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BACKGROUND Severe post-caesarean pain remains an important issue associated with persistent pain and postpartum depression. Women's sleep quality prior to caesarean delivery and its influence on postoperative pain and analgesic intake have not been evaluated yet. METHODS Women undergoing caesarean delivery with spinal anaesthesia (bupivacaine 12 mg, fentanyl 20 μg, morphine 100 μg) were evaluated preoperatively for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (PSQI 0-5 indicating good sleep quality, PSQI 6-21 poor sleep quality). Peak and average postoperative pain scores at rest, movement and uterine cramping were evaluated during 24 h using a verbal numerical pain score (VNPS; 0 indicating no pain and 100 indicating worst pain imaginable), and analgesic intake was recorded. Primary outcome was peak pain upon movement during the first 24 h. RESULTS Seventy-eight of 245 women reported good sleep quality (31.2%; average PSQI 3.5 ± 1.2) and 167 poor sleep quality (68.2%; average PSQI 16.0 ± 3.4; p

Background Over 1.4 million Caesarean deliveries are performed annually in the United States, out of which 30% are elective repeat procedures. Post-operative hyperalgesia is associated with an increased risk for persistent post-surgical pain; however, there are no data on whether residual scar hyperalgesia (SHA) from a previous Caesarean delivery (CD) persists until the next delivery. We hypothesized that residual SHA may be present in a substantial proportion of women and is associated with increased post-operative pain. Methods One hundred and sixty-three women scheduled for a repeat CD under spinal anaesthesia were enrolled into the study. Mechanical temporal summation (mTS) and SHA index were measured preoperatively. SHA was considered present when the index was >0. Post-operative pain scores at 12, 24 and 48 h and wound hyperalgesia (WHA) at 48 h were recorded. Results SHA was present in 67 women 41% with a median SHA index of 0.42 (Q 25 = 0.25; Q 75 = 1.1, range 0.03–4.25). Women with SHA had overall higher post-operative pain scores and SHA was correlated with preoperative mTS (r = 0.164, p

Approximately 50 years ago, pharmacogenetics was described as a new field of medicine that may explain human drug action. Anaesthesia played a key role in the early investigations. An understanding of how a person's DNA influences drug metabolism and effectiveness may allow individually tailored prescriptions, improving outcomes and safety. The ultimate goal of pharmacogenetic research is to offer tailored personalised medicine to improve both the efficacy of medication and patient safety by helping to predict risk of adverse outcomes. In this review, we present a selection of historical landmarks where anaesthesia has been a catalyst for pharmacogenetic development. We examine the level of evidence and cite examples of candidate genes and common polymorphisms known to alter the response to peri-operative medication. Finally, we set forth current views and potential exciting perspectives that may arise from the application of pharmacogenetics to the daily practice of anaesthesia and pain medicine.

Objective Magnesium affects blood pressure by modulating vascular tone and reactivity. In obstetric patients, magnesium is administered to prevent eclamptic seizures and as a tocolytic to treat preterm labour. Prior to studying vascular sensitivity in women with pre-eclampsia, we sought to determine the effect of magnesium on venous tone in healthy women of childbearing age. Design Dose–response study. Setting Columbia-Presbyterian Medical Center, New York. Population Ten healthy non-pregnant women (age range 21–47 years). Methods Vascular response to magnesium sulphate (MgSO4) was measured in a dorsal hand vein using the linear variable differential transformer (LVDT) technique. Complete dose–response curves to MgSO4 (0.0000275–0.088 mmol/min) were determined after 50% preconstriction of the vein with phenylephrine. Main outcome measures The ED50 of MgSO4 (dose resulting in 50% of maximal effect, Emax) was determined. Blood samples from the contralateral upper extremity were obtained to assess total plasma magnesium levels at baseline and at the highest infused dose of magnesium. ED50 results are expressed as geometric mean (95% confidence interval, CI). Emax results and magnesium plasma concentrations are expressed as mean [SD]. Results The ED50 of MgSO4 was 0.000307 mmol/min (95% CI 0.138, 0.666) and Emax was 102% [20%]. Conclusion Magnesium induces dose-dependent venodilation in healthy women in the absence of systemic haemodynamic effects. The dose resulting in vasodilation using the LVDT/hand vein model is two to three orders of magnitude less than the therapeutic doses of magnesium used for tocolysis or seizure prophylaxis. Studies of the effect of systemically administered therapeutic doses of magnesium on vascular reactivity in pre-eclampsia will be of interest.

We explore social workers’ perception of the importance and rank ordering of ethical principles. Do they have a generally agreed upon hierarchy of ethical principles? Do they apply similar hierarchies of ethical principles when facing different cases? Are their professional and personal hierarchies of ethical principles similar? The findings based on a structured questionnaire indicated that while social workers attach high importance to most ethical principles closely associated with social work, they do not hold a universal hierarchy of ethical principles. Social workers change their ethical hierarchies in different professional situations but there is no difference between their professional and personal ethical hierarchies. Implications for practice and education are discussed.

This article examines a community-based sample of Holocaust survivors aged 75 and over, in comparison to persons of similar age and sociocultural background who did not personally experience the Holocaust. The analysis compares respondents' sociodemographic characteristics, interpersonal resources (locus of control and social network), and vulnerability, stratified by gender (n = 194). Assessments of vulnerability (physical health, mental health, and posttraumatic stress disorder--PTSD) are compared across groups. The results reveal almost no differences regarding the sociodemographic and interpersonal variables. Nevertheless, survivors are found to be more vulnerable than the others in the comparison group: (a) male survivors demonstrate a higher prevalence of PTSD, and (b) female survivors indicate greater health-related difficulties and poorer self-rated health.

Protocols for testing conditioned pain modulation (CPM) vary between different labs/clinics. In order to promote research and clinical application of this tool, we summarize the recommendations of interested researchers consensus meeting regarding the practice of CPM and report of its results.

SUMMARY. Between 1967 and 1977, catches of Tilapia galilaea in Lake Kinneret fell from an annual average of about 200 tonnes to a low of 70 tonnes in 1974, and then returned to their former level. Total yearly mortality (Z) was estimated at 1.84 between 1970 and 1976. Assuming a natural mortality (M) of 0.94, total stock size averaged 300–700 tonnes in that period, while recruitment averaged < 0.7–3 million per year. Three broods hatched in years of relatively high water levels (1970, 1971 and 1972) yielded especially low recruitment. The Von Bertalanffy growth coefficient (K) was estimated at 0.67, and final length (L∞) at 25–36cm total length. First year's growth, 23–152mm, was closely related to final length, which appeared to be affected by genetic variation in the population. Yearly fluctuations in size distribution were attributed to changes in the proportions of fast- and slow-growers, as well as in the abundance of year-classes. Recruitment to the fishery, at 17–20cm, occurred between ages l+and3+. The highest growth rates for age-1 T, galilaea, 1–2% mean weight per day, occurred in April and May, the Peridinium season. However, only a small proportion of age-1 fish reached marketable size by July, when their food supply began to diminish. During the autumn months, there was hardly any length increment, and all T. galilaea became lean, especially the age-0 group. It is surmised that recruitment of stocked fish could be increased by introduction in December and by use of fingerlings which are potentially able to grow to marketable size in less than two seasons.