Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study.

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women's experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women's needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Chronic Headache: a Review of Interventional Treatment Strategies in Headache Management.

PURPOSE OF THE REVIEW: To provide an overview of current interventional pain management techniques for primary headaches with a focus on peripheral nerve stimulation and nerve blocks. RECENT FINDINGS: Despite a plethora of treatment modalities, some forms of headaches remain intractable to conservative therapies. Interventional pain modalities have found a niche in treating headaches. Individuals resistant to common regimens, intolerant to pharmaceutical agents, or those with co-morbid factors that cause interactions with their therapies are some instances where interventions could be considered in the therapeutic algorithm. In this review, we will discuss these techniques including peripheral nerve stimulation, third occipital nerve block (TON), lesser occipital nerve block (LON), greater occipital nerve block (GON), sphenopalatine block (SPG), radiofrequency ablation (RFA), and cervical epidural steroid injections (CESI). Physicians have used several interventional techniques to treat primary headaches. While many can be treated pharmacologically, those who continue to suffer from refractory or severe headaches may see tremendous benefit from a range of more invasive treatments which focus on directly inhibiting the painful nerves. While there is a plethora of evidence suggesting these methods are effective and possibly durable interventions, there is still a need for large, prospective, randomized trials to clearly demonstrate their efficacy.

How to Prevent Depression? Current Directions and Future Challenges in Children with Chronic Medical Conditions.

With its high rates of chronicity and concomitant economic costs to society, depression ranges among the most prevalent mental disorders. Several trials have succeeded in demonstrating the beneficial effects of early depression prevention programs for otherwise healthy children and adolescents. However, comparable programs for children and adolescents with a medical condition are still scarce. This paper discusses the situation of chronically ill children and adolescents who are at risk of developing comorbid depressive symptoms using the example of three conditions frequently encountered in pediatric psychosomatic medicine: diabetes, epilepsy and inflammatory bowel disease (IBD). Each patient group is introduced with regards to specific risk factors and correlates of depression. Also, existing customized depression prevention programs and according research trials are presented. Reviewing the body of literature, it becomes apparent that risk factor research and depression prevention are still in their infancy for these three patient groups. While new risk factor models and biomarker approaches emerge as a promising rationale for depression prevention, research is called upon to include randomized control trials as well as longitudinal designs in order to achieve more optimally tailored preventive interventions for children and adolescents with chronic medical conditions.

Effects of exposure to food images on physiological reactivity and emotional responses in women with bulimia nervosa / Efecto de la exposición a imágenes de comida sobre la reactividad psicofisiológica y las reacciones emocionales en mujeres con bulimia nerviosa

Background: The aim of this study is to compare the effectiveness of two exposure procedures on habituation of emotional responses to food stimuli: (a) exposure to external cues (food images) without eating forbidden food (CE) and (b) exposure to external cues eating forbidden food (with purge prevention). The influence of craving-trait and mood state on the habituation process is also studied. Method: Emotional modulation of the defense startle reflex was assessed in 26 women at risk of bulimia nervosa. After four exposure trials, changes in the following variables were measured: (a) food craving-state; (b) physiological measures: hearth rate (HR) and skin conductance response (SCR); (c) motivational patterns towards food (defense startle response); and (d) valence, arousal and dominance of the emotional response to food images. Results: After treatment, subjects tended to show non-significant lower SCR and heart orientation responses (vs. defense responses); defense startle response was also significantly lower. Conclusions: The exposure procedure, the induced emotional state and the number of exposure trials are analyzed (AU)

Antecedentes: en este estudio comparamos la eficacia de dos procedimientos de exposición sobre la habituación de reacciones emocionales a alimentos: a) claves externas (imágenes de comida) sin ingerir alimentos prohibidos, y b) claves externas en personas que sí los han ingerido (impidiendo que se produzca el vómito). Además consideramos la influencia de la intensidad del craving rasgo y del estado de ánimo. Evaluamos la modulación emocional del reflejo defensivo de sobresalto motor (RMS) en 26 mujeres con riesgo de padecer bulimia nerviosa. Método: tras cuatro bloques de exposición, se midieron los cambios en: a) craving estado por la comida; b) tasa cardíaca (TC) y respuesta electrodérmica de conductancia (SCR); c) patrones motivacionales ante la comida (RMS); y d) estimaciones afectivas de valencia, arousal y dominancia de las emociones producidas por las imágenes de los alimentos. Resultados: como consecuencia del tratamiento los sujetos tendían a mostrar de forma estadísticamente no significativa menores SCRs y una tendencia de cambio de patrón de respuesta de defensa cardíaca (RD) a respuesta de orientación (RO); sí se apreciaban diferencias significativas en RMS. Conclusiones: se comenta el papel desempeñado por el tipo de exposición utilizado, los estados emocionales inducidos y el número de ensayos de exposición (AU)