Long-term effects of neonatal pain and sucrose treatment.

Purpose: In neonatal intensive care units, applying sucrose solution for analgesia is now a routine treatment for mild procedural pain. Studies of animal and human infants provide clear evidence of benefits in the short term, but few studies have investigated the long term benefits. Thus, we determined whether sucrose could ameliorate painful stimulation during infancy in Sprague-Dawley rats and also explored the long-term effects of repeated sucrose administration during infancy. Female and male rats were included to investigate sex-related differences. Methods: Rat pups were stimulated either with painful or tactile stimuli for the first 14 days of their lives. Pups were pretreated either with sucrose or not treated before stimulation. Behavioral tests were conducted during adolescence and adulthood. Hotplate, rotarod, open field, elevated plus maze, and radial arm water maze tests were employed to assess the behavioral consequences of early life manipulations and treatments. Results: Painful stimulation during infancy increased the sensitivity to pain later in life, and sucrose did not remedy this effect. Motility, coordination, anxiety, and cognition tests in adulthood obtained mixed results. Pain during infancy appeared to increase anxiety during adulthood. Learning and memory in adulthood were affected by pain during infancy, and sucrose had a negative effect even in the absence of pain. No sex-related differences were observed in any of the behavioral tests by employing this model of neonatal pain. Conclusion: Painful stimulation during infancy resulted in deficiencies in some behavioral tests later in life. Sucrose pretreatment did not mitigate these shortcomings and it actually resulted in negative outcomes.

Cardiovascular Disease Risk Factors Awareness among Women with a History of Preeclampsia in Jordan.

Introduction: Preeclampsia is a pregnancy-specific hypertensive disease that affects 3-5% of pregnant women all over the world and 1.3% of pregnancies among Jordanian women. Objectives: This study aims to assess the cardiovascular disease risk factors awareness among women with a recent history of preeclampsia in Jordan and assess the role of healthcare providers in providing counseling about cardiovascular disease risk factors. Methods: A descriptive cross-sectional design was used to recruit 180 women with a recent history of preeclampsia during the last 12 months. Data were obtained from patients' medical records and the Attitude and Beliefs about Cardiovascular Disease Risk Questionnaires. Results: The results revealed that 43.9% of women with a recent history of preeclampsia have hypertension, 6.7% have diabetes mellitus, 16.1% have dyslipidemia, 28.9% have a family history of cardiovascular disease, 66.1% are overweight or obese, and 7.2% are smokers. The mean total score of knowledge subscale was 5.5 (SD = 1.21) out of 8. Only 20% of the participants had good cardiovascular disease knowledge. The mean total score of risk perception was 15.47 (SD = 7.8). The mean score of perceived benefits and intention to change behaviors was 2.30 (SD = 0.62). The mean score of healthy eating intentions was 2.54 (SD = 0.81). Income, having diabetes mellitus, and receiving counseling about preeclampsia as cardiovascular disease risk factor were associated with some dimensions of cardiovascular disease risk factors awareness. Conclusion: The prevalence of cardiovascular disease risk factors was relatively high among the study participants. The majority of participants had inadequate cardiovascular disease knowledge. In addition, the role of healthcare providers in providing counseling about cardiovascular disease and related risk factors, including PE was limited. Providing more counseling related to cardiovascular disease by nurses and doctors is essential to enhance women's cardiovascular disease knowledge and intention to change lifestyle.

Effects of an educational program on self-efficacy towards type 1 diabetes mellitus disease among parents and adolescents in Jordan.

BACKGROUND: Type 1 diabetes mellitus is one of the most common childhood chronic diseases worldwide. In Jordan, the prevalence of type 1 diabetes mellitus is increasing rapidly over the last few years. Type 1 diabetes mellitus is a challenging disease since appropriate management of parents' and adolescents' diabetes requires knowledge, skills, and behavioral changes. OBJECTIVES: To assess the effectiveness of a diabetes education program on self-efficacy towards type 1 diabetes mellitus among parents of young children and adolescents. METHODS: A one-group pre-test-post-test study design was used. Participants registered in a diabetes education program and completed both pre-and post-test. RESULTS: A total of 44 participants; 29 parents and 15 adolescents completed pre- and post-education tests. There was a statistically significant difference in the average mean score from the pre-test (M = 3.51, SD = 0.615) to the post-test [M = 4.22, SD = 0.484, t (43) =6.704, p < 0.000] for the self-efficacy scale, and overall self-efficacy scores were significantly improved after undertaking the education program. CONCLUSION: Based on the findings, it is suggested that providing an evidence-based type 1 diabetes mellitus education program could significantly positively affect the self-efficacy of adolescents and parents of young children with type 1 diabetes mellitus. RECOMMENDATION: Staff nurses should be competent enough to provide basic diabetic health education to the adolescents, parents, and caregivers of children with type 1 diabetes mellitus.

Home-Based Exercise to Improve Motor Functions, Cognitive Functions, and Quality of Life in People with Huntington's Disease: A Systematic Review and Meta-Analysis.

Exercise in different settings has become a fundamental part of Huntington's disease (HD) management. The aim of this systematic review and meta-analysis was to investigate the effectiveness of home-based exercises (HBE) in HD. Randomized controlled trials (RCTs) investigating the effect of HBE on motor, cognitive, or health-related quality of life (QoL) outcomes in HD were included. Standardized mean difference (SMD), the 95% confidence interval, and p-values were calculated by comparing the outcomes change between HBE and control groups. Seven RCTs met the inclusion criteria. The included RCTs prescribed different types of HBEs, i.e., aerobic strengthening, walking, balance, and fine motor exercises. The HBE protocol length was between 6 and 36 weeks. The meta-analyses showed a significant effect of HBE intervention on motor function measure by Unified Huntington Disease Rating and overall QoL measure by Short Form-36 post-treatment respectively, [SMD = 0.481, p = 0.048], [SMD = 0.378, p = 0.003]. The pooled analysis did not detect significant changes in cognition, gait characteristics, or functional balance scales. The current study shows the positive effect of HBE in HD, especially on motor function and QoL. No significant adverse events were reported. The current results support the clinical effect of HBE intervention on motor function and QoL in HD patients. However, these results should be taken with caution due to the limited available evidence. Well-designed clinical studies that consider the disease severity and stages are required in the future.

The Difficulties in Emotional Regulation among a Cohort of Females with Lipedema.

BACKGROUND: Lipedema is a chronic and progressive adipose tissue disorder that causes significant morbidity and negatively influences mental health and quality of life, and increases the risk of depression, anxiety, and eating disorders. One construct of relevance to better understanding psychological disorders is emotion regulation (ER). Therefore, the aim of this study is to investigate the difficulties in ER among lipedema patients compared to healthy people without lipedema. METHODS: This cross-sectional study assessed differences in ER and anxiety between two groups: 26 female patients with lipedema and 26 sex- and age-matched healthy controls. The Difficulties in Emotion Regulation Scale (DERS) assessed emotional regulation across six dimensions: Impulse control, goal-directed behavior, awareness, clarity, non-acceptance, and strategies. Anxiety was assessed by the Hamilton Anxiety Scale (HAM-A). ANOVA assessed differences in measures between lipedema and healthy control groups. RESULTS: Lipedema patients presented with significantly more difficulties in ER and a higher level of anxiety than those without lipedema. Specifically, the lipedema group showed higher and significant differences in total DERS and anxiety scores and all DERS subscales scores compared to those without lipedema. CONCLUSIONS: Lipedema patients showed significant difficulties with ER, and were associated with anxiety symptoms, indicating that ER difficulties may play a role in developing emotional disorders, such as anxiety, for patients with lipedema. The health care provider should pay more attention to ER difficulties and psychological status among lipedema patients.

Effectiveness of non-pharmacological rehabilitation interventions in pain management in patients with multiple sclerosis: Systematic review and meta-analysis.

BACKGROUND: Multiple sclerosis (MS) is a progressive inflammatory and autoimmune neurological disease caused by inflammation and demyelination of the central nervous system. Pain is a typical symptom of central nervous system demyelination, affecting 63% of adults with MS. Recently, the role of non-pharmacological pain management in patients is growing because the non-pharmacological interventions are considered safe, affordable, easy, and accessible. However, to date, no systematic reviews or meta-analyses have comprehensively examined the therapeutic effects of the variety of non-pharmacological therapeutic interventions in the management of pain in patients with MS. OBJECTIVE: The study aimed to conduct a systematic review with meta-analysis to assess the effectiveness of the non-pharmacological rehabilitation interventions in pain management in patients with MS. METHODS: A comprehensive search using PubMed, Cochrane, and Science Direct databases was performed and included all randomized controlled trials, randomized cross-over trials, and quasi-experimental trials assessing the effect of non-pharmacological interventions for managing pain in patients with MS. This study was conducted according to PRISMA guidelines of a systematic review and pair-wise meta-analysis. Meta-analyses were performed by calculating the standardized mean difference at a 95% confidence interval using Review Manager software. RESULTS: Twenty-nine papers were included in the systematic review, and only 22 of them were included in the meta-analysis. The pooled analysis showed a significant effect of neuromodulation and transcranial direct current stimulation on pain intensity reduction in patients with MS (SMD -0.51, 95% CI -0.51 to -0.09, P = 0.02), (SMD -0.67, 95% CI -1.18 to -0.16 P = 0.01), respectively. The analysis showed significant improvement in pain intensity in patient with MS after mind-body therapies (SMD -0.45, 95% CI -0.82 to -0.7, P = 0.02), mindfulness (SMD -0.55, 95% CI -0.96 to -0.14, P = 0.009), hypnosis (SMD -0.88, 95% CI -1.30 to -0.46, P = 0.0001), trigger point therapies (SMD -0.83, 95% CI -1.65 to -0.01, P = 0.05) and cognitive behavioral therapy (SMD -0.64, 95% CI -1.18 to -0.11, P = 0.02). However, there is no significant effect of relaxation therapy on pain reduction in patients with MS (SMD -0.82, 95% CI -1.94 to 0.31, P = 0.15). CONCLUSIONS: The results indicated that the majority of the non-pharmacological rehabilitation interventions showed potential therapeutic effects in reducing pain intensity in patients with MS.

Therapeutics effects of inhaled magnesium sulfate combined with adrenergic beta-2 agonist on children with acute asthma: Systematic review and meta-analysis.

AIM: To review the evidence on the effectiveness of inhaled magnesium sulfate (MgSO4) combined with beta-2 (B2) agonist as compared to inhaled B2 agonist alone in treating pediatric patients with moderate to severe asthma attacks METHODS: The search was conducted on five electronic databases namely the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, PubMed, Science Direct, and Google Scholar. RESULTS: Eight trials were included in the review. All studies involved a total of 1585 children aged 2-17 years with moderate to severe asthma attacks. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Three studies that assessed the effect of inhaled MgSO4 as adjunctive therapy on vital signs revealed no effect of inhaled MgSO4 on vital signs (SMD -0.11, 95% CI 0.27-0.04, p = 0.16, I2 = 68%). Two studies that assessed the effect of inhaled MgSO4 as adjunctive therapy on asthma severity score (ASS) revealed no effect of inhaled MgSO4 on ASS (SMD 0.22, 95% CI 0.01-0.44, Z = 2.01, p = 0.04, I2 = 88%). Two studies that assessed the effect of inhaled MgSO4 as adjunctive therapy on peak expiratory flow rate (PEFR) revealed a large effect of B2 agonist alone on PEFR (SMD 2.02, 95% CI 0.83-3.2, p < 0.001, I2 = 98%). CONCLUSION: This review does not support the use of inhaled MgSO4 as adjunctive therapy to B2 agonist for asthmatic children.

Identification of Adolescents with Adiposities and Elevated Blood Pressure and Implementation of Preventive Measures Warrants the Use of Multiple Clinical Assessment Tools.

The burden of abdominal adiposity has increased globally, which is recognized as a key condition for the development of obesity-related disorders among youth, including type 2 diabetes, cardiovascular disease, and hypertension. High blood pressure (BP) and cardiovascular diseases increase the rates of premature mortality and morbidity substantially. Aims: to investigate the relation between abdominal adiposity and elevated BP among adolescent males in Jordan. Methods: Nationally representative sample of male adolescents was selected using multi-cluster sampling technique. Study sample included 1035 adolescent males aged 12 to 17 years. Multiple indicators were used to assess adiposity including waist circumference (WC) and total body fat (TF), truncal fat (TrF), and visceral fat (VF). Systolic blood pressure was measured to assess hypertension. Results: After adjusting for age, smoking status, and physical activity, the odds of having stage two hypertension increased 6, 7, and 8 times for adolescents who were on 90th percentile or above for Trf, VF, and WC, respectively. Conclusion: Elevated BP was significantly associated with total and abdominal adiposity among adolescent males in Jordan. Use of multiple clinical assessment tools is essential to assess abdominal obesity among adolescents.

Cognitive functioning in Deaf children using Cochlear implants.

BACKGROUND: Cognitive abilities like language, memory, reasoning, visualization, and perceptual functioning shape human action and are considered critical to the successful interaction with the environment. Alternatively, hearing loss can disrupt a child's ability to communicate, and negatively impact cognitive development. Cochlear implants (CI) restore auditory input thereby supporting communication and may enhance cognitive performance. This study compares general cognitive development after cochlear implantation (2017-2019) in two groups of Jordanian children implanted earlier (age:4-6 years, N = 22) and later (7-9 years, N = 16) to the development of randomly selected normal hearing peers (N = 48). DESIGN: Visualization, reasoning, memory, and attention were assessed using the Leiter-R scale at baseline (before implantation), 8 months and 16 months post implantation for children with hearing loss. Same times of testing (baseline, 8 months and 16 months) were used for normal hearing peers. RESULTS: Over the 16-month period, the cognitive improvement of 4-6-year-old deaf children was greater than that of their normal hearing peers on the scales of visualization (5.62 vs. 4.40), reasoning (2.53 vs. 2.38) and memory (17.19 vs. 11.67). while the improvement of 7-9-year-old was less major than that of their normal hearing peers on all scales. CONCLUSIONS: These results suggest that CI not only enhances communication skills but may improve cognitive functioning in deaf children. However, the extent of this improvement was dependent on age at intervention; current results demonstrated that the children received CI at young ages had better cognitive improvements.

Oral Sucrose for Neonatal Pain: Perception of Jordanian Nurses.

BACKGROUND: Neonatal pain management using sucrose has been an established practice in Western countries. However, in the developing world, the practice is still not widely accepted. Neonatal nurses' perceptions about the neonatal pain experience and efficacy of oral sucrose may influence that decision. PURPOSE: To investigate Jordanian neonatal nurses' perceptions about the use of oral sucrose for neonatal pain. DESIGN AND SAMPLE: A cross-sectional descriptive design was used to collect data from 191 neonatal nurses working in 3 different hospital settings in northern and middle central Jordan. MAIN OUTCOME VARIABLES: Knowledge and perception of Jordanian nurses about neonatal pain and oral sucrose and their relationship to demographic variables. RESULTS: More than half of nurses had knowledge deficit about pain management. Fifty-five percent of the nurses had a positive perception toward pain assessment tools, and the majority indicated positive opinion toward oral sucrose usage. Demographic factors can impact their perceptions.

Knowledge and attitudes regarding Covid-19 among syrian refugee women in Jordan.

OBJECTIVES: To explore knowledge and attitude about Covid-19, among Syrian refugee mothers in the Governorate of Irbid, where the first outbreak of Covid-19 in Jordan took place. METHODS: This is a cross-section study among Syrian refugee mothers, who were pregnant or having had children. Data was collected through an online questionnaire. The survey link was distributed in April 2020, through the social network's messaging services Facebook and WhatsApp. Contact information was obtained from local community centres and non-governmental organisations in the town of Irbid, the north of Jordan. RESULTS: In total, 389 Syrian refugee mothers participated in the study. It showed that 66% of mother's access information regarding Covid-19. The main sources of information were Facebook 87%, WhatsApp 69%, television 53%, while 21% indicated that they access professional databases or government websites. In general, Syrian refugee mothers were knowledgeable about Covid-19 transmission and prevention. However, they lacked adequate knowledge about transmission of Covid-19 between the mother and the child, and smoking risks associated with Covid-19. CONCLUSIONS: There are gaps in the knowledge and attitude of Syrian refugee mothers in the Governorate of Irbid in relation to the Covid-19 pandemic. There is a need for further health education measures.

Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults: A Randomized Controlled Trial.

BACKGROUND: Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses. METHODS: A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students' responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393). RESULTS: Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group. CONCLUSIONS: CBT is an effective evidence-based psychological intervention for relieving nurses' ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses' accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended.

Caregivers Help-Seeking Behaviors for Postdischarged Neonates from Neonatal Intensive Care Units: A Jordanian Study.

PURPOSE: This study will explore and describe help-seeking behaviors and decision-making processes of Arab Muslim caregivers in Jordan when seeking help for their sick neonates after discharge from Neonatal Intensive Care Units (NICU). This study which will contribute to the global discussion on the reasons/conditions contributing to neonatal mortality. DESIGN AND METHODS: A descriptive cross-sectional survey was used. Two research assistants interviewed 275 identified neonate caregivers by telephone from May 1 to August 30, 2019. Data were analyzed using SPSS version 25. RESULTS: Caregivers who had a neonate who had been discharged from a NICU were surveyed about the types of condition for which they would seek medical help. The vast majority (98.2%) stated that they would seek help if their child was unconscious and 95.3% reported that they would do so if their child experienced a convulsion. Fewer caregivers (43.3%) stated that abdominal distension (43.3%) would cause them to seek help immediately. CONCLUSION: Recognition of danger signs during the neonatal period was considered poor among neonate caregivers. Using self-management treatments and home remedies delayed appropriate medical treatment for neonate illnesses. Lack of money was identified as the most common reason for delaying going to or not using health facilities. This study highlights the need to create a specialized program to focus on interventions that could reduce neonatal deaths and improve families' help-seeking behaviors in Jordan. IMPLICATIONS FOR PRACTICE: Nurses are required to be well-trained to support caregivers to prioritize neonatal issues (pre and post discharge) that require quick action (minutes versus hours) and which most commonly lead to mortality. Nurses are required to provide appropriate education for caregivers pre-discharge and such teachings could be reinforced during home visits.

Low birth weight in Jordan: a hospital-based study.

Background: Low birth weight (LBW) is one of the leading causes of neonatal and infant morbidity and mortality.Objective: To determine the prevalence and possible risk factors associated with LBW in four regional hospitals in Jordan.Methods: This retrospective study analyzed the medical records of all singleton live births for the period 2011-2015.Results: A total of 22,789 singleton live births were included for this study. Of these, 4133 (18%) had a LBW. Rates of LBW increased over the 5 years study period. Factors associated with LBW were preterm birth, pregnancy complications or comorbidities, older maternal age (≥35 years), first-born infants, and having a female baby.Conclusion: Midwives' assessment and health education messages to mothers included awareness of risk factors associated with LBW of neonates in Jordan. Effective public health interventions need to highlight the importance of a healthy diet and valuing female off-spring.

Efficacy of Sucrose in Reducing Pain during Immunization among 10- to 18-Month-Old Infants and Young Children: A Randomized Controlled Trial.

PURPOSE: Sucrose is recommended to reduce pain associated with vaccination in neonates. However, research results concerning its effectiveness in infants and young children are inconclusive. This study aims to determine the efficacy of sucrose administration in reducing pain during immunization in 10- to 18-month-old infants and young children as assessed by behavioral pain parameters, crying time, and saliva substance (P) concentration. DESIGN AND METHODS: This was a double-blind, randomized controlled trial and included healthy infants and young children undergoing their 10- to 18-month immunization. Behavioral pain outcome was measured during, and shortly after the last injection. The infant's pain was also measured by a salivary test using substance (P), and videotaping of crying time. RESULTS: The study results indicate that, compared with a placebo group, the sucrose group had significantly less pain post-immunization (F (1,129) = 1.72, p = 0.001). Moreover, substance (P) was lower in the intervention group post-immunization, and it could be considered a good predictor of pain reduction associated with immunization. CONCLUSIONS: Sucrose administration during immunization injection helps in reducing pain, which is one of the most critical factors affecting compliance with the immunization schedule. Substance (P) measurement can be used as a predictor of immunization pain level in 10- to 18-month-old infants and young children. PRACTICE IMPLICATIONS: Sucrose is an effective method to reduce needle pain during immunization; therefore, healthcare providers should administer sucrose as a pain relief intervention in the immunization clinical setting.

Effect of Depth of Total Intravenous General Anesthesia on Intraoperative Electrically Evoked Compound Action Potentials in Cochlear Implantation Surgery.

PURPOSE: This study aims to compare the effect of the depth of total intravenous anesthesia (TIVA) on intraoperative electrically evoked compound action potential (e-ECAP) thresholds in cochlear implant operations. METHODS: Prospectively, a total of 39 patients aged between 1 and 48 years who were scheduled to undergo cochlear implantation surgeries were enrolled in this study. Every patient received both light and deep TIVA during the cochlear implant surgery. The e-ECAP thresholds were obtained during the light and deep TIVA. RESULTS: After comparing the e-ECAP means for each electrode (lead) between the light and deep anesthesia, no significant differences were detected between the light and deep anesthesia. CONCLUSION: The depth of TIVA may have no significant influence on the e-ECAP thresholds as there was no statistical difference between the light and deep anesthesia.

Number and Frequency of Routinely Applied Painful Procedures in University Neonatal Intensive Care Unit.

Neonates at the neonatal intensive care unit (NICU) are at high risk for procedural pain exposure. This study describes the type and frequency of procedures in neonates admitted to University Intensive Care Unit. This was a prospective cohort study of 150 neonates admitted to the NICU during the first 7 days of life at a governmental hospital. The type and frequency of procedures were evaluated using a tool which included the type and number of procedures performed per shift. A total of 14,008 painful procedures were performed on neonates with an average of 97.11 painful procedures per baby and 13.9/day for each baby. Adhesive removal (21.3%) was the most frequently performed procedure. The number of painful procedures was inversely correlated with gestation age ( p < .001) and birth weight ( p < .001). The number of painful procedures performed on neonates is high, particularly for neonates with small gestational age and low birth weight babies.

Factors Associated With Infant Pain Severity Undergoing Immunization Injections.

PURPOSE: Factors influencing infants' behavioral and vocal (cry) response to painful stimuli are explored to improve pain management plans for infants undergoing immunizations. DESIGN AND METHODS: An observational study design was used. Pain responses of 60 to 75 days-old infants (44% male vs 56% female) undergoing two-month immunization injections were videotaped and coded using the Modified Behavioral Pain Scale (MBPS), and duration of total crying time during injection was recorded. The influences of five factors (gender, caregiver attendance, previous experience of nociception (circumcision), mode of delivery), and weight (birth and current) were examined at baseline, during and post-immunization. RESULTS: Higher birth weight was the most significant factor that reduced pain responses during (p = 0.001) and post-immunization (p = 0.03). A higher birth weight reduced full lung crying (p = 0.04), which reflects crying during injection as compared to total crying time. Vaginal delivery had a significant effect on behavioral pain responses of infants only post-immunization (p = 0.006). Parent's presence in the immunization room significantly reduced total crying time (p = 0.03). Uncircumcised male infants had a significant reduction in behavioral pain responses during immunization (p = 0.01) compared to circumcised infants. CONCLUSIONS: The literature well supports the acknowledgement of early pain experience and its psychological consequences. Knowing and controlling for each of mentioned factors early in life during every painful procedure could improve coping mechanisms of infants for any painful procedures later in life. PRACTICE IMPLICATIONS: Control of certain factors during early life experiences can modify pain of immunization.

Persistent Hiccups After Cervical Epidural Steroid Injection.

BACKGROUND Hiccup is a rare complication after a cervical epidural steroid injection used in the treatment of chronic pain. A few studies have reported on the physiological and pharmacological aspects of hiccups after epidural steroid injection and there have been some case reports published. Our presented case report provides insight into the side effect of hiccups that can occur in association with cervical epidural analgesia, and will help inform anesthesiologist about this unpleasant complication. CASE REPORT We present a rare case of persistent hiccups after a cervical epidural steroid injection in a 60-year-old male patient with chronic pain due to disc protrusion in C3-C7. CONCLUSIONS Persistent hiccups after epidural injection is a serious complication. As the exact mechanism of hiccups is not yet known, regardless the level of epidural or the mixture of drugs used, and the incident of hiccups after epidural injection is not well-reported, we think that the etiology and the incident rate must be further evaluated.

Infant Resuscitation Practices of Midwives in a Developing Country.

BACKGROUND: Effective basic newborn resuscitation is an important strategy to reduce the incidence of birth asphyxia and associated newborn outcomes. Outcomes for newborns can be markedly improved if health providers have appropriate newborn resuscitation skills. PURPOSE: To evaluate the skills of midwives in newborn resuscitation in delivery rooms in Jordan. METHODS: Data were collected from observation of 118 midwives from National Health Service hospitals in the north of Jordan who performed basic newborn resuscitation for full-term neonates. A structured checklist of 14 items of basic skills of resuscitation was used. Descriptive statistics were used to analyze the data. RESULTS: The results highlighted the lack of appropriate performance of the 8 necessary skills at birth by midwives. About 17.8% of midwives had performed the core competencies at birth (ie, assessing breathing pattern/crying, cleaning airways) appropriately and met the standard sequence. Less than half of midwives assessed skin color (40.7%) and breathing pattern or crying (41.5%) appropriately with or without minor deviations from standard sequences. Of the 6 skills that had to be performed by midwives at 30 seconds up to 5 minutes after birth, 4 skills were not performed by about one-quarter of midwives. IMPLICATIONS FOR PRACTICE AND RESEARCH: The midwives' practices at the 2 hospitals of this study were not supported by best practice international guidelines. The study showed that a high proportion of midwives had imperfect basic newborn resuscitation skills despite a mean experience of 8 years. This highlights the critical need for continuing medical education in the area of basic newborn resuscitation. The results highlight the need for formal assessment of midwives' competence in basic newborn resuscitation. National evidence-based policies and quality assurance are needed to reflect contemporary practice.