Kajsa Landgren

Acupuncture reduces crying in infants with infantile colic: a randomised, controlled, blind clinical study

Objective To investigate whether acupuncture reduces the duration and intensity of crying in infants with colic. Patients and methods 90 otherwise healthy infants, 2–8 weeks old, with infantile colic were randomised in this controlled blind study. 81 completed a structured programme consisting of six visits during 3 weeks to an acupuncture clinic in Sweden. Parents blinded to the allocation of their children met a blinded nurse. The infant was subsequently given to another nurse in a separate room, who handled all infants similarly except that infants allocated to receive acupuncture were given minimal, standardised acupuncture for 2 s in LI4. Results There was a difference (p=0.034) favouring the acupuncture group in the time which passed from inclusion until the infant no longer met the criteria for colic. The duration of fussing was lower in the acupuncture group the first (74 vs 129 min; p=0.029) and second week (71 vs 102 min; p=0.047) as well as the duration of colicky crying in the second intervention week (9 vs 13 min; p=0.046) was lower in the acupuncture group. The total duration of fussing, crying and colicky crying (TC) was lower in the acupuncture group during the first (193 vs 225 min; p=0.025) and the second intervention week (164 vs 188 min; p=0.016). The relative difference from baseline throughout the intervention weeks showed differences between groups for fussing in the first week (22 vs 6 min; p=0.028), for colicky crying in the second week (92 vs 73 min; p=0.041) and for TC in the second week (44 vs 29 min; p=0.024), demonstrating favour towards the acupuncture group. Conclusions Minimal acupuncture shortened the duration and reduced the intensity of crying in infants with colic. Further research using different acupuncture points, needle techniques and intervals between treatments is required.

Effect of minimal acupuncture for infantile colic: a multicentre, three-armed, single-blind, randomised controlled trial (ACU-COL)

Background Evidence for treating infantile colic with acupuncture is contradictory. Aim To evaluate and compare the effect of two types of acupuncture versus no acupuncture in infants with colic in public child health centres (CHCs). Methods A multicentre, randomised controlled, single-blind, three-armed trial (ACU-COL) comparing two styles of acupuncture with no acupuncture, as an adjunct to standard care, was conducted. Among 426 infants whose parents sought help for colic and registered their childs fussing/crying in a diary, 157 fulfilled the criteria for colic and 147 started the intervention. All infants received usual care plus four extra visits to CHCs with advice/support (twice a week for 2 weeks), comprising gold standard care. The infants were randomly allocated to three groups: (A) standardised minimal acupuncture at LI4; (B) semi-standardised individual acupuncture inspired by Traditional Chinese Medicine; and (C) no acupuncture. The CHC nurses and parents were blinded. Acupuncture was given by nurses with extensive experience of acupuncture. Results The effect of the two types of acupuncture was similar and both were superior to gold standard care alone. Relative to baseline, there was a greater relative reduction in time spent crying and colicky crying by the second intervention week (p=0.050) and follow-up period (p=0.031), respectively, in infants receiving either type of acupuncture. More infants receiving acupuncture cried <3 hours/day, and thereby no longer fulfilled criteria for colic, in the first (p=0.040) and second (p=0.006) intervention weeks. No serious adverse events were reported. Conclusions Acupuncture appears to reduce crying in infants with colic safely. Trial registration number NCT01761331; Results.

Remembering the Chaos - But Life Went on and the Wound Healed. A Four Year Follow Up with Parents having had a Baby with Infantile Colic

Objective: To elucidate parent´s experience of having had a baby with colic four years previously and of how the colic and care influenced the family in a long-term perspective. Methodology and Participants: A qualitative inductive follow-up study with 13 individual and one focus group interview including four parents. Altogether ten mothers and seven fathers representing 12 families, who had been interviewed when they were in the midst of the colicky period four years ago, were in the present study interviewed between December 2010 and May 2011. Parents’ narratives were analysed using content analysis. Results: Parent´s memories of the exhausting colic period were vivid, but when the colic had healed the family relationships also healed. Although it had taken longer time for some parents to attach to their child they now experienced a close relationship with their four year old child and felt confident in their role as parent. The colic scream was still unbearable and evoked negative feelings in the parents. Parents had decreased confidence in Child Health services and made suggestions for improvements in the health care approach. Most of all they wished for an effective treatment of infantile colic. Conclusion: The family relationships were healed and the colic left only few residual symptoms but parents still had decreased confidence in the Child Health Center. Consequently, there is a need to raise awareness to parents’ situation when having a child with infantile colic.

Acupuncture in the treatment of infantile colic

Regarding the recently published review ”Looking for new treatments of Infantile Colic“ by Savino et al. we want to add that positive effects of acupuncture have been demonstrated to release pain and agitation and that acupuncture seems to be a safe treatment when performed by trained acupuncturists. Inconclusive results in the few published articles on the subject can be due to different acupuncture points, different insertion time, different needling methods, differences in the outcome variables, in how the crying was measured and insufficient sample sizes. Further research is needed on understanding the utility, safety, and effectiveness of acupuncture in infants with colic.

Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials

Abstract Objective: Needle acupuncture in small children has gained some acceptance in Western medicine. It is controversial, as infants and toddlers are unable to consent to treatment. We aimed to assess its efficacy for treating infantile colic. Design: A systematic review and a blinding-test validation based on individual patient data from randomised controlled trials. Primary end-points were crying time at mid-treatment, at the end of treatment and at a 1-month follow-up. A 30-min mean difference (MD) in crying time between acupuncture and control was predefined as a clinically important difference. Pearson’s chi-squared test and the James and Bang indices were used to test the success of blinding of the outcome assessors [parents]. Eligibility criteria and data sources: We included randomised controlled trials of acupuncture treatments of infantile colic. Systematic searches were conducted in Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and AMED, and in the Chinese language databases CNKI, VIP, Wang fang, SinoMed and Chinese Clinical Trial Registry. Results: We included three randomised controlled trials with data from 307 participants. Only one of the included trials obtained a successful blinding of the outcome assessors in both the acupuncture and control groups. The MD in crying time between acupuncture intervention and no acupuncture control was −24.9 min [95% confidence interval, CI −46.2 to −3.6; three trials] at mid-treatment, −11.4 min [95% CI −31.8 to 9.0; three trials] at the end of treatment and −11.8 min [95% CI −62.9 to 39.2; one trial] at the 4-week follow-up. The corresponding standardised mean differences [SMDs] were −0.23 [95% CI −0.42 to −0.06], −0.10 [95% CI −0.29 to 0.08] and −0.09 [95% CI −0.48 to 0.30]. The heterogeneity was negligible in all analyses. The statistically significant result at mid-treatment was lost when excluding the apparently unblinded study in a sensitivity analysis: MD −13.8 min [95%CI −37.5 to 9.9] and SMD −0.13 [95%CI −0.35 to 0.09]. The registration of crying during treatment suggested more crying during acupuncture [odds ratio 7.7; 95% CI 2.7–20.6; one trial]. GRADE-Moderate quality evidence. Conclusions: Percutaneous needle acupuncture treatments should not be recommended for infantile colic on a general basis. Systematic review registration: PROSPERO 2015:CRD42015023253 Key points The role of acupuncture in the treatment of infantile colic is controversial. Available trials are small and present conflicting results. There were no clinically important differences between infants receiving acupuncture and no acupuncture control in this IPD meta-analysis of randomised controlled trials. The data indicate that acupuncture induces some treatment pain in many of the children. The study results indicate that percutaneous needle acupuncture should not be recommended for treatment of infantile colic on a general basis.

Ear Acupuncture in Addiction Treatment

Acupuncture is currently used in the treatment of addictions by approximately 2,500 addiction treatment programs. Clinical evidence supports that it is effective in ameliorating withdrawal and craving symptoms associated with alcohol, opiate, and cocaine dependence, as well as symptoms associated with most other addictions. Acupuncture for cocaine dependence has been particularly recognized as an important innovation, since there are presently no established pharmaceutical treatments for cocaine dependence. Acupuncture is used by programs as a foundation for later psychosocial recovery. It is a non-verbal, non-threatening, “first-step” intervention that has an immediate calming effect on clients regardless of the specific substance used and regardless of whether a coexisting psychiatric disorder has been diagnosed. Initial participation with acupuncture has been found to improve participants’ overall treatment retention, and to facilitate their subsequent involvement. In most programs, clients receive 3–5 ear acupuncture points while seated together in a large group room so that a substantial number of individuals can be treated conveniently. This safe and cost-efficient procedure has gained increasing acceptance from agencies responsible for overseeing addiction treatment. Evidence for the benefit of acupuncture in coexisting psychiatric conditions and other behavioral health settings also will be presented. This chapter will describe the practical use and research findings related to acupuncture for addiction. Mechanisms of action that involve physiology and psychosocial process will be covered.

Gaining hope and self-confidence—An interview study of women’s experience of treatment by art therapy for severe fear of childbirth

BACKGROUND Fear of childbirth is a serious problem that can have negative effects on both women and babies and to date treatment options are limited. The aim of this study was to elucidate the experience of undergoing art therapy in women with severe fear of childbirth. METHOD Nineteen women residing in Sweden, who had undergone art therapy for severe fear of childbirth, were interviewed during 2011-2013 about their experiences of the treatment. All women had received both support from a specialist team of midwives and treatment by an art therapist who was also a midwife. The women were interviewed three months after giving birth. The transcribed interviews were analysed with a phenomenological hermeneutical method. FINDINGS A main theme and three themes emerged from the analysis. The main theme was Gaining hope and self confidence. The three themes were; Carrying heavy baggage, Creating images as a catalyst for healing and Gaining new insights and abilities. Through the use of images and colours the women gained access to difficult emotions and the act of painting helped them visualize these emotions and acted as a catalyst for the healing process. DISCUSSION Art therapy was well accepted by the women. Through sharing their burden of fear by creating visible images, they gained hope and self-confidence in the face of their impending childbirth. CONCLUSION The results may contribute to knowledge about the feasibility of treating fear of childbirth by art therapy.

Creating an Opportunity to Reflect: Ear Acupuncture in Anorexia Nervosa – Inpatients' Experiences

ABSTRACT The aim of this study was to elucidate the meaning of receiving acupuncture as a complement in the treatment of anorexia nervosa at a specialist unit. Nine inpatients were interviewed, one to three times. The sixteen interviews were analysed with a phenomenological hermeneutic method. The main theme found was “Creating a pause, a framework for rest and reflection.” The participants described acupuncture to be an attractive part of the treatment, offering a pause in a very stressful situation. The relaxing effect was palpable. They described unusual calmness and a meditative state allowing them to think clearly and to reflect, and also positive physical sensations like getting warm. Anxiety decreased and gaining weight became easier to endure. Participants appreciated acupuncture as an optional treatment that they could influence. The given frame for reflection allowed processing emotions, releasing control and seeing themselves as capable to relax. Where symptoms are intense and pharmacological treatments have modest effect, like in anorexia nervosa, adjunctive therapies that help manage symptoms deserve greater attention.

Promoting health in children and adolescents with – or at risk of – Type 2 diabetes mellitus in the United States: An interview – study of nurses’ experiences of their role

Introduction: Type 2 diabetes mellitus (T2DM) in children and adolescents is increasing throughout the world and the USA. Previous research has shown that the nurses have an important role in the management of T2DM in children and adolescents, but few studies have covered how the nurses perceive and experience their role. Aim: This paper aims to describe how nurses experience their role in the care of children and adolescents with T2DM and their families. Methods: Semi-structured interviews were used to collect the data from eight registered nurses and nurse practitioners who worked in an American university hospital area participated in the study. An inductive qualitative approach was used and the data were analysed through the content analysis. The findings were described in four categories: overcoming challenges; improving life quality; being cooperative and being committed to one’s role as a diabetes nurse forming the theme Promoting health. Conclusions: The diabetes nurse has a key role in the work of promoting health and the results elucidate the complexity of the role. To be able to plan for and to implement an evidence-based approach based on theoretical models of behaviour and consideration of the child’s needs, not only requires a commitment from health professionals but also involves education and discussions that require both commitment and managerial and economic support from leaders in children’s healthcare and managers of health services.