Joanne Motiño Bailey

Dose escalation of a curcuminoid formulation

BackgroundCurcumin is the major yellow pigment extracted from turmeric, a commonly-used spice in India and Southeast Asia that has broad anticarcinogenic and cancer chemopreventive potential. However, few systematic studies of curcumins pharmacology and toxicology in humans have been performed.MethodsA dose escalation study was conducted to determine the maximum tolerated dose and safety of a single dose of standardized powder extract, uniformly milled curcumin (C3Complex™, Sabinsa Corporation). Healthy volunteers were administered escalating doses from 500 to 12,000 mg.ResultsSeven of twenty-four subjects (30%) experienced only minimal toxicity that did not appear to be dose-related. No curcumin was detected in the serum of subjects administered 500, 1,000, 2,000, 4,000, 6,000 or 8,000 mg. Low levels of curcumin were detected in two subjects administered 10,000 or 12,000 mg.ConclusionThe tolerance of curcumin in high single oral doses appears to be excellent. Given that achieving systemic bioavailability of curcumin or its metabolites may not be essential for colorectal cancer chemoprevention, these findings warrant further investigation for its utility as a long-term chemopreventive agent.

Childbirth Education and Birth Plans

Childbirth education is considered a key component to prenatal care, although many women do not receive any formalized preparation. There are multiple models of childbirth education for both within health care settings, including Centering Pregnancy, and external programs, such as Lamaze and Bradley. As a component of childbirth preparation, a birth plan can be a medium to improve patient-provider communication regarding a desired labor and birth experience and improve satisfaction with care.

Human papillomavirus in amniotic fluid

BackgroundThere is evidence to suggest that human papillomavirus (HPV) can cross the placenta resulting in in-utero transmission. The goal of this study was to determine if HPV can be detected in amniotic fluid from women with intact amniotic membranes.MethodsResidual amniotic fluid and cultured cell pellets from amniocentesis performed for prenatal diagnosis were used. PGMY09/11 L1 consensus primers and GP5+/GP6+ primers were used in a nested polymerase chain reaction assay for HPV.ResultsThere were 146 paired samples from 142 women representing 139 singleton pregnancies, 2 twin pregnancies, and 1 triplet pregnancy. The women were 78% Caucasian, 5% African American, 14% Asian, and 2% Hispanic. The average age was 35.2 years with a range of 23–55 years. All samples were β-globin positive. HPV was not detected in any of the paired samples.ConclusionGiven the age range, race, and ethnicity of the study population, one would anticipate some evidence of HPV if it could easily cross the placenta, but there was none.

Postpartum Hemorrhage Prevention: A Case Study in Northern Rural Honduras

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Safe Motherhood policies have been directed towards the reduction of PPH by recommending active management of third-stage labor as the standard of care. One component of active management involves routine use of a uterotonic agent within 1 minute of the delivery of the baby. A case study at Clínica Materno-Infantil, a free-standing public birth center in Honduras, is presented, focusing on methods to reduce PPH. The nursing staff was trained to estimate blood loss and in methods to manage PPH, including elements of active management of the third stage of labor. Medical records were reviewed and an analysis of PPH management compared to estimated blood loss (EBL) was conducted. There was no significant correlation between PPH management techniques and EBL (r = .060; P = .368). There was a statistically significant (P < .001) correlation between oxytocin administration and lower EBL (r = -.232), indicating that there was less blood loss when oxytocin was administered. At Clínica Materno-Infantil, routine use of a uterotonic agent appears beneficial and further implementation of active management of the third stage of labor appears warranted.

Psychosocial factors in risk of cervical intraepithelial lesions.

BACKGROUND This study examines the relationship among psychosocial factors, behavioral risks for abnormal cervical cytology, and abnormal cervical cytology. METHODS A self-administered questionnaire was used to measure perceived stress, discrimination, lifetime stressful events, optimism, social support, and psychological state. Women with normal Pap smears attending a primary care clinic and women attending a colposcopy clinic because of an abnormal Pap smear were eligible. The scores between the two groups were compared. RESULTS A total of 265 women participated in the study. There were no significant relationships between psychosocial factors and cervical cytology status. In a regression model, age (B = -0.057, p = 0.001) was predictive of having abnormal cervical cytology. Smoking was correlated with an increased family Apgar score (p = 0.021), Perceived Stress Scale (PSS) score (p = 0.049), and Revised Life Stressor Checklist score (p < 0.001). A higher mean number of lifetime male partners was related to increased family Apgar score (p = 0.012), Revised Life Stressor Checklist score (p < 0.001), and major event discrimination (p < 0.001). Earlier age at coitarche was associated with increased family Apgar score (p < 0.001). CONCLUSIONS These results do not support that psychosocial factors play a role in the risk of developing abnormal cervical cytology. Behavioral risks for developing abnormal cervical cytology are associated with life stressors, family function, and perceived discrimination.

Reduced postpartum hemorrhage after implementation of active management of the third stage of labor in rural Honduras

To assess outcomes after auxiliary nurses were trained and given resources to use active management of the third stage of labor (AMTSL) for all women giving birth in a low‐resource, low‐risk, rural, public birth center setting in northern rural Honduras.

Retrospective Review of Nurse-Midwifery Care at a Large University Health System.

The purpose of the study is to characterize practice trends, outcomes, and changes over time of a full-scope midwifery service over the past 30 years from 1983 to 2013. The types of clients served and the evolution of the services provided and resulting outcomes are described as an exemplar of the changing nature of providing midwifery services in a tertiary care hospital setting. The overall data reveal that despite small increases in intervention practices, such as epidurals, inductions, and cesarean births, midwives have a commitment to providing safe, evidenced-based, woman-centered care within a collaborative practice model at a tertiary care center. The role of midwives as leaders in supporting physiologic birth in this setting and encouraging opportunities for interprofessional education and collaborative is demonstrated.

Cervical Cancer Precursors, Diet and Bitter Taste (6-n-propylthiouracil ‘PROP’) Receptors~!2008-02-19~!2008-05-09~!2008-06-12~!

Prior studies suggest that 6-n-propylthiouracil (PROP) taste responsiveness is linked with reduced preferences for sweet and high-fat foods, lower adiposity, and favorable plasma lipid profiles. We hypothesize that women with more severe and persistent cervical intraepithelial neoplasia (CIN) have a greater sensitivity to PROP. To measure this, women with CIN II or III submitted a DNA blood sample and a food frequency questionnaire. Out of the samples tested, thirty- eight (47%) were classified as nontasters (AV) and 36 (44%) were classified as tasters (PA). There were no significant differences (p<0.05) between the taster groups with respect to demographic variables or food frequency data. Women with CIN II at baseline were significantly (p<0.003) more likely to clear the disease than women with CIN III at baseline. Genetic markers of PROP may indicate the likelihood of a womans acceptance of bitter foods, but had no association with food consumption, body mass index, and persistence of CIN.