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(2) HIGH
RATE OF CAESAREAN SECTIONS SEEN IN
LATIN AMERICA
- BUT IS THIS THE PREFERENCE
OF WOMEN OR
HEALTHCARE WORKERS?
(3) OVERNIGHT
CALLS IN PRIMARY CARE CAN BE
HANDLED BY
NURSE TELEPHONE
CONSULTATION
SERVICE
(1) PACIFIERS
AND SUGARY SOLUTIONS MAY HELP
RELIEVE PAIN IN NEWBORN BABIES
(Randomised trial of analgesic effects
of sucrose, glucose and
pacifiers in term neonates)
http://www.bmj.com/cgi/content/full/319/7222/1393
Giving newborn babies who undergo painful
medical
procedures a small amount of a sugary
solution followed by a
pacifier to suck (known as a dummy in
the UK) can help to
alleviate their distress, say authors
of a study in this week's
BMJ. This technique is also simple and
safe and should be
widely used, say the research team.
Dr Ricardo Carbajal et al from Poissy Hospital
in France
studied 150 new born babies and their
response to pain when
undergoing the routine procedure of taking
blood samples
(venepuncture) during their first few
days of life. The research
team used a recognised rating scale to
ascertain "pain" in the
babies, which is based on the facial expression,
limb
movements and vocal expression of the
infant. The team then
observed the individual and combined effects
of giving the
babies oral sugar (in the form of glucose
and sucrose
solutions) and pacifiers as well as the
effects of receiving
neither.
They found that pacifiers had a better
analgesic effect than the
sweet solutions, but that the best method
of reducing pain
was a combination of sucrose solution
(made from sterile
water mixed with sugar) followed by sucking
on the pacifier.
Carbajal et al suggest that the pain relief
elicited by sweet
solutions is probably because they activate
painkillers that
occur naturally in the body ('endogenous
opioids').
However, the precise mechanism by which
pacifiers relieve
pain is unknown, say the authors. They
speculate that the
effect may be due to "sensory dominance"
whereby the
sensation elicited by sucking is so strong
that it diverts their
attention away from the pain or because
pacifiers enhance
their ability to cope with the pain because
babies find sucking
on a pacifier a pleasurable activity.
Carbajal et al conclude that minor procedures,
such as taking
blood, are common in newborns and that
giving these infants
an oral sweet solution followed by a pacifier
to suck is a
simple, non-invasive and safe method that
can relieve pain.
They therefore advocate that these methods
be more widely
used.
Contact:
Dr Ricardo Carbajal, Paediatrician, Department
of
Paediatrics, Poissy Hospital, France
Email: carbajaal@club-internet.fr
(2) HIGH RATE
OF CAESAREAN SECTIONS SEEN IN
LATIN AMERICA - BUT IS THIS THE PREFERENCE
OF WOMEN OR HEALTHCARE WORKERS?
(Rates and implications of caesarean
sections in Latin
America: ecological study)
http://www.bmj.com/cgi/content/full/319/7222/1397
(Commentary: all women should have
a choice)
http://www.bmj.com/cgi/content/full/319/7222/1397#resp1
(Commentary: increase in caesarean
sections may reflect
medical control not women's choice)
http://www.bmj.com/cgi/content/full/319/7222/1397#resp2
(Commentary: "health has become secondary
to a sexually
attractive body")
http://www.bmj.com/cgi/content/full/319/7222/1397#resp3
Rates of caesarean births are high in the
majority of Latin
American countries, which is leading to
an unnecessary
increased risk for young women and their
babies, claim
researchers in this week's BMJ. Dr Jos
Belizn and
colleagues from the World Health Organisation
in Uruguay
also observe a link between the level
of caesareans within the
richer countries and among more affluent
women.
Commentators on the study argue that the
reasons behind the
high level of caesarean sections in this
part of the world may
be because this method of birth is more
"convenient" for
healthcare workers or because women believe
that a
caesarean section will leave them with
a more "sexually
attractive body" than a vaginal birth.
Dr Jos Belizn and colleagues from the World
Health
Organisation (WHO) in Uruguay studied
births in 19 Latin
American countries and estimate that in
twelve of these,
caesarean section rates range between
16.8 and 40 per cent
of births (the WHO recommended in 1985
that caesareans
should account for no more than 15 per
cent of all births).
Based on their estimates of national caesarean
section rates,
the authors calculate that 850,000 unnecessary
caesareans
are performed each year in the region
and that concerted
action from public health authorities,
medical associations,
medical schools, health professionals
and the media are
needed to reduce the rates.
But why shouldn't women "side-step their
biblical sentence
to painful childbirth", ask Professor
Elaine Showalter and
Anne Griffin from Princeton University
in an accompanying
editorial. They argue that the biggest
issue surrounding
caesarean births is not that wealthier
women are having more
but that women in underdeveloped countries
are being denied
the option. Showalter and Griffin also
claim that the WHO
guidelines of 15 per cent for national
caesarean section rates
are "arbitrarily chosen and need to be
reviewed" and that
"women's equal access to quality medical
services should be
our central concern".
In a separate commentary Dr Arachu Castro
from Harvard
School of Public Health writes that "the
systematic use of
medical technology, justified by the idea
that a woman's
body is not capable of giving birth without
medical
intervention, seems to be more directed
towards the
convenience of healthcare professionals
than the benefit of the
women in labour". She argues that by having
a woman in a
horizontal position, connected to a hormone
drip, having
undergone epidural anaesthesia and wired
up to an electronic
fetal monitor "creates the impression
that she is being taken
care of". On the contrary, Castro says,
women tend to
perceive such an experience as painful,
frightening and
confusing and she concludes that women
should be given
back the central role in childbirth and
that new guidelines
restricting the use of caesarean sections
while improving the
quality of care should be welcomed.
The reason behind the high rates of caesarean
sections among
Latin American women is that they want
to avoid genital
damage, because "health has become secondary
to a
sexually attractive body" argues Hilda
Bastian a consumer
health advocate from Australia in a third
commentary on
Belizn et al's paper. She fears that the
"fashion" for
caesarean sections could grow in to "something
far worse"
and just as when upper class women in
the last century
abandoned breast feeding it will be the
poorer families who
pay the cost of this trend.
Contact:
Dr Jos Belizn, Director, Latin American
Centre for
Perinatology, Pan American Health Organisation,
World
Health Organisation, Montevideo, Uruguay
Email: belizanj@clap.ops-oms.org
Professor Elaine Showalter, Professor of
English, Princeton
University Department of English, Prinecton,
USA
Email: 112075.445@compuserve.com
Dr Arachu Castro, Research Associate, Department
of
Population and International Health, Harvard
School of
Public Health, USA
Email: acastro@hsph.harvard.edu
Hilda Bastian, Consumer health advocate,
Blackwood,
Australia
Email: hilda.bastian@flinders.edu.au
(3) OVERNIGHT
CALLS IN PRIMARY CARE CAN BE
HANDLED BY NURSE TELEPHONE
CONSULTATION SERVICE
(Overnight calls in primary care:
randomised controlled trial
of management using nurse telephone
consultation) BMJ
http://www.bmj.com/cgi/content/full/319/7222/1408
A nurse telephone consultation service
can manage as high a
proportion of primary care calls at night
as it can during
evenings and weekends, report a team of
researchers in this
week's BMJ. In their study conducted in
Wiltshire, Felicity
Thompson from the University of Southampton
and
colleagues also found that the telephone
consultation service
did not lead to the patients that were
dealt with attending a
daytime surgery in the subsequent three
days.
Thompson et al conducted the study within
a 55 member
general practice co-operative serving
97,000 patients. The
night nurse telephone consultation service
ran over two
two-week periods during the Autumn of
1997 from 11.15pm
to 8am. They found that 59 per cent of
calls were handled by
the nurse alone. /more follows However,
over the same
period as the study, the team also found
that the evening and
weekend service received over four times
as many calls, in
fewer hours as were received during the
night. They therefore
conclude that a nurse telephone consultation
service operated
at a co-operative level might therefore
be uneconomic at
night. The economies of scale offered
by larger groups of
practices or by the NHS Direct services,
may prove
beneficial, they say.
Contact:
Dr Steve George, Director, University of
Southampton
Health Care Research Unit, Community Clinical
Sciences
Division, Southampton General Hospital,
Southampton
Email: pluto@soton.ac.uk
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