Maureen Groer

Increasing daily walking improves glucose tolerance in overweight women

BACKGROUND Physical activity (PA) has been shown to benefit glucose tolerance. Walking is a convenient low-impact mode of PA and is reported to be the most commonly performed activity for those with diabetes. The purpose of this study was to determine whether a recommendation to accumulate 10,000 steps/day for 8 weeks was effective at improving glucose tolerance in overweight, inactive women. METHODS Eighteen women (53.3 +/- 7.0 years old, 35.0 +/- 5.1 kg/m(2)) with a family history of type 2 diabetes completed a 4-week control period followed by an 8-week walking program with no changes in diet. The walking program provided a goal of accumulating at least 10,000 steps/day, monitored by a pedometer. RESULTS During the control period, participants walked 4972 steps/day. During the intervention period, the participants increased their accumulated steps/day by 85% to 9213, which resulted in beneficial changes in 2-h postload glucose levels (P < 0.001), AUC(glucose) (P = 0.025), systolic blood pressure (P < 0.001), and diastolic blood pressure (P = 0.002). There were no changes in body mass, body fat percentage, and waist circumference during the walking intervention. CONCLUSIONS The 10,000 steps/day recommendation resulted in improved glucose tolerance and a reduction in systolic and diastolic blood pressure in overweight women at risk for type 2 diabetes. This demonstrates that activity can be accumulated throughout the day and does not have to result in weight loss to benefit this population.

Immune, health and endocrine characteristics of depressed postpartum mothers

The purpose of the study was to examine demographic, immune, endocrine, stress and health characteristics of depressed mothers, measured between 4 and 6 weeks postpartum, and compare them to non-depressed mothers. The top decile (N=25) of Profile of Mood States depression scores was used to categorize mothers as depressed and these data were then compared to means of the remaining mothers (N=175) in a study of stress and immunity during the postpartum. Depressed mothers were younger, had smaller birth weight infants, and their babies experienced more illness symptoms at 4-6 weeks postpartum. Depressed mothers were less likely to be breastfeeding and had lower serum prolactin levels. Depressed mothers were more likely to smoke, to have daytime sleepiness, and more symptoms of infection than non-depressed mothers. Depressed mothers also had higher perceived stress, postpartum stress, and negative life event reports. There was evidence suggesting that depressed mothers had a downregulated hypothalamic-pituitary-adrenocortical (HPA) axis, in that salivary cortisol was lower in depressed mothers. Depressed mothers also had lower serum levels of Interferon-gamma (IFN-gamma) and a lower IFN-gamma/Interleukin-10 (IL-10) ratio in both sera and in whole blood stimulated cultures, suggesting a depressed Th1/Th2 ratio in depressed mothers. The data supports the possibility that postpartum depression may be associated with a dysregulated HPA axis and possible depressed cellular immunity.

Differences Between Exclusive Breastfeeders, Formula-Feeders, and Controls: A Study of Stress, Mood, and Endocrine Variables:

The purpose of this study was to examine relationships among lactational status, naturalistic stress, mood, and levels of serum cortisol and prolactin and plasma adrenocorticotropic hormone (ACTH). Eighty-four exclusively breastfeeding, 99 exclusively formula-feeding, and 33 nonpostpartum healthy control women were studied. The postpartum mothers were studied cross-sectionally once between 4 and 6 weeks after the birth. Stress was measured using the Perceived Stress Scale, the Tennessee Postpartum Stress Scale, and the Inventory of Small Life Events. Mood was measured using the Profile of Mood States. Serum prolactin, plasma ACTH, and serum cortisol levels were measured by commercial ELISA (enzyme-linked immunosorbent assay) kits. Results indicate that breastfeeding mothers had more positive moods, reported more positive events, and perceived less stress than formula-feeders. Reports of stressful life events were generally equivalent in the two groups. Serum prolactin was inversely related to stress and mood in formula-feeders. When breast and formula-feeders were compared to controls, they had higher serum cortisol, lower stress, and lower anxiety. Breastfeeders had lower perceived stress than controls. Breastfeeders had lower depression and anger and more positive life events reported than formula-feeders. However, there were few correlations among stress, mood, and the hormones in postpartum mothers, and those only in formula-feeders, whereas strong relationships were found between serum ACTH and a number of stress and mood variables in controls. Postpartum mothers reported a range of stress and negative moods at 4 to 6 weeks, and in formula-feeders, serum prolactin was related to some of the stress and mood variables. Breastfeeding appears to be somewhat protective of negative moods and stress.The purpose of this study was to examine relationships among lactational status, naturalistic stress, mood, and levels of serum cortisol and prolactin and plasma adrenocorticotropic hormone (ACTH)....

Development of the preterm infant gut microbiome: a research priority

The very low birth weight (VLBW) infant is at great risk for marked dysbiosis of the gut microbiome due to multiple factors, including physiological immaturity and prenatal/postnatal influences that disrupt the development of a normal gut flora. However, little is known about the developmental succession of the microbiota in preterm infants as they grow and mature. This review provides a synthesis of our understanding of the normal development of the infant gut microbiome and contrasts this with dysbiotic development in the VLBW infant. The role of human milk in normal gut microbial development is emphasized, along with the role of the gut microbiome in immune development and gastroenteric health. Current research provides evidence that the gut microbiome interacts extensively with many physiological systems and metabolic processes in the developing infant. However, to the best of our knowledge, there are currently no studies prospectively mapping the gut microbiome of VLBW infants through early childhood. This knowledge gap must be filled to inform a healthcare system that can provide for the growth, health, and development of VLBW infants. The paper concludes with speculation about how the VLBW infants’ gut microbiome might function through host-microbe interactions to contribute to the sequelae of preterm birth, including its influence on growth, development, and general health of the infant host.

A Pilot Study Evaluating the Effect of Mindfulness-Based Stress Reduction on Psychological Status, Physical Status, Salivary Cortisol, and Interleukin-6 Among Advanced-Stage Cancer Patients and Their Caregivers:

Purpose: To investigate whether a mindfulness-based stress reduction program for cancer (MBSR-C) improved psychological and physical symptoms, quality of life (QOL), and stress markers among advanced-stage cancer patients and caregivers. Design: A pilot within-subject design was used. Method: Patients previously diagnosed with advanced-stage breast, colon, lung, or prostate cancer and on treatment were recruited from the Moffitt Cancer Center and Research Institute. Twenty-six patient–caregiver dyads completed a modified 6-week, self-study MBSR-C program based on the Kabat–Zinn model. Psychological and physical symptoms and QOL were compared pre– and post–MBSR-C sessions. Salivary cortisol and interleukin-6 were assessed pre– and post–MBSR-C session at 1, 3, and 6 weeks. Findings: Following the 6-week MBSR program, patients showed improvements in stress and anxiety (p < .05); caregivers’ psychological and QOL also improved but were not statistically significant. Both patients and caregivers had decreases in cortisol at Weeks 1 and 3 (p < .05) but not at Week 6. Similar to cortisol levels at Week 6, salivary interleukin-6 levels were lower overall (before/after an MBSR-C session), compared with Week 1 for patients and caregivers. Conclusions: MBSR-C may be a beneficial intervention for reducing stress, anxiety, cortisol levels, and symptoms in advanced-stage cancer patients and may also benefit caregivers.

Toxoplasma gondii antibody titers and history of suicide attempts in patients with schizophrenia

Toxoplasma gondii (T. gondii) a widespread neurotropic parasite, has been previously associated with schizophrenia and more recently with suicidal behavior. However, no previous study has examined the association of T. gondii with suicidal behavior in schizophrenia patients. 950 individuals diagnosed with schizophrenia by SCID were recruited from the Munich area of Germany. Solid-enzyme immunoassay methods were used to measure IgG plasma antibodies to T. gondii, other neurotropic pathogens and gliadin. Logistic regression models were developed to analyze the association of T. gondii seropositivity or serointensity with history of suicidal behavior. In those younger than the median age of the sample, 38, T. gondii serointensity was associated with history of suicidal behavior (p = 0.02), while in the older patients the relationship was not significant (p = 0.21). Seropositivity was also associated with history of suicide attempt in younger patients, odds ratio 1.59 (95% CI 1.06 to 2.40), p = 0.03. Seropositivity for CMV (p = 0.22), HSV-1 (p = 0.36) and gliadin (p = 0.92) was not related to history of suicide attempt in the entire sample or any age subgroup. T. gondii serology might become, with interaction with vulnerability genes, a candidate biomarker for a subgroup of schizophrenia patients prone to attempting suicide.

Postpartum Stress: Current Concepts and the Possible Protective Role of Breastfeeding

Objective: To review stress during the postpartum and the research supporting that a unique, protective biology exists in breastfeeding mothers that may reduce reactivity to stress. Data Sources: Publications from nursing and biomedical literature. Study Selection: Studies reviewed were those that have contributed to concurrent conceptualizations of postpartum stress. Additionally, studies with sufficient participants were analyzed for common findings. Animal literature was reviewed for studies on the stress response in lactating and nonlactating animal models. Data Extraction: Stress during the postpartum may be conceptualized as physical, intrapersonal, and interpersonal. Animal data and a few recent human studies suggest that the neuroendocrinology of the lactating mother may down-regulate the magnitude of the stress response. Data Synthesis: A diminished stress response may serve to protect the breastfeeding maternal-infant dyad from environmental stimuli and to direct the physiology of the mother toward milk production, energy conservation, and nurturance. Conclusion: Nurses understand the benefits of breastfeeding for optimal infant health, but new research suggests that maternal health may also be benefited in a biologic and as yet unexplored way.

Measures of salivary secretory immunoglobulin A and state anxiety after a nursing back rub

This study examined the effects of a 10-minute nursing back rub on salivary secretory immunoglobulin A (s-IgA) and state anxiety in well older adult subjects. A control group (n = 14) received no intervention, and an experimental group (n = 18) received a slow stroke effleurage back rub. All subjects initially completed the state portion of the Spielberger State/Trait Anxiety Inventory (STAI) and provided a timed, nonstimulated saliva sample. Control subjects lay positioned in bed for 10 minutes, and experimental subjects received the back rub. Both groups then provided a second saliva sample and completed the STAI again. Anxiety scores decreased for both groups, but not significantly, and s-IgA concentration increased in the experimental group. This study provides rationale for further research into the holistic benefits of the nursing back rub and should encourage nurses to continue to provide caring touch interventions to patients.

A Pilot Study to Determine the Safety and Feasibility of Oropharyngeal Administration of Own Mother’s Colostrum to Extremely Low Birth Weight Infants

&NA;Own mothers colostrum is rich in cytokines and other immune agents that may stimulate oropharyngeal-associated lymphoid tissue if administered oropharyngeally to extremely low-birth-weight (ELBW) infants during the first days of life when enteral feeding is contraindicated. However, the safety and feasibility of the oropharyngeal route for the administration of colostrum have not been determined. PURPOSE:To determine the safety of oropharyngeal administration of own mothers colostrum to ELBW infants in first days of life. A secondary purpose was to investigate the feasibility of (1) delivering this intervention to ELBW infants in the first days of life and (2) measuring concentrations of secretory immunoglobulin A and lactoferrin in tracheal aspirate secretions and urine of these infants. SUBJECTS:Five ELBW infants (mean birth weight and gestational age = 657 g and 25.5 weeks, respectively). DESIGN:Quasi-experimental, 1 group, pretest-posttest design. METHODS:Subjects received 0.2 mL of own mothers colostrum administered oropharyngeally every 2 hours for 48 consecutive hours, beginning at 48 hours of life. Concentrations of secretory immunoglobulin A and lactoferrin were measured in tracheal aspirates and urine of each subject at baseline, at the completion of the intervention and again 2 weeks later. RESULTS:All infants completed the entire treatment protocol, each receiving 24 treatments. A total of 15 urine specimens were collected and 14 were sufficient in volume for analysis. A total of 15 tracheal aspirates were collected, but only 7 specimens (47%) were sufficient in volume for analysis. There was wide variation in concentrations of secretory immunoglobulin A and lactoferrin in urine and tracheal aspirates among the 5 infants; however, several results were outside the limits of assay detection. All infants began to suck on the endotracheal tube during the administration of colostrum drops. Oxygen saturation measures remained stable or increased slightly during each of the treatment sessions. There were no episodes of apnea, bradycardia, hypotension, or other adverse effects associated with the administration of colostrum. CONCLUSIONS:Oropharyngeal administration of own mothers colostrum is easy, inexpensive, and well-tolerated by even the smallest and sickest ELBW infants. Future research should continue to examine the optimal procedure for measuring the direct immune effects of this therapy, as well as the clinical outcomes such as infections, particularly ventilator-associated pneumonia.

Neuroendocrine and immune relationships in postpartum fatigue.

Purpose:To explore relationships between fatigue, depression, stress, and infection in the postpartum. Study Design and Methods:This was a cross-sectional, correlational design with a sample of 119 new mothers at 4 to 6 weeks postpartum. Mothers completed fatigue, mood, and stress instruments as well as maternal and infant infection checklists. Morning blood and hindmilk (in breastfeeders) samples were collected. ELISA was used to measure prolactin, cortisol, melatonin, and secretory IgA (sIgA). Correlations between psychosocial, health, and biologic variables were explored. Results:Fatigue was correlated with symptoms of infection in both mothers and babies, with perceived stress and postpartum stress as well as with depression. Serum prolactin was inversely associated with depression. Milk sIgA was related to milk prolactin and inversely related to stress. Milk melatonin and prolactin were inversely related, and fatigue scores were correlated with melatonin and inversely with prolactin. Clinical Implications:The data suggest that fatigue, stress, depression, and infection are related in postpartum mothers and that these relationships extend to levels of serum hormones and milk factors. It is possible that a cycle is established that multiplies the effects of fatigue when mothers experience stress and that this cycle of stress and fatigue may lead to immune deficits and infectious illnesses.