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Background: There is little published research that has examined practitioners' views and experiences of pain relieving measures commonly used during labour and birth, particularly for non-pharmacological measures such as water immersion. Furthermore, there is minimal published research examining the process of policy and guideline development, that is, the translation of published research to usable practice guidance., Aims: The aims of phase three of a larger study were to explore midwives knowledge, experiences and support for the option of water immersion for labour and birth in practice and their involvement, if any, in development of policy and guidelines pertaining to the option., Methods: Phase three of a three phased mixed methods study included a web based survey of 234 Australian midwives who had facilitated and/or been involved in the development of policies and/or guidelines relating to the practice of water immersion., Findings: Midwives who participated in this study were supportive of both water immersion for labour and birth reiterating documented benefits of reduced pain, maternal relaxation and a positive birth experience. The most significant concerns were maternal collapse, the difficulty of estimating blood loss and postpartum haemorrhage whilst barriers included lack of accredited staff, lifting equipment and negative attitudes. Midwives indicated that policy/guideline documents limited their ability to facilitate water immersion and did not always to support women's informed choice., Conclusion: Midwives who participated in this study supported the practice of water immersion reiterating the benefits documented in the literature and minimal risk to the woman and baby., Ethical Considerations: The Human Research Ethics Committee of the University of South Australia approved the research., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objectives: Showering before entering a swimming pool is highly recommended to reduce the risk of biological and chemical contamination. This study evaluated the behaviour of indoor swimming pool users; analysed the variables associated with lack of showering; and assessed awareness of the importance of showering., Study Design: Cross-sectional study., Methods: A self-administered questionnaire was used to collect data about users of swimming pools located in five different Italian cities. The association between specific variables and the lack of showering was assessed. P < 0.05 was considered to indicate statistical significance., Results: In total, 4356 questionnaires were analysed. Sixty-five percent of interviewees always showered before entering the pool. The main reason given for pre-swim showering was 'to wash oneself' (50.5%); or 'to get used to the temperature of the water' (44.3%); and 5.2% answered 'for both reasons'. Risk factors significantly associated with lack of showering were: female sex (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.2-1.59), age 14-17 years (OR 5.09, 95% CI 3.40-7.64); not reading the swimming pool rules (OR 1.24, 95% CI 1.10-1.41); living in Central Italy (OR 3.3, 95% CI 2.65-4.1) or Southern Italy (OR 1.35, 95% CI 1.18-1.55); and previous/current attendance of a swimming course (OR 1.7, 95% CI 1.48-1.97)., Conclusions: The results revealed low compliance with the rule of showering before entering a swimming pool, and little awareness of the preventive role of showering in the hygienic management of swimming pools. There is a need for targeted educational interventions to inform swimming pool users of the reasons for the importance of showering before entering a pool., (Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Cannabis is the most commonly used illicit substance worldwide. Cannabinoids or cannabinoid receptor agonists are often used to treat nausea, vomiting, and anorexia. However, in recent years, several medical journals have published reports of patients with nausea and vomiting thought to be induced by chronic cannabis use., Objective: The authors seek to inform readers about Cannabinoid Hyperemesis Syndrome (CHS)., Method: The authors describe four patients with chronic cannabis abuse, episodic, intractable nausea and vomiting, and compulsive hot water bathing. Previous cases of CHS are reviewed, pathophysiology is hypothesized, and difficulties with making the diagnosis are discussed., Conclusion: CHS should be strongly considered in the differential diagnosis of patients with intractable vomiting and/or compulsive hot water bathing., (Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.)

This uncontrolled intervention study explored the effects of stone spa use on the psychological states of women. Sixty-eight female volunteers (mean age 37.5 years (standard deviation 14.8)) recruited at a women-only stone spa facility participated in the study. They completed the short-form Profile of Moods States (POMS) and the State-Trait Anxiety Inventory (STAI) before and after stone spa use in order to determine changes in mood and anxiety states. Six factors relating to mood were measured using the POMS: Tension-Anxiety, Depression-Dejection, Anger-Hostility, Vigor, Fatigue, and Confusion. The two anxiety concepts of state anxiety and trait anxiety were also measured. The scores for Tension-Anxiety and Anger-Hostility and both anxiety measures were improved statistically after stone spa use. Stone spa use shows considerable promise for improving mood and reducing anxiety. Since this study was a descriptive, prospective and uncontrolled intervention study, further investigation of these promising findings is warranted.

The authors evaluated the feasibility of using salivary cortisol as a noninvasive measure of hypothalamic-pituitary-adrenal (HPA)-axis responses to stressful events of daily living in elderly nursing home residents. Ten medically stable male nursing home residents (age 81.7 +/- 12.42) gave salivary samples before and after an assisted bath, and at corresponding times on the subsequent (control) day. Regression models, with measures of salivary cortisol on the bath and control days for two timepoints before the bath and four timepoints after the bath as the dependent variables, yielded significant effects of time, bath status, and day. Salivary cortisol testing is noninvasive and easy to collect from long-term care patients, including those with moderate degrees of dementia. It may be of use as a tool for studying the stressors associated with care, the determinants of HPA responses, and the consequences of hypercortisolemia in these vulnerable patients.

Parental participant modeling and contact desensitization were used to reduce phobia of warm water bathing in a 6-year-old male burn victim traumatized by his natural parents. Cradled in an adoptive parent's arms, the child contacted, entered, and remained in increasingly warmer and deeper water for 3-min intervals during daily 15-min bathing routines. Treatment effected heat and depth tolerance to the point that the subject maintained desired behavior without parental assistance. Heat and depth tolerance persisted through a 6-month follow-up period.