Fathers' breastfeeding knowledge, attitudes, and involvement in the Asian context: A mixed-studies review

BACKGROUND

Despite numerous initiatives attempting to enhance BF across Asia, recent studies show that exclusive BF rates remain alarmingly low. With globalization, society has shifted from traditional family roles towards more egalitarian marriages, where Asian fathers are now more involved in parenting. As fathers' involvement in breastfeeding is highly complex and context-sensitive, evaluation of a wide range of concepts and evidence within the Asian context is necessary.

OBJECTIVE

This review aims to consolidate and appraise empirical studies exploring fathers' breastfeeding knowledge, attitude, and involvement within the Asian context.

DESIGN

A systematic mixed-studies review was conducted. Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and ProQuest Dissertations and Theses Global) were searched from each database's inception date until June 2022. Studies were appraised using the Mixed Method Appraisal Tool and data was synthesised using the results-based convergent integration method.

FINDINGS

Twenty-two studies were included in this review. The synthesis of findings identified two main themes and six sub-themes.

KEY CONCLUSIONS

Asian fathers have a varied understanding of breastfeeding and their involvement in breastfeeding is influenced by personal, cultural, religious, social, and environmental factors.

IMPLICATIONS FOR PRACTICE

Perinatal care professionals play a crucial role in engaging and enhancing fathers' involvement in breastfeeding education programmes. The findings also urge policymakers to introduce more 'father-friendly' breastfeeding guidelines and educate perinatal care professionals to be more aware and sensitive to the needs of fathers. There is also a need to introduce more flexible and economically sensitive paternal leave policies to improve fathers' breastfeeding involvement.

Facing a new life-The healthy transition to motherhood: What individual and environmental factors are needed? A phenomenological-hermeneutic study

OBJECTIVE

The aim of the study was to highlight first-time mothers' experiences of the transition to motherhood uncovering personal and environmental conditions facilitating or preventing the process of a healthy transition in a Swedish context.

DESIGN

A qualitative study with interview data analyzed using a phenomenological hermeneutic method.

SETTING AND PARTICIPANTS

Ten recent first-time mothers were selected from three primary healthcare centers in western Sweden.

FINDINGS

Four themes emerged, and the transition could be divided into several phases, interpreted as facing a new life, while feeling unprepared for identity and existential issues. The experience of becoming a mother was described as oscillation between a loss of former identity from previous life, and on the other hand, the joy and expectations of forming a new family. The mothers had high demands of themselves, often influenced by social media and needed to value the flow of information and `let go of control` to be able to make adequate decisions. The close family of origin was invaluable in this process being able to provide confirmation in the new role, facilitating the development of their own security and self-confidence.

KEY CONCLUSIONS

The vulnerability expressed by new mothers shows that support from the family of origin, partners and professionals are indispensable. The desired result after the transition to motherhood is a prosperous, maturity and confident mother. The main promoting factor in this process seems to be having a safe base that can provide required support.

IMPLICATIONS FOR PRACTICE

The level of wellbeing after the transition is crucial and the possibility of a warm, responsive and secure parenting needs to be strengthened. The challenge to preventive health care will be to identify a lack of support and ensure that these mothers gain sufficient support to meet today´s demands and still feel that they are good enough mothers for their children.

Influence of social support and stressful life events on adherence to colorectal cancer screening using faecal occult blood test in Spanish medium risk population

INTRODUCTION

Colorectal cancer (CRC) is the second cause of cancer-related deaths worldwide. Five-year survival rate in Spain is 57%. The most important prognostic factor is the stage of the tumor at the diagnosis. CRC can be early diagnosed, but the adherence to screening programs is low (<50%). This study aims to ascertain the influence of social support and stressful life events on the adherence to the population screening of CRC with fecal occult blood test in Spanish average risk population.

METHODS

Multicenter case-control study. We conducted a simple random sampling among individuals invited to participate in the colorectal cancer screening program. We analyzed epidemiological and social variables associated with lifestyle and behavioral factors. We performed a descriptive and a bivariant analyses and a logistic regression analysis.

RESULTS

Four hundred and eight patients (237 cases and 171 controls) were included. Multivariant analyses showed independent association between higher adherence to the screening program and older age (OR: 1.06; 95% CI: 1.01-1.10), stable partner (OR: 1.77, 95% CI: 1.08-2.89) and wide social network (OR: 1.68; 95% CI: 1.07-2.66). Otherwise, lower adherence was associated to perceiving barriers to participate in the program (OR: 0.92; 95% CI: 0.88-0.96). We find a statistically significant association between lower adherence and high impact stressful life events in the bivariant analyses, and the tendency was maintained (OR: 0.63, 95% CI: 0.37-1.08) in the multivariant.

CONCLUSION

Social variables decisively influence the adherence to colorectal cancer screening. The implementation of social interventions that improve social support, reduce impact of stressful life events and the design of screening programs that decrease the perceived barriers, will contribute to increase the participation on these programs. Secondary, the colorectal cancer diagnosis will be made in early-stages with the consequent mortality reduction.

Association of mental health and negative life events with weight change in patients with overweight: A cohort study

BACKGROUND

It is unclear to what extent mental health and negative life events (NLEs) contribute to weight change in patients with overweight. This study aimed to evaluate the association of anxiety, depression, NLEs and quality of life (QoL) with weight change over ten years in middle-aged individuals with overweight.

METHODS

Population-based cohort study of 2889 middle-aged men and women with a body mass index ≥27 kg/m². Relative weight change over ten years was defined as weight loss (≤- 5 %), stable weight (between >- 5 % and <5 %) or weight gain (≥5 %). At baseline, participants reported anxiety symptoms, depressive symptoms, recent (last year) and distant (lifetime) NLEs, and a mental component summary of QoL. With multinomial logistic regression adjusting for potential confounding, we examined the association of mental health and NLEs with weight change after a median (25th, 75th percentiles) follow-up of 9.7 (9.0-10.5) years.

RESULTS

In 51 % participants weight was stable, 33 % participants lost weight and 17 % gained weight. Mild (odds ratio 1.36; 95 % confidence interval 1.05-1.75), and moderate to very severe depressive symptoms (1.43; 0.97-2.12) and four or more distant NLEs (1.35; 1.10-1.67) were associated with weight gain. Anxiety symptoms, the mental component summary of QoL were not associated with either weight gain or weight loss.

LIMITATIONS

Due to the observational design residual confounding cannot be excluded.

CONCLUSION

Our study suggests that depressive symptoms or having experienced distant NLEs are associated with weight gain over time in middle-aged individuals with overweight. These subgroups might benefit from proactive attention from their health care providers.

Gestational Diabetes Mellitus and Its Implications across the Life Span

Gestational diabetes mellitus (GDM) has historically been perceived as a medical complication of pregnancy that also serves as a harbinger of maternal risk of developing type 2 diabetes mellitus (T2DM) in the future. In recent decades, a growing body of evidence has detailed additional lifelong implications that extend beyond T2DM, including an elevated risk of ultimately developing cardiovascular disease. Furthermore, the risk factors that mediate this lifetime cardiovascular risk are evident not only after delivery but are present even before the pregnancy in which GDM is first diagnosed. The concept thus emerging from these data is that the diagnosis of GDM enables the identification of women who are already on an enhanced track of cardiometabolic risk that starts early in life. Studies of the offspring of pregnancies complicated by diabetes now suggest that the earliest underpinnings of this cardiometabolic risk profile may be determined in utero and may first manifest clinically in childhood. Accordingly, from this perspective, GDM is now seen as a chronic metabolic disorder that holds implications across the life span of both mother and child.

Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies

Background

A significant proportion of the global population is displaced, many being women. Qualitative studies can generate in-depth findings that will contribute to an understanding of their experiences, but there is a need for further synthetization efforts. The aim was to provide a comprehensive perspective about adult women’s experiences of armed conflicts and forced migration, focusing on women in or from countries in the Middle East, Balkans, or Africa.

Methods

Systematic review of English reports presenting empirical qualitative studies published in scientific journals 1980 or later, utilizing searches performed in September 2021 within three databases combined with manual screening. Of the 3 800 records screened in total, 26 were included. Methodological details and quality were appraised using pre-specified extraction and appraisal tools. The findings within the included reports were analyzed with thematic analysis.

Results

Most reports utilized interviews, including in total 494 participants, and were appraised as having insignificant methodological limitations. The first theme concerns changed living conditions, involving reduced safety, insufficient access to resources meeting basic needs, forced migration as a last resort, and some positive effects. The second theme concerns the experienced health-related consequences, involving psychological distress, risks during pregnancy and childbirth, exposure to violence and discrimination as a woman, as well as a lack of adequate healthcare services and social support. The third theme concerns the resources and strategies that enhance resilience, involving social support and family life, as well as utilization of internal resources and strategies.

Conclusion

When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-022-00481-x.

Patient and health practitioner views and experiences of a cancer trial before and during COVID-19: qualitative study

Background

Understanding patient and health practitioner perspectives on clinical trials can inform opportunities to enhance trial conduct and design, and therefore patient experience. Patients with haematological cancers have faced additional risk and uncertainty during the pandemic but it is unclear how they and practitioners have experienced cancer trials during this period. In the context of a haemato-oncology trial (PETReA), we compared patient and practitioner views and experiences of PETReA before and during COVID-19.

Methods

Qualitative study embedded within PETReA. Semi-structured interviews (N=41) with patients and practitioners from 16 NHS sites before (n=17) and during the first wave of COVID-19 (n=24). Analysis drew on the framework approach.

Results

Practitioners acknowledged the need for the trial to continue during the pandemic but their treatment preferences altered, becoming more pronounced for patients who had a favourable response to induction treatment, while staying unchanged for patients with a less favourable response. Practitioners commented that COVID-19 meant the evidence base for the trial arms was lacking or mixed, but that it likely increased the risks of maintenance treatment for patients with a favourable response to induction treatment. While only one participant interviewed withdrew from PETReA during the pandemic, others said they would consider withdrawing if information that they were at increased risk of severe illness from COVID-19 became available. During COVID-19, patients described less frequent contact with the trial team, which left some feeling less clear about their trial pathway. However, several described having in-depth, collaborative discussions with practitioners about the risks and benefits of randomisation in the context of COVID-19. Patients valued these discussions and were reassured by the emphasis practitioners placed on patients being free to withdraw if circumstances changed, and this helped patients feel comfortable about continuing in PETReA.

Conclusions

The findings point to ways trial communication can support patients to feel comfortable about continuing in a trial during uncertain times, including adopting a more in-depth, collaborative exploration of the risks and benefits of trial arms with patients and emphasising voluntariness. The results are relevant to trialists recruiting patients who are clinically extremely vulnerable or are at increased risk of poor COVID-19 outcomes despite being vaccinated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06453-z.

Factors related to dyadic adjustment in couples with children of pediatric age

AIM

To identify a relationship between social support, family life cycle, family transition and stressful events; and the dyadic adjustment among couples from Seville with children of pediatric age.

METHOD

Descriptive, observational and cross-sectional study. Ninety-five Sevillian couples were recruited following a consecutive stratified sampling by quotas. They filled in a questionnaire with the study variables and the Dyadic Adjustment and Social Support scales. Data collection was carried out in 2015. The project was approved by the Research Ethics Committee of the University of Seville. Mann-Whitney U and Kruskall-Wallis non-parametric tests were used for statistical analysis, and Spearman test for correlation between variables. Significance was stated for P<.05.

RESULTS

The couples were mostly marriages with good dyadic adjustment and social support. A percentage of 26.3 had infant and 73.7% children of school age. No relationship between the life cycle nor the family transition and the dyadic adjustment were identified. The beginning-end of schooling was related to spousal cohesion and there were positive correlations between dyadic adjustment and social support; and negative correlations between the number of children and social support, consensus and satisfaction of the couple.

CONCLUSIONS

Social support and the number of children are identified as the main conditioning factors of dyadic adjustment. In this sense, it is essential to know the resources available to each couple to face the difficulties where social support and the union between the spouses can help them face the challenges.

Life experiences of adult heart transplant recipients: a new life, challenges, and coping

PURPOSE

The process during and after heart transplantation is quite complicated, and studies addressing patient experiences are needed. Heart transplantation particularly affects the recipients' activities of daily living and exposes them to various complications. The aim of this study is to explore the experiences of heart transplant recipients during and after heart transplantation.

METHODS

This qualitative, phenomenological research was conducted with 11 heart transplant recipients in the university hospital, which is one of the 14 heart transplantation centers in Turkey. The data were collected through in-depth semi-structured interviews in a private room that ensured both the comfort of the participants and the necessary conditions for safe data collection. The interviews were recorded using an audio recorder, transcribed, and then analyzed using inductive content analysis. Data collection was terminated after the 11th interview when the data reached the saturation point.

RESULTS

The study data were categorized into the following three main themes and subthemes: (1) a new life with a new heart; an opportunity arising at an unexpected time, heart donation, and transplantation as a value, (2) challenges; management of medication therapy and side effects, emotion management, maintaining social relations, and social stigma, and (3) coping; faith in God and praying, responsibility of living with a blessing (donated heart), health professional support, family support, and peer counseling. In line with these themes, expressions of value given to new life and gratitude to heart transplantation were important. The availability and diversity of support sources came to the fore in coping. Social stigma expressions of especially male patients were remarkable in challenges.

CONCLUSION

At the end of the study, the experiences of heart transplant recipients were obtained regarding a new life with a new heart, challenges, and coping. The study results provide an insight into the challenges that the heart transplant recipients face and their coping strategies, guiding the healthcare professionals. The challenges and relevant coping strategies of heart transplant recipients may be integrated into clinical practice and may help plan patient's care. The results may also be used to design and implement an intervention program to improve care for these patients.

Associations of positive and adverse childhood experiences and adulthood insomnia in a community sample of Chinese adults

STUDY OBJECTIVES

Research has documented that adverse childhood experiences (ACEs) are associated with increased adult sleep disturbances, little is known about whether positive childhood experiences (PCEs) influence sleep health in adulthood. This study aimed to examine the associations of ACEs and PCEs with adulthood insomnia, as well as the extent to which PTSD and depressive symptoms mediated these associations.

METHODS

A sample of 7245 adults in China (male 32.7%; mean age 38.09 years, SD = 7.84, range from 18 to 81) completed self-report questionnaires to assess ACEs, PCEs, PTSD and depressive symptoms. Multiple linear regressions were used to examine the independent and interaction effects of ACEs and PCEs on insomnia. Path analyses were performed to examine the direct and indirect effects of ACEs and PCEs on insomnia.

RESULTS

After adjustment of demographics, ACEs (β = 0.11, p < 0.001) and PCEs (β = -0.09, p < 0.001) were both independently associated with adulthood insomnia, while the relationship between PCEs and insomnia was weakened but still significant among participants with high levels of ACEs. After controlling for demographics, PTSD and depressive symptoms partially mediated the overall effect of PCEs on insomnia, and fully mediated the relationship between ACEs and insomnia.

CONCLUSIONS

These data demonstrate that both positive and adverse childhood experiences influence adulthood insomnia. The findings highlight the importance of joint assessment of PCEs and ACEs to prevent and intervene insomnia. Optimizing the early childhood environment may help to foster healthy sleep throughout the life course.

Life events as predictors for disability pension due to musculoskeletal diagnoses: a cohort study of Finnish twins

Purpose

Musculoskeletal diagnoses (MSD) are one of the largest diagnostic groups for disability pensions (DP). This study investigated the associations between life events and DP due to MSD, considering sociodemographic, health, and familial factors.

Methods

The study sample included 18,530 Finnish twins, 24–64 years old at baseline, who responded to a questionnaire in 1981 including a 21-item life event inventory. Information on DP with diagnosis codes (ICD codes: M00–M99) were obtained from the official national pension registers. Life events were divided into family- and work-related events. “Positive change in life” was analyzed separately. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI).

Results

During the follow-up of 23 years, 1273 (7%) individuals were granted DP due to MSD. In discordant pair analysis, family-related events (≥ 4 events) increased (HR 1.63, 95% CI 1.31, 2.03) and the absence of such events decreased (HR 0.68, 95% CI 0.48, 0.95) the risk of DP due to MSD. For work-related events (≥ 3 events), the risk estimates were non-significant when controlling for familial factors. Having had a positive change in life decreased the risk of DP due to MSD (HR 0.79, 95% CI 0.65, 0.96) while controlling for familial confounding, but were non-significant in the full model controlling for various covariates (HR 0.91, 95% CI 0.75, 1.12).

Conclusions

The associations between life events and the risk of DP due to MSD are complex and potentially affected by familial and other confounding factors including sociodemographics and health.

Feeling excluded and not having anyone to talk to: Qualitative study of interpersonal relationships following a cancer diagnosis in a sibling

PURPOSE

To explore experiences related to interpersonal relationships following a cancer diagnosis in a sibling.

METHODS

Respondents (n = 7 females) were recruited by means of convenience sampling during a camp for children affected by childhood cancer and their siblings. Data from children and adolescents with a sibling diagnosed with cancer was collected through individual face-to-face interviews and analyzed using systematic text condensation.

RESULTS

Two categories portrayed the experiences related to interpersonal relationships following a cancer diagnosis in a sibling. Feeling excluded while wanting to maintain a relationship with their ill sibling and be involved in the care portrayed that trying to be involved in the care of their ill sibling was a stressful and difficult experience, since they were simultaneously expected to also manage household chores and attend school. Feeling stigmatized and exposed in social contexts while needing an allowing space to talk about their experiences portrayed the emotional difficulties evoked by social situations and behaviors of others, which left respondents feeling exposed and mistreated. Having the possibility to talk about their experiences and receiving social support was described as essential in order to cope with the situation.

CONCLUSIONS

Health professionals need to take into consideration the emotional difficulties and vulnerable situation that children and adolescents who have a sibling diagnosed with cancer are at risk of experiencing. Stigmatization and social exposure present a risk of psychological distress. Having an allowing space to communicate feelings and experiences is desired. Interventions may be necessary to help these individuals psychologically cope.

Experiences of suffering multiple trauma: A qualitative study

OBJECTIVES

In an effort to strengthen health care professionals' ability to anticipate and address multiple trauma patients' needs, this study aims to explore the experience of suffering from multiple trauma.

DESIGN

This is a qualitative descriptive study. Nine interviews were analysed using content analysis.

SETTING

The study included patients who had been registered in the Swedish Intensive Care registry [SIR] due to suffering multiple trauma.

FINDINGS

The analysis revealed one theme, A detour in life, based on three sub-themes: (a) Feeling lost and not knowing what to expect, (b) Striving to get life back on track and (c) Dealing with 'dead ends' during rehabilitation. The theme showed that those who suffered multiple trauma did not know what to expect of their recovery and they expressed experiencing a lack of understanding and guidance from healthcare professionals. As it was important to focus on the present and find ways to move on in life, they sought for other ways to find direction in matters of rehabilitation and care.

CONCLUSIONS

A shared understanding is essential in order to define a person's needs. By setting short-term goals and improving documentation, healthcare professionals across the trauma recovery continuum could more easily gain insight of their patients' needs and address them with supportive guidance.

Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia

PURPOSE

To investigate exposure to traumatic and stressful events and their association with depression, suicidal ideation, and alcohol abuse in people with severe mental disorder (SMD) in Ethiopia.

METHODS

As part of the Programme for Improving Mental health carE, 300 people with SMD (84% primary psychosis, 11% bipolar disorder, and 16% depression with psychotic features) in a rural district were identified by psychiatric nurses. A cross-sectional assessment included clinical characteristics, experience of being restrained, exposure to stressful events as measured by an adapted version of the List of Threatening Experiences scale, traumatic events as measured by endorsement of 13 locally relevant potentially traumatic events that occurred since the onset of the participant's mental illness, depression symptoms measured by the Patient Health Questionnaire, the Suicidal Behavior Module of the Composite International Diagnostic Interview, and hazardous drinking which was calculated as a sum score of eight or higher on the Alcohol Use Disorders Identification Test.

RESULTS

Almost half of participants reported being restrained since becoming ill, which was associated with more suicidal ideation and less hazardous drinking. More than one-third experienced traumatic events since becoming ill, including being assaulted, beaten, or raped. Exposure to traumatic events was associated with hazardous drinking.

CONCLUSIONS

In this rural Ethiopian setting, people with SMD experienced high levels of traumatic and stressful events which were associated with co-morbid conditions. Greater attention needs to be given to trauma prevention and integration of treatment for trauma sequelae in efforts to expand integrated mental health care.

Elderly and forced displacement in Colombia

Objective

To describe the experiences of older adults around forced displacement due to the Colombian armed conflict.

Methods

Interpretive-comprehensive study, with a hermeneutical approach; several types of sampling were carried out. The participants were 12 people aged over 60 years, who reported having being displaced and who participated in the SABE Colombia Survey. The data were encoded using the Atlas.ti software. A process of condensation of central analytical, support and emerging categories was made.

Results

The displacement generated by the armed conflict has been decisive in the current life conditions of the participants. They know that they are survivors of someone else's violence; there is dislocation, loss of territory, de-anchoring, lack of protection and insecurity. To the stigma of old age, it is added being displaced and being strangers in a place where they don't belong. They live the violent uprooting of their lands and the confusion of their identity; they found themselves in a foreign scene where they were the unusual and the strangers; from receiving threats, they passed to be labeled as 'threatening'. This forced displacement stems from violence, but also from fear, and it marks the trajectory of life for older people who experience a prolonged struggle for survival in often hostile environments, living "permanently" displaced.

Conclusion

When there is displacement, older people are not only shed of their land and their home, but also from their cosmos and their vital referents; in addition, it changes their life trajectory and their place in the world. Interventions should be designed based on specific particular and contextual analyses.

Different associations of routine work time with exercise behavior and objectively measured physical activity among middle-aged and older adults: a daily and longitudinal analysis

This study examined whether routine work time was associated with exercise time, moderate-to-vigorous physical activity (MVPA), and step counts (SC) among middle-aged and older adults. A 7-day diary survey was conducted with 158 adults, and 138 participated in the 1-year follow-up survey for measuring routine work time and exercise time. An accelerometer was used to measure MVPA and SC, and a questionnaire assessed perceived barriers and self-efficacy. Daily analyses revealed that while longer routine work time was associated with shorter exercise time after adjusting for perceived exercise barriers and exercise self-efficacy, it was associated with higher amounts of MVPA and SC. Longitudinal analysis showed that increased routine work time was associated with decreased exercise time and increased MVPA and SC. Changes in perceived barriers and self-efficacy did not mediate these associations. Actual lack of time would inhibit exercise behavior independently of perceived barriers and self-efficacy but elevates MVPA and SC.

Stressful life events, gender and obesity: A prospective, population-based study of adolescents in British Columbia

Objective

To determine whether stressful life events are related to levels of obesity in a group of ethnically diverse Canadian youth and the extent to which the relationship differs by gender.

Methods

This study of 905 adolescents (age 13–17 years) from a BC population-based cohort (BASUS) used self-reported data from Wave 5 (2011 fall) on stressful life events and socio-demographic factors and from Wave 6 (2012 spring) on weight and height. Multivariable logistic regression models conditioned on known confounders and used a cross-product term for effect modification by gender. Post-estimation analysis calculated gender-specific predicted mean probabilities of having obesity associated with greater frequency of stressful life events.

Results

Compared to young men reporting no stressful life events in the previous year, young men reporting one event were nearly 50% more likely to have obesity at 6-month follow-up (OR 1.47 [95% CI: 0.63, 3.41]) and those reporting multiple stressful life events were twice as likely to have obesity at 6-month follow-up (OR 2.07 [95% CI: 0.79–5.43]). Only young women reporting multiple events showed a higher likelihood of having obesity at the end of the study (OR 1.32 [95% CI: 0.41–4.18]) than their counterparts reporting no life events.

Conclusions

Results suggest that the frequency of major life events may be an important social stressor associated with obesity in adolescents, particularly for young men. However, findings should be replicated in larger samples using measured anthropometry to inform future obesity prevention strategies.

The impact of positive contextual factors on the association between adverse family experiences and obesity in a National Survey of Children

Adverse family experiences (AFEs) are associated with childhood obesity. We evaluated whether certain positive contextual factors reduce the risk of obesity and overweight among children exposed to AFEs in a nationally representative sample. Using data derived from the National Survey of Children's Health 2011-12 (N = 43,864), we calculated the distribution of positive contextual factors (very good/excellent maternal mental health, neighborhood and school safety, and child resilience) and AFEs across weight status. The AFEs composite score was modeled as a categorical measure (0 or ≥1 AFEs). Positive contextual factors, AFEs and their interactions were evaluated in weighted, adjusted, multinomial logistic regression models predicting the odds of overweight and obesity. Children exposed to lack of very good/excellent maternal mental health and at least one AFE were at risk for overweight (OR = 1.43; 95% CI: 1.16, 1.76) and obesity (OR = 1.53; 95% CI: 1.22, 1.93). Unsafe school or neighborhood environment and exposure to 1 or more AFEs was. associated with overweight (OR = 1.32; 95% CI: 1.08, 1.61) and obesity (OR = 1.66; 95% CI: 1.34, 2.05). Lack of child resilience and exposure to 1 or more AFEs was associated with an increased risk of obesity (OR = 1.45; 95% CI: 1.17, 1.90) and overweight (OR = 1.29; 95% CI: 1.06, 1.57). These odds of obesity and overweight all decreased when positive contextual factors were present. Among children exposed to AFEs, overweight and obesity risk is reduced with positive contextual factors. Optimizing the early childhood environment can impact obesity risk.

Abrupt and unexpected stressful life events are followed with increased disease activity in spondyloarthritis: A two years web-based cohort study

OBJECTIVE

The contribution of environmental factors to spondyloarthritis (SpA) course remains poorly characterized. We previously reported a possible triggering of disease flares by stressful life events and vaccination. The objective of the present study was to specify the types of vaccine and life event that may influence disease activity.

METHODS

A prospective cohort of adult SpA was followed for two years. Patients logged on to a secured website every month to complete a standardized auto-questionnaire. They reported whether they had been exposed to stressful life events, vaccinations or other environmental factors. Patients were asked to rate the distress resulting from exposure to life events on a numerical rating scale (NRS: 0-10). Primary outcome variable was the variation of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) measured on two consecutive connections. Months where an event occurred were compared to months without events. The cut-off value of 1 is defined as the minimal clinically important variation for the BASDAI.

RESULTS

The 272 enrolled SpA patients returned 3,388 questionnaires. Months where an abrupt and unexpected traumatic event occurred were associated with a significant increase of BASDAI of 0.57 [95%CI: 0.29; 0.85] (P<0.001). The higher the rating of distress, the larger the impact on BASDAI, reaching a clinically meaningful increase of 0.99 [0.17; 1.82] for a VNS≥9. The effect of stressful events on BASDAI persisted during a median of 3 months. No other environmental factor was significantly associated with BASDAI variations.

CONCLUSION

Among stressful life events, abrupt and unexpected events were associated with transient worsening of disease activity in SpA, which reached a clinically meaningful increase for the highest rating of distress. Association between vaccines and disease flare was not confirmed.

Quality of life and trust among young people with narcolepsy and their families, after the Pandemrix® vaccination: protocol for a case-control study

Background

The extensive vaccination programme against swine flu resulted in an increased incidence of narcolepsy among children and adolescents. There is a need to explore if these young persons’ experiences have affected their trust in healthcare, their willingness to participate in future prevention programmes, and their contacts with the healthcare system. The overall aim is to identify factors important for the life-situation of children and adolescents with narcolepsy and their families, and factors that correlate with trust in healthcare.

Methods/design

Data will be collected via questionnaires from all available children with narcolepsy following the vaccination and their families, as well as a control group of children with diabetes and their families. Longitudinal descriptive interviews will also be conducted with a selection of 20–25 children and their families. Techniques from media research will be used for Internet-based data collection and analysis of information relating to narcolepsy from social media.

Discussion

This project will use the situation of young persons with narcolepsy after the swine flu vaccination as a case to build a model that can be used in situations where trust in healthcare is essential. This model will be based on findings from the included studies on how trust is influenced by support, quality of life, burden of disease, impact on family, and use of social media. The model developed in this project will be beneficial in future situations where trust in healthcare is essential, such as new pandemic outbreaks but also for “everyday” adherence to health advice.

Number of recent stressful life events and incident cardiovascular disease: Moderation by lifetime depressive disorder

OBJECTIVE

We investigated whether number of recent stressful life events is associated with incident cardiovascular disease (CVD) and whether this relationship is stronger in adults with a history of clinical depression.

METHODS

Prospective data from 28,583 U.S. adults (mean age=45years) initially free of CVD who participated in Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Number of past-year stressful life events (Wave 1), lifetime depressive disorder (Wave 1), and incident CVD (Wave 2) were determined by structured interviews.

RESULTS

There were 1069 cases of incident CVD. Each additional stressful life event was associated with a 15% increased odds of incident CVD [Odds Ratio (OR)=1.15, 95% Confidence Interval (CI): 1.11, 1.19]. As hypothesized, a stressful life events by lifetime depressive disorder interaction was detected (P=0.003). Stratified analyses indicated that stressful life events had a stronger association with incident CVD among adults with (OR=1.18, 95% CI: 1.10, 1.27, n=4908) versus without (OR=1.10, 95% CI: 1.07, 1.14, n=23,675) a lifetime depressive disorder.

CONCLUSION

Our findings suggest that a greater number of recent stressful life events elevate the risk of new-onset CVD and that this risk is potentiated in adults with a history of clinical depression.

The emotional process from diagnosis to birth following a prenatal diagnosis of fetal anomaly: A qualitative study of messages in online discussion boards

OBJECTIVE

to explore written statements found in online discussion boards where parents currently expecting, or with previous experience of expecting, a child with a prenatally diagnosed congenital anomaly communicate about their emotional process from diagnosis to birth.

DESIGN

cross-sectional qualitative study of messages in public online discussion boards.

SETTING

Swedish public discussion boards about reproductive subjects.

SAMPLE

ten pregnant women and eight parents (of children with prenatal diagnoses) who had written 852 messages in five threads in Swedish online discussion boards identified via systematic searches.

MEASUREMENTS AND FINDINGS

three phases were identified in the process of moving from the diagnosis to the birth: shock, existential crisis, and life remodeling. The people posting message ('posters') moved from initial shock to existential crisis and, lastly, a phase of remodeling life later in the pregnancy. During the pregnancy, considerable worries about both antenatal and postnatal aspects were expressed. To cope with their situation, the posters distanced themselves from the diagnoses, vented their feelings, sought control, and obtained practical support from friends and relatives.

KEY CONCLUSIONS

expectant parents faced with a prenatal diagnosis move from initial shock to a phase of life remodeling and acceptance. Burdened with considerable worries, expectant parents cope with their situation through informational, emotional, and instrumental support from health professionals, family, friends, and peers.

IMPLICATIONS FOR PRACTICE

health professionals should make sure that expectant parents feel involved in planning their children's postnatal care, that they are offered sufficient information, and that they have access to emotional and instrumental support structures.

Patients' experience during weaning of invasive mechanical ventilation: A review of the literature

OBJECTIVE

Weaning from invasive mechanical ventilation (IMV) is influenced by physiological and psychological factors, the latter being the least studied. The aim was to identify, through the literature, patients' experiences during weaning from IMV and report its influencing factors.

METHOD

The literature search was conducted using the Pubmed, CINAHL and PsycINFO databases. The search terms were: "patient", "experience" and "ventilator weaning". The research limits were: age (>19years) and language (English, Spanish and Finnish).

RESULTS

Fifteen publications were analysed. The main results were grouped into three main categories according to patient's perceptions, feelings and experiences, influence of professionals' attention and determinants for successful weaning. Patients remember IMV weaning as a stressful process where they experience anxiety, frustration, despair or uncertainty. Nurses have a key role in improving communication with patients and foreseeing their needs. Family support and the care provided by the caregivers were shown as essential during the process. The patient's self-determination, self-motivation and confidence are identified as important factors to achieve successful IMV weaning.

CONCLUSIONS

Psychological care, in addition to physical and technical care, is important at providing holistic care. Interventional studies are needed to improve the care during the weaning experience.

[Autism spectrum disorder and evaluation of perceived stress parents and professionals: Study of the psychometric properties of a French adaptation of the Appraisal of Life Event Scale (ALES-vf)]

INTRODUCTION

Autism and related disorders are grouped into the category of « Autism Spectrum Disorder » (ASD) in the DSM-5. This appellation reflects the idea of a dimensional representation of autism that combines symptoms and characteristics that vary in severity and intensity. Despite common characteristics, there are varying degrees in intensity and in the onset of symptoms, ranging from a disability that can be very heavy with a total lack of communication and major disorders associated with the existence of a relative autonomy associated, sometimes, with extraordinary intellectual abilities. Parents are faced with several difficult situations, such as sleep disturbances, agitation, shouting, hetero violence, self-harm, learning difficulties, stereotyping, lack of social and emotional reciprocity, inappropriate behavior, etc. They can feel helpless and may experience stress related to these developmental and behavioral difficulties. The heterogeneity of symptoms, the presence of behavioral problems, the lack of reciprocity and autonomy also represent a challenge for practitioners in institutions and teachers at school. The objective of this research is to present the validation of a French translation of the Appraisal of Life Events Scale (ALES-vf) from Ferguson, Matthex and Cox, specifically adapted to the context of ASD. ALES was originally developed to operationalize the three dimensions of perceived stress (threat, loss and challenge) described by Lazarus and Folkman.

METHODOLOGY

ALES-vf was initially translated into French and adapted to the situation of parents of children with ASD. It was subsequently administered to 343 parents, 150 paramedical professionals involved with people with ASD, and 155 teachers from an ordinary school environment and from specialized schools, welcoming in their classroom at least one child with ASD.

RESULTS

An exploratory factor analysis performed on data from 170 parents highlighted two exploratory models with four and three factors, slightly different from the original three-factor model of Ferguson and his collaborators. Confirmatory analyzes were conducted on data from 173 other parents to test two exploratory models and the original model of Ferguson. It has also been tested on data from 305 professionals (paramedical professionals and teachers) and on the whole sample (parents and professionals). The results suggest a better match of the original three-factor model. In addition, Cronbach's alpha coefficients and inter-item correlations showed a good internal consistency for these three factors. Finally, variance analysis and regressions were performed to test the effect of the nationality of the parents, the child's level of autonomy, the child's level of communication, and on the perceived stress by experienced professionals.

CONCLUSION

ALES-vf, after our adaptation has good psychometric properties for use not only with parents but also with professionals (teachers, educators, psychologists) working with children with ASD. Our analyses showed that the nationality of the parents does not significantly influence the subscales « threat » and « challenge » of ALES-vf, which makes it usable in other Francophone countries. Specificities in the subscales were identified based on group membership (parents and professionals). For example parents get higher average scores on subscales « loss » and « threat » and a lower average score on the subscale « challenge », compared to professionals. Finally, regarding the specifics found among professionals, the results show that the years of experience have an effect on perceived stress. Specifically, teachers and educators who have more experience perceive their work with children with ASD as a challenge. This is consistent with the results of studies showing that teachers who have had experience with children with ASD had less difficulty in their interventions.

Experiences of termination of pregnancy for a fetal anomaly: A qualitative study of virtual community messages

OBJECTIVE

to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly.

DESIGN

cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis.

SETTING

two large and active Swedish virtual communities.

SAMPLE

1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination).

MEASUREMENTS AND FINDINGS

before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child.

KEY CONCLUSIONS

spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences.

IMPLICATIONS FOR PRACTICE

information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies.

Psychological stress, adverse life events and breast cancer incidence: a cohort investigation in 106,000 women in the United Kingdom

Background

Women diagnosed with breast cancer frequently attribute their cancer to psychological stress, but scientific evidence is inconclusive. We investigated whether experienced frequency of stress and adverse life events affect subsequent breast cancer risk.

Methods

Breast cancer incidence was analysed with respect to stress variables collected at enrolment in a prospective cohort study of 106,000 women in the United Kingdom, with 1783 incident breast cancer cases. Relative risks (RR) were obtained as hazard ratios using Cox proportional hazards models.

Results

There was no association of breast cancer risk overall with experienced frequency of stress. Risk was reduced for death of a close relative during the 5 years preceding study entry (RR = 0.87, 95 % confidence interval (CI): 0.78–0.97), but not for death of a spouse/partner or close friend, personal illness/injury, or divorce/separation. There was a positive association of divorce with oestrogen-receptor-negative (RR = 1.54, 95 % CI: 1.01–2.34), but not with oestrogen-receptor-positive breast cancer. Risk was raised in women who were under age 20 at the death of their mother (RR = 1.31, 95 % CI: 1.02–1.67), but not of their father, and the effect was attenuated after excluding mothers with breast or ovarian cancer (RR = 1.17, 95 % CI: 0.85–1.61).

Conclusions

This large prospective study did not show consistent evidence for an association of breast cancer risk with perceived stress levels or adverse life events in the preceding 5 years, or loss of parents during childhood and adolescence.

Electronic supplementary material

The online version of this article (doi:10.1186/s13058-016-0733-1) contains supplementary material, which is available to authorized users.

Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: a qualitative interview study

Background

Immigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants.

Methods

Pregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis.

Results

The analysis resulted in five categories: 1) “Trustworthy information”, 2) “Language barriers”, 3) “Psychosocial situation”, 4) “Peer support”, and 5) “Religious positions”.

Conclusion

The potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies.

Gender Differences in Perceived Social Support and Stressful Life Events in Depressed Patients

OBJECTIVE

To study the gender differences in perceived social support and life events in patients with depression.

METHODS

A total of 118 patients aged 18 to 60 years, with depressive disorder according to the DSM-IV-TR, were evaluated using the Multidimensional Scale of Perceived Social Support and Presumptive Stressful Life Events Scale.

RESULTS

The perceived social support score was significantly higher in males than females (p < 0.001). Males perceived significantly higher social support from friends than females (p < 0.001), whereas support from significant others was higher in females. There was a higher mean number of total life events as well as specific type of life events in males that became apparent after controlling for education (p < 0.05). Financial loss or problems was the most commonly reported life event in both males and females. Work-related problems were more commonly reported by males, whereas family and marital conflict were more frequently reported by females.

CONCLUSION

Perceived social support and stressful life events were higher in males with depression than females.

Association between stressful life events and resting heart rate

Background

Despite a diverse literature, the association between stress and various cardiovascular conditions remains controversial. Moreover, a direct association between stressful life events (SLEs) and heart rate (HR) have not been fully investigated. This study evaluated the association between SLEs and resting HR in middle-aged Koreans.

Methods

A cross-sectional analysis was conducted for 1,703 men and 2,730 women aged 27–87 years from the community-based Korean Genome and Epidemiology Study-Kanghwa study. All participants completed a baseline health examination. The life experience survey questionnaire was administered to measure SLEs experienced during the past 3 months. Resting blood pressure and HR were measured twice over a 5 minute interval. If the difference in blood pressure was more than 10 mmHg, then a third blood pressure and HR measurement was taken after 5 minutes of rest. The average of the last two measurements was used for analysis. The association between SLEs and HR was assessed by correlation and multiple linear regression analysis.

Results

Compared with people with no SLEs (mean HR of 67.30 beats/min), HR was significantly lower in those who experienced one (mean HR of 65.64 beats/min, p = 0.002), two (mean HR of 63.73 beats/min, p < 0.001), and 3+ SLEs (mean HR of 64.17 beats/min, p < 0.001). This association was observed even after adjustment for sex, age, body mass index, hypertension treatment, oral contraceptive use, postmenopausal hormone therapy, thyroid disease, liver disease, cigarette smoking use, alcohol drinking use, and blood urea nitrogen to creatinine ratio. Compared with people with no SLEs, those with 1, 2, and 3+ SLEs had a lower resting HR by 1.485 (p = 0.005), 3.718 (p < 0.001), and 3.176 (p < 0.001), respectively.

Conclusion

Our findings suggest that the experience of a recent SLEs are associated with a lower resting HR in Korean adults. Although further investigation is required, people who have experienced recent SLEs and have a lower HR than usual may need attention for their stress level.

Functional gastrointestinal disorders induced by esophageal atresia surgery: is it valid in humans?

Background/Aims

Functional gastrointestinal disorders (FGID) affect 15%-20% of the general pediatric and adult population. Animal models suggest that a neonatal stress such as invasive procedures and maternal separation could be responsible for visceral hypersensitivity and FGID. We tested the hypothesis that congenital esophageal atresia (EA), a condition corrected during the neonatal period and associated with multiple stresses, is a clinically significant risk factor for the development of FGID later in life. We postulated that, to be clinically significant, the effect of neonatal stress on the incidence of FGID should be as strong as that of enteric infections in the development of irritable bowel syndrome in children.

Methods

Subjects with EA and healthy controls were enrolled in this multicenter cohort study. Gastrointestinal symptoms were assessed by a questionnaire and FGID was diagnosed using the Rome III criteria.

Results

Fifty-three children (25 girls; median age, 12 years) with EA were compared to 72 age- and sex-matched controls. Although 11 children with EA (21%) had a FGID diagnosis versus 8 controls (11%), this difference was not significant (χ² = 2.20, P > 0.05). In subjects with EA, the presence of associated malformations, the occurrence of complications during the first month, and the length of hospital stay > 30 days did not influence the incidence of FGID. Chronic abdominal pain was present in 38% of subjects with EA versus 25% of controls (P > 0.05).

Conclusions

Neonatal stress secondary to surgical correction of EA is not a clinically significant risk factor for the development of FGID in childhood.

Correlation of Occupational Stress Index with 24-hour Urine Cortisol and Serum DHEA Sulfate among City Bus Drivers: A Cross-sectional Study

Objectives

The questionnaire of occupational stress index (OSI) has been popular in the workplace, and it has been tailored for bus drivers in Taiwan. Nevertheless, its outcomes for participants are based on self-evaluations, thus validation by their physiological stress biomarker is warranted and this is the main goal of this study.

Methods

A cross-sectional study of sixty-three city bus drivers and fifty-four supporting staffs for comparison was conducted. Questionnaire surveys, 24-hour urine cortisol testing, and blood draws for dehydroepiandrosterone-sulfate (DHEA-S) testing were performed. The measured concentrations of these biological measures were logarithmically transformed before the statistical analysis where various scores of stressor factors, moderators, and stress effects of each OSI domain were analyzed by applying multiple linear regression models.

Results

For drivers, the elevated 24-hour urine cortisol level was associated with a worker's relationship with their supervisor and any life change events in the most recent 3 months. The DHEA-S level was higher in drivers of younger age as well as drivers with more concerns relating to their salary and bonuses. Non-drivers showed no association between any stressor or satisfaction and urine cortisol and blood DHEA-S levels.

Conclusion

Measurements of biomarkers may offer additional stress evaluations with OSI questionnaires for bus drivers. Increased DHEA-S and cortisol levels may result from stressors like income security. Prevention efforts towards occupational stress and life events and health promotional efforts for aged driver were important anti-stress remedies.