Selected Coping Strategies in Labor: An Investigation of Women's Experiences

Abstract: Background: Antenatal education classes offer women information about labor and birth and ways of coping with pain and emotional distress. The purpose of this paper was to describe women's experiences of using, starting, and discontinuing three coping strategies in labor that were taught in antenatal education classes. Methods: An exploratory research design was used in which 121 women were interviewed within 72 hours of the birth of their first child. Information was obtained on why women initiated and discontinued their use of three coping strategies (breathing technique, postural changes, relaxation technique) and the reported effects of use. Results: The effects of the coping strategies investigated varied widely among participants. Common aspects of care, changes of environment, and use of pharmacological pain relief affected women's discontinuation of coping strategies. Conclusions: The implications of study findings for clinical practice include the need for caregivers to provide women with accurate information about the effects of coping strategies and to be alert to aspects of care that may disrupt women's use of strategies. (BIRTH 30:3 September 2003)     

Impact of the Australian Measles Control Campaign on immunity to measles and rubella.

To evaluate the impact of the 1998 Australian Measles Control Campaign on immunity to measles and rubella, 4400 opportunistically-collected sera, submitted to diagnostic laboratories across Australia from subjects aged 1-49 years, and 3000 from subjects aged 1-18 years, were tested before and after the campaign, respectively. The proportion of individuals aged 1-18 years who were immune to measles rose from 85% before, to 90% after, the campaign (P < 0.001). The greatest increase was in preschool (7%, P < 0.001) and primary school (10%, P < 0.001) children, who were actively targeted by the campaign. Rubella immunity in 1-18 year-olds rose from 83% to 91% (P < 0.0001), again with significant increases in preschool (4%, P = 0.002) and primary school (16%, P < 0.001) children. 94% of individuals aged 19-49 years were immune to rubella. These serosurveys confirm other evidence of the effectiveness of the Australian Measles Control Campaign and demonstrate the value of serosurveillance using opportunistically collected sera.     

‘Walking the tightrope’: The role of peer support workers in facilitating consumers’ participation in decision‐making

In adult mental health services, the participation of consumers is essential. The aim of this study was to explore the challenges faced by peer support workers when involving mental health consumers in decision‐making about their care and the strategies they employed to overcome these challenges so as to improve mental health consumers’ participation in decision‐making and recovery. Semi‐structured individual interviews were conducted with six peer support workers currently employed in psychiatric hospitals and/or community mental health systems. Thematic analysis identified challenges related to role definition, power imbalance, doctor‐centric medical approaches to care, and lack of resources. Strategies to overcome these challenges that were reported, included the following: facilitating meaningful involvement for service users, appropriate use of the lived experience, building relationships and communication, promoting rights and advocacy, and promoting professionalism of peer support workers (PSWs). Nursing staff need ongoing support and education to understand and value the varied roles of PSWs and thereby empower PSWs to engage in enhancing consumer decision‐making. The roles of the PSWs should be viewed as complementary, and greater appreciation and understanding of roles would better support recovery‐oriented care.     

Calcitonin gene-related peptide (CGRP): Responsible for the increased blood flow induced by the stimulation of sensory nerves

Calcitonin gene-related peptide (CGRP) is a potent vasodilator neuropeptide contained in sensory nerves. We have examined the relative contribution of CGRP and substance P-like peptides (with which CGRP is commonly colocalized) to the increase in blood flow induced by the stimulation of sensory nerves. The sensory nerve stimulant capsaicin increased blood flow in rabbit and rat skin and this effect was substantially inhibited by the CGRP antagonist CGRP_8–37. Further, electrical stimulation of the rat saphenous nerve led to an increase in blood flow which was significantly inhibited by CGRP_8–37. CGRP_8–37 also had a partial inhibitory effect on oedema formation, an effect which is suggested to be a consequence of the inhibition of blood flow.

     

Positron emission tomography-computed tomography protocol considerations for head and neck cancer imaging

Positron emission tomographic-computed tomographic (PET-CT) imaging of patients with primary head and neck cancers has become an established approach for staging and restaging, as well as radiation therapy planning. The inherent co-registration of PET and CT images made possible by the integrated PET-CT scanner is particularly valuable in head and neck cancer imaging due to the complex and closely situated anatomy in this part of the body, the varied sources of physiologic and benign 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) tracer uptake that occurs in the neck, and the varied and complex posttreatment appearance of the neck. Careful optimization of both the CT and the PET portion of the examination is essential to insure the most accurate and clinically valuable interpretation of these examinations.     

The range of coping strategies women use to manage pain and anxiety prior to and during first experience of labour

OBJECTIVES: To investigate whether nulliparous women, during pregnancy, can identify their own pre-existing coping strategies for managing pain and anxiety and whether the range of coping strategies used in Labour by women who do not attend antenatal classes can be described. DESIGN: Qualitative semi-structured interviews. SETTING: Two large maternity units in a city in the North of England. PARTICIPANTS: Twenty-three nulliparous women were interviewed during their third trimester of pregnancy (prior to any antenatal class attendance) regarding strategies used to cope with previous experiences of pain and anxiety. A separate sample of 20 women, who had not attended any form of antenatal education, were interviewed within 72h of their first experience of labour regarding the coping strategies used to manage pain and anxiety during labour. FINDINGS: Template Analysis was used to code data from transcribed interviews. The findings indicate that as women approach their first experience of labour they can identify coping strategies that they have employed to manage pain and anxiety in their past. Equally women who have not attended antenatal classes use a wide range of strategies in labour. The range of identified coping strategies is described and comprises thoughts and behaviours with positive and negative consequences. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is possible to help nulliparous women to identify, in pregnancy, a range of strategies that they have previously employed to manage pain and anxiety. This range reflects the coping strategies that women may potentially use in labour to manage pain and anxiety. Women may benefit from assistance in pregnancy to develop strategies for labour that are based on knowledge of their own coping repertoire, which includes enhancing positive strategies and finding alternatives to negative strategies.     

Gaseous oxygen perfusion of the renal vessels as an adjunct in kidney preservation.

Gaseous oxygen perfusion of the stored kidney provides life-supporting renal function in canine kidneys damaged by 30 min of warm ischaemia followed by cold storage for a total of 24 hr. Other simple methods of renal preservation, including simple flushing and cold storage and oxygenation of the flush solution and the fluid surrounding the kidney during storage, did not result in consistent life-supporting renal function under these experimental conditions. Low pressure venous oxygen perfusion of the kidney produced significantly better renal function than arterial oxygen perfusion as measured by post-transplant creatinine values. This preservation technique uses apparatus readily available in hospitals and once instituted does not require supervision. It may have clinical application in cadaveric renal transplantation, particularly if the donor kidney has been subjected to warm ischaemia.     

Imaging of tinnitus

From a radiologic workup perspective, tinnitus is classified into pulsatile, which can be objective, and nonpulsatile, which is typically subjective. There is considerable discrepancy within the literature regarding the percentage of positive findings in patients with pulsatile tinnitus. The authors discuss the overlap in the radiographic findings detected in association with tinnitus in both asymptomatic patients and symptomatic patients and the importance for imaging to detect treatable causes. They discuss imaging related to diagnosis and treatment and provide an imaging workup algorithm.