The more tense a woman who has to undergo an elective cesarean section is, the more her blood pressure drops after she undergoes a spinal or epidural anesthesia procedure prior to the operation, according to experts at the Rabin Medical Center-Beilinson Campus.

In an article in the latest issue of Hebrew language Rabin Hamagazine, hospital anesthesiologist Dr. Sharon Orbach reports that half of all pregnant women who undergo such a spinal injection suffer an immediate drop in blood pressure that causes the patient to feel unwell, faint and/or nauseous.

Since the phenomenon is common but does not occur in all women in this situation, Orbach and Beilinson colleagues conducted research to find out what caused the reaction and whether there was a way to prevent it. They observed 100 women who had a planned, rather than emergency cesarean section at their hospital and found that the more stressed the woman was, the more likely a blood pressure drop after the injection of anesthesia to eliminate pain below the waist. Each physician rated the amount of stress shown by the patient on a scale of one to 10.

The team reached the conclusion that women should be prepared mentally and emotionally for the surgery.

“Childbirth preparation courses are routine in every hospital,” said Orbach, but women are not prepared for the eventuality of a c-section. Anxiety, she concluded, results from lack of information and expectation that the experience would be a negative one. Among the ways to calm women down, in addition to explaining the procedure, are music, meditation and positive thinking. Going into such surgery with a feeling of safety and a calm atmosphere can minimize the need for additional medications, said Orbach.

SMOKING & CHILD ABUSE LINK FOUND


Searchers have long suspected some kind of link between childhood abuse and smoking. But in an interesting twist, a new study from the University of Washington finds a connection not between whether or not an abused child will ever begin smoking, but to how much they smoke once they start.

“In other words, people are as likely to smoke whether or not they were sexually or physically abused, but they’re inclined to smoke more if they were abused and have a history of smoking,” said social work Prof. Todd Herrenkohl, who published an article in the Journal of Adolescent Health.

Herrenkohl and co-authors probed the Lehigh Longitudinal Study, which began in the mid-1970s. Participants were recruited from child-welfare abuse and protective service programs, as well as day-care programs, private nursery programs and Head Start classrooms in eastern Pennsylvania.

UW researchers looked specifically for any connection between physical or sexual abuse and adolescent and adult smoking.

They found that boys who had experienced either type of abuse and were smokers, smoked more than those who hadn’t been abused as a child. For girls who smoked, only those who had been sexually abused smoked more as adolescents.

That frequency of adolescent smoking by both girls and boys, in turn, led to increased smoking in adulthood, especially among women.

Lead author Allison Kristman-Valente, a doctoral candidate in social work, found the difference between boys and girls to be one that requires more study. “There may be other factors at work that we need to disentangle,” she said. “I think the big ‘aha’ finding is the one on gender differences.

Hopefully this will encourage other researchers to look at gender differences in smoking among teens and adults.”

In the Lehigh study, slightly more than 50 percent of the participants said they had smoked in adolescence – about five times the national average for children aged 12 to 17. Fifty-seven percent of males and 44% of females reported smoking in adolescence. Researchers said they don’t know why the smoking rate was so high in this study. Herrenkohl theorizes that the reasons could have been socioeconomic, geographical or the fact that participants in this study were already at relatively high risk. When study participants were evaluated as adults, 49% reported smoking in the past year (at nearly equal rates for men and women).

Kristman-Valente said what is of great concern is the fact that so many women who were abused as children were smoking while raising children, and that women who smoke frequently also are less successful in smoking cessation programs. Since tobacco use often begins in adolescence, researchers say it’s important that public policies are in place to try to prevent kids from lighting up a cigarette in the first place.

“Early adversity can persist throughout a person’s life, so early intervention or prevention of child abuse can potentially lead to long-term public health benefits,” Kristman- Valente said. “I hope our findings encourage more focus on the connection between child maltreatment and smoking in particular.

Not many people look at this consequence, even though smoking is the number one cause of preventable death in the US.”

BE CAREFUL LETTING OFF STEAM


Home nebulizers that produce cold or hot steam to open up clogged nostrils or bronchi can be dangerous if not maintained properly, the Health Ministry warned recently. Legionnaire’s disease, a potentially fatal pneumonia most often caused by Legionella pneumophila – aerobic bacteria carried by amoeba that thrive in stagnant water – is the main risk.

The bacteria were first identified in 1976 at an American Legion convention in Philadelphia where infected air conditioning pipes caused 221 to become ill, and 34 of those died. There are as many as 18,000 cases of Legionnaire’s disease annually in the US alone.

The ministry said that Legionella can multiply in water systems with warm or hot water, especially in places where limescale and other deposits are. If nebulizers are used at home, one should empty the device out, wipe it with a towel and dry it. Water for filling it should be boiled and cooled before use, even if taken from mineral bottles or drips from air conditioners.

Once a week, the devices should be cleaned carefully and dried according to the manufacturer’s instructions. At the beginning of the season when it is used, the nebulizer should be washed carefully and dried before use, as well as at the end of the season, before storage.

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