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Preterm infants with bronchopulmonary dysplasia (BPD) have cardiorespiratory compromise that prolongs the transition time from gavage to nipple feeding. Heart rate variability (HRV) provides an indirect measure of the autonomic nervous system's influence on heart rate and cardiorespiratory stability. The purpose of this case study was to describe HRV responses of three preterm infants with BPD during the transition from gavage to nipple feeding. The infants responded to nipple feeding with increases in sympathetic influence on heart rate, and the increase continued in the 10-minute postfeeding. The infants were capable of balancing sympathetic and parasympathetic influences on heart rate related to the work of feeding.Copyright © 2010 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The effects of antenatal phenobarbital on behavioral state and heart rate (HR) were examined in a randomized sample of 49 preterm infants. The study describes the preterm infants' behavioral state and HR responses to nursing procedural care over the first 72 hours after birth. DESIGN: Not given. SETTING: The study was conducted in the neonatal intensive care unit of a midwestern university hospital. POPULATION: The sample was comprised of 49 preterm infants (control = 22; experimental = 27). Infants were designated as control or experimental on the basis of the mother's randomization to the placebo or phenobarbital study groups. INTERVENTIONS: Behavioral state was assessed with the Anderson Behavioral State Scale (ABSS). Electrodes on the infant's chest transmitted continuous HR to a bedside cardiorespiratory monitor. Measurements of behavioral state and HR were obtained on Days 1,2, and 3 of life. Measurements were obtained for 5 min before, during, and for 5 min following a routine caregiving procedure. MAIN OUTCOME MEASURE(S): There were no effects of study group or day of life on behavioral state. The frequencies and percentages of behavioral states for procedure, respiratory status, and age are illustrated in Table 2. Post hoc testing showed that behavioral states were aroused to fussy/crying during the caregiving procedure compared to a predominance of sleep/drowsy behavior during pre- and postprocedure for Days, 1,2, and 3. There were no effects for study group, respiratory status, age, or day of life on HR. RESULTS/CONCLUSIONS: There were no differences in behavioral state and HR responses between control and experimental group infants suggesting that antenatal phenobarbital did not have a sedative effect on infants in the experimental group. Age had an effect on behavioral response to care giving. Older infants, 30 to 33 weeks PCA, more often expressed awake and fussy/cry behavior compared to younger infants. Age did not have any effect on HR in response to caregiving in this sample. In the present sample, the infants' HR responses in the first 72 hours of life were less indicative of distress than their behavioral responses. The results reported here suggest that behavioral responses may be more sensitive than HR responses in very young preterm infants. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

The purpose of this research was to explore personal illness models of parents of preadolescents and adolescents regarding diabetes mellitus. Personal illness models were defined as the parents' cognitive representations of the disease. Fifty-five parents of children ages 10 to 17 years with a diagnosis of insulin-dependent diabetes mellitus were interviewed using a semistructured questionnaire. Data were content analyzed for common themes. Parents attributed the cause of diabetes to genetics coupled with a viral infection. Most believed the diabetes would last a lifetime but they were hopeful for a cure. Parents requested ongoing education for their children, support groups, counseling, one consistent healthcare provider, and intensive insulin therapy. Parents reported that the major problems caused by diabetes were increased structure of daily routines and that their children with diabetes felt different from healthy peers. Parents' fears about diabetes included long-term complications, early death, and severe insulin reactions. [ABSTRACT FROM AUTHOR]

The purpose of this research study was to explore personal illness models of preadolescents and adolescents regarding diabetes mellitus. Personal illness models were defined as the adolescents' cognitive representations of their disease. Sixty children ages 10 to 17 years with a diagnosis of insulin-dependent diabetes mellitus were interviewed using a semistructured questionnaire. Data were content analyzed for common themes. Although most participants expressed an understanding that their disease would last a lifetime, they were hopeful for a cure. Participants wanted healthcare professionals to provide strategies for controlling blood glucose to prevent future complications. Family and friends who followed the same diet as the adolescent with diabetes were viewed as supportive. The majority of adolescents were responsible for much of their own disease management. Their greatest fears concerned insulin reactions and long-term complications such as amputation of limbs. [ABSTRACT FROM AUTHOR]

The lifetime emotional, social, and financial consequences experienced by individuals with schizophrenia have significant effects on their families. Family responses to having a family member with schizophrenia include: care burden, fear and embarrassment about illness signs and symptoms, uncertainty about course of the disease, lack of social support, and stigma. Study findings about families in which parents are hostile, critical, or overly involved are equivocal about whether this negative environment contributes to patient relapse. This review summarizes the studies related to the family responses and emotional environment of families who have a member with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: The transition from gavage to nipple feeding is difficult for preterm infants with bronchopulmonary dysplasia because of tachypnea and hypoxemia from chronic respiratory distress., Objective: The aim of this study was to test the hypothesis that preterm infants with bronchopulmonary dysplasia who transitioned from gavage to nipple feeding with the semidemand method would achieve nipple feeding sooner and be discharged from hospital sooner than control infants who received standard care., Methods: Forty-two infants were randomized to the control condition and 44 to the experimental protocol. Mean gestational ages and birth weights were 25 ± 1.5 weeks and 784 g for controls and 25 ± 1.4 weeks and 787 g for experimental infants. Control infants received standard care that included gradual increases in the number of nipple to gavage feedings per day. Experimental infants received the semidemand method that used infant behavioral and cardiorespiratory signs to regulate frequency, length, and volume of nipple feedings. General linear model procedures were used to compare study groups., Results: Experimental infants achieved nipple feeding at M = 5.9 ± 0.7 days compared with control infants, M = 12.3 ± 0.8 (p < .0001). Length of hospitalization was not significantly different between groups., Discussion: The semidemand method significantly shortened the time for infants to attain nipple feeding in a manner taking their respiratory distress into consideration.

Despite public health campaigns and safer sex messages, many men who have sex with men (MSM) continue to participate in high-risk sexual behaviors, which may make them vulnerable to HIV infection and sexually transmitted infections. The purpose of this study was to determine the relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of MSM. This correlational study sampled 205 MSM (M = 37 years of age, SD = +/-8) representing the diverse ethnic composition of South Florida. This sample consisted of ethnic minorities (79%) with a large number of foreign-born men (69%). Participants completed measures of depressive symptoms, self-esteem, and sexual behaviors. Results indicated that higher levels of depressive symptoms and higher levels of self-esteem had a statistically significant relationship to lower levels of safer sexual behaviors. Lower income, lower educational level, and preference for Spanish language were associated with higher levels of depressive symptoms; lower income was associated with lower levels of self-esteem; and foreign birth and a preference for Spanish language were associated with lower levels of safer sex behaviors. Higher levels of depressive symptoms and higher levels of self-esteem were associated with high-risk sexual behaviors in this sample of MSM. Further research needs to be directed at culturally specific mental health and HIV prevention strategies for these vulnerable MSM.

Objective: To examine the effect of kangaroo care on heart rate variability in a healthy preterm infant., Design: Case study., Setting: Private room on a postpartum unit., Participant: A mother-preterm infant dyad., Intervention: Kangaroo (skin-to-skin) care., Main Outcome Measure: Heart rate variability, a noninvasive measurement of the sympathetic and parasympathetic components of the autonomic nervous system's influence on heart rate., Results: Heart rate variability, especially the parasympathetic component, was high when the infant was fussy in the open crib, indicating increased autonomic nervous system activity. With kangaroo care, the infant fell asleep, and both sympathetic and parasympathetic components of heart rate variability decreased., Conclusions: The wide fluctuations in the parasympathetic component of heart rate variability suggest immaturity of the sympathovagal response. Overall, kangaroo care produced changes in heart rate variability that illustrate decreasing stress.

The lifetime emotional, social, and financial consequences experienced by individuals with schizophrenia have significant effects on their families. Family responses to having a family member with schizophrenia include: care burden, fear and embarrassment about illness signs and symptoms, uncertainty about course of the disease, lack of social support, and stigma. Study findings about families in which parents are hostile, critical, or overly involved are equivocal about whether this negative environment contributes to patient relapse. This review summarizes the studies related to the family responses and emotional environment of families who have a member with schizophrenia.

The ability of a preterm infant to make the transition from gavage to oral nipple feeding depends on the infant's neurodevelopment in relation to behavioral organization, to a rhythmic suck-swallow-breathe pattern, and to cardiorespiratory regulation. Research-based knowledge about infant neurodevelopment in these three areas has led to the creation of a semidemand feeding method to aid in this transition. The method combines the use of nonnutritive sucking to promote awake behavior for feeding, use of behavioral assessment to identify readiness for feeding, and systematic observation of and response to infant behavior cues to regulate frequency, length, and volume of oral feedings. Semidemand feeding may be individualized for healthy preterm infants. This article discusses both the relevant knowledge about neurodevelopment and the semidemand feeding method itself.

Issues and Purpose: Motor vehicle crashes account for the greatest number of childhood injuries, but there has been little study of the psychological responses., Design and Methods: This longitudinal, descriptive study included 143 children 7 to 15 years of age who experienced a motor vehicle-related injury. Parents/guardians completed the Child Behavior Checklist Behavioral Problem Scale. Each child and parent completed the post-traumatic stress disorder (PTSD) section of the Diagnostic Interview for Children and Adolescents at 2 and 6 months postinjury., Results: Twenty-two percent of the children met criteria for PTSD. There were no associations for presence or absence of PTSD with age, gender, race, injury, or cause of injury., Practice Implications: Children who are injured in motor vehicle crashes are at risk for PTSD. Anticipatory guidance about behavioral distress symptoms should be provided to parents of children who experience motor vehicle related injuries.

This randomized experiment was undertaken to determine if any difference in success occurred between an audio versus a vibration alarm for nocturnal enuresis. Similar rates of success were achieved for 47 children, aged 6 to 12 years, who partially or totally completed the 3-month period of alarm use.

Objective: To test the hypothesis that healthy preterm infants randomly assigned to a semi-demand feeding protocol would require fewer days to attain oral feeding and have a satisfactory weight gain compared with control infants receiving standard care., Study Design: In 2 neonatal intensive care nurseries, 81 infants 32 to < or = 34 weeks' postconceptional age were randomly assigned to the control (n = 41) or experimental (n = 40) protocol for transition from gavage to oral feedings. The control protocol followed the standard practice of gradually increasing scheduled oral feedings, whereas the experimental protocol used a semi-demand feeding method contingent on infant behavior. Analysis of variance techniques were used to compare the study groups for number of days to attain oral feeding and weight gain., Results: The semi-demand method shortened the time for infants to achieve oral feeding by 5 days (P < .001). There were no differences in weight gain between the study groups, and both groups had satisfactory weight gain., Conclusion: The semi-demand method for the transition from gavage to oral feeding in healthy, preterm infants 32 to < or = 34 weeks postconceptional age promotes faster attainment of oral feeding and does not compromise their weight gain.

The purpose of this research was to examine the effect of behavioral state activity during nipple feeding on feeding success for a group of 20 preterm infants. The infants, fed per hospital policy at scheduled three-hour intervals, were observed during four early nipple feedings. Nine of the 20 infants were able to successfully nipple their four nipple feedings; the other 11 infants were unable to successfully complete their nipple feedings. The 9 successful feeders exhibited significantly more awake behavior during feeding than unsuccessful feeders (F = 7.82; p = .012). The unsuccessful feeders spent 53 percent of their feeding in sleep states; successful feeders were in sleep states only 30 percent of their feeding time. Along with other research, these findings suggest that infant behavioral state may be a key consideration for nipple feeding success in preterm infants.

Purpose: To describe the responses of mothers and fathers who were offered bone marrow transplantation (BMT) for their children with genetic disorders., Design: Qualitative., Setting: Private hospital rooms/offices., Participants: Six mothers and 4 fathers of children with genetic disorders., Results: The basic social-psychological problem confronting the parents was the conflicting alternatives of life versus death for their children. It was certain that these children would die from their genetic disorders but without having to endure the pain and suffering of a BMT. The BMT would be difficult, possibly resulting in death, but with a chance of survival., Conclusions: Parents believed that BMT was the only chance of survival for their children, leaving them no choice except to pursue the BMT treatment.

Although the practice of using calf blood pressure (BP) measurement is widespread, virtually no information is available about calf site BP measurements in preterm infants. This research compared oscillometric upper arm BP measurements with calf BP measurements in 65 preterm infants with a mean weight of 1629 +/- 437 gm. Differences between arm and calf BP measurements were analyzed with repeated-measures multivariate analysis of variance of systolic, diastolic, and mean arterial pressures. There were no significant differences between arm and calf systolic BP on days 1, 3, and 5 of life. With post hoc testing there was a significant difference on day 7 between systolic arm BP (60.4 +/- 8.4 mm Hg) and calf BP (57.7 +/- 7.1 mm Hg) (t = 3.68, p < 0.01). There were no significant differences between arm and calf measurements for diastolic and mean arterial pressures and no main effect from infant weight on differences between arm and calf BP. It may be reasonable to use either arm or calf BP during the first 5 days of life.

Transition of preterm infants from enteral to nipple feeding is a necessary milestone for hospital discharge. This study tested the efficacy of one potential intervention to facilitate the transition process. Ten minutes of nonnutritive sucking (NNS) and a control condition were administered randomly before first nipple feedings. The sample consisted of 20 preterm infants (gestational ages 27-33 weeks, M = 31.6, SD = 1.7; birth weights 931-2, 140 g, M = 1,649, SD = 373) who served as their own controls. NNS resulted in fewer behavioral state changes during feedings and produced quiet, awake states more frequently during feedings. Heart rates did not differ between feedings following NNS compared with those in the control condition.

Objective: To describe the experience of high-risk pregnancy from the perspectives of mothers and fathers., Design: A naturalistic inquiry using selected grounded-theory techniques., Setting: Interviews occurred within the hospital., Participants: A sample of 21 parents who experienced high-risk pregnancy and the birth of a preterm infant., Main Outcome Measures: Responses and management of responses to high-risk pregnancy., Results: Emotional responses to high-risk pregnancy were (a)vulnerability--the realization that pregnancy outcome was at risk, (b)heightened anxiety--the transition from normal activities to bed rest and hospitalization, and (c)inevitability--the imminent premature delivery of an infant with a guarded prognosis., Conclusions: These findings have relevance for perinatal nurses. Nurses who have knowledge of the emotional responses parents experience during high-risk pregnancy can provide supportive care to these individuals.

The effectiveness of an enhanced preparation intervention was compared with the standard preparation intervention for accuracy in overnight urine specimen collections. The sample consisted of 179 individuals with type I insulin-dependent diabetes mellitus (IDDM). Subjects were assigned randomly to an enhanced or standard preparation group. The enhanced preparation included written instructions, a reminder to post instructions in the bathroom, a toilet seat cover with a reminder to save urine, and a nurse-initiated telephone call to review the instructions. The standard preparation included written instructions and a telephone number to call with any questions. For subjects without previous collection experience, significantly fewer inaccurate collections were reported in the enhanced preparation group than in the standard group (chi 2 = 4.61, P < .05). There were no differences in collection accuracy between enhanced and standard groups for subjects with collection experience (chi 2 = .4598, P > .05).

A convenience sample of 24 parents of growing preterm infants reported concerns related to their preterms' health and development, parenting abilities, family relationships, and finances.

The purpose of the study was to determine if selected risk factors related to preterm birth continued to be associated with family functioning when preterm children were 2 to 4 years of age. A convenience sample of 55 mothers and 27 fathers participated in the survey. Parents completed the Family Dynamics Measure and the family APGAR. Multiple regression analyses were computed to examine the associations between the dependent variables for family functioning and the independent variables, which included child's developmental status, neonatal hospitalization length, adequacy of family economics, parental age, and marital status. Of these risk factors, longer neonatal hospitalizations continued to be associated with poorer family role functioning for mothers (R2 = .237, F = 2.43, p = .039).