Concern For Pain Research Articles

A case–control study of caesarean delivery on maternal request: who and why?

Objective: The current study aimed to evaluate the profile of women who are most likely to undergo caesarean delivery on maternal request (CDMR) and clarify their reasons for this decision. Methods: For this multicentre case–control study, data were collected from 429 women who underwent CDMR and 429 matched controls who delivered vaginally from June, 2008 through February, 2009. Participants were interviewed by telephone regarding sociodemographic variables, health and lifestyle. Results: CDMR predictors were as follows: increasing age (OR = 1.09/year; 95%CI: 1.05–1.14), family status (unmarried without a steady partner versus married – OR = 3.60; 95%CI: 1.08–11.97), decreasing level of religiosity (secular versus ultra-orthodox – OR = 11.82; 95%CI: 3.75–37.21), and never having engaged, or ceasing sports activity during pregnancy (OR = 1.79; 95%CI: 1.09–2.91 and 2.38; 95%CI: 1.28–4.43, respectively). Above average income reduced the probability of CDMR (OR = 0.56; 95%CI: 0.33–0.94). The most frequent reasons for choosing CDMR were concern for pain (21.9%), concern for their own or baby's health (20.4% and 16.5%, respectively) and emotional aspects (10.0%). Conclusions: Older, unmarried and/or secular women had increased probability of CDMR. Addressing specific concerns regarding vaginal delivery may provide the basis for a patient-oriented intervention for preventing unnecessary surgery.

Self-cannulation for haemodialysis: patient attributes, clinical correlates and self-cannulation predilection models.

Background and ObjectivesWith emerging evidence in support of home haemodialysis (HHD), patient factors which determine uptake of the modality need to be better understood. Self-cannulation (SC) is a major step towards enabling self-care ‘in-centre’ and at home and remains the foremost barrier to its uptake. Human factors governing this aspect of HD practice are poorly understood. The aim of this study is to better understand self-cannulation preferences and factors which define them in end stage renal disease (ESRD).DesignIn this multicentre study, 508 of 535 patients from predialysis (Group A: n = 222), in-centre (Group B: n = 213), and home HD (Group C: n = 100) responded to a questionnaire with 3 self-cannulation questions. Simultaneously, data on clinical, cognitive and psychosocial variables were ascertained. The primary outcome measure was ‘perceived ability to self-cannulate AV access’. Predictive models were developed using logistic regression analysis.Results36.6% of predialysis patients (A) and 29.1% of the ‘in-centre’ haemodialysis patients (B) felt able to consider SC for HD. Technical-skills related apprehension was highest in Group B (14.4%) patients. Response to routine venepuncture and the types of SC concerns were significant predictors of perceived ability to self-cannulate. There was no significant difference in concern for pain across the groups. In multivariable regression analysis, age, education level, 3MS score, hypoalbuminemia in Groups B & C and additionally, attitude to routine phlebotomy and the nature of specific concern for self-cannulation in Groups A, B and C, are significant predictors of SC preference. The unadjusted c-statistics of models 1 (derived from Group A and validated on A) and 2 (derived from B+C and validated on B), are 0.76(95% CI 0.69, 0.83) and 0.80 (95% CI 0.74, 0.87) respectively.ConclusionsThere is high prevalence of perceived ability to self-cannulate. Modifiable SC concerns exist in ESRD. The use of predictive models to objectively define and target education and training strategies could potentially impact on HD self-management and future uptake of home HD.

Attitudes towards catch-and-release recreational angling, angling practices and perceptions of pain and welfare in fish in New Zealand

AbstractAlthough there is still some debate regarding whether fish have the capacity to feel pain, recent scientific research seems to support the notion that fish can indeed suffer. However, the continued scientific discourse has led to questions regarding how members of the public perceive issues of pain and welfare in fish. A questionnaire was developed and randomly distributed to 700 members of the general public in New Zealand. Questionnaires gathered basic demographic information, information regarding respondents’ participation in and opinions on angling practice, and opinions about fish welfare and pain. The response rate was 62.4% (437/700). The primary aim of the study was to assess public concerns for the impact of catch-and-release angling (CRA) on the welfare of fish. Most respondents indicated a belief that fish are capable of feeling some pain although older respondents scored the capacity of fish to feel pain lower than younger respondents. Likewise, most respondents believed that CRA causes pain and compromises survival in fish. Principle Component Analysis identified two major components within responses. These were: i) importance placed on good fishing techniques; and ii) concern for pain and survival of fish. Female respondents showed more concern about angling practices and their impact on pain and survival of fish than male respondents. Respondents who participate in CRA and considered it acceptable showed less concern for pain and survival in fish than both respondents who do not participate and those who considered CRA unacceptable. The majority of respondents considered angling an acceptable pastime (65%; 284/435) but also indicated support for the introduction of guidelines and regulations to improve fish welfare in the future (76.4%; 334/434). Those respondents that did not believe regulations were necessary provided statistically lower importance scores for both pain and survival in fish and good angling practices than respondents that did. Education about good angling practices may provide the best route by which fish welfare can be improved.

Concern for Pain in the Pre‐Operative Period‐ Is the Internet Being Used for Information By Patients?

This study was conducted to provide information regarding prevalence of pain, type of provider managing pain, and use of Internet for information regarding pain, among patients coming for presurgical anesthesia consultation at a major academic institution. With IRB approval, patients were invited to participate in a voluntary and anonymous 14 question survey given to them when they presented for anesthesia consultation prior to their surgical procedure. The qualitative/categorical data were summarized by number (percentage [%]) and analyzed by Chi-square test or Fisher's exact test as appropriate. All data analyses were performed using the statistical software SAS, v9.2. A total of 1039 patients were asked to complete the survey and 670 patients returned their responses (response rate = 64.5%). 83% of patients had a history of prior surgery. 57% were concerned about postoperative pain. 30% of patients had chronic pain for more than 3 months pre-operatively. 16% of patients had looked online for information regarding pain. Pain physicians were involved in pain management only in 3.8% of these patients. Patients are presenting for surgery with significant pre-operative pain issues. Knowing this information pre-operatively will help healthcare personnel manage postsurgical pain more effectively. Patients are also using the Internet to obtain information regarding pain. As providers, there may be value to directing patients to reliable information online during consultation. As all physicians will eventually be managing chronic pain in their patients, pain education should be given priority in medical school curriculum.