Theoretical approaches in the development of interventions to promote breastfeeding: A scoping review

PROBLEM AND BACKGROUND

There is a low world rate of exclusive breastfeeding and a short duration of breastfeeding. More studies have constructed interventions to improve breastfeeding behavior, but the actual effect is not significant.

AIM

The purpose of this review is identifying the ways that various theories have an influence on theory-based breastfeeding intervention studies.

METHODS

A scoping review using Arksey and O'Malley's framework explored breastfeeding promotion practices. PubMed, The Cochrane Library, Web of Science, Embase, and CINAHL databases were searched from database creation to March 9, 2024. Building on previous research, key terms were used to search the literature. Data analysis involved descriptive and interpretive summaries of theories used and the proposed interventions.

FINDINGS

An online search yielded 906 articles, with 28 meeting the inclusion criteria for the scoping review, including 5 reviews and 23 articles. Reviews demonstrated that interventions based on theories were more effective. Articles promoting breastfeeding used theories of self-efficacy (n = 9), theory of planned behavior (n = 8), social cognitive theory (n = 5) and individual and family self-management theory (n = 1). These theories were used in developing specific content of the intervention program (n = 20, 86.9%), constructing the framework of the program (n = 10, 43.5%), and evaluating outcomes (n = 19, 82.6%). Most interventions focused on education, professional support, and/or peer support for breastfeeding.

CONCLUSION AND DISCUSSION

Theory can guide decisions and play a role in selecting a methodology or lens. Researchers should make deliberate choices in the use of a theory that relates to aspects of breastfeeding behavior. Future interventions based on theories should be more varied and effective and need to consider families' and social factors.

Fear of childbirth and influencing factors of expectant fathers in China: a cross-sectional study

Fear of childbirth not only brings negative psychological experiences to expectant fathers and affect their ability to prepare for parenthood but can even affect children's emotional and cognitive development. It is essential to identify men with a more severe fear of birth and its related risk factors for the better transition of fathers' role. The objective of this study was to investigate the prevalence of fear of childbirth among Chinese expectant fathers, identify its contributing factors and explore the association among fear of childbirth, resilience and dyadic coping. A cross-sectional survey was conducted in the obstetric department of two tertiary hospitals in Wuhan, China. The socio-demographic questionnaire, the father's version of the Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ A), the Connor-Davidson Resilience Scale-10 (CD-RISC), and the Dyadic Coping Inventory (DCI) were used to explore the correlation of fear of childbirth, resilience and dyadic coping of participants. Ultimately, a total of 1176 expectant fathers were included in this study. The prevalence of fear of childbirth was 32.1%. Gestational weeks of pregnant women, monthly income, adverse birth experience, gravidity and parity of pregnant women were considered risk factors for the expectant fathers with fear of childbirth. Furthermore, there was a weak negative correlation between fear of childbirth and resilience and dyadic coping. In conclusion, the prevalence of fear of childbirth in expectant fathers in China was high. Adequate identification of factors influencing the fear of childbirth among expectant fathers is necessary to reduce the fear of childbirth and to develop appropriate interventions in preparing fathers for their new parenting role.

Effectiveness of remote monitoring for glycemic control on maternal-fetal outcomes in women with gestational diabetes mellitus: A meta-analysis

BACKGROUND

The current pandemic and future public health emergencies highlight the importance of evaluating a telehealth care model. Previous studies have reached mixed conclusions about the effectiveness of remote monitoring on glycemic control and maternal and infant outcomes in women with gestational diabetes mellitus (GDM).

OBJECTIVES

This meta-analysis aimed to evaluate the effectiveness of remote blood glucose monitoring for women with gestational diabetes mellitus and to provide evidence-based guidance on the management of women with gestational diabetes mellitus for policymakers and healthcare providers during situations such as pandemics or natural disasters.

METHODS

The Cochrane Library, PubMed, Web of Science, EBSCO, Embase, Medline, CINAHL databases, and ClinicalTrials.gov were systematically searched from their inception to July 10, 2021. Randomized controlled trials (RCTs) published in English with respect to remote blood glucose monitoring in women with GDM were included in the meta-analysis. Two independent reviewers performed data extraction and assessed the quality of the studies. Risk ratios, mean differences, 95% confidence intervals, and heterogeneity were calculated.

RESULTS

A total of 1265 participants were included in the 11 RCTs. There were no significant differences in glycemic control and maternal-fetal outcomes between the remote monitoring group and a standard care group, which included glycosylated hemoglobin (HbA1c), fasting blood glucose, mean 2-h postprandial blood glucose, caesarean birth, gestational weight gain, shoulder dystocia, neonatal hypoglycemia, and other outcomes.

CONCLUSION

This meta-analysis reveals that it is unclear if remote glucose monitoring is preferable to standard of care glucose monitoring. To improve glycemic control and maternal-fetal outcomes during the current epidemic or other natural disasters, the implementation of double-blind RCTs in the context of simulating similar disasters remains to be studied in the future.

Effectiveness of a breastfeeding promotion intervention model based on Society ecosystems Theory for maternal women: a study protocol of randomized controlled trial

BACKGROUND

Breastfeeding is recognized internationally as the most scientific and effective way to feed infants and young children. According to the World Health Organization in 2022, the exclusive breastfeeding rate within 6 months is 34.1% in China, which is still far from the goal of "more than 60% exclusive breastfeeding rate of infants within 6 months" by 2030 required by China's State Council. It is necessary to promote breastfeeding and provide maternal breastfeeding guidance to increase exclusive breastfeeding. Factors influencing breastfeeding can be explained by the society ecosystems theory, distributed in macro, mezzo and micro systems. The interventions focused on breastfeeding promotion are mainly carried out in the health systems and services, home and family environment, community environment, work environment, policy environment or a combination of these facilities. But there is sparse research on integrating resources in the macro, mezzo and micro systems of maternal breastfeeding processes to promote breastfeeding behavior. A randomized controlled trial will test the effect of a breastfeeding promotion intervention model based on the society ecosystems theory versus usual prenatal and postnatal care on maternal and infant health and the exclusive breastfeeding rate at 6 months.

METHODS/DESIGN

The study is a single-blind, parallel design, randomized controlled trial with an intervention group (n = 109) and a control group (n = 109) that compares the effect of a breastfeeding promotion intervention model based on the society ecosystems theory with usual prenatal and postnatal care. The intervention covers macro- (policy, culture), mezzo- (family-hospital-community) and micro- (biological, psychological and social) systems of the maternal breastfeeding process. Infant feeding patterns, neonatal morbidity and physical and mental health of antenatal and postpartum women will be collected at baseline (28 to 35 weeks of gestation), 1-, 4-, and 6-month postpartum.

DISCUSSION

This is a multifaceted, multifactorial, and multi-environmental breastfeeding promotion strategy to help mothers and their families learn breastfeeding knowledge and skills. The study provides a new modality for adding breastfeeding interventions to prenatal and postnatal care for healthcare providers in the hospital and the community.

TRIAL REGISTRATION

Chinese Clinical Trial Registry at www.chictr.org.cn , ChiCTR2300075795.

Galactagogue Food Consumption, Perception of Insufficient Milk Supply, and Exclusive Breastfeeding in Chinese Postpartum Women: An Analysis of Repeated Measures

INTRODUCTION

Little research has explored galactagogue food consumption in China. This study aims to investigate consumption patterns and how they relate to perceived insufficient milk supply and exclusive breastfeeding.

METHODS

Data were collected from postpartum women in China at six time points: baseline demographic questionnaire before hospital discharge (T0), galactagogue food questionnaire at 1 month postpartum (T1), Hill and Humenick Lactation Scale at 6 weeks postpartum (T2), and breastfeeding practices at 1, 2, 3 and 4 months postpartum (T1, T3, T4, T5).

RESULTS

Of 218 participants who completed the galactagogue food questionnaire, 64.68% were consumers. No association was found between galactagogue food consumption and perceived insufficient milk supply. Consumers were less likely to breastfeed exclusively.

DISCUSSION

Future research should emphasize a deeper understanding of consumer behaviors and family support in providing professional guidance on postpartum nutrition that considers not only social and cultural experiences but also broader medical aspects.

Development of a prediction model for neonatal hypoglycemia risk factors: a retrospective study

Background

It's challenging for healthcare workers to detect neonatal hypoglycemia due to its rapid progression and lack of aura symptoms. This may lead to brain function impairment for the newborn, placing a significant care burden on the family and creating an economic burden for society. Tools for early diagnosis of neonatal hypoglycemia are lacking. This study aimed to identify newborns at high risk of developing neonatal hypoglycemia early by developing a risk prediction model.

Methods

Using a retrospective design, pairs (470) of women and their newborns in a tertiary hospital from December 2021 to September 2022 were included in this study. Socio-demographic data and clinical data of mothers and newborns were collected. Univariate and multivariate logistic regression were used to screen optimized factors. A neonatal hypoglycemia risk nomogram was constructed using R software, and the calibration curve and receiver operator characteristic curve (ROC) was utilized to evaluate model performance.

Results

Factors integrated into the prediction risk nomogram were maternal age (odds ratio [OR] =1.10, 95% CI: 1.04, 1.17), fasting period (OR=1.07, 95% CI: 1.03, 1.12), ritodrine use (OR=2.00, 95% CI: 1.05, 3.88), gestational diabetes mellitus (OR=2.13, 95% CI: 1.30, 3.50), gestational week (OR=0.80, 95% CI: 0.66, 0.96), fetal distress (OR=1.76, 95% CI: 1.11, 2.79) and neonatal body mass index (OR=1.50, 95% CI: 1.24, 1.84). The area under the curve (AUC) was 0.79 (95% confidence interval [CI]: 0.75, 0.82), specificity was 0.82, and sensitivity was 0.62.

Conclusion

The prediction model of this study demonstrated good predictive performance. The development of the model identifies advancing maternal age, an extended fasting period before delivery, ritodrine use, gestational diabetes mellitus diagnosis, fetal distress diagnosis and an increase in neonatal body mass index increase the probability of developing neonatal hypoglycemia, while an extended gestational week reduces the probability of developing neonatal hypoglycemia.

Co-Parenting Impact on Breastfeeding: Systematic Review and Meta-Analysis

Background: Although the beneficial effects of exclusive breastfeeding (EBF) on infants and mothers have been identified, EBF rates remain unsatisfactory. Co-parenting interventions for perinatal couples have not been systematically evaluated and analyzed for their effects on breastfeeding outcomes. Aims and Objectives: To systematically evaluate the effects of co-parenting interventions on the rate of EBF, breastfeeding knowledge, breastfeeding attitude, breastfeeding self-efficacy, parental relationship, and partner support. Methods: Randomized controlled trials and quasi-experimental studies were systematically screened in eight online databases from inception to November 2022. Trials included in this review were assessed using the Cochrane Risk of Bias Assessment Tool. Eligible trials were used to conduct a meta-analysis using Review Manager software. The I² statistic was used to assess heterogeneity between studies. When it was not possible to conduct a meta-analysis, a descriptive analysis was used to present the findings due to insufficient data from the included studies. Results: Fifteen of the 1,869 articles reviewed met the inclusion criteria. Co-parenting interventions significantly improved the EBF rate at 16 weeks (odds ratio [OR] = 3.85, 95% confidence interval, CI [1.84 to 8.03], p < 0.001, I² = 69%) and 6 months (OR = 2.82, 95% CI [1.47 to 5.41], p = 0.002, I² = 85%). This study revealed that co-parenting interventions made statistically significant improvements in parental relationship (standardized mean difference [SMD] = 0.26, 95% CI [0.13 to 0.38], p < 0.001, I² = 80%). There was no evidence of the effectiveness of interventions in terms of overall parental support (SMD = 0.75, 95% CI [-0.46 to 1.97], p < 0.001, I² = 96%). Given the discrepant and limited research data, findings on breastfeeding knowledge, breastfeeding attitudes, and breastfeeding self-efficacy were presented descriptively. Conclusion: Co-parenting interventions effectively increase EBF rates at 16 weeks and 6 months postpartum, and improve breastfeeding knowledge, breastfeeding attitude, and parental relationships.

Incidence and risk factors for postpartum hemorrhage after vaginal delivery: A systematic review and meta-analysis

AIM

To estimate the incidence and identify risk factors of postpartum hemorrhage (PPH) after vaginal delivery.

METHODS

A systematic review and meta-analysis was conducted. PubMed, Cochrane Library, CINAHL, Web of Science, EMBASE, and ClinicalTrials.gov databases were systematically searched from inception to April 30th, 2022. Cross-sectional, cohort, case-control, and secondary analysis of randomized controlled studies that reported the incidence of PPH and the related risk factors in vaginal delivery were eligible through screening of 2343 articles. The incidence, associated standard error, adjusted odds ratios, relative risks and associated 95% confidence intervals were combined in the meta-analysis.

RESULTS

Thirty-six articles were included in the descriptive review. The incidence of PPH (blood loss ≥500 mL and blood loss ≥1000 mL) was 17% and 6%, respectively. Forty-one identified risk factors were divided into five categories under two criteria: history and demographics; maternal comorbidity; pregnancy-related factors; labor-related factors; delivery-related factors.

CONCLUSIONS

With the increasing incidence of PPH globally, obstetric health care providers need to improve their awareness of these multi-factorial risks to optimize obstetric care and reduce maternal morbidity. This systematic review and meta-analysis have raised important questions about the nature of vaginal delivery, such as the duration of prolonged labor, details on the use of oxytocin, and the presence of genital tract trauma. There should be highlighted by obstetric personnel on these factors during a patients' labor process.

Attitudes and knowledge of palliative care of Chinese undergraduate nursing students: A multicenter cross-sectional study

BACKGROUND

Helping patients and families to relieve severe pain and manage grief are issues that palliative care is designed to address, but integrating these topics in nursing education and practice requires increased attention. It is necessary to understand the knowledge and attitudes of nursing students to develop a targeted approach toward integrating palliative care in practice settings.

OBJECTIVES

To investigate attitudes and knowledge toward palliative care among undergraduate nursing students in China and to explore correlations and associated factors.

DESIGN

A cross-sectional study.

SETTINGS

Seven comprehensive universities in China.

PARTICIPANTS

A total of 582 undergraduate nursing students participated.

METHODS

Online questionnaires were available from December 2020 to February 2021. The Frommelt Attitude Toward Care of the Dying Scale and the Palliative Care Quiz for Nursing were used to measure students' attitude and knowledge of palliative care. Descriptive and correlational methods were used to analyse the associated factors and their correlation with knowledge and attitudes.

RESULTS

Attitude scores showed significant differences in gender, education level, religious preference, previous education in palliative care, experience in caring for dying patients and previous experience with bereavement. Knowledge of palliative care was influenced by gender, religious preference, prior education in palliative care, experience in caring for dying patients, and previous experience with bereavement. A positive correlation exists between knowledge and attitudes toward palliative care among undergraduate nursing students.

CONCLUSIONS

The findings highlight the need to offer palliative care courses in nursing education and practice settings in Chinese health care settings. Nurse educators need to integrate the concept of palliative care into the curriculum of nursing education programs. Healthcare administrators and nurse leaders should promote investment and training in the education of nurses in practice settings to deliver high-quality palliative care services.

Perceived social support and professional identity in nursing students during the COVID-19 pandemic era: the mediating effects of self-efficacy and the moderating role of anxiety

BACKGROUND

Health professionals, including nurses, experienced heavy workloads and significant physical and mental health challenges during the coronavirus disease (COVID) 19 pandemic, which may affect career choices for those considering nursing and for nursing students. The COVID-19 pandemic is not only a period of risk, but also an occasion to redeploy the professional identity (PI) of nursing students. However, the relationship between perceived social support (PSS), self-efficacy (SE), PI and anxiety remains unclear under the background of COVID-19. This study aims to explore whether PSS has an indirect effect on PI through mediation of SE and whether the anxiety can moderate the relationship between PSS and SE in nursing students during their internship period.

METHODS

An observational, national cross-sectional study was conducted following the STROBE guidelines. An online questionnaire was completed by 2,457 nursing students from 24 provinces in China during their internship during September to October 2021. Measures included Chinese translations of the Professional Identity Questionnaire for Nursing Students, the Perceived Social Support Scale, the General Self-Efficacy Scale, the 7-item Generalized Anxiety disorder scale.

RESULTS

Both PSS (r = 0.46, p < 0.001) and SE (r = 0.51, p < 0.001) were positively correlated with PI. The indirect effect of PSS on PI through SE was positive (β = 0.348, p < 0.001), with an effect of 72.7%. The results of the moderating effect analysis showed that anxiety attenuated the effect of PSS on SE. Moderation models indicated that anxiety has a weak negative moderating effect on the effect of PSS on SE (β =-0.0308, p < 0.05).

CONCLUSIONS

A better PSS and higher scores in SE were associated with PI in nursing students, and a better PSS had an indirect effect on the PI of nursing students through SE. Anxiety played a negative moderating role in the relationship between PSS and SE.

Fertility Intentions, Parenting Attitudes, and Fear of Childbirth among College Students in China: A Cross-Sectional Study

STUDY OBJECTIVE

This study aimed to investigate the current situation regarding fertility intentions, parenting attitudes, and fear of childbirth among college students in mainland China and the factors related to these variables.

DESIGN

A cross-sectional study SETTING: Colleges across China PARTICIPANTS: Five hundred and eighty-three college students attending regular institutions of higher education MAIN OUTCOME MEASURES: Fertility intentions and fear of childbirth were measured using the Swedish Fertility Awareness Questionnaire and the Childbirth Fear Prior to Pregnancy scale.

RESULTS

Only 38.8% of participants expressed their willingness to have children, and there was a significant difference between male and female students (P < .02). Males regarded having children as more important (P < .01), and females were more concerned about the negative effects of becoming parents, including difficulties in the labor market, having less freedom, and having less money. When deciding whether to have children, factors such as work, economics, and childcare were more important to females. Students who did not want children had higher levels of fear of childbirth than those who wanted children or were unsure (P < .02).

CONCLUSIONS

The fertility intentions of college students were not optimistic. In addition to the 2-child Chinese fertility policy, interventions aimed at reducing the cost of raising children, eliminating gender inequality in the workplace, and normalizing childcare institutions might help alleviate conflict between work and childrearing.

Utilization of complementary and alternative medicine by perimenopausal women in China: a cross-sectional study

OBJECTIVE

To investigate the utilization of complementary and alternative medicine (CAM) by perimenopausal women and explore factors associated with their preference.

METHODS

A cross-sectional study was conducted involving 558 perimenopausal women in Wuhan, China. Online questionnaires were available from December 2021 to April 2022. Instruments used were the International Complementary and Alternative Medicine Questionnaire and the Greene Climacteric Scale. The association between scores and participants' sociodemographic characteristics and perimenopausal symptoms was analyzed using multiple linear regression.

RESULTS

The overall utilization of CAM by perimenopausal women was 50.4% (281/558). Perimenopausal symptoms affecting the frequency of CAM usage included anxiety (adjusted β = 0.18), somatic (adjusted β = 0.07), and vasomotor symptoms (adjusted β = 0.76), P < 0.05. The most commonly used CAM were massage (37.7%), herbal therapies (19.9%), and dietary supplements (18.2%). Walking (58.6%) was the most popular self-practice therapy. Perimenopausal women consulted Western (38.4%) and Chinese medicine physicians (34.8%) and dentists (36.0%) most frequently.

CONCLUSIONS

Perimenopausal women experience discomforts during this age-related stage, and their use of CAM to manage symptoms is common. The usage and preferences of these management strategies are worthy of further exploration. There is a need to understand cost-effective and appropriate management interventions to improve the quality of life of perimenopausal women.

Breastfeeding Practices of Women Returning to Full-Time Employment in China: Prevalence and Determinants

BACKGROUND

Returning to work after childbirth is a common reason for women to stop breastfeeding. This study aimed to assess breastfeeding practices and breastfeeding support available to employed women in China, and factors affecting breastfeeding duration.

METHODS

A cross-sectional survey of 1,243 breastfeeding women employed full-time was conducted. Participants completed a sociodemographic questionnaire and the Workplace Breastfeeding Support Scale (WBSS). Multiple linear regression analysis was used to explore the factors that are associated with breastfeeding.

RESULTS

The mean exclusive breastfeeding duration and any breastfeeding duration of full-time employed women were 5.7 ± 0.5 months and 9.8 ± 1.5 months, respectively. The total WBSS score was 46.6 ± 5.3 (M ± SD). Generally, women perceived coworkers (M [SD] = 4.8 [1.0]) and supervisors (M [SD] = 5.7 [1.2]) to be supportive of breastfeeding. Lower scores on the WBSS were related to lack of technical and facility support, indicating no access to a refrigerator to store breast milk (M [SD] = 2.0 [1.5]) or to a breast pump (M [SD] = 1.7 [1.7]). Similarly, a private area for expressing breast milk (M [SD] = 1.4 [1.0]) was unavailable. Maternity leave, residential province, ethnicity, education level, average monthly household income, main reason for stopping exclusive breastfeeding, commute time greater than 1 hour, and the total WBSS score were also factors influencing breastfeeding duration of the full-time employed women.

CONCLUSIONS

There were gaps in breastfeeding practices and workplace breastfeeding support of Chinese full-time employed women when compared with the World Health Organization recommendations. Occupational health providers should consider these findings when developing programs to support breastfeeding in the workplace.

Effectiveness of Internet-based psychological interventions for treating perinatal depression: A systematic review and meta-analysis

BACKGROUND

Perinatal depression can result in short- and long-term adverse effects for women and their children if untreated. Psychological interventions, the preferred treatment for most women with perinatal depression, can also be provided online.

AIMS

This study aimed to provide a comprehensive and systematic review of Internet-based psychological interventions and to evaluate their effectiveness in the treatment of perinatal depression.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic literature search was conducted of six databases, including CINAHL, PubMed, Embase, Web of Science, the Cochrane Library and PsycINFO. Depression and anxiety, which were the primary and secondary results of this search, were presented as standardised mean differences (SMD) and 95% confidence intervals (CIs). This review was conducted according to the PRISMA checklist.

RESULTS

Thirteen studies involving 2158 perinatal women were included. Content, method, duration and frequency of Internet-based psychological interventions were varied. Participants indicated a high rate of satisfaction with these interventions; participants' dropout rates ranged from 2.6% to 60.8%. Meta-analysis demonstrated that Internet-based psychological interventions improved perinatal depression (SMD = -0.72, CI = [-1.02, -0.42], p < .01) and anxiety symptoms (SMD = -0.52, CI = [-0.73, -0.30], p < .01), with heterogeneity of 86% and 59%, respectively.

CONCLUSIONS

Internet-based psychological interventions are considered as convenient and effective alternative treatment for perinatal depression and anxiety. In the future, additional studies are needed to investigate the long-term effects of these interventions on the mental health of perinatal women and the effects on the growth and development of infants while controlling for the dropout rate.

RELEVANCE TO CLINICAL PRACTICE

Internet-based psychological interventions are innovative approaches to improving perinatal depressive symptoms that can leverage mental health resources and improve accessibility while promoting multidisciplinary integration. The approach, content, frequency and duration of intervention should be considered comprehensively to achieve the objectives of the intervention while maintaining compliance of women with perinatal depression.

Effects of needs-based education for prenatal anxiety in advanced multiparas: a randomized controlled trial

Background

Prenatal anxiety is a common concern which may have adverse effects on maternal and infant health outcomes. Studies addressing needs-based education interventions for prenatal anxiety are limited.

Aim

To explore the effects of needs-based education on alleviating prenatal anxiety among advanced multiparas when compared with routine prenatal health education.

Methods

A total of 86 advanced multiparas were randomized into the intervention group (n = 43) or the control group (n = 43) in this study. The control group received routine prenatal care. The intervention group received five needs-based education programs presented by trained researchers. The Pregnancy-related Anxiety Questionnaire was used to evaluate changes in anxiety level of participants. Concurrent physiological parameters, including blood pressure, heart rate and non-stress test were also measured.

Results

Scores on the Pregnancy-related Anxiety Questionnaire of the intervention group were significantly lower than those of the control group (t = 4.21, P < 0.05). Systolic blood pressure (t = 3.64, P < 0.05) and heart rate (t = 2.39, P < 0.05) of the intervention group were also significantly lower than the control group whereas no differences were noted in diastolic blood pressure and non-stress test.

Conclusion

A needs-based education program is an effective intervention strategy to allay prenatal anxiety in advanced multiparas.

Trial registration

The trial was retrospectively registered in the Chinese Clinical Trial Registry as number ChiCTR2100047552.

Psychological interventions for sexual function and satisfaction of women with breast cancer: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To systematically evaluate the effectiveness of psychological interventions for women with breast cancer on sexual function, sexual satisfaction, sexual relationships, sexual distress and sexual quality of life.

BACKGROUND

Sexual dysfunction is common in women with breast cancer and seriously affects their quality of life and marital harmony. Several studies have explored the effects of psychological interventions related to sexual function of women with breast cancer, but results were inconclusive.

DESIGN

A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHOD

A search of PubMed, EMBASE, PsycINFO, Web of Science, the Cochrane Library, Scopus, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov. and Open Grey was conducted from inception to 9 May 2021. Two reviewers independently screened studies, extracted data and conducted a quality appraisal of included studies using the Joanna Briggs Institute critical appraisal checklists.

RESULTS

Fifteen studies involving 1307 participants were included. The current study showed that psychological interventions made statistically significant improvements in sexual function (SMD = 0.82; 95% CI = [0.43, 1.20]; p < .001), sexual satisfaction (SMD = 0.95; 95% CI = [0.19, 1.72]; p = .01), sexual relationships (SMD = 0.37; 95% CI = [0.15, 0.60]; p = .001) and sexual distress (MD = -5.05; 95% CI = [-7.88, -2.22]; p = .0005) of women with breast cancer. A subgroup analysis regarding the types of psychological interventions indicated that cognitive behavioural therapy and psychoeducational therapy were beneficial to sexual function and satisfaction, and psychosexual counselling could also improve sexual function.

CONCLUSION

Psychological interventions, especially psychoeducational therapy and cognitive behavioural therapy, are effective for improving the sexual health of women with breast cancer.

RELEVANCE TO CLINICAL PRACTICE

This current study provides evidence for the application of psychosexual interventions in women with breast cancer.

REGISTRATION

The study has been registered on the PROSPERO on 6 June 2021, with the registration number CRD42021253493.

Development of a breastfeeding duration risk nomogram for use in postpartum Chinese women

Previous studies have investigated influencing factors of early discontinuation of breastfeeding, but few studies have developed an easy-to-use tool to identify risk of breastfeeding cessation at 6 months after birth. This research team aimed to develop and validate an exclusive breastfeeding duration risk nomogram in Chinese mothers. A longitudinal cohort survey was conducted. Data were collected from 394 postpartum women in three hospitals in Hubei Province, China from December 2017 to December 2018. The LASSO regression model was used to screen for optimized factors in an exclusive breastfeeding duration model. Multivariable logistic regression was applied to construct a prediction model. Discrimination and calibration were assessed using a C-index and calibration curve, and internal validity was established using bootstrapping validation. Factors integrated in the prediction risk nomogram were monthly household income (odds ratio [OR] = 1.31, 95% confidence interval [CI]: [0.95, 1.80]), experiences of breastfeeding (OR = 1.23, 95% CI: [0.92, 1.63]), attitude (OR = 1.72, 95% CI: [0.94, 3.16]), self-efficacy (OR = 2.45, 95% CI: [1.40, 4.29]), perceived insufficient milk supply (OR = 0.12, 95% CI: [0.06, 0.25]) and postpartum depression (OR = 0.06, 95% CI: [0.02, 0.17]). The model displayed good discrimination with a C-index of 0.87 (95% CI: [0.84, 0.91]) and good calibration. The C-index interval validation was confirmed to be 0.86. This study resulted in the development of a novel nomogram with good accuracy to aid healthcare professionals in assessing the probability of a mother discontinuing exclusive breastfeeding at the breast before 6 months.

COVID-19 related fear and depression of pregnant women and new mothers

OBJECTIVE

To explore factors associated with depression and COVID-19 related fear among pregnant women and new mothers.

DESIGN

A cross-sectional survey was conducted in China from July 2020 to July 2021.

SAMPLE

A total of 3027 pregnant and new mothers were recruited.

MEASUREMENT

Sociodemographic characteristics and the perceptions of the COVID-19 pandemic were collected. The Patient Health Questionnaire-9 (PHQ-9) and the Fear Scale was used to assess the depressive and fear level towards the COVID-19 pandemic, respectively.

RESULTS

Approximately 17.2% of the participants had depression (PHQ-9 ≥10). In Hong Kong, participants who perceived that they have increased knowledge to prevent infection were less likely to have depression (adjusted odds ratio [aOR] = 0.83; 95% confidence interval [CI] = 0.74-0.94). There was no association between perceived severity if infected and severity of spread and the depression level in our sample. An inverse relationship was found between the COVID-19 related fear level and perceived knowledge to prevent infection (Beta-coefficient [β] = -0.20; 95% CI = -0.38 to -0.02).

CONCLUSION

Public health nurses need to promote accurate and up to date COVID-19 related information at clinical and community settings and implement effective screening for depression and fear symptoms to identify these high-risk groups to improve women's psychological well-being.

Simulation-based childbirth education for Chinese primiparas: A pilot randomized controlled trial

OBJECTIVE

To evaluate the effectiveness and feasibility of simulation-based childbirth education (SBCE) on reducing fear of childbirth (FOC) of Chinese primiparas.

METHODS

A total of 56 primiparas completed the trial including 26 in the intervention group and 30 in the control group. The intervention group received four sessions of SBCE while the control group received routine prenatal care. Chinese versions of the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) and Childbirth Self-Efficacy Inventory (CBSEI) were used to evaluate FOC and childbirth self-efficacy. Birth outcomes including delivery method, labor duration and Apgar scores were collected.

RESULTS

Scores on the WDEQ-A of the intervention group were statistically lower than those of the control group (P < 0.05). The CBSEI scores of the intervention group were significantly higher than those of the control group (P < 0.05). The cesarean birth rate of the intervention group was lower than that of the control group (34.61% vs 46.67%, P > 0.05).

CONCLUSION

Simulation-based childbirth education alleviates FOC, increases childbirth self-efficacy and improves birth outcomes, providing a new perspective to alleviate FOC of primiparas in the future.

PRACTICE IMPLICATIONS

Simulation-based childbirth education is an effective and feasible method to educate women about childbirth. Its integration into routine prenatal care of Chinese primiparas should be encouraged to reduce FOC.

Experience predicts the duration of exclusive breastfeeding: The serial mediating roles of attitude and self-efficacy

BACKGROUND AND AIMS

The relationship between prior breastfeeding experience and the duration of exclusive breastfeeding is of significant interest, but few studies have explored the mechanisms underlying this relationship. The purpose of this study is to address two hypotheses: (a) that attitude and self-efficacy mediate the relationship between previous breastfeeding experience and the duration of exclusive breastfeeding; and (b) that attitude and self-efficacy have serial mediation functions in this relationship.

METHODS

The data collection process was divided into two stages. The original stage included 394 women hospitalized after delivery who completed socio-demographic questionnaires (including previous breastfeeding experience), the Iowa Infant Feeding Attitude Scale (IIFAS), and the Breastfeeding Self-efficacy Short-Form Scale (BSES-SF). Follow-up data about duration of exclusive breastfeeding were obtained at six months postpartum.

RESULTS

Mediation analysis indicated that previous breastfeeding experience directly affected the duration of exclusive breastfeeding and that the rate of the total indirect effect was 22.878%. Self-efficacy mediated previous breastfeeding experience and duration of exclusive breastfeeding, whereas attitude and self-efficacy played the series mediational role between previous breastfeeding experience and duration of exclusive breastfeeding. Cluster analysis supported these results.

CONCLUSIONS

The duration of exclusive breastfeeding can be promoted by improving breastfeeding attitude and self-efficacy in women without breastfeeding experience.

Efficacy of Community-based Pelvic Floor Muscle Training to Improve Pelvic Floor Dysfunction in Chinese Perimenopausal Women: A Randomized Controlled Trial

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on perimenopausal women with pelvic floor dysfunction (PFD). A two-group longitudinal experimental design with multiple comparisons. The intervention group (n = 37) received a 3-month intervention combining Kegel and yoga exercise. The control group (n = 37) received Kegel exercise. The combined training alleviated PFD symptoms, improved life quality and increased pelvic floor muscle strength of perimenopausal women. Women with PDF symptoms can integrate PFMT and yoga exercise to promote rehabilitation and improved outcomes. Combined exercise should be taught and practiced under supervision by qualified health professionals.

International survey on fear and childbirth experience in pregnancy and the postpartum period during the COVID-19 pandemic: study protocol

INTRODUCTION

The COVID-19 pandemic has caused unprecedented disruptions around the world. Adding to the existing stress surrounding pregnancy and childbirth, the threat of infection and social isolation policies may negatively impact pregnant women and new mothers. Literature on the effect of COVID-19 on fear during pregnancy and childbirth experience is limited. As the COVID-19 pandemic continues to affect the global population, it is important to understand how it has impacted pregnant women and new mothers' experiences worldwide to inform perinatal care and interventions.

METHODS AND ANALYSIS

This multicountry study involving China and Canada targets to recruit 1000 pregnant women and new mothers who gave birth since 2020 in each participating country. Participants will be recruited online in the local language through mothers' groups, antenatal and postnatal clinics and hospital wards. All questionnaires will be completed online. Participants' level of fear, depression and childbirth experience will be assessed along with other sociodemographic, medical and COVID-related measures. Regression models will be used to compare the outcomes among the participating countries.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the institutional review boards of the participating countries. Findings will be disseminated in peer-reviewed journals and academic conferences. Results from this study may guide the formulation of future health guidelines and policies in the face of a pandemic.

Efficacy and Safety of Domperidone and Metoclopramide in Breastfeeding: A Systematic Review and Meta-Analysis

Objectives: To evaluate the efficacy and safety of domperidone and metoclopramide used by breastfeeding women. Methods: A systematic literature search retrieved citations from PubMed, Embase, The Cochrane Library, Medline, EBSCO, Web of Science, ClinicalTrials.gov (from inception to January, 2021) and bibliographies of known articles. Randomized controlled trials exploring the effects of domperidone and metoclopramide in breastfeeding women with term and preterm infants experiencing adequate or low milk supply were identified. Human milk volume and maternal side effects were presented as mean difference (MD) or relative risks (RR) with 95% confidence intervals (CI). Results: Sixteen trials involving 729 women were included in the qualitative analysis and 14 trials involving 607 women were included in the meta-analysis. In mothers of preterm infants with low milk supply, domperidone demonstrated a significant increase in daily human milk volume (MD = 90.53 mL/day, 95% CI [65.42 to 115.64], I² = 9%). However, metoclopramide did not show significant difference in daily human milk volume in women with preterm infants (MD = -1.14 mL/day, 95% CI [-31.42 to 29.14], I² = 0%). No differences in maternal side effects were noted with domperidone (RR = 1.20, 95% CI [0.74 to 1.97], I² = 0%) or metoclopramide (RR = 1.05, 95% CI [0.52 to 2.11], I² = 27%) in women with preterm infants. Regarding the women with term infants, there were insufficient data in the current review. Conclusions: Domperidone can be used to treat low milk supply in women with preterm infants without significant side effects based on the current review. More evidence exploring the efficacy and safety of domperidone and metoclopramide are still needed for breastfeeding women in the future.

Efficacy of yoga on physiological and psychological discomforts and delivery outcomes in Chinese primiparas

BACKGROUD AND PURPOSE

Almost every woman experiences discomforts during pregnancy. This study aimed to evaluate the efficacy of yoga on physiological and psychological discomforts and delivery outcomes in Chinese primiparas.

MATERIALS AND METHODS

A randomized controlled trial was conducted. Participants in the control group (n = 32) received routine prenatal care, whereas participants in the intervention group (n = 32) received routine prenatal care and yoga exercise three times a week for 12 weeks. Outcomes evaluated included physiological discomforts, prenatal depression, anxiety, childbirth self-efficacy and delivery outcomes. Intention-to-treat analysis was conducted.

RESULTS

Yoga decreased the symptoms of physiological discomforts during pregnancy (F = 6.966, p = 0.010), promoted childbirth self-efficacy (F = 11.900, p = 0.001), increased the rate of vaginal delivery (χ² = 4.267, p = 0.039), and shortened the length of the first (t = -2.612, p = 0.012), second (z = -3.313, p = 0.001) and third stages of labor (z = -3.137, p = 0.002).

CONCLUSION

Yoga offers beneficial effects on physiological discomforts, childbirth self-efficacy and delivery outcomes in Chinese primiparas.

The integration of immersive virtual reality simulation in interprofessional education: A scoping review

BACKGROUND

Contemporary healthcare systems are in dire need of teamwork and interprofessional collaboration, however, existing curricula of health education programs offer few opportunities to build these capabilities. Virtual simulations enable interaction and cooperative learning for students pursuing health majors.

OBJECTIVE

To explore the effectiveness of immersive virtual reality simulation (IVRS) in interprofessional education (IPE) and the experience of students from various disciplines in a virtual clinical environment.

DESIGN, DATA SOURCES AND METHODS

A scoping review was conducted. Literature was systematically searched from CINAHL, EMBASE, ERIC, MEDLINE/PubMed, ProQuest, PsycINFO, Scopus, Science Direct, Cochrane Library and Open Grey databases. Among 2352 records, 12 research articles were found and analyzed.

RESULTS

The experiences of students participating in IVRS centered on enhanced cooperation and communication across their disciplines. They obtained a more accurate picture of the patient and developed an interdisciplinary care plan. After the IPE session, they had greater appreciation of the importance of a team approach and shared learning. Students acknowledged the usability of virtual worlds (VWs) and appreciated the immersive learning experience that was offered. They gained valuable insight into mutual roles and believed that this experience would benefit their role as a health care team member.

CONCLUSIONS

This study supports the usability of VWs for IPE. As a new teaching modality, the IVRS experience effectively promotes interprofessional collaboration and communication. Future advances in the use of these technologies are expected to revolutionize health science education.

The Relationship of Previous Breastfeeding Experiences and Factors Affecting Breastfeeding Rates: A Follow-Up Study

Background/Objective: Many studies have focused on the effects of previous breastfeeding experience (PBE) on subsequent breastfeeding, but few have explored their specific relationships. To explain the relationship between PBE and subsequent breastfeeding behavior based on a follow-up study. Materials and Methods: After delivery, 394 participants who had no PBE completed a demographic questionnaire, breastfeeding knowledge questionnaire, the breastfeeding self-efficacy short-form scale (BSES-SF), and the Iowa infant feeding attitudes scale (IIFAS). Multiparas with PBE also completed the maternal breastfeeding evaluation scale (MBFES) in addition to the aforementioned four questionnaires. On the 42nd day after delivery, participants completed the breastfeeding experience scale (BES) through social networking platforms (QQ, WeChat: both are Chinese social medias). At 4 and 6 months postpartum, researchers contacted participants by phone or a social network regarding their exclusive and partial breastfeeding experiences. Results: In this study, exclusive breastfeeding rates were 58.6% and 30.5% at 4 and 6 months. PBE affected breastfeeding attitudes (p < 0.05), self-efficacy (p < 0.01), and difficulties (p < 0.05). Breastfeeding knowledge, attitude, self-efficacy, and difficulties were relevant to exclusive and partial breastfeeding at 4 and 6 months (p < 0.05). Multivariate logistic regression analysis showed that compared with women without PBE, the probability of exclusive breastfeeding of multiparas with PBE at 4 and 6 months increased by 275% and 369%, respectively. Conclusions: The rate of breastfeeding remains low among Chinese women, but PBE is associated with a higher probability of breastfeeding at 4 and 6 months postpartum. Multiparas, especially those having PBE were more likely to breastfeed for an extended period based on their knowledge, attitude, self-efficacy, and ability to manage difficulties.

Factors associated with postpartum women's knowledge, attitude and practice regarding human milk banks and milk donation: A cross-sectional survey

BACKGROUND

Breast milk is the optimal method of human nutrition, and donor human milk is often needed to reduce the incidence of necrotizing enterocolitis and septicemia in preterm infants and improve their survival rate. Donor human milk is recommended as the first alternative when mothers' milk is not available. The establishment of human milk banks is of great significance to promote the breastfeeding of preterm infants. However, there are insufficient studies on human milk banks and milk donation in China.

OBJECTIVES

(1) To investigate postpartum women's knowledge, attitude and practice regarding human milk banks and milk donation and to analyze the influencing factors. (2) To explore reasons why postpartum women reject milk donation and donor milk.

DESIGN AND SETTINGS

A cross-sectional survey was conducted from February 2019 to July 2019 at two hospitals in Wuhan, a large city in central China.

PARTICIPANTS

Mothers who returned to hospital for postpartum follow-up within six months participated in this survey (N = 1078).

METHODS

Questionnaires were used to obtain sociodemographic data and to determine participants' knowledge, attitude and practice regarding human milk banks and milk donation.

FINDINGS

Of the respondents, 216 (20%) had prior knowledge of human milk banks and milk donation. For the sub-domain of knowledge, the item with the highest correct response rate was the benefit of breast milk, and the item with the lowest correct rate was the acceptance of donor human milk. For the sub-domain of attitude, 811(75.3%) of participants held a supportive attitude for the establishment of human milk banks, and 877(81.3%) were supportive of donating breast milk while 412 (38.3%) were supportive of accepting donor human milk. For the sub-domain of practice, the practice of milk donation was not optimistic as participants lacked interest in donating breast milk and spreading knowledge of breast milk banks, and only 28.3% of participants indicated that they would donate breast milk continuously. Participants' age, educational background, weight of the newborn and having prior knowledge of human milk banks were factors that could positively predict their knowledge, attitude and practice associated with human milk banks and milk donation; medication usage during pregnancy or lactation was a factor negatively predicting their knowledge about human milk banks and milk donation.

CONCLUSION

This study reveals that a majority of postpartum women are supportive of human milk banks and more willing to donate breast milk than receive donor milk. Lack of knowledge about human milk banks and safety concerns are the main factors hindering postpartum women from donating or accepting donor milk. Findings suggest that it is important to enhance public awareness regarding human milk banks as potential resources for life-saving therapy for preterm infants.This information should be disseminated during the early stage of the establishment of human milk banks. Moreover, health education of pregnant women should include the importance of human milk as well as the alternative and safety of donor milk from milk banks, especially for promoting the health of preterm infants and infants who are unable to receive mothers' breastmilk.

Worldwide research on fear of childbirth: A bibliometric analysis

Objective

To review the research on fear of childbirth, analyze and evaluate the publications by means of bibliometric analysis, and provide suggestions and scopes for future study.

Data sources

Web of Science, PubMed, Embase and the Cochrane Library databases.

Study selection

All published articles focusing on the fear of childbirth from inception to February 10, 2020.

Data extraction

A total of 743 articles were included for final analysis. Bibliographic data were exported from databases and then cleaned manually before using Microsoft Excel and VOSviewer to analyze and visualize the findings.

Data synthesis

It was found that 743 articles have been cited 31515 times (h-index: 98). The volume of publications increased by 29.3 times in the past two decades. Across the globe, Sweden was the most prolific country having 129 articles (17.4%) with six of its institutions in the top ten most prolific institutions in the world. Fifty-two (7.8%) documents were published in Midwifery journal. The most prolific author was Hildingsson, who published 35 articles (4.7%). “Cesarean section,” “experience,” and “factor” were the words that appeared most frequently in titles and abstracts of studies. “Point prevalence of psychiatric disorders during the second trimester of pregnancy: A population-based study” was the most cited article and received 525 citations.

Conclusion

There is an increasing interest in the research in fear of childbirth during the past two decades. This study has demonstrated that the Swedish authors have a leading role on this topic. Researchers especially in countries with high birth rates, need to promote research projects in this field as it is an important public health issue.

Technology-supported lifestyle interventions to improve maternal-fetal outcomes in women with gestational diabetes mellitus: A meta-analysis

BACKGROUND

The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem. Lifestyle interventions have been recognized as effective measures to enhance maternal and child health. Traditional education approaches, personalized consultation and home visits to promote change in patients' lifestyle are limited by cost, lack of resources and inability to provide broad coverage. The increased use of technological approaches can cross these barriers.

OBJECTIVES

The meta-analysis aimed to evaluate the effectiveness of technology-supported lifestyle interventions for women with gestational diabetes mellitus.

METHODS

Databases that were reviewed included the Cochrane Library, PubMed, Web of Science, EBSCO, Embase, Medline, CINAHL and ClinicalTrials.gov. from inception to September 2019. Randomized controlled trials (RCTs) of technology-supported lifestyle interventions used for women with gestational diabetes mellitus (GDM) were identified. Two reviewers independently assessed each study using Cochrane Collaboration's tool. Maternal-fetal outcomes as well as weight gain in pregnancy and maternal blood glucose were presented as relative risks (RR) or a mean difference (MD).

RESULTS

Of the 3993 articles reviewed, ten RCTs involving 979 women were included. Technology-supported lifestyle interventions reduced pregnancy weight gain (MD = -1.55, 95% CI = [-1.81 to -1.29], P < 0.001) and mean (1-h and 2-h) postprandial blood glucose (MD = -0.31, 95% CI = [-0.58 to -0.03], P = 0.03), with low heterogeneity of 36% and 18%, respectively. No evidence of significant effect existed on other maternal-fetal outcomes, such as weeks of gestation at delivery, caesarean birth, pre-eclampsia/gestational hypertension, instrumental vaginal birth, premature delivery, newborn weight, neonatal hypoglycemia, large-for-gestational age, fetal macrosomia, NICU admission and respiratory morbidity (I² ranging from 0% to 51%). No significant improvement was noted in glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG), with strong heterogeneity of 95% and 84%, respectively.

CONCLUSIONS

Technology-supported lifestyle interventions are associated with reducing pregnancy weight gain and mean (1-h and 2-h) postprandial blood glucose in women with GDM. Well-designed research studies are needed to identify the full potential of technology-supported lifestyle interventions, especially interventions guided by theoretical models.

Survey on medication information literacy and influencing factors among pregnant Chinese women

BACKGROUND

The use of medication during pregnancy is very common. Medication safety has been a great concern among pregnant women and is highly influenced by women's medication information literacy (MIL). There have been few studies focusing on MIL of pregnant women in China. The misuse of medication during pregnancy may impose on risks on pregnancy.

OBJECTIVES

The focus of this study was to investigate the MIL of pregnant Chinese women and to identify influencing factors.

METHODS

Convenience sampling was used following the distribution of a researcher-designed questionnaire to pregnant women at obstetric clinics. A scale was developed to evaluate participants' MIL which included medication information needs, medication information sources, medication information quality discrimination, medication information source awareness, and medication-taking behavior. Demographic characteristics of participants, health status and medication use during pregnancy were also collected.

RESULTS

Questionnaires were completed by 570 participants, yielding a 99% response rate. The total score on the Pregnant Women's Medication Information Literacy Scale ranged from 47 to 96 with a mean score of 74.25 ± 8.22. A total score of 80% or higher indicated the participants' have sufficient medication information literacy which was achieved by 28.2% of the sample. Rate of participants who have sufficient MIL on subscale domains were: medication information needs (76.6%), medication-taking behavior (49.9%), medication information source awareness (26.8%), medication information quality discrimination (17.3%) and medication information sources (15.3%). Significant differences were found in the MIL of participants related to education level, location of residence, occupation, household income, age, weeks of gestation and medication history (p < .05). Binary logistic regression analysis indicated that education, income level, location of residence, occupation, and weeks of gestation affected participants' MIL.

CONCLUSIONS

The overall MIL is low among pregnant Chinese women, which suggests a need for healthcare professionals focusing on medication safety teaching to pregnant women. Interventions by health care professionals in obstetric clinics that promote MIL and prevent adverse events related to medications should be individualized based upon pregnant woman's education level, financial resources, community of residence, occupation and week of gestation.

A Web-based Survey of Marital Quality and Job Satisfaction among Chinese Nurses

PURPOSE

This study aimed to use a web-based survey to investigate the correlation between job satisfaction and marital quality and to identify the association of demographics with job satisfaction and marital quality.

METHODS

Married nurses (N = 2,296) completed the questionnaires. Correlations and linear regression analyses were carried out.

RESULTS

Both marital quality and job satisfaction were relatively low. Additionally, marital quality was positively correlated with job satisfaction. Age, marital status (in years) and average daily hours spent with spouse had positive impact on job satisfaction. Multiple linear regression analyses showed that age, monthly income, average daily hours spent with spouse and marital quality were positively associated with job satisfaction.

CONCLUSION

Because of the shifts nurses working, there is little time for nurses to spend with their spouses and family. It is recommended that hospital leaders could provide more flexibility with nurses' shift choices so nurses can arrange their work-life balance better. Other considerations like reducing workload and reducing working hours should be promoted as options. Nurse managers could offer counseling services including strategies to cope with the balance between work and life. This effort could improve job satisfaction and reduce the rate of turnover of nurses.

Effects of physical exercise during pregnancy on maternal and infant outcomes in overweight and obese pregnant women: A meta-analysis

BACKGROUND

Overweight and obesity are related to maternal and infant physical health, such as gestational diabetes, preeclampsia, and macrosomia. The purpose of this meta-analysis was to assess the effect of physical exercise on maternal and infant outcomes in overweight and obese pregnant women.

METHODS

Two researchers independently searched Cochrane Library, Embase, PubMed, Web of Science, and ClinicalTrials.gov. for English-language articles based on randomized controlled trials examining physical exercise in overweight and obese pregnant women and its effect on maternal and infant outcomes. Primary outcomes were gestational weight gain and a relative risk of gestational diabetes. Secondary outcomes were gestational hypertension, preeclampsia, cesarean delivery, birthweight, large for gestational age, small for gestational age, macrosomia, and preterm birth. Risk bias was evaluated by Cochrane Collaboration's tool. The results of integration were reported as relative risks (RR), mean difference, or standard mean difference with 95% confidence intervals (CI). This meta-analysis was registered on PROSPERO on November 18, 2017, with registration number CRD42017081565.

RESULTS

Thirteen studies involving 1439 participants were included. Physical exercise reduced gestational weight gain (mean difference = -1.14 kg, 95% CI = [-1.67 to -0.62], P < 0.0001) and the risk of gestational diabetes (RR = 0.71, 95% CI = [0.57-0.89], P = 0.004) in overweight and obese pregnant women. There were no significant differences in other outcomes such as gestational hypertension, preeclampsia, cesarean delivery, birthweight, large for gestational age, small for gestational age, macrosomia, and preterm birth.

CONCLUSIONS

Prenatal exercise interventions reduced gestational weight gain and the risk of gestational diabetes for overweight and obese pregnant women, which reinforced the benefits of exercise during pregnancy. However, no evidence was found with respect to benefits and/or harm for infants. Consideration should be taken when interpreting these findings as a result of the relative small sample size in this meta-analysis. Further larger well-designed randomized trials may be helpful to assess the short-term and long-term effects of prenatal exercise on maternal and infant outcomes.

Maternal Prepregnancy Body Mass Index, Gestational Weight Gain, and Cessation of Breastfeeding: A Systematic Review and Meta-Analysis

Background: Suboptimal breastfeeding, a major factor of maternal and child morbidity and mortality, has been reported around the world. Maternal weight status, as a significant variable influencing breastfeeding outcomes, needs to be studied sufficiently. Objective: This review is to explore the effect of different prepregnancy BMI and gestational weight gain (GWG) categories on breastfeeding initiation and cessation. Materials and Methods: Cohort studies were systematically searched in Embase, Web of Science, PubMed, and CINAHL databases from database establishment to February 2019. Summary risk ratio (RR) on breastfeeding initiation and cessation was estimated with the use of a random-effects model. Results: Thirty cohort studies were included in meta-analysis. Prepregnancy obesity was a risk factor for breastfeeding initiation (RR 1.49, 95% CI [1.33-1.67]), exclusive and any breastfeeding (ABF) duration (RR 1.26, 95% CI [1.17-1.36]; RR 1.34 95% CI [1.16-1.56]). Inadequate GWG was a risk factor for breastfeeding initiation (RR 1.27, 95% CI [1.08-1.49]). Excessive GWG was a risk factor for ABF duration when women were prepregnancy overweight and obese (RR 1.42 95% CI [1.32-1.53]; RR 1.89 95% CI [1.13-3.17]). Conclusion: If women are obese before pregnancy or gain excessive/inadequate weight during pregnancy, they are less likely to initiate and continue breastfeeding according to recommendation time. Hence, guidance about proper weight management to reproductive age women and consultation about recommended GWG to pregnant women should be fully implemented to improve breastfeeding practices. Besides, future research needs to find out the association between prepregnancy underweight status and breastfeeding outcomes.

Meta-analysis of risk and protective factors for gastrointestinal bleeding after percutaneous coronary intervention

AIM

To quantitatively analyse factors related to gastrointestinal bleeding after percutaneous coronary intervention and provide evidence for the prevention of gastrointestinal bleeding.

DATA SOURCES AND REVIEW METHODS

Cochrane Library, Pubmed, Embase, and Ovid databases were searched from inception to 31 May 2018; case-control and cohort studies published in English were included. The methodological quality of each study was assessed by two independent reviewers using the Newcastle-Ottawa Scale. Meta-analysis was performed using Revman version 5.3.

RESULTS

A total of 16 publications yielded data about risk factors. It was found that age older than 70 years, age (per 10-year increase), female sex, baseline anaemia, history of smoking, history of using alcohol, history of peptic ulcer disease, chronic renal failure, previous bleeding, shock, congestive heart failure, acute myocardial infarction, prior use of inotropic medications, and prior use of antithrombotic medications were positively associated with gastrointestinal bleeding. Four articles yielded data about protective factors. It was found that proton-pump inhibitor and bivalirudin therapy were negatively associated with gastrointestinal bleeding after percutaneous coronary intervention.

CONCLUSION

This research found risk and protective factors which can assist in effective management of this potentially fatal complication.

Family-Centered Breastfeeding Education to Promote Primiparas' Exclusive Breastfeeding in China

BACKGROUND

Few breastfeeding education programs focus on primiparas and the importance of family members on exclusive breastfeeding in China. Research aim: This study aimed to explore the influence of a family-centered breastfeeding education program in promoting exclusive breastfeeding up to 6 months postpartum and to improve women's attitude and knowledge, family members' knowledge, and family support.

METHODS

This was a two-group quasi-experimental design with multiple comparisons. Participants ( N = 59) were randomized to either the intervention ( n = 29) or the control ( n = 30) group. The intervention group received two prenatal breastfeeding education lectures that included important family members, three home visits, eight telephone calls, text or video/audio support, and quality online resources during lactation. The control group received in-hospital care and follow-up by community nurses after discharge.

RESULTS

Compared with the control group, the intervention group was more likely to exclusively breastfeed in the first 6 months, odds ratio = 0.44, 95% confidence interval [0.20, 0.98]. The mean knowledge level of the intervention group improved more across time ( p < .05) and was higher than the control group ( p < .05). Perceived family support within the intervention group was significantly higher than the control group from 1 to 6 months ( p < .05).

CONCLUSION

The breastfeeding education program is an effective strategy to promote exclusive breastfeeding in China.

Attitudes of Chinese Adults to Breastfeeding in Public: A Web-Based Survey

OBJECTIVE

To explore Chinese adults' perceptions and attitudes toward breastfeeding in public places.

MATERIALS AND METHODS

This was a web-based survey including 10 items on breastfeeding participants (N = 2,021) who were recruited by convenience sampling.

RESULTS

Almost 95% believed that public places should have lactation rooms, 86% thought it was acceptable for mothers to breastfeed in this location, and 65% of respondents agreed that it was acceptable for mothers to breastfeed in public. Though 47% believed that viewing women breastfeeding in public was embarrassing, more than 80% felt that breastfeeding in public was appropriate and decent and did not violate social morality. More than 90% of respondents approved of policies supporting breastfeeding in public. Women, married people, those who had children, had some knowledge about breastfeeding, or had the experience of viewing women breastfeeding in public were more likely to hold positive perceptions and attitudes toward breastfeeding in public places.

CONCLUSIONS

Prior experience and knowledge about breastfeeding have a great influence on people's perceptions and attitudes toward breastfeeding in public, so education about breastfeeding is very important. Breastfeeding education should not only include the techniques of breastfeeding practices but also include information policies that support breastfeeding in public, including the importance of lactation rooms.

Father's Role in Breastfeeding Promotion: Lessons from a Quasi-Experimental Trial in China

AIMS

The aims of this study were to evaluate the effectiveness of an educational intervention involving fathers on breastfeeding initiation and exclusive breastfeeding rate, and to explore mothers' perceptions of their partners' support of breastfeeding.

MATERIALS AND METHODS

This study was a quasi-experimental pretest-posttest design with two groups. A convenience sample consisting of 72 expectant mothers was recruited. Thirty-six women with their partners were assigned to the intervention group, and 36 women alone were in the control group. Both groups were offered similar education contents, and the intervention group was given additional information on how fathers could support their partners, both emotionally and physically, during the breastfeeding process. Student's t test, chi-square test, and Mann-Whitney U test were used to detect group differences.

RESULTS

The prevalence rates of exclusive breastfeeding at 4 months and 6 months of the intervention group were significantly higher than there were in the control group (51.4% and 26.4%, p = 0.034; 40.0% and 17.6%, p = 0.041). Women in the intervention group were less likely to use infant formula at 1 and 6 months postpartum (5.6% and 23.5%, p = 0.032; 20.0% and 44.1%, p = 0.032). Related to the process of breastfeeding, partners in the intervention group supported their partners by taking care of the infant, doing housework, and providing emotional support.

CONCLUSIONS

Involving the fathers in breastfeeding education could improve the exclusive breastfeeding rate and prolong the duration of exclusive breastfeeding. The mothers appreciated support from the fathers.

The impact of psychological empowerment and organizational commitment on Chinese nurses' job satisfaction

Background: Research findings have shown that job satisfaction of Chinese nurses is at a low level. Limited studies have focused on the impact of psychological empowerment and organizational commitment on job satisfaction of Chinese nurses. Aims: The aim of this study is to describe job satisfaction, psychological empowerment and organizational commitment of Chinese nurses and to explore the impact of psychological empowerment and organizational commitment on the nurses' job satisfaction. Methods: A total of 726 nurses were recruited in a convenience sample from 10 tertiary hospitals. Data were collected using four questionnaires including Job Satisfaction Survey, Psychological Empowerment Scale, Organizational Commitment Scale and Demographic Questionnaire. Descriptive analysis, correlation and stepwise multiple regression were used for data analysis. Results: Nurses' job satisfaction, psychological empowerment, and organizational commitment were identified at moderate levels. Nurses' job satisfaction and psychological empowerment were significantly different in terms of age and length of service; nurse job satisfaction varied with respect to marital status. Findings further indicated that nurse job satisfaction was positively correlated with psychological empowerment and organizational commitment. Psychological empowerment, organizational commitment, and marital status were significant predicting factors of nurse job satisfaction. Conclusions: This study provides evidence to help nursing managers and health policy-makers to develop intervention programs aimed at enhancing nurse job satisfaction and retaining nurses.

The impact of psychological empowerment and organizational commitment on Chines nurses' job satisfaction

Abstract Background: Research findings have shown that job satisfaction of Chinese nurses is at a low level. Limited studies have focused on the impact of psychological empowerment and organizational commitment on job satisfaction of Chinese nurses. Aims: The aim of this study is to describe job satisfaction, psychological empowerment and organizational commitment of Chinese nurses and to explore the impact of psychological empowerment and organizational commitment on the nurses' job satisfaction. Methods: A total of 726 nurses were recruited in a convenience sample from 10 tertiary hospitals. Data were collected using four questionnaires including Job Satisfaction Survey, Psychological Empowerment Scale, Organizational Commitment Scale and Demographic Questionnaire. Descriptive analysis, correlation and stepwise multiple regression were used for data analysis. Results: Nurses' job satisfaction, psychological empowerment, and organizational commitment were identified at moderate levels. Nurses' job satisfaction and psychological empowerment were significantly different in terms of age and length of service; nurse job satisfaction varied with respect to marital status. Findings further indicated that nurse job satisfaction was positively correlated with psychological empowerment and organizational commitment. Psychological empowerment, organizational commitment, and marital status were significant predicting factors of nurse job satisfaction. Conclusions: This study provides evidence to help nursing managers and health policy-makers to develop intervention programs aimed at enhancing nurse job satisfaction and retaining nurses.

The effect of breast cancer health education on the knowledge, attitudes, and practice: a community health center catchment area

Studies indicate that women in China are not frequently carrying out breast cancer prevention practices. This is assumed to be due to lack of knowledge and/or lack of personalized instruction. This study was to explore the effect of breast cancer health education on women's knowledge and attitudes on breast cancer and breast self-examination, behavior related to breast self-examination among women living in the catchment area of a community health center. A pretest and posttest assessment of a 1-h health education session was conducted with 38 participants. A telephone reminder and questionnaires were administered at 1 and 3 months after the education. Three instruments were administered at each contact to assess the knowledge and attitudes on breast cancer and behavior related to breast self-examination and accuracy of breast self-examination before education, 1- and 3-month follow-ups after education. The findings showed the incidence of self-examination, and scores on the accuracy of breast self-examination practice were significantly increased immediately following the intervention and at 1- and 3-month follow-ups. Furthermore, the scores of the health belief regarding perceived benefits, perceived competency, and perceived seriousness significantly improved. The current findings imply community-based intervention could be used to teach women about the general knowledge of breast cancer and how to perform breast self-examination correctly, especially for women who are lack of such information.

Interactions between inflammatory and oxidative stress in preeclampsia

OBJECTIVE

Oxidative stress and a generalized inflammatory state are features of preeclampsia (PE). The objective of this study was to compare the levels of products of inflammatory reaction and oxidative stress markers in patients with PE, and to determine the relationship between oxidative stress and inflammation in PE.

METHODS

Plasma concentrations of high-sensitive C-reactive protein (hs-CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), malondialdehyde (MDA), and 8-isoprostane were measured in 53 women with PE and 20 age- and BMI-matched normotensive women.

RESULTS

The plasma concentrations of hs-CRP, IL-6, TNF-alpha, and 8-isoprostane were significantly higher in women with PE than in those with normotensive pregnancies, and these parameters, except for 8-isoprostane, were markedly elevated in those with severe PE (SPE), rather than mild PE (MPE). Moreover, plasma levels of 8-isoprostane, not MDA, were significantly correlated with the plasma levels of hs-CRP, IL-6, and TNF-alpha in patients with PE.

CONCLUSIONS

These findings suggest that oxidative stress and inflammatory reaction are closely associated with PE, and the interactions between them may participate in the pathogenesis of PE.