Hypnosis to Reduce Distress in Children Undergoing Anorectal Manometry: A Randomized Controlled Pilot Trial

Background/Aims@#To assess the effectiveness and feasibility of a brief session of hypnosis to reduce distress in children with functional constipationundergoing anorectal manometry (ARM). @*Methods@#A partially-blinded randomized controlled pilot trial was conducted in children 4-18 years old scheduled for ARM. Children were randomized to receive a brief session of hypnosis prior to ARM or standard care. Non-blinded and blinded observers rated the child’s level of distress using the Observation Scale of Behavioral Distress and a 4-point-Likert scale, respectively. Differences between groupswere analyzed using Fisher’s exact test or Mann-Whitney U test as appropriate. @*Results@#Data from 32 children (15 hypnosis and 17 standard care) were analyzed. Prior to insertion of the catheter, the observed mean levels of distress were lower in the hypnosis group according to both the non-blinded observer (median 0.0 [interquartile range {IQR} 0.0-0.3] vs 1.4 [IQR 0.3-2.4]; P = 0.009) and the blinded observer (median 0.0 [IQR 0.0-0.0] vs 0.5 [IQR 0.0-1.0]; P = 0.044). During ARM, observed and reported levels of distress did not differ significantly. In the hypnosis group, 92.9% of parents and childrenreported that hypnosis helped the child to relax. There were no significant differences in resting pressure, squeeze pressure, or duration of the procedure between both groups. @*Conclusion@#A brief session of hypnosis for children before ARM is an easily incorporable intervention that lowers distress levels prior to theprocedure and is positively perceived by children and parents.

Taiwanese Parents' Experience of Making a "Do Not Resuscitate" Decision for Their Child in Pediatric Intensive Care Unit

PURPOSE: The purpose of this project was to explore the parental experience of making a "do not resuscitate" (DNR) decision for their child who is or was cared for in a pediatric intensive care unit in Taiwan. METHODS: A descriptive qualitative study was conducted following parental signing of a standard hospital DNR form on behalf of their critically ill child. Sixteen Taiwanese parents of 11 children aged 1 month to 18 years were interviewed. Interviews were recorded, transcribed, analyzed and sorted into themes by the sole interviewer plus other researchers. RESULTS: Three major themes were identified: (a) "convincing points to sign", (b) "feelings immediately after signing", and (c) "postsigning relief or regret". Feelings following signing the DNR form were mixed and included "frustration", "guilt", and "conflicting hope". Parents adjusted their attitudes to thoughts such as "I have done my best," and "the child's life is beyond my control." Some parents whose child had died before the time of the interview expressed among other things "regret not having enough time to be with and talk to my child". CONCLUSION: Open family visiting hours plus staff sensitivity and communication skills training are needed. To help parents with this difficult signing process, nurses and other professionals in the pediatric intensive care unit need education on initiating the conversation, guiding the parents in expressing their fears, and providing continuing support to parents and children throughout the child's end of life process.

Land use and water quality in guangzhou, china: a survey of ecological and social vulnerability in four urban units of the rapidly developing megacity

This interdisciplinary paper aims at Guangzhou's development and its effects on surface and groundwater quality taking the new city axis as an example. Qualitative morphological analyses, field mappings, interviews and water sampling of standard in-situ and various hydrochemical parameters were conducted between 2007 and 2009 in order to examine the following research questions: Which types of land use can be found within the new city axis? Are there infrastructure differences of water supply and wastewater disposal? How does land use affect the quality of surface and groundwater? How do inhabitants perceive and appraise settlement structures, infrastructures and environmental quality and how do they cope with their individual situation? Within four small-scale research areas, so-called urban units, different stages and types of development and factors influencing the water resources as well as spatial variations of water quality could be identified. Deficits in city planning, water supply and sanitation lead, for example, to informal building expansion and groundwater use as well as to high concentrations of coliform bacteria in urban rivers. A wide range of ecological and social vulnerabilities became obvious

Dynamics of ecosystem service value caused by land use changes in manas river of xinjiang, China

This study aims to quantify the impacts of land use changes on ecosystem service value during large scale land development, and to provide key information for both economic development and policy makers for eco-environmental protection. The study area locates in Manas river watershed which is a typical land development region in northwest China. Landsat MSS/TM/ETM+ images in 1976, 1989, 1999 and 2008 were applied to estimate ecosystem service value based on land use, and subsequently ecosystem service value dynamics were analyzed in response to land use changes. It is found that the built-up area and cultivated land increased significantly from 1976 to 2008. The decreasing ecosystem service value [from 17362.2 million Yuan in 1976 to 16975.0 million Yuan in 2008] is mainly caused by the reduced grassland. The combined ecosystem service value of water body and grassland is over 60% of the total value. Functions of water supply, waste treatment, soil formation and retention and biodiversity protection contributed to over 70% of the total service value. The results suggest that a reasonable land use plan should emphasize protection of water body, woodland and grassland as they have the highest ecosystem service value

Mushroom poisoning surveillance analysis, Yunnan province, China, 2001-2006

Background: In Yunnan, China, 17,000 tons of mushrooms are harvested annually.  Yunnan is home to at least 150 poisonous species of mushrooms. From 1985 to 2000, 378 mushroom poisoning events were reported, including 326 deaths. In 2004, China established new reporting criteria and report forms.  We undertook a descriptive study of mushroom poisoning in Yunnan from 2001-2006.  Methods: We reviewed surveillance data from 2001-2006.  We analyzed all investigation forms submitted from 2004-2006, including data on mushroom species.  County level climactic and demographic data were collected and analyzed for association with mushroom poisoning.  Double-entry was performed and data was analyzed using Epi Info 3.3.2. Results: From 2001-2006, 97 events including 662 cases and 148 deaths were reported.  The overall case fatality rate was 22.4 % (Mean: 30.7%; SD: 15.7). The mortality rates due to mushroom poisoning in 2001-2006 were 0, 0.01, 0.03, 0.07, 0.17, and 0.06 per 100,000 respectively. Most (86.6 %) events occurred from May to August. Most events occurred in rural settings and were limited to a single household. Counties reporting events had higher average rainfall and lower average income compared to non-reporting counties. All poisoning were associated with ingestion of wild mushrooms, and the Amanita group was the most commonly implicated type. Majority (94.3%) of events was associated with serving fresh mushrooms, and 97.3% of suspected mushrooms were picked by the victims themselves in rural areas. Most (91.6%) victims sought health care service, and majority (65.6%) went to primary care facilities for initial management. Conclusion: Mushroom poisoning is the most common lethal food poisoning with a high CFR in Yunnan. However, the mortality is low. Mushroom poisoning was likely underestimated prior to 2004 due to lack of food poisoning reporting criteria. Event-based surveillance has limited sensitivity and probably overestimates CFR. Prevention efforts are hindered by the difficulty of identifying mushroom species in the field. Cultivated mushroom could be the safer alternatives but altering eating customs is difficult.