Adolescents' willingness to use the contraceptive vaginal ring.

OBJECTIVE: The objective of this study was to assess adolescents' attitudes towards the contraceptive vaginal ring (CVR). We also aimed to identify the factors associated with their willingness to use it. METHODS: We conducted a descriptive cross-sectional study. Fifty-nine female volunteers, aged 14 to 18 years, were recruited in a clinical setting. The participants completed a self-administered questionnaire collecting information on sexual and contraceptive history as well as personal and demographic data. After reading information describing the CVR, they were asked about their perceptions of and willingness to adopt this contraceptive method. We used a logistic regression model to assess factors associated with their willingness to use the CVR. RESULTS: Our population was mostly composed of coitally experienced (86%), high school level (71%) adolescents living with their parents (97%). Only a minority (17%) were willing to use the CVR, while 39% remained undecided. Participants were concerned about experiencing vaginal discomfort and difficulty in inserting or removing the ring. They also feared that it would interfere with their sexual activities or cause urinary tract infections, leukorrhea, or vaginitis. Willingness to adopt the CVR increased with the number of contraceptive methods already used (OR = 1.92; P = 0.015) and was not associated with a lack of contraceptive compliance. CONCLUSIONS: A minority of adolescents are willing to use the CVR, but many are ambivalent. Health care professionals should focus on addressing concerns about vaginal insertion. Adolescents who tend to be the most interested in the CVR are those who have experience with a greater number of contraceptives.

Early docosahexaenoic acid supplementation of mothers during lactation leads to high plasma concentrations in very preterm infants.

Very preterm infants are vulnerable to deficiency in DHA. In a longitudinal study, 10 mothers who delivered ≤29 wk gestation and planned to breast-feed received DHA (1200 mg/d) until 36 wk after conception. The plasma DHA status was assessed in their 12 infants (including 2 pairs of twins) from birth to d 49. Fatty acid profiles were measured weekly in breast milk, and in plasma of mothers and infants at baseline and at d15 and 49. Plasma and breast milk fatty acid concentrations in the DHA-supplemented group at d 49 were compared with a reference group of very preterm infants (n = 24, including triplets) whose mothers (n = 22) did not receive DHA during lactation. The infants' plasma DHA concentration tended to be greater in the DHA group than in the reference group (P = 0.10) and was greater when expressed as a percentage of total fatty acids (P = 0.009). At d 49, maternal milk DHA in the DHA group (1.92 ± 1.10 mmol/L) was ~12 times higher than in the reference group (0.15 ± 0.27 mmol/L) (P < 0.001). The amount of DHA provided to the infants increased from wk 1 through wk 7 in the DHA group (P < 0.001). Although enteral intake at wk 7 did not differ between the DHA group [119 ± 51 mL/(kg·d)] and the reference group [113 ± 66 mL/(kg·d)], DHA group infants received 55 ± 38 mg/(kg·d) of DHA, and the reference group infants received 7 ± 11 mg/(kg·d) (P < 0.001). Early supplementation with DHA to lactating mothers with low dietary DHA intake successfully increased the plasma DHA status in very preterm infants.

Hypnotizability and opinions about hypnosis in a clinical trial for the hypnotic control of pain and anxiety during pregnancy termination.

This descriptive study evaluates the hypnoanalgesic experience's effect on participants' hypnotizability and opinions about hypnosis and identifies factors associated with hypnotizability. Hypnotizability was assessed using the Stanford Hypnotic Susceptibility Scale: Form A in 290 women 1 month after their participation in a randomized clinical trial evaluating hypnotic intervention for pain/anxiety versus standard care during pregnancy termination. Opinions were collected before and after the intervention. The regression model describing hypnotizability (F = 13.55; p < .0001; R(2) = 0.20) retained 5 variables but not the intervention group. The variable explaining most of total variance (62.9%) was the level of perceived automaticity/involuntariness. Opinions about hypnosis were modified by the hypnotic experience compared to standard care but were not associated with hypnotizability. Exposure to hypnoanalgesia did not influence hypnotizability but modifies significantly the opinions about hypnosis. Consistent with previous findings, perceived automaticity appears to best predict hypnotizability.

Do children undergoing cancer procedures under pharmacological sedation still report pain and anxiety? A preliminary study.

OBJECTIVES: We aimed to quantify children's levels of pain and fear during needle puncture procedures in a context where intravenous sedation-analgesia seems to be effective for pain and anxiety relief. The relevance of a nonpharmacological intervention in the pharmacological regimen was evaluated. DESIGN: Fear and pain were assessed by children, parents and physicians, on a visual analog scale (VAS, 0-10 cm), before and during puncture procedures. Higher scores represented more intense pain/fear. RESULTS: During 4 consecutive months, 18 children were recruited, but four were excluded from analyses because they did not receive the full sedation regimen (midazolam/ketamine) (N = 14, mean age +/- SD: 9.9 +/- 3.4 years). Parents self-reported their own anxiety before the procedure (4.69 +/- 3.17), but no correlation was found with their children's self-reported fear. Before procedures, the children's fear was self-reported on a VAS by children (2.93 +/- 2.93), parents (4.45 +/- 2.87), and physicians (3.67 +/- 2.48). During procedures under sedation, the children's pain (1.71 +/- 2.74) did not correlate with the parents' (4.01 +/- 3.23) and physicians' (1.83 +/- 2.32) ratings. Children anticipating high levels of pain and fear on the VAS experienced higher levels of pain (r = 0.65, P < 0.05) and fear (r = 0.59, P < 0.05) during the procedures. Sixteen parents (16/18) agreed to participate with their children if a study evaluating hypnosis for pain and anxiety was conducted. CONCLUSIONS: Sedation is effective in lowering levels of fear and pain in children during procedures, but they still anticipate fear before the procedures. Parents are anxious for their children. Future hypnotic intervention could be helpful for children as well as parents to cope with anxiety during procedures.

Women's views regarding hypnosis for the control of surgical pain in the context of a randomized clinical trial.

OBJECTIVE: The aim of this study was to assess women's satisfaction with a hypnotic intervention for anxiety and pain management during a pregnancy-terminating procedure. METHODS: Women (N = 350) scheduled for first-trimester surgical abortion were randomly assigned to standard care or to a short, standardized hypno-analgesia intervention before and during the procedure. We assessed their individual use of the various hypnotic strategies proposed during the intervention and their views (likes/dislikes) about the hypnotic intervention, the pregnancy termination experience, and their participation in this randomized study. RESULTS: Mental imagery of a secure place was the strategy used by most women (71%) in the hypnosis group, but a significant proportion of them also used dissociation (42%) and focal analgesia (39%). Advantages of hypnosis over standard care were found in the patients' report that they could resume their normal activities right after being discharged from the hospital (72% in hypnosis vs. 56% in control group) and in their appreciation of the accompaniment (hypnotherapist vs. nurse) provided during the procedure (97% in hypnosis vs. 56% in control group). Among those who received hypnosis, 97% affirmed that they would recommend hypnosis to a friend for a similar procedure. More than 98% in both groups indicated they would again volunteer to participate in a study evaluating hypnosis for pain management. CONCLUSIONS: Women in the hypnosis group generally reported higher levels of satisfaction with various aspects of the procedure. This is consistent with the growing literature in favor of hypnotic interventions to improve pain management and care.