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.

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.

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.

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.

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.

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.

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.

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.

Postpartum evaluation of vitamin D among a sample of Jordanian women.

The aims of this study were to explore the vitamin D status among a sample of Jordanian postpartum women and identify factors associated with vitamin D deficiency. A total of 171 postpartum women agreed to participate. Participants completed a questionnaire on factors related to vitamin D deficiency and provided a blood sample to assess their plasma vitamin D (25(OH)D) levels using DIA source Immuno-Assays S.A. ANALYSIS: The majority of women (76%, n = 130) had vitamin D deficiency and 24% (n = 41) of participants had vitamin D insufficiency. Factors associated with vitamin D deficiency were younger age (< 30 years), low education level, unemployment, multiparity, lactation, dress style, limited sunlight exposure, high BMI, dark skin colour and lack of multivitamin use. Vitamin D supplementation must be considered during pregnancy and lactation to prevent hypovitaminosis in both mother and baby.

Sudden unexpected infant death in Jordan and the home environment.

BACKGROUND: The aim of this study was to evaluate maternal common practice for infant sleep care and the home environment, in order to explore the major risk factors associated with sudden unexpected infant death in Jordan. METHODS: Data were collected via semi-structured questionnaire interview to investigate the sociodemographic features, infant sleep practices and home environments. The sample included 604 mothers with infants <1 year old. Descriptive statistics were generated. RESULTS: Sleep practices were identified as leading factors in unexpected infant death. They included infant head covering (84%), heavy bedding with multiple quilts (81%) or blankets (67%), and co-bedding (66%). Environmental risk factors included high incidence of smoking, exposure to toxic solid fuel heaters during winter and inadequate room ventilation. CONCLUSION: Factors leading to unexpected infant death were high in Jordan. Unsafe infant sleeping practices and poor environmental factors put infants at high risk of sudden death. Lack of awareness of risk factors increases the risk.

Prevalence of Hypovitaminosis D Among Jordanian Healthy Infants: A Descriptive Cross Sectional Study.

UNLABELLED: To determine vitamin D deficiency and associated risk factors of hypovitaminosis D among Jordanian healthy infants. DESIGN AND METHODS: A total of 171 infants receiving a routine health check at a Maternal and Child Health Care Center were recruited. Plasma vitamin D 25-OHD level was assessed using a standard analysis of a blood sample. Other data collected included age, gender, birth order, season of birth, and mode of feeding. RESULTS: Prevalence of vitamin D deficiency (≤15 ng/mL) was 77% (132 out of 171 infants). Infants at risk of vitamin D deficiency were those between 1 to 6 months of age, male, third born or later, born in winter, and exclusively breastfed. The multivariate model showed birth order to be the largest contributor of vitamin D deficiency (R(2)=0.196), followed by breastfed infants (R(2)=0.071), infants born in winter (R(2)=0.037), male gender (R(2)=0.028), and infants aged between 1 and 6 months (R(2)=0.027). CONCLUSION: Hypovitaminosis D appears to be more common among healthy infants in Jordan. Hypovitaminosis D was found to be common among third or later exclusively breastfeed male infants aged 1 to 6 months who were born during winter. PRACTICE IMPLICATION: Maternal and child health nurses have a critical role to play in educating mothers about the importance of preventing hypovitaminosis D through adequate sun exposure and ensuring adequate supplementation. A higher dose of vitamin D supplementation for high-risk infants beyond the age of 1 year from developing countries should be administered.

Diuretics for transient tachypnoea of the newborn.

BACKGROUND: Transient tachypnoea of the newborn (TTN) results from delayed clearance of lung liquid and is a common cause of admission of full-term infants to neonatal intensive care units. The condition is particularly common after elective caesarean section. Conventional treatment involves appropriate oxygen administration and continuous positive airway pressure in some cases. Most infants receive antibiotic therapy. Hastening the clearance of lung liquid may shorten the duration of the symptoms and reduce complications. OBJECTIVES: To determine whether diuretic administration reduces the duration of oxygen therapy and respiratory symptoms and shortens hospital stay in term infants presenting with transient tachypnoea of the newborn. SEARCH METHODS: An updated search was carried out in September 2015 of the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 9, 2015), MEDLINE via Ovid, EMBASE, PubMed, and CINAHL via OVID. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials that compared the effect of diuretics administration versus placebo or no treatment in infants of less than seven days of age, born at 37 or more weeks of gestation with the clinical picture of transient tachypnoea of the newborn. DATA COLLECTION AND ANALYSIS: We extracted and analysed data according to the methods outlined in the latest Cochrane Handbook for Systematic Reviews of Interventions. Two review authors assessed trial quality in each potentially eligible manuscript and two review authors extracted data. MAIN RESULTS: Our previous systematic review included two trials enrolling a total of 100 infants with transient tachypnoea of the newborn (Wiswell 1985; Karabayir 2006). The updated search revealed no new trials. Wiswell 1985 randomised 50 infants to receive either oral furosemide (2 mg/kg body weight at time of diagnosis followed by a 1 mg/kg dose 12 hours later if the tachypnoea persisted) or placebo. Karabayir 2006 randomised 50 infants to receive either intravenous furosemide (2 mg/kg body weight) or an equal volume of normal saline placebo. Neither trial reported on the need for respiratory support. Neither trial demonstrated a statistically significant impact of furosemide on transient tachypnoea of the newborn regarding duration of symptoms or length of hospitalisation. AUTHORS' CONCLUSIONS: Diuretics cannot be recommended as treatment for transient tachypnoea of the newborn and it should not be used unless additional data become available. This finding suggests that either furosemide is not effective in promoting resorption of lung fluid, or factors other than delayed resorption of this fluid contribute to the pathogenesis of transient tachypnoea of the newborn. The question remains as to whether furosemide given to the infant (or even to the mother before caesarean section) might shorten the duration of the illness. As elective caesarean section continues at a high level, these two interventions might be worthy of trials.

Prevalence and factors associated with the occurrence of preterm birth in Irbid governorate of Jordan: A retrospective study.

Prevention is important to reduce the prevalence of preterm births. Although prematurity has been well studied in developed countries, data from developing countries, such as Jordan, are still limited. This retrospective study analysed medical records to determine possible risk factors leading to preterm birth in the Irbid governorate of Jordan. All preterm births during the year 2011 were reviewed. Abstracted data included mother's age and gravidity. Newborn information included gender, birthweight and gestational age at birth. A total of 647 singleton births were included. There were more females than males (54.9% vs. 45.1%), with 75.6% being the second child or more. Half the mothers (50.2%) were 25-35 years of age. Factors associated with preterm birth were male gender (P = 0.008), maternal age > 35 years (P = 0.005) and first birth (P = 0.003). Nurses need to provide support and education to mothers with potential risk about reproductive health and family planning.

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.

Furosemide for transient tachypnoea of the newborn.

BACKGROUND: Transient tachypnoea of the newborn (TTN) results from delayed clearance of lung liquid and is a common cause of admission of full term infants to neonatal intensive care units. The condition is particularly common after elective caesarean section. Conventional treatment involves appropriate oxygen administration and continuous positive airway pressure in some cases. Most infants receive antibiotic therapy. Hastening the clearance of lung liquid may shorten the duration of the symptoms and reduce complications. OBJECTIVES: To determine whether furosemide administration reduces the duration of oxygen therapy and respiratory symptoms and shortens hospital stay in term infants with transient tachypnoea of the newborn. SEARCH METHODS: An updated search was carried out in January 2013 of the following databases: The Cochrane Library issue 1, 2013 (CENTRAL, The Cochrane Central Register of Controlled Trials), PubMed, MEDLINE via Ovid, CINAHL via OVID and EMBASE. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials that compared the effect of furosemide administration versus placebo or no treatment in infants of less than seven days of age, born at 37 or more weeks of gestation with the clinical picture of transient tachypnoea of the newborn. DATA COLLECTION AND ANALYSIS: We extracted and analysed data according to the methods outlined in the latest Cochrane Handbook for Systematic Reviews of Interventions. Two review authors assessed trial quality in each potentially eligible manuscript and two review authors extracted data. MAIN RESULTS: Our updated review includes two completed trials. Wiswell 1985 and Karabayir 2006 investigated 100 infants with transient tachypnoea of the newborn. Wiswell 1985 randomised 50 infants to receive either oral furosemide (2 mg/kg body weight at time of diagnosis followed by a 1 mg/kg dose 12 hours later if the tachypnoea persisted) or placebo. Karabayir 2006 randomised 50 infants to receive either intravenous furosemide (2 mg/kg body weight) or an equal volume of normal saline placebo. Neither trial reported on the need for respiratory support. Neither trial demonstrated a statistically significant impact of furosemide on transient tachypnoea of the newborn regarding duration of symptoms or length of hospitalisation. AUTHORS' CONCLUSIONS: Oral or intravenous furosemide cannot be recommended as treatment for transient tachypnoea of the newborn and it should not be used unless additional data become available. This finding suggests that either furosemide is not effective in promoting resorption of lung fluid, or factors other than delayed resorption of this fluid contribute to the pathogenesis of transient tachypnoea of the newborn. The question remains as to whether furosemide given to the infant (or even to the mother before caesarean section) might shorten the duration of the illness. As elective caesarean section continues at a high level, these two interventions might be worthy of trials.

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.

Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age.

BACKGROUND: Administration of oral sucrose or glucose with and without non-nutritive sucking is frequently used as a non-pharmacological intervention for needle-related procedural pain relief in infants. OBJECTIVES: To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared with no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012); MEDLINE via Ovid (1966 to 2012); CINAHL via OVID (1982 to 2012). The World Health Organization International Clinical Trials Registry Platform was also searched for any ongoing trials. Clinical trial registries, conference proceedings and references for randomised controlled trials (RCTs) were also searched. An updated search was run to capture any new publications before finalising the review in April 2012 and no new included studies were identified. Two review authors (MK & JF) independently abstracted data and assessed quality using a standard form. Authors have been contacted for missing data. SELECTION CRITERIA: Randomised-controlled trials using a sweet-tasting solution to treat pain in healthy term infants (gestational age 37 weeks and over), between one month and 12 months of age who required needle-related procedures. These procedures included but were not limited to: subcutaneous or intramuscular injections, venepuncture, and heel lance. Studies in which the painful procedure was circumcision, lumbar puncture or supra-pubic bladder aspiration were not included as they are more severe and painful than needle-related procedures. Control conditions included no treatment or placebo (water) or any other identical intervention (same appearance and consistency) without active ingredient, another sweet-tasting solution, a pharmacological pain-relieving method (e.g. paracetamol, topical anaesthetic cream), non-pharmacological pain-relieving method (e.g. distraction method, non-nutritive sucking). DATA COLLECTION AND ANALYSIS: Assessment of trial quality, data extraction and synthesis of data were performed using standard methods of the Cochrane Pain, Palliative and Supportive Care Group. We report mean differences (MD) with 95% confidence intervals (CI) using fixed-effect models as appropriate for continuous outcome measures. We planned to report risk ratio (RR) and risk difference (RD) for dichotomous outcomes. The Chi(2) test and I(2) statistic were used to assess between-study heterogeneity. MAIN RESULTS: Sixty-five (65) studies were identified for possible inclusion in this review. Fourteen published RCTs with a total of 1551 participants met the inclusion criteria. Duration of cry was significantly reduced in infants who were administered a sweet-tasting solution [MD -13.47 (95% CI -16.80 to -10.15)], P < 0.00001 compared with water. However, there was considerable heterogeneity between the studies (I(2) = 94%) that we were unable to explain. Meta-analysis was not able to be undertaken for any of the other outcome measures, except for cry duration, because of differences in study design. However, most of the individual studies that measured pain found sucrose to significantly reduce pain compared with the control group. One study compared sucrose and Lidocaine-prilocaine cream and no significant difference was found between the two treatments for the outcomes pain and cry duration. Due to the differences between the studies, we were unable to identify the optimal concentration, volume or method of administration of sweet-tasting solutions in infants aged one to 12 months. Further large RCTs are needed. AUTHORS' CONCLUSIONS: There is insufficient evidence to confidently judge the effectiveness of sweet-tasting solutions in reducing needle-related pain in infants (one month to 12 months of age). The treatments do, however, appear promising. Data from a series of individual trials are promising, as are the results from a subset meta-analysis of studies measuring duration of crying. Further well controlled RCTs are warranted in this population to determine the optimal concentration, volume, method of administration, and possible adverse effects.

The effectiveness of glucose in reducing needle-related procedural pain in infants.

This systematic review examined the effectiveness of glucose in relieving needle-associated pain in infants. Meta-analysis was not undertaken, and there was variation in dose, administration method, concentration, and outcome measurement. Glucose was more effective than placebo in relieving infant pain as measured by behavioral outcomes, but there were mixed findings for physiological outcomes. Based on these findings, 25%-50% glucose appears effective for infant pain management.

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.