Impact of a Psychodermatological Education Package on the Subjective Distress, Family Burden, and Quality of Life among the Primary Caregivers of Children Affected with Epidermolysis Bullosa

Background

Epidermolysis bullosa (EB) has profound effect on the subjective distress, family burden, and quality of life (QOL) of the primary caregivers (PCG). Knowledgeable PCG can efficiently manage children with these skin diseases and also improve their QOL.

Objectives

To assess the subjective distress, family burden, and QOL, to develop and assess the short-term effectiveness of a psycho-dermatological education package (PDEP) for the PCG of children with EB.

Methods

In this interventional study, 30 PCG of EB were assessed for subjective distress, family burden, and QOL. PDEP, a structured educational tool explaining the disease and its care and stress management, was developed by the authors for the PCG and administered to them after one month of enrolment. They were reassessed after three months and compared with the baseline assessment scores. For comparison, 37 PCG of CI were also studied.

Results

The mean age (years) of the subjects was 28.7 ± 6.7 for EB and 30.5 ± 4.6 for CI. The mean or median (range) baseline scores for subjective distress, family burden and QOL of PCG (n = 20) of EB were 8.4 ± 7.9, 6.5 (0-30); 28.5 ± 17.5, 24 (7-77) and 12.6 ± 6.7, 11.5 (4-28) and for PCG (n = 14) of CI were 12 ± 4.3, 38.9 ± 16.2 and 17.7 ± 3.6 respectively. The PDEP improved the QOL (p = 0.01), knowledge (p < 0.01) and practices (p < 0.001) for PCG of EB and it improved subjective distress (p < 0.001), QOL (p < 0.01) and knowledge (p < 0.01) for PCG of CI.

Conclusions

PDEP is an effective educational tool in improving the QOL and knowledge of PCG, which in turn provides efficient management and psychological support to children affected with EB and CI. It should, therefore, be routinely used for educating the PCG of children with EB and CI.

Mental health effects of domestic violence against women in Delhi: A community-based study

Background:

Domestic violence (DV) against women is an all-pervasive phenomenon considered to have serious health consequences for women. This study aimed to assess the association of DV against women with their mental health status.

Materials and Methods:

This community-based, cross-sectional study was carried out among 827 ever married women from Delhi selected through cluster sampling followed by systematic random sampling. Data were collected using structured and in-depth questionnaires. Mental health status was estimated using self-reporting questionnaire 20.

Results:

The prevalence of psychological, physical, sexual, physical, or sexual violence and any form of violence was very high. A quarter of the women (25.3%) reported unhealthy mental status (>8 score) in the past 4 weeks. Women who had experienced DV showed poor mental health status and more suicidal tendencies when compared with women who had not experienced violence.

Conclusion:

DV has significant effect on women's mental health underscoring the need to develop public health interventions.

Knowledge, attitude, practice and learning needs of nursing personnel related to domestic violence against women: a facility based cross sectional survey

Background: Domestic violence against women (DVAW) is widely recognized as a public health problem. In India, health sector response to DVAW is suboptimal. Present study aimed to assess the knowledge, attitude, practice and learning needs of nursing personnel regarding women’s health issues related to domestic violence.Methods: This facility based cross sectional study was carried out among 100 nursing personnel from Public sector in Delhi, selected using stratified random sampling. Data were collected using a validated, pretested, structured self reported questionnaire with a few open ended questions. It included knowledge, attitude, practice and learning needs of nursing personnel relevant to DV. Descriptive statistics were used for data analysis using Stata 11.0 (College Station, Texas, USA).Results: Two third of nursing personnel (67%) had moderate knowledge scores and 27% had poor knowledge scores; 19% had favourable attitude scores towards DV; 57% had good practice scores; 44% reported moderate to high need for learning and majority lacked preparedness to manage DV victims. The knowledge was significantly associated with younger age, single, graduate/ Post graduates, B.Sc. Nursing degree holders, working in tertiary hospital, as staff nurse/public health nurse/sister in charge and those with lesser experience, (p<0.05). The attitude was significantly associated with younger age, single, graduate/post graduates, and those with lesser experience, (p<0.05).Conclusions: Nursing personnel had substantial gap in their knowledge, attitude and practice related to DV and a large unmet learning need highlighting the need for relevant pre service and continuing education.

A Randomized Controlled Trial of 2 Inhalation Methods When Using a Pressurized Metered Dose Inhaler With Valved Holding Chamber

BACKGROUND

Information on the comparative efficacy of single deep breathing versus tidal breathing for inhaled asthma medications is limited, although such information can be of much use for the treatment of patients suffering from asthma. The objective of the present study was to compare the relative difference in improvement in peak expiratory flow (PEF) with single maximal inhalation with breath-holding versus 5 tidal breaths during inhalation of salbutamol from a pressurized metered dose inhaler (pMDI) with valved holding chamber (VHC) in children 5-15 y of age with asthma.

METHODS

The randomized controlled trial was carried out on children with asthma between 5 and 15 y of age using a pMDI with a VHC either by a single deep breath with breath-hold or 5 tidal breaths. The experimental group received 200 μg of salbutamol from the pMDI with VHC with a single maximal inhalation and breath-hold technique, whereas the control group received 200 μg of salbutamol from pMDI with VHC using the 5 tidal breaths technique. The outcome variable, PEF, was reassessed 30 min after salbutamol use.

RESULTS

Eighty-two subjects (mean age 8.79 ± 2.5 y, 65 boys and 17 girls) were analyzed. There was significant improvement in the PEF, from baseline (pre-intervention) to post-intervention within the single maximal inhalation with breath-hold group and tidal breathing group independently (P < .001). The mean difference in improvement in PEF between the single maximal inhalation with a breath-hold and 5 tidal breaths group was 30.0 ± 18.16 and 28.29 ± 13.94 L/min, respectively, and was not statistically significant (P = .88).

CONCLUSIONS

Single maximal inhalation with a breath-hold technique is not superior to tidal breathing for improvement in PEF following salbutamol inhalation. Either method may be used in children between 5 and 15 y of age. (India's Clinical Trials Registry CTRI/2013/04/003559.).

Determinants of Health Care Services Utilisation for Childhood illness in a selected village of Jhajjar, Haryana - A Survey

This quantitative community-based study identifies-households, primary caregivers (PCGs), child, demographic factors and health care services characteristics and the pattern of health care services utilisationfor childhood illnesses. A cross-sectional household sur- vey was conducted in a ,selected village of Jhajjar district of Haryana from June 2011 to June 2012, in which 1265 households were contacted. Total 340 primary care givers of children suffering from illness currently or during last 2 weeks .were- interviewed using a semi-structured interview schedule. One way ANOVA and the chi-square test were used to determine the association with selected variables (p<0.05, CI 95%). Major- ity of primary care givers were mothers 269 (79.1%), in the age group of 25- 35 years (149, 43.8%) with mean age 28.2 ? 9.9 years (15-70). Majority of sick children 328 (96.4%) were between 2 months to 5 years, male (206, 60.6%). Majority of sick children suffered from cold and cough (218, 64.1%) During the current illness majority of PCGS 205 (60.3%) had been to the private health care facility to seek the treatment. Signft- cant relationship- was found between the private health care facility utilisation and the selected variables. All primary care givers despite low socio economic status, health care services from private sector due to availability and accessibility of health care profes- sionals even in the evening and night time, quick relief and good individual attention by them without loss of wages.

Predictors of breastfeeding problems in the first postnatal week and its effect on exclusive breastfeeding rate at six months: experience in a tertiary care centre in Northern India

In spite of the countless benefits of breastfeeding, prevalence of exclusive breastfeeding (EBF) has been far from optimal in the developing world. Breastfeeding problems at or after 4 weeks has been reported as one among the constraints to EBF. The study aimed to determine the breastfeeding problems in the 1 st postnatal week, their predictors and impact on EBF rate at 6 months. Under a prospective cohort design, 400 mother-newborn dyads were assessed for breastfeeding problems before discharge and at 60 ± 12 h of discharge. Nearly 89% of the mother-newborn dyads had one or more BF problems before discharge. Major concern was difficulty in positioning and attaching the infant to the breast (88.5%), followed by breast and nipple problems (30.3%). BF problems continued to persist even after discharge in a significant proportion of the mothers (72.5%). The only independent predictor of BF problems in the 1 st week was the caesarean section (odds ratio: 1.9, 95% confidence interval: 1.3-3.2, P < 0.05). There was a marked improvement in the EBF status (69.5%) at 6 months, and BF problems did not predict EBF failure at 6 months.

Neonatal nursing: an unmet challenge in India

Nurses comprise a key component to maternal and newborn health care delivery, including the care of 'at-risk' or sick newborns. However, the efficiency and effectiveness of services rely heavily on adequate numbers of highly skilled neonatal nurses. Currently, in India, a significant shortage of trained nurses in the field of newborn care is contributing to poor neonatal outcomes. Specifically, nurses caring for newborns lack the competency and experience needed to ensure optimal care. This deficiency has been linked to a lack of expert faculty, standardized training and minimal or no exposures to newborn clinical care areas during pre service education. Moreover, in addition to a lack of operational research in the area, nurses who provide care for newborns are often faced with numerous system related issues that impede their ability to provide optimal care. Most notably, frequent changes of work place, poor wages, and lack of continuing education, skill maintenance, recognition, and collaborative team culture further compromise the nursing care. All these lead to poor motivation and competency. To meet this challenge, it is essential that emphasis be placed on the identification and support of nursing faculty with expertise in newborn and neonatal care who are able to ensure that nurses receive standardized education for pre-service, in-service and ongoing care. In addition, importance should be placed on encouraging newborn nursing research as well as on governmental increases in salary compensation. Lastly, given the shortage of physicians to take care of sick neonates in remote areas, the creation of a cadre of Neonatal nurse practitioner/ advanced practice nurses would be an invaluable solution in developing countries. Furthermore, centralized oversight of newborn education and training would be best served, if responsibility was placed with Reproductive maternal newborn child health (RMNCH) workers and district level officers.

Educational barriers of nurses caring for sick and at-risk infants in India

AIM

To gain ideas and information from healthcare providers to optimize the education and clinical practices of nurses caring for sick or at-risk newborns in India.

BACKGROUND

Improving infant survival has been identified as a Millennium Development Goals; however, India still faces many challenges with 3.1 million neonatal deaths and 2.6 million stillbirths annually. Skilled nursing care has been associated with decreased morbidity and mortality in newborns. However, core competencies in newborn care education and training are lacking for nurses.

METHODS

Qualitative data were collected from 12 focus groups with 101 newborn care providers from three areas of India as well as from a 2-day stakeholders' meeting. Data analysis was undertaken using descriptive and thematic content analysis.

RESULTS

Perceived challenges included limited manpower and high nurse turnover, lack of access to evidence-based orientation to newborn care and problems with access to appropriate learner-based, neonatal training. Relevant, ongoing education opportunities, led by nursing leaders were identified to be important solutions.

CONCLUSION

Findings provide insight into the current healthcare system in India with specific reference to the nursing care of at-risk newborns. There is a lack of existing resources to provide standardized and specific orientation curricula for nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policy makers in health and education need to: support and enact learner-based orientation and continuing educational opportunities as well as ongoing competency-based education programmes; encourage nurse leader involvement and support; and provide sustainable system-related supports. Nurses and other health providers need to work together to influence government policy.

Knowledge, attitude and performance of IMNCI trained nursing personnel: an evaluative survey

OBJECTIVE

A cross-sectional survey of nursing personnel's knowledge, attitude and their consultations with sick children under 5 y of age, at specified levels of health care in terms of IMNCI guidelines, was conducted at six community health centers (CHC) of a selected district of Haryana, India.

METHODS

Total enumeration technique was used to assess knowledge and attitude of 183 IMNCI trained nursing personnel towards the training programme using a pretested structured questionnaire. Total 236 consultations of sick children presenting to the facilities made by conveniently selected 65 nursing personnel were also observed.

RESULTS

Majority of nursing personnel had good knowledge 94 (51.4 %) and excellent attitude 98 (53.55 %) scores related to IMNCI programme. Nursing personnel performed best in assessing sick children (2 mo-5 y) in areas of fever (89.7 %, CI 96.9-79.7), cough (89.2 %, CI 96.7-81.6), and identifying treatment (89.1 %, CI 96.7-83.7). Their performance in identifying classifications related to diarrhea (74.1 %, CI 84.7-62.8), malnutrition (67.2 %, CI 78.6-59.0), anemia (77.3 %, CI 87.5-70.0), immunization (78.9 % CI 88.8-71.8) and feeding problem (75.9 %, CI 86.3-66.9) was relatively less. Similarly, in assessing young infants (0-2 mo) performance of nursing personnel was best in the areas of possible serious bacterial infection (PSBI) (88.1 %, CI 99.1-87.3), and identifying the treatment (86.7 %, CI 94.9-80.2) and low in dehydration (70.8 %, CI81.8-52.6), feeding problem (50.5 %, CI 62.7-40.9), feeding assessment (50.6 %, CI 62.8-39.8), and immunization (70 %, CI 81.1-61.2).

CONCLUSIONS

IMNCI trained nursing personnel have good knowledge and attitude towards child care and their performance can be improved further with drills, exercises and supervised practices.

Coping strategies adopted by nurses experiencing domestic violence by their marital partners

This facility-based study was conducted at a tertiary care hospital in New Delhi. Thirty nurses identified to be exposed to physical or sexual violence ever in life through a pilot study were purposively selected for further studying their coping strategies. The pilot study was initially conducted among 60 ever married female nurses sampled conveniently. Data was collected using self-administered standardised questionnaire adapted from WHO multi-country study on women's health and domestic violence. To estimate coping strategies, Section 9 of the data were analysed using SPSS 12 software. Eleven respondents (36.3%) experiencing physical or sexual violence, informed friends and close relatives about husband's violent behaviour while 40 percent talked to no one. Only 5 (16.7%) nurses sought help from formal agencies. Reasons for not seeking help mainly were considering violence as normal/not serious (20%), fear that he would end relationship (20%), fear of consequences (16.7%). Nurses mainly sought help on being encouraged by friends/family (6.7%). The study found that relatively few nurses experiencing domestic violence talk to someone or seek help from formal agencies.

Skeletal muscle strength in young Asian Indian females after vitamin D and calcium supplementation: a double-blind randomized controlled clinical trial

CONTEXT

Randomized control trials (RCT) of the effect of vitamin D/calcium supplementation on skeletal muscle strength have not shown promising effect in the elderly.

OBJECTIVE

Our objective was to assess the effect of vitamin D and/or calcium on muscle strength in young adults with vitamin D deficiency.

DESIGN AND SETTING

We conducted a RCT using a factorial design at a tertiary-care center from September 2010 to April 2011.

SUBJECTS

A total of 173 healthy females with mean age, body mass index, and 25-hydroxyvitamin D [25(OH)D] of 21.7 ± 4.4 yr, 20.8 ± 2.96 kg/m(2), and 9.3 ± 3.37 ng/ml, respectively, were block randomized to 1) double placebo, 2) calcium/placebo, 3) cholecalciferol/placebo, and 4) cholecalciferol/calcium for 6 months. Cholecalciferol was given at 60,000 IU/wk for 8 wk followed by 60,000 IU/fortnight. Elemental calcium was given in doses of 500 mg twice per day for 6 months.

METHODS

Assessment included hand grip (primary outcome) and pinch grip strength, distance walked in 6 min, dyspnea score, quality of life by Short Form (36) Health Survey (SP-36), serum 25(OH)D, 1,25-dihydroxyvitamin D, and intact PTH.

RESULTS

The serum 25(OH)D increased significantly to 29.9 ± 8.35 and 27.0 ± 9.54 ng/ml in two groups on cholecalciferol. The mean hand grip strength (19.4 ± 3.92, 21.1 ± 3.31, 20.6 ± 3.92, and 20.1 ± 4.00 kg) and its increase from baseline (0.3 ± 2.25, 0.3 ± 2.64, -0.3 ± 2.41, and 0.6 ± 2.30 kg) were comparable in four groups at 6 months. Quality of life, urinary calcium/creatinine ratio, and adverse effects were also comparable in groups.

CONCLUSION

Oral cholecalciferol/calcium supplementation in the dose/schedule used is effective and safe in increasing and maintaining serum 25(OH)D. However, this does not lead to improved skeletal muscle strength in young females.

Study of cardiovascular risk factors among tertiary hospital employees and their families

BACKGROUND

The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families.

METHODS AND RESULTS

A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above. The mean age of the study group was 43.3 ± 9.5 years. There was a high prevalence of major cardiovascular risk factors - current smoking 58 (12.8%), tobacco consumption 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus 25 (5.8%), hypertension 94 (20.7%), hypercholesterolemia 110 (25.7%), hypertriglyceridemia 148 (34.5%), physical inactivity 180 (39.7%), body mass index ≥23 kg/m(2) 350 (77.3%), central obesity 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption 387 (85.4%), heavy drinking 12 (2.6%), and stress 58 (12.7%).

CONCLUSION

This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.

Inter-Rater Reliabilty of Neonatal Infant Pain Scale (NIPS) as a Multidimensional Behavioral Pain Tool

Evaluation of pain in human neonate is complex and difficult because pain is a subjective phenomenon. Neonates cannot verbalize pain rather they express through cry and body movements. However measurement of pain provides a value of pain. There is no gold standard in pain assessment tool. JCAHO recommends selection of a valid and reliable and also age appropriate pain assessment tool.

To determine the interobserver reliabity and clinical utility of NIPS scale To analyze the inter-rater reliability, reproducibility of NIPS scale between three observers prospective observation study was designed to establish reliability and validity of NIPS among 27 neonates who underwent venipuncture, Hepatitis vaccination (intramuscular) and heel prick at a tertiary care level III NICU. The baseline data and behavioral responses to procedural pain were rated by three observers trained in NIPS scale.

At the end of 100 observation across the various time intervals and three phases, inter-rater reliability of NIPS scale among the three observers were. 82,.81,.75. Acceptable psychometric properties are reported for the tool which includes cronbach's alpha levels of. 9,.85,.9 between the observers. CNIPS was found to be highly reliable and valid multidimensional scale and practical and has good clinical utility.

Domestic Violence against Nurses by their Marital Partners: A Facility-based Study at a Tertiary Care Hospital

BACKGROUND

In recent times, domestic violence against women by marital partners has emerged as an important public health problem.

OBJECTIVES

1. To determine the prevalence, characteristics and impact of domestic violence against nurses by their marital partners, in Delhi, India. 2. To identify nurses' perceptions regarding acceptable behavior for men and women.

MATERIALS AND METHODS

A facility-based pilot study was conducted at All India Institute of Medical Sciences (AIIMS), New Delhi. Data were collected using self-administered standardized questionnaire, among 60 ever married female nurses working at AIIMS hospital, selected by convenience sampling. The principal outcome variables were controlling behavior, emotional, physical and sexual violence by marital partners. Data were analyzed using SPSS 12 software. The test applied was Fisher's exact test and 1-sided Fisher's exact test.

RESULTS

Sixty percent of nurses reported marital partner perpetrated controlling behavior, 65% reported emotional violence, 43.3% reported physical violence and 30% reported sexual violence. About 3/5(th) of nurses (58%) opined that no reason justified violence, except wife infidelity (31.67%). Of the physically or sexually abused respondents, 40% were ever injured, and 56.7% reported that violence affected their physical and mental health.

CONCLUSION

There is a high magnitude of domestic violence against nurses and this is reported to have affected their physical and mental health.

Study of cardiovascular risk factors among tertiary hospital employees and their families

BACKGROUND

Cardiovascular diseases have become the leading cause of mortality and morbidity in most countries of the world. The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families.

METHODS AND RESULTS

A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above (N1 = 453 for the questionnaire, anthropometric and clinical parameters; N2 = 429 for biochemical investigations). Evaluation for cardiovascular risk factors, anthropometric measurements, blood pressure, fasting blood glucose and serum lipids were performed using standard definitions. The mean age of the study group was 43.3 +/- 9.5 years. There was a high prevalence of major cardiovascular risk factors--current smoking in 58 (12.8%), tobacco consumption in 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus in 25 (5.8%), hypertension in 94 (20.7%), hyperlipidemia--hypercholesterolemia in 110 (25.7%) & hypertriglyceridemia in 148 (34.5%), physical inactivity in 180 (39.7%), body mass index e" 23 kg/m2 in 350 (77.3%), central obesity i.e. waist circumference > 90 cm for males and > 80 cm for females -in 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption in 387 (85.4%), heavy drinking in 12 (2.6%), and stress in 58 (12.7%).

CONCLUSION

The study demonstrated an overall high prevalence of cardiovascular risk factors even amongst employees at a tertiary hospital and their families. This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.

Breastfeeding practices of urban and rural mothers

This longitudinal study was conducted to describe the prevalence of exclusive breastfeeding and factors influencing it in urban (tertiary care hospital of Delhi) and rural (First Referral Unit in Haryana) settings. The exclusive breastfeeding rates were 38%, 30%, 24%, 20%, 16% and 1% at discharge, 1.5, 2.5, 3.5, 4.5 and 6 months, respectively in the urban and; 57%, 16%, 9%, 6%, 5% and 0% at discharge, 1.5, 2.5, 3.5, 4.5 and 6 months, respectively in rural setting. Use of formula feeding was very high (55%) among the urban mothers during hospital stay. The factors associated with continuation of exclusive breastfeeding were mothers knowledge regarding breastfeeding and reinforcement by health professionals, whereas the factors associated with cessation were perceived insufficiency of milk, and cultural practices.

Cabbage leaves vs hot and cold compresses in the treatment of breast engorgement

This study was conducted to evaluate the effect of cold cabbage leaves and alternate hot and cold compresses in decreasing breast engorgement and pain in post-natal mothers admitted in AIIMS, New Delhi.

HIV knowledge improvement among nurses in India: using a train-the-trainer program

Nurses play a major role in the health care delivery system; therefore, education of nurses is critical to successful prevention programs for persons with HIV. Little is known about nurses' knowledge of HIV in India. The purpose of this study was to determine the effects of a nurse-led train-the-trainer HIV education program on improving the HIV knowledge of nurses. A group of senior nurses (N = 10), were responsible for training a cohort of 10 nurses each, totaling 100 nurses. The 2-day training program included HIV epidemiology and etiology, infection control, psychosocial support, counseling, modes of transmission, natural history of the disease, symptoms of early and late disease, diagnostic testing, and legal and ethical issues. Pre- and posttest scores were calculated using a self-administered structured questionnaire that measured HIV-related knowledge in terms of cognitive and transmission knowledge. Paired t-tests indicated that both measures of HIV knowledge improved significantly from pretest to posttest.

A Comparison of Cabbage Leaves vs. Hot and Cold Compresses in the Treatment of Breast Engorgement

OBJECTIVE

To assess and compare the efficacy of cold cabbage leaves and hot and cold compresses in the treatment of breast engorgement.

MATERIAL AND METHODS

This was a quasi-experimental study conducted in the postnatal ward of the All India Institute of Medical Sciences (AIIMS), New Delhi. The study comprised a total of 60 mothers;30 in the experimental group and 30 in the control group. The control group received alternate hot and cold compresses and the experimental group received cold cabbage leaf treatment for relieving breast engorgement. The pre- and posttreatment scores of breast engorgement and pain were recorded. The data were analyzed using descriptive and inferential statistical methods using the statistical software STRATA.

RESULTS

Both the treatments, i.e., hot and cold compress and cabbage leaves were effective in decreasing breast engorgement and pain in postnatal mothers (P </= 0.001).Cold cabbage leaves and hot and cold compress were both equally effective in decreasing breast engorgement (P = 0.07), whereas hot and cold compresses were found to be more effective than cold cabbage leaves in relieving pain due to breast engorgement (P </= 0.001) in postnatal mothers.

CONCLUSION

Cold cabbage leaves as well as alternate hot and cold compresses both can be used in the treatment of breast engorgement. Hot and cold compresses are more effective in decreasing pain than cold cabbage leaves in relieving pan due to breast engorgement.