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PubMed1998

EMG activity of the orbicularis oris and mentalis muscles in children with malocclusion, incompetent lips and atypical swallowing--part I.

The function and the level of activity of the orbicularis oris (upper and lower), and of the mentalis muscles were verified electromyographically in resting position and in several movements and carried out in 18 children aged 8-12 years, divided into three groups: one with normal occlusion, and two with Class II division 1, with atypical swallowing and/or incompetent lips, who had received no orthodontic treatment. It was observed that, in a resting position with the lips separated, there was no activity in any of the muscles. When there was a contact of the lips, action potentials were recorded in the muscles studied, in those individuals with incompetent lips. In the movements of sucking either through a straw or a pacifier and the thumb, there were no differences among the groups. The incompetent lips group presented very marked muscle activity of the lower orbicularis oris and mentalis in the movement of sucking a lollipop. In deglutition of saliva, the orbicularis oris presented slight activity, and the mentalis, moderate. In deglutition of water, the mentalis presented very marked activity, whereas, the upper and lower orbicularis oris presented moderate and marked activities, respectively.

Action Potentials↗
PubMed2000

A taste of honey.

Infantile botulism classically presents with a triad of clinical features: Bulbar palsies (slow/absent pupil response) Alert Absent fever Other common features are: Constipation, ptosis and poor feeding The diagnosis is a clinical one, confirmed by EMG and by testing stool for the organism, C. botulinum, or its toxin. Parents should be advised not to dip pacifiers in honey. In future Botulinum Immune Globulin may be available and should be considered if further trials are published showing benefit. Nosocomial infections, such as RSV, are important and should be carefully avoided, particularly in patients recovering from botulism.

Botulism↗
PubMed2001

Development of sucking behavior in infants who have not been fed for 2 months after birth.

BACKGROUND: Term infants are able to develop sucking behavior after birth. However, the requirements for this development have not yet been fully elucidated. In the present study, we investigated whether an oral-feed practice is necessary for the development of sucking behavior and whether non-nutritive sucking could support the development of this behavior while the infants cannot be fed. METHODS: Subjects of the present study were four term or near-term infants who had never been fed orally for approximately 2 months after birth because of gastrointestinal problems. Sucking pressure was measured with a silicone tube inserted into an artificial nipple and sucking efficiency was calculated during an entire feeding. RESULTS: Sucking pressure, frequency and duration at the first time oral feed corresponded to values obtained for normal-term infants at their first oral feed. Although infants who had not received oral feeding demonstrated poor sucking abilities initially, sucking performance improved with practice. Sucking parameters measured 1 month since oral feeding was initiated in these infants corresponded to values obtained for normal-term infants at 1 month of age. Although infants who had not received oral feeding had often sucked a pacifier for sedation, this non-nutritive sucking did not result in the development of sucking behavior. CONCLUSIONS: These results demonstrate that an oral feeding practice is necessary for the development of sucking behavior and that non-nutritive sucking does not affect the development of sucking.

Enteral Nutrition↗
PubMed1999

Mastitis in the first year postpartum.

BACKGROUND: Limited information is available about the frequency and risk factors for lactation mastitis. The purpose of this study was to investigate frequency, risk factors, and outcome for lactation mastitis. METHODS: We analyzed data from a cohort study of 350 mothers with healthy term infants, who were followed up for one year postpartum. RESULTS: Eighty-three women (23.7% of the sample) reported one or more episodes of mastitis symptoms, and 61 (17.4%) women reported symptoms including fever. Fifty-six women (16%) received one or more courses of antibiotics for mastitis. Thirty women (8.5%) of the total cohort had recurrent episodes of mastitis symptoms. A total of 123 episodes of mastitis symptoms were reported. No cases of abscess were reported. Using multiple logistic regression, the adjusted risk ratio for mastitis symptoms associated with sore nipples in the first month was 2.07 (95% CI = 1.17, 3.66). A reduced risk of mastitis was associated with maternal smoking during pregnancy, with supplementation with water in the first month, and with the use of a pacifier on a daily basis within the first month. A history of mastitis symptoms was associated with a longer overall duration of breastfeeding. CONCLUSIONS: Our results suggest that mastitis may be a marker for an ample milk supply. Mothers presenting with mastitis can be reassured that the outlook for continued successful lactation is good. Further research is needed to investigate the reasons for recurrence of mastitis and the etiology of episodes occurring late in lactation.

Adult↗
PubMed2001

Maternity care practices: implications for breastfeeding.

BACKGROUND: Many United States mothers never breastfeed their infants or do so for very short periods. The Baby-Friendly Hospital Initiative was developed to help make breastfeeding the norm in birthing environments, and consists of specific recommendations for maternity care practices. The objective of the current study was to assess the impact of the type and number of Baby-Friendly practices experienced on breastfeeding. METHODS: A longitudinal mail survey (1993-1994) was administered to women prenatally through 12 months postpartum. The study focused on the 1085 women with prenatal intentions to breastfeed for more than 2 months who initiated breastfeeding, using data from the prenatal and neonatal periods. Predictor variables included indicators of the absence of specific Baby-Friendly practices (late breastfeeding initiation, introduction of supplements, no rooming-in, not breastfeeding on demand, use of pacifiers), and number of Baby-Friendly practices experienced. The main outcome measure was breastfeeding termination before 6 weeks. RESULTS: Only 7 percent of mothers experienced all five Baby-Friendly practices. The strongest risk factors for early breastfeeding termination were late breastfeeding initiation and supplementing the infant. Compared with mothers experiencing all five Baby-Friendly practices, mothers experiencing none were approximately eight times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination. CONCLUSION: Increased Baby-Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to increase adoption of these practices is illustrated by the small proportion of mothers who experienced all five practices measured in this study.

Adolescent↗
PubMedDate not supplied

Urticaria and hidden salicylates.

A 23-month-old girl had a chronic urticaria resistant to antihistamine therapy. She was found to be using large quantities of a topical salicylate preparation which was being regularly applied to her pacifier. Once this habit was stopped, her urticaria cleared and has not recurred.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

A pictorial and video guide to circumcision without pain.

3 Despite the 1999 American Academy of Pediatrics (AAP) policy statement indicating that routine neonatal circumcision is not medically necessary, circumcision continues to be the most frequently performed surgical procedure in the newborn period in the United States. Further, many health care practitioners routinely perform this procedure without the use of any or with inadequate or ineffective analgesia and anesthesia. Multiple studies have evaluated the safety and efficacy of specific pharmacologic and nonpharmacologic interventions to relieve circumcision pain and discomfort. Penile nerve blocks, local anesthetics, various operative instruments, acetaminophen, sweet oral solutions, pacifiers, a physiologic restraining device, intrauterine sounds, and music all have been evaluated. This article synthesizes these studies and highlights their significance for current clinical practice. The article provides a detailed pictorial and video guide to circumcision with an emphasis on the use of multimodal strategies to ensure adequate anesthesia, analgesia, and infant comfort before, during, and after the procedure.

Acetaminophen↗
PubMed2000

Reactivation of coagulation after stopping infusions of recombinant hirudin and unfractionated heparin in unstable angina and myocardial infarction without ST elevation: results of a randomized trial. OASIS Pilot Study Investigators. Organization to Assess Strategies for Ischemic++ Syndromes.

AIMS: To compare effects of heparin and hirudin on biochemical markers of coagulation. METHODS AND RESULTS: Patients (n=395) with unstable angina or myocardial infarction without ST elevation were randomized to a 72-h infusion of one of three regimens: unfractionated heparin (bolus of 5000 IU followed by an infusion of 1200 IU. h(-1)), low-dose hirudin (HBW 023; 0.2 mg. kg(-1)bolus followed by 0.10 mg. kg(-1). h(-1)) or medium-dose hirudin (0.4 mg. kg(-1)bolus followed by 0.15 mg. kg(-1). h(-1)). Infusions were adjusted to maintain an activated partial thromboplastin time of between 60-100 s. Activated partial thromboplastin time, prothrombin fragment 1.2 (F1.2), thrombin antithrombin III complex and D-dimer were measured before, during and after the infusion. Median activated partial thromboplastin time was similar in the two groups early on, but was significantly lower in the heparin group than in the combined hirudin group 48 h after starting the infusion (53 s and 75 s, respectively;P<0.001), and 6 h after stopping (31 s and 46 s, respectively;P<0.001). Median F1.2 levels were not significantly different between the groups during the infusion. Median thrombin antithrombin III levels in the heparin and hirudin groups were 2.8 microg. l(-1)and 2.3 microg. l(-1), respectively, at 6 h (P<0.001), and 3.0 microg. l(-1)and 2.3 microg. l(-1), respectively, at 48 h (P<0.001). Median D-dimer levels were 320 ng. ml(-1)and 260 ng. ml(-1)48 h after starting the infusion in the heparin and hirudin groups, respectively (P<0.001), and 415 ng. ml(-1)and 280 ng. ml(-1), respectively (P<0.001) 6 h after stopping. D-dimer levels were significantly elevated above baseline values in both groups 24-48 h after stopping the infusions. CONCLUSIONS: The greater reduction of thrombin antithrombin III and D-dimer during the hirudin infusion supports the hypothesis that hirudin is a more potent antithrombin agent than heparin. Increased D-dimer levels after stopping heparin or hirudin suggest that there is an ongoing pro-coagulant state. These results point to the greater efficacy of hirudin in preventing early clinical events (death, myocardial infarction and refractory ischaemia) compared with heparin that have been observed in large randomized trials. Persistent activation of coagulation afterstopping infusions in our study suggests that a longer course of antithrombotic treatment may be needed to pacify the thrombus.

Angina, Unstable↗
PubMed2000

The premature infant and painful procedures.

Pain management for premature infants raises challenging questions for nurses. This group of infants is often physiologically fragile and they may undergo frequent painful procedures on a daily basis. Contrary to ideas from the past, premature infants are able to feel pain, and nervous system elements required for the transmission of painful stimuli are functional by 24 weeks gestation. Painful procedures are harmful to the infant's physiological stability and the ability to self-regulate, which includes maintenance of motor control and stable sleep/wake cycles. Assessment of pain in the premature infant is complex. Major indicators of pain include facial grimaces and physiological parameters such as heart rate and oxygen saturation. The Premature Infant Pain Profile (PIPP) is one tool designed specifically for preterm infants. Nonpharmacological nursing measures such as swaddling or nesting and offering a pacifier are useful strategies to help infants cope with painful procedures. The nurse may also maintain a therapeutic environment to assist the infant in self-regulation. Pharmacological agents such as morphine, fentanyl, and acetaminophen are effective in relieving procedural pain. The use of oral sucrose before and during painful procedures offers new possibilities for pain relief. Recent research shows that oral sucrose is a safe and effective analgesic for short-term procedures. Research studies to determine the most effective doses and modes of oral sucrose administration are ongoing. It is thought that the relief of pain is owing to the sweet taste of the sucrose that activates endogenous pain-modulating systems.

Analgesics, Opioid↗
PubMed2000

Is changing the sleep environment enough? Current recommendations for SIDS.

Sudden infant death syndrome (SIDS or cot death) was the major cause of post-neonatal infant death in many countries in the late 1970s and 1980s. There is now very strong evidence that public intervention campaigns targeting the prone sleeping position, which had been identified by epidemiological studies as a major risk factor, were followed by substantial falls in the rate of SIDS. In the present review we discuss the evidence on which current recommendations for the prevention of SIDS are based. The prone sleeping position is now clearly causally associated with SIDS. Further reductions in SIDS may be produced by recommending the back sleeping position as opposed to the side position. Maternal smoking in pregnancy and bed sharing by infants of mothers who smoke are also strongly associated with SIDS, but have been harder to influence. Paternal smoking has also been implicated, although the magnitude of the reported risk is small. Finally, breastfeeding, pacifier use and having the infant sharing the parents bedroom, but not the bed, may also reduce risk. Continued reductions in SIDS mortality will require innovative public health education to target these major risk factors, while building on the "back to sleep" approach.

Journal Article↗
PubMedDate not supplied

[Oral sugar solutions in pain therapy of neonates and premature infants].

OBJECTIVES: We review the efficacy of oral sugar solutions for treating procedural pain in neonates and address the following questions: Do newborns need analgesic therapy for procedural pain during blood sampling? How do sugars influence pain-reactions of neonates? What is the efficacy of sugar solutions in clinical practice? METHODS: We searched for relevant articles in the PubMed database from 1990 to September 2000. RESULTS: Treatment of procedural pain in newborns is desirable because they are more sensitive to pain than adults, they show marked pain reactions during blood sampling and repeated acute pain in the newborn period results in longterm behavioural changes. Oral sugar solutions have been studied for treatment of procedural pain in neonates. Their initial effect is the result of orotactile stimulation by the intraoral fluid. The orogustatory stimulation by the sweet taste prolongs the effect for up to 10 minutes through endorphin release. In randomized-controlled trials oral sugar solutions (2 ml of 25% sucrose or 30% glucose) reduced pain reactions and crying and attenuated the heart rate increase after capillary and venous blood sampling in term and preterm neonates. They are more effective than traditional calming strategies, like cuddling by parents, use of a pacifier, or breast feeding. Yet, sugar solutions provide no adequate analgesia for more severe pain, e.g. during circumcision. CONCLUSIONS: Sugar solutions effectively relieve procedural pain during blood sampling in neonates. Additional studies are needed to determine the minimal effective dose and the efficacy and side effects of repeated sugar doses in the same patient.

Analgesia↗
PubMedDate not supplied

[Sleeping problems and attachment quality in toddlers].

The study presented addresses the association between 18-months-olds' attachment quality and subsequent sleeping problems at 30 months. The sample consisted in 62 healthy, firstborn children and their primary caregivers. Attachment quality was assessed using Ainsworths' Strange Situation Procedure. Sleeping disorders were diagnosed conducting a standardized psychiatric interview with the mothers. Securely attached toddlers showed sleeping problems more often than insecurely-avoidant attached ones. Attachment disorganization was not related to sleeping problems. Analyzing the impact of self-stimulation behavior (i.e. thumb or pacifier sucking) it could be demonstrated that all 30-months-olds who showed self-stimulating behavior were insecurely-avoidant attached to their primary caregiver. Thus, insecure-avoidant toddlers might incline to suppress attachment behavior and negative emotions when being separated from parent in the evening and night hours.

Adult↗
PubMed2002

Episodic stridor with latex nipple use in a 2-month-old infant.

Latex allergy in the pediatric population is most commonly identified in patients who have undergone multiple operations for neural tube defects or exstrophic genitourinary anomalies. However, there are a significant number of children who, without the usual risk factors, clinically and/or serologically appear to be latex allergic. There is sporadic information in the medical literature regarding reactions to latex allergens in household items, especially in patients younger than 1 year old. Several recent reports even support the existence of reactions to latex pacifiers. We report a case of an atopic 2-month-old infant who experienced the previously unreported reaction of repeated stridor on exposure to a latex nipple while feeding. It is important that clinicians recognize stridor as a potential reaction to latex in infants.

Anaphylaxis↗
PubMed2000

Efficacy of a slow-release device containing fluoride, xylitol and sorbitol in preventing infant caries.

A novel slow-release administration device, the "Fall-Asleep Pacifier" (FAP), was studied as a prophylactic measure against mutans streptococcal oral infection and dental caries in a risk group of 1-year-old children by comparing the test (T, n = 34) and control (C, n = 88) groups in a prospective cohort study. In the T group the children received their fluoride tablets (Fludent, containing NaF corresp. 0.25 mg F0- , xylitol 159 mg and sorbitol 153 mg) in the evenings in FAP. In the C group the children received the same dose of Fludent crushed in food in the evenings. The proportion of children, whose plaque samples from the upper incisors were mutans streptococcus positive at the age of 24 months, was significantly (P < 0.05) greater in group C (25%) than in group T (9%). The children in the T group developed significantly (P < 0.001) less (none) new dentinal carious lesions in their primary dentitions than the children in the C group between 2 and 3 1/2 years of age. Fifty-four percent of the children to whom the FAP was offered complied with regular use of it. The beneficial effect observed in the T group compared with the C group was apparently mostly due to the administration mode via FAP, which could prolong the intra-oral bioavailability of the prophylactic preparation.

Chi-Square Distribution↗
PubMed1992

Preliminary observations on the training of Burmese elephants using xylazine.

A traditional elephant training method was chosen to be modified by the use of xylazine as a sedative and muscle relaxant. Three elephant calves with different degrees of tameness were trained using xylazine. The drug was helpful in the training process. Xylazine made restraint of the elephants much easier and safer. During training, repeated doses of xylazine were used to prevent beatings, the wounds worsening and to pacify the elephants. The tamest elephant calf was punished less and took less time to be trained than the others. It is important to play with elephant calves to win their acceptance of man. A tame calf still needs training to learn about fettering, walking, sitting, etc. Elephants need to be considered man's working companions, and deserve sympathy and humane treatment.

Journal Article↗
PubMed1993

The she-male phenomenon and the concept of partial autogynephilia.

The term autogynephilia denotes a male's propensity to be sexually aroused by the thought or image of himself with female attributes. Some autogynephiles imagine themselves, in their sexual fantasies, as complete women. Others, here called partial autogynephiles, imagine themselves with a mixture of male and female anatomic features, usually women's breasts and men's genitals. Partial autogynephiles evince a particular sexual interest in those individuals known in the vernacular as she-males. These are men, often involved in prostitution or pornography, who have undergone breast augmentation while maintaining their male genitals. Partial autogynephiles appear less likely to pursue surgical sex reassignment than gender-dysphoric men whose erotic self-image includes a vagina. Some patients with a persistent desire for women's breasts but no or conflicted desires to live as women full-time or undergo vaginoplasty may be pacified with mildly feminizing doses of estrogenic hormones.

Adult↗
PubMedDate not supplied

Psychoactive plants and ethnopsychiatric medicines of the Matsigenka.

For the Matsigenka of the Peruvian Amazon, health and well-being in daily life depend upon harmonious relationships within the social group and with the spirit world. Psychoactive plants play a crucial role in curing disrupted social relationships while giving humans access to the otherwise remote, parallel world of spirits. Different species and cultivars of psychoactive plants, as well as varying admixtures and doses, are used to obtain different intensities and qualities of psychoactive experience, depending upon the individual's goals. Strongly psychoactive plants are used by shamans to travel to the realm of spirits. A number of mild to strongly psychoactive plants are used by male hunters to purify their souls and improve their aim. Mildly psychoactive plants are used to improve women's concentration for spinning and weaving cotton, to control negative emotions such as grief and anger, to manipulate the content of dreams, and to pacify sick or frightened children. A majority of such remedies come from the botanical families of Rubiaceae, Solanaceae and Cyperaceae, known sources of psychoactive compounds. Interdisciplinary research into the culture, botany and pharmacology of psychoactive plants in indigenous medical systems contributes to a better understanding of the role of psychological states in human health and well-being.

Ethnobotany↗
PubMed2001

The effect of high-pass filtering on TEOAE in 2-month-old infants.

The aim of the present study was to investigate the effect of high-pass filtering on TEOAE obtained from 2-month-old infants as a function of filter cut-off frequency, activity states and pass/fail status of infants. Two experiments were performed. In Experiment 1, 100 2-month-old infants (200 ears) in five activity states (asleep, awake but peaceful, sucking a pacifier, feeding, restless) were tested by use of TEOAE technology. Five different filter conditions were applied to the TEOAE responses post hoc. The filter conditions were set at 781 Hz (default setting), 1.0, 1.2, 1.4 and 1.6 kHz. Results from this experiment showed that TEOAE parameters such as whole-wave reproducibility (WR) and signal-to-noise ratio (SNR) at 0.8 kHz and 1.6 kHz, changed as a function of the cut-off frequency. The findings suggest that the 1.6 kHz and 1.2 kHz filter conditions are optimal for WR and SNR pass/fail criteria, respectively. Although all infant recordings appeared to benefit from the filtering, infants in the noisy states seemed to benefit the most. In Experiment 2, the high-pass filtering technique was applied to 23 infants (35 ears) who apparently failed the TEOAE tests on initial screening but were subsequently awarded a pass status based on the results from a follow-up auditory brainstem response (ABR) assessment. The findings showed a significant decrease in noise contamination of the TEOAE with a corresponding significant increase in WR. With high-pass filtering at 1.6 kHz, 21/35 ears could be reclassified into the pass category.

Acoustic Stimulation↗