Acupuncture for labour pain

Background: Acupuncture involves puncturing the skin with thin sterile needles at defined acupuncture points. Previous studies are inconclusive regarding the effect of acupuncture on labour pain, but some studies have found a reduction in the use of pharmacological pain relief when acupuncture is administered. The appropriate dose of acupuncture treatment required to elicit a potential effect on labour pain has not been fully explored. The dose is determined by many different factors, including the number of needles used and the intensity of the stimulation. In Sweden, manual stimulation of the needles is common practice when acupuncture is used for labour pain, but electrical stimulation of the needles, which gives a higher dose, could possibly be more effective. The overall aim of this thesis was to evaluate the effectiveness of acupuncture with manual stimulation (MA) of the needles as well as acupuncture with a combination of manual and electrical stimulation (EA) in reducing labour pain, compared with standard care without any form of acupuncture (SC). Methods: The study was designed as a three-armed randomised controlled trial in which 303 nulliparous women with normal pregnancies were randomised to MA, EA, or SC. The primary outcome was labour pain, assessed using the Visual Analogue Scale (VAS). Secondary outcomes were relaxation during labour, use of obstetric pain relief, and associations between maternal characteristics and labour pain and use of epidural analgesia respectively. Also, labour and infant outcomes, recollection of labour pain, and maternal experiences, such as birth experience and experience of the midwife, were investigated two months after the birth. The sample size calculation was based on the potential to discover a difference of 15 mm on the VAS. Data were collected during labour before the interventions, the day after birth, and two months later. Besides using the VAS, information was collected by means of study specific protocol, questionnaires and medical records. Results: The mean VAS scores were 66.4 in the MA group, 68.5 in the EA group, and 69.0 in the SC group (mean differences: MA vs. SC 2.6 95% CI -1.7 to 6.9, and EA vs. SC 0.6 95% CI -3.6 to 4.8). Other methods of pain relief were used less frequently in the EA group, including epidural analgesia, MA 61.4%, EA 46%, and SC 69.9%. (EA vs. SC OR 0.4 95% CI 0.2 to 0.7). No statistically significant differences were found in the recollection of labour pain between the three groups two months after birth (mean VAS score: MA 69.3, EA 68.7 and SC 70.1). A few maternal characteristics were associated with labour pain (age, dysmenorrhea, and cervix dilatation), but none of the investigated characteristics predicted the outcome of the acupuncture treatment in MA or EA. Women in the EA group experienced acupuncture as being effective for labour pain to a higher extent than women who received MA, MA 44.4%, EA 67.1% (EA vs. MA OR 2.4 95% CI 1.2 to 4.8). Women in the EA group also spent less time in labour (mean 500 min) than those who received MA (mean 619 min) and SC (mean 615 min) (EA vs. MA HR 1.4 95% CI 1.0 to1.9, EA vs. SC HR 1.4, 95% CI 1.1 to 2.0), and had less blood loss than women receiving SC, (EA vs. SC OR 0.1 95% CI 0.3 to 0.7). The women’s assessment of the midwife as being supportive during labour (MA 77.2%, EA 83.5%, SC 80%), overall satisfaction with midwife care (MA 100%, EA 97.5%, SC 98.7%), and having an overall positive childbirth experience (MA 64.6%, EA 61.0%, SC 54.3%) did not differ statistically. No serious side effects of the acupuncture treatment were reported. Conclusion: Acupuncture, regardless of type of stimulation, did not differ from standard care without acupuncture in terms of reducing women’s experience of pain during labour, or their memory of pain and childbirth overall two months after the birth. However, other forms of obstetric pain relief were less frequent in women receiving a combination of manual and electrical stimulation, suggesting that this method could facilitate coping with labour pain.

The Passionate Combining Entrepreneurs

Entrepreneurs are portrayed as salient drivers of regional development and for a number of years nascent entrepreneurs have been studied in a large number of countries as part of the Global Entrepreneurship Monitor project and the Panel Study of Entrepreneurial Dynamics. Scholars have devoted much effort to investigating factors that determine how individuals engage in entrepreneurial activities, with most of the discussion limited to business start-ups. However, since this type of project does not follow identical nascent entrepreneurs over time, limited knowledge exists about their development and whether they stay in this nascent phase for a long time. In practice, it is common for entrepreneurs to run a business and at the same time work in wage work, so-called combining entrepreneurs. In Sweden, almost half of all business owners combine wage work with a business. However, not all combining entrepreneurs will eventually decide to leave the wage work and invest fully in the business. Consequently, much research has focused on the first step of entering entrepreneurship full time, but less has focused on the second step, the transition from the combining phase to full-time self-employment. The aim of this thesis is therefore to contribute to the theory of entrepreneurship by gaining a deeper understanding of combining entrepreneurs and their motives and intentions.   In the context of combining entrepreneurs, the theory of identity, resources and choice overload has been used to examine how entrepreneurs’ age (when starting the business), entrepreneurial tenure (the length of engagement in the side-business), hours spent (weekly involvement in the side-business), involvement in entrepreneurial teams (leading the business with one or more partners) and involvement in networks (business networks) influence their passion for engaging in entrepreneurship while sustaining wage work. Different categories of combining entrepreneurs and their intentions have also been examined.   A survey was administered to 1457 entrepreneurs within the creative sector in two counties in Sweden (Gävleborgs County and Jämtlands County). Since there were no separate mailing lists to only combining entrepreneurs, the survey was sent to all entrepreneurs within the chosen industry and counties. The total response rate was 33.5 percent and of them 57.6 percent combined, yielding 262 combining entrepreneurs who answered the questionnaire. The survey was then followed up with eight focus group interviews and two single interviews to validate the answers from the questionnaire.   The results indicate three types of combining entrepreneurs: nascent – with the intention to leave the combining phase for a transition into full-time self-employment, lifestyle – with the intention to stay in the combining phase, and occasional – with the intention to leave the combining phase for full-time wage work and close down the business. Transitioning fully to self-employment increases with the individual’s age. Also, a positive interactive effect exists with involvement in entrepreneurial networks. The results also indicate that the ability to work with something one is passionate about is the top motive for combining wage work with a side-business. Passion is also more likely to be the main motive behind the combining form among individuals who are older at business start-up, but passion is less likely to be the main motive behind the combining form among individuals who spend more time on the business. The longer the individual has had the side-business, the less likely passion is the main motive behind the combining form, and passion is less likely to be the main motive among those who are part of an entrepreneurial team.

Can therapy dogs evoke awareness of one's past and present life in persons with Alzheimer's disease?

BACKGROUND: Persons with Alzheimer's disease (AD) sometimes express themselves through behaviours that are difficult to manage for themselves and their caregivers, and to minimise these symptoms alternative methods are recommended. For some time now, animals have been introduced in different ways into the environment of persons with dementia. Animal-Assisted Therapy (AAT) includes prescribed therapy dogs visiting the person with dementia for a specific purpose. AIM: This study aims to illuminate the meaning of the lived experience of encounters with a therapy dog for persons with Alzheimer's disease. METHOD: Video recorded sessions were conducted for each visit of the dog and its handler to a person with AD (10 times/person). The observations have a life-world approach and were transcribed and analysed using a phenomenological hermeneutical approach. RESULTS: The result shows a main theme 'Being aware of one's past and present existence', meaning to connect with one's senses and memories and to reflect upon these with the dog. The time spent with the dog shows the person recounting memories and feelings, and enables an opportunity to reach the person on a cognitive level. CONCLUSIONS: The present study may contribute to health care research and provide knowledge about the use of trained therapy dogs in the care of older persons with AD in a way that might increase quality of life and well-being in persons with dementia. IMPLICATIONS FOR PRACTICE: The study might be useful for caregivers and dog handlers in the care of older persons with dementia.