Denise Tiran

Bio: Denise Tiran is an academic researcher from University of Greenwich. The author has contributed to research in topics: Pregnancy & MEDLINE. The author has an hindex of 15, co-authored 46 publications receiving 716 citations.

The use of fenugreek for breast feeding women

Abstract: Fenugreek is widely used as a culinary spice and is frequently used in Indian Ayurvedic and in Traditional Chinese Medicine, particularly as a galactogogue to encourage lactation. Little research appears to have been undertaken on the effectiveness of this spice and the majority of evidence for side-effects has arisen from case reports of complications. Skin test patching appears to suggest a significant proportion of patients susceptible to fenugreek allergy. For example, allergic reaction to inhalation of fenugreek seed powder has resulted in wheezing, rhinitis and fainting, while dermal application of fenugreek paste for dandruff of the scalp in an asthmatic woman caused facial oedema, numbness of the head and wheezing. Mild gastrointestinal symptoms have also been reported. This may be due to allergenic chemicals occurring naturally within the plant, or to the presence of substances such as nitrates from the soil in which the plant is grown, as has occurred in certain areas of Jordan. Research on the use of fenugreek by non-insulin diabetic patients has shown a small reduction in fasting and post-prandial blood sugar levels, but a more statistically significant decrease in total cholesterol and triglyceride levels of patients with coronary artery disease. Of more concern is the potential for fenugreek to interact with prescribed pharmacological medications, notably warfarin. It is also possible that fenugreek may potentiate antihypertensive and antidiabetic medication and increase the risk of bleeding in women requiring non-steroidal antiinfammatories, especially aspirin. With reference to women who are breast feeding, the following recommendations can be extrapolated from these findings:

The use of herbs by pregnant and childbearing women: a risk-benefit assessment

Abstract: This paper reviews some of the evidence in relation to herbal remedies, and considers both their efficacy and safety for pregnant and childbearing women. It concludes with some suggested guidelines for midwifery and obstetric practice.

The physiological basis of reflexology and its use as a potential diagnostic tool.

Abstract: Ill-health changes the anatomy and physiology of affected organs, some of which can be observed visually, elicited through physical examination or confirmed through biomedical analysis. Understanding how anatomical changes contribute to physiological signs and symptoms will help practitioners identify the pathology, appreciate its origin and development and justify prescribed interventions in a way which can be upheld by critical external scrutiny. Reflexology contributes to an holistic approach to care and has recently improved its credibility as a discipline which supports orthodox care. Several research publications have identified possible theories and principles for the mechanism of action of reflexology, but more research to explain its contribution in identifying ill-health and diseases, as well as appropriate treatment modalities, is needed. This paper explores the physiological basis of reflexology, some of the theories for the mechanism of action and its potential as a diagnostic tool.

Complementary therapies to reduce physiological stress in pregnancy.

Abstract: Pregnancy is a period of enormous physio-pathological and psychosocial adaptation in a woman's life. Although it is usually a time of joy and anticipation, many women experience some degree of anxiety, concern and fear regarding their own health and that of their babies, as well as the approaching labour. Worry about social, financial, occupational and relationship issues can often add to their stress levels which increases the possibility of pregnancy complications. However while mild to moderate stress facilitates successful adjustment to these demands, a significant increase in the levels of stress hormones may compromise the health of both mother and fetus. Complementary therapies are increasingly popular with expectant mothers and are gradually being integrated into conventional maternity care, primarily by midwives. However, there is debate about whether these therapies simply provide a form of relaxation for pregnant women with psychological stress or whether they could-or should-be used more constructively to deal with physio-pathological stress. This paper considers the physiological effects of certain complementary therapies in reducing the impact of stress in pregnancy.

Ginger to reduce nausea and vomiting during pregnancy: evidence of effectiveness is not the same as proof of safety.

Abstract: Ginger is a common traditional remedy taken by numerous women experiencing nausea and vomiting in pregnancy (NVP). There is considerable evidence to support its effectiveness as an anti-emetic, but also increasing concern over its safety. Ginger is a powerful herbal medicine which acts pharmacologically and thus has specific indications, contraindications, precautions and side-effects, the most notable of which is an anticoagulant action. Midwives and other professionals advising women in early pregnancy about strategies for coping with NVP should be aware of the risks and benefits of ginger in order to provide comprehensive and safe information to expectant mothers. This paper reviews some of the contemporary research evidence which demonstrates that ginger is not a universally appropriate or safe choice for women with NVP and offers a checklist for professionals advising expectant mothers.

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Abstract: Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants. Information to inform physicians about the extent of excretion for a particular drug into human milk is needed but may not be available. Previous statements on this topic from the American Academy of Pediatrics provided physicians with data concerning the known excretion of specific medications into breast milk. More current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed (http://toxnet.nlm.nih.gov). Therefore, with the exception of radioactive compounds requiring temporary cessation of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication. This report discusses several topics of interest surrounding lactation, such as the use of psychotropic therapies, drugs to treat substance abuse, narcotics, galactagogues, and herbal products, as well as immunization of breastfeeding women. A discussion regarding the global implications of maternal medications and lactation in the developing world is beyond the scope of this report. The World Health Organization offers several programs and resources that address the importance of breastfeeding (see http://www.who.int/topics/breastfeeding/en/).

Molecular, Clinical and Environmental Toxicology

Abstract: Molecular, clinical, and environmental toxicolog , Molecular, clinical, and environmental toxicolog , کتابخانه دیجیتال جندی شاپور اهواز

Interventions for nausea and vomiting in early pregnancy.

Abstract: Background Nausea, retching and vomiting are very commonly experienced by women in early pregnancy. There are considerable physical, social and psychological effects on women who experience these symptoms. This is an update of a review of interventions for nausea and vomiting in early pregnancy last published in 2014. Objectives To assess the effectiveness and safety of all interventions for nausea, vomiting and retching in early pregnancy, up to 20 weeks’ gestation. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register, the Cochrane Complementary Medicine Field's Trials Register (19 January 2015) and reference lists of retrieved studies. Selection criteria All randomised controlled trials of any intervention for nausea, vomiting and retching in early pregnancy. We excluded trials of interventions for hyperemesis gravidarum, which are covered by another Cochrane review. We also excluded quasi-randomised trials and trials using a cross-over design. Data collection and analysis Four review authors, in pairs, reviewed the eligibility of trials and independently evaluated the risk of bias and extracted the data for included trials. Main results Forty-one trials involving 5449 women, met the inclusion criteria. These trials covered many interventions, including acupressure, acustimulation, acupuncture, ginger, chamomile, lemon oil, mint oil, vitamin B6 and several antiemetic drugs. There were no included studies of dietary and other lifestyle interventions. Evidence regarding the effectiveness of P6 acupressure, auricular (ear) acupressure and acustimulation of the P6 point was limited. Acupuncture (P6 or traditional) showed no significant benefit to women in pregnancy. The use of ginger products may be helpful to women, but the evidence of effectiveness was limited and not consistent, though three recent studies support ginger over placebo. There was only limited evidence from trials to support the use of pharmacological agents including vitamin B6, Doxylamine-pyridoxoine and other anti-emetic drugs to relieve mild or moderate nausea and vomiting. There was little information on maternal and fetal adverse outcomes and on psychological, social or economic outcomes. We were unable to pool findings from studies for most outcomes due to heterogeneity in study participants, interventions, comparison groups, and outcomes measured or reported. The methodological quality of the included studies was mixed. Risk of bias was low related to performance bias, detection bias and attrition bias for most studies. Selection bias risk was unclear for many studies and almost half of the studies did not fully or clearly report all pre-specified outcomes. Authors' conclusions Given the high prevalence of nausea and vomiting in early pregnancy, women and health professionals need clear guidance about effective and safe interventions, based on systematically reviewed evidence. There is a lack of high-quality evidence to support any particular intervention. This is not the same as saying that the interventions studied are ineffective, but that there is insufficient strong evidence for any one intervention. The difficulties in interpreting and pooling the results of the studies included in this review highlight the need for specific, consistent and clearly justified outcomes and approaches to measurement in research studies.

The Interaction Between Chronic Stress and Pregnancy: Preterm Birth from A Biobehavioral Perspective

Abstract: Women's health care providers are increasingly aware that chronic stressors—such as poverty, ongoing perceived stress and anxiety, intimate partner violence, and experiences of racism—are associated with an increased incidence of preterm birth in the United States. It is important to increase our understanding of the explanatory pathways involved in these associations. This article discusses the concepts of stress, chronic stress response, allostatic load, the physiology of labor initiation, and the pathophysiologic interactions that may contribute to the occurrence of chronic stress-related preterm birth. Implications for future research and interventions are explored.

Understanding phenomenology: the lived experience

Abstract: This article details the use of Phenomenology as a research method which is to fully describe a person's lived experience of an event or experience. It stresses that only those that have experienced phenomena can communicate them to the outside world. It therefore provides an understanding of an experience from those who have lived it. The two schools of phenomenology which are described are utilized in both midwifery and nursing research. These are Husserlian and Heideggerian (Hermeneutics) phenomenology. The main focus in this article, however, is on the Husserlian approach, its background, data collection, data analysis methods and its application to midwifery research.