[The Relationship Among Physical Activity During the Third Trimester, Maternal Pre-Pregnancy Body Mass Index, Gestational Weight Gain, and Pregnancy Outcomes].

BACKGROUND: Most pregnant women tend to reduce physical activities during pregnancy because they are uncertain of the amount of moderate-level physical activity they should do. As the influence of physical activity during the third trimester remains unclear, it is important to clarify the pregnancy outcomes of physical activity during pregnancy and weight management among Taiwanese women. PURPOSE: To examine the potential association between physical activity during the third trimester of pregnancy and the birth weight or delivery mode of the baby in order to see whether weight gain during pregnancy affects birth weight and delivery mode and to estimate the associations between pre-pregnancy body mass index and birth weight. METHODS: A prospective study was performed. Data were collected from 123 pregnant women, all between 28 and 40-weeks gestation, at a medical center in central Taiwan. The Chinese version of the 'pregnancy physical activity questionnaire' was used to collect data. Birth weight, delivery data, and the last weight measurement before delivery were retrieved from the medical records or via a postpartum telephone interview. RESULTS: The results revealed that the amount of weight gained during pregnancy was a significant predictor of birth weight. Birth weight was not associated with pre-pregnancy body mass index or with physical activity and intensity of activity during the third trimester. Results provide no consistent evidence for an association between weight gain during pregnancy and the mode of delivery. Although no association was identified between total physical activity and delivery mode, the intensity of activity made a difference, with moderate-intensity activity of pregnant women increased 1 MET-hour/week. Thus, the odds of vaginal delivery over caesarean section increased by 1.017 times (COR = 1.014; p < .05; AOR = 1.017; p < .05). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings of the present study indicate that weight gain during pregnancy and moderate-intensity activity are both associated with birth weight and delivery mode. These findings provide evidence that health counseling during pregnancy as well as offering physical activity guidance may be done using a more empirical research base.

Pain, Anxiety, and Fatigue During Labor: A Prospective, Repeated Measures Study.

BACKGROUND: Pain, anxiety, and fatigue are known to significantly influence labor; however, the interacting relationships among the three symptoms have not been empirically shown. PURPOSE: The aim of this study was to investigate the interrelationships among intrapartum pain, anxiety, and fatigue relative to the mode of delivery, with or without epidural analgesia (EDA). METHODS: A prospective, repeated measures design was adopted, and women with uncomplicated pregnancies at term (N = 186) were enrolled. Self-reported visual analog scales were used to assess pain, anxiety, and fatigue during the four phases of labor, as determined by cervical dilation (e.g., Phase 1 = 2-4 cm, Phase 2 = 4-6 cm, Phase 3 =10 cm, and Phase 4 = immediately after delivery of the placenta). Of the 186 participants, 48 received EDA when their cervical dilation was 3-4 cm. RESULTS: Throughout the process of labor, pain, anxiety, and fatigue were significantly correlated, no matter whether participants had received EDA, especially during Phases 1 and 3. For the participants undergoing EDA, the level of fatigue decreased more slowly than the levels of pain and anxiety. The participants who received EDA had significantly greater pain and fatigue in Phase 1 of labor than those who did not receive EDA. Mode of delivery was correlated with age, parity, and pain level in Phase 2 of labor and anxiety level in Phase 2 of labor. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Intrapartum pain, anxiety, and fatigue were strongly interrelated. Intrapartum pain management (EDA) led to a significant decline in anxiety and fatigue. Furthermore, fatigue accumulated during the course of labor and was not easily diminished. These findings provide a reference for maternity nurses to develop strategies for managing multiple symptoms.

Comparison of Pregnancy Stress Between In Vitro Fertilization/Embryo Transfer and Spontaneous Pregnancy in Women During Early Pregnancy.

BACKGROUND: Women who undergo in vitro fertilization/embryo transfer (IVF/ET) face complicated psychological stress and negative emotions, which may affect health during pregnancy and the development of the fetus. The current literature does not address the question of whether women who become pregnant spontaneously and women who undergo IVF face similar levels of pregnancy stress. PURPOSE: This study investigates the differences in pregnancy stress between women with spontaneous pregnancy and women with IVF/ET pregnancy living in central Taiwan during their first 20 weeks of pregnancy. METHODS: A prospective, longitudinal design with repeated measures, generalized estimated equations model, Wilks' λ, and Bonferroni test was used. Purposive samples of 163 women who had undergone IVF/ET and of 94 women who had undergone spontaneous pregnancy were enrolled as participants. Pregnancy stress was measured using the Chinese version of the self-administered Pregnancy Stress Scale at the 9th, 12th, and 20th weeks of pregnancy. RESULTS: The psychological stress experienced by IVF participants significantly increased with gestational week during the first 20 weeks of pregnancy (p < .01) but did not significantly increase in spontaneous-pregnancy participants. Gestational week was the main factor found to influence stress ratings for "identifying maternal role." "Altering body structure and body function" was the main factor found to influence pregnancy stress (p < .00). The method of becoming pregnant had no significant influence on pregnancy stress during the first 20 weeks of pregnancy (p > .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this study provide clinical evidence that IVF/ET does not cause more stress for women than spontaneous pregnancy. However, the intensity and trend of stresses differed between these two groups. These findings suggest that nurses should consider method of pregnancy when assessing the risk of stress in expectant mothers for each gestational week and when providing appropriate care and support.

Maternal-foetal attachment during early pregnancy in Taiwanese women pregnant by in vitro fertilization.

AIM: The aim of this study was to investigate maternal-foetal attachment at 9, 12 and 20 weeks gestation and to identify factors that influenced maternal-foetal attachment in Taiwanese women who conceived by in vitro fertilization. BACKGROUND: Development of maternal-foetal attachment is an important part of taking on the maternal role. However, evidence about maternal-foetal attachment after assisted conception is inconclusive. DESIGN: A longitudinal design with repeated measures. METHODS: A prospective, longitudinal design with repeated measures was used. Over an 18-month period in 2006-2008, a convenience sample of 160 women who conceived after undergoing successful in vitro fertilization were recruited from a major infertility care centre in Taiwan. Data were collected by self-reported measures, including: (1) Maternal-Foetal Attachment Scale; (2) Symptoms Checklist; (3) Pregnancy-related Anxiety Scale; (4) Social Support Apgar; (5) Chinese childbearing attitude Questionnaire; and (6) Awareness of Foetus Scale. The selected instruments to measure each variable were administered to participants at 9, 12 and 20 weeks gestation. RESULTS: Maternal-foetal attachment increased as pregnancy progressed from 9 to 20 weeks gestation. General linear mixed model showed predictors of maternal-foetal attachment included Chinese childbearing attitude, awareness of the foetus, and social support. CONCLUSION: Health provider awareness of cultural influences on the development of early maternal-foetal attachment of women pregnant by in vitro fertilization is needed. Prenatal education in early pregnancy might incorporate more information about foetal development to allow the mother to visualize her unborn child. Providing social support for women who were conceived by in vitro fertilization is beneficial to the development of maternal-foetal attachment.

Development of a Chinese childbearing attitude questionnaire for infertile women receiving in vitro fertilization treatment.

The purpose of this study was to report the second phase of instrument development, a culturally sensitive questionnaire of childbearing attitudes to assess the psychosocial responses of infertile women. Using a nonexperimental quantitative design, we investigated 238 women who are undergoing in vitro fertilization treatment. Data collection and relevant planning occurred in two phases: in-depth interviews of women to generate items for the questionnaire and establishing the questionnaire's content and construct validity. Through factor analysis, five factors were extracted from the "attitude toward childbearing questionnaire": gender identification with self and society, insurance of marriage and inheritance, happy family life, spiritual investment, and continuing the family line and procreation. The total variance of these five factors was 64.31%. Cronbach's α and test-retest reliability were between .72 and .87 and between .60 and .76, respectively, demonstrating acceptable internal consistency and stability. The information obtained through the questionnaire could be used to provide infertile women with personal counseling and appropriate psychological support during and after assisted reproductive technology.

Effects of prone and supine positioning on gastric residuals in preterm infants: a time series with cross-over study.

BACKGROUND: Few studies have examined the effect of body position on gastric residuals at different time points in feeding preterm infants. Further, the results of previous studies are inconsistent. OBJECTIVES: To describe the changing pattern of gastric residuals over time in the prone and supine position and to examine the effects of position on gastric residuals at different feeding volumes in preterm infants. DESIGN: A randomized, time series with cross-over study. SETTING: A neonatal intensive care unit affiliated with a medical center in central Taiwan. PARTICIPANTS: 35 preterm infants who were asymptomatic for gastroesophageal reflux, other gastrointestinal diseases or other significant morbidities of any kind other than prematurity. METHODS: Infants were randomly assigned to the following treatments: 3h in a supine position followed by 3h in a prone position, or vice versa. Measurements of gastric residual volume were taken by syringe at 30, 60, 90, 120 and 150 min following feeding when the enteral intake was set at 50 or 100ml/kg/day. RESULTS: The rate of decrease of gastric residuals in the prone and supine positions was fastest during the first half an hour post-feeding according to measurements taken at 30, 60, 90, 120 and 150 min at feeding volumes of 50 and 100ml/kg/day (p<001). Gastric residuals were significantly lower in the prone than in the supine position at the five measurement points. CONCLUSIONS: Placing preterm infants in the prone position for the first half an hour post-feeding and then changing the position according to the behavior cues of the infants is suggested. This result contributes to a better understanding of the relationships between time, position, and gastric residuals; it could also help health care professionals to provide efficient feeding as well as perform the appropriate positioning of preterm infants.

Trajectories of depressive symptoms and fatigue among postpartum women.

OBJECTIVES: To identify and characterize the trajectories of depressive and fatigue symptoms and determine the relationship between these two trajectories and associated predictors. DESIGN: A prospective, follow-up study. SETTING: A teaching medical center in central Taiwan. PARTICIPANTS: A convenience sample of 121 low-risk, childbearing women. METHODS: Depressive and fatigue symptoms were assessed using the Edinburgh Postnatal Depression Scale and Fatigue Continuum Form respectively during the third trimester (time 1), one day postpartum (time 2), three days postpartum (time 3), and one week postpartum (time 4). Participants also completed structured questionnaires on demographic features, health status, and sleep quality. RESULTS: The mean age of participants was 31.2 years. We observed four distinctive trajectories of depressive symptoms and three trajectories of fatigue using group-based trajectory modeling. A frequent conoccurrence of similar levels of these symptoms was found; that is, mothers in the high-risk depressive symptoms group were most likely to fall into the high-risk group for fatigue. Joint trajectories were predicted by poor sleep score (odds ratio = 2.96, 95% confidence interval = 1.2, 7.3) using multinomial logistic regression analysis. CONCLUSION: Overlapping but distinct trajectories of depressive symptoms and fatigue were found. These results suggest that differentiation between depressive symptoms and fatigue is possible and important for improving care during the early postpartum period.

Postpartum depression and correlated factors in women who received in vitro fertilization treatment.

INTRODUCTION: Postpartum depression is a significant mental health problem that occurs more frequently in the first 4 weeks postpartum and also may occur later during the first postpartum year. Women who receive in vitro fertilization (IVF) treatment have a particular perinatal experience that may create postpartum mental health concerns. The purpose of this cross-sectional study was to evaluate factors associated with postpartum depression in women who received IVF treatment. METHODS: Sixty of 71 eligible postpartum women who were treated at an infertility treatment center and who conceived by IVF were included in this study, which used a self-administered, structured questionnaire. RESULTS: The prevalence of postpartum depression was 25%, including mild (16.7%), moderate (6.7%), and severe (1.7%). Pearson correlation analysis showed that the frequency of receiving IVF treatment and perceived stress were positively correlated with postpartum depression, whereas family function and social support were negatively correlated with postpartum depression. Multiple regression analysis showed that the frequency of receiving IVF treatment, birth method, and social support were significant predictive factors for postpartum depression when covariates were controlled (R(2) 56.6%). DISCUSSION: A higher frequency of IVF treatment, cesarean birth, and inadequate social support increase the possibility of postpartum depression, and clinicians should provide appropriate anticipatory education or counseling.

The anxiety of Taiwanese women with or without continuity treatment after previous in vitro fertilisation failure.

AIMS AND OBJECTIVES: To compare the anxiety levels of Taiwanese women who continued with in vitro fertilisation treatment and those who discontinued treatment post-in vitro fertilisation failure. BACKGROUND: In vitro fertilisation is perceived as the last resort of infertility treatment. The impact of unsuccessful in vitro fertilisation treatment on psychological function has been documented; however, research comparing the levels of anxiety of women who cease and those who continue in vitro fertilisation post-failure is scant. DESIGN: A cross-sectional comparative study design was used. METHOD: Fifty-eight women in whom in vitro fertilisation had failed within the previous year were recruited to this study from a medical centre in northern Taiwan; 34 women continued treatment and 24 discontinued treatment. The State-Trait Anxiety Inventory was used to assess their levels of anxiety. RESULTS: Women in the group who continued treatment exhibited higher state and trait anxiety (TA) than women in the group who discontinued treatment (p < 0·005). The number and frequency of in vitro fertilisation cycles were significantly higher in the group who continued treatment than in those who did not. A strong positive correlation between state and TA (r = 0·8, p < 0·01) existed in both groups. CONCLUSIONS: Both groups exhibited considerable levels of anxiety; however, the women who continued in vitro fertilisation treatment had higher levels of anxiety than those who discontinued treatment. RELEVANCE TO CLINICAL PRACTICE: The level of anxiety of women who decide to continue in vitro fertilisation treatment should be assessed as early as possible and counselling services provided to women who experience in vitro fertilisation failure should concentrate more on relieving psychological distress. One year after discontinuing treatment, some women still experience considerable anxiety; therefore, the care and assistance provided to these women need to be continually evaluated.

[The internationalization of the nursing profession in Taiwan].

Globalization, nursing manpower migration, and the multinational nature of the medical industry have increased the level of internationalization in Taiwan's nursing profession. In nursing practice, competencies for the general nursing list (Taiwan version) and ICNP (International Classification for Nursing Practice) have been clinically tested and revised. In academic nursing, significant effort is invested toward achieving the three general objectives of internationalized teaching, internationalized campuses, and international academic exchanges. We should further test and revise Taiwan's competencies for the general nursing list, and the ICNP should be continually tested and revised. Additionally, nursing personnel should strengthen foreign language competencies, appreciate different nursing practice cultures, participate in international exchange activities, and place increasing emphasis on international cooperation in research and nursing education accreditation. Such should further enhance and strengthen international cooperation, which should further encourage internationalization in the domestic nursing profession.

Perinatal attachment in naturally pregnant and infertility-treated pregnant women in Taiwan.

AIM: This article is a report of a study of the differences in maternal-foetal attachment and maternal-infant attachment among naturally pregnant and infertility-treated pregnant women in Taiwan. BACKGROUND: Studies have shown that infertility treatment is likely to make up an increasing proportion in the coming years. As these experiences are unique, the attachment relationship may be affected. METHOD: The research data were collected from two obstetrics clinics which were located in central Taiwan. In 2008, all participants (n = 125) were asked to fill out the prenatal questionnaires at the beginning of the study and were followed up with postnatal questionnaires that were mailed to them 1-2 months after labour (n = 110). We used chi-square tests for categorical and t- tests for continuous variables. Multivariate analysis of variances was then performed, and changes in the maternal-foetal attachment and maternal-infant attachment Scales were assessed. FINDINGS: Women who became pregnant after fertility treatment had higher maternal-foetus and maternal-infant attachment scores, and this result was statistically significant; pregnancy mode and level of education are the main factors that have a significant effect on maternal-foetus attachment; and pregnancy mode and participation in prenatal education have a main effect on maternal-infant attachment. CONCLUSION: Development of a specific support group for mothers, such as a group for prenatal education, and providing useful resources for pregnant women with a lower level of education are involved in the future research studies for therapeutic intervention.

Grief responses and coping strategies among infertile women after failed in vitro fertilization treatment.

Reproductive technology has increased the childbearing potential for many infertile women, but in vitro fertilization (IVF) failures are common, which often trigger grief responses and coping strategies to manage the stressful life event. The present cross-sectional study investigated 66 women who had experienced at least one failure with IVF treatment. The data were gathered by a self-administered structured questionnaire, and included the participant's personal profile, grief responses and the Jalowiec's coping scale. The most common grief response among the respondents was bargaining, followed by acceptance, depression, anger, denial, and isolation. The order of coping strategies used, from highest-to-lowest, were confrontative, optimistic, self-reliant, fatalistic, supportive, evasive, palliative, and emotive. Use and self-perceived effectiveness among all coping strategies had a high correlation, except emotion. Bargaining, the most common grief response, was associated with a variety of coping strategies. All coping strategies were correlated with grief responses. The results of identifying the grief responses and associated coping strategies of women who have undergone failed IVF treatment may assist nurses and other health care professionals in their efforts to provide appropriate information, care and psychological support.

The Chinese version of the Facts on Aging Quiz scale: reliability and validity assessment.

BACKGROUND: The use of health care services by older adults is increasing with the aging of the population. It is therefore essential that health care workers are current in their knowledge about gerontology; thus, educational programs regarding the care of elders are essential. Chinese-language assessments to measure knowledge about gerontology and aging and attitudes toward older adults are lacking. OBJECTIVE: This study was designed to measure the reliability and validity of a Chinese-language version of Palmore's facts on aging quiz (FAQ 1). METHOD: Cronbach's alpha, construct validity, content validity and convergent validity of the Chinese version of the FAQ 1 were assessed. A sample of 220 student nurses was recruited. Part of the sample (n=125; Group A) was comprised of experienced nurses who had returned to school for advanced degrees. The remaining 95 participants were first-year undergraduate students without prior work experience (Group B). The FAQ 1 was administered to all participants. The Chinese-language version of Kogan's Attitudes toward Older People (KAOP) was also administered to assess convergent validity of the FAQ 1. RESULTS: Cronbach's alpha of the FAQ was 0.68, content validity was 0.82, and construct validity and convergent validity were acceptable. Group A had more correct answers on each item than Group B, indicating that students with prior work experience with the elderly were more knowledgeable regarding older people and aging. CONCLUSIONS: Based on the results of the assessment, the Chinese version of FAQ 1 is a valid and reliable instrument for measuring students' or health care providers' knowledge about older people.

Cigarette smoking and cognitive impairment: a 10-year cohort study in Taiwan.

The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ> or =6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio=OR=0.31; 95% CI=0.18-0.53; p<0.001) and those who continued to smoke (OR=0.37; 95% CI=0.20-0.70; p<0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose-response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.

Comparison of symptomatology in Taiwanese women pregnant with and without assisted reproductive technology.

We compared the symptoms of 91 Taiwanese women, 50 pregnant by assisted reproductive technology (ART), with those of 41 women, pregnant without assistance. They completed a self-administered demographic questionnaire and symptomatology inventory (SI) during each trimester. The ART group had a higher frequency of complications and hospitalizations than the unassisted women. No significant differences were found in physical and affective symptoms in the ART group across three trimesters, but significant differences were found in the unassisted group. In addition, ART and non-ART women differed in types of individual symptoms experienced each trimester. These findings suggest the need for nurses to assess each group for the presence of specific symptoms throughout pregnancy and to provide individualized symptom management.