Evaluating the diagnostic properties of the Whooley questionnaire as a case-finding instrument for depression among Chinese women during and after pregnancy

Purpose: There is a rising prevalence in undetected perinatal depression in many countries, more effort in screening and early identification of perinatal depression is needed. While the Whooley questionnaire is the recommended case-finding strategy for perinatal depression, there is no validated Chinese version. The aim was to evaluate the diagnostic accuracy and stability of the translated Chinese Whooley questionnaire against gold standard measurement during and early after pregnancy.Materials and Methods: This observational study recruited 131 pregnant women from an antenatal clinic in Hong Kong from September 2019 to May 2020. We translated the Whooley questionnaire in Chinese and evaluated self-reported responses against an interviewer-assessed diagnostic standard (DSM-IV criteria) in 107 women at 26-28 gestational weeks. We calculated sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio, with DSM-IV diagnosis as the gold standard.Results: The Chinese Whooley questions had a sensitivity of 79% (95% CI 54.4-93.9), a specificity of 97% (95% CI 90.4-99.3), a positive likelihood ratio of 23.2 (95% CI 7.4-72.1) and a negative likelihood ratio of 0.2 (95% CI 0.1-0.5) in identifying perinatal depression.Conclusion: The translated Chinese Whooley questionnaire has an acceptable diagnostic accuracy in identifying perinatal depression. It can be implemented in health services among Cantonesespeaking Chinese population.

COVID-19 mRNA vaccine-mediated antibodies in human breast milk and their association with breast milk microbiota composition

Newborns can acquire immunological protection to SARS-CoV-2 through vaccine-conferred antibodies in human breast milk. However, there are some concerns around lactating mothers with regards to potential short- and long-term adverse events and vaccine-induced changes to their breast milk microbiome composition, which helps shape the early-life microbiome. Thus, we sought to explore if SARS-CoV-2 mRNA vaccine could change breast milk microbiota and how the changes impact the levels of antibodies in breast milk. We recruited 49 lactating mothers from Hong Kong who received two doses of BNT162b2 vaccine between June 2021 and August 2021. Breast milk samples were self-collected by participants pre-vaccination, one week post-first dose, one week post-second dose, and one month post-second dose. The levels of SARS-CoV-2 spike-specific IgA and IgG in breast milk peaked at one week post-second dose. Subsequently, the levels of both antibodies rapidly waned in breast milk, with IgA levels returning to baseline levels one month post-second dose. The richness and composition of human breast milk microbiota changed dynamically throughout the vaccination regimen, but the abundances of beneficial microbes such as Bifidobacterium species did not significantly change after vaccination. Additionally, we found that baseline breast milk bacterial composition can predict spike-specific IgA levels at one week post-second dose (Area Under Curve: 0.72, 95% confidence interval: 0.58-0.85). Taken together, our results identified specific breast milk microbiota markers associated with high levels of IgA in the breast milk following BNT162b2 vaccine. Furthermore, in lactating mothers, BNT162b2 vaccines did not significantly reduce probiotic species in breast milk.

Feasibility and effectiveness of WhatsApp online group on breastfeeding by peer counsellors: a single-blinded, open-label pilot randomized controlled study

INTRODUCTION

With mobile technologies becoming more advanced and accessible, mobile health (mHealth) has been incorporated in delivering timely and convenient breastfeeding support. However, its feasibility and potential efficacy remain to be examined. Therefore, the primary objective of this study is to assess the feasibility and acceptability of an online instant messaging peer support group for breastfeeding. The secondary objective is to evaluate the effect of the intervention on breastfeeding outcomes.

METHODS

A pilot randomized controlled trial was conducted. A total of 33 primiparous women were recruited in the antenatal clinic at a public hospital in Hong Kong between March and April 2021. They were randomized to receive either standard care (n = 18) or standard care and receive peer-group support in an online instant messaging app (n = 15). Participants received telephone follow-up for up to six months postpartum or until they stopped breastfeeding. After completing the study, six participants in the intervention group were interviewed to understand their perceptions of the intervention.

RESULTS

This pilot study shows that online messaging peer support group is feasible and acceptable to women. In total, 54.4% of the eligible women agreed to participate, and 97.0% completed the follow-up. Participants perceived that providing peer support through instant messaging app is appropriate. It serves as a channel for the participants to ask questions and obtain information. Furthermore, meetings of the peer supporters and group members can be held to enhance the effectiveness of the intervention. In addition, no significant differences were found in any and exclusive breastfeeding rates, breastfeeding attitude, and breastfeeding self-efficacy between the two groups.

CONCLUSIONS

This study shows that online messaging peer support group is feasible and acceptable. A full-scale study should be conducted to understand the effect of the online instant messaging peer support group on breastfeeding outcomes.

TRIAL REGISTRATION

The study protocol is registered on Clinicaltrial.gov (NCT04826796) on 1 April 2021.

Using the Revised Health Care System Distrust Scale to evaluate healthcare distrust among Chinese men in Hong Kong: An analysis from a prostate cancer screening behaviours survey

Information about the level of distrust in healthcare systems is very limited in Chinese populations, and no validated instrument has been developed to measure this distrust. Therefore, to begin addressing this research gap, this study evaluated the psychometric properties of a traditional Chinese version of the Revised Health Care System Distrust Scale and used it to assess the level of distrust in a healthcare system. The study involved a community-based personal interview survey of individuals in Hong Kong. A total of 340 men were randomly recruited. In addition to the distrust instrument, the two-item Trust in Physician Scale and the Patient Health Questionnaire-9 were used. The two-factor structure of the distrust scale was confirmed. The item-total correlations corrected for overlap were >0.4 for both the Competence and Values Distrust subscales, confirming the internal construct validity of the scale. The Cronbach's alpha coefficient was 0.77 for both subscales. The scores of both the Competence and Values subscales were moderately negatively correlated with the total score of the Trust in Physician Scale, providing support for convergent validity. Regarding known-group validity, the scale could differentiate people according to marital status, monthly personal income and severity of depressive symptoms. Moreover, we found that men who had previously undergone prostate cancer screening had higher Values Distrust scores than those who had not. The descriptive analysis showed that only about half of the participants reported that they received high-quality medical care and that the healthcare system provided excellent medical care, suggesting that more effort is needed to improve the quality of care and people's satisfaction with healthcare in Hong Kong. In summary, the translated traditional Chinese version of the Revised Health Care System Distrust Scale used in this study is a valid and reliable scale for assessing the level of distrust in a healthcare system.

Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women

BACKGROUND

This study's objective was to assess the diagnostic properties of the Whooley questions in identifying depression among perinatal women according to previously published studies. We conducted a systematic review and meta-analysis of studies investigating the diagnostic accuracy of the Whooley questions in perinatal women.

METHODS

Nine databases were searched in October 2021. All primary studies evaluated the diagnostic properties of the Whooley questions compared with a diagnostic gold standard in women during the perinatal period or, if not identified as being in the perinatal stage within the study, women between 20 weeks' gestation to 4 weeks post-delivery. A bivariate mixed-effects meta-analysis was performed to estimate pooled diagnostic properties and measure heterogeneity. Meta-regression was conducted to evaluate factors contributing to heterogeneity.

RESULTS

Six studies were included in the review; five were used in the meta-analysis. The pooled sensitivity (95 % confidence interval) was 0.95 (0.81-0.99), pooled specificity was 0.60 (0.44-0.74), pooled positive likelihood ratio was 2.4 (1.6-3.4), pooled negative likelihood ratio was 0.09 (0.02-0.32), and pooled diagnostic odds ratio was 27 (7-106); heterogeneity was substantial (I² = 0.90, 0.81-1.00). Participant age and setting (community vs. hospital) significantly contributed to heterogeneity.

CONCLUSIONS

The Whooley questions have high sensitivity but moderate specificity for perinatal women. The Whooley questions are a short and acceptable tool for identifying depression in perinatal women. However, a potential risk exists of incorrectly identifying a high proportion of women as positive. Using the Whooley questions followed by a secondary case-finding tool could reduce the misdiagnosis risk.

Validating the use of the revised childbirth experience questionnaire in Hong Kong

Objective

To evaluate the psychometric properties of the traditional Chinese version of the Childbirth Experience Questionnaire (CEQ 2.0) and assess the childbirth experiences of Chinese women.

Methods

A cross-sectional survey was conducted in Hong Kong from July 2020 to February 2021. In total, 975 mothers, who could read traditional Chinese and gave birth in 2020 or 2021, were included in the analysis. Data were fitted into the model proposed by the original developers using the confirmatory factor analysis. The data were then randomly split into training and validation sets for exploratory and confirmatory factor analyses. Childbirth experiences were assessed. Factor structure, internal construct validity, internal consistency, and known-group validity were assessed.

Results

The originally proposed CEQ2.0 model showed a poor fit. An exploratory factor analysis identified a revised four-factor model (CEQ2.0-R) on a randomly split sample, which showed a satisfactory fit (CFI=0.912; TLI=0.884; SRMR=.053; RMSEA=0.072) on the other split sample. The revised scale comprised 13 items and four domains: (1)“Own capacity” (6 items), (2) “General support” (3 items), (3) “Perceived safety” (2 items), and (4) “Professional support” (2 items). CEQ2.0-R showed high internal construct validity and reliability. It can differentiate between participants with different characteristics, including parity, oxytocin augmentation, and companionship during labour. The childbirth experiences of the participants were merely positive, and participants reported that more support from midwives is needed.

Conclusions

CEQ2.0-R can adequately describe the childbirth experiences of women in Hong Kong. The questionnaire is easy to be administer and can be used to assess several domains of the childbirth experiences. It may be useful to evaluate the aspects of support needed during childbirth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04456-x.

The Effect of Maternal Self-Regulated Motivation on Breastfeeding Continuation

OBJECTIVE

Women frequently report breastfeeding problems in the early postpartum period. Women who have self-endorsed beliefs that breastfeeding benefits their babies and themselves are more likely to continue breastfeeding despite breastfeeding barriers. Maternal self-endorsed beliefs is a key component of maternal self-regulated motivation. The present study examined the association between maternal self-regulated motivation, breastfeeding duration and exclusivity in Chinese women.

METHODS

This was a prospective cohort study, of which we recruited participants in postnatal maternity units of publicly funded hospitals in Hong Kong. Postpartum women were asked to fill in the validated breastfeeding self-regulation questionnaire (BSRQ) before hospital discharge and their breastfeeding status was assessed by telephone follow-ups at 6 and 12 weeks postpartum. Multiple logistic regression was used to study the relationship between breastfeeding self-regulated motivation and the duration of breastfeeding at follow-up.

RESULTS

At 6 and 12 weeks postpartum, women who breastfed exclusively scored significantly higher in self-regulated motivation than those who formula-fed. The self-regulated motivation was associated with higher odds of exclusive breastfeeding at 6 weeks and any breastfeeding at 12 weeks postpartum.

CONCLUSIONS FOR PRACTICE

The study found that self-regulated motivation was positively related to breastfeeding duration. Maternal self-regulated motivation toward breastfeeding could be enhanced by the availability of social support and breastfeeding-friendly facilities, resulting in longer breastfeeding duration.

Exposure to baby-friendly hospital practices and mothers' achievement of their planned duration of breastfeeding

BACKGROUND

Both breastfeeding intentions and exposure to baby-friendly hospital practices were found to be associated with a longer duration of breastfeeding. This study aims to examine the effect of exposure to baby-friendly hospital practices on mothers' achievement of their planned duration of breastfeeding.

METHODS

A total of 1011 mother-newborn pairs from the postnatal units of four public hospitals in Hong Kong were recruited. Sociodemographic data and breastfeeding intention data were collected via self-report questionnaires during the postnatal hospitalization and exposure to Baby-Friendly hospital practices were assessed through hospital records and maternal self-report. Breastfeeding status after hospital discharge was assessed through telephone follow-up for up to 12 months postnatal, or until participants were no longer breastfeeding.

RESULTS

Only 55% (n = 552) of study participants achieved their intended duration of breastfeeding. Participants with higher socioeconomic status, previous breastfeeding experience, and those who had lived in Hong Kong for less than 5 years, were more likely to achieve their planned duration of breastfeeding. Among baby-friendly hospital practices, feeding only breast milk during the hospitalization and providing information about breastfeeding support on discharge were associated with participants' achieving their individual breastfeeding intentions. After adjustment, when compared with women who experienced onebaby-friendly practice, participants who experienced six baby-friendly hospital practices were significantly more likely to achieve their planned duration of breastfeeding (adjusted odds ratio = 8.45, 95% confidence interval 3.03-23.6).

CONCLUSIONS

Nearly half of participants did not achieve their planned breastfeeding duration. Exposure to baby-friendly hospital practices, especially in-hospital exclusive breastfeeding and providing breastfeeding support information upon hospital discharge may help more mothers to achieve their individual breastfeeding goals.

Breastfeeding Duration and the Theory of Planned Behavior and Breastfeeding Self-Efficacy Framework: A Systematic Review of Observational Studies

Introduction Numerous studies have shown that the constructs of the Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB) and Breastfeeding Self-Efficacy (BSE) Framework can effectively identify relationships between maternal psychosocial factors and breastfeeding initiation. However, the ability of these theories to predict breastfeeding duration has not been adequately analyzed. The aim of the review was to examine the utility of the constructs of TRA/TPB and BSE to predict breastfeeding duration. Methods We conducted a literature search using Pubmed (1980-May 2015), Medline (1966-May 2015), CINAHL (1980-May 2015), EMBASE (1980-May 2015) and PsycINFO (1980-May 2015). We selected studies that were observational studies without randomization or blinding, using TRA, TPB or BSE as the framework for analysis. Only studies reporting on breastfeeding duration were included. Results Thirty studies were selected, which include four using TRA, 10 using TPB, 15 using BSE and one using a combination of TPB and BSE. Maternal intention and breastfeeding self-efficacy were found to be important predictors of breastfeeding duration. Inconsistent findings were found in assessing the relationship between maternal attitudes, subjective norms, perceived behavior control and breastfeeding duration. Discussion The inadequacy of these constructs in explaining breastfeeding duration indicates a need to further explore the role of maternal self-determination in breastfeeding behavior.

Effect of Secondary Cigarette Smoke from Household Members on Breastfeeding Duration: A Prospective Cohort Study

OBJECTIVE

Maternal smoking and exposure to tobacco smoke is one modifiable risk factor that affects breastfeeding initiation and duration. We prospectively examine the effects of maternal and paternal smoking and other family members' smoking status on the duration of breastfeeding.

MATERIALS AND METHODS

A cohort of 1,277 mother-infant pairs admitted to the postpartum units of four major public hospitals in Hong Kong. Demographic data, maternal, paternal and household smoking habits, and other potential confounding variables were collected via self-reported questionnaires during the postnatal hospitalization. Breastfeeding status after hospital discharge was assessed through telephone follow-up up to 12 months postpartum, or until participants were no longer breastfeeding. If the participant had weaned during that follow-up interval, she was asked to report the total duration (in weeks) of both any and exclusive breastfeeding.

RESULTS

A total of 1,240 (97%) mother-infant pairs completed followed up, 2.5% were smokers, 29.2% of their partners smoked, and 11.3% had another smoker living in their home. Maternal and other family members' smoking predicted breastfeeding cessation. When compared with mothers in nonsmoking family, those exposed to two or more family members who smoked had approximately a 30% increased risk of breastfeeding cessation (adjusted hazard ratio [aHR] = 1.31; 95% CI 1.01-1.68).

CONCLUSION

Mothers who were exposed to two or more smokers in the household had a significantly shorter duration of any breastfeeding at 12-month follow-up.

Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula

BACKGROUND

The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps.

OBJECTIVES

To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates.

METHODS

We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report.

RESULTS

After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95).

CONCLUSION

After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.

Interventions to increase the uptake of seasonal influenza vaccination among pregnant women: A systematic review

BACKGROUND

Pregnant women and their infants under 6 months of age infected with influenza have a high risk of serious morbidity and mortality. Influenza vaccine during pregnancy offers 3-for-1 benefits to pregnant women, fetuses and newborn infants. Current vaccination uptake rates during pregnancy, however, are often lower than other high-risk groups and the general population.

METHODS

We systematically reviewed evidence on the effectiveness of interventions to improve influenza vaccination coverage in pregnant women. Risk differences (RDs) were calculated from the included studies.

RESULTS

Eleven studies were included in the review, of which four were randomized controlled trials (RCTs). Three cohort studies assessed provider-focused interventions while four RCTs and one cohort study evaluated pregnant women-focused interventions. Two cohort studies and a prospective intervention study assessed the effectiveness of bundled interventions. No study solely assessed the effectiveness of interventions to enhance access to influenza vaccination. One moderate quality RCT showed that an influenza pamphlet, with or without a verbalized benefit statement, improved the vaccination rate (RD=0.26; RD=0.39). The other reviewed RCTs showed discordant results, with RDs ranging from -0.15 to 0.03. Although all observational studies significantly improved vaccination rates (RDs ranged from 0.03 to 0.44), the quality of the evidence varied.

CONCLUSIONS

There is a lack of effective interventions to increase the influenza vaccination rate in pregnant women. Based on the existing research, we recommend that clinicians provide influenza pamphlets to pregnant women with a verbalized statement about the benefits of influenza vaccine to newborns. Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Increased clarity in reporting the content of interventions would help to improve the comparability and generalizability of the published studies.

Nutritionist's variation in counseling style and the effect on weight change of patients attending a community based lifestyle modification program

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist’s skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient’s weight outcome. 24 nutrition consultations were observed during the program and the nutritionists were interviewed for their perception on practice (n = 4). A statistically significant difference was observed between the nutritionists in regard to patient’s weight change after adjustment for age and baseline weight (p < 0.001). Key nutritionist skills identified that influenced weight outcome were meticulous investigation of the underlying obesity cause, identification of the subject’s stage of change, and psychological support.