Effects of maternal voice on pain and mother-Infant bonding in premature infants in Taiwan: A randomized controlled trial.

PURPOSE: This study aimed to examine the effectiveness of maternal voice in alleviating premature infants' pain during the heel sticks and facilitating mother-infant bonding during hospitalization. DESIGN AND METHODS: A randomized controlled trial with a parallel group design was conducted in which 64 premature infant-mother dyads were randomly assigned to an intervention group or a control group. Voice recordings of the mother reading a children's book were created and subsequently played for the infant during a heel stick procedure once daily for 3 consecutive days. The primary outcomes were heart rate, respiratory rate, oxygen saturation, and pain response assessed using the Neonatal Infants Pain Scale before, during, and after the procedure. The secondary outcome was mother-infant bonding evaluated using the Mother-Infant Bonding Inventory on the seventh postnatal day. Data were analyzed using generalized estimation equations. RESULTS: The two groups did not significantly differ in length of gestation, sex, weight, or other demographic characteristics. At 1 min after the procedure, the intervention group had a lower heart rate (p < 0.001) and Neonatal Infants Pain Scale score (p < 0.001) than the control group did. CONCLUSIONS: The maternal voice intervention slowed the heart rate and alleviated the pain response of the hospitalized premature infants. PRACTICE IMPLICATIONS: This intervention has clinical potential to provide mothers with an opportunity to care for their infants and infants with an opportunity to be soothed during health care, thus enhancing the infant-mother connection. The clinical trial registration number is NCT04158206.

[Nursing Experience Using Art Therapy With Parents Facing the Death of a Newborn].

When a newborn requires immediate hospitalization due to a potentially life-threatening situation, parents face a sudden and significant increase in stress. This situation and the potential loss of their child will bring great grief and loss to the parents, which may lead to conditions that foster dysfunctional family dynamics. This article describes the author's experience providing hospice care to a dying infant with a group B streptococcus infection in the neonatal intensive care unit. The author served as the primary care nurse from April 5th to July 6th, 2019. Data were collected during direct care provision, observations, and interactions with parents, while overall systemic assessments were used in analysis to establish that the health problems of the case were: (1) existing infection: related to group B streptococcus; (2) ineffective tissue perfusion: insufficient perfusion of multiple organs, including brain, heart, lung, and kidney, due to sepsis infection; and (3) caregiver grief: facing the death of a newborn. Nursing care provided to the patient included maintaining individualized physical functions and retaining physical integrity during the end-of-life period. The nursing care provided to the parents included the use of art therapy to encourage them to express their inner emotions through the writing of memoirs and diaries and their participation in companionship. This intervention was designed to help the parents transition from the grief of denying the collapse to the fact that their baby had died. As Taiwanese culture typically avoids discussions of death, the nursing experience described in this article may provide a reference for caring for similar patients. This article highlights the beauty of nursing through art therapy, demonstrates the achievement of whole-person and family-centered nursing, shows how the case was successfully helped through the crisis, and illustrates how normal family functions may be maintained.

Arecoline Promotes Migration of A549 Lung Cancer Cells through Activating the EGFR/Src/FAK Pathway.

Arecoline is the primary alkaloid in betel nuts, which are known as a risk factor for oral submucosal fibrosis and oral cancer. Lung cancer is a severe type of carcinoma with high cell motility that is difficult to treat. However, the detailed mechanisms of the correlation between Arecoline and lung cancer are not fully understood. Here, we investigated the effect of Arecoline on migration in lung cancer cell lines and its potential mechanism through the muscarinic acetylcholine receptor 3 (mAChR3)-triggered EGFR/Src/FAK pathway. Our results indicate that different concentrations of Arecoline treatment (10 µM, 20 µM, and 40 µM) significantly increased the cell migration ability in A549 and CL1-0 cells and promoted the formation of the filamentous actin (F-actin) cytoskeleton, which is a crucial element for cell migration. However, migration of H460, CL1-5, and H520 cell lines, which have a higher migration ability, was not affected by Arecoline treatment. The EGFR/c-Src/Fak pathway, which is responsible for cell migration, was activated by Arecoline treatment, and a decreased expression level of E-cadherin, which is an epithelial marker, was observed in Arecoline-treated cell lines. Blockade of the EGFR/c-Src/Fak pathway with the inhibitors of EGFR (Gefitinib) or c-Src (Dasatinib) significantly prevented Arecoline-promoted migration in A549 cells. Gefitinib or Dasatinib treatment significantly disrupted the Arecoline-induced localization of phospho-Y576-Fak during focal adhesion in A549 cells. Interestingly, Arecoline-promoted migration in A549 cells was blocked by a specific mAChR3 inhibitor (4-DAMP) or a neutralizing antibody of matrix metalloproteinase (MMP7 or Matrilysin). Taken together, our findings suggest that mAChR3 might play an essential role in Arecoline-promoted EGFR/c-Src/Fak activation and migration in an A549 lung cancer cell line.

Synergistic effects of cognitive impairment on physical disability in all-cause mortality among men aged 80 years and over: Results from longitudinal older veterans study.

OBJECTIVE: We evaluated effects of the interrelationship between physical disability and cognitive impairment on long-term mortality of men aged 80 years and older living in a retirement community in Taiwan. METHODS: This prospective cohort study enrolled older men aged 80 and older living in a Veterans Care Home. Those with confirmed diagnosis of dementia were excluded. All participants received comprehensive geriatric assessment, including sociodemographic data, Charlson's Comorbidity Index (CCI), geriatric syndromes, activities of daily living (ADL) using the Barthel index and cognitive function using the Mini-Mental State Examination (MMSE). Subjects were categorized into normal cognitive function, mild cognitive deterioration, and moderate-to-severe cognitive impairment and were further stratified by physical disability status. Kaplan-Meier log-rank test was used for survival analysis. After adjusting for sociodemographic characteristics and geriatric syndromes, Cox proportional hazards model was constructed to examine associations between cognitive function, disability and increased mortality risk. RESULTS: Among 305 male subjects aged 85.1 ± 4.1 years, 89 subjects died during follow-up (mean follow-up: 1.87 ± 0.90 years). Kaplan-Meier unadjusted analysis showed reduced survival probability associated with moderate-to-severe cognitive status and physical disability. Mortality risk increased significantly only for physically disabled subjects with simultaneous mild cognitive deterioration (adjusted HR 1.951, 95% CI 1.036-3.673, p = 0.038) or moderate-to-severe cognitive impairment (aHR 2.722, 95% CI 1.430-5.181, p = 0.002) after adjusting for age, BMI, education levels, smoking status, polypharmacy, visual and hearing impairment, urinary incontinence, fall history, depressive symptoms and CCI. Mortality risk was not increased among physically independent subjects with or without cognitive impairment, and physically disabled subjects with intact cognition. CONCLUSIONS: Physical disability is a major risk factor for all-cause mortality among men aged 80 years and older, and risk increased synergistically when cognitive impairment was present. Cognitive impairment alone without physical disability did not increase mortality risk in this population.