Paternal depressive symptoms and factors associated among expectant fathers in a northeastern province of Thailand.

Globally, depression is a major mental health problem among expectant fathers. Therefore, factors associated with paternal depressive symptoms (PDS) need investigation. This hospital-based cross-sectional study was aimed to investigate the prevalence of and factors associated with PDS among expectant fathers in a northeastern province of Thailand. In the north-eastern province, Sakon Nakhon, 440 expectant fathers from eight hospitals participated in the study by completing a questionnaire related to socio-demographic characteristics, the Edinburgh Postnatal Depression Scale (EPDS), psychosocial factors and social support. An EPDS score of at least eleven out of 30 was interpreted as having PDS. Multivariable linear regression analysis was applied with a statistical significance at 0.05, and the coefficient ß was presented. In total, 81 expectant fathers (18.4%, 95% confidence interval 14.6-22.3) had PDS, and the mean (standard deviation) of the EPDS score was 6.65 (4.25). Insufficient money (ß = - 0.099, p = 0.016), marital adjustment (ß = - 0.098, p = 0.027), self-esteem (ß = - 0.150, p < 0.001), wife's stress (ß = 0.079, p = 0.049), and expectant father's stress (ß = 0.400, p < 0.001) were factors independently associated with PDS. In conclusion, screening expectant fathers during the pregnancy period of their wives is essential, and factors associated with PDS should not be neglected by healthcare providers. Also, there is need of an intervention program to prevent the symptoms, especially for expectant fathers having insufficient money or having stress.

Oral health knowledge, literacy and behavior of pregnant women: a qualitative study in a northeastern province of Thailand.

BACKGROUND: Pregnancy is a unique period of women's lives, and oral health is an important public health indicator during this period. Pregnant women have increased vulnerability to oral health problems. The study aimed to describe oral health knowledge, literacy and behavior of pregnant women in a northeastern province of Thailand. METHODS: A descriptive study was used. Twenty pregnant women who attended antenatal care clinics of eight public hospitals in the province were recruited by use of purposive sampling. They participated voluntarily in individual interview. The Health Belief Model was used as conception framework. All data were transcribed and subjected to content analysis. RESULTS: Five categories emerged: Misbelief and lack of knowledge, Oral health problems and dental care seeking, Oral health information from different persons, Self-care management of oral health, and Fear of and anxiety towards dental treatment. The findings showed that low knowledge of need for treatment, little importance to oral health and low priority of dental needs affect the demand for dental care. Fear of and anxiety towards dental treatment were the results of negative past experiences of neglecting dental care. Some women perceived health benefits of practicing self-care of oral health during pregnancy. CONCLUSION: The findings help to better understand the oral health issues of pregnant women and provide baseline information for oral health promotion. Such promotion and culturally appropriate care should be integrated in maternal health education classes.

Life satisfaction, body image and associated factors among women with breast cancer after mastectomy.

BACKGROUND: Women having undergone mastectomy due to breast cancer have experiences which are very much individual and contextual. In order to understand the women and improve their quality of life, the aim of this study was to investigate life satisfaction, body image and associated factors among Swedish women with breast cancer after mastectomy. METHODS: This descriptive cross-sectional study enrolled 481 Swedish women with breast cancer after mastectomy who completed a questionnaire comprising socio-demographic characteristics, sources of information, and life satisfaction and body image (outcome variables). Multiple linear regression analyses were used to estimate relationships between socio-demographic characteristics, information support, sources of information, treatment variables, and outcome variables. RESULTS: All dimensions of life satisfaction were associated with body image. Treatment options were factors associated with life satisfaction, while sources of information were a factor that increased life satisfaction in the dimensions of physical symptoms, sickness impact and quality of close-friend relationship. Underlying disease, age 31-45 years, chemotherapy and breast reconstruction increased body image dissatisfaction. CONCLUSION: The finding that some socio-demographic characteristics, treatment options and sources of information were associated with life dissatisfaction and body image dissatisfaction can increase healthcare professionals' understanding of women with breast cancer after treatment. They should provide accurate and realistic information, focus attention on the women's needs, and prepare psychological intervention programs that make the women cope with their life situations during follow-up care.

Life situations of Swedish women after mastectomy due to breast cancer: A qualitative study.

PURPOSE: Breast cancer is a significant health issue all around the world and the most frequent type of cancer among Swedish women. The aim of this study was to explore and describe life situations of Swedish women with breast cancer after mastectomy. METHODS: A qualitative study with semi-structured interviews was conducted by using an interview guide concerning experiences of changes in the women's daily lives and functions. Thirty-three women with breast cancer having undergone mastectomy participated. The data from the interviews were subjected to content analysis. RESULTS: Six categories emerged: Embarrassment with body image and loss of femininity; Feelings of fear, worry and anxiety; Better appreciation of life; Support from different sources; Experiences of care from health care professionals; and Need of information and follow-up care. CONCLUSION: The women's body image limits their daily lives, and psychological distress reminds them of their disease. Reception of support from family and healthcare professionals and perception of positive life are important. Sometimes there is a lack of information and follow-up from healthcare professionals, who should be aware of the women's feelings and needs.

Psychological distress and health-related quality of life among women with breast cancer: a descriptive cross-sectional study.

PURPOSE: Breast cancer is the most common type of cancer found in women in Sweden and worldwide. Treatment leads to increased survival of patients, but they are at risk to experience psychological distress, including anxiety and depressive symptoms, and decreased health-related quality of life (HRQoL). This study investigated the relationship between psychological distress and HRQoL and related factors among women with breast cancer in Sweden. METHODS: This descriptive cross-sectional study was conducted in Sweden. A total of 481 women with breast cancer answered voluntarily a questionnaire about sociodemographic and support factors, psychological distress, and HRQoL. Data were subjected to Pearson's correlation and linear regression analyses. RESULTS: Psychological distress was related to HRQoL in terms of body image, future perspective, side effects of systemic therapy, breast symptoms, arm symptoms, and hair loss. Women with lower age were associated with increased symptoms of anxiety, while those having undergone breast reconstruction were associated with increased symptoms of depression. Breast reconstruction and chemotherapy worsened body image, low support from partner decreased sexual functioning and enjoyment, and low support from physicians and nurses worsened future perspective, side effects of systemic therapy, breast symptoms, and indignation about hair loss. CONCLUSIONS: Psychological distress was correlated with the HRQoL. Increased support from physicians, nurses, and husband/partner may increase the HRQoL among women with breast cancer. Breast cancer treatments such as breast reconstruction and chemotherapy were factors that decreased the psychological distress and increased the HRQoL.

Contraception practices among young unmarried women seeking abortion following unintended pregnancy in Ho Chi Minh City, Vietnam.

The aim of this study was to explore and describe contraception practices among young unmarried Vietnamese women seeking abortion after an unintended pregnancy. A qualitative study was conducted with voluntary participation of 42 women at a hospital in Ho Chi Minh City. Interview data were subjected to content analysis from which five categories were identified: (1) attitudes towards sexuality and contraception, (2) knowledge about contraception, (3) use of contraceptive methods, (4) cultural and traditional issues concerning sexuality and contraception, and (5) abortion as a solution to unwanted pregnancy. Prior to their abortion, women had viewed premarital sex as a means of maintaining a relationship with their boyfriends. Misconceptions, misbeliefs, fear of side effects and limited knowledge were reasons for not using contraception and, in case of unintended pregnancy, abortion was the solution. Boyfriends played an important role in influencing the use (or non-use) of contraceptives. Sexual and reproductive health education including counselling for gender equality, safer sex practices and the prevention of unintended pregnancy should be provided to both women and men in ways which combine traditional and modern views of sexuality. Intervention research to develop sexual and reproductive health education programmes, including contraception counselling, should be carried out.

Knowledge, attitude and self-efficacy program intended to improve public health professionals' ability to identify and manage perinatal depressive symptoms: a quasi-experimental study.

BACKGROUND: During the perinatal period women lack screening and treatments for perinatal depressive symptoms, while public health professionals (PHPs) in primary care centres (PCCs) need training for identification and management of such symptoms. This quasi-experimental study was aimed at evaluating knowledge, attitudes and self-efficacy among PHPs after participating in a Knowledge, Attitude, and Self-efficacy (KAS) program for identification and management of perinatal depressive symptoms. METHOD: The KAS-program, carried through in Sakonnakhon in north-eastern Thailand, comprised one day of theory and a four-week period of field practice. Thirty-three PHPs from PCCs participated in the program. Twenty-three of them participated in focus group discussions (FGDs). Chi-square for trend, paired-sample T-tests and content analysis were used. RESULTS: Knowledge, attitude and self-efficacy scores increased after the PHPs had fully participated in the KAS-program. Four categories emerged from the FGDs: increased understanding and knowledge, being aware and having a positive attitude, having confidence and ability to work, and need of regular training and feedback. CONCLUSION: The KAS-program may contribute to giving PHPs in PCCs the knowledge, positive attitude and self-efficacy they need to identify and manage perinatal depressive symptoms. Implementation of the KAS-program to other healthcare professionals such as nurses/midwives is great of interest.

Life situation and support during pregnancy among Thai expectant mothers with depressive symptoms and their partners: a qualitative study.

BACKGROUND: Expectant parents may have positive and negative emotions during pregnancy and receive support from different sources. Studies on life situation and support among couples have rarely been conducted. This study aims to explore life situation and support during pregnancy among expectant mothers with depressive symptoms and their partners. METHODS: Twenty-seven expectant mothers, in the last trimester of pregnancy with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 7) from seven public antenatal care clinics in Sakonnakhon, a north-eastern province of Thailand, and their partners were interviewed. In total, 54 semi-structured interviews were subjected to content analysis. RESULTS: Four categories emerged: (1) Having obstacles in life, (2) Facing life transition, (3) Enhancing confidence, and (4) Dissatisfaction with support. The informants described obstacles regarding economy, fear of health problems, getting an abnormal child and partners' behaviours. They received support from family members and social networks, but some were dissatisfied with the support from the healthcare. For example, expectant fathers wished to receive more health information and be more involved. CONCLUSIONS: Healthcare professionals should be aware of the influence of cultural and contextual factors when providing antenatal care to expectant parents. Male involvement in the care must not be neglected.

Intervention intended to improve public health professionals' self-efficacy in their efforts to detect and manage perinatal depressive symptoms among Thai women: a mixed-methods study.

BACKGROUND: Targeting perinatal depressive symptoms among women can reduce premature mortality. However, public health professionals (PHPs) in primary healthcare settings often have low self-efficacy for detection and management of perinatal depressive symptoms among women. This mixed-methods study was aimed at developing and evaluating a self-efficacy improvement programme (SIP) intended to increase PHPs' self-efficacy in efforts to detect and manage perinatal depressive symptoms. METHODS: The SIP consisted of 1 day of theory and 4 weeks of practice. Sixty-six PHPs from sub-district health promotion hospitals (primary health care level) in Sakonnakhon, a north-eastern province in Thailand, were randomised into an intervention group (n = 33) and a control group (n = 33). Twenty-three of the intervention group participants also took part in focus group discussions (FGDs). Multiple linear regression and qualitative content analysis were used to analyse the data. RESULTS: After the SIP, the intervention group participants had higher self-efficacy score than those in the control group (p = 0.004). The FGDs resulted in four categories emerging: Having confidence, Changing knowledge and attitudes, Increasing perception of an important role, and Increasing awareness of performed function. CONCLUSIONS: To enhance the ability of PHPs to detect and manage perinatal depressive symptoms, an intervention programme based on self-efficacy modification is recommended.

Perinatal depressive symptoms among Thai women: A hospital-based longitudinal study.

The authors of this longitudinal study investigated risk factors for postpartum depressive symptoms and differences in depressive symptoms at late pregnancy and at 1 and 3 months postpartum. In Sakhonnakhon Province, in northeastern Thailand, 449 women were recruited during late pregnancy and followed at 1 and 3 months postpartum with the use of psychosocial factors. Depressive symptom scores were measured using the Edinburgh Postnatal Depression Scale (EPDS). The scores were compared using dependent-samples t-tests, and multiple linear regression analyses were used to identify risk factors for depressive symptoms at 1 and 3 months postpartum. EPDS scores decreased from late pregnancy to 1 month postpartum and remained on the same level until 3 months postpartum. Low psychological well-being scores and low personal monthly income were risk factors for increased EPDS scores at 1 and 3 months postpartum. Pregnant women in Thailand who have a low income, have limited social support, and report low psychological well-being are at increased risk for postpartum depression. Results of this study suggest they should be screened for depressive symptoms during pregnancy, referred for diagnosis, and provided treatment to reduce the risk of ongoing depressive symptoms during the postpartum period.

Antenatal depressive symptoms during late pregnancy among women in a north-eastern province of Thailand: Prevalence and associated factors.

BACKGROUND: Globally, depression is prevalent during pregnancy and several factors have been associated with antenatal depressive symptoms (ADS). However, ADS have rarely been investigated in Thailand. This study aimed at exploring the prevalence of ADS and factors associated with these symptoms among Thai women in late pregnancy. METHODS: A cross-sectional study including 449 women in late pregnancy was carried out. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms with a score of 10 points or higher. Socio-demographic characteristics and psychosocial risks were measured in association with ADS. Percentage and 95% confidence interval (CI) were used to assess the prevalence of ADS. Odds ratio (OR) and 95%CI were used to determine ADS-related risk factors among women. RESULTS: The prevalence of ADS was 46.8% (95%CI 42.3-51.4). Pregnant women aged less than 20 years (OR 2.58, 95%CI 1.14-5.84) and those not having enough money (OR 2.71, 95%CI 1.22-6.05) had an increased risk of ADS. Psychosocial risks related to ADS for women were low psychological well-being (OR 3.12, 95%CI 1.75-5.58), low self-esteem (OR 2.08, 95%CI 1.24-3.49), and low sense of coherence (OR 1.82, 95%CI 1.12-2.95). CONCLUSIONS: The prevalence of ADS among Thai women in their late pregnancy is high. Socio-demographic characteristics and psychosocial factors are independently associated with ADS. Healthcare providers in Thailand should consider EPDS as a standardised screening tool for ADS and use it at antenatal care clinics. Implementing programs focusing on both pregnant women and their family might increase the prevention of perinatal depression.

Self-care management of Thai Buddhists and Muslims with type 2 diabetes after an empowerment education program.

The aim of the present study was to explore self-care management of Thai Buddhists and Muslims with type 2 diabetes and inadequate blood glucose levels, after they had been subjected to a 6-month diabetes empowerment education program. Twenty-seven participants (male and female) were selected through purposive convenience sampling for an explorative qualitative study. Semistructured focus group interviews with four open-ended questions were used to study the participants' self-care behavior at the beginning and the end of the program, and the data obtained were subjected to content analysis. At the end, one third of the participants had been able to reduce their blood glucose to acceptable levels. Most of the others had achieved reduced but irregular blood glucose levels; however, some did not achieve any reduction. Diet was the most difficult problem, and economic difficulties, incorrect knowledge, and misleading beliefs were barriers. In conclusion, an empowerment education program can substantially improve the outcome of self-care management for many people with type 2 diabetes. In the planning of such programs, barriers should be taken into account.

Correction: Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand.

[This corrects the article DOI: 10.1371/journal.pone.0193054.].

Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand.

Thailand has one of the world's highest prevalence of cervical cancer, mainly caused by the human papillomavirus (HPV). HPV infections can successfully be prevented by vaccination, which is available at a cost but not yet implemented in the national vaccination program. Parents play a critical role in deciding whether to vaccinate their child against HPV. Thus, the aim was to examine the association between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. A cross-sectional design was used among three schools in Thailand: Nakorn Phatom province (suburban) and Bangkok (urban). Parents of 9-12-year-old daughters completed the questionnaires, guided by the Health Belief Model. In total, 359 parents completed the questionnaires; of those, 301 were included in the final analyses. The ordinary least squares (OLS) regression analysis showed that background knowledge of HPV and the HPV vaccine was positively related to knowledge of HPV and cervical cancer. For beliefs, knowledge was positively associated with susceptibility (i.e., parents' perceived risk of an HPV infection/ related disease), severity, and benefit. However, knowledge was not significantly related to barriers. For acceptance, higher susceptibility and benefit were related to higher acceptance, and greater knowledge was associated with higher acceptance. Thus, we found associations between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. Parents, who reported religion as important, as opposed to those who did not, were more favorable toward the HPV vaccination. Four out of ten mothers had never undergone a cervical cancer screening, but most had accepted previous childhood vaccinations for their daughters. The overall acceptance of the vaccine was high, and we believe our results are promising for future implementation of the HPV vaccination in the national childhood vaccination program in Thailand.

Caregiving to persons living with HIV/AIDS: experiences of Vietnamese family members.

AIMS AND OBJECTIVES: To examine the experiences of caregiving among Vietnamese family members of persons living with HIV/AIDS. BACKGROUND: As the number of persons living with HIV/AIDS increases, the need of family caregivers who can take responsibility for the home care of these persons increases. Vietnam has one of the fastest growing HIV epidemics in Asia. DESIGN: A descriptive cross-sectional study with quantitative and qualitative methods was used. METHODS: A purposive sample of 104 family caregivers, both male and female, participated voluntarily by answering a questionnaire of caregiver burden, and 20 of them participated in in-depth interview. RESULTS: Female caregivers were mainly mothers and wives while male caregivers were mainly husbands, fathers and siblings. The largest group of family caregivers reported moderate to severe burden. There was no difference between genders in total caregiver burden, but there were several differences between older and younger caregivers in some items of caregiver burden. Five categories of experiences emerged: Different types of caregiving to persons living with HIV/AIDS, cultural and religious issues associated with caregiving, keeping secret to avoid stigma and discrimination, lack of knowledge about disease and provision of care, and fear, anxiety and frustration. CONCLUSIONS: Stigma and discrimination should be decreased by providing knowledge to the general public about HIV/AIDS, in particular about ways of transmission and protection. Special knowledge should be given to family caregivers to enable them to give care to persons living with HIV/AIDS at home. This could be done through culturally appropriate training/intervention programmes in which coping methods should be included. Support group interventions should also be carried through. The results obtained can be used as baseline information. RELEVANCE TO CLINICAL PRACTICE: Health care providers should consider gender, age and culture of family members of persons living with HIV/AIDS. Knowledge about HIV/AIDS, provision of care at home and in hospital, and support groups should be developed and implemented.

'Paddling upstream': Fathers' involvement during pregnancy as described by expectant fathers and mothers.

AIMS AND OBJECTIVES: To describe the perspectives of expectant mothers and fathers on fathers' involvement during pregnancy. BACKGROUND: Becoming a father is a major life event and paternal involvement during pregnancy has a positive influence on the family. However, research into both expectant mothers' and fathers' perspectives on fathers' involvement during pregnancy is relatively scarce. DESIGN: A descriptive qualitative study was used. METHODS: Thirty expectant parents (20 women and 10 men) were interviewed either as part of one of four focus groups or in an individual interview. Qualitative content analysis was performed on the interview transcripts. RESULTS: A theme of 'Paddling upstream' emerged as an expression of the latent content of the interviews concerning perspectives on fathers' involvement. Five sub-themes described the manifest content: trying to participate, trying to be understanding, trying to learn, trying to be a calming influence and trying to find a balanced life. Expectant parents suggested several ways to improve fathers' involvement and to meet parents' need for shared involvement. CONCLUSION: Expectant mothers and fathers wanted the father to be more involved in the pregnancy. Although fathers attempted different strategies, they did not always perceive what was expected of them and encountered many barriers as they tried to navigate through this unique experience. The best support for the father was the mother. Expectant parents wanted their healthcare to include the father more thoroughly and to focus on the whole family. RELEVANCE TO CLINICAL PRACTICE: Prenatal care professionals can overcome barriers that prevent paternal involvement. Although fathers are not able to engage in the pregnancy on the same level as the mother, we suggest that their specific needs also be recognised through an increased awareness of gender norms in healthcare.

Parental stress and dyadic consensus in early parenthood among mothers and fathers in Sweden.

BACKGROUND: Parental stress can negatively affect the parent-child relationship and reduce the well-being of the whole family. Family disagreement is associated with parental divorce and with psychological problems in children. AIMS: The aim was to examine perceived parental stress and draw comparisons among mothers and among fathers, in relation to educational level, parental experience, existence of a parental role model and sense of coherence. The aim was also to examine perceived dyadic consensus and its association with perceived parental stress within couples. METHODS: Questionnaires were completed by 320 mothers and 315 fathers at 1 week and 18 months post-partum. The Swedish Parenthood Stress Questionnaire, the Sense of Coherence Scale and the Dyadic Consensus Subscale were used. RESULTS: Low education, lack of a role model and poor sense of coherence promoted stress in mothers in the subareas social isolation and spouse relationship problems, while lack of a role model and poor sense of coherence promoted stress in fathers in the subarea social isolation. Furthermore, parental experiences promoted stress among mothers in the subarea incompetence while this was not seen among fathers. Mothers perceived a higher level of dyadic consensus than fathers in the items recreational activities, friends, aims and life goals, time spent together, and decisions regarding career and personal development. Household tasks was the only item where fathers perceived a higher level of dyadic consensus than mothers. Additionally, there were associations between perceived parental stress and dyadic consensus in several items and in the total score. CONCLUSIONS: To promote parents' health and family stability, health professionals should consider factors affecting stress and stress reactions, and take gender roles into account.

Efficacy of miswak on oral pathogens.

The oral cavity harbors a diverse and abundant number of complex oral pathogens causing different oral diseases. The development of dental caries and periodontal diseases has been found to be closely associated with various gram positive and gram negative microrganisms. Miswak, a natural toothbrush, has been documented as a potent antibacterial aid and its use is encouraged in different countries because of its good taste, texture, availability, cost and beneficial effect on teeth and supporting tissues. Different researches have been carried out to evaluate the antimicrobial effects of Miswak. This review encompasses the efficacy of Miswak on suppression of oral pathogens with respect to conducted on fungi as well as cariogenic, periodontal and endodontic bacteria.

Religion and self-management of Thai Buddhist and Muslim women with type 2 diabetes.

AIMS AND OBJECTIVES: To report of a qualitative study of how religion affects the self-management of Thai Buddhist and Muslim women with type 2 diabetes. BACKGROUND: The importance of diabetes self-management is well recognised. However, research on such self-management in Thailand is scarce, in particular on the influence of religion on the self-management of Thai Buddhist and Muslim women with type 2 diabetes. DESIGN: A descriptive qualitative study was conducted. METHODS: Purposive convenience sampling was used, and 48 women, 19 Buddhist and 29 Muslim, aged from 28-80 years, participated. Data were collected in 2008-09 and analysed by use of manifest and latent content analysis. RESULTS: Four themes of the influence of religion on the self-management among Thai women with type 2 diabetes emerged: religion - a way of coping with diabetes, spiritual practice - a help for disease control, spiritual practice - an effort to struggle with everyday life, and support from family - a cultural practice. CONCLUSIONS: The Buddhist and Muslim women had self-management capabilities that were often related to their religions. However, many of them had poor control of their blood sugar levels and needed assistance. RELEVANCE TO CLINICAL PRACTICE: Reference to religion and spiritual practice can be an effective means of helping diabetes patients better manage their disease and change their lifestyles. Furthermore, family and economic and social environments should be taken into account both in care and in interventions aimed at helping patients cope and empowering them to control their disease.

Putting culture in the curriculum: a European project.

The purpose of this paper is to describe the rationale for and the method of designing a framework for a European curriculum to promote intercultural competence in health care students. The background relating to the migration of people into and across Europe is cited as the factor driving the need for such a project. The project group emerged from the European organisation known as COHEHRE (Consortium of Higher Education Institutes in Health and Rehabilitation in Europe). Composed of a group of nurse educators from 5 European countries it charts the process which led them to create a curriculum framework. The completed work is available in the form of a CD-ROM. The paper describes the steps taken to reach the project outcomes over 4 years. The methods of dissemination of the project outcomes are included. The discussion considers the journey of the group towards the outcomes of the project and identifies the need to discover how effective the framework is in achieving the aims of the group. In conclusion it articulates the hope that this work will improve the care which is shown to all recipients of health care whatever their cultural background.