Acupuncture with manual and electrical stimulation for labour pain : a longitudinal randomised controlled trial

Background: Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective.  Methods: A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals. 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC). Primary outcome: labour pain, assessed by Visual Analogue Scale (VAS). Secondary outcomes: relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women.  Results: Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67).  Conclusions: Acupuncture does not reduce women's experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated. These findings were obtained in a context with free access to other forms of pain relief.

Acupuncture with manual and electrical stimulation for labour pain : a two month follow up of recollection of pain and birth experience.

BACKGROUND: In a previous randomised controlled trial we showed that acupuncture with a combination of manual- and electrical stimulation (EA) did not affect the level of pain, as compared with acupuncture with manual stimulation (MA) and standard care (SC), but reduced the need for other forms of pain relief, including epidural analgesia. To dismiss an under-treatment of pain in the trial, we did a long-term follow up on the recollection of labour pain and the birth experience comparing acupuncture with manual stimulation, acupuncture with combined electrical and manual stimulation with standard care. Our hypothesis was that despite the lower frequency of use of other pain relief, women who had received EA would make similar retrospective assessments of labour pain and the birth experience 2 months after birth as women who received standard care (SC) or acupuncture with manual stimulation (MA). METHODS: Secondary analyses of data collected for a randomised controlled trial conducted at two delivery wards in Sweden. A total of 303 nulliparous women with normal pregnancies were randomised to: 40 min of MA or EA, or SC without acupuncture. Questionnaires were administered the day after partus and 2 months later. RESULTS: Two months postpartum, the mean recalled pain on the visual analogue scale (SC: 70.1, MA: 69.3 and EA: 68.7) did not differ between the groups (SC vs MA: adjusted mean difference 0.8, 95 % confidence interval [CI] -6.3 to 7.9 and SC vs EA: mean difference 1.3 CI 95 % -5.5 to 8.1). Positive birth experience (SC: 54.3 %, MA: 64.6 % and EA: 61.0 %) did not differ between the groups (SC vs MA: adjusted Odds Ratio [OR] 1.8, CI 95 % 0.9 to 3.7 and SC vs EA: OR 1.4 CI 95 % 0.7 to 2.6). CONCLUSIONS: Despite the lower use of other pain relief, women who received acupuncture with the combination of manual and electrical stimulation during labour made the same retrospective assessments of labour pain and birth experience 2 months postpartum as those who received acupuncture with manual stimulation or standard care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01197950.

Layout och typografi i vetenskapliga artiklar : En kartläggning av konventioner gällande grafisk formgivning inom matematik, medicin och utbildningsvetenskap

En deskriptiv visuell innehållsanalys genomfördes med en korpus bestående av vetenskapliga artiklar från 30 topprankade tidskrifter jämnt fördelade på de tre disciplinerna matematik, medicin och utbildningsvetenskap, med syfte att undersöka om det fanns ett samband mellan tidskrifternas disciplintillhörighet och den grafiska formgivningen. Kartläggningen omfattade layout (bl.a. sidformat, spalter, marginalstorlek, användning av grafiska element, placering av tabeller, figurer och pagina) och typografiskt utseende hos titel, rubriker, brödtext och abstrakt (t.ex. teckenstorlek, textjustering, teckengrovlek, typsnitt, färg och radavstånd). Resultaten visar att disciplinerna använde olika men även gemensamma konventioner i sitt grafiska utseende. Matematik uppvisade enkelspaltig layout med liten typografisk variation, genomgående användning av typsnitt från familjen Transitional eller Transitional/Didone för hela dokumentet, avsaknad av kulört färg och sällan användning av grafiska element. Medicin uppvisade större variation med användning av kulört färg, icke-centrerad typografi med både sansseriff- och seriff-typsnitt, grafiska element och ramar som förstärker det ofta använda dubbelspaltiga gridsystemet. Utbildningsvetenskap uppvisade en grafisk design som återfanns i båda disciplinerna, men påminde mest om matematik till utseendet. Kodbok ingår i sin helhet som bilaga. Uppsatsen i sig är delvis formgiven med utgångspunkt i de erhållna resultaten.

Grafisk profilering i tatueringsbranschen

En väl utformad grafisk profil kan hjälpa ett företag att skapa medvetenhet och kundlojalitet. Den grafiska profilen består bland annat av logotyp, färger, typsnitt och profil- och korrespondensmaterial som allt måste vara enhetligt utformat och anpassat efter företagets kultur, målgrupp och vision. Projektet syftar till att undersöka och beskriva hur tatuerares grafiska profil bör vara utformad för att bäst fylla sitt syfte. En enkätundersökning gjordes med målet att skapa förståelse för tatueringskundernas syn på den grafiska profilen och kompletterades med en intervju med en förtroendeingivande tatuerare som i sina åsikter fick representera tatueringsbranschen. Litteratur i ämnet grafisk profilering och grafisk design kompletterade undersökningen ytterligare. Resultaten från enkätundersökningen stämde inte helt överens med litteraturen vilket gör det svårt att ge ett exakt svar på projektets frågeställningar

Manual and electroacupuncture for labour pain : study design of a longitudinal randomized controlled trial

Introduction. Results from previous studies on acupuncture for labour pain are contradictory and lack important information on methodology. However, studies indicate that acupuncture has a positive effect on women's experiences of labour pain. The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain as the primary outcome. This paper will present in-depth information on the design of the study, following the CONSORT and STRICTA recommendations. Methods. The study was designed as a randomized controlled trial based on western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture, or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. A Visual Analogue Scale was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. This trial is registered at ClinicalTrials.gov: NCT01197950.