Classic Maya bloodletting and the cultural evolution of religious rituals: quantifying patterns of variation in hieroglyphic texts.

Religious rituals that are painful or highly stressful are hypothesized to be costly signs of commitment essential for the evolution of complex society. Yet few studies have investigated how such extreme ritual practices were culturally transmitted in past societies. Here, we report the first study to analyze temporal and spatial variation in bloodletting rituals recorded in Classic Maya (ca. 250-900 CE) hieroglyphic texts. We also identify the sociopolitical contexts most closely associated with these ancient recorded rituals. Sampling an extensive record of 2,480 hieroglyphic texts, this study identifies every recorded instance of the logographic sign for the word ch'ahb' that is associated with ritual bloodletting. We show that documented rituals exhibit low frequency whose occurrence cannot be predicted by spatial location. Conversely, network ties better capture the distribution of bloodletting rituals across the southern Maya region. Our results indicate that bloodletting rituals by Maya nobles were not uniformly recorded, but were typically documented in association with antagonistic statements and may have signaled royal commitments among connected polities.

Testing the Paleolithic-human-warfare hypothesis of blood-injection phobia in the Baltimore ECA Follow-up Study--towards a more etiologically-based conceptualization for DSM-V.

OBJECTIVE: The research agenda for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has emphasized the need for a more etiologically-based classification system, especially for stress-induced and fear-circuitry disorders. Testable hypotheses based on threats to survival during particular segments of the human era of evolutionary adaptedness (EEA) may be useful in developing a brain-evolution-based classification for the wide spectrum of disorders ranging from disorders which are mostly overconsolidationally such as PTSD, to fear-circuitry disorders which are mostly innate such as specific phobias. The recently presented Paleolithic-human-warfare hypothesis posits that blood-injection phobia can be traced to a "survival (fitness) enhancing" trait, which evolved in some females of reproductive-age during the millennia of intergroup warfare in the Paleolithic EEA. The study presented here tests the key a priori prediction of this hypothesis-that current blood-injection phobia will have higher prevalence in reproductive-age women than in post-menopausal women. METHOD: The Diagnostic Interview Schedule (version III-R), which included a section on blood and injection phobia, was administered to 1920 subjects in the Baltimore ECA Follow-up Study. RESULTS: Data on BII phobia was available on 1724 subjects (1078 women and 646 males). The prevalence of current blood-injection phobia was 3.3% in women aged 27-49 and 1.1% in women over age 50 (OR 3.05, 95% CI 1.20-7.73). [The corresponding figures for males were 0.8% and 0.7% (OR 1.19, 95% CI 0.20-7.14)]. CONCLUSIONS: This epidemiological study provides one source of support for the Paleolithic-human-warfare (Paleolithic-threat) hypothesis regarding the evolutionary (distal) etiology of bloodletting-related phobia, and may contribute to a more brain-evolution-based re-conceptualization and classification of this fear circuitry-related trait for the DSM-V. In addition, the finding reported here may also stimulate new research directions on more proximal mechanisms which can lead to the development of evidence-based psychopharmacological preventive interventions for this common and sometimes disabling fear-circuitry disorder.

Factors affecting children's attitudes toward health care and responses to stressful medical procedures.

Assessed factors hypothesized to influence children's and mothers' attitudes toward health care phenomena and children's distress during a stressful medical procedure in a pediatric outpatient clinic. Children, ages 6-11 years, and their mothers attending a county health department for a well-child physical examination participated. Pearson correlation coefficients were calculated and hierarchical regression analyses were conducted. Results indicated that several factors, including age, health locus of control, and maternal health care attitudes were significant predictors and/or correlates of children's attitudes toward health care and their behavioral responses during an aversive procedure. Implications of these findings for health prevention and education efforts with children are discussed.

Use of a phlebotomy service in a paediatric unit.

This article evaluates the literature and research concerning venepuncture and the use of a phlebotomy service in an acute paediatric setting. It also highlights concerns expressed by nursing and medical staff about the introduction of such a service.

Use of distraction with children during an acute pain experience.

The purpose of this study was to investigate the effectiveness of a distraction technique in reducing a child's perceived pain and behavioral distress during an acute pain experience. A convenience sample of 100 children, ages 3 years 6 months through 12 years 11 months, scheduled for routine blood draws, was recruited and randomly assigned to an experimental or control group. During venipuncture, the control subjects received standard preparation, which consisted of being comforted by physical touch and soft voices, while experimental subjects were encouraged to use a kaleidoscope as a distraction technique. Results of the MANCOVA, with age as a covariate, indicated a significant difference between the groups. Univariate post hoc tests confirmed that the experimental group perceived less pain and demonstrated less behavioral distress than the control group.

An analysis of a behavioral intervention for children undergoing venipuncture.

An examination of factors was conducted to determine the effectiveness of the distraction component of a behavioral intervention (use of a party blower). In one condition, parents were instructed to coach children in the use of a party blower and to praise child cooperation. In a second condition, nurses were instructed to assist parents in coaching the child. Parents used the coaching skills they learned and got their children to use the distraction technique. Use of the distraction technique was associated with less crying. Encouragement from a health care professional and intervention early in the procedure did not enhance the intervention's effectiveness. Older children and children who were less distressed during the initial phase of the procedure were less likely to reject the intervention.

Factors influencing young children's coping behaviors during stressful healthcare encounters.

The authors examined the coping behaviors of 80 preschool children during venipuncture, and selected situational and personal variables thought to influence their coping. The children's behaviors were recorded on the Children's Coping Strategies Checklist-Intrusive Procedures; the helpful behaviors of health professionals were recorded on the Nursing Actions Checklist. Information about specific influencing variables was gathered through questionnaires and parent interviews. The children's report of procedural pain was correlated with the number of coping behaviors used, with the children's attempts to protect themselves, and with helpful nursing interventions. Socioeconomic status, nursing interventions, and preparation for the procedure had low to moderate correlations with number and type of the children's coping behaviors. The results indicate that a child's coping is related to the situation, and the actions of professionals in that situation rather than to the characteristics of the individual child.

Cortisol and heart rate changes in first- and fourth-time donors.

It is well-known that during blood donation some subjects experience mild, moderate, or severe stress reactions. The frequency of these reactions is higher in first-time donors than in experienced ones. However, hormonal variations might nevertheless be present in subjects who show no clinical reaction. Cortisol is the hormone classically involved in response to stress. The aim of this study was to evaluate cortisol behavior in blood donors who did not manifest clinical reaction. Cortisol was studied before and after the first and fourth blood donation in 20 blood donors, aged 25-45 years. Blood pressure and heart rate were also evaluated. Plasma cortisol concentrations decreased during the first (from 202.6 +/- 9.2 ng/ml at -15 min, to 147.5 +/- 8.0 ng/ml, at +30 min; p < 0.001), but not during the fourth (142.5 +/- 7 ng/ml vs. 153.0 +/- 10.1 ng/ml) blood donation; blood pressure remained stable throughout donations, while the heart rate significantly decreased (from 78 to 68 beats/min; p < 0.001) only during the first experience. The increased cortisol levels observed before the first donation are apparently due to emotional components, since they were not observed in experienced donors. We may conclude that blood donation per se is not a stressful event and that moderate stress, as suggested by the increased cortisol levels and heart rate at the first donation, is secondary to emotional rather than to physical factors and occurs during a never-experienced-before event.

Family history of hypertension and pain during blood donation.

Parental history of hypertension was associated with significantly lower venipuncture pain ratings in women with little or no blood donation experience. Healthy men (N = 288) and women (N = 434) presenting at Red Cross blood donor clinics provided pain ratings in response to an initial blood sample and venipuncture for blood donation. Analyses were restricted to 460 individuals with and without a confirmed parental history of hypertension (N = 188 and 272, respectively). There were no significant gender or parental history effects on initial blood sample pain ratings. Significantly lower venipuncture pain ratings were observed 1) for men vs. women, 2) for more experienced blood donors, and 3) among subjects with 0-1 previous donations, for women with vs. women without a parental history of hypertension. Although pain ratings were positively correlated with subjective anxiety throughout donation, there were no significant differences in anxiety ratings between women with and without a parental history of hypertension. The results provide suggestive evidence of an association between genetic risk for hypertension and decreased pain sensitivity.

Common toxicities of cancer chemotherapy.

Sixty cancer patients who were receiving chemotherapy at an outpatient Oncology Centre were surveyed for their views on a list of treatment-related toxicities. The severity of each toxicity was assessed using a visual analogue scale. Sixty percent of patients felt that the overall toxicity was acceptable. Ten percent felt like giving up. Problem with venous access was named the worst toxicity by 37% of patients, followed by nausea and vomiting (19%), and long waiting time (11%). Male patients tended to tolerate chemotherapy better. The female patients were significantly more affected by hair loss than their male counterpart. Better understanding of the toxicities of chemotherapy as perceived by the patients themselves allows them to take appropriate measures in improving their quality of life.

Venepuncture causes rapid rise in plasma ACTH.

Serum cortisol and adrenocorticotropin (ACTH) levels were measured on nine sleeping volunteers at midnight, before and after the stress of being woken and exposed to a single standard venepuncture. In six volunteers, plasma ACTH levels were raised within 90 seconds of venepuncture, while it remained undetectable in the other three. Cortisol levels began to rise within 4 minutes. ACTH and cortisol levels may be greatly altered by the stress of venesection. Plasma ACTH measured after a difficult venesection in a subject with poor venous access may be misleading.

Treatment adherence difficulties among children with cancer: the role of parenting style.

Investigated the prevalence of treatment adherence problems among children undergoing cancer treatment and explored the relationship of sociodemographic factors, child functional status, and parenting style to these difficulties. Nurse ratings of adherence difficulties encountered during the cancer treatment regimen were completed on 77 children and their caregivers. A subset of caregivers also completed a measure of parenting attitudes and practices. Results indicated that certain adherence difficulties were related to the child's age and functional status, the family's socioeconomic status (SES), and parenting style. The child's age was related to adherence to procedure-related tasks; younger children had more frequent problems with completing these tasks. More functional children had a greater number of adherence problems. Families with a lower SES had more difficulties with timeliness and cancellations/delays of clinic appointments and promptness of reporting of the child's reactions to treatment. Children of caregivers who had a more "supportive" parenting style (were more sensitive to children's input, had a less restrictive attitude towards parenting, and were more nurturant) canceled and delayed fewer appointments, were on time more frequently for appointments, and reported reactions to treatment with less delay. Implications of these findings for future research on treatment adherence and for clinical interventions are discussed.

Blood-letting in bulimia nervosa.

Three cases of blood-letting in association with bulimia nervosa are reported. This association has not previously been described.

Children's venipuncture pain: influence of technical factors.

Several aspects of venipuncture technique were evaluated to assess their relationship to reported pain. Subjects were 514 children aged 5-17 who had venipuncture performed by a technician in a hospital outpatient laboratory. A research assistant timed the duration of venipuncture and then obtained visual analogue pain scores from the children following venipuncture. Blood volume obtained from venipuncture was also measured. The technician who performed the procedure, amount of blood drawn, and time required to complete the venipuncture did not contribute to the prediction of children's pain. Age and anxiety, which were treated as covariates, were significant predictors of pain. The distribution of pain experienced by children was positively skewed and about one-third of children were above the mean pain score. From the results of this study, venipuncture pain can be recommended for the study of issues in children's pain. Further, the findings recommend the development and utilization of interventions to reduce children's venipuncture pain.