Development and evaluation of a newborn care education programme in primiparous mothers in Nepal.

BACKGROUND: the health and survival of newborns depend on high levels of attention and care from caregivers. The growth and development of some infants are unhealthy because of their mother's or caregiver's lack of knowledge or the use of inappropriate or traditional child-rearing practices that may be harmful. OBJECTIVE: to develop a newborn care educational programme and evaluate its impact on infant and maternal health in Nepal. DESIGN: a randomised controlled trial. PARTICIPANTS: one hundred and forty-three mothers were randomly assigned to the intervention (n=69) and control (n=74) groups. Eligible participants were primiparous mothers who had given birth to a single, full-term, healthy infant, and were without a history of obstetric, medical, or psychological problems. METHODS: prior to being discharged from the postnatal unit, the intervention group received our structured newborn care education programme, which consisted of one-on-one educational sessions lasting 10-15minutes each and one postpartum follow-up telephone support within two weeks after discharge, in addition to the hospital's routine general newborn care education. The control group received only the regular general newborn care education. Outcomes were measured by using Newborn care Knowledge Questionnaires, Karitane Parenting Confidence Scale, State-Trait Anxiety Inventory for Adults and infant health and care status. FINDINGS: the number of mothers attending the health centre due to the sickness of their babies was significantly decreased in the intervention group compared to the control group. Moreover, the intervention group had significant increases in newborn care knowledge and confidence, and decreases in anxiety, compared with the control group. CONCLUSIONS: the structured newborn care education programme enhanced the infant and mother health. Moreover, it increased maternal knowledge of newborn care and maternal confidence; and reduced anxiety in primiparous mothers. Thus, this educational programme could be integrated into routine educational programs to promote maternal and infant well-being in Nepalese society.

Translation and validation of the Karitane Parenting Confidence Scale in Nepali language.

BACKGROUND: a mother׳s lack of confidence in the early postnatal period may negatively influence their ability to care for their infant. Parenting confidence contributes to the parent-infant relationship and other aspects of infant development. The Karitane Parenting Confidence Scale is a 15-item self-report questionnaire designed to measure parents' subjective confidence in their parenting abilities, or 'perceived parenting self-efficacy', and is designed for mothers with infants aged 0-12 months. OBJECTIVES: to translate the Karitane Parenting Confidence Scale into Nepali language and assess the validity and reliability among Nepalese postnatal mothers. DESIGN: cross-sectional study. SETTING: outpatient department of maternity and women׳s hospital in Kathmandu, Nepal. PARTICIPANTS: one hundred postnatal mothers within 5-6 weeks of childbirth were recruited using the convenience sampling method. METHODS: following back-translation procedures, mothers completed questionnaires during follow-up visit at immunisation/postnatal clinics. For the validity and reliability have been assessed internal consistency, discriminant validity, and construct validity. RESULTS: the translated Karitane Parenting Confidence Scale mean score was 35.47±5.48, ranging from 32 to 42. Cronbach׳s alpha coefficient for internal consistency was 0.87. A difference was found between primiparous and multiparous mothers׳ confidence scores. There was a significant correlation between maternal confidence and anxiety scores. Demographic response patterns suggest that the maternal confidence level was affected by education level. CONCLUSIONS: the Nepali version of Karitane Parenting Confidence Scale showed adequate reliability and validity. Therefore, the Nepali Karitane Parenting Confidence Scale is considered a suitable instrument to assess maternal confidence in Nepali postnatal mothers.

Nepalese primiparous mothers' knowledge of newborn care.

A cross-sectional study was carried out to explore the knowledge level of newborn care and to investigate the relationship between newborn-care knowledge and selected demographic variables among primiparous mothers. It was carried in outpatient department of a maternity and women's hospital in Kathmandu, Nepal with 276 primiparous mothers between 38 and 42 weeks of gestation. Data were collected during the antenatal period with using two instruments: the Newborn-care Knowledge Questionnaire and State-Trait Anxiety Inventory for Adults. Participants had a moderate level of knowledge on newborn care (56%), and among its four components, participants had lowest knowledge in breastfeeding (44%) and adequate knowledge (78%) of immunization. Maternal education and socioeconomic status had a significant, positive association with newborn-care knowledge. Newborn-care knowledge was strongly predicted by anxiety. This is the first study to examine the maternal levels of knowledge of newborn care in Nepal. This study identified specific knowledge gaps in newborn care among primiparous mothers. Moreover, the results suggest the need of maternal-education programs in improving the health and well-being of mothers and newborns.

Atrial fibrillation induced by applying acetylcholine to subadventitial layer of pulmonary vein in normal canine heart.

OBJECTIVES: We determined whether acetylcholine (Ach) application to the pulmonary vein (PV) wall could induce AF and clarified its mechanisms, and determined whether circumferential PV radiofrequency ablation (CPVA) could prevent Ach-induced AF in canine hearts. METHODS: Thirty seven beagle dogs were used for the study. Ach was injected into the subadventitial layer of the left superior PV (LSPV), at different distance from the LSPV-left atrium junction (LSPV-LA-J) to locate AF initiation. When AF was not induced by Ach alone, programmed electrical stimulation (S1-S2 method) was added to elicit AF. Atropine was injected at the same site of Ach injection to determine whether muscarine-receptor blockade suppressed AF, and CPVA at the LSPV-LA-J was performed using a newly devised basket electrode-catheter. RESULTS: AF was reproducibly induced by Ach injection in 19 of the 26 dogs (73%). S1-S2 method after Ach initiated AF in 5 of the remaining 7 dogs. Ach into the subadventitial layer of the LSPV, especially the distal portion, could elicit AF, which was preceded by pause (sinus arrest) ≥ 2.0 sec (37%) (pause-AF group), sinus bradycardia (32%) (brady-AF group) and sinus tachycardia (32%) (tachy-AF group). The time from Ach injection to AF initiation and AF duration were not significantly different between pause-AF, brady-AF and tachy-AF groups. AF was not initiated by injecting Ach after atropine pretreatment. To eliminate AF, 1-6 (average 4.1 ﾂｱ 1.2) CPVAs at the LSPV-LA-J were required. CONCLUSIONS: Our observations suggest that local Ach application can initiate AF in PVs, preceded by a variety of modes such as pause, bradycardia or tachycardia, and an increase in vagal tone at the LSPV plays a critical role in eliciting AF in structurally normal heart.

Circadian distribution of paroxysmal atrial fibrillation in patients with and without structural heart disease in untreated state.

BACKGROUND: This study aimed to compare the circadian distribution of the onset, maintenance and termination of paroxysmal atrial fibrillation (PAF) between structural and non-structural heart diseases (SHD and NSHD, respectively) in the untreated state. SUBJECTS AND METHODS: We included 217 patients with 338 PAF (79 SHD patients with 131 episodes; 138 NSHD patients with 207 episodes). The probabilities for the onset, maintenance and termination of PAF for each hour were analyzed using Holter monitoring data and harmonic models being fitted into a cosinusoidal function. RESULTS: The SHD group had a triphasic circadian pattern at the onset with higher peaks at midnight, in the early morning and in the late afternoon (p < 0.05), whereas the NSHD group showed a single peak at midnight (p < 0.01). The probability of maintenance revealed a single peak during midnight (SHD, p < 0.0001; NHD, p < 0.01). The termination showed a peak at noon in the SHD group (p < 0.05), whereas there was a double peak at 10:00 am and 8:00 pm in the NSHD group (p=0.06). RR intervals just after the PAF onset showed marked shortening in the daytime initiation PAF as compared to the nighttime initiation PAF in both SHD and NSHD groups (p < 0.01). CONCLUSION: These observations suggest that the SHD group has very complex onset hours, whereas the NSHD group shows complex termination hours. Reflexly accelerated sympathetic tone just after the PAF onset is suggested in the daytime initiation PAF.

The relationship between the parturient's positions and perceptions of labor pain intensity.

BACKGROUND: While the effect of the maternal position on reducing labor pain has been studied, the data presented to date have not been conclusive. OBJECTIVES: To determine if maternal position reduced the intensity of labor pain during cervical dilatation from 6 to 8 centimeters. METHOD: Pain intensity was measured using the visual analogue scale (VAS) on 39 primiparous and 19 multiparous women (N = 58) who alternately assumed the sitting and supine positions for 15 minutes during cervical dilatation from 6 to 8 centimeters. RESULTS: The pain scores for the sitting position were significantly lower than those for the supine position. The Wilcoxon signed-ranks test showed the VAS scores for the (a) total labor pain ("total" being defined as both abdominal and lumbar pain) during contraction (p =.011), (b) continuous total labor pain (p =.001), (c) lumbar pain during contraction (p <.001), and (d) continuous lumbar pain (p <.001) in the sitting position (significantly lower than in supine position). The diminished pain scores were greater than 13 millimeters, which is the minimum clinically significant change in patient pain severity as measured with the 100 millimeter VAS. The largest decrease occurred in lower back pain. No significant differences were found for abdominal pain scores in either the sitting or supine positions. CONCLUSION: The sitting position offers an effective method to relieve lower back labor pain during cervical dilatation from 6 to 8 centimeters. Similar relief was experienced for women who reported pain only on contraction as well as those with continuous pain.