There are currently no published scoring instruments with prior empirical evidence to support the validity and reliability of the accuracy of the drug withdrawal scores generated in infants greater than 28 days of life with a diagnosis of Neonatal Abstinence Syndrome (NAS). This study was done to identify the signs of withdrawal in infants greater than 28 days of life with NAS and determine if further adaptation of the modified-FNAST was necessary to accurately measure the severity of drug withdrawal in this sub population of infants. This aim could not analyzed due to limitations of the data. The study was also done to describe the relationship between the medications used to treat the infant NAS and the longitudinal trajectory of the Finnegan scores. The results of the study revealed that the total modified-FNAST scores ranged from 0-21 on day 1 of life with a mean of 8.68 and a SD (4.127), and then gradually decreased with less variability over the length of the hospitalization until discharge. Four medications were used to treat the infants for NAS. The medications used to treat the infants for NAS included morphine (99%), phenobarbital (66.2%), clonidine (25.1%), and buprenorphine (1.9%). The minimum to maximum dosage and minimum to maximum duration of inpatient treatment days for each of the medications were explored and revealed, morphine (dosage range, 0.33-2.170 mg/kg/day and duration of 14-81 days), buprenorphine (dosage range 7.00-61.30 mcg/kg/day and duration of 4.00-30.00 days), clonidine (dosage range 3.97-28.93 mcg/kg/day and duration of 16.00-87.00 days), and phenobarbital (dosage range 3.00-16.00 mg/kg/day and duration of 2.00-84.00 days). Most of the infants received morphine alone or in combination with phenobarbital or clonidine consistent with the established evidence-based NAS weaning protocol. The Mixed Effects Model Analysis revealed that there was an overall decrease in the total Finnegan scores over time (p < 0.0001). The mean total Finnegan scores showed a statistically significant difference in the groups treated with and without clonidine (p = 0.0031). The group treated with clonidine had higher mean total Finnegan scores. The infants treated with phenobarbital did not show a significant association with the total Finnegan scores (p = 0.6852). In addition, all other control variables failed to show significant associations with the repeated measures of total Finnegan scores including: gender (p = 0.6257), infant birth weight (p = 0.9375), gestational age (p = 0.8444) and the estimated number of cigarettes smoked by the mother during the pregnancy (p = 0.7300). The interaction between the infants treated with clonidine and phenobarbital were not statistical significant either. (p = 0.6412). Key Words: Neonatal Abstinence Syndrome, opioid, modified-FNAST, reliable, valid, factor analysis

This study assessed indicators of adoption of abstinence-only-until-marriage education as an innovation by middle school principals in the state of Texas. It also assessed school principals?? likelihood of adopting such programs. This study was conducted in the context of changing school policies related to sexuality education and an influx of governmental funding intended to encourage instruction about abstinence-only-until-marriage. The impact of school-based, abstinence education and the role of the principal are of special interest for those promoting healthy sexual behavior among youth. The study??s sample consisted of 433 responses from a proportional random sample of middle school principals selected from 20 Education Service Center Regions in the state of Texas. Rogers?? Diffusion of Innovations Theory provided the theoretical framework and foundation for this research. Five perceived attributions of an innovation??relative advantage, compatibility, complexity, trialability and observability??were the study??s independent variables. The dependent variable was defined as the likelihood of principals adopting abstinence-only-until-marriage education in their schools. Location of schools (i.e., in rural or urban counties), was examined as having a possible moderating effect on other variables. Findings from this study indicated the middle school principal who was most willing to adopt abstinence-only-until-marriage education programs into his or her school??s curriculum strongly believed abstinence education provided important advantages for youth, and strongly perceived abstinence-only-until-marriage education to be consistent with his or her professional and personal beliefs and values. The average principal also did not perceive abstinence-only-until-marriage education to be complex. The typical respondent agreed that elements of abstinence-only-until-marriage education could be easily tried in the school, and considered it important to observe other principals adopting abstinence-only-until-marriage education prior to adopting the innovation. Trialability, complexity and religion were the strongest predictors for likelihood of adoption. Efforts to promote abstinence-only-until-marriage education in the public schools are dependent upon an understanding of the role of administrators in the curriculum adoption process. This study contributes to the knowledge base related to the school principal??s influence on abstinence promoting programs.

Background: Kubemenda is a word in Kiswahili and a conception that the infants‟ health will be negatively affected if the mother has sexual intercourse during the breastfeeding period. Aim: The aim of this study is to explore if nurses experience concerns among parents about sexuality during the breastfeeding period related to kubemenda. Furthermore, to investigate the nurses own perception and knowledge about kubemenda and if general information is given to the parents about breastfeeding and sexuality as well as information related to kubemenda. Method: Semi-structured qualitative interviews with open and closed questions with six nurses that worked at Muhimbili National Hospital. All the interviews were recorded, transcribed and analyzed with content analysis. Result: Kubemenda was defined as ill health in infancy caused by the mother having sexual intercourse during the breast-feeding period. This cultural belief was used as an old fashioned way of family planning. There was a non-existing relation between breastfeeding and kubemenda according to the nurses but they experienced concerns among mothers about timing of sex resumption related to kubemenda. It was hard for the nurses to manage the influence of family-members when informing and educating the mothers about sexuality. There were no guidelines as to what information they should provide regarding kubemenda. Conclusion: Kubemenda is still an existing problem in the society that is hard to eliminate due to strong cultural influence. There is an imminent need of national guidelines for health personnel as to what information they should provide regarding kubemenda. / Bakgrund: Kubemenda är ett ord på Kiswahili och innebär en uppfattning om att barns hälsa påverkas negativt om mamman har samlag under amningsperioden. Syfte: Syftet med studien var att undersöka om sjuksköterskor upplever oro bland föräldrar om sexualitet i samband med amningsperioden relaterat till kubemenda. Vidare var syftet att undersöka sjuksköterskors egen uppfattning och kunskap om kubemenda samt om generell information ges till föräldrarna angående amning och sexualitet samt information relaterat till kubemenda. Metod: Semistrukturerade intervjuer utfördes bland sex sjuksköterskor som arbetade på Muhimbili National Hospital. Intervjuerna spelades in, transkriberades och analyserades med innehållsanalys. Resultat: Kubemenda definierades som ohälsa bland spädbarn där orsaken var att mamman hade samlag under amningsperioden. Denna kulturella uppfattning användes som traditonell familjeplanering. Det fanns inget samband mellan amning och kubemenda enligt sjuksköterskorna men de upplevde oro bland mammor angående sexuell avhållsamhet relaterat till kubemenda. Sjuksköterskorna upplevde det svårt att hantera familjens kulturella inflytande på mamman när de informerade om sexualitet. Det saknades riktlinjer för vilken information som skulle ges angående kubemenda. Slutsats: Kubemenda är fortfarande ett problem i samhället som är svårt att avlägsna på grund av starkt kulturellt inflytande. Det finns ett behov av riktlinjer för vårdpersonal om vilken information som ska ges till patienter angående kubemenda.

This study assessed indicators of adoption of abstinence-only-until-marriage education as an innovation by middle school principals in the state of Texas. It also assessed school principals?? likelihood of adopting such programs. This study was conducted in the context of changing school policies related to sexuality education and an influx of governmental funding intended to encourage instruction about abstinence-only-until-marriage. The impact of school-based, abstinence education and the role of the principal are of special interest for those promoting healthy sexual behavior among youth. The study??s sample consisted of 433 responses from a proportional random sample of middle school principals selected from 20 Education Service Center Regions in the state of Texas. Rogers?? Diffusion of Innovations Theory provided the theoretical framework and foundation for this research. Five perceived attributions of an innovation??relative advantage, compatibility, complexity, trialability and observability??were the study??s independent variables. The dependent variable was defined as the likelihood of principals adopting abstinence-only-until-marriage education in their schools. Location of schools (i.e., in rural or urban counties), was examined as having a possible moderating effect on other variables. Findings from this study indicated the middle school principal who was most willing to adopt abstinence-only-until-marriage education programs into his or her school??s curriculum strongly believed abstinence education provided important advantages for youth, and strongly perceived abstinence-only-until-marriage education to be consistent with his or her professional and personal beliefs and values. The average principal also did not perceive abstinence-only-until-marriage education to be complex. The typical respondent agreed that elements of abstinence-only-until-marriage education could be easily tried in the school, and considered it important to observe other principals adopting abstinence-only-until-marriage education prior to adopting the innovation. Trialability, complexity and religion were the strongest predictors for likelihood of adoption. Efforts to promote abstinence-only-until-marriage education in the public schools are dependent upon an understanding of the role of administrators in the curriculum adoption process. This study contributes to the knowledge base related to the school principal??s influence on abstinence promoting programs.

Despite the large volume of research on tobacco withdrawal, the vast majority of studies have focused on the onset and remission of symptoms over the course of several days and weeks, with the earliest assessment periods occurring the day after cessation. To date, there has been no systematic study of the very early time course of the tobacco withdrawal syndrome, despite its obvious relevance to the maintenance of both smoking and postcessation abstinence. The published literature contains a range of estimates about the early appearance of withdrawal symptoms, but without reference to empirical data. The main objective of the current study was to conduct a comprehensive, multimodal assessment of the early time course of the symptoms associated with smoking withdrawal among cigarette smokers. Participants were 50 smokers randomly assigned to either abstain or smoke at their own pace during four hours in the laboratory. Dependent measures included a physiological measure (resting heart rate); sustained attention (the Rapid Visual Information Processing task; RVIP); selective attention to smoking stimuli (an emotional Stroop task); and self-report (the Wisconsin Smoking Withdrawal Scales; WSWS). After baseline assessment, participants were assigned to the two conditions and the dependent measures were collected every 30 minutes. Generalized Estimating Equations (GEEs) revealed that abstinent participants displayed greater withdrawal than continuing smokers on all measures with the exception of the Stroop task. Statistically significant differences in withdrawal were found within 60 minutes on heart rate, within 30 minutes on the RVIP, and between 30 minutes and 180 minutes postcessation on the various subscales of the WSWS. These findings provide the first evidence of the early time course of tobacco withdrawal symptoms, although further research is needed to distinguish withdrawal effects from drug offset effects. Implications for the understandi ng the maintenance of daily smoking and for the treatment of tobacco dependence are discussed.

Introduction: The high prevalence of HIV in South Africa was confirmed by Department of Health (2005) which reported an HIV prevalence rate of 40.7 percent amongst antenatal clinic attendees at public facilities in KwaZulu-Natal in 2004. Abstinence is one of the strategies used by many different cultures where young unmarried people are encouraged to abstain from sex until marriage, to prevent young girls from getting pregnant and acquiring sexually transmitted infections (STIs). Aim: The aim of this study was to investigate African rural high school learners' choice of sexual abstinence and to compare abstinent versus non-abstinent African rural high school learners in order to be able to develop tailored educational messages. Abstinence was defined as not having penetrative sex, since this is the accepted definition of abstinence in Zulu culture. Objectives: a) To investigate the prevalence of abstinence from sexual intercourse amongst African rural high school learners, b) To assess demographic, psychosocial, and economic determinants of abstinence from sexual intercourse, c) To make recommendations about abstinence interventions. Method: A descriptive cross-sectional study was carried out in a rural area (Ugu District in southern KwaZulu-Natal). One class of Grade 9 learners, ages 14-20 years, was selected from each often randomly selected rural high schools. An anonymous selfreporting semi-structured questionnaire used the I-Change model to investigate demographic and economic information, attitudes, social influences, self-efficacy and intentions towards sexual abstinence. Chi square and T-tests were used for bivariate analysis and Logistic regression was used to develop a model for abstinence from sexual intercourse. Results: A total of 454 learners participated with a mean age of 16.76 years (SD 1.41) age range 14-20 years. Of the sample 208 (45.8%) were male and 246 (54.2%) female. The majority were Christian (84.6% (n=384)) and of this population, 28.3% (n=127) reported that they had 'ever had sex'. Furthermore, 24.5% (n=91) of learners reported that they were currently sexually active. Fifty six percent (n=252) of learners reported that they abstained from sex. When comparing learners reporting abstinence (n= 252) with those not abstinent (n= 202), abstinent learners were significantly more often females, who had never had sex (p / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

To investigate how federal discourse constructs adolescence, the author analyzed discussions of abstinence-only sexuality education from the U.S. Congressional Record from 2001 to 2007. He used grounded theory methodology to identify theoretical codes and construct a model from the data. The grounded theory developed focused on Congress’s maintenance of its role in mediating concern over the sexual behavior of adolescents as opposed to finding a solution to the problem it had identified. The author relates this theory to Foucault’s (1974/1991) concept of governmentality. He discusses Congress’s discourse about adolescence using Lesko’s (2001) confident characteristics of adolescence as a framework.

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2009. / Directed by Kathleen Casey; submitted to the Dept. of Educational Leadership and Cultural Foundations. Title from PDF t.p. (viewed May 5, 2010). Includes bibliographical references (p. 212-219).

This thesis has two overarching aims. The first aim is to understand the origins and development of temperance and abstinence in British Methodism, particularly through the theology that informed what may broadly be called the Methodist teetotal movement in its period of greatest popularity from 1830 until 1919. The second is to consider the downfall of this movement in the period from 1945 until 1974, when the Methodist Connexion adopted the view that each Methodist “must consider his personal attitude to all drugs in relation to his Christian vocation”. The need for the study arises from the relative dearth of historical investigation regarding Methodism and abstinence. Representations of Methodism and abstinence tend either to be partisan or to lack wider understanding of the abstinence movement, or the theology of Methodism. Methodologically, this thesis attempts to hold together historical and theological considerations; it is important to consider both the socio-economic contexts in which diverse abstinence and teetotal movements arose and the theological motivations that drove British Methodist belief and practice. Regarding the origins and development of temperance and abstinence in British Methodism, it is proposed in this thesis that the Bible Christians were the first organised Methodist abstainers, and that their practice was likely to have been influenced by John Wesley's theologies of sanctification, holiness and Christian perfection. The thesis is an attempt to counter the Bible Christian’s diminished historical significance, as well as to investigate the likely impact of the theological underpinnings for their abstinence. Regarding the downfall of temperance and abstinence in British Methodism in the period from 1945 until 1974, this thesis will propose that a loss of focus upon holiness as a catalyst for abstinence was detrimental to the growth and continuation of the teetotal movement throughout Methodism after World War Two. It will highlight the general rejection of this focus on encouraged abstinence in the second half of the twentieth century, acknowledging the changes and disagreement within British Methodism to which this dismissal led. Concluding comments allude to the need for a renewed witness within British Methodism to societal and theological imperatives for both temperance and abstinence.

Objetivos: Avaliar a influência da adição de clonidina a sedação e analgesia com morfina e midazolan em infusão contínua em crianças submetidas à ventilação mecânica. Métodos: Estudo randomizado, duplo cego e placebo controlado, realizado na UTI Pediátrica do Hospital Geral de Caxias do Sul. Incluídas crianças submetidas à ventilação mecânica que utilizaram morfina e midazolan em infusão contínua. Foram randomizados a receber clonidina (5 μg/kg/cada 8 horas) ou placebo associados a infusão dos sedativos. Diariamente eram anotadas as doses infundidas nas 24 horas, assim como as doses de sedação intermitente e aplicado o escore de Finnegan para definir e quantificar abstinência. Os grupos foram comparados quanto a doses de sedativos administradas, tempo de uso de infusão contínua, presença e duração da abstinência.Resultados: Foram incluídas 69 crianças (31 no grupo clonidina e 38 no placebo). Completaram o estudo 59 pacientes, 25 no grupo clonidina e 34 no placebo. Os grupos foram semelhantes nas características gerais (peso, idade, sexo, indicação de ventilação mecânica). Não houve diferença nas doses de sedativos utilizadas, tanto em infusão contínua quanto intermitente. A prevalência da abstinência foi semelhante (72 e 75%, respectivamente), da mesma forma que sua duração, além de não haver diferença no tempo de ventilação mecânica. Conclusão: Neste estudo, a adição de clonidina ao esquema de sedação não influiu nas doses diárias e cumulativas de sedativos utilizados e também não alterou a prevalência ou a evolução da abstinência. Atribuímos à ausência de eficácia ao elevado grau de sedação utilizado neste serviço para crianças em ventilação mecânica. / Objective: To evaluate the sedative effect of associating clonidine to the morphine plus midazolan intravenous infusion in children submitted to mechanical ventilation Methods: Randomized, double blind, placebo controlled, carried through clinical assay in the PICU of the Hospital Geral of Caxias do Sul. It has been enclosed children submitted to mechanical ventilation, which had used morphine and midazolan in continuous infusion. It’s had been randomized to received clonidine (5μg/kg/8/8h) and placebo associated to infusion of sedative. Daily it’s written the administered doses in the 24 hours, beyond the doses of intermittent sedation and the Finnegan Score applied to define and to quantify the withdrawal. The groups had been compared to managed doses of sedatives, time of use of continuous infusion, presence and duration of the abstinence. Results: 69 patients had been enclosed to project (31 in clonidine group and 38 in the placebo group). The two groups had been similar in general characteristics (weight, age, gender, indication of mechanical ventilation). It did not have difference in the midazolan and morphine doses used between the groups, in the necessity of extra sedation as well. 59 patients had completed the study, 25 in clonidine group and 34 in placebo group. The prevalence of the abstinence was similar (72% and 75%, respectively), in the same way that its duration. It hasn’t been any difference in the mechanical ventilation time also. Conclusion: The clonidine did not show effectiveness in the evolution of the abstinence in this study, probably for objectives of sedation used in this service.