Factors associated with postpartum depressive symptoms among women who conceived with infertility treatment.

Infertility treatment experiences may accumulate and influence postpartum psychological well-being among women with infertility. However, the association between infertility treatment experiences and postpartum depressive symptoms remained unclear. This cross-sectional survey aimed to describe depressive symptom scores of 180 women, who conceived while undergoing infertility treatment, at 2-6 months after childbirth, and to explore factors, including infertility history and treatment experiences, associated with postpartum depressive symptoms. Data were collected via telephone interviews and patient record reviews. Postpartum depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, with a cutoff score of 10. The prevalence of postpartum depressive symptoms was 34.4 %. Higher perceived stress levels after childbirth than before undergoing infertility treatment, a duration of infertility diagnosis longer than three years, maternal age >35 years, pregnancy conceived through in vitro fertilization (IVF), and experiencing all three lines of infertility treatment, namely ovarian stimulation, intrauterine insemination, and IVF, were associated with a higher risk of postpartum depressive symptoms. Breastfeeding, social support, and baby sex in line with stated preference were negatively associated with postpartum depressive symptoms. There were no significant interactions between the variables. The women's infertility history and treatment experiences were found to have influenced their postpartum depressive symptoms, especially among women who had a long duration of infertility, conceived through IVF, and had received all lines of infertility treatment.

Classification of Vascular Hotspots and Micro-Vessel Flow Velocity Waveforms in Low-Grade Squamous Intraepithelial Lesions and HPV Condyloma of the Cervix.

To assess hotspot micro-vessel flow velocity waveforms in human papillomavirus (HPV) cervical infections using transvaginal power Doppler ultrasound (TV-PDU) and to explore the associations of these sonographic parameters with HPV condyloma and low-grade squamous intraepithelial lesions (LSIL) of the cervix. A total of 39 patients with cervical HPV infections with abnormal cytology and colposcopy results (26 cases of LSIL; 13 cases of HPV condyloma) were enrolled to assess the vascular classification of the cervix and micro-vessel flow velocity using TV-PDU before treatment; 40 individuals with a pathologically normal cervix were used as the control group; seven parameters were measured, including vascular grading classification (Class I, Class II, and Class III), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end-diastolic velocity (ED), time average maximum velocity (TAMV), and the vascular index (VI = PS/ED). According to vascular classification, most LSILs were class I (69.2%, 18/26), followed by class II (26.9%, 7/26) and class III (3.8%, 1/26). Most HPV condylomas were class I (92.3%, 12/13), and one was class II (7.7%, 1/13). PI, RI, VI (p < 0.0001), and the PSs (p < 0.05) were significantly lower in these cases than in the controls. The ED and TAMV were not significantly different between the patients and controls (p = 0.4985 and p = 0.1564). No sonographic parameter was significantly different between LSIL and HPV condyloma. The mean PI, RI, and VI were significantly lower in LSIL than in the controls. For HPV condyloma, a PI of 1.07 had an 84.6% sensitivity, 85.0% specificity, and an AUC of 88.8%; for LSIL, a PI of 1.08 had a 100% sensitivity, 85% specificity, and an AUC of 94.2%; for HPV infection (HPV condyloma + LSIL), a PI of 1.08 had a 94.9% sensitivity, 85% specificity, and an AUC of 92.4%. Hotspot vascular classification and micro-vessel flow velocity waveforms may provide a potential practical method for the auxiliary diagnosis of cervical HPV infection. The PI may represent a valuable index for distinguishing the micro-vessel flow velocity waveforms in LSIL and HPV condyloma. Since the case numbers were limited in the current study, further validation is needed.

Cervical Power Doppler Angiography with Micro Vessel Blood Flow Indices in the Auxiliary Diagnosis of Acute Cervicitis.

We have conducted cervical imaging of uterine and micro-vessel flow velocity waveforms in acute pelvic inflammatory disease (PID) by transvaginal power Doppler ultrasound (TVPDU) in order to explore the associations of sonographic parameters with simple and complex cervicitis. Thirty-eight patients with acute PID (26 with acute simple cervicitis and 12 with complex cervicitis) were enrolled for an assessment of vascular grading of cervix and micro-vessel flow velocity using TVPDU before treatment. Seven parameters, including vascular grading (VG), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end diastolic velocity (ED), time average maximum velocity (TAMV), and vascular index (VI = PS/ED), were measured and recorded. Forty-one healthy patients were assessed as the control group. Vascular grading (VG) was significantly higher in the study group than the control group (p < 0.0001). The PI, RI, and VI were significantly lower in the study group than control group (p < 0.0001). No significant associations were observed between seven sonographic parameters and acute simple or/and complex cervicitis. For acute simple cervicitis, a PI cutoff of 1.1 had a sensitivity of 85.4% and a specificity of 92.1% (area under ROC curve [AUC], 93.2%). A RI of 0.6 had a sensitivity of 85.4% and a specificity of 78.9% (AUC, 86.1%). A VI of 2.6 had a sensitivity of 85.4% and a specificity of 78.9% (AUC, 84.9%). Power Doppler angiography of micro-vessel flow velocity waveforms in the cervix could represent a practical method to assist the diagnosis of pelvic inflammatory disease presented as acute cervicitis detected on transvaginal ultrasound before medical or surgical treatment. Cervical PI may be a useful index to detect micro-vessel flow velocity waveforms in acute cervicitis and differentiate acute simple cervicitis from complex cervicitis.

Exploring bowel dysfunction of patients following colorectal surgery: A cohort study.

AIMS AND OBJECTIVES: To examine changes in patients' bowel function and to compare patients' outcome among different operation and treatment after rectal resection. BACKGROUND: Anal-preserving surgery is the trend of treatment of colorectal cancer and bowel function after surgery needs to be concerned. DESIGN: Prospective cohort study. METHODS: A total of 38 patients with convenience sampling were recruited from a teaching hospital. The low anterior resection syndrome (LARS) score was used to assess bowel function disturbances before discharge and at 1 week, 1 month and 3 months after discharge. We followed the STROBE checklist to ensure rigour in our study. RESULTS: Approximately half of the patients experienced major LARS, including daily stool frequency of more than seven times and stool clustering at least once a week. The LARS scores observed at 1 month after discharge were significantly higher than those observed before discharge. Patients who received intersphincteric resection had higher LARS scores compared with those who received other surgeries. Furthermore, patients who underwent concurrent chemoradiotherapy, operation (OP) and chemotherapy had the highest LARS scores compared with those who underwent only an OP. CONCLUSION: The patients experienced varied intestinal dysfunction after surgery based on their treatment plan and surgical method. Nurses should provide individualised health education for these patients. RELEVANCE TO CLINICAL PRACTICE: A health education booklet is recommended to educate patients about LARS symptoms and the techniques to adapt in their daily lives after surgery.

Sleep quality at 3 months postpartum considering maternal age: A comparative study.

BACKGROUND: Poor sleep quality is related to old age among the general population, but few studies have focused on postpartum women of advanced maternal age. The present study aimed to describe and compare sleep quality between women younger or older than 35 years of age at 3 months postpartum, and to examine the related factors. METHODS: A cross-sectional survey was conducted with 160 postpartum women who had given birth at a teaching hospital in Taiwan. The participants were assigned to two groups according to age (≥35 years, n=80; and 20-34 years, n=80). Sleep quality was measured using the Pittsburgh Sleep Quality Index with a cut-off score of 5. RESULTS: The prevalence of poor sleep quality at 3 months postpartum was higher in older mothers (61.6%) than in younger mothers (38.4%, p<0.01). Multiple logistic regression revealed that poor sleep quality was positively correlated with the severity of postpartum physical symptoms, lack of exercise, and room-sharing with infants. After adjustment for those variables, older mothers were three times more likely to have poor sleep quality than younger mothers (odds ratio=3.08; 95% confidence interval 1.52-6.23). CONCLUSION: Health care providers should pay attention to sleep problems among postpartum women, especially mothers of advanced maternal age. In particular, health care providers should evaluate sleep quality among postpartum women, instruct them not to share the bed with their infants at night, perform exercise, and manage their postpartum physical symptoms to improve the sleep quality.

[Effects of Auricular Acupressure on Improving the Sleep Quality of Puerperae].

BACKGROUND: Puerperae exhibit generally poor sleep quality. Previous studies have shown auricular acupressure as effective in improving the sleep problems of nurses, college students, and elderly indigenous Taiwanese women. However, no study has yet examined the effectiveness of auricular acupressure in improving the sleep quality of postpartum women. PURPOSE: To explore the efficacy of auricular acupressure (AA) on puerperae who were affected by sleep disturbance. METHODS: A prospective quasi-experimental design was used and 60 puerperae with insomnia who scored at least 5 on the Chinese of version of the Pittsburgh Sleep Quality Index (CPSQI) were recruited at one postpartum centre (a "doing-the-month" care centre) in northern Taiwan. The experimental group (n=30) received pasted auricular magnetic beads and acupressure on the Shenmen, Xin, and Shen points. The control group (n=30) received general nursing directions about insomnia only. All participants were assessed using the CPSQI prior to the intervention and on the 21st post-intervention day. The intervention effects were analysed using the Generalized Estimating Equation (GEE). RESULTS: After three weeks of the AA intervention, the mean global PSQI score had decreased significantly more in the experimental group than in the control group (p<.05). Furthermore, experimental-group participants reported better sleep quality (p<.05), longer total sleep time (p<.001) and lower sleep disturbance (p<.05) than their control-group peers. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The present pilot study found complementary AA to be an effective intervention for treating puerperae with insomnia. This non-pharmacological and nonintrusive intervention for improving sleep disturbance in puerperae promotes the quality of sleep.

Effect of auricular acupressure for postpartum insomnia: an uncontrolled clinical trial.

AIMS AND OBJECTIVES: This study examined the effects of auricular acupressure therapy on women with postpartum insomnia. BACKGROUND: Postpartum women generally have poor sleep quality because of frequent night-time breastfeeding during the first month after giving birth. DESIGN: A one-group pretest/post-test quasi-experiment was conducted. METHODS: A convenience sampling method was used to recruit participants at a postpartum centre (doing-the-month centre) in Northern Taiwan, from January 2014-July 2014. Thirty women with postpartum insomnia received auricular acupressure therapy on one auricular point (Shenmen point pressing) four times a day for 14 days. The Chinese version of the Pittsburgh Sleep Quality Index was used to assess sleep quality before and after the 14-day treatment. RESULTS: After the 14-day auricular acupressure treatment, the Pittsburgh Sleep Quality Index total scores of the women decreased from 8·7 (pretest) to 5·57 (post-test, 36% reduction). Scores on the subscales of the Pittsburgh Sleep Quality Index, including sleep quality, sleep latency, sleep duration and sleep disturbance, also statistically improved (p < 0·05). CONCLUSIONS: Hormone changes and frequent breastfeeding were identified as characteristics that may exacerbate poor sleep quality of postpartum women, for whom the auricular acupressure intervention may effectively improve sleep quality. RELEVANCE TO CLINICAL PRACTICE: Auricular acupressure can be an alternative complementary therapy to aid postpartum women with insomnia in improving sleep quality.

Physical activities during pregnancy and type of delivery in nulliparae.

The aim of this study was to investigate changes in physical activity across pregnancy and the relationship between trimester-specific physical activity and unplanned caesarean sections (CSs). A cohort study design was carried out. A cohort of 150 pregnant women was established when they received prenatal care at 29-40 weeks of gestation at a medical centre in northern Taiwan. Participants were asked to recall the amounts of physical activity in which they had engaged in the three trimesters as assessed by the Pregnancy Physical Activity Questionnaire (PPAQ). Overall self-reported physical activity for the cohort decreased by 31% in the first trimester compared to the pre-gravid period, then increased in the second trimester and remained stable until delivery. A repeated measures analysis of variance was used to evaluate the data and revealed significantly more physical activity during the second trimester than in the first and third trimesters (F = 36.471, P = 0.000). In addition, there was a significant difference between normal spontaneous delivery and unplanned CS groups (F = 4.770, P = 0.031). Logistic regression determined that the odds ratio of undergoing a CS increased by 0.644 (95% confidence interval: 0.429-0.968) for women in the third trimester who performed low levels of physical activity. Results support the benefits of physical activity, and professionals are encouraged to provide pregnant women with information on recommendations for physical activity, particularly in terms of reducing unplanned CSs.

Back massage intervention for relieving lower back pain in puerperal women: A randomized control trial study.

This study evaluates the effectiveness of a back massage (BM) intervention in relieving lower back pain (LBP) in post-partum women.This is a randomized controlled trial study. Sixty normal spontaneous delivery women (response rate: 96.7%), who gave birth at our hospital, participated in this study from February to May of 2012. We randomly assigned 30 women to the experimental group and 30 women to the control group. During the 1 month post-partum period, the women in the experimental group received a BM for 5 consecutive days, whereas the women in the control group received routine care only. The LBP score was assessed according to a pain visual analog scale. After 5 days of intervention, the experimental group (n = 30) experienced significantly less LBP than did the control group (n = 30) (2.97 ± 1.71 vs. 4.43 ± 1.77, t = 3.26, P = 0.002). BM therapy can effectively reduce LBP during the first post-partum month. Additional studies are required to confirm the effects of BM therapy during extended post-partum periods.

Stress, sleep quality and unplanned Caesarean section in pregnant women.

This study examines the relationship among prenatal maternal stress, sleep quality and unplanned Caesarean delivery. For this research, we adopted a prospective survey design and a sample of 200 women in the early stages of labour. The findings were as follows: (i) 11.5% of the participants underwent unplanned Caesarean sections; (ii) based on a Pittsburg Sleep Quality Index split point of 5, approximately 90.5% of the participants experienced poor sleep quality; and (iii) the odds ratio for primiparas undergoing an unplanned Caesarean section was 4.183 times that for multiparas (95% confidence interval (CI) = 1.177 to 14.864), indicating a statistically significant difference. The results also showed that stress was a significant factor related to unplanned Caesarean sections; a 1-point increase on the Pregnancy Stress Rating Scale was associated with a 1.033-fold higher probability of undergoing an unplanned Caesarean section (95% CI = 1.002 to 1.065). Furthermore, prenatal stress was a significant variable that can be used to predict unplanned Caesarean deliveries.

Randomised controlled trial of the effectiveness of using back massage to improve sleep quality among Taiwanese insomnia postpartumwomen.

OBJECTIVE: to examine the effectiveness of using back massage to improve sleep quality in postpartum women. DESIGN AND SETTING: randomised controlled trial, conducted at a postpartum centre in Northern Taiwan. PARTICIPANTS: sixty postpartum women reporting poor quality of sleep were recruited from February 2012 to May 2012. INTERVENTIONS: participants were assigned randomly to either an intervention or a control group. Participants in both groups received the same care except for back massage therapy. The intervention group received a single 20-minutes back massage session at the same time each evening for 5 consecutive days. Sessions were administered by a certified massage therapist. MEASURES AND FINDING: the outcome measure was the Pittsburgh Sleep Quality Index (PSQI), which was administered pre- and post-test. Using a generalised estimation equation to control several confounding variables, the changes in mean PSQI were significantly lower in the intervention group (B=-3.97, standard error=0.43, p<0.001) than in the control group. CONCLUSIONS: an intervention involving back massage in the postnatal period significantly improved the quality of sleep. IMPLICATIONS FOR PRACTICE: midwives should evaluate maternal sleep quality and design early intervention programs to improve the quality of sleep, to increase maternal health. Midwives interested in complementary therapies should be encouraged to obtain training in back massage and to apply it in postpartumcare.

A survey of patients' quality of life and health-care needs prior to undergoing total joint replacement surgery.

The objective of this study was to identify patients' quality of life (QOL) and health-care needs before undergoing total joint replacement surgery. This study used a cross-sectional descriptive survey approach. Data were collected in 2007. The results for role limitations because of physical functioning were the lowest. Health-care needs for exercise guidance were the highest. Male participants experienced superior QOL for the physical components (t = 2.379, P < .05). Participants who were single (F = 3.804; F = 4.539) and employed full time (F = 4.961; F = 3.994) had superior QOL for both the physical and mental components (P < .05). The predictive factors for physical components of QOL included occupational status, the previous total joint replacement and other health problems. The predictive factor for the mental components of QOL was marital status. Because role performance is limited by physical functioning, the participants experienced a poor QOL for the physical components. The participants had substantial health-care needs before surgery, particularly for rehabilitation exercise guidance and pain management.

Community-based postpartum exercise program.

AIMS AND OBJECTIVES: To evaluate the effectiveness of an exercise programme for postpartum women to lose weight and relieve fatigue and depression. BACKGROUND: The optimal period for weight loss is six months postpartum. However, most women cannot return to their pre-pregnancy fitness level within that period of time. DESIGN: A quasi-experimental one-group pretest-post-test design was carried out. METHODS: A convenience sampling method was used to recruit 28 women at 2-6 months postpartum. The 'Yoga and Pilates Exercise Programme for Postpartum Woman' was designed for this study and was delivered in group sessions once a week for three months (12 times total) for 60 minutes each time by a professional coach. Of the participants, 23 completed the entire program. The participants' body composition and levels of depression and fatigue were measured before and after the programme to identify differences. RESULTS: Women in the high-score group showed a significant decrease of 6·71 ± 5·71 points (t = 3·113, p = 0·021) in the depression score after participating in the exercise programme. No significant difference was found for the level of fatigue before and after the exercise programme (p > 0·05). Significant reductions in the participants' body weight, body fat percentage, fat mass and basic metabolic rate were observed after the exercise programme (p < 0·001). CONCLUSIONS: These physical activities benefited the physical and mental health of postpartum women and enhanced their quality of life. RELEVANCE TO CLINICAL PRACTICE: It is worthwhile promoting a yoga and Pilates exercise programme for postpartum women in communities.

The effect of using a relaxation tape on pulse, respiration, blood pressure and anxiety levels of surgical patients.

AIM: This study aims to investigate the effect of a relaxation tape on levels of anxiety in surgical patients. BACKGROUND: Surgery is a stressful event for patients. Because of uncertainty regarding surgery and anaesthesia, patients often experience heightened anxiety and fear. DESIGN: A one-group pretest-post-test quasi-experimental design. METHODS: Samples were taken from surgical patients in a medical centre in northern Taiwan. The patients were given relaxation tapes the day before their scheduled surgery. Tests were conducted before and after patients listened to the tapes. STAI and respiration, pulse and blood pressure were used to collect data measurements on the anxiety level of these patients. RESULTS: The average age of 80 patients was 43·14 (SD 17·27) years. After the patients listened to the relaxation tape, their respiration rate dropped from 18·4 (SD 6·9) -17·8 (SD 7·4), pulse rate dropped from 81·9 (SD 33·5) - (SD 33·7), systolic blood pressure decreased from 125·4 (SD 16) mmHg - 121·5 (SD 13·4) mmHg and STAI score dropped from 50·9 (SD 11·1) - 41·1 (SD 9·8). They all showed a significant level of difference (p < 0·05). A one-time listen to the tape during the entire hospital stay was the experience of the majority (66·3%) and indicated that the STAI score can be further reduced by increasing the number of tape listening sessions (F = 14·1, p < 0·001). CONCLUSION: The results show that a relaxation tape can significantly reduce the level of anxiety and vital signs related to anxiety in surgical patients. Relevance to clinical practice. The results of this study can provide an empirical basis for nursing treatments. We recommend that relaxation tapes be included in standard of care to alleviate anxiety in surgical patients.

Effects of postpartum exercise program on fatigue and depression during "doing-the-month" period.

This study explored the effectiveness of an exercise program on reducing levels of fatigue and depression among postpartum women who were "doing-the-month" in a maternity center in Taiwan. Previous studies related to postpartum have focused on depression rather than women's feelings of fatigue, and no study related to exercise has previously been conducted in a Taiwan maternity center. A low-intensity exercise program was specifically designed and administered to 31 subjects in the study's intervention group. Another 30 subjects (the control group) followed a traditional, non-physically active postpartum care regimen. Those in the intervention group were required to participate in at least 6 exercise program sessions during their one month postpartum stay. All subjects were asked to fill out a fatigue and depression questionnaire before and after the program. A Fatigue Symptom Checklist (FSC) was used to measure fatigue, and the Center for Epidemiological Studies Depression (CESD) was used to confirm the development of depression. Results showed statistically significant differences between the two groups in terms of fatigue levels, with statistical improvements (p < .05) registered by the intervention group in terms of levels of physical and psychological fatigue and fatigue symptoms. However, no significant changes in depression between the two groups were found. Study results demonstrate that a low-intensity exercise program can offer a good platform for clinicians and researchers to help reduce fatigue in postpartum women.

The number of Baby Friendly hospital practices experienced by mothers is positively associated with breastfeeding: a questionnaire survey.

OBJECTIVES: The objective of this study was to examine the association between number of Baby Friendly hospital practices (based on World Health Organization/United Nations Children's Fund Ten Steps to successful breastfeeding) experienced by mothers and breastfeeding initiation during hospital stay, breastfeeding at 1 month and breastfeeding at 3 months after delivery. METHODS: The study population consisted of mothers who gave birth to infants without congenital anomalies at hospitals in Taiwan from June to October of 2003, inclusively. A total of 2079 mothers participated in the postal questionnaire survey. RESULTS: Only 1% of women reported experiencing all 10-step practices, while 5.7% of women did not report experiencing any Baby Friendly practices. Mothers who delivered at certified Baby Friendly hospitals experienced more 10-step practices. The level of breastfeeding increased as the number of 10-step practices experienced increased at all three time points when confounders were controlled in the model. CONCLUSIONS: This study found a dose-response relationship between number of 10-step practices experienced and breastfeeding. However, very few women in Taiwan reported experiencing all 10 steps. Our findings highlight the need for greater attention to implement the 10 steps.

Adherence to "Doing-the-month" practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan.

According to traditional Chinese custom, women should be confined to home and assisted with tasks for 1 month after giving birth to a child. This restrictive regimen is referred to as doing-the-month. The objectives of this study were to describe adherence to doing-the-month practices and to explore the association between adherence to doing-the-month practices and physical symptoms and depression among postpartum women in Taiwan. Participants were 202 women at 4-6 weeks after delivery. Adherence to doing-the-month practices was associated with lower severity of physical symptoms and lower odds of postnatal depression, after adjustment for potential confounders. Adherence to doing-the-month practices was associated with better health status among postpartum women in Taiwan.

Health-related quality of life among 3--4-year-old children born with very low birthweight.

AIM: This paper reports a study comparing health-related quality of life at 3-4 years of age among children born with very low birthweight (

Development and psychometric properties of the Chinese language version of the TAPQOL: a health-related quality of life instrument for preschool children.

The objectives of this study were to assess psychometric properties of the Mandarin version of the TZO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire in Taiwanese preschool children. Two groups of children, a very low birthweight group (n=118) and a not-very low birthweight group (n=170), were recruited. The internal consistency was acceptable and the correlation coefficients between the 12 subscales were low. Confirmatory factor analysis supported the 12-factor structure. Children with very low birthweight had significantly lower quality of life scores. This instrument may be used in clinical and research applications to investigate quality of life among preschool children.

[Concepts and measures of health-related quality of life for children].

Health-related quality of life is considered an important outcome indicator in medical care, yet few studies have been conducted on Taiwanese children's health-related quality of life due to the lack of a measurement tool and no clear agreement on a concept definition. The authors present a review of previous work done in this area with the intended goal of helping Taiwanese health professionals gain insights into the concept of children's quality of life and to incorporate their new knowledge into their care plans. It is also hoped that the information will help researchers in their efforts to study quality of life among children as an indicator for assessing pediatric patient outcomes.