Lumbar Sympathetic Blocks Speed Early and Second Stage Induced Labor in Nulliparous Women

Background: Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study.

Methods: At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 [micro sign]g fentanyl; and 100 [micro sign]g epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 [micro sign]g fentanyl; and 50 [micro sign]g epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia.

Results: Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block.     

Unexpected capacity-building experiences of multicultural,multilingual participants in a public health initiative

Aims

This study of a levy-voter funded public health initiative program (1) identifies capacity-building concerns, (2) summarizes those concerns at the community-based organization (CBO) level, and (3) documents the desired CBO capacity-building outcome.

Participants

Nineteen participants from nine CBOs were included, representing 95% of participants (19/20) and 90% of CBOs (9/10) from the initiative's program population.

Methods

Interviews were conducted. A focus group validated data. Demographic surveys were completed.

Methodology and Analysis

Data were analyzed using demographic and inductive content analyses. Fifteen capacity-building unexpected concerns were identified. Participants from eight out of nine (88.8%) CBOs shared at least ten concerns. Seven CBO capacity-building outcomes were identified.

Results

Capacity-building providers helped participants mitigate the Initiative's capacity-building testing of the National Implementation Research Network (NIRN) model. Participants' NIRN processes were Western and mainstream. Participants wanted community-designed processes and the funder to understand CBO clients’ backgrounds, cultures, and languages. The contract money did not match the needed capacity-building processes, time, and workload.

Discussion

The funder's pre-selected the NIRN Western majority approach did not fit. Participants wanted to lead. Capacity-building only for home-based program development was less desired. Social justice leadership could have made a difference.     

Concept analysis of recovery from substance use

In this paper, we provide an analysis of the concept of recovery from substance use. We performed a literature search in CINAHL Plus, PsycINFO, MEDLINE, and Embase using key terms that focused on the concept of recovery from substance use. We also conducted a grey literature search and included select resources. Inclusive years for the search ranged from January 1, 2000 to March 10, 2022. Records were screened for eligibility by two independent reviewers; data were extracted by one reviewer and confirmed by a second. A total of 22 literature sources were included. Identified core attributes of recovery include: (i) recovery as a process, (ii) recovery as more than managing substance use, (iii) recovery as life improvements, and (iv) recovery as a person-centred, individual concept. Antecedents, consequences, and empirical referents are identified, and model and contrary cases are presented. We propose the following definition for recovery: Recovery from substance use is defined by the affected individual, who sets goals and objectives for life improvements that include managing their substance use, but this is not the sole focus. Recovery is a person-centred, individualized process that can be measured by referents that suit the individual's own goals and objectives. What may constitute “recovery” and “recovered” requires definition by each individual.     

Childhood Memories About Food: The Successful Dieters Project

PURPOSE: The Successful Dieters Project explored and described the characteristics of dieters. This paper reports the results of a content analysis of one question about childhood memories surrounding food. METHODS: All subjects were interviewed once with an intensive interview guide, were weighed, and were measured for height and waist-hip ratios. SUBJECTS: Subjects (N = 162) were 76 men and 86 women, who ranged in age from 21 to 84 years. FINDINGS: Gender and weight history differences were noted in the areas of food rules, the age at which dieting to control weight began, family food rules, positive versus negative memories, and the use of food as a reward or punishment. Parental experience with food deprivation was a strong force in shaping children's attitudes toward food. CONCLUSIONS: Childhood memories about food appear to contribute to differences among the obese, the always-normal-weight, and the successful dieter. Further research into this area of investigation is warranted.