Effects of an individualized nutritional educational program in pregnant women: A randomized controlled trial in Japan.

AIM: To evaluate the effectiveness of an individualized nutritional education program in promoting adequate nutrient intake in pregnant women. METHODS: A stratified randomized controlled trial was conducted. Participants were stratified by factors affecting the primary outcome and randomly assigned to the intervention or control groups. Intervention group participants received an individualized 30-min booklet-based education program in their 2nd and 3rd trimesters; the control group received usual care. The primary outcome was protein intake after the intervention, which was compared between the intervention and control groups. Secondary outcomes included comparing the amount of increase of protein before and after the intervention. Nutrient intake was measured using a self-administered short dietary history questionnaire, and analyses of covariance and t tests were performed. RESULTS: Of the 130 participants, 66 were assigned to the intervention group and 64 to the control group. There was no difference in protein intake between the two groups after the intervention (p = .051, 95% CI [-0.021, 12.4]). Comparing the increase in protein intake before and after intervention, the intervention group was 7.4 g/day higher than that of the control group (p = .040; F = 4.31; effect size = 0.36). CONCLUSIONS: The primary outcome, a comparison of protein intake between the groups after the program, revealed no significant differences. However, on comparing the amount of protein increase before and after the intervention, the intervention group's increase was significantly higher than that of the control group. Results indicate the potential for individualized face-to-face interventions for pregnant women in Japan.

Prenatal education program decreases postpartum depression and increases maternal confidence: A longitudinal quasi-experimental study in urban Japan.

BACKGROUND: Mothers in urban Japan are at high risk for postpartum depression. Previous research indicates that parents who understand their baby's behavior may have lower risks for postpartum depression. HUG Your Baby helps parents understand their baby's behavior. AIM: The purpose of this longitudinal study was to determine whether mothers receiving prenatal HUG Your Baby teaching would have better outcomes than a control group with respect to postpartum depression and related factors. METHODS: Pregnant women, after thirty weeks' gestation, were recruited to either the intervention or the control group. The intervention group received HUG Your Baby education, which teaches how to recognize and respond to a baby's behavior. The control group received a leaflet and regular, prenatal treatment. Participants completed the Edinburgh Postnatal Depression Scale, Karitane Parenting Confidence Scale, and three other scales at one and three months, postpartum. Questions about knowledge of baby's behavior was administered prenatally, and at one and three months, postpartum. FINDINGS: Data derived from 221 mothers (Control 100, Intervention 121) were included in the analysis. Researchers found significant differences regarding postpartum depression at one and three months and parenting confidence at one month. Scores were favorable for the intervention group. CONCLUSIONS: The HUG Your Baby program has a positive impact on preventing postpartum depression and increasing parenting confidence. It warrants wider implementation and evaluation in prenatal programs.

Women's experience of receiving team-midwifery care in Japan: A qualitative descriptive study.

BACKGROUND: Team-midwifery care remains limited in Japan. To introduce changes to the midwifery system, an in-depth understanding of women's perception of receiving team-midwifery care is crucial. AIM: This study aimed to describe women's experience of receiving team-midwifery care in Japan and to understand the central essence of this form of care. METHODS: This study used a descriptive research design and involved focus group interviews in a birth clinic in central Tokyo. This birth clinic provided continuous team-midwifery care involving five to six midwives in one team from pregnancy to the postpartum period. Interview data were analysed by content analysis. The ethical review board of St. Luke's International Hospital, Tokyo approved this study (12-R178). FINDINGS: Thirteen women who gave birth within 19 months were included. The women's experience of receiving team-midwifery care was described as "feelings of becoming closer and connected through a warm mutual relationship" with the midwives. The women felt that the midwives genuinely focused on their care and noticed their desire for their family to be involved. A trusting relationship was built through regular meetings. The women also described their experience as "a lasting feeling of ease and security". The midwives' continuity of care empowered the women even after their discharge. CONCLUSION: The underlying assumption for the women's empowerment was the continuity of woman-centred care built through a trusting relationship between the women and the midwives. These important elements constitute the central essence of team-midwifery care which can be adopted regardless of the care system.

Women's choice of maternal healthcare in Parung, West Java, Indonesia: Midwife versus traditional birth attendant.

BACKGROUND: In the 1990s, the Indonesian government launched programmes to train traditional birth attendants (TBAs) and increase the number of midwives. AIM: To identify and compare the factors that influence women's choice of a midwife or a TBA for maternal healthcare in Indonesia. METHODS: This study used a descriptive design for comparing women's choice of maternal healthcare. The participants were (1) married women, (2) experienced birth within two years, (3) living in a rural or urban village, and (4) capable of communicating in the Indonesia language. Three instruments were used: (1) traditional belief questionnaire, (2) preference for caregiver questionnaire, and (3) women-centered care (WCC) questionnaire which measured women's perceptions of care that they received during pregnancy. FINDINGS: A total of 371 women participated in this study. All these subjects answered based on their most recent birth within the last two years. Of the 371 women, 207 (55.8%) chose a midwife and 164 (44.2%) chose a TBA for giving birth. Women choosing midwives were generally satisfied and perceived receiving WCC. Factors determining choice were (1) women's background, (2) perception of WCC, (3) satisfaction, (4) choice of antenatal care (ANC), (5) family encouragement, and (6) traditional beliefs. DISCUSSION: The choice of caregivers was determined by not only education, parity, usual source of healthcare payment, and family encouragement but also traditional beliefs. CONCLUSION: Indonesian women's choice of a midwife instead of a TBA for their maternal healthcare resulted in a higher satisfaction of care and more ANC visits.

A comparison of midwife-led care versus obstetrician-led care for low-risk women in Japan.

BACKGROUND: Continuity of midwife-led care is recommended in maternity care because of its various positive outcomes. In Japan, midwife-led care is receiving broad attention as well. In order to popularise midwifery care within the entire system of perinatal care in Japan, there is a need to show evidence that continuity of midwife care for women will bring about positive outcomes. AIM: The objectives of this study were to compare the health outcomes of women and infants who received midwife-led care with obstetrician-led care in Japan. METHODS: This was an observational study using non-random purposive sampling with a survey questionnaire. Settings where midwife-led care and obstetrician-led care were chosen by purposive samples. Participants were low-risk women who received antenatal care and delivered a term-singleton-infant at the participating settings during the research period. Measurements were: Women-centred care pregnancy questionnaire, Stein's maternity blues questionnaire, and Edinburgh Postnatal Depression Scale. FINDINGS: Midwife-led care was perceived by women to be beneficial and had no adverse outcomes compared to obstetrician-led care. Main findings are: (1) Perception of Women-centred care was higher; (2) Less premature rupture of membranes, and the Apgar scores of the infants were similar; (3) Exclusively breast-feeding during hospitalisation and at one-month postpartum; (4) Stein's maternity blues scale scores was lower in women who received midwife-led care than those who received obstetrician-led care. CONCLUSIONS: Continuity of midwife-led care was perceived by women to be beneficial and had no adverse outcomes. Therefore, midwife-led care in low-risk pregnancy could be applicable and recommended.

Outcomes of independent midwifery attended births in birth centres and home births: a retrospective cohort study in Japan.

OBJECTIVE: the objective of this study was to describe and compare perinatal and neonatal outcomes of women who received care from independent midwives practicing home births and at birth centres in Tokyo. DESIGN: a retrospective cohort study. SETTINGS: birth centres and homes serviced by independent midwives in Tokyo. PARTICIPANTS: of the 43 eligible independent midwives 19 (44%) (10 assisted birth at birth centres, nine assisted home birth) participated in the study. A total of 5477 women received care during their pregnancy and gave birth assisted by these midwives between 2001 and 2006. METHODS: researchers conducted a retrospective chart review of women's individual data. Collected data included demographic characteristics, process of pregnancy and perinatal and neonatal outcomes. We also collected data about independent midwives and their practice. FINDINGS: of the 5477 women, 83.9% gave birth at birth centres and 16.1% gave birth at home. The average age was 31.7 years old and the majority (70.6%) were multiparas. All women had vaginal spontaneous deliveries, with no vacuum, forceps or caesarean section interventions. No maternal fatalities were reported, nor were breech or multiple births. The average duration of the first and second stages of labour was 14.9 hours for primiparas and 6.2 hours for multiparas. Most women (97.1%) gave birth within 24 hours of membrane rupture. Maternal position during labour varied and family attended birth was common. The average blood loss was 371.3mL, while blood loss over 500mL was 22.6% and over 1000mL was 3.6%. Nearly 60% of women had intact perinea. There were few preterm births (0.6%) and post mature births (1.3%). Infant's average birth weight was 3126g and 0.5% were low-birthweight-infants, while 3.3% had macrosomia. Among primiparas, the birth centre group had more women experiencing an excess of 500mL blood loss compared to the home birth group (27.2% versus 17.6% respectively; RR 1.54; 95%CI 1.10 to 2.16). Multiparas delivering at birth centres were more likely to have a blood loss over 500mL (RR1.28; 95%CI 1.07 to 1.53) and over 1000mL (RR1.75; 95%CI 1.04 to 2.82) compared to women birthing at home. CONCLUSION: our results for birth outcomes with independent midwives at birth centres and home births in Japan indicated a high degree of safety and evidence-based practice. This study had some limitations because of its incomplete data and low response rate. However, this is one of the few studies that reported outcomes of Japanese independent midwives and the safety of their practice. A birth registry system would provide us with more accurate and complete information of all childbirths with which to evaluate the safety of independent Japanese midwives.

The relationship between women-centred care and women's birth experiences: a comparison between birth centres, clinics, and hospitals in Japan.

OBJECTIVE: the goal of women-centred care (WCC) is respect, safety, holism, partnership and the general well-being of women, which could lead to women's empowerment. The first step in providing WCC to all pregnant women is to describe women's perceptions of WCC during pregnancy in different health facilities. The objectives of this study were to ask (a) what are the perceptions and comparison of WCC at Japanese birth centres, clinics, and hospitals and (b) what are the relationships between WCC and three dimensions of women's birth experience: (1) satisfaction with care they received during pregnancy and birth, (2) sense of control during labour and birth, and (3) attachment to their new born babies. DESIGN: this was a cross-sectional study using self-completed retrospective questionnaires. SETTING: three types of health facility: birth centres (n=7), clinics (n=4), and hospitals (n=2). PARTICIPANTS: participants were women who had a singleton birth and were admitted to one of the study settings. Women who were seriously ill were excluded. Data were analysed on 482 women. MEASUREMENTS: instrumentation included: a researcher-developed WCC-pregnancy questionnaire, Labour Agentry Scale, Maternal Attachment Questionnaire, and a researcher-developed Care Satisfaction Scale. FINDINGS: among the three types of settings, women who delivered at birth centres rated WCC highly and were satisfied with care they received compared to those who gave birth at clinics and hospitals. WCC was positively associated with women's satisfaction with the care they received. KEY CONCLUSIONS: women giving birth at birth centres had the most positive perceptions of WCC. This was related to the respectful communication during antenatal checkups and the continuity of care by midwives, which were the core elements of WCC. IMPLICATIONS FOR PRACTICE: health-care providers should consider the positive correlation of WCC and women's perception of satisfaction. Every woman should be provided continuity of care with respectful communication, which is a core element of WCC.

Evaluation of a reproductive health awareness program for adolescence in urban Tanzania--a quasi-experimental pre-test post-test research.

BACKGROUND: Sub-Saharan Africa is among the countries where 10% of girls become mothers by the age of 16 years old. The United Republic of Tanzania located in Sub-Saharan Africa is one country where teenage pregnancy is a problem facing adolescent girls. Adolescent pregnancy has been identified as one of the reasons for girls dropping out from school. This study's purpose was to evaluate a reproductive health awareness program for the improvement of reproductive health for adolescents in urban Tanzania. METHODS: A quasi-experimental pre-test and post-test research design was conducted to evaluate adolescents' knowledge, attitude, and behavior about reproductive health before and after the program. Data were collected from students aged 11 to 16, at Ilala Municipal, Dar es Salaam, Tanzania. An anonymous 23-item questionnaire provided the data. The program was conducted using a picture drama, reproductive health materials and group discussion. RESULTS: In total, 313 questionnaires were distributed and 305 (97.4%) were useable for the final analysis. The mean age for girls was 12.5 years and 13.2 years for boys. A large minority of both girls (26.8%) and boys (41.4%) had experienced sex and among the girls who had experienced sex, 51.2% reported that it was by force. The girls' mean score in the knowledge pre-test was 5.9, and 6.8 in post-test, which increased significantly (t=7.9, p=0.000). The mean behavior pre-test score was 25.8 and post-test was 26.6, which showed a significant increase (t=3.0, p=0.003). The boys' mean score in the knowledge pre-test was 6.4 and 7.0 for the post-test, which increased significantly (t=4.5, p=0.000). The mean behavior pre-test score was 25.6 and 26.4 in post-test, which showed a significant increase (t=2.4, p=0.019). However, the pre-test and post-test attitude scores showed no statistically significant difference for either girls or boys. CONCLUSIONS: Teenagers have sexual experiences including sexual violence. Both of these phenomena are prevalent among school-going adolescents. The reproductive health program improved the students' knowledge and behavior about sexuality and decision-making after the program for both girls and boys. However, their attitudes about reproductive health were not likely to change based on the educational intervention as designed for this study.

Classification of perA sequences and their correlation with autoaggregation in typical enteropathogenic Escherichia coli isolates collected in Japan and Thailand.

Enteropathogenic Escherichia coli (EPEC) strains produce a bundle-forming pilus (BFP) that mediates localized adherence (LA) to intestinal epithelial cells. The major structural subunit of the BFP is bundlin, which is encoded by the bfpA gene located on a large EAF plasmid. The perA gene has been shown to activate genes within the bfp operon. We analyzed perA gene polymorphism among typical (eae- and bfpA-positive) EPEC strains isolated from healthy and diarrheal persons in Japan (n=27) and Thailand (n=26) during the period 1995 to 2007 and compared this with virulence and phenotypic characteristics. Eight genotypes of perA were identified by heteroduplex mobility assay (HMA). The strains isolated in Thailand showed strong autoaggregation and had an intact perA, while most of those isolated in Japan showed weak or no autoaggregation, and had a truncated perA due to frameshift mutation. The degree of autoaggregation was well correlated with adherence to HEp-2 cells, contact hemolysis and BFP expression. Our results showed that functional deficiency due to frameshift mutation and subsequent nonsense mutation in perA reduced BFP expression in typical EPEC strains isolated in Japan.

Variations in the WNK1 gene modulates the effect of dietary intake of sodium and potassium on blood pressure determination.

WNK lysine-deficient protein kinase 1 (WNK1) is a member of the WNK family of serine/threonine kinases with no lysine (K), and these kinases have been implicated as important modulators of salt homeostasis in the kidney. It is well known that high dietary sodium and low dietary potassium have been implicated in the etiology of increased blood pressure. However, the blood pressure response to dietary sodium and potassium intake varies considerably among individuals. In this study, we have detected that the haplotypes of the WNK1 gene are associated with blood pressure variations in the general Japanese population. In addition, we investigated the interactions between the haplotypes of the WNK1 gene and dietary sodium and potassium intake for determining inter-individual variations in blood pressure. Our data support the hypothesis that part of the variation in blood pressure response to dietary sodium and potassium intake among individuals can be explained by variations in the WNK1 gene.

Intimin types determined by heteroduplex mobility assay of intimin gene (eae)-positive Escherichia coli strains.

We developed a quick genetic approach to screen variants of the intimin gene (eae) by using a heteroduplex mobility assay (HMA) that targets the 5' conserved region of eae. The eae variants were categorized into 4 major HMA types and 10 minor subtypes.

Typing of bfpA genes of enteropathogenic Escherichia coli isolated in Thailand and Japan by heteroduplex mobility assay.

We developed a rapid genetic approach for screening bfpA variants of enteropathogenic E. coli(EPEC) using a heteroduplex mobility assay (HMA). A total of 204 human EPEC strains were isolated in Thailand and Japan. Of 34 bfpA-positive EPEC strains, bfpA variants were classified into 5 HMA-types. Different HMA-types were found in EPEC of the same serotypes. The results suggest that HMA is a simple and easy method to analyze polymorphism of bfpA gene, and can be used in laboratories without large apparatus such as sequencers.