The consideration of individual contextual factors in neonatal pain assessment : validation and revision of the Bernese Pain Scale for Neonates

Neonates are dependent on a caregiver to discover that they are in pain and to manage it. Numerous pain assessment scales have been developed, but pain assessment is challenging because neonates of different gestational ages (GAs) have widely varied pain responses. Individual contextual factors such as GA or health status may account for this variability in pain response. The aim of the present dissertation was the validation and revision of the Bernese Pain Scale for Neonates (BPSN) by testing its psychometric properties and analyzing the influence of individual contextual factors on the variability in pain response. The BPSN is a pain assessment tool that is widely used in Swiss neonatal intensive care units. In this prospective multisite validation study, 154 neonates between 24 2/7 and 41 4/7 weeks of gestation were videotaped during 1-5 routine capillary heel sticks in their first 14 days of life. For each heel stick, three video sequences were produced: baseline, heel stick, and recovery. Comprehensive psychometric testing was conducted to examine the BPSN’s underlying factor structure, interrater reliability, concurrent and construct validity, sensitivity and specificity. Single and multiple linear mixed effects analyses were used to examine the influence of individual contextual factors on variability in pain response. The results of the psychometric testing indicated a significant reduction of the scale from nine to four items: crying, facial expression, posture and heart rate. This modified BPSN showed promising reliability and validity, especially when the cut-off that discriminates between no or low pain and moderate to severe pain is adjusted to increase with increasing GA. Apart from the GA, baseline behavioral state and ventilation status were the individual contextual factors which the revised BPSN should account for. The BPSN-Revised is a promising tool for acute procedural pain assessment in full-term and preterm neonates with different GAs. Future studies should test its validity, feasibility and clinical utility

Psychische Gesundheit von Müttern und ihren Kindern: Die perinatale Gesundheitsversorgung kann einen entscheidenden Beitrag leisten

Psychische Erkrankungen während der Schwangerschaft und nach der Geburt können betroffene Mütter und ihre Kinder schwer belasten und zu hohen Folgekosten für die Gesellschaft führen. Um eine Übertragung der Problematik der Mutter auf die Kinder zu vermeiden, ist eine frühzeitige und wirksame Behandlung von perinatalen psychischen Erkrankungen essenziell

Schmerzen bei den Kleinsten - Prävention und Behandlung

687 Expertinnen und Experten aus 41 Ländern versammelten sich am 12. International Symposium on Pediatric Pain (ISPP) in Basel. Sie tauschten sich über die neusten Erkenntnisse zur Prävention und Behandlung von Schmerzen bei Neugeborenen, Kindern und Jugendlichen aus

Perinatal mental health care from the user and provider perspective: protocol for a qualitative study in Switzerland

Background: Mental disorders in the perinatal period (PMD) can severely harm women and their children if not detected early and treated appropriately. Even though mental health care is covered by health insurance and is used widely by women in the perinatal period in Switzerland, it is not known if the care provided is meeting the needs of the patients and is efficient in the view of health care professionals. The aim of this study is to identify strengths, gaps and requirements for adequate mental health care in the perinatal period from the perspectives of patients and care providers for a wide range of relevant mental disorders. Methods: In the qualitative study we conduct (1) semi-structured single interviews with former PMD patients to obtain narratives about their experiences and needs for health care for their condition. Women are included who have been treated for PMD but are mentally stable at the time of the interview (n = 24). We will stratify the sample by 4 clusters of relevant ICD-10 F-diagnoses, covering the most frequent and the most severe mental disorders. We will further stratify the sample based on whether the women already had experience with psychiatric or psychological health care or not before their last episode of PMD. We will also conduct (2) three interprofessional focus groups with health and social care professionals involved in perinatal care, and a health insurance representative. The focus groups will consist of 5–8 professionals. Data collection and thematic analysis will consider Levesque’s et al. (2013) conceptual model on access to health care. Discussion: The study will provide fundamental data on the experiences and perspectives about perinatal mental health care from user and provider perspectives. The study will generate the evidence base needed to develop models of integrated, coordinated, patient- and family-centred care that is accessed by women with various types of PMD. Trial registration: The study was registered on ClinicalTrials.gov in November 2019 under the identifier NCT04185896

Effects of a dog-assisted social- and emotional-competence training for prisoners: a controlled study

Abstract: Background: Previous research has called for improving psychological interventions and developing new treatments for prisoners. Animal-assisted prison-based programmes have increasingly been used as an approach, but there is a lack of studies investigating the effectiveness of such programmes. Objective: To investigate the effects of a dog-assisted social- and emotional- competence training on the socioemotional competences of prisoners compared to treatment as usual. Methods: In a controlled trial, we investigated 62 prisoners that participated in either a 6-month dog- assisted psychotherapeutic programme or the standard treatment. We assessed social and emotional competences before and after the training and at a 4-month follow-up. Data were analysed with linear models. Results: The prisoners' self-assessed social and emotional competences did not differ. The psychotherapists rated the prisoners' emotional competences in the intervention group higher at the follow-up but not after the training. The psychotherapists did not rate the prisoners' social competences in the intervention group differently but did find them to have higher self-regulation at follow-up and lower aggressiveness after the training than the control group. Conclusions: This study indicates that dog-assisted programmes with a therapeutic aim might be beneficial for prisoners. However, the inconsistent results indicate that more research is needed to determine the potential and limits of animal-assisted programmes in forensic settings

Individual contextual factors in the validation of the Bernese pain scale for neonates: protocol for a prospective observational study

Background: The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual factors. Therefore, the aim of this study is the validation of the BPSN using a large sample of neonates with different GAs. Furthermore, the influence of individual contextual factors on the variability in pain reactions across GA groups will be explored. The results will be used for a modification of the BPSN to account for individual contextual factors in future clinical pain assessment in neonates. Methods and design: This prospective multisite validation study with a repeated measures design will take place in three university hospital neonatal intensive care units (NICUs) in Switzerland (Bern, Basel and Zurich). To examine the impact of GA on pain responses and their variability, the infants will be stratified into six GA groups ranging from 24 0/7 to 42 0/7. Among preterm infants, 2–5 routine capillary heel sticks within the first 14 days of life, and among full-term infants, two heel sticks during the first days of life will be documented. For each heel stick, measurements will be video recorded for each of three phases: baseline, heel stick, and recovery. The infants’ pain responses will be rated according to the BPSN by five nurses who are blinded as to the number of each heel stick and as to the measurement phases. Individual contextual factors of interest will be extracted from patient charts. Discussion: Understanding and considering the influence of individual contextual factors on pain responses in a revised version of the BPSN will help the clinical staff to more appropriately assess pain in neonates, particularly preterm neonates hospitalized in NICUs. Pain assessment is a first step toward appropriate and efficient pain management, which itself is an important factor in later motor and cognitive development in this vulnerable patient population. Trial registration: The study is registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461. Registration date: 12 April 2016. Keywords: Pain assessment, Premature infants, Contextual factors, Diagnosti

Understanding European Regional Diversity - Lessons learned from Case Studies

The content of this report is a deliverable to the FP 7 project RUFUS (Rural future Networks) concerning the case studies made within the project. As a deliverable in a EU framework project it reports extensively on the methods and empirical data collected in the project’s case studies. The work has as an overarching motive to translate research findings into implications that are relevant for policy makers in the EU. The conclusions from the case studies are therefore of two types – the findings made and the implications they might give for policy making within the field of rural development