scholarly journals Effects of a Comprehensive Oral Care Program and a Combined Toothbrush and Mouthwash Program with 0.2% Chlorhexidine on Oral Health in Mechanically Ventilated Intubated Patients: A Clinical Trial

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Fatemeh Kord Salarzehi ◽  
Alireza Rahat Dahmardeh ◽  
Seyed Mohammad Nasiodin Tabatabaei ◽  
Fariba Yaghoubinia
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Oral Health ◽  
Oral Care ◽  
Health Improvement ◽  
Control Group ◽  
Specific Method ◽  
Health Score ◽  
Combination Methods ◽  
The Mean

Background: Patients’ oral health is impaired in Intensive Care units (ICUs) due to loss of consciousness, open mouth, intubation, and mechanical ventilation. Objectives: The current study aimed to compare the effects of comprehensive and combined programs on oral health in patients under mechanical ventilation. Methods: This single-blind clinical trial with three groups was performed on 90 patients with mechanical ventilation admitted to ICUs of medical centers affiliated to the Zahedan University of Medical Sciences, Iran, in 2020. Patients under mechanical ventilation were randomly divided into three groups, including those receiving a comprehensive program, those receiving a combined program, and controls through permutated blocks. In the two intervention groups, oral care was performed for 5 minutes, three times per day, during the 5 days of the study with a specific method. The control group received routine oral care. The patients’ oral health was measured once before the intervention and then every day until the fifth day of the intervention using the Beck Oral Assessment scale. The data were analyzed using the analysis of variance and chi-square in IBM SPSS Statistics software version 26. Results: The mean oral health score in the three groups was not significantly different before the intervention and on the second day of the study (P > 0.05). However, on the third to fifth days of the study, the oral health score in the two intervention groups showed a significant decrease compared to the control group, indicating an oral health improvement in these groups (P = 0.001). The mean oral health score in the control group increased during the study days. Conclusions: Comprehensive care and combination methods can improve oral health in patients under mechanical ventilation. Nurses are recommended to use regular and codified oral care methods.

scholarly journals Effect of Oral Care Protocol on Dental and Gingival Plaque Index in Patients With Endotracheal Tube Admitted to the Intensive Care Unit

2021 ◽  
Author(s):  
Ali Ghaempanah ◽  
Mitra Payami Bosari ◽  
Abolfazl Amini ◽  
Soqrat Faghihzadeh ◽  
Zahra Aghazadeh
Keyword(s):  
Oral Health ◽  
Dental Plaque ◽  
Oral Care ◽  
Plaque Index ◽  
Control Group ◽  
Control Groups ◽  
Double Blind ◽  
Care Protocol ◽  
The Mean ◽  
And Control

Oral health is one of the most critical aspects of nursing care in critically ill patients. The study aimed to investigate the effect of oral health protocol on dental and gingival plaque index in patients with endotracheal tubes admitted into the ICU. This double-blind clinical trial was conducted on 70 patients admitted into ICU randomly by tossing a coin, and 35 patients were assigned to each of the experimental and control groups. Oral care was performed in the experimental group using the chlorhexidine (CHX) solution, toothpaste, and oral moisturizer protocol; in the control group, according to the routine method, 0.2% CHX was used twice a day. The data were collected at the time of inclusion and four days later, using the MGI and the O'Leary dental plaque index. The mean ages in the experimental and control groups were 38.4±14.4 and 41±14.5 years, respectively. In the experimental and control groups, 77% and 83% of the subjects were male, respectively. After the intervention, the mean gingival index in the experimental and control groups was 0.59±0.31 and 0.90±0.41, and the plaque index was 42.53±15.97 and 53.52±11.9, respectively. The differences before and after the intervention in each group and the difference between the two groups in both gingival and dental plaque indices were statistically significant (P=0.0001). The results showed that the oral health protocol was more effective in improving gingival and dental plaque indices than the routine (CHX) method.

Oral Health: Something to Smile About!

2014 ◽  
Vol 23 (4) ◽  
pp. 282-288 ◽  
Author(s):  
Cindy L. Munro
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Oral Health ◽  
Randomized Clinical Trial ◽  
Critically Ill ◽  
Oral Care ◽  
Well Being ◽  
Critically Ill Adults ◽  
The Impact ◽  
Ill Adults

Oral health is integrally linked to overall well-being. This article describes a research program focused on the contribution of poor oral health to systemic illness. Initial investigations examined factors related to streptococcal virulence that were important in dental caries and endocarditis and led to development of immunization strategies in animal models to reduce risk of endocarditis. Clinical investigations related to critically ill adults began with descriptive and observational studies that established the importance of dental plaque in development of ventilator-associated pneumonia (VAP) and examined existing nursing practices in oral care. Subsequent intervention studies sponsored by the National Institutes of Health (NIH) to test oral care protocols in critically ill adults have built on that foundation. The group’s first NIH-funded randomized clinical trial tested the effects of toothbrushing and use of chlorhexidine in reducing risk of VAP in critically ill adults and showed that VAP was reduced by topical application of chlorhexidine initiated after intubation, although toothbrushing did not reduce VAP. The study had a rapid and dramatic effect on clinical practice. Results of the study were published in September 2009 in the American Journal of Critical Care, and in May 2010, the Institute for Health-care Improvement updated the recommendations for the care of patients receiving mechanical ventilation (the ventilator bundle) to include daily oral care with chlorhexidine, referencing the results of that study as evidence for the change. Chlorhexidine is now the standard of care for adults receiving mechanical ventilation. Because the effects of chlorhexidine after intubation were so beneficial, a second recently completed NIH-funded randomized clinical trial investigated the impact of chlorhexidine applied before intubation compared with after intubation. Currently a large randomized clinical trial is being launched to determine the optimal frequency of toothbrushing for critically ill patients receiving mechanical ventilation in an effort to maximize oral health benefits while minimizing systemic risks. The importance of collaboration and mentoring in building nursing science is discussed. Future directions for research also are explored.

scholarly journals Oral Candidiasis and COVID-19 in Users of Removable Dentures: Is Special Oral Care Needed?

Gerontology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Laura Silva Jerônimo ◽  
Rafael Paschoal Esteves Lima ◽  
Thaís Yumi Umeda Suzuki ◽  
José Augusto César Discacciati ◽  
Cláudia Lopes Brilhante Bhering
Keyword(s):  
Mechanical Ventilation ◽  
Candida Albicans ◽  
Oral Health ◽  
Early Diagnosis ◽  
Elderly Patients ◽  
Oral Candidiasis ◽  
Oral Care ◽  
Antifungal Treatment ◽  
Immunocompromised Patients ◽  
Appropriate Care

Elderly patients with systemic disorders and immunocompromised patients seem to have a higher risk of developing morbidity from COVID-19. <i>Candida albicans</i> (<i>C. albicans</i>) is a potentially dangerous pathogen for these patients, especially for denture wearers with prosthetic stomatitis who require mechanical ventilation. <i>C. albicans</i> infection, the main candidiasis infection associated with denture wear, can complicate COVID-19 and increase the associated morbidity and mortality. Therefore, early diagnosis of <i>C. albicans</i> infection in COVID-19 patients is important to establish more effective antifungal treatment methods and prophylaxis strategies. Hospitalized COVID-19 patients should undergo an oral examination to assess their oral health, and those with poor oral health should receive the appropriate care and monitoring.

scholarly journals Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome

2020 ◽  
Vol 09 (03) ◽  
pp. 201-206
Author(s):  
Surabhi Chandra ◽  
Sahil Goel ◽  
Ritika Dawra
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Neuromuscular Blockade ◽  
Distress Syndrome ◽  
Control Group ◽  
Case Group ◽  
The Mean ◽  
Mean Time

AbstractPediatric acute respiratory distress syndrome (PARDS) is a challenging problem with high mortality. Role of neuromuscular blockade in the management of ARDS to date has been controversial, and this study was done to study the role of neuromuscular blockade in children having PARDS and development of associated complications, if any. This was a prospective, case–control study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital, over a period of 24 months. Patients of age 1 to 18 years who presented with or developed PARDS during their course of hospitalization were included after written informed consent was obtained from their parents and/or guardians. Patients with PARDS requiring invasive mechanical ventilation were partitioned into a case group and a control group. Case group patients were sedated and paralyzed using midazolam (1 µg/kg/min) and vecuronium (1 µg/kg/min), respectively, along with institution of definitive management. Control group patients were given definitive and supportive therapy, but no neuromuscular blocking agents (NMBAs). All patients were followed up for signs and symptoms of myopathy or neuropathy during the entire duration of hospital stay and up to 3 months after discharge. During the study period, 613 patients were admitted to the PICU of which 91 patients qualified as having PARDS. Sepsis was the main etiology in 67 of the 91 patients (73.6%) with PARDS. Fifty-nine patients were included in the study, of which 29 patients were included in the case group and 30 patients were included in the control group. Among the 29 case group patients, 25 patients (86.2%) were successfully extubated. Four patients from the case group expired, while 14 out of 30 control group patients (46.7%) expired. Hypotension was present in 26 case group patients (89.6%), of which all showed resolution within 48 hours of definitive treatment. The mean time to resolution of hypotension was 41.6 hours (standard deviation [SD]: 5.759; range: 24–48) for case group patients, significantly lower (p < 0.0001) than the mean time to resolution of 103 hours (SD: 18.995; range: 90–126) for the 10 control group patients with hypotension that survived. Mean oxygenation index (OI) following 48 hours of vecuronium therapy was significantly lower (p < 0.0001; 95% confidence interval: 5.9129–9.9671) than mean OI at admission for case group patients. None of the patients receiving vecuronium exhibited neuromuscular deficit during their hospital stay, at time of discharge, or at follow-up evaluation up to 3 months after discharge. In this study, pediatric cases diagnosed with PARDS and managed with mechanical ventilation and vecuronium therapy had improved mean OI following 48 hours of NMBA therapy and a lower mortality when compared with matched control group patients. Incidence of NMBA-related weakness was not commonly observed in these patients.

scholarly journals Convalescent Plasma for COVID-19: A multicenter, randomized clinical trial

2020 ◽  
Author(s):  
Cristina Avendano-Sola ◽  
Antonio Ramos-Martinez ◽  
Elena Munez-Rubio ◽  
Belen Ruiz-Antoran ◽  
Rosa Malo de Molina ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Randomized Clinical Trial ◽  
Strong Dependence ◽  
Standard Of Care ◽  
Ordinal Scale ◽  
Control Group ◽  
Standard Of Care Treatment ◽  
And Control ◽  
To Receive

Background: Passive immunotherapy with convalescent plasma (CP) is a potential treatment for COVID-19 for which evidence from controlled clinical trials is lacking. Methods: We conducted a multi-center, randomized clinical trial in patients hospitalized for COVID-19. All patients received standard of care treatment, including off-label use of marketed medicines, and were randomized 1:1 to receive one dose (250-300 mL) of CP from donors with IgG anti-SARS-CoV-2. The primary endpoint was the proportion of patients in categories 5, 6 or 7 of the COVID-19 ordinal scale at day 15. Results: The trial was stopped after first interim analysis due to the fall in recruitment related to pandemic control. With 81 patients randomized, there were no patients progressing to mechanical ventilation or death among the 38 patients assigned to receive plasma (0%) versus 6 out of 43 patients (14%) progressing in control arm. Mortality rates were 0% vs 9.3% at days 15 and 29 for the active and control groups, respectively. No significant differences were found in secondary endpoints. At inclusion, patients had a median time of 8 days (IQR, 6-9) of symptoms and 49,4% of them were positive for anti-SARS-CoV-2 IgG antibodies. Conclusions: Convalescent plasma could be superior to standard of care in avoiding progression to mechanical ventilation or death in hospitalized patients with COVID-19. The strong dependence of results on a limited number of events in the control group prevents drawing firm conclusions about CP efficacy from this trial. (Funded by Instituto de Salud Carlos III; NCT04345523).

scholarly journals Intravesical Instillation of Sodium Hyaluronate (Cystistat®) for the Treatment of Patients with Radiation Cystitis-Randomized Clinical Trial

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Farzad Allameh ◽  
Abbas Basiri ◽  
Saleh Ghiasy ◽  
Atefeh Javadi ◽  
Seyyed Ali Hojjati ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Hyaluronic Acid ◽  
Sodium Hyaluronate ◽  
Intravesical Instillation ◽  
Control Group ◽  
Radiation Cystitis ◽  
Vas Score ◽  
The Mean

Background: Radiotherapy (RT) is a choice to manage pelvic organ malignancies that can affect bladder; therefore, it causes radiation cystitis with some bothering urinary symptoms and decreasing the patient’s quality of life. Intravesical hyaluronic acid (HA) is an agent with promising results in some studies for cystitis, and Cystistat is a derivative of hyaluronic acid. Objectives: This clinical trial aimed at evaluating the effects of intravesical instillation of Cystistat on symptoms of radiation cystitis and quality of life (QOL). Methods: A total of 58 patients with radiation cystitis were randomized in 2 groups (case: 30, control: 28). One group received intravesical Cystistat, the other received normal saline weekly for up to 4 weeks and then monthly for up to 2 months. Hematuria, Visual Analog scale (VAS) and QOL based on King’s Health questionnaire were compared before and 3, 6 and 9 months after intravesical instillation. Results: The mean age of the patients was 63.93 ± 10.89 years old. The mean of each sub-category of QOL and total score of QOL, as well as, VAS score were significantly improved in comparison to the control group at each time of follow-ups (P < 0.05). Hematuria was significantly different in the 3rd, 6th and 9th month of follow-ups (P < 0.05). Conclusions: Findings showed that patients with radiation cystitis could significantly benefit from intravesical instillation of HA, their hematuria would be successfully resolved rather than control group in addition to lowering the VAS score, so their QOL would be improved.

scholarly journals The Effect of Health Literacy Counselling on Self-Care in Women after Mastectomy: a Randomized Clinical Trial

2020 ◽  
Vol 9 (1) ◽  
pp. 39-45
Author(s):  
Masoume Rastegar ◽  
Zohreh Mahmoodi ◽  
Sara Esmaelzadeh Saeieh ◽  
Nasibeh Sharifi ◽  
Kourosh Kabir
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Health Literacy ◽  
Intervention Group ◽  
Self Care ◽  
Essential Element ◽  
World Health ◽  
Control Group ◽  
Fars Province ◽  
The Mean

Introduction: Breast cancer has a high prevalence, constituting a major cause of mortality in women around the world. Health literacy has a vital role in the self-care of chronic diseases such as cancer and is an essential element in the ability of each person to engage with health promotion. The aim of this study was to determine effect of health literacy counselling on selfcare in women after mastectomy. Methods: This study is a randomized, controlled, clinical trial carried out on 72 women with breast cancer after mastectomy in Fars province. The eligible women entered the study using convenience sampling and were then divided into an intervention and a control group through randomized blocks of four. Health literacy questionnaire and self-care questionnaire were distributed among the participants before, immediately after and three weeks following the intervention. Data analysis was performed in SPSS ver.13. Results: The results showed no significant differences between the two groups in terms of their health literacy and self-care scores before the intervention (P=0.299 and 0.059). A comparison of the mean values showed a greater increase in the mean score of health literacy and score of selfcare immediately and three weeks after the intervention in the intervention group compared to the control group. Also, the mean score of the dimensions of self-care in chemotherapy increased over time in the intervention group. Conclusion: The findings of this study confirm the higher effectiveness of counseling with a health literacy approach on overall self-care in chemotherapy and all its dimensions.

scholarly journals Efektivitas salin hipertonik terhadap waktu transpor mukosiliar dan skor gejala hidung penderita rinitis alergi

2018 ◽  
Vol 47 (2) ◽  
pp. 123
Author(s):  
Woro Safitri ◽  
Dwi Reno Pawarti ◽  
Titiek Hidayati Ahadiah
Keyword(s):  
Clinical Trial ◽  
Allergic Rhinitis ◽  
Symptom Score ◽  
Saline Group ◽  
Nasal Symptom ◽  
Control Group ◽  
Mucociliary Transport ◽  
Transport Time ◽  
Total Nasal Symptom Score ◽  
The Mean

Latar belakang: Rinitis alergi (RA) adalah suatu penyakit inflamasi mukosa hidung yang diperantara oleh imunoglobulin E (IgE), setelah mukosa hidung terpapar alergen. Tujuan: Mengidentifikasi efektivitas cuci hidung salin hipertonik terhadap waktu transpor mukosiliar dan skor gejala hidung total (SGHT) pada penderita RA. Metode: Penelitian dilaksanakan pada bulan Juli hingga Desember 2016 di Poli Telinga Hidung Tenggorok – Bedah Kepala Leher Rumah Sakit Dr. Soetomo Surabaya. Uji klinis acak terkontrol pada 2 kelompok dengan desain control group in clinical trial. Pengambilan sampel dilakukan secara consecutive sampling. Uji korelasi yang digunakan adalah uji t berpasangan dan uji Wilcoxon. Hasil: Didapatkan sampel 42 penderita, yaitu 21 penderita pada kelompok loratadin, serta 21 penderita pada kelompok loratadin dan cuci hidung salin hipertonik. Didapatkan rerata penurunan transpor mukosiliar kelompok loratadin dan cuci hidung salin hipertonik lebih bermakna daripada kelompok loratadin (p=0,001). Penurunan transpor mukosiliar kelompok loratadin didapatkan rerata -2,30 (SD=2,77), kelompok loratadin dan cuci hidung salin hipertonik didapatkan rerata -6,27 (SD=3,91). Penurunan SGHT kelompok loratadin didapatkan rerata -2,48 (SD=1,72), sedangkan kelompok loratadin dan cuci hidung salin hipertonik didapatkan rerata -4,3 (SD=1,20). Kesimpulan: Penambahan cuci hidung salin hipertonik pada terapi loratadin lebih efektif dibandingkan terapi tunggal loratadin dalam menurunkan transpor mukosiliar dan SGHT pada penderita RA. Kata kunci: Loratadin, cuci hidung salin hipertonik, transpor mukosiliar, skor gejala hidung total, rinitis alergi ABSTRACT Background: Allergic rhinitis (AR) is a nasal mucous membrane inflamatory which mediated by Imunoglobulin E (IgE) after allergen exposure in nasal mucosa. Purpose: To identify the effectiveness of nasal hypertonic saline irrigation on reduction of mucociliary transport time (MCTT) and total nasal symptom score (TNSS) in AR patients. Methods: The was conducted from July until December 2016 in Oto Rhino Laryngology - Head and Neck Surgery of Dr. Soetomo Hospital Surabaya. The study was randomized controlled clinical trials on two groups, with the control group in clinical trial design. Paired t and Wilcoxon test was used as the correlation test. Results: There was 42 patients, 21 patients in loratadine group, and 21 patients in loratadine with hypertonic nasal saline group. The average of mucociliary transport time decrease of loratadine with hypertonic nasal saline group was more significant than loratadine group (p=0.001). The mean of decreasing mucociliary transport time in loratadine group was -2.30 (SD=2.77) and loratadine with hypertonic nasal saline group was -6.27 (SD=3.91). The mean of decreasing TNSS in loratadin group was -2.48 (SD=1.72), and loratadin with hypertonic nasal saline group was -4.3 (SD=1.20). Conclusions: The addition of hypertonic nasal saline in loratadine was more effective, compared to monotherapy of loratadine in decreasing mucociliary transport time and TNSS in patient with AR. Keywords: Loratadine, hypertonic nasal saline, mucociliary transport, total nasal symptom score, allergic rhinitis

Effect combined learning on oral health self-efficacy and self-care behaviors of students: a randomized controlled trial

2020 ◽  
Author(s):  
Zahra Sadat Hashemi ◽  
Mahboobeh khorsandi ◽  
Mohsen Shamsi ◽  
Rahmatollah Moradzadeh
Keyword(s):  
Oral Health ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Self Care ◽  
Control Group ◽  
Case Group ◽  
Oral Diseases ◽  
Positive Effects ◽  
Education Data ◽  
The Mean

Abstract Background: In order to prevent oral diseases, the use of appropriate educational methods at childhood is one of the most important determinants of the public health. Therefore, the aim of this study was to investigate the effect of training through animations and games on oral health self-efficacy and self-care behaviors in students aged 6-12 years old. Methods: In this interventional study, 82 students were selected using cluster random sampling (38 subjects in the case group and 44 in the control group). The case group received 4 sessions of blended learning per week including animations and games while the control group received routine school education. Data were collected in six domains, including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis. Results: Five months after the intervention, the mean score of self-care increased from 3.8 to 4.8 of 5, the mean score of self-efficacy increased from 36.8 to 48.9 of 70, and the mean score of behavior increased from 17.07 to 18.29 of 32, indicating significant changes (p < 0.05). There were no significant changes in these variables in the control group (p >0.05) Conclusion: Use of combined methods for oral health self-care education has positive effects on the students' performance and self-efficacy. IRCT registration number: This trial has been registered at IRCT. IRCT2017042133565N1 Registration date: 2017-05-17 https://en.irct.ir/trial/25851

scholarly journals Effectiveness of a family-centered behavioral and educational counselling approach to improve periodontal health of pregnant women: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pei Liu ◽  
Weiye Wen ◽  
Ka Fung Yu ◽  
Xiaoli Gao ◽  
Edward Chin Man Lo ◽  
...  
Keyword(s):  
Oral Health ◽  
Pregnant Women ◽  
Oral Hygiene ◽  
Controlled Trial ◽  
Test Group ◽  
Control Group ◽  
Oral Health Promotion ◽  
Periodontal Health ◽  
The Mean ◽  
Family Centered

Abstract Background Poor oral hygiene and high hormone levels during pregnancy can lead to a deterioration in periodontal health. This study assessed the effectiveness of a family-centered behavioral and educational counselling program on improving the periodontal health of women during pregnancy and postpartum. Methods A randomized controlled trial was conducted among pregnant women (10th-22nd gestational week) and their husbands. Participating families were randomized into test and control groups. Intervention in the test group included explanation of oral health education (OHE) pamphlets, oral hygiene instruction, individualized feedback, and proposed solutions to overcome barriers in self-care. Reinforcements were implemented in the 3rd trimester of pregnancy and six months postpartum. In the control group, only OHE pamphlets were distributed. The assessed outcomes were bleeding on probing (BOP), periodontal pocket (Poc), loss of clinical attachment (LoA), and Visible Plaque Index (VPI). The data collection was carried out at baseline (T0), in the 32nd gestational week (T1), and 12 months postpartum (T2). Results Altogether 589 pregnant women were recruited, and 369 attended all three visits (test:188; control:181). In the test group, the mean VPI score at T0 was 0.19, which decreased to 0.14 at T1 and 0.15 at T2. In the control group, the mean VPI decreased from 0.19 at T0 to 0.16 at T1, but increased to 0.22 at T2. A main effect of time and intervention and an interaction between time and intervention were detected (all p < 0.05), indicating that the intervention effect differed between T1 and T2. The test group showed a significantly greater decrease over time than the control group did. Similarly, the mean BOP% decreased more significantly over time in the test group (T0:57%, T1:46%, T2:35%) than in the control group (T0:58%, T1:52%, T2:46%). For Poc and LoA, there were improvements in both study groups at 12 months postpartum, compared with during pregnancy (p < 0.001). Conclusions Providing family-centered, behavioral, and educational counselling to pregnant women at an early stage of pregnancy and with reinforcements can improve their oral hygiene and reduce gingival inflammation. The effect can be sustained over an extended period and is greater than that of distributing oral health leaflets alone. Trial registration Clinicaltrials.gov, #NCT02937194. Registered 18 October 2016. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02937194?cond=Family-centered+oral+health+promotion+for+new+parents+and+their+infants&draw=2&rank=1

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