Hip fracture after first-ever stroke: a population-based study.

OBJECTIVES: The aim of this study is to estimate the risk of hip fracture after first-ever stroke, using a nationwide population-base data set and a retrospective cohort design. MATERIALS AND METHODS: The cohort study involved 18,413 patients surviving a first-ever stroke during the 12-year period from 1997 to 2008. Another 18,413 control subjects were randomly selected with adjustment for age, gender and enrolled year. Stroke type, duration between stroke and hip fracture, six comorbidities and five categories of medication prior to hip fracture were investigated. RESULTS: This study found that 788 (4.3%) subjects in the study group suffered from hip fracture, with a 4.2 years median time frame (interquartile range = 1.8-7.1). In the control group, 492 subjects (2.7%) suffered from hip fracture during a 4.8 years median time frame (interquartile range = 2.0-7.5). The relative risk of hip fracture for stroke was increased in the first four years (1.4-2.4) and gradually declined to the level of the general population. Cox regression analysis showed osteoporosis-related factors, including ageing, female and antidepressants, significantly increased hip fracture risk (hazard ratios 1.89, 1.57, 1.92). CONCLUSIONS: These findings imply that osteoporosis may play a major role in the occurrence of hip fracture in the first four years after a first-ever stroke. Early intervention to prevent bone loss should be regarded as an important part in stroke management, especially in older females, and should be sustained for four years at least. The benefit of antidepressants in stroke patients should be weighed against the increased risk of hip fracture.

Post-partum weight retention in women in Asia: a systematic review.

Obesity is a health issue for people in Asia, and many studies support that childbearing may contribute to women's obesity. However, most studies of post-partum weight retention (PWR) focus on Western countries. This paper aimed to review recent data on PWR and discuss the related factors of PWR for women in Asia. Three electronic databases - MEDLINE, CINAHL and PsycINFO - were searched for data from January 1990 to August 2010. Twelve studies were identified as containing information related to PWR. Chinese, Taiwanese and Korean women tend to have higher gestational weight gain and PWR than women in other Asian countries in this review. The average reported gestational weight gain in these studies ranged from 8.3 kg to 18.0 kg, and the average weight retention at 6 months post partum in various countries ranged from 1.56 kg to 4.1 kg. Gestational weight gain had a positive effect on PWR, but there were no consistent conclusions for other factors. Only a few psychosocial and behavioural factors have been studied. Moreover, no one has assessed changes in waist circumference and waist-to-hip ratio for measuring central obesity and ensuring risk of chronic disease. Focusing on changes in maternal weight and body composition, and considering the impact of psychological and behavioural factors are suggested for future studies in Asia.

[A phenomenological study of nurses' caring: the experience of stillbirth among Taiwanese women].

To understand how Taiwanese women experience nurses' caring care during perinatal bereavement, a phenomenological approach was conducted. A purposive sample of sixteen women participated in the study. All the subjects' interviews were tape recorded and then transcribed. The transcription of each subject's oral description of her nurses' caring experience was analyzed using Colaizzi's phenomenological methodology. Seven themes were derived from the analysis: understanding, being there, offering self, mastering situation, predicting consequences, providing choice and sharing experience. Data from this phenomenological study not only describe the essential structure of nurses' caring but can also sensitize health care providers to both the needs and concerns of stillbirth women.

Effects of support group intervention in postnatally distressed women. A controlled study in Taiwan.

OBJECTIVE: The symptoms of depression experienced by women during the postnatal period may have profound effects on the lifelong health of both the mother and the child. In this randomized controlled study, we systematically evaluated the effects of weekly supportive group meetings for women with postnatal distress. METHODS: Sixty postnatally distressed women were randomly assigned to support (n=30) and control (n=30) groups. Women assigned to the support group participated in four supportive group sessions that comprised discussions concerning transition to motherhood, postnatal stress management, communication skills, and life planning. RESULTS: Subjects who attended the support sessions had significantly decreased scores on the Beck Depression Inventory (BDI) and the Perceived Stress Scale (PSS), and significantly increased scores on the Interpersonal Support Evaluation List (ISEL) as evaluated at the end of the fourth weekly session. In contrast, no significant changes were observed in the control group during this period. CONCLUSION: This is the first controlled study to provide evidence that participation in support groups for postnatally distressed women provides quantifiable psychosocial benefits.

Psychosocial aspects of Taiwanese postpartum depression phenomenological approach: a preliminary report.

To understand how Taiwanese women experience postpartum depression, a phenomenological study was conducted. A purposive sample of six mothers participated in the present study. All the subjects' interviews were tape recorded and then transcribed. The transcription of each subject's oral description of postpartum depression experience was analyzed using Colaizzi's phenomenological methodology. Three categories, with ten themes, were derived from the analysis. The first category is unbalanced role-enacting. It includes these four themes: (1) the discrepancies in the husband-wife relationship; (2) the shadowy position of a daughter-in-law; (3) the incompetence as a mother; and (4) the dilemma of a woman's identity. The second category is fragmented time-space representation. The themes included are: (5) cultural bondage; (6) loss of ideals; and (7) reinterpretation of family history. The third category is the uneasy self. It contains the themes of: (8) psychological disability; (9) sense of self-dissatisfaction; and (10) the notion or behavior of destruction.

[Effectiveness of videotape education for mothers of prematurity].

To investigate the effectiveness of an educational videotape on preterm mothers' knowledge, confidence, perceived stress, and social support, mothers who had given birth prematurely were recruited to participate in this study. Sixty-two mothers were randomly assigned to a control or experimental group. During hospitalization, mothers assigned to the experimental group received additional educational videotape which was designed by researchers for this particular study, regarding the knowledge and skills of caring for premature infants. While mothers in the control group received routine educational care. Both groups of mothers filled out the questionnaire including knowledge of prematurity, maternal confidence, perceived stress and perceived social support at three time periods (before discharge, one week after discharge, and one month after discharge). The findings indicated that mothers who received a videotape education reported having higher knowledge and confidence of caring for their preterm babies than mothers who were in the control group. Moreover, mothers in the experimental group perceived lower stress than the control group mothers when their babies were one month old. The scores of perception of stress, parity, and receiving a videotape education are the best predictors to maternal confidence a week after discharge. Further, the mothers' perception of stress, parity, and the perception of social support can predict and explain 47.1% of the variance of the maternal confidence. These results can apply to clinical practice for nursing mothers who have given preterm births. A convenient videotape education can improve mothers' knowledge and confidence of caring for their premature babies at home.

Effect of group teaching projects on women's stress during postpartum hospitalization.

In view of the trend toward early hospital discharge and an acute nursing shortage in Taiwan, the effectiveness of postpartum teaching in meeting a mother's immediate need for task performance should be evaluated. The purpose of this study was to identify and document the effectiveness of group teaching programs conducted as a collaborative effort by nursing teachers and student nurses during the practicum period. A quasi-experimental study was conducted with data collected from 230 women (control group was 119 women; experimental group was 111 women, including three subgroups: subgroup 1 received "maternal care" classes; subgroup 2 received "infant feeding" classes; and subgroup 3 received "newborn care" classes) at one medical center in southern Taiwan. The Postpartum Stress Inventory and a Social Support Scale were used to obtain postpartum stress and social support ratings for both groups. The t-test was used to compare the differences between groups of mean scores for postpartum stress and social support. Findings show that the mother-related stress of the experimental subgroup 1 was significantly less than in the control group, and the friend support in experimental subgroup 3 was significantly greater than in the control. Therefore, group teaching related to maternal care was found to be effective in lowering stress and classes related to newborn care resulted in increased friend support for the mother. More evidence concerning the effectiveness of such teaching in economic terms and in terms of human welfare is urgently needed.

[Postpartum adjustment of women who were home during the "traditional Chinese one month postpartum period of confinement" and those who were in maternity care centers].

The purpose of this study was to explore the difference in postpartum adjustment between women who were at home for there "doing the month" and those who stayed in a maternity care center. A repeated measures design was conducted, with data collected at 1 and 4 weeks postpartum. A total of 120 postpartum women participated in this study. Data were analyzed by factor analysis to determine the relationships within categories of postpartum strssors and depression. Then, the data were analyzed by 2 x 2 repeated measure MANOVA to determine the variations among groups and time. The results indicated that women who were in maternity centers for the "doing the month" perceived significantly higher stress than did the home group, and that women perceived higher stress at 4 weeks postpartum than at 1 week postpartum. Factor analysis of the data defined four categories of postpartum stress. It was found that women at maternity care centers perceived significantly higher stress from factors named, "stress from lacking of support system" and "stress from identifying maternal role". In addition, women doing the month at maternity care centers showed significantly higher depression level than women doing the month at home. However, there is no significant difference in postpartum stress and postpartum depression between time 1 (1 week postpartum) and time 2 (4 weeks postpartum).