.96 respectively). A non-significant trend favoured the intervention group on most subscales of the CBCL and the BSID-III (most notably motor development: d =0.52). In contrast, at 5-year follow-up, no intervention effects were found. Also, irrespective of treatment allocation, higher depression or anxiety during pregnancy was associated with higher CBCL and lower WPPSI-III scores at 5 years. This is one of the first controlled studies to evaluate the long-term effect of antenatal depression treatment on infant neurodevelopmental outcomes, showing some benefit. Nevertheless, caution should be taken interpreting the results because of a small sample size, and larger studies are warranted.
Asunto(s)
Ansiedad/terapia , Desarrollo Infantil/fisiología , Depresión/terapia , Complicaciones del Embarazo/terapia , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Ansiedad/diagnóstico , Ansiedad/psicología , Escala de Evaluación de la Conducta , Conducta Infantil/psicología , Preescolar , Terapia Cognitivo-Conductual , Depresión/diagnóstico , Depresión/psicología , Femenino , Estudios de Seguimiento , Humanos , Pruebas de Inteligencia , Estudios Longitudinales , Masculino , Madres/psicología , Relaciones Padres-Hijo , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/psicología , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Efectos Tardíos de la Exposición Prenatal/prevención & control , Efectos Tardíos de la Exposición Prenatal/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Resultado del TratamientoAsunto(s)
Productos Biológicos/administración & dosificación , Trasplante de Células Madre Mesenquimatosas/métodos , Osteoartritis/terapia , Medicina Regenerativa/métodos , Productos Biológicos/farmacología , Biomarcadores/sangre , Cartílago Articular/efectos de los fármacos , Cartílago Articular/fisiopatología , Ensayos Clínicos como Asunto , Humanos , Inyecciones Intraarticulares , Inyecciones Subcutáneas , Células Madre Mesenquimatosas , Osteoartritis/diagnóstico , Evaluación de Resultado en la Atención de Salud , Plasma Rico en Plaquetas , Resultado del TratamientoRESUMEN
The air-surface exchange of mercury (Hg) was measured, using a dynamic polycarbonate flux chamber, for soils with low or "background" Hg concentrations (<0.1 mg/kg) at eleven locations across the contiguous United States. Sampling locations included agricultural, desert, grassland, mixed and pine forest ecosystems (n=1326 soil flux measurements at 46 individual sites). An overall soil Hg flux of 0.9+/-0.2 ng/m2/h for these background soils was obtained by averaging the means for the different locations. Soil Hg fluxes were significantly lower in dark conditions than in the light for all but the grassland sites. Mean inlet air Hg concentrations were 1.0+/-0.1 ng/m3 in the dark and 1.3+/-0.2 ng/m3 in the light. Soil temperature inside and outside of the chamber, air temperature, relative humidity, and irradiance were measured concurrently with soil Hg flux. Soil-air Hg exchange was weakly predicted by environmental variables (R2 from 0.07 to 0.52). For a single location, flux was better correlated with soil moisture than other measured environmental parameters, suggesting that soil moisture might be an important driver for Hg emissions from background soils. In addition, based on data collected we suggest some quality control measures for use of Tekran 2537A analyzers when measuring low mercury fluxes. Using basic scaling procedures, we roughly estimate that natural emissions from soils in the contiguous U.S. release approximately 100 Mg/yr of Hg to the atmosphere.
Asunto(s)
Contaminantes Atmosféricos/análisis , Mercurio/análisis , Contaminantes del Suelo/análisis , Agricultura , Clima Desértico , Monitoreo del Ambiente , Poaceae , Árboles , Estados Unidos , VolatilizaciónRESUMEN
Whole system elemental mercury (Hg0) flux was measured for approximately 1.5 years using two large gas exchange mesocosms containing approximately 100 two-year old aspen trees (Populus tremuloides) planted in soil with elevated mercury concentrations (12.3 microg/g). We hypothesized that during leafout, whole mesocosm Hg0 flux would increase due to movement of Hg0 in the transpiration stream from the soil to the air. This hypothesis was not supported; plants were found to assimilate Hg0 from the contaminated air, and whole system Hg0 emissions were reduced as plants leafed-out due to shading of the soil. Surface disturbance, watering, and increases in soil moisture, light, and temperature were all found to increase whole system Hg0 flux, with light being a more significant factor. Although surface soils were maintained at 15-20% moisture, daily watering caused pulses of Hg0 to be released from the soil throughout the experiment. Data developed in this experiment suggested that those processes acting on the soil surface are the primary influence on Hg emissions and that the presence of vegetation, which shields soil surfaces from incident light, reduces Hg emissions from enriched soils.
Asunto(s)
Ecosistema , Mercurio/metabolismo , Transpiración de Plantas/fisiología , Populus/metabolismo , Contaminantes del Suelo/análisis , Difusión , Monitoreo del Ambiente , Contaminantes del Suelo/metabolismo , VolatilizaciónRESUMEN
Previous research has indicated that foliar mercury (Hg) flux is bi-directional, with influence from both atmospheric and soil Hg. This work investigated the role of soil and air Hg concentrations on foliar Hg exchange using a single-plant gas-exchange system. The exchange of Hg vapor with aspen seedlings grown in soil Hg concentrations of 0.03+/-0.01, 5.8+/-0.5, and 12.3+/-1.3 microg g(-1) and exposed to atmospheric Hg concentrations of 2.4+/-0.5, 11.0+/-0.9, and 30.4+/-2.2 ng m(-3) was measured. At background atmospheric Hg concentrations of 2.4 ng m(-3), foliage released Hg at all three soil Hg concentrations and fluxes ranged from 1.6 to 5.5 ng/m(2)/h. At higher atmospheric Hg concentrations (>11 ng m(-3)), net deposition to foliage ranged from -9 to -47 ng/m(2)/h, exhibiting increase uptake with higher air Hg concentrations. Fluxes associated with aspen showed an immediate response to changes in atmospheric Hg concentrations. Compensation points, the air concentration where no net flux of Hg vapor occurred, were 3-4 ng m(-3) in the light and 2-3 ng m(-3) in the dark for trees grown in soils of 0.03 and 6 microg g(-1) Hg content, and 5-6 ng m(-3) in the light and 2.5-3.5 ng m(-3) in the dark for trees grown in 12 microg g(-1) Hg soils.
Asunto(s)
Mercurio/análisis , Hojas de la Planta/química , Populus/fisiología , Contaminantes del Suelo/análisis , Aire , Monitoreo del Ambiente , Mercurio/química , Mercurio/farmacocinética , Raíces de Plantas/química , Populus/química , Contaminantes del Suelo/farmacocinética , VolatilizaciónRESUMEN
Abuse of women in domestic relationships has become an epidemic. Research studies have documented that abuse does not end when a woman with children leaves the abuser but, in fact, the danger increases. A father's legal right to custody of and access to his children and the children's bond with their father prevent a woman from truly breaking free of her abuser. Theoretical literature has addressed how custody and access can serve as a means for an abuser to continue his abuse and expose his children to ongoing abuse and discord. Research on how custody and access issues are affecting abused women is limited. Key details about this phenomenon are not known. Hence, a research study using the qualitative methodology of phenomenology was conducted on abused women's experiences with custody and access and the ongoing exposure to abusive ex-partners. Six single mothers who had left abusive relationships and were at the time sharing custody of and/or access to their children with their abusive ex-partners participated in the study. Unstructured, non-directive interviews were conducted. Direction for analysis was taken from the specific steps outlined by Giorgi. Data analysis revealed that all of the women were living in great fear for their safety and that of their children. The ongoing danger and stress of living with the restrictions of the law took its toll on the women and ultimately affected their physical health and psychological well-being. The women described their experiences as having four components: (1) safety--living with ongoing danger; (2) stress--living with the restrictions of the law and the legal system; (3) coping--social support systems; and (4) to heal and move forward in life.
Asunto(s)
Mujeres Maltratadas/psicología , Custodia del Niño , Adolescente , Adulto , Colombia Británica , Niño , Custodia del Niño/legislación & jurisprudencia , Preescolar , Emociones , Femenino , Humanos , Persona de Mediana Edad , Seguridad , Apoyo Social , Estrés PsicológicoRESUMEN
In 1993, the authors introduced an interdisciplinary course in health care ethics at the University of British Columbia. They were motivated by two convictions: (1) an interdisciplinary approach to health care decision making is best; and (2) every significant health care decision has an ethical component. They wanted to encourage students from the various health care disciplines to participate in interdisciplinary decision making in their future practices by giving them an opportunity to study health care ethics together during their training. The authors give detailed descriptions of the objectives, format, curriculum, and evaluation of this innovative course in the hope that other educators who may want to develop similar courses can learn from their experience.
Asunto(s)
Educación Médica , Ética Médica , Comunicación Interdisciplinaria , Grupo de Atención al Paciente , Enseñanza/métodos , Colombia Británica , Confidencialidad , Curriculum , Toma de Decisiones , Evaluación Educacional , Objetivos , Asignación de Recursos para la Atención de Salud , Humanos , Consentimiento Informado , Relaciones Interprofesionales , Motivación , Defensa del Paciente , Participación del Paciente , Autonomía Profesional , Evaluación de Programas y Proyectos de Salud , Estudiantes de Medicina , Resultado del TratamientoRESUMEN
Advances in technology and the increased awareness and activism of health care consumers have brought a heightened focus to the ethical questions associated with end-of-life decision-making in health care. This attention is manifested in increased discussion, both in the literature and informally, of end-of-life issues; in increased numbers of advanced directives; and, recently in Canada, in the formation of the Senate Committee on Euthanasia and Assisted Suicide whose charge was to develop policy on these issues. Nurses have valuable perspectives to add to this discourse.
Asunto(s)
Directivas Anticipadas , Ética en Enfermería , Derecho a Morir , Directivas Anticipadas/legislación & jurisprudencia , Canadá , Humanos , Defensa del Paciente , Derecho a Morir/legislación & jurisprudenciaRESUMEN
Abuse against women, with its potential to affect every aspect of a woman's health and well-being, as well as the health and future of her children, is a reality that should be intolerable. Nurses are uniquely suited to address the needs of abused women because of their focus on holistic care and their advocacy role. Additionally, some abused women may find it easier to trust nurses simply because most nurses are women. To feel comfortable when working with abused women, nurses require various kinds of support. They need the support of the institutions in which they work so that they can undertake their work from a firm base. They need support from their professional associations so that they can be assured that all nurses are operating under the same obligation to the client. Lastly, they need the kind of support that comes from being prepared by their education, not only to understand, but also to provide holistic nursing care to abused women. It is unreasonable to expect front-line workers to undertake a task that is so clearly value-laden without the onset support of their educational institution, their facility's administration, and their professional associations. These are the bodies that should be expected to set the agenda to provide leadership. It is only when nurses have this firm base of support that they will be at ease with their role and feel able to intervene consistently and effectively. There is a growing body of knowledge on why nursing care to abused women is only sporadically delivered and frequently ineffective at present. Some reasons for this can be identified at the level of the individual nurse. It is, however, time for the educational, institutional, and professional levels to provide leadership. Nurses should and can be the most effective professionals working with abused women.
Asunto(s)
Actitud del Personal de Salud , Concienciación , Mujeres Maltratadas , Educación en Enfermería , Conocimientos, Actitudes y Práctica en Salud , Enfermeras y Enfermeros/psicología , Apoyo Social , Maltrato Conyugal/prevención & control , Ética en Enfermería , Femenino , Salud Holística , Humanos , Modelos de Enfermería , Defensa del Paciente , Rol , Autoimagen , Maltrato Conyugal/estadística & datos numéricos , Resultado del TratamientoRESUMEN
Health care professionals are increasingly aware of the moral dimensions of their practice, and nurses are no exception. Changes in technology, in society and in nursing itself are demanding that nurses have ethical knowledge and skills. No matter what their area of clinical practice, today's nurses are increasingly confronted with ethical problems and the need to make ethical decisions.
Asunto(s)
Educación en Enfermería , Ética en Enfermería , HumanosRESUMEN
A phenomenological study was conducted in order to describe the experience of children as they accompany their mothers who are leaving abusive relationships. Thirteen children were interviewed. The children describe their experience as having three components: living with violence, living in transition and living with Mom. Themes within these components are identified, and implications for nursing practice are discussed.
Asunto(s)
Psicología Infantil , Maltrato Conyugal/psicología , Violencia , Adaptación Psicológica , Niño , Preescolar , Fantasía , Femenino , Pesar , Humanos , Masculino , Investigación Metodológica en Enfermería , Enfermería Pediátrica/métodos , Maltrato Conyugal/enfermería , Maltrato Conyugal/prevención & controlAsunto(s)
Toma de Decisiones , Ética en Enfermería , Juicio , Derechos Humanos , Humanos , Defensa del PacienteAsunto(s)
Factores de Edad , Negro o Afroamericano , Empleo , Composición Familiar , Estado Civil , Población Blanca , Niño , Cultura , Demografía , Divorcio , Economía , Etnicidad , Matrimonio , Población , Características de la Población , Clase Social , Factores SocioeconómicosRESUMEN
Abstract We have responded to Monsieur Henry's comments in the order in which he presents them.