KOSTRZEWA, R. M., J. W. KLARA, J. ROBERTSON AND L. C. WALKER. Studies on the mechanism of sprouting of noradrenergic terminals in rat and mouse cerebellum after neonatal 6-hydroxydopa. BRAIN RES. BULL. 3(5) 525-531, 1978.-The effect of various pharmacologic agents on the noradrenergic innervation of rat cerebellum was observed. It was found that the neurotoxin 6-hydroxydopa (6-OHDOPA), when given to rats at birth, caused a 46% reduction at 5 weeks of age in tyrosine hydroxylase activity in the locus coeruleus, the nucleus of origin for noradrenergic fibers innervating the cerebellum. At the same time, however, both tyrosine hydroxylase activity and NE content were elevated by 50% in the cerebellum. By treating gravid mice with the 6-OHDOPA, which crosses the placental barrier to affect the brains of developing pups, a dissociation has been shown between the elevated cerebellar NE levels and reduced telencephalic NE content. None of the other assorted pharmacological agents-namely amphetamine, metaraminol, apomorphine, α-methyl-ρ-tyrosine, L-dihydroxyphenylalanine and tyramine-when given at birth, caused a permanent elevation in cerebellar NE content. This series of studies suggests that a reduced number of noradrenergic perikarya are providing a greater innervation of the cerebellum than in control rats. Also, alteration of the telencephalic noradrenergic fibers, which are also derived from the locus coeruleus, does not appear to be a necessary event for the initiation of sprouting of noradrenergic fibers in the cerebellum. Because none of the acute-acting pharmacological agents caused a permanent elevation of NE in the cerebellum, it appears that damage, and not mere stimulation or blockade, is a necessary event for initiation of sprouting.

Introduction and Background The number of incarcerated pregnant women is increasing every day. At the same time, their quality of care is decreasing. From being treated like animals by jail staff to having unqualified staff members instructing them during labor, this has to change. Not only is the safety of the woman at risk, but most importantly her unborn baby. Purpose Statement Incarcerated pregnant women deserve the same healthcare as anyone else. The PICO question addressed in this paper is the following. In incarcerated pregnant women, how does ineffective health maintenance compared with effective health maintenance affect poor outcomes after childbirth? Literature Review CINAHL was used to locate five sources that were published within the last five years. The source had to include the words “childbirth,” “jail,” “prison,” “incarceration,” and “nurse.” If the article did not meet these guidelines they were excluded. One exception to these criteria was one source from 2013. The source was slightly outdated but had valuable data to be explored, so it was included. Findings Incarcerated pregnant women are de-humanized and maltreated every day and nothing is changing. Standards of care have been set in place for organizations, but they are not followed. Evaluation of these organizations and their healthcare is crucial to move forward and better health care for people in incarceration. Conclusions Insufficient research has caused a gap in literature. Limited resources are available to examine an incarcerated pregnant woman’s life and healthcare. Future research is essential to provided adequate care to these women.

Abstract Introduction and Background: Methadone, Buprenorphine and other opioid management therapies are being put into effect to help pregnant women who have abused opioids in the months prior to getting pregnant and continued the abuse during pregnancy. Purpose Statement: The purpose of this research was to determine if opioid maintenance therapies would have lasting effects on infants in their growth development. The population in the studies were derived from women who had or were currently abusing opioids during their pregnancy. The interventions taken were to prescribe women with a specific opioid maintenance treatment and measure the outcome on the infant such as birth weight, head circumference, ability to eat, etc. Literature Review: The East Tennessee State University Sherrod Library database was used to search for articles pertaining to the research. The method includes searching for key terms such as opioids on fetal development and ways to improve fetal development with opioid addiction within the years of 2017 to 2022 from peer reviewed journal articles. Findings: The researchers in each study were able to come to a consensus that there were no more effects put into fetal development with the opioid therapy and the subjects that were not given therapy during pregnancy. Conclusion: In the end, some studies showed minor effects that infants would have with getting opioid maintenance therapy in utero but concluded that infants would not experience any more damage to their development by receiving the treatment over infants who did not receive the treatment in utero.

Magister Artium - MA / Comprehensive policies exist to tackle Nigeria’s poor maternal, neonatal and child health (MNCH) indices, but departures from policy intent during implementation result in less than expected outcomes. In Nigeria’s federal system of government, national level policies are transferred to subnational level, the states as mediators of for implementation. Executive powers at the state level reside with governors. This study aims to contribute to a better understanding of the role of states in policy implementation, taking a historical and comparative view of implementation of three complex programmes, which had intergovernmental collaborative aspirations. Study was set in two (subnational) states (Anambra and Ebonyi). In addition, national level data were collected from Abuja – Federal Capital Territory, where policymaking is domiciled. A qualitative case study design triangulated information from document reviews (69) and in-depth interviews (44). Emerson’s integrated collaborative governance (CG) framework was used to examine the overarching multi-level governance and how this impacted the policy process.

Att få barn för tidigt kan för många upplevas som en traumatisk upplevelse. Direkt efter barnets födelse kastas föräldrarna in i en avancerad intensivvårdsmiljö där barnets liv ligger i vårdpersonalens händer, vilket kan skapa en enorm stress. Studiens syfte var att undersöka föräldrars upplevelse av att vara delaktiga i sitt barns vård på en neonatal intensivvårdsavdelning. Metoden som användes var integrativ litteraturstudie där 13 artiklar inkluderades. I resultatet framkom tre huvudteman: Första tiden som förälder på NIVA, Tydlig kommunikation med vårdpersonal och Förtroendefull relation till vårdpersonal. Det visade sig att det var viktigt för föräldrarna att delta i omvårdnaden för att deras självförtroende samt föräldraroll skulle växa. För att de skulle uppleva att deras delaktighet i sitt barns vård skulle bli så bra som möjligt var det viktigt att få daglig information. Resultatet visade också att förtroende för vårdpersonal samt ett öppet klimat var en avgörande faktor för föräldrarnas upplevelse

Indiana University-Purdue University Indianapolis (IUPUI) / Objective: Nutritional assessment of infants in the Newborn Intensive Care Unit (NICU) depends on the performance of accurate, serial anthropometric measurements. In this Level IV NICU, nurses used tape measures more often than length boards making the length measurements inaccurate. The purpose of this study is to determine if an in-person, hands-on length board training program versus a self-instruction poster education, increases the use of length boards to measure length in NICU infants. Methods: Two nursing in-service education training sessions on how to correctly use a length board were held with the NICU staff over two separate two (2-week) periods. One session consisted of a self-direct education training method. The second education method was an in-person interactive learning experience with hands on practice. At the end of each education session, the participants completed the same four-question post-test. One month later, data was collected for one month following each of the training periods on the tool used to obtain linear measurements on infants in the NICU. Statistics: A 2x2 contingency table was constructed using the two qualitative variables of length board uses after the poster education versus length board uses after the live in-service education. Analysis was performed using SAS 9.4 ™ statistical software. Chi squared equals 93.980 with 1 degree of freedom. P-value <0.0001. Results: The month following the self-directed poster education, two hundred ninety-one (291) or 92% measurements were obtained using a tape measure and 19 (7%) obtained using a length board. The month following the interactive, in-service training, one hundred forty-eight (148) or 57% measurements were obtained using a tape measure and 105 (41%) with a length board. Thirty five percent (35%) more length measurements were obtained using a length board after the line in-service training (P-value <0.0001). Conclusion: Nurses in a Level IV Newborn Intensive Care Unit utilized length boards significantly more after a live in-service education than after a self-directed education.

Background: In the pregnant population, being physical active and meeting gestational weight gain (GWG) guidelines have numerous health benefits for both mother and infant. Markers of lipid metabolism are known to be influenced by these two variables in the non-pregnant population. However, the relationship between physical activity (PA) and GWG on lipid markers has yet to be assessed during pregnancy. My thesis aims to address this gap in the literature. Methods: The first objective of my thesis was to examine the relationship between maternal PA and GWG on gross measurements of fetal and placental development (n=40). Specifically, three markers of placental efficiency (Pl-E) were examined (birthweight [BW], BW-to-placenta weight ratio, and residual BW). The second objective of my thesis was to analyze maternal serum lipid and glucose markers (n=40), in mid (24-28 weeks) and late (34-38 weeks) gestation as well as from the umbilical cord (UC) as they relate to both PA and GWG. The third objective of my thesis was to explore how PA level and GWG status affect markers of lipid metabolism in term placenta (n=31). Markers of placental lipid transport (FATP1, FABP4, FAT/CD36) were assessed at the protein level, and enzymatic activity of placental lipoprotein lipase was also measured. Lastly, placental lipid storage was assessed by examining triglyceride content, paired with lipid droplet staining. Results: There was no relationship between PA independently or in combination with GWG on any Pl-E markers. A significant association was found between GWG and BW in women who gained weight excessively compared to insufficiently. Neither PA nor GWG categorization was associated with maternal lipid and glucose markers. Total cholesterol levels measured in UC serum were significantly lower in women categorized as active throughout pregnancy (p<0.0001) or whose activity dropped in late gestation (p<0.0001) compared to those who were inactive v throughout gestation. Glucose levels were lower in UC blood of women who gained weight appropriately in mid-gestation compared to those who gained insufficient (p=0.040) or excessive (p=0.021) weight. In terms of placental fatty acid transport, there was a significant interaction between PA status and GWG categorization and placental FATP1 protein expression (F=14.62, p<0.0001). Finally, while no differences were found in placental lipid droplet staining, the droplets were more likely to be clustered within the syncytiotrophoblast border. Conclusion: In conclusion, maternal PA had no association with Pl-E, while GWG was only associated with BW. My thesis work found that while maternal serum lipid markers were not associated with PA and GWG, both maternal PA and GWG status were related to changes in UC and placental lipid markers throughout pregnancy. In combination with previous research from our lab, it is suggested that women who are physically active during pregnancy, and gain weight appropriately may be transporting fewer nutrients (i.e. fatty acid, glucose, cholesterol) to the placenta than those who are inactive, yet simultaneously increasing metabolization. Future research should further investigate these findings by performing functional experiments.

Mycket vanlig inom sluten hälso- och sjukvård är vård av barn som är utsatta för smärta orsakad av ingrepp och procedurer. Smärta i samband med sjukdom eller medicinisk vård kan leda till betydande och livslånga fysiologiska och psykologiska konsekvenser. Därför är det viktig med adekvat smärtbedömning och behandling. Detta är en utmaning och kräver mycket erfarenhet av sjukvårdspersonal. Särskilt hos prematura barn, spädbarn och barn i åldern upp till sex år vilka inte än har förmåga att uttrycka sig verbalt är detta av vikt. Därför kan man använda sig av en smärtskattningsskala. Smärtbedömningen är mer objektiv och information om barnens smärta kan som ett värde tydlig dokumenteras och åtgärder utvärderas.Syftet med denna forskningsöversikt var att belysa vilka skattningsskalor som kan användas för bedömning av smärta hos barn (0-6 år) inom sluten hälso- och sjukvård. En forskningsöversikt genomfördes efter en litteratursökning av vetenskapliga artiklar via databaserna Cinahls och PubMed och en manuell artikelsökning. Totalt inkluderades 16 primärartiklar i studien, vilka granskades avseende kvalitet och vetenskaplig klassificering.I resultatet framkom att smärtskattningsskalor kan användas för granskning av smärta hos barn inom sluten hälso- och sjukvård. Alla dessa skalor har påvisat validitet och majoriteten även reliabilitet. Sex av dessa har visat till och med hög reliabilitet. I tre studier har skalorna visat klinisk nytta och genomförbarhet i praktiken. Undersökningsgrupper varierade avseende antal deltagare och deras egenskaper. Bara i sex studier var antalet deltagare mer än 100 barn. I åtta studier bestod undersökningsgruppen av för tidigt födda barn i olika gestationsålder och spädbarn. I tre utfördes smärtbedömning i samband med analgetikaadministration. I fem studier granskades barnen före, under och/eller efter en smärthändelse. I tre studier undersöktes några barngrupper även för att bedöma långvarig smärta.Slutsatsen blev att smärtskattningssskalorna har visat tillförlitlighet och giltighet, men bara i tre av dessa studier undersöktes den kliniska nyttan och genomförbarheten i praktiken.Nyckelord: Smärtbedömning,

Kontinuerligt ljud kan vara påfrestande i den dagliga arbetsmiljön. På sjukhus vårdas patienter som är utsatta för en konstant ljudmiljö. Även barn som vårdas på avdelningar utsätts för den konstanta ljudmiljön. Arbetsuppgifter och lagen kräver av sjuksköterskor att de utför ett professionellt arbete som ska garantera högsta patientsäkerhet under dessa arbetsförutsättningar. Studiens syfte var att belysa ljudmiljöns påverkan på sjuksköterskors arbete och patientsäkerhet inom intensivvård samt neonatal intensivvård.Frågan om eventuella lösningar att reducera larm kom även att undersökas. Författarna valde en litteraturöversikt som metod.I litteraturstudien undersöktes och jämfördes 16 artiklar med varandra. Artiklarna söktes i databaserna CINAHL, PubMed, PsychInfo och Academic Search Elite. För att få så många artiklar som möjligt gjordes både databassökningar och manuella sökningar. Artiklarna som uppfyllde inklusionskriterierna skulle varaengelsk-eller svenskspråkiga, inte äldre än 10 år, originalartiklar, handla om intensivvård och vara peer reviewed. För att besvara syftet delades resultaten in i fyra rubriker. Man fann bland annat att sjuksköterskor hanterade larmen på en intensivvårdsavdelning bättre om de hade extra kunskapom övervakning och larmapparatureller hade längre yrkeserfarenhet inom området samtövervakningssystemen och apparaterna de arbetademed. Larmen skulle kunna minskas om de anpassades efter individuella patientbehov. Sjuksköterskor påverkas negativt av en konstant (hög) ljudmiljö vilket i sin tur påverkar patientsäkerheten. Patientsäkerheten blir påverkad då sjuksköterskor använder larmen som informationskälla men kan även bli stressade av för många olika larm och även ignorera dem.

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