Nursing

This study sought to investigate the contributing factors to and frequency of violence against health care workers (HCWs) working in western Turkey. The population is composed of a random sample of 1,209 HCWs from 34 health care workplaces. Written questionnaires were given to HCWs at all sites, where staff were instructed to register all types of violence they had experienced. In all, 49.5% of HCWs reported having experienced verbal, physical, or verbal and physical violence, with this total being made up of 39.6% men and 60.4% women. A larger percentage (69.6%) of general practitioners reported experiencing verbal abuse and physical violence by patients and patients' family members or friends. Younger workers, inexperienced staff, and those in emergency services were more likely to report violence. Violence directed toward HCWs is a common occupational hazard. Public health authorities should plan preventive interventions based on the findings of this study.

Background: Listening to music has a stress-reducing effect in surgical procedures. The effects of listening to music immediately before a cesarean section have not been studied. The objective of this study was to assess the effects of listening to selected music while waiting for a cesarean section on emotional reactions, on cognitive appraisal of the threat of surgery, and on stress-related physiological reactions. Methods: A total of 60 healthy women waiting alone to undergo an elective cesarean section for medical reasons only were randomly assigned either to an experimental or a control group. An hour before surgery they reported mood, and threat perception. Vital signs were assessed by a nurse. The experimental group listened to preselected favorite music for 40 minutes, and the control group waited for the operation without music. At the end of this period, all participants responded to a questionnaire assessing mood and threat perception, and the nurse measured vital signs. Results: Women who listened to music before a cesarean section had a significant increase in positive emotions and a significant decline in negative emotions and perceived threat of the situation when compared with women in the control group, who exhibited a decline in positive emotions, an increase in the perceived threat of the situation, and had no change in negative emotions. Women who listened to music also exhibited a significant reduction in systolic blood pressure compared with a significant increase in diastolic blood pressure and respiratory rate in the control group. Conclusion: Listening to favorite music immediately before a cesarean section may be a cost-effective, emotion-focused coping strategy. (BIRTH 39:2 June 2012)

Rituximab is a monoclonal antibody directed against the CD20 antigen on the surface of normal and malignant B lymphocytes. Its use in autoimmune conditions is rapidly expanding. Late-onset neutropenia (LON) is a wellrecognized side effect of rituximab therapy in lymphoma patients. Only a small number of cases of LON have been reported in patients with autoimmune disorders. The aim of this work is to review cases in Israel and to compare them to published cases in the literature thus adding to the body of knowledge regarding this unusual phenomenon. Members of the Israeli Rheumatology Association were encountered by email, requesting reports of cases of LON after therapy with rituximab. Submitted cases were reviewed, with demographics and clinical data collated and tabled. Current cases were compared to previously published rheumatology cases. Twelve episodes of LON following rituximab therapy were reported. All patients were female with an average age of 50 years (range 22-78). LON occurred at an average of 155 days after therapy (range 71-330). The average leukocyte count was1,456 white cells, with an average of 413 neutrophils (range 0-1,170 neutrophils). Three of the patients underwent bone marrow biopsies which showed white cell line maturation arrest with an increased number of lymphocytes. No blasts were seen. Our results add support to the growing evidence that this adverse event usually follows a benign course and is not an absolute contraindication for repeat treatment if required in the future. However, vigilance is recommended with routine periodic blood counts, especially 5 months following rituximab administration when the risk is expected to be the highest.

Systolic click murmur syndrome: auscultatory changes following ventricular exeasystoles and beta-blocking agents. .I Irish Med Assoc 1975;68: 369-375. 2. Abinader EG. Adrenergic beta blockade and ECG changes in the systolic click murmur syndrome.

The problem: In most of the industrialized world, a childhood obesity epidemic is evident, with the numbers rising each year. Purpose: To discuss the current literature in relation to childhood obesity and to provide health practitioners, especially nurses, with the fundamental knowledge that is imperative in the recognition of children who are at risk and thereby tailor appropriate interventions. Method: Databases that were accessed for current literature included CINAHL, Science Direct and ProQuest. Keywords used in the search included obesity, childhood, health, relevant national statistics, policy and health risks. The literature was confined to the past 10 years with emphasis on the past 5 years. The 50 most pertinent papers from a variety of countries were chosen, and 35 papers that represented key areas of relevance were selected as the basis of this article. This selection of papers dictated the key areas of discussion such as the acknowledged factors in childhood obesity. Findings: Although childhood obesity may be related to specific cultural and national circumstances, universal themes emerged from the literature review. These include social factors, exercise, advertising, public policy and the importance of partnerships in policy. Conclusion: Any country that has a high rate or increasing rate of childhood obesity must acknowledge core factors that contribute to this serious health problem. Furthermore, public policy and community partnerships that include all health professionals have a responsibility in the prevention of childhood obesity. This can be implemented through education, research and advocacy of all nurses involved with children and families.

Four out of 19 male patients suffering from familial Mediterranean fever (FMF) had fertility problems while on colchicine therapy (0.5-2.0 mg daily for as long as 11 years). Three of the patients had had children while off therapy but their wives could not conceive while they were on therapy. In one patient primary sterility remained one year after cessation of colchicine. In this and two other patients the spermogram was normal but the sperm penetration test was pathological. The fourth patient had azoospermia. Patients should be informed about this possible risk of colchicine therapy. The need for continued follow-up and the value of the sperm penetration test in the detection of fertility problems in male patients on long-term colchicine therapy are stressed. It is concluded however, that overall the benefits outweigh the danger of long-term colchicine treatment in male patients with FMF. Die Wirkung der LangzeitColchizin-Behandlung auf die mannliche Fertilitiit bei Patienten mit familiarem Mittelmeerfieber Zusammenfassung: Vier von 19 mannlichen Patienten, die an famGrem Mittelmeerfieber (FMF) leiden, hatten Fertilitatsprobleme wahrend sie unter Colchizin-Behandlung standen (0,5 bis 2,O mg taglich fur bis zu 11 Jahren). Drei der Patienten bekamen vor Beginn oder nach Absetzen der Behandlung Kinder, wahrend ihre Frauen unter der Behandlung nicht empfingen. Bei einem Patienten blieb die primare Sterilitat fur ein Jahr nach Absetzen des Colchizins bestehen. Bei diesem und zwei anderen Patienten war das Spermiogramm normal, dagegen war der SpermatozoenPenetrations-Test pathologisch. Der vierte Patient hatte eine Azoospermie. Patienten sollten uber dieses mogliche Risiko einer Colchizin-Behandlung aufgeklart werden. Die Notwendigkeit von Kontrolluntersuchungen und der Wert des SpermatozoenPenetrations-Tests in der Aufdeckung von Fertilitatsstorungen bei mannlichen Patienten unter LangzeitColchizin-Behandlung werden betont. Es wird jedoch insgesamt geschlossen, dai3 die Vorteile der Langzeit-Colchizin-Bandlung das Risiko bei mannlichen Patienten mit FMF aufwiegen. Since the introduction of long term colchicine therapy for familial Mediterranean fever

T h e obstetric histories were examined for 36 women with familial Mediterranean fever (FMF) on long-term colchicine treatment followed for periods ranging between 3 and 12 years. Seven of 28 pregnancies (25%) associated with colchicine therapy ended in rniscarriage. Thirteen women (36%) had periods of infertility; these were due t o ovulatory dysfunction in six women, to peritoneal adhesions in four and remained unexplained in three women. T h e rates for miscarriage and infertility are high but are similar t o those reported for women with FMF before colchicine therapy was introduced. All 16 infants born to mothers who had taken colchicine during pregnancy were healthy. Currently, we do not advise discontinuation of colchicinc before planned pregnancy but recommend amniocentesis for karyotyping and reassurance. Familial Meditdrranean fever (FMF) is manifested by shorl, self-limiting attacks of fever, peritonitis, pleuritis and arthritis. The disease affects mainly Jewb, Armenians, Arabs and Turks. Symptoms start usually before the age of 20 years. Amyloidosis is the main complication of the disease and develops in a small percentage of patients (Ehrenfeld et al. 1961; Eliakim el al. Continuous prophylaxis with colchicine is effective in the suppression of the attacks in most patients (Levy & Eliakim 1Y77). It has been shown recently that colchicinc prevents both the development of amyloidosis and additional lYSl).

Williams eases parents' anxiety in making decisions about their child's illness. As a doctor, Gordon Williams has experienced rigorous educational processes to become an expert in the field of pediatric rheumatology. Parents also experience a rigorous process in becoming knowledgeable about juvenile arthritiswhat it is, how to treat it, and how to help their child. Dr. Williams has written the first book about juvenile arthritis that will help parents assume responsibility for primary care of their child with arthritis. He has given us the clues we need to guide our children with arthritis in leading as normal a life as possible. I recommend this book to all parents who ask for help in understanding their child's illness.

T h e obstetric histories were examined for 36 women with familial Mediterranean fever (FMF) on long-term colchicine treatment followed for periods ranging between 3 and 12 years. Seven of 28 pregnancies (25%) associated with colchicine therapy ended in rniscarriage. Thirteen women (36%) had periods of infertility; these were due t o ovulatory dysfunction in six women, to peritoneal adhesions in four and remained unexplained in three women. T h e rates for miscarriage and infertility are high but are similar t o those reported for women with FMF before colchicine therapy was introduced. All 16 infants born to mothers who had taken colchicine during pregnancy were healthy. Currently, we do not advise discontinuation of colchicinc before planned pregnancy but recommend amniocentesis for karyotyping and reassurance. Familial Meditdrranean fever (FMF) is manifested by shorl, self-limiting attacks of fever, peritonitis, pleuritis and arthritis. The disease affects mainly Jewb, Armenians, Arabs and Turks. Symptoms start usually before the age of 20 years. Amyloidosis is the main complication of the disease and develops in a small percentage of patients (Ehrenfeld et al. 1961; Eliakim el al. Continuous prophylaxis with colchicine is effective in the suppression of the attacks in most patients (Levy & Eliakim 1Y77). It has been shown recently that colchicinc prevents both the development of amyloidosis and additional lYSl).

Increased chemotactic activity of peripheral polymorphonuclear (PMN) cells has been described in disease states of different etioloa,y and ma,y represent a common pathway in the generation of an inflammatory reaction. The suppressive effect of colchicine on PMN chemotaxis may explain its effect in apparently unrelated disorders.

Objective. Anti-ribosomal P antibodies (aRib-P Ab) are highly specific for systemic lupus erythematosus (SLE), but their correlatation with disease activity and manifestations including renal, hepatic and central nervous system (CNS) involvement is still controversial. The aim of our study was to evaluate the prevalence of aRib-P Ab and their correlation with clinical manifestations and anti-dsDNA antibodies in SLE patients from Israel. Methods. Elevated titers of aRib-P Ab utilizing the ELISA method were analyzed in 141 sera samples from 44 SLE patients, 20 Familial Mediterranean Fever (FMF) patients, 22 primary antiphospholipid syndrome (PAPS) patients, 12 patients with infections, and 43 healthy individuals. The SLEDAI score was utilized for assessing SLE disease activity. Results. Elevated titers of aRib-P Ab were present in 11% of SLE patients (n = 6). The mean SLEDAI was 7 (range: 3-10). No statistically significant association was observed between the presence of aRib-P Ab and disease manifestations present in the SLEDAI. The 6 SLE patients had renal disease (n = 1), leucopenia (n = 1), rash (n = 3), and CNS involvement manifested as psychosis (n = 1) or depression (n = 1).

The problem: In most of the industrialized world, a childhood obesity epidemic is evident, with the numbers rising each year. Purpose: To discuss the current literature in relation to childhood obesity and to provide health practitioners, especially nurses, with the fundamental knowledge that is imperative in the recognition of children who are at risk and thereby tailor appropriate interventions. Method: Databases that were accessed for current literature included CINAHL, Science Direct and ProQuest. Keywords used in the search included obesity, childhood, health, relevant national statistics, policy and health risks. The literature was confined to the past 10 years with emphasis on the past 5 years. The 50 most pertinent papers from a variety of countries were chosen, and 35 papers that represented key areas of relevance were selected as the basis of this article. This selection of papers dictated the key areas of discussion such as the acknowledged factors in childhood obesity. Findings: Although childhood obesity may be related to specific cultural and national circumstances, universal themes emerged from the literature review. These include social factors, exercise, advertising, public policy and the importance of partnerships in policy. Conclusion: Any country that has a high rate or increasing rate of childhood obesity must acknowledge core factors that contribute to this serious health problem. Furthermore, public policy and community partnerships that include all health professionals have a responsibility in the prevention of childhood obesity. This can be implemented through education, research and advocacy of all nurses involved with children and families.

This article discusses nursing education and changing paradigms of knowledge, emphasizing critical thinking, nursing praxis, and the place of the educator as a role model who provides knowledge, facilitates critical thinking, and teaches students how to cope with the knowledge. It interprets the connection between knowledge and power as a potential source of injustice and inequality in the student-teacher relationship; and tries to solve this problematic issue by annulling the differences in power. Examples from clinical areas are presented to illustrate differential power the educator-teacher-researcher has in different clinical areas.

Increased chemotactic activity of peripheral polymorphonuclear (PMN) cells has been described in disease states of different etioloa,y and ma,y represent a common pathway in the generation of an inflammatory reaction. The suppressive effect of colchicine on PMN chemotaxis may explain its effect in apparently unrelated disorders.