Buffered lidocaine for skin infiltration prior to hemodialysis.

This study compared the effects of buffered versus unbuffered lidocaine when used as local anesthetic in preparation for cannulation of the arterial and venous sites of children requiring hemodialysis. The subjects for this study were seven children, ages 6-18 years, observed during 101 dialysis treatments. For each subject undergoing hemodialysis on a given day, one syringe containing 1% lidocaine (L) and one containing buffered lidocaine (BL) were prepared. The BL solution was prepared by adding 2 mL of 8.4% sodium bicarbonate to 20 mL of 1% lidocaine just prior to use. The choice of local anesthetic used for cannulation of the arterial or venous site was randomly assigned to be either L or BL. Nurses, raters, and subjects were blind to contents of the syringe. The procedures for piercing the skin, pausing, and infiltrating were standardized, as was the volume administered. Speed of injection was not controlled. Comparisons of self-reported pain and behavioral observations for L versus BL revealed no significant differences for pain of infiltration or pain of cannulation. Technique variables such as the speed of injection, which tended to be very slow for these children, appear to significantly influence infiltration pain and the relative merits of buffering.

How compliant is compliant? Evaluating adherence with breast self-exam positions.

The present study examined compliance with the three recommended breast self-examination (BSE) positions over a 6-month follow-up period. An ongoing behavioral measure that provided information about the type of exam performed during each BSE occasion was employed. Results indicated that adherence to all three position types was obtained in only 40% of the exams. Forty-two percent of exams were comprised of only one position, with the supine position being the most frequently practiced exam type. Implications of these results with regard to BSE research and current breast cancer screening recommendations are discussed.

Parental anxiety and minor illness.

Anxious parents can present a challenge to pediatricians. This study examines the relationship of the anxiety of parents seeking pediatric care for minor conditions to parental perceptions of the child's present condition, worries about the child not related to the present condition, and other personal worries. Assessments of 150 parents were made regarding parental anxiety, perceptions, and worries before and after a pediatric visit. A high-anxiety group (HAG) and low-anxiety group (LAG) were derived from the 25% most and 25% least-anxious parents. A 2 x 2 repeated-measures analysis of variance revealed that both before and after the pediatric visit, parents in the HAG reported significantly poorer understanding of the child's condition and reported more worry about the reason for the visit, the child's behavior, finances, school or day care, relationships, employment, and future and past events than parents in the LAG (p < .003). The results suggest that factors unrelated to the child influence the anxiety of highly anxious parents of a child with a minor ailment. Actions that focus solely on the child and the child's condition could have a limited impact on anxiety. When faced with an anxious parent of a child with a minor condition, it appears sensible not only to be aware of perceptions and worries related to the child, but also other personal life concerns for that parent, the parent's general tendency to worry or become anxious, and how that parent is processing information.

Parental anxiety and response to symptoms of minor illness in infants.

Examined the relationship between parental anxiety and parental contact with the clinic following a child's initial DPT immunization. The subjects were 80 volunteer mothers who brought their 8-week-old infants to an outpatient clinic for a well-child visit. At the time of the visit, maternal anxiety, anxiety proneness, perception of the infant as fussy or difficult, and demographic information were assessed. Seventy-two hours after the immunization, subjects reported DPT side effects and physician contacts. Discriminant function analysis found that mothers who were anxious prior to DPT administration and who had infant girls were more likely to contact the clinic by telephone. This relationship was independent of prior maternal experience with DPT immunization, maternal perception of the infant's general fussiness, and maternal Trait anxiety.

Anxiety in parents seeking pediatric care.

Interviewed parents of 103 children brought to a pediatric walk-in clinic, before and after seeing a physician. Previsit state anxiety was minimally related to parent perceptions of child's condition or the hospital. Anxiety, perception of child's discomfort, and perception of illness severity decreased while perceived understanding of child's illness increased postvisit. Parent perceptions of their child's condition and of the visit contributed little to the prediction of postvisit anxiety. Parent perceptions of their child's illness and the hospital were minimally related to their level of state anxiety when they brought their child to an acute care service. The visit with the physician decreased parent anxiety and improved parent perceptions of their child's condition, but these effects had little relationship to postvisit anxiety.

The role of social modeling in unexplained pediatric pain.

Interviewed 20 children with recurrent unexplained pain (UP) and 20 children with recurrent explained pain (EP) secondary to sickle cell anemia and their parents to determine the presence of models of pain or illness behavior in the child's environment. The location, intensity, frequency, and environmental consequences of the children's and the models' pain were also assessed. The hypothesis that UP Ss would identify more models was supported. In addition, UP Ss identified more positive consequences of the child's pain behavior while EP Ss identified more negative consequences. Children perceived the frequency and intensity of their pain to be similar to their models', while parents did not report such a relationship. Body location data suggest that children may model either general illness behavior or exact symptoms. Implications for future research are discussed.

The effects of videotape modeling and daily feedback on residential electricity conservation, home temperature and humidity, perceived comfort, and clothing worn: Winter and summer.

Two studies were conducted in all-electric townhouses and apartments in the winter (N = 83) and summer (N = 54) to ascertain how energy conservation strategies focusing on thermostat change and set-backs and other low-cost/no-cost approaches would affect overall electricity use and electricity used for heating and cooling, the home thermal environment, the perceived comfort of participants, and clothing that was worn. The studies assessed the effectiveness of videotape modeling programs that demonstrated these conservation strategies when used alone or combined with daily feedback on electricity use. In the winter, the results indicated that videotape modeling and/or feedback were effective relative to baseline and to a control group in reducing overall electricity use by about 15% and electricity used for heating by about 25%. Hygrothermographs, which accurately and continuously recorded temperature and humidity in the homes, indicated that participants were able to live with no reported loss in comfort and no change in attire at a mean temperature of about 62 degrees F when home and about 59 degrees F when asleep. The results were highly discrepant with prior laboratory studies indicating comfort at 75 degrees F with the insulation value of the clothing worn by participants in this study. In the summer, a combination of strategies designed to keep a home cool with minimal or no air conditioning, in conjunction with videotape modeling and/or daily feedback, resulted in overall electricity reductions of about 15% with reductions on electricity for cooling of about 34%, but with feedback, and feedback and modeling more effective than modeling alone. Despite these electricity savings, hygrothermograph recordings indicated minimal temperature change in the homes, with no change in perceived comfort or clothing worn. The results are discussed in terms of discrepancies with laboratory studies, optimal combinations of video-media and personal contact to promote behavior change, and energy policies that may be mislabeled as sacrificial and underestimate the effectiveness of conservation strategies such as those investigated in these studies.