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Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Author/s: 
Viktoriya Ovsepyan, Petra Kelsey, Ann E Evensen

Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.

Methods: A literature review was conducted on PubMed by searching the terms “IUD insertion”, “pain management”, “anxiety”, “gynecologic procedures”. The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT) scale.

Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, “verbal analgesia”, lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.

Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.

Keywords 
IUD Intrauterine Devices managing pain contraception anxiety

Pets Are Associated with Fewer Peer Problems and Emotional Symptoms, and Better Prosocial Behavior: Findings from the Longitudinal Study of Australian Children

Author/s: 
Christian, H., Mitrou, F., Cunneen, R., Zubrick, S.R.

Abstract

OBJECTIVE: 

To investigate the longitudinal association between pet ownership and children's social-emotionaldevelopment.

STUDY DESIGN: 

Two time-points of data from the Longitudinal Study of Australian Children were analyzed for children at ages 5 (n = 4242) and 7 (n = 4431) years. The Strengths and Difficulties Questionnaire (SDQ) measured children's social-emotional development. Pet ownership status and type (dog, cat, other) as well as sociodemographic and other potential confounders were collected. Longitudinal panel regression models were used.

RESULTS: 

Overall, 27% of children had abnormal scores on 1 or more SDQ scales. By age 7, 75% of children had pets with ownership highest in single-child households. Owning any type of pet was associated with decreased odds of abnormal scores for emotional symptoms (OR, 0.81; 95% CI, 0.67-0.99), peer problems (OR, 0.71; 95% CI, 0.60-0.84), and prosocial behavior (OR, 0.70; 95% CI, 0.38-0.70), compared with non-pet owners. Dog ownership was associated with decreased odds of abnormal scores on any of the SDQ scales (OR, 0.81; 95% CI, 0.71-0.93). For children without any siblings, only the prosocial behavior scale was significantly associated with pet ownership (OR, 0.21; 95% CI, 0.07-0.66). In longitudinal models, cat-only and dog-only groups were associated with feweremotional symptoms and peer problems compared with non-pet owners.

CONCLUSIONS: 

Early school age is an important period for family pet acquisition. Pets may protect children from developing social-emotional problems and should be taken into account when assessing child development and school readiness. Children without siblings may benefit most in terms of their prosocial behavior.

Copyright © 2020 Elsevier Inc. All rights reserved.

Keywords 
pets children Health

Recommended Adult Immunization Schedule, United States, 2020

Author/s: 
Freedman, M., Kroger, A., Hunter, P., Ault, K.A.

In October 2019, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2020. The 2020 adult immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html, summarizes ACIP recommendations in 2 tables and accompanying notes (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2020 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www.acponline.org), American Academy of Family Physicians (www.aafp.org), American College of Obstetricians and Gynecologists (www.acog.org), and American College of Nurse-Midwives (www.midwife.org).

Keywords 
guidelines adult immunization
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