Metabolic aspects of a hypoxia test for placental sufficiency

A hypoxia test for placental sufficiency was performed on 24 healthy pregnant women nearing term and 23 high-risk pregnant women in advanced stages of gestation. Hypoxia was induced by inhalation of a breathing mixture containing 7% oxygen through a semi-open system which permitted partial rebreathing, thus preventing hypocapnia. The changes in fetal heart rate (FHR) resulting from maternal hypoxia were recorded continuously by external or internal monitoring. The changes observed in FHR were more marked in high-risk cases. Maternal blood gases were tested before and after 10 min of hypoxia in 10 normal and 10 high-risk patients. In no case was maternal acidosis observed. All pregnant patients regarded as high-risk because of hypertensive disorders or chronic renal disease manifested metabolic alkalosis. This finding cannot be explained. It is regarded as being responsible for the more severe FHR changes through a negative Bohr effect, which reduces the dynamic exchange of oxygen in the placenta. Metabolic alkalosis does not appear in high-risk pregnant women exposed to milder hypoxia by breathing 12% oxygen. The changes in FHR observed during severe maternal hypoxia, i.e., 7% oxygen, are probably due more to maternal metabolic alkalosis than to placental insufficiency. Consequently, the "severe hypoxia test" cannot be used as a test for placental insufficiency.     

Laser-Doppler flowmetry in neurosurgery

It is theorized that persons with strong sense of coherence are likely to define an event as less stressful and be able to manage a problem more successfully than those with weak sense of coherence. The study investigated the relationship among coherence and personal and environmental concerns, appraisal of threat, emotional distress, and high-risk behaviors in minority women at risk for human immunodeficiency (HIV) infection. As predicted, a significant negative relationship was seen between level of coherence and concerns. Moreover, women strong in coherence reported less negative appraisals of threat, less emotional distress, and fewer high-risk behaviors than those with weak coherence. Results of tests of a path model investigating the impact of coherence and appraisal on distress and risk revealed coherence to be significantly and negatively associated with appraisal, distress, and risk, both directly and indirectly through its association with appraisal. The path model accounted for 45% of the variance in distress, 10% of the variance in appraisal, and 4% of risk behavior. Continuing investigation of factors such as coherence that can lessen the seriousness of environmental stressors is imperative as it relates to women at risk for HIV infection.     

Individual differences in perceived riskiness of drinking in pregnancy: antecedents and consequences

OBJECTIVE: This study examined whether differences in perceived riskiness of alcohol consumption during pregnancy were related to self-reported alcohol consumption among a community sample of pregnant women. Further, this study examined the impact of prior experiences on risk perceptions, focusing on previous pregnancy experiences and on previous alcohol-related problems. METHOD: The hypothesized relationships among variables were tested simultaneously in a structural equation model. Subjects included 159 pregnant women, all of whom drank regularly before pregnancy recognition, who were recruited from prenatal clinics and through newspaper advertisements. RESULTS: Perceived riskiness of drinking during pregnancy was lower among women who had previously given birth to a healthy child and among women with greater numbers of previous alcohol problems. Prior adverse pregnancy experience did not predict perceived risk. Perceived risk negatively predicted actual alcohol consumption during pregnancy, suggesting that previous healthy pregnancy experiences and alcohol problems increase drinking in pregnancy indirectly, through perceived risk. A direct positive effect from previous alcohol problems to drinking in pregnancy also was observed. CONCLUSIONS: Findings suggest that risk perceptions play a role in drinking behavior among pregnant women and help to illuminate the relationship between parity and alcohol consumption. Interventions designed to reduce drinking among pregnant women, which have generally relied on providing information, may be improved by considering the impact of previous experiences and addressing erroneous beliefs.     

A model of home care for high-risk childbearing families. Women with diabetes in pregnancy

With a national trend toward decreased hospitalizations for high-risk childbearing women, home care and follow-up services have gained increased importance. The Quality-Cost Model of Nurse Specialist Transitional Follow Up Care is presented as a method to provide home care for high-risk pregnant women, specifically those whose pregnancies are complicated by diabetes mellitus. The model offers opportunities for intensive education, assessment, intervention, and support throughout the pregnancy and postpartum period. In addition, this model can potentially decrease the burden of care on the woman and her family by providing a comprehensive program of home care, follow up, support, and education.     

Battle of the sexes: Gender stereotype confirmation and reactance in negotiations.

The authors examined how gender stereotypes affect negotiation performance. Men outperformed women when the negotiation was perceived as diagnostic of ability (Experiment 1) or the negotiation was linked to gender-specific traits (Experiment 2), suggesting the threat of negative stereotype confirmation hurt women's performance relative to men. The authors hypothesized that men and women confirm gender stereotypes when they are activated implicitly, but when stereotypes are explicitly activated, people exhibit stereotype reactance, or the tendency to behave in a manner inconsistent with a stereotype. Experiment 3 confirmed this hypothesis. In Experiment 4, the authors examined the cognitive processes involved in stereotype reactance and the conditions under which cooperative behaviors between men and women can be promoted at the bargaining table (by activating a shared identity that transcends gender). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Insecure attachment moderates women's adjustment to inflammatory bowel disease severity.

Objective: Insecure attachment was explored as a moderator of the relationship between disease severity and psychosocial variables in a study of adjustment in women with inflammatory bowel disease (IBD). Method: Participants were 218 women recruited through notices placed in the community, in gastroenterologists' offices, and through online postings to support groups and message boards specifically for people with Crohn's disease, colitis, or IBD in general. Participants completed a mail-in or online survey assessing severity and frequency of symptoms, attachment style (separated into anxious and avoidant subscales), perceived social support, negative affect, and efficacy of coping with IBD. Results: Anxious and avoidant attachment styles were correlated positively with disease severity and negative affect and negatively with perceived social support and coping efficacy. Hierarchical regressions indicated that disease severity was most strongly associated with negative affect for high avoidant attachment, as compared with moderate and low avoidant attachment. Disease activity was inversely related to perceived social support and coping efficacy for high and moderate, but not low, anxious attachment. Conclusion: Our study indicates that attachment moderates associations between disease severity in women with different kinds of IBD and psychological indicators of adjustment. Limitations and relationship to previous research on attachment and health are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Motivating Impact of Informing Women Smokers of a Link Between Smoking and Cervical Cancer: The Role of Coherence.

This research assessed the role of having a coherent explanation of the link between smoking and cervical cancer in motivating women to stop smoking. In the 1st study, women were given a leaflet with either a detailed or a minimal explanation of the link or no leaflet. The leaflets were similarly effective at providing a coherent explanation. In a cross-sectional analysis, having a coherent explanation moderated the relationship between perceived vulnerability and intention: Higher perceived vulnerability to cervical cancer was associated with greater intention to quit smoking only amongst women with a more coherent explanation of the link between smoking and cervical cancer. This rinding was replicated in a 2nd study. These results are consistent with H. Leventhal et al.'s (1997) self-regulatory model, which suggests that motivation to change behavior depends not only on perceiving a threat but also on having a coherent model linking the behavior with the threat. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal renal artery blood flow velocimetry in normal and hypertensive pregnancies

OBJECTIVE: To investigate the effect of normal pregnancy and hypertensive disorders of pregnancy on the maternal renal artery Doppler blood flow velocity indices. METHODS: The patient material consisted of 30 normal pregnant women, 29 women with pregnancy induced hypertension, 43 women with preeclampsia and 22 pregnant women with chronic hypertension. Blood flow velocities in the segmental renal arteries from the right kidney were analysed by pulsed and color Doppler. The systolic/diastolic (s.d.) ratio, resistance index (RI) and pulsatility index (PI) were used for Doppler waveform analysis. RESULTS: In all of the groups of hypertensive pregnant women renal artery Doppler indices were significantly lower compared to the normal pregnant women group. There was a significant negative relationship between renal artery PI and mean arterial pressure in the preeclampsia group and in the chronic hypertension group. CONCLUSION: The present results demonstrate that the mechanism of renal autoregulation in preeclampsia might be altered, leaving glomerulus unprotected from increased blood pressure. It seems that the concept of renal vasoconstriction in preeclampsia might be disputed and needs further investigation.     

Medicaid and non-Medicaid prenatal care by nurse-midwives. Comparison of risk, time, care coordination, and reimbursement

The purpose of the study was to compare high-risk pregnant women with medical assistance payment (HRMA) and those with private insurance payment (HRPI) on use of provider time, care coordination activities, and financial reimbursement. Comparisons were also conducted for the same factors between the high-risk and low-risk women (LRMA) that received medical assistance payment for their care. Total time spent by care providers in giving antepartum, intrapartum, and postpartum care was highest for the HRPI women. However, the two medical assistance groups started prenatal care significantly later and had fewer visits, and one-third did not return for their 6-weeks postpartum visit. The HRPI group also had a higher cesarean birth rate. Rates of care coordination activities such as calls, referrals, and consultations were significantly higher for the HRPI and HRMA women compared with those for the LRMA women. However, the HRMA women have limited financial and psychosocial resources that require additional provider management and referrals. Reimbursement rate was highest for the HRPI group in which approximately 73% of the total amount billed was collected compared with approximately 56% among medical assistance women. Recommendations for policy, practice, and further research are offered.     

Treatment of severe forms of sickle cell anemia with bone marrow allograft: French experience (15 cases). SFGM

OBJECTIVE: To determine whether home uterine activity monitoring reduces the likelihood of preterm birth in women successfully treated for preterm labor in their current pregnancies. METHODS: Women between 20-34 weeks' gestation who had been treated successfully for preterm labor were solicited to participate in a randomized clinical trial of home uterine activity monitoring versus routine high-risk care. The sample size of 56 was based on power calculations using the results of earlier investigators. Twenty-eight women were randomized to home uterine activity monitoring and 29 were assigned to the type of care appropriate for women discharged after hospitalization for parenteral treatment of preterm labor. One of the routine-care subjects was lost to follow-up. The two groups were comparable in distribution for race, insurance status, multiple gestation, marital status, gestational age at beginning of the study, and incidence of prior preterm birth. RESULTS: The 28 women receiving routine care had a 54% incidence of preterm birth, whereas the incidence was 57% in monitored women (relative risk 1.08, 95% confidence interval 0.6-1.9; P = .79). The incidences of delivery before 32 weeks and 34 weeks also were unaffected by the intervention. CONCLUSION: Home uterine activity monitoring is not effective in reducing the likelihood of preterm delivery in patients successfully treated for preterm labor in their current pregnancies.     

Marital conflict typology and children's appraisals: The moderating role of family cohesion.

Intense and frequent marital conflict is associated with greater appraisals of threat and self-blame in children, but little else is known about contextual factors that might affect appraisals. Systemic family theories propose that to understand child adaptation, it is necessary to understand the interconnected nature of family subsystem relationships. In a sample of 257 families with 8- to 12-year-old children, this study examined whether a four-level typology of marital conflict management was related to children's perceptions of marital conflict and their appraisals of perceived threat and self-blame. In addition, family cohesion was tested as a moderator of the relationship between marital conflict style and children's appraisals. Observational coding was used to group couples into Harmonious, Disengaged, Conflictual-Expressive, and Conflictual-Hostile groups. Children's report of the intensity, frequency, and degree of resolution of interparental discord corresponded well with observers' ratings. The relationship between marital conflict style and appraisals of threat and self-blame was moderated by family cohesiveness. At high levels of family cohesiveness, no group differences were found for either perceived threat or self-blame, whereas when family cohesiveness was low, threat was higher for the Harmonious and Conflictual-Hostile groups, as compared to the Conflictual-Expressive group, and self-blame was higher for both conflict groups (expressive and hostile), as compared to the Disengaged group. The results provide further evidence of interconnected nature of family subsystem relationships and the importance of distinguishing among different approaches to marital conflict management for understanding the complex and perhaps subtle but meaningful effects different family system factors have on child adaptation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The development of maternal-fetal attachment during pregnancy

This study is to examine the degree to which women engage in attachment behaviors toward their unborn children. Cranley's Maternal-Fetal Attachment Scale (MFAS) was modified to Japanese version (MFAS-J2), which consists of 20 items with .87 reliability. MFAS-J2 was administered to both normal and high-risk pregnant women (n = 275) during gestation. All subjects were restricted to women who were having their first child, and they were between 5 and 40 weeks gestation at the time they completed the instrument. Demographic data were also gathered. Results: (1) Maternal-fatal attachment increased significantly from 5 to 40 weeks of gestation. Especially feeling fetal movement had positive effect on maternal-fetal attachment. (2) Women who reported negative perception or ambivalent feeling about their pregnancy showed low attachment score. And women whose husband reported negative feeling about their pregnancy responded lower in the scale. (3) Some negative relationships were observed between maternal-fetal attachment score and the histories of abortion and sterility. (4) Maternal-fetal attachment showed no significant correlations to factors of threatened abortion, premature labor, and IUGR. (5) Maternal-fetal attachment showed negative correlations to State-Trait anxiety during early pregnancies.     

Quinine pharmacokinetics in young children with severe malaria

In this study, we determined selenium concentrations in serum samples of healthy women (146 pregnant and 74 nonpregnant) living in the Mediterranean area of the coast of Granada (southeast Spain). The subjects were distributed in two groups: group A (pregnant women), divided into three categories according to the trimester of pregnancy, and group B (nonpregnant women). No significant differences were observed in the selenium levels either among pregnant women according to the trimester of pregnancy or in the group of nonpregnant women. No other significant differences were determined as regards the age of pregnant women (P > 0.05). Serum selenium levels are slightly lower during pregnancy. Considering that serum selenium levels affect the body selenium status, the concentrations determined establish the non-existence of selenium problems in the daily dietary intake with respect to maternal and fetal necessities during pregnancy.     

A population-based survey of obstetric practices among rural women in the Bizana district, Transkei

OBJECTIVE: To determine for the Bizana district, Transkei, the proportion of deliveries that occur at home, home delivery practices, the proportion of women with high-risk pregnancies delivered at home, attendance for antenatal care at the health services and at traditional healers, and the reasons why mothers choose to deliver at home or in the health services. DESIGN: Questionnaire survey. SETTING: Rural community, South Africa. PARTICIPANTS: Two hundred women from randomly selected clusters, obtained from a multistage random sampling process. MAIN OUTCOME MEASURES: Place of delivery, home delivery practices and antenatal care for the most recent delivery (within the previous 5 years). RESULTS: Two-thirds had delivered at home and one-third within the health services. Of those who delivered at home, 62 (47%) were alone at the time of delivery while the remainder were assisted by a close relative or neighbour; 38% had one or more risk factors for obstetric complications. Ninety-seven per cent attended at least once for antenatal care. Home delivery practices and reasons for place of delivery are described. CONCLUSIONS: Antenatal care should include education about the home management of a normal childbirth. Waiting areas for mothers should be established at hospital level for high-risk pregnant mothers.     

Targets as perceivers: How people determine when they will be negatively stereotyped.

Research on stereotype threat has demonstrated that when targets are forced to contend with the threat of being negatively stereotyped, their academic performance suffers (C. M. Steele & J. Aronson, 1995). The present research explored how the targets of negative stereotypes determine when they must contend with this threat. Across 5 experiments, the authors manipulated both the possibility and probability that Black and female students would be stereotyped as unintelligent prior to taking an analytical test. Collectively, these experiments showed that these students contended with stereotype threat only when they perceived that it was both possible and probable that they would be negatively stereotyped. The authors discuss the implications of these findings on the experience of being the target of negative stereotypes and on the academic achievement of Blacks and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survival in cerebral palsy: the role of severity and diagnostic labels

This paper describes the implementation of a project to prevent the negative biopsychosocial outcomes of teenage pregnancy. The purposes of this project were 1) to reach, as early as possible, young women under 20 years, either pregnant or already young mothers, living in the downtown area of Quebec city on the fringe of society, and perceived to be at risk, and 2) to develop their capacities to take care of themselves and their children, by helping them to recognize their needs, to use adequately the available resources, and to break out of their isolation. A team from Le Centre jeunesse de Québec worked with 25 young pregnant women and 3 young mothers, over a period of 21 months. This team provided the women and their children with a continued and individualized follow-up, which allowed them to develop their autonomy.     

Transmission of paratuberculosis

Antenatally, as more women are being treated in the home setting rather than the hospital setting, diagnostic modalities such as ultrasonographic imaging need to be available for use by the home care provider. In the home setting, the care provider and treatment modalities are brought to the patient, whereas patients managed in the hospital setting must attend the provider site to receive the same services. Without the availability of diagnostic ultrasonography in the home setting, pregnant women who are treated in the home rather than the hospital are required to incur an added financial and physical burden associated with attendance at care. Financially, nonreimbursed out-of-pocket costs incurred by the patient may include costs of transportation, costs of child care, and loss of wages. Physically, patients are prevented from maintaining recommended bed rest and dietary treatment regimens. Ultrasonographic evaluations can be performed safely in the home setting by nurses who have received added educational preparation and ultrasonographic imaging experience, thereby providing the essential care often necessary for women who experience pregnancies complicated by high-risk conditions.     

Ethnocentrism between groups of unequal power in response to perceived threat to social identity and valued resources.

Hypothesized that perceived threat to social identity and perceived threat to valued resources would each increase ethnocentrism, and that high power groups would be more ethnocentric than low power groups. In Exp 1, a negative message was only a threat to the Ss' group identity; in Exp 2, it was also a threat to their payment for experimental participation. Results show that these threats increased ethnocentrism. However, neither expert power (Exp 1), nor expert power linked to reward power (Exp 2) moderated this reaction. As predicted, in-group–out-group differentiation along the female sex-role stereotype and attitude dimensions was correlated with strength of group identification in the high threat conditions of Exp 1. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does a helping hand mean a heavy heart? Helping behavior and well-being among spouse caregivers.

Being a caregiver for an ill or disabled loved one is widely recognized as a threat to the caregiver’s quality of life. Nonetheless, research indicates that helping behavior, broadly construed, promotes well-being. Could helping behavior in a caregiving context promote well-being as well? In the present study, we used ecological momentary assessment to measure active helping behavior and both positive and negative affect in 73 spouse caregivers. Results indicate that when controlling for care recipient illness status and functional impairment and caregiver “on call” caregiving time, active helping predicted greater caregiver positive affect—especially for individuals who perceived themselves as interdependent with their spouse. In addition, although both helping and on-call time predicted greater negative affect for caregivers who perceived low interdependence, helping was unrelated to negative affect among caregivers perceiving high interdependence. Helping valued loved ones may promote caregivers’ well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)