Allostatic load: a useful concept for advancing nursing research

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145197/1/jocn13753.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145197/2/jocn13753_am.pd

Validation of alternative indicators of social support in perinatal outcomes research using quality of the partner relationship

Aim To test alternatives to the current research and clinical practice of assuming that married or partnered status is a proxy for positive social support. Background Having a partner is assumed to relate to better health status via the intermediary process of social support. However, women's health research indicates that having a partner is not always associated with positive social support. Design An exploratory post hoc analysis focused on posttraumatic stress and childbearing was conducted using a large perinatal database from 2005–2009. Methods To operationalize partner relationship, four variables were analysed: partner (‘yes’ or ‘no’), intimate partner violence (‘yes’ or ‘no’), the combination of those two factors, and the woman's appraisal of the quality of her partner relationship via a single item. Construct validity of these four alternative variables was assessed in relation to appraisal of the partner's social support in labour and the postpartum using linear regression standardized betas and adjusted R ‐squares. Predictive validity was assessed using unadjusted and adjusted linear regression modelling. Results Four groups were compared. Married, abused women differed most from married, not abused women in relation to the social support, and depression outcomes used for validity checks. The variable representing the women's appraisals of their partner relationships accounts for the most variance in predicting depression scores. Conclusions Our results support the validity of operationalizing the impact of the partner relationship on outcomes using a combination of partnered status and abuse status or using a subjective rating of quality of the partner relationship.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98144/1/jan12015.pd

Exploring the optimal allostatic load scoring method in women of reproductive age

AimsThe aim of this study was to determine the optimal allostatic load scoring method.DesignThis is a secondary analysis of data on women of reproductive age from the 2001-2006 National Health and Nutrition Examination Survey.MethodsWe created allostatic load summary scores using five scoring methods including the count-based, Z-Score, logistic regression, factor analysis and grade of membership methods. Then, we examined the predictive performance of each allostatic load summary measure in relation to three outcomes: general health status, diabetes and hypertension.ResultsWe found that the allostatic load summary measure by the logistic regression method had the highest predictive validity with respect to the three outcomes. The logistic regression method performed significantly better than the count-based and grade of membership methods for predicting diabetes as well as performed significantly better for predicting hypertension than all of the other methods. But the five scoring methods performed similarly for predicting poor health status.ConclusionWe recommended the logistic regression method when the outcome information is available, otherwise the frequently used simpler count-based method may be a good alternative.ImpactThe study compared different scoring methods and made recommendations for the optimal scoring approach. We found that allostatic load summary measure by the logistic regression method had the strongest predictive validity with respect to general health status, diabetes and hypertension. The study may provide empirical evidence for future research to use the recommended scoring approach to score allostatic load. The allostatic load index may serve as an -early warning- indicator for health risk.ç ®ç è¿ é¡¹ç  ç©¶ç ç ®ç å ¨äº ,ç¡®å® æ ä½³é åº è´ è ·è¯ å æ ¹æ³ ã è®¾è®¡è¿ æ ¯å¯¹2001å¹´è ³2006æ é ´å ¨å ½å ¥åº·å è ¥å »æ£ æ ¥è° æ ¥ä¸­è ²é¾ å¦ å¥³æ °æ ®ç äº æ¬¡å æ ã æ ¹æ³ æ ä»¬ä½¿ç ¨äº äº ç§ è¯ å æ ¹æ³ (å æ ¬å ºäº è®¡æ °æ³ ã Z计å æ³ ã é »è¾ å å½ æ³ ã å  å­ å æ æ³ å é ¶å± åº¦æ ¹æ³ )æ ¥å å»ºäº é åº è´ è ·æ± æ »å æ °ã ç ¶å ,æ ä»¬æ£ æ ¥äº ä¸ ä¸ ä¸ªç» æ ç ¸å ³ç å ç§ é åº è´ è ·æ± æ »æ °å ¼ç é¢ æµ æ §è ½:æ ´ä½ å ¥åº·ç ¶æ ã ç³ å°¿ç å é« è¡ å ã ç» æ æ 们å ç °,é »è¾ å å½ æ³ ç é åº è´ è ·æ± æ »å æ °å¯¹è¿ ä¸ ä¸ªç» æ å ·æ æ é« ç é¢ æµ æ 度ã é »è¾ å å½ æ³ å ¨é¢ æµ ç³ å°¿ç æ ¹é ¢ç è¡¨ç °æ æ ¾ä¼ äº å ºäº è®¡æ °æ³ å é ¶å± åº¦æ ¹æ³ ,å ¨é¢ æµ é« è¡ å æ ¹é ¢ç è¡¨ç °ä¹ æ æ ¾ä¼ äº æ æ å ¶ä» æ ¹æ³ ã ä½ è¿ äº ç§ è¯ å æ ¹æ³ å ¨é¢ æµ ä¸ è ¯å ¥åº·ç ¶æ æ ¹é ¢ç è¡¨ç °ç ¸ä¼¼ã ç» è®ºå½ ç» æ èµ æ å ¯ç ¨æ ¶,æ ä»¬æ ¨è é »è¾ å å½ æ³ ,å ¨å ¶ä» æ ¹é ¢,å¸¸ç ¨ä¸ æ ´ç® å ç å ºäº è®¡æ °æ³ å ¯è ½ä¹ æ ¯ä¸ ä¸ªä¸ é ç é æ ©ã å½±å è¯¥ç  ç©¶æ¯ è¾ äº ä¸ å ç è¯ å æ ¹æ³ ,并æ å ºäº æ ä½³è¯ å æ ¹æ³ ç 建议ã æ 们å ç °ç ¨é »è¾ å å½ æ³ è¿ è¡ ç é åº è´ è ·æ± æ »å æ °å¯¹æ ´ä½ å ¥åº·ç ¶æ ã ç³ å°¿ç å é« è¡ å å ·æ æ 强ç é¢ æµ æ æ æ §ã è¯¥ç  ç©¶å ¯ä»¥ä¸ºä» å ä½¿ç ¨æ ¨è ç è¯ å æ ¹æ³ å¯¹æ æ é åº è´ è ·è¯ å æ ä¾ å® éª æ §è¯ æ ®ã é åº è´ è ·æ æ °å ¯ä»¥ä½ ä¸ºå ¥åº·é£ é ©ç -é¢ è­¦-æ æ  ãPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151983/1/jan14014_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151983/2/jan14014.pd

Abuse‐Related Post‐Traumatic Stress, Coping, and Tobacco Use in Pregnancy

Objective: To examine the relationship between trauma history, posttraumatic stress disorder (PTSD), coping, and smoking in a diverse sample of pregnant women, some of whom are active smokers. Design: Secondary analysis from a prospective study on PTSD and pregnancy outcomes. Setting: Maternity clinics at three health systems in the midwestern United States. Participants: Women age 18 or older (1,547) interviewed at gestational age fewer than 28 weeks. Methods: Participants were classified at nonsmokers, quitters (stopped smoking during pregnancy), and pregnancy smokers. Demographic, trauma, and pregnancy factors, substance use, and use of tobacco to cope were compared across groups. Logistic regression assessed the influence of these factors on being a smoker versus a nonsmoker and a quitter versus a pregnancy smoker. Results: Smokers differed from nonsmokers on all demographic risk factors (being African American, being pregnant as a teen, having lower income and less education, and living in high‐crime areas), had higher rates of current and lifetime PTSD, and were more likely to report abuse as their worst trauma. Pregnancy smokers had lower levels of education, were more likely to classify their worst trauma as “extremely troubling,” and were more likely to exhibit PTSD hyperarousal symptoms. In regression models, smoking “to cope with emotions and problems” doubled the odds of continuing to smoke while pregnant even after accounting for several relevant risk factors. Conclusion: Smoking behavior in pregnancy may be influenced by the need to cope with abuse‐related PTSD symptoms. Clinicians should consider using trauma‐informed interventions when working with tobacco‐using pregnant women.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86982/1/j.1552-6909.2011.01261.x.pd

Recurrent pregnancy loss is associated with a pro-senescent decidual response during the peri-implantation window

During the implantation window, the endometrium becomes poised to transition to a pregnant state, a process driven by differentiation of stromal cells into decidual cells (DC). Perturbations in this process, termed decidualization, leads to breakdown of the feto-maternal interface and miscarriage, but the underlying mechanisms are poorly understood. Here, we reconstructed the decidual pathway at single-cell level in vitro and demonstrate that stromal cells first mount an acute stress response before emerging as DC or senescent DC (snDC). In the absence of immune cell-mediated clearance of snDC, secondary senescence transforms DC into progesterone-resistant cells that abundantly express extracellular matrix remodelling factors. Additional single-cell analysis of midluteal endometrium identified DIO2 and SCARA5 as marker genes of a diverging decidual response in vivo. Finally, we report a conspicuous link between a pro-senescent decidual response in peri-implantation endometrium and recurrent pregnancy loss, suggesting that pre-pregnancy screening and intervention may reduce the burden of miscarriage

In Search of an Adult Attachment Stress Provocation to Measure Effect on the Oxytocin System: A Pilot Validation Study

Oxytocin is a promising biomarker for psychiatric conditions arising from early relational trauma, childhood maltreatment, and attachment dysregulation, including posttraumatic stress and dissociative disorders

Blood Pressure and Job Domains Among Hotel Housekeepers

Hotel housekeepers have challenging working conditions, putting them at risk for poor health such as hypertension. Despite their risks, few studies have measured their blood pressure (BP). The purpose of this study was to explore hotel housekeepers’ blood pressure and the associations between work and BP. Methods: A community engagement approach was used to recruit study participants. Data sources included questionnaires, and BP measurement. Results: Over 25% of the 39 hotel housekeepers reported hypertension diagnosis and/or antihypertensive medication used. Across the job domains, job satisfaction was correlated with diastolic BP, and workload was correlated with systolic BP. There were difference in blood pressure reading, diagnosis and job domains between workers affiliated with union and those with no union affiliation. Discussion: Hypertension is a major concern among this worker group and warrants further investigation. Studies targeting union and non-union workers are needed, given their differences. Researchers will likely benefit from a community engagement approach with hotel housekeepers

Dichotomy in the Impact of Elevated Maternal Glucose Levels on Neonatal Epigenome

Context Antenatal hyperglycemia is associated with increased risk of future adverse health outcomes in both mother and child. Variations in offspring's epigenome can reflect the impact and response to in utero glycemic exposure, and may have different consequences for the child. Objective We examined possible differences in associations of basal glucose status and glucose handling during pregnancy with both clinical covariates and offspring cord tissue DNA methylation. Research Design and Methods This study included 830 mother-offspring dyads from the Growing Up in Singapore Towards Healthy Outcomes cohort. The fetal epigenome of umbilical cord tissue was profiled using Illumina HumanMethylation450 arrays. Associations of maternal mid-pregnancy fasting (fasting plasma glucose [FPG]) and 2-hour plasma glucose (2hPG) after a 75-g oral glucose challenge with both maternal clinical phenotypes and offspring epigenome at delivery were investigated separately. Results Maternal age, prepregnancy body mass index, and blood pressure measures were associated with both FPG and 2hPG, whereas Chinese ethnicity (P = 1.9 x 10(-4)), maternal height (P = 1.1 x 10(-4)), pregnancy weight gain (P = 2.2 x 10(-3)), prepregnancy alcohol consumption (P = 4.6 x 10(-4)), and tobacco exposure (P = 1.9 x 10(-3)) showed significantly opposite associations between the 2 glucose measures. Most importantly, we observed a dichotomy in the effects of these glycemic indices on the offspring epigenome. Offspring born to mothers with elevated 2hPG showed global hypomethylation. CpGs most associated with the 2 measures also reflected differences in gene ontologies and had different associations with offspring birthweight. Conclusions Our findings suggest that 2 traditionally used glycemic indices for diagnosing gestational diabetes may reflect distinctive pathophysiologies in pregnancy, and have differential impacts on the offspring's DNA methylome.Peer reviewe

Dichotomy in the Impact of Elevated Maternal Glucose Levels on Neonatal Epigenome

Context Antenatal hyperglycemia is associated with increased risk of future adverse health outcomes in both mother and child. Variations in offspring's epigenome can reflect the impact and response to in utero glycemic exposure, and may have different consequences for the child. Objective We examined possible differences in associations of basal glucose status and glucose handling during pregnancy with both clinical covariates and offspring cord tissue DNA methylation. Research Design and Methods This study included 830 mother-offspring dyads from the Growing Up in Singapore Towards Healthy Outcomes cohort. The fetal epigenome of umbilical cord tissue was profiled using Illumina HumanMethylation450 arrays. Associations of maternal mid-pregnancy fasting (fasting plasma glucose [FPG]) and 2-hour plasma glucose (2hPG) after a 75-g oral glucose challenge with both maternal clinical phenotypes and offspring epigenome at delivery were investigated separately. Results Maternal age, prepregnancy body mass index, and blood pressure measures were associated with both FPG and 2hPG, whereas Chinese ethnicity (P = 1.9 x 10(-4)), maternal height (P = 1.1 x 10(-4)), pregnancy weight gain (P = 2.2 x 10(-3)), prepregnancy alcohol consumption (P = 4.6 x 10(-4)), and tobacco exposure (P = 1.9 x 10(-3)) showed significantly opposite associations between the 2 glucose measures. Most importantly, we observed a dichotomy in the effects of these glycemic indices on the offspring epigenome. Offspring born to mothers with elevated 2hPG showed global hypomethylation. CpGs most associated with the 2 measures also reflected differences in gene ontologies and had different associations with offspring birthweight. Conclusions Our findings suggest that 2 traditionally used glycemic indices for diagnosing gestational diabetes may reflect distinctive pathophysiologies in pregnancy, and have differential impacts on the offspring's DNA methylome.Peer reviewe

Risk Factors for Postpartum Depressive Symptoms in Low-Income Women With Very Low-Birth-Weight Infants

PURPOSE: This study examined factors associated with postpartum depressive symptoms in mothers with premature infants in the neonatal intensive care unit (NICU). SUBJECTS: A total of 113 new mothers with very low-birth-weight infants in their initial NICU admission were recruited from 2 urban hospitals servicing low-income minority communities. DESIGN: This study employed a cross-sectional design. METHODS: Data were collected during the infants' postpartum NICU admission and included maternal demographic information (eg, age, education, race, living with the baby's father), infant illness severity (Neurobiologic Risk Score from infant's medical record), and maternal psychological measures (the Center for Epidemiologic Studies Depression Scale, the Perinatal Posttraumatic Stress Questionnaire, and the State-Trait Anxiety Inventory). RESULTS: The findings indicated that 47 (42%) women had elevated postpartum depressive symptoms and 33 (30%) women had elevated postpartum posttraumatic stress symptoms (PTSs). Factors associated with postpartum depressive symptoms included PTS, anxiety, maternal age, and whether the mother lived with the baby's father (F₄, ₁₀₄ = 52.27, P < .001). The severity of the infants' illness, parental stress, and maternal education were not associated with depressive symptoms among low-income mothers of NICU infants. CONCLUSIONS: On the basis of our findings, we recommend that low-income women should be screened for symptoms of anxiety, posttraumatic stress, and postpartum depression on their infants' admission to the NICU. When this is not feasible, we advise NICU healthcare providers to assess women for familial support, maternal age, posttraumatic stress related to their infants birth, and anxiety to determine which mothers are at the greatest risk for postpartum depressive symptoms. Screening for postpartum depression in the NICU can aid in early identification and treatment, thereby decreasing negative consequences for mothers and their infants