Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study

ObjectiveTo compare labour and birth outcomes between nulliparous women who used versus did not use intrapartum epidural analgesia.DesignProspective cohort study.SettingTwo maternity hospitals in Ireland.PopulationA total of 1221 nulliparous women who gave birth vaginally or by emergency caesarean section.MethodsMultinomial logistic regression was used to analyse categorical outcomes, with results presented as ratios of relative risks (RRR). For dichotomous outcomes we used logistic regression, with results presented as odds ratios (OR).Main outcome measuresMode of birth, IV syntocinon use, pyrexia (≥38 °C), antibiotic treatment, first stage labour ≥10 h, second stage labour ≥2 h, blood loss (≥500 mls, ≥1000 mls), perineal trauma. Neonatal outcomes included Apgar score ≥7 at 1 min and 5 min, admission to neonatal intensive care unit, and infant feeding method.ResultsWomen using EA were more likely to require a vacuum-assisted birth (RRR 3.35, p < 0.01) or forceps-assisted birth (RRR 11.69, p < 0.01). Exposure to EA was associated with significantly greater risk of ≥10 h first (OR 6.72, p = 0.01) and ≥2 h second (OR 2.25, p < 0.01) stage labour, increased likelihood of receiving IV syntocinon (OR 9.38, p < 0.01), antibiotics (OR 2.97, p < 0.01) and a greater probability of pyrexia (OR 10.26, p < 0.01). Women who used EA were half as likely to be breastfeeding at three months postpartum (OR 0.53, p < 0.01). No differences were observed between groups in neonatal outcomes.ConclusionsOur data shows significant associations between EA use and several intrapartum outcomes.     

Chronic pain,pain severity and analgesia use in Australian women of reproductive age

Background

The increasing prevalence and adverse outcomes associated with opioid analgesia use in women of reproductive age have become a significant public health issue internationally, with use during pregnancy potentially affecting maternal and infant health outcomes.

Chronic strain,daily work stress and pain among workers with rheumatoid arthritis: Does job stress make a bad day worse?

The structure of the job and the daily experience of work are challenges for workers with rheumatoid arthritis. Yet little is known about how these two factors interact to put workers with chronic pain at risk for worse pain on a given day. This exploratory 20 workday diary study of 27 workers with rheumatoid arthritis used hierarchical linear modelling to examine how the structure of the job and neuroticism moderate the relationship between daily undesirable work events (daily stressors), and pain reports within a day. On days with more undesirable work events compared to days with fewer events, individuals with jobs associated with job ‘strain’ (high demand/low control) reported greater midday pain, irrespective of neuroticism and negative mood, than workers with other combinations of demand and control. These findings demonstrate the utility of analysing fluctuating within-person relationships among pain, mood and daily work stressors within the context of the structure of the job, and helps to explain why daily work stressors result in worse health outcomes for some but not all workers with RA.     

Japanese women's experiences of pharmacological pain relief in New Zealand

BackgroundIn Japan, most women manage labour pain without pharmacological interventions. However, New Zealand statistics show a high percentage of epidural use amongst Asian women. Entonox (a gas mixture of nitrous oxide and oxygen) and pethidine are also available to women in New Zealand. This article investigates how Japanese women in New Zealand respond to the use of pharmacological pain relief in labour.QuestionsThe study was guided by two research questions: (1) How do Japanese women experience and manage labour pain in New Zealand? (2) How do they feel about the use of pharmacological pain relief?MethodsThirteen Japanese women who had given birth in New Zealand were interviewed individually or in a focus group. The conversations were analysed using thematic analysis.FindingsAlthough in Japan very few women use pain relief, nine women received epidural and/or Entonox out of 11 women who experienced labour pain. The contrast between their Japanese cultural expectations and their birth experiences caused some of the women subsequent personal conflict.ConclusionJapanese women's cultural perspectives and passive attitudes were demonstrated to influence the decision-making process concerning pain relief. It was concluded that understanding Japanese cultural worldviews and approaches to the role of pain in labour would help maternity providers in their provision of appropriate care for Japanese women.     

在文化的“盲点”处起舞——廖辉英、林白对女性性别针砭的比较

廖辉英与林白通过文本传达了男权中心文化对女性的挤压和扭曲，展现了女性生存的尴尬与自救的艰辛，并且在书写女性命运境遇的过程中进行着谋求女性解救的努力和探索。     

Pain in the Act: The Meanings of Pain Among Professional Wrestlers

This paper draws upon the relational turn in the study of pain to understand and explain the ways in which professional wrestlers manage and make sense of physical suffering. The paper focuses on how pain-laden interactions in the ring and the gym give form to the ways in which participants of wrestling think and feel about pain. The research is based on a long-term ethnography of professional wrestling. The article does two things: (a) explores the bodily skills that wrestlers cultivate to handle a context of ever-present pain, and (b) explains what the wrestlers’ interactions tell us about the meanings of pain that wrestlers come to share. Based on the reconstruction of participants’ lived experience of pro wrestling, I suggest that pain becomes attractive to wrestlers because it is given substantive meaning which encompasses denial, authenticity, solidarity, and dominance.

Work & stress: Information

The aim of this study was to investigate whether psychosocial factors at work are related to low-back pain among nursing personnel. It was conducted as a short-term follow-up study of 200 Danish female nursing personnel, providing care for the elderly. Self-reported measures of psychosocial factors such as time pressure, emotional demands of clients, control and social support were obtained by questionnaire at baseline, while stress, physical exertion and low-back pain were reported by diary records made in two, three-day periods in the subsequent 6 months. The study examines the possible influence of psychosocial factors preceding low-back pain as well as stress and physical exertion reported simultaneously with low-back pain. Only stress was associated with low-back pain (Odds Ratio (OR)=2.3; Confidence Interval (CI)=1.3-3.9) while neither physical exertion or any of the psychosocial factors were related to low-back pain. A possible pathway connecting emotional demands of clients to low-back pain through the mediation of stress was suggested.     

Is Pain a Significant Factor in Elder Self-Neglect?

ABSTRACT

Purpose. Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls.

Methods. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant.

Summary of Results. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (χ² = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (χ² = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009).

Conclusion. The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.     

Are psychosocial factors associated with low-back pain among nursing personnel?

The aim of this study was to investigate whether psychosocial factors at work are related to low-back pain among nursing personnel. It was conducted as a short-term follow-up study of 200 Danish female nursing personnel, providing care for the elderly. Self-reported measures of psychosocial factors such as time pressure, emotional demands of clients, control and social support were obtained by questionnaire at baseline, while stress, physical exertion and low-back pain were reported by diary records made in two, three-day periods in the subsequent 6 months. The study examines the possible influence of psychosocial factors preceding low-back pain as well as stress and physical exertion reported simultaneously with low-back pain. Only stress was associated with low-back pain (Odds Ratio (OR)=2.3; Confidence Interval (CI)=1.3-3.9) while neither physical exertion or any of the psychosocial factors were related to low-back pain. A possible pathway connecting emotional demands of clients to low-back pain through the mediation of stress was suggested.