Severely negative life events increase the risk of children's asthma attacks over the coming few weeks. This risk is magnified and brought forward in time if the child's life situation is also characterised by multiple chronic stressors.
Potentially significant numbers of infants hospitalized in Neonatal Intensive Care UniG (NlCUs) and Pediatric Intensive Care Units (PlCUs) experience chronic pain. However, the phenomenon of chronic pain in infancy has neither been defined nor described adequatety by researchen. To stimulate and focus furtherwork in the area, the purposeof this studywasto exploreexpertopinions on definitional and assessment parameters of infant chronic pain. Forty-five health care professionals, with a median of 17 years of clinical experience, were recruited from 4 tertiary-level, university-affiliated institutions. Individual (n = 24) and group (n = 21) interviews were conducted by trained interviewers. Qualitative data were analyzed using a standard descriptive method. Health care professionals were able to offer preliminary def initions of chronic pain in infants. The most contentious def initional issue was whether iatrogenically prolonged pain (pain induced and maintained by medical procedures) should be considered chronic pain. Possible indicators for chronic pain included inability to settle, social withdrawal, constant grimacing, tense body, hypo-or hyper-reactions to acute pain, and dysregulated sleep or feeding patterns. These indicators differed significantly from those traditionally used to measure acute pain.Perspective: Despite infants' established capacity to physiologically experience chronic pain, no current definitions exist that are wholly applicable to infancy. By exploring the definitional parameters and potential assessment cues of infant chronic pain, this study provides a foundation for improving pain measurement and management in infants with chronic pain.
A case-control study was conducted among commercial table-egg layer and pullet operations in Iowa and Nebraska, United States, to investigate potential risk factors for infection with highly pathogenic avian influenza (HPAI) H5N2. A questionnaire was developed and administered to 28 case farms and 31 control farms. Data were collected at the farm and barn levels, enabling two separate analyses to be performed-the first a farm-level comparison of case farms vs. control farms, and the second a barn-level comparison between case barns on case farms and control barns on control farms. Multivariable logistic regression models were fit using a forward-selection procedure. Key risk factors identified were farm location in an existing control zone, rendering and garbage trucks coming near barns, dead-bird disposal located near barns, and visits by a company service person. Variables associated with a decreased risk of infection included visitors changing clothing, cleaning and disinfecting a hard-surface barn entryway, and ceiling/eaves ventilation in barns.
Ninety children aged 6 to 13 y and suffering from chronic asthma were included in a prospective follow‐up study lasting 18 mo in order to assess whether life events involving substantial positive effects on the child can protect against the increased risk associated with stressful life events. The main outcome measures included positive life events, positive long‐term experiences, severely negative life events, chronic psychosocial stress and new asthma exacerbation. The results showed that, provided they occurred in close proximity to severely negative life events, positive life events, generally related to the child's own achievements, afforded protection against the increased risk of a new asthma exacerbation precipitated by severe events in children whose lives were marked by low to medium levels of chronic stress. No such effect was found in children exposed to high chronic stress nor did long‐term positive experiences, such as when the child has a rewarding hobby, affect the asthma risk. Conclusion: Life events with a definite positive effect can counteract the increased risk of an asthma exacerbation precipitated by a severely negative life event, provided the chronic stress is only of low to medium level. Because this protective influence does not apply where there is high chronic stress, reducing this condition must be seen as a priority in children suffering from asthma, as these children are also more vulnerable to negative life events precipitating asthma exacerbation.
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