Fathers make a difference: positive relationships with mother and baby in relation to infant colic

BACKGROUND

Maternal psychological factors like depression, anxiety and stress have been associated with infant fussiness or colic. However, little research exists on whether positive factors such as social support and the happiness of the mother-partner relationship are associated with lower rates of infant fussiness or colic.

OBJECTIVES

We investigated the association between infant colic and three types of maternal support: general maternal social support (during pregnancy and post partum), the happiness of the mother-partner relationship (during pregnancy and post partum) and partner involvement in caring for the newborn.

METHODS

Participants were 3006 women in the First Baby Study, a prospective study of the effect of mode of first delivery on subsequent childbearing. Women were interviewed by telephone during pregnancy and 1 month after first childbirth and asked about social support and if their baby had a variety of problems since birth, including 'Colic - crying or fussiness three or more hours a day'. Multivariable logistic regression models were used to model the association between maternal support and infant colic, controlling for confounders, including maternal race or ethnicity, insurance, marital status, smoking, mode of delivery, maternal post-partum depression, breastfeeding, other neonatal illnesses and newborn gestational age.

RESULTS

Infant colic was reported by 11.6% of new mothers. High general maternal social support (in comparison with low), measured during pregnancy, was associated with lower reported infant colic (adjusted odds ratio (AOR), 0.55, 95% confidence interval (CI), 0.40-0.75) and measured post partum (AOR, 0.51, 95% CI, 0.39-0.67); high relationship happiness (in comparison with low), measured during pregnancy (AOR, 0.71, 95% CI, 0.54-0.93), and measured post partum (AOR, 0.22, 95% CI, 0.12-0.40); and high partner involvement with newborn care (in comparison with low) (AOR, 0.60, 95% CI, 0.44-0.81).

CONCLUSION

Higher levels of maternal social support during pregnancy and post partum are associated with lower rates of maternal reported infant colic.

Psychosocial Stress During First Pregnancy Predicts Infant Health Outcomes in the First Postnatal Year

OBJECTIVES

To evaluate the impact of psychosocial stress during pregnancy on infant health outcomes in the first postnatal year.

METHODS

A sample of 3000 women completed a stress inventory (the Psychosocial Hassles Scale) during their third trimester before first childbirth. Infant health outcomes were measured via maternal report at 1, 6 and 12 months postpartum. Poisson regression was used to model the effect of maternal stress during pregnancy on infant health outcomes in the first year, controlling for age, race/ethnicity, education, insurance coverage, marital status, and cigarette smoking during pregnancy.

RESULTS

Women who were younger, minority, unmarried, publicly insured and without a college degree were more likely to report high levels of prenatal stress. High prenatal stress was a significant predictor of maternal reporting of gastrointestinal illness (p < 0.0001), respiratory illness (p = 0.025), and total illness in the first year (p < 0.0001). High prenatal stress was also a significant predictor of urgent care visits (p < 0.0001) and emergency department visits (p = 0.001). It was not a significant predictor of hospitalizations (p = 0.36).

CONCLUSIONS

Maternal prenatal stress is associated with increased maternal reporting of infant illness, as well as increased frequency of both urgent care visits and emergency department visits.

First birth Caesarean section and subsequent fertility: a population-based study in the USA, 2000-2008

STUDY QUESTION

Is first birth Caesarean delivery associated with a lower likelihood of subsequent childbearing when compared with first birth vaginal delivery?

SUMMARY ANSWER

In this study of US women whose first delivery was in 2000, those who had a Caesarean delivery were less likely to have a subsequent live birth than those who delivered vaginally.

WHAT IS ALREADY KNOWN

Some studies have reported lower birth rates subsequent to Caesarean delivery in comparison with vaginal delivery, while other studies have reported no difference.

STUDY DESIGN, SIZE, DURATION

We conducted a retrospective cohort study of 52 498 women who had a first singleton live birth in the State of Pennsylvania, USA in 2000 and were followed to the end of 2008 via Pennsylvania birth certificate records to identify subsequent live births during the 8- to 9-year follow-up period.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Birth certificate records of first singleton births were linked to the hospital discharge data for each mother and newborn, and linked to all birth certificate records for each mother's subsequent deliveries which occurred in 2000 to the end of 2008. Poisson regression models were used to evaluate the association between first birth factors and whether or not there was a subsequent live birth during the follow-up period.

MAIN RESULTS AND THE ROLE OF CHANCE

Over an average of 8.5 years of follow-up, 40.2% of women with a Caesarean first birth did not have a subsequent live birth, compared with 33.1% of women with a vaginal first birth (risk ratio (RR): 1.21, 95% confidence interval (CI): 1.18-1.25). Adjustment for the demographic confounders of maternal age, race, education, marital status and health insurance coverage attenuated the RR to 1.16 (95% CI: 1.13-1.19). Specific pregnancy and childbirth-related complications associated with not having a subsequent live birth included diabetes-related disorders, abnormalities of organs and soft tissues of the pelvis, fetal abnormalities, premature or prolonged rupture of membranes, hypertensive disorders, amnionitis, fetal distress and other maternal health problems. However, adjustment for the pregnancy and childbirth complications had little effect on the RR of not having a subsequent live birth (RR = 1.15, 95% CI: 1.11-1.19).

LIMITATIONS, REASONS FOR CAUTION

We were unable to distinguish between women who did not have a subsequent live birth and those who moved out of the state, which may have introduced a selection bias if those who had Caesarean births were more likely to emigrate than those who delivered vaginally. In addition we were unable to measure pre-pregnancy body mass index, weight gain during pregnancy and prior infertility, which would have been helpful in our efforts to reduce selection bias.

WIDER IMPLICATIONS OF THE FINDINGS

The results of this study provide further corroboration of previous studies that have reported reduced fertility subsequent to Caesarean section in comparison with vaginal delivery.

STUDY FUNDING/POTENTIAL COMPETING INTERESTS

This study was funded by the US National Institute of Child Health and Human Development (NICHD, R01-HD052990). No competing interests are declared.

Patient satisfaction with results of hysterectomy

OBJECTIVE

The objectives of this study were to measure patient satisfaction with the results of hysterectomy and to determine factors associated with dissatisfaction.

STUDY DESIGN

A total of 1299 women who underwent hysterectomy at 28 hospitals in Maryland were interviewed before and at 3, 6, 12, 18, and 24 months after the operation.

RESULTS

At 12 and 24 months after the hysterectomy 95.8% and 96.0%, respectively, reported that the hysterectomy had completely or mostly resolved the problems or symptoms they had before surgery; 93.3% and 93.7%, respectively, reported that the results were better than or about what they expected; 85.3% and 81. 6%, respectively, reported that their health was better than before the hysterectomy; and 87.9% and 93.1%, respectively, reported being totally recovered. The factor most strongly and consistently associated with patient reports of negative outcomes was readmission because of a postdischarge complication.

CONCLUSION

Postdischarge complication necessitating readmission plays an important role in patient dissatisfaction with the results of hysterectomy.

Effectiveness of hysterectomy

OBJECTIVE

To measure the effectiveness of hysterectomy in relieving adverse symptoms and to identify factors associated with lack of symptom relief.

METHODS

In a 2-year prospective study, data were collected before and at 3, 6, 12, 18, and 24 months after hysterectomy in 1,299 women who had hysterectomies for benign conditions at 28 hospitals across Maryland. Effectiveness was measured in terms of relief of symptoms such as problematic vaginal bleeding, pelvic pain, and urinary incontinence. Psychologic function and quality of life before and after surgery also were assessed.

RESULTS

Symptom severity, depression, and anxiety levels decreased significantly after hysterectomy and quality of life improved, particularly in the area of social function. However, 8% of women had at least as many symptoms at problematic-severe levels 1 and 2 years after hysterectomy as before. In multiple logistic regression, several presurgical patient characteristics predicted lack of symptom relief, including therapy for emotional or psychologic problems, depression, and household income of $35,000 or less. Bilateral oophorectomy predicted lack of symptom relief at 24 months but not at 12 months after hysterectomy.

CONCLUSION

Significant improvements were seen after hysterectomy for all three aspects of health status (symptoms, psychologic function, and quality of life), which persisted or continued to improve throughout the 2 years of follow-up. However, hysterectomy did not relieve symptoms for some women, particularly those who had low incomes or were in therapy at the time of hysterectomy.

Hysterectomy and sexual functioning

CONTEXT

Women considering hysterectomy often are concerned about its potential effects on their sexual functioning but the effects of hysterectomy on sexual functioning remain unclear.

OBJECTIVE

To examine changes in sexual functioning after hysterectomy.

DESIGN AND SETTING

A 2-year prospective study (Maryland Women's Health Study) of hysterectomy, which included measures of sexual functioning prior to hysterectomy and at 6, 12, 18, and 24 months after hysterectomy, performed during 1992 and 1993.

PATIENTS

Of 1299 women interviewed prior to hysterectomy, 1101 (84.8%) completed the study and provided information about their sexual functioning. Most were between the ages of 35 and 49 years, white, married or living with a partner, and high school graduates.

MAIN OUTCOME MEASURES

Frequency of sexual relations, dyspareunia, orgasm, vaginal dryness, and sexual desire.

RESULTS

The percentage of women who engaged in sexual relations increased significantly from 70.5% before hysterectomy to 77.6% and 76.7% at 12 and 24 months after hysterectomy. The rate of frequent dyspareunia dropped significantly from 18.6% before hysterectomy to 4.3 % and 3.6% at 12 and 24 months after hysterectomy. The rates of not experiencing orgasms dropped significantly from 7.6% before hysterectomy to 5.2% and 4.9% at 12 and 24 months after hysterectomy. Low libido rates also decreased significantly from 10.4% before hysterectomy to 6.3% and 6.2% at 12 and 24 months after hysterectomy. The distribution of women not reporting vaginal dryness in the past month improved significantly from 37.3% before hysterectomy to 46.8% and 46.7% at 12 and 24 months after hysterectomy. Prehysterectomy depression was associated with experiencing dyspareunia, vaginal dryness, low libido, and not experiencing orgasms after hysterectomy.

CONCLUSIONS

Sexual functioning improved overall after hysterectomy. The frequency of sexual activity increased and problems with sexual functioning decreased.

Hormone replacement and menopausal symptoms following hysterectomy

Hormone replacement therapy (HRT) is recommended for most women who experience surgical menopause following hysterectomy/oophorectomy for noncancerous conditions; it is also commonly prescribed for postmenopausal women. Beginning in 1992, 1,299 women undergoing hysterectomy in 28 hospitals throughout Maryland were interviewed prior to hysterectomy and were subsequently followed over a 2-year period. Interviews included questions about HRT use and symptoms associated with menopause. The majority of the women (66 percent) were white, 55 percent had a high school education or better, 49 percent were obese (body mass index > or =27.3), and 11 percent were postmenopausal. Over 40 percent of premenopausal women underwent bilateral oophorectomy. At 3 months posthysterectomy, 89 percent of these women were on HRT; this figure dropped to 85 percent at 24 months. Among postmenopausal women, 50 percent were on HRT both at 3 months and at 24 months posthysterectomy. Among premenopausal women who had unilateral oophorectomy, 21 percent were on HRT at 3 months, increasing to 35 percent at 24 months. Among premenopausal women who had no ovaries removed, 5 percent were on HRT at 3 months, increasing to 13 percent at 24 months. There were few within-group differences between HRT users and nonusers, except that among postmenopausal women, HRT users were younger and more likely to be white and had higher income and educational levels. Women who were postmenopausal or who underwent bilateral oophorectomy were less likely to have hot flashes if they were on HRT, but women with 0-1 ovary removed who were on HRT were more likely to have hot flashes than those not on HRT. Black women were significantly more likely to experience hot flashes than were white women, independent of HRT status and weight. Obese women were on HRT at approximately the same rates as nonobese women but were significantly more likely to have hot flashes, even when analyses controlled for HRT and race.

Cost-Effectiveness of Laparoscopic-Assisted Vaginal Hysterectomy

This study enrolled nearly 1300 women having hysterectomy for benign indications at 28 hospitals during 1992 and 1993. Of these procedures, 816 were performed abdominally, 311 vaginally, and 154 were laparoscopic-assisted vaginal hysterectomies (LAVH). On average, LAVH was more expensive ($4294) than abdominal ($2753) and vaginal ($2312) hysterectomies, primarily due to higher operating room and surgical supply costs. Women who had LAVH were younger, had higher incomes, were more educated, more likely to be treated at nonteaching and smaller hospitals, and had lower comorbidity scores than those in the other two groups. After adjusting for these differences, LAVH was not significantly different from vaginal hysterectomy in terms of operative and postoperative complications, readmissions, postoperative days of pain, days in bed, days of feeling tired, days before resuming full activities, and days before going back to work full time. Compared with abdominal hysterectomy the vaginal groups combined had significantly fewer days of pain, days of feeling tired, and days back to work full time. By 6 months after surgery the three groups were quite similar in terms of patient satisfaction and other outcome measures.

Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis

OBJECTIVE

To investigate racial differences in the presence of leiomyomas, condition severity, associated symptoms and age at diagnosis between black and white hysterectomy patients.

STUDY DESIGN

This study included 409 black women and 836 white women aged 18 or older who underwent hysterectomy for noncancerous conditions at 28 hospitals in Maryland. Patients were interviewed shortly before surgery, and hospital records were abstracted after discharge.

RESULTS

Overall, 89% of the black women and 59% of the white women were found to have leiomyomas. Among those with a confirmed presurgical diagnosis of leiomyomas, the average age at diagnosis was 37.5 years for black women and 41.6 for white women, and the average age at hysterectomy was 41.7 for black women and 44.6 for white women. The average uterine weight for black women with leiomyomas was 420.8 g and for white women was 319.1 g. Black women were more likely to have seven or more leiomyomas (57%) in comparison to white women (36%). Black women with leiomyomas were more likely to be anemic (56%) than white women (38%) and more likely to report having very severe or severe pelvic pain (59%) than white women (41%).

CONCLUSION

Black women having hysterectomy had larger and more numerous leiomyomas, and the leiomyomas were more symptomatic than in white women despite a younger age at diagnosis and hysterectomy.

Pathologic findings from the Maryland Women's Health Study: practice patterns in the diagnosis of adenomyosis

Criteria for the diagnosis of adenomyosis vary widely in practice. The reported frequency of adenomyosis in hysterectomy specimens varies from 5-70% in published series. In this study, 1252 pathology reports on hysterectomy specimens from women enrolled in the Maryland Women's Health Study were reviewed. The frequency of adenomyosis was calculated based on two subgroups: 1114 reports from 15 hospitals, and 705 reports signed by 25 pathologists. The frequency of diagnosis of adenomyosis ranged from 12% to 58% among the 15 hospitals, and 10% to 88% among the 25 pathologists. This wide variation could not be explained by differences in patient age or number of pregnancies, factors known to correlate with the frequency of adenomyosis. These data suggest that adenomyosis may be overdiagnosed. Stringent and widely accepted criteria for the diagnosis of adenomyosis are needed, as epidemiologic studies of this common condition would be facilitated by the use of standard criteria in practice.

Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992

OBJECTIVES

This study sought to describe prevalence rates of chronic gynecological conditions and correlates of these conditions in a representative sample of US women.

METHODS

National Health Interview Survey data from 1984 through 1992 for women aged 18 to 50 were used.

RESULTS

The estimated annual prevalence rate for the reported presence of one or more gynecological conditions was 97.1 per 1,000 women. Menstrual disorders were most common, with an annual prevalence rate of 53.0 per 1,000 women. Adnexal conditions and fibroids were the next most common conditions, with rates per 1,000 women of 16.6 and 9.2, respectively. Prolapse, endometriosis, and fibroids were the conditions most likely to lead to hysterectomy within the year prior to the interview. More than three quarters (77.1%) of women with gynecological conditions had talked with a doctor in the previous year concerning their condition, and 28.8% reported spending 1 or more days in bed in the previous year because of their condition.

CONCLUSIONS

Nearly a tenth of American women aged 18 to 50 report having one or more chronic gynecological conditions annually, the most common being disorders of menstruation.

A comparison of alternative ways of measuring fatigue among patients having hysterectomy

In a study of the outcomes of hysterectomy, 1,205 patients rated their fatigue levels via three single-item measures and the Profile of Mood States (POMS) Fatigue Scale. The single-item fatigue measures asked patients to indicate how often they were tired during the day, how often feeling tired had prevented them from doing what they wanted to do, and how big a problem feeling tired was for them. All four measures of fatigue were found to be correlated with pain, activity limitation, and psychological dysfunction, although the POMS Fatigue Scale was more strongly related to psychological dysfunction than the other fatigue measures. All four measures indicated substantial relief from fatigue 6 months after hysterectomy among the participants in this study. Patients who remained or became fatigued by 6 months posthysterectomy had more physician contacts than those not fatigued, and were less satisfied with the results of the surgery. Fatigue was found to be a useful outcome measure of medical treatment. Each of the fatigue measures examined provided unique and useful information, with no one fatigue measure proving to be substantially superior to the others.

Hysterectomy and race

OBJECTIVE

To investigate black-white differences in factors related to hysterectomy.

METHODS

Discharge summary data were analyzed for 53,159 hysterectomies that occurred in Maryland from 1986-1991.

RESULTS

The average annual age-adjusted hysterectomy rate was higher for black women (49.5 per 10,000) than for white women (41.2 per 10,000). For 65.4% of the hysterectomies in black women, the principal diagnosis was uterine fibroids, compared to 28.5% for white women. Logistic regression was used to measure the effect of race on complications, length of stay, and mortality after adjustment for a variety of factors including age, comorbidities, diagnosis, route (abdominal, vaginal, or subtotal), hospital characteristics, and source of payment. In comparison to white women, black women having hysterectomy were found to have an increased risk of one or more complications of surgical or medical care (odds ratio 1.4, 95% confidence interval [CI] 1.3-1.5), a length of stay of more than 10 days (odds ratio 2.7, 95% CI 2.5-3.1), and in-hospital mortality (odds ratio 3.1, 95% CI 2.0-4.8).

CONCLUSIONS

In a study of more than 53,000 hysterectomies, black women were more than twice as likely to have a diagnosis of uterine fibroids as white women, were more likely to have complications, had a longer hospitalization, and had more than three times the in-hospital mortality rate.

Technology anxiety as a potential mediating factor in response to medical technology

Technology anxiety, defined as a fear of working with medical equipment, was measured via the use of the Technology Response Questionnaire. Nurses (N = 414) working on nine types of nursing units at two hospitals participated in the study. Nurses working on psychiatric units were found to be most anxious about working with medical equipment, while nurses working on surgical and adult intensive care units were least anxious. A comparison of the nurses who were highest and lowest on technology anxiety indicated that those who were most anxious about technology were less positive toward computers, felt more stressed by their work, were lower on job satisfaction, less positive toward the physicians they worked with, lower on personality scales of autonomy and adaptability, were less likely to do care planning regularly or to use nursing diagnoses, and tended to be older than less anxious nurses.

The impact of computer systems in a medical environment

The acceptance and proliferation of computer technology in health care has not been as rapid as many expected. Research in this area suggests that several factors are related to computer acceptance including social network processes, attitudes toward computers, and personality characteristics. Potential implications for the field of magnetic resonance imaging are discussed.

Adapting to the implementation of a medical information system: a comparison of short- versus long-term findings

This study compares short and long-term responses of a panel of hospital employees to the introduction of a Medical Information System. Personality attributes, education, age, and the person's work shift consistently affected the quality of employee adaptation.

Medical information system training: an analysis of the reactions of hospital employees

Six months after the implementation of a medical information system (MIS) employees were questioned concerning their evaluation of the training they received. Wide variability is observed in the range of employee responses to questions addressing their: satisfaction with the training experience, desire for any additional training, ease of learning to use the system, and level of felt competence in currently using the system. The results of stepwise regression analyses of the response patterns indicate that personality traits, attitudes toward automation, and work history variables are key factors in explaining why employees have different reactions to training.