Efficacy of eutectic mixture of local anesthetics in alleviating pain associated with lumbar puncture in newborns: a placebo compared randomized controlled trial

Background: Lumbar puncture (LP) is one of the most commonly encountered painful procedure in paediatric medicine. Research has shown that neonates too experience pain from noxious stimuli that can be more intense than what is experienced by an adult, and so have the right to receive safe, efficient and effective pain management. Objective was to determine efficacy of topical eutectic mixture of local anesthetics (EMLA) in alleviating pain associated with lumbar puncture among newborns admitted to sick newborn care unit (SNCU).Methods: The study was a one-year tertiary care teaching hospital-based randomised comparative double blinded trial among 42 neonates aged 32 weeks or more admitted to SNCU and required a diagnostic lumbar puncture, randomly assigned to one of two groups. Half hour before the procedure, 1 g of topical EMLA cream was applied to LP site in intervention group versus placebo in other group. At different stages, the heart rate, transcutaneous oxygen saturation level, and total behaviour score were captured on a video camera and rated using the neonatal facial coding system.Results: EMLA dramatically lowers pain sensitivity when compared to placebo. Total behavioural score means±standard deviation (SD) at the moment of needle insertion (EMLA: 1.05±1.24; placebo: 2.71±1.76, p≤0.001) and post procedural 5 minute later was (EMLA: 0.05±0.22; placebo: 0.81±0.92, p≤0.01). Similarly, oxygen saturation level when needle was in spinal place (EMLA: 96.76±2.45; placebo: 94.29±3.62, p=0.01) and post procedural 1 hour later was (EMLA: 98.81±1.94; placebo: 97.48±2.18, p=0.04). The heart rate of all newborns in both groups was greater than it was at baseline, although the difference was not significant.Conclusions: EMLA is an effective agent in reducing pain associated with LP among newborns.

Are Perceptions of Health Dependant on Social Class? Studying Soft Power and Symbolic Violence in a Health Promotion Program among Young Men at Vocational Schools

Health behaviour among young people has a social gradient, and tends to be skewed in terms of gender as well. Young men in vocational educational settings are an example where the inequality in health is apparent. Addressing this problem requires an understanding of health behaviour and its determinants in the target group in order to be able to develop interventions that can address the problem. The aim of the paper is to investigate to what extent a multicomponent intervention based on the Whole School Approach, targeting the risk behaviours, smoking, eating and physical activity that have an impact on health behaviour among male students in a disadvantaged educational setting. The paper uses self-reported longitudinal data on risk behaviours from the “Gearing up the Body” 1-year intervention program that was implemented among students at a Danish vocational school. For the analysis, we created a score model to categorise students and behaviour. Analyses suggest that interventions had only a modest impact and what evidence there is shows that the interventions reduced the health behaviour scores by 0.03 points. More specifically, we find that symbolic violence reduces the health behaviour score of the healthy types by 0.20 points, whereas soft power increases the health behaviour of the unhealthy type by 0.05 points. An explanation for the disappointing results of the “Gearing up the Body” program is tension between different understanding of what is “right” and “wrong” health behaviour. We find that the ideas of soft power and symbolic violence can contribute to a better understanding of why health and health behaviour is understood differently among vocational students. Thus, the finding demonstrates that one needs to apply a participatory approach rather than a normative approach addressing the health behaviour of disadvantaged individuals.

The Impact of the Covid-19 Pandemic on Children and Adolescents Mental Health: A Literature Review

The emergence of a new Coronavirus Disease 2019-2022 has turned the globe down and disrupted main determinants of health. The world constitutes by more than 2.2 billion children, which is approximately 28% of the world's population. Compare to adult, this pandemic has a long -term adverse consequences among children and adolescents. The objective of this literature review was to examine the impact of COVID-19 pandemic on children and adolescent’s mental health. PubMed and Google Scholar databases were searched from 07 April 2021 to 22 April 2021. A systematic literature search was performed in accordance with PRISMA and 07 literatures were selected. Among 16,169 samples, the mean percentage of male was higher 5 by 6.11% than female of 43.89%. Depression was mentioned in three studies and the percentages were 43.7% (n=8079), 22.6% (n=2330), and 22.8% (n=3613). Anxiety was mentioned in four studies and the percentages were 37.4% (n=8079), 18.9% (n=2330), and 23.87 ± 15.79 and 29.27 ± 19.79 (n=3613) and in one study according to CAQ and NRS, the level of anxiety was 19.4% and 21.8%. The combination of anxiety and depression was 31.3%. One study mentioned that pro social behaviour score was higher in females than males. In other two studies, various psychological symptoms are mentioned such as worry, fear, helplessness, boredom, difficulty in concentration, irritability, restlessness, nervousness, feeling of loneliness and uneasiness. These psychological symptoms have long-term effect on child’s health. Therefore, as a nurse, we should take care of the child and aware that the child and their parents regarding various psychological problems and its management.

Nutritional knowledge, attitude and behaviours regarding Coronavirus Disease 2019 among residents of Gonabad, Iran

Objective: Coronavirus Disease 2019 (COVID-19) is a respiratory disease and a major global health-related issue. Knowledge, attitude and behaviours associated with this disease are being developed. Infected animals and consumption of contaminated foods are probably the main sources of this viral infection. Adhering to a healthy diet is effective in preventing patient affliction and recovery. Thus, the present research aims to determine the nutritional knowledge, attitude and behaviours associated with COVID-19 among Residents of Gonabad, Iran. Design: The present online cross-sectional survey was conducted in March 2020 on 389 people selected through convenient sampling method. The data collection instrument was a questionnaire developed by the present researchers comprising four sections: demographic information, knowledge, attitude and nutritional behaviour. The collected data were analysed statistically in SPSS. Setting: Gonabad city in Khorasan Razavi in the Northeast of Iran. Participants: All people at or above 18 years of age. Results: The present results revealed that the mean age of the participants was 37·3 ± 11·3 years. The mean scores for knowledge, attitude and nutritional behaviour were, respectively, 9·7 ± 1·4, 14·3 ± 3·5 and 29·6 ± 4·2. The mean scores for nutritional knowledge and attitude showed no statistically significant correlation with age, education, occupation, marital status and economic status. However, the mean nutritional behaviour score was significantly higher among women than men (P = 0·004). Conclusions: Participants’ nutritional attitude and behaviour regarding COVID-19, at its early stage in Iran, were average and above average. The public education provided with this regard can have affected this result.

Effects of holothuria extract on pain behaviour and Fos like immunoreactivity (FLI) in formalin pain

Introduction: The aim of this study was to determine the effects of gamat extract on pain behaviour and Fos like immunoreactivity (FLI) expression in the ventral posterolateral thalamus using the acute pain model. Materials & Methods: Fourteen Sprague-Dawley male rats (220-300 gram) were given intraplantar injection of 0.05ml formalin (1%) followed by intraperitoneal administration of either 4 mg/kg gamat extracts (Holothuria spp.) or saline (control). Behavioural changes were observed and rats were sacrificed 2 hours post-formalin injection. Immunohistochemistry testing was done on the brain sections. FLI was examined using a light microscope attached to an image analyser. The behaviour and FLI data were analysed using repeated measure analysis of variance and independent t-test respectively. Significance level was taken as p<0.05. Results: The control group has significantly higher pain scores compared to holothuria group (F (1) =13.635, p=0.003). There was significant reduction in the pain behaviour score in the holothuria group when compared to the control group in phase 1 (t (14) =2.9, p=0.012) and most of the time from 15 to 60 minutes post-formalin injection (t (12) =3.535, p=0.004). There was a significant reduction (P<0.05) in the number of FLI on the contralateral aspect of the ventral posterolateral thalamic nucleus in the group that received 4mg/kg of holothuria extract (63 3.18) compared to control group (84 6.36). Conclusion: This study showed that administration of holothuria extract significantly suppressed the pain behaviour and reduced the number of FLI in formalin injected rats compared to control.

Behaviour of twin- and triplet-born lambs and their dam 3 to 18 hours after birth is not a useful predictor of lamb survival to weaning

Objective: An experiment was designed to determine if behaviour traits expressed by twinand triplet-bearing lambs and their dams at 3 to 18 hours of age (after the immediate ewelamb bonding had occurred) were associated with lamb survival to weaning.Methods: The behaviour of twin and triplet lambs and their dams was assessed in the paddock at 3 to 18 hours after birth. Observations were made of the number of high- and low-pitched bleats, time to stand, make contact with dam, suck from dam and follow dam were recorded for each lamb. The maternal behaviour score of each dam was assessed. A random sub-sample of lambs were assessed during a maternal-recognition test at 12 or 24 hours of age. Traits included time spent standing, sitting, walking, time taken to reach the ewes and time spent with the ewes as well as the number of high- and low-pitched bleats emitted by the lamb.Results: In the paddock, for each additional second required for twin-born lambs to follow their dam, lambs were 1.004 (95% confidence interval [CI] 1.000 to 1.008) times more likely to survive to weaning (p<0.05). The opposite relationship, however, was seen in triplet lambs. For each additional second required for triplet-born lambs to follow their dam, lambs were 0.996 (95% CI 0.993 to 0.999) times as likely to survive to weaning (p<0.05). During the maternal recognition test, twin-born lambs were 0.989 (95% CI 0.979 to 1.000) times as likely to survive to weaning for every additional second they took to reach the contact zone (p<0.05). Similarly, triplet-born lambs were 0.994 (95% CI 0.989 to 0.999) as likely to survive for every additional second they took to reach their dam (p<0.05).Conclusion: All ewe behaviours and the majority of lamb paddock and test behaviours were not associated with the survival of twin- or triplet-born lambs and, therefore, are of little use as indicators of lamb survival to weaning.

Effect of particulate matter exposure on patients with COPD and risk reduction through behavioural interventions: the protocol of a prospective panel study

IntroductionPatients with chronic obstructive pulmonary disease (COPD) are vulnerable to particulate matter (PM) exposure which can increase acute exacerbations and hospitalisation. Interventions to avoid PM exposure are important but evidence-based guidance is lacking. This study aims to assess the impact of PM on lung function, quality of life and exacerbations in patients with COPD using a panel design study; it will also provide evidence for interventional measures to reduce harm from PM exposure.Methods and analysisA prospective panel study of patients with COPD aged ≥40 years will be conducted. Patients will be required to have a forced expiratory volume in one second <80% of the predicted value at enrolment. A total of 120 patients from three different regions will be enrolled, 60 from the metropolitan area, 30 from an industrialised area and 30 from a clean rural area. Clinical outcomes will be assessed through COPD assessment test scores, the St. George’s Respiratory Questionnaire for patients with COPD and pulmonary function testing. Indoor and outdoor PM in the patients’ environments will be measured using gravimetric and light scattering platforms. To estimate the individual dose of PM exposure, a time–activity diary, Geographic Information System and land use regression model will be combined in every season for 1 year. The correlation between PM exposure and the health status of patients with COPD will be evaluated. In addition, 40 patients with the lowest score of life behaviour score to reduce environmental PM exposure will be randomised to a control or intervention group, who will receive in-depth education on risk-reducing behaviours.Ethics and disseminationThis study was approved by the Institutional Review Board of each site. The participants received comprehensive information and provided informed consent. The result of this study will be discussed in the form of conference presentations and peer-reviewed publications.Trial registration numberNCT04020237.

Association of parental social network diversity with behaviour problems and resilience of offspring in a large population-based study of Japanese children

ObjectivesThe current study aimed to elucidate the impact of parental social network diversity on the behaviour problems and resilience of offspring.DesignWe used cross-sectional data from the Kochi Child Health Impact of Living Difficulty study in 2016.Setting and participantsParticipants were first, fifth and eighth grade children living in Kochi prefecture, Japan (N=9653). We calculated parental social network diversity by counting the number of people with whom parents connected on a daily basis (ie, structural social network diversity) and by assessing perceived psychosocial support (ie, functional social network diversity).Primary outcome measuresChild behaviour problems and resilience were respectively assessed using the Strengths and Difficulties Questionnaire (SDQ) and the Child’s Resilient Coping Scale (CRCS), as rated by caregivers.ResultsDiversity in parental structural and functional social networks showed an inverse association with SDQ total difficulties score (B=−0.16 (95% CI −0.25 to −0.07) and −0.20 (95% CI −0.27 to −0.13), respectively), and a positive association with prosocial behaviour score (B=0.11 (95% CI 0.08 to 0.15) and 0.09 (95% CI 0.06 to 0.12), respectively) and CRCS score (B=0.75 (95% CI 0.46 to 1.05) and 1.12 (95% CI 0.88 to 1.35), respectively) in the adjusted model. Parental mental health accounted for 36% and 43% of the total effects of structural and functional social network diversity respectively on the total difficulties score. For prosocial behaviour score, parental involvement accounted for 31% of the effects of functional social network diversity.ConclusionThe results shed light on new strategies to enhance child mental health that do not directly involve children but rather focus on parental social networking.

Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study

ObjectiveTo study the association of caregiver factors and stroke survivor factors with supervised community rehabilitation (SCR) participation over the first 3 months and subsequent 3 to 12 months post-stroke in an Asian setting.DesignProspective cohort study.SettingCommunity setting.ParticipantsWe recruited stroke survivors and their caregivers into our yearlong cohort. Caregiver and stroke survivor variables were collected over 3-monthly intervals. We performed logistic regression with the outcome variable being SCR participation post-stroke.Outcome measuresSCR participation over the first 3 months and subsequent 3 to 12 months post-strokeResults251 stroke survivor-caregiver dyads were available for the current analysis. The mean age of caregivers was 50.1 years, with the majority being female, married and co-residing with the stroke survivor. There were 61%, 28%, 4% and 7% of spousal, adult-child, sibling and other caregivers. The odds of SCR participation decreased by about 15% for every unit increase in caregiver-reported stroke survivor’s disruptive behaviour score (OR: 0.845; 95% CI: 0.769 to 0.929). For every 1-unit increase in the caregiver’s positive management strategy score, the odds of using SCR service increased by about 4% (OR: 1.039; 95% CI: 1.011 to 1.068).ConclusionWe established that SCR participation is jointly determined by both caregiver and stroke survivor factors, with factors varying over the early and late post-stroke period. Our results support the adoption of a dyadic or more inclusive approach for studying the utilisation of community rehabilitation services, giving due consideration to both the stroke survivors and their caregivers. Adopting a stroke survivor-caregiver dyadic approach in practice settings should include promotion of positive care management strategies, comprehensive caregiving training including both physical and behavioural dimensions, active engagement of caregivers in rehabilitation journey and conducting regular caregiver needs assessments in the community.