Preventive interventions for paternal perinatal depression: a scoping review protocol.

INTRODUCTION: The objective of this scoping review is to map the literature describing preventive interventions for paternal perinatal depression. Depression is a common mental disorder experienced by fathers as well as mothers around childbirth. Perinatal depression has negative consequences for men, and suicide is the most serious adverse effect. Impaired father-child relationships can also result from perinatal depression, negatively impacting child health and development. Considering its severe effects, early prevention of perinatal depression is important. However, little is known about preventive interventions for paternal perinatal depression including Asian populations. METHODS AND ANALYSIS: This scoping review will consider studies of preventive interventions for perinatal depression in men with a pregnant wife or partner, and new fathers (less than 1 year post partum). Preventive intervention includes any form of intervention intended to prevent perinatal depression. Primary prevention intended to promote mental health will also be included if depression is included as an outcome. Interventions for those with a formal diagnosis of depression will be excluded. MEDLINE (EBSCOhost), CINAHL (EBSCOhost), APA PsycINFO (EBSCOhost), Cochrane Central Register of Controlled Trials and Ichushi-Web (Japan's medical literature database) will be searched for published studies, and Google Scholar and ProQuest Health and Medical Collection will be searched for grey literature. Beginning in 2012, the search will include the last 10 years of research. Screening and data extraction will be performed by two independent reviewers. Data will be extracted using a standardised data extraction tool and presented in diagrammatic or tabular form, accompanied by a narrative summary. ETHICS AND DISSEMINATION: As this study involves no human participants, approval from a human research ethics committee is not required. Findings of the scoping review will be disseminated through conference presentations and publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: https://osf.io/fk2qe/.

Enzyme-linked immunosorbent assay using thin-layered microfluidics with perfect capture of the target protein.

We developed a process for enzyme-linked immunosorbent assay on a glass microchip via the use of a thin-layered microfluidic channel. This channel possesses a high aspect ratio (width/depth ∼200) and has an antibody layer immobilized directly on the channel surface. A depth of several microns and an excessive width and length (mm scale) of the channel provide a large-volume capacity (102 nL) and maximum capture efficiency of the analyte for a high level of detection sensitivity (102 pg mL-1). The developed reusable immunosensor has demonstrated high-performance characteristics by requiring less than 50 µL of sample and providing analysis in less than 25 min. This new method could impact the development of point-of-care devices for biomedical applications.

Sexual Dysfunctions Among People Living With HIV With Long-Term Treatment With Antiretroviral Therapy.

INTRODUCTION: Sexuality plays an essential role in the psychosocial well-being of people living with HIV (PLHIV) but it is still less assessed by healthcare professionals during treatment. AIM: To investigate the frequency of those screening positive for sexual dysfunction (SD) and associated factors according to gender/sexual orientation in PLHIV under long-term treatment with antiretroviral therapy (ART). METHODS: Between September 2013 and October 2016, 234 PLHIV adults in treatment in São Paulo were included. Participants were sexually active, did not present sexual orientation disorder or body dysmorphic disorder, and did not use sexual hormones. We performed clinical interviews and measured levels of depression, anxiety, and levels of sexual hormones. SD was assessed using a self-report questionnaire. MAIN OUTCOME MEASURES: Proportion of participants screening positive for SD in the International Index of Erectile Function, the Index of Premature Ejaculation, and the Female Sexual Function Index. In the regression analyses, the outcome SD considered any SD presented with disregard to gender. RESULTS: 70% of participants reported consistent adherence to ART and 96% had an undetectable viral load. The median (Md) duration of ART was 198 months (inter quartil range, IQR 111.6-230.4) and the median CD4 was 655 cells/mm3 (IQR 443-871). Screening positive for erectile dysfunction was 49.7%, premature ejaculation 16.9%, female sexual dysfunction 27.4% and hypoactive desire 45.1%. Lower testosterone and prolactin levels were associated with erectile dysfunction in heterosexual men (n = 58); lower levels of oestradiol and higher levels of follicle stimulating hormone were associated with female sexual dysfunction and hypoactive desire in female participants (n = 63). The multivariable model used included comorbidities and hormonal abnormality and found that age (odds ratio, OR = 1.04, 95% confidence interval, 95%CI 1.00-1.08, P = .026) and the presence of depression/anxiety (OR = 2.96; 95%CI 1.52-5.77; P = .001) were associated with SD. Also, men reporting engaging in sex with other men were associated with screening positive for SD (OR 2.66; 95%CI 1.52-5.77, P = .013). During treatment of PLHIV, it is important to evaluate sexual health and symptoms of depression and anxiety specifically. The strength of this study consists in evaluating PLHIV who have been in long-term treatment with ART and analyzing those screening positive for SD and associated factors for each group (heterosexual men, men reporting engaging in sex with other men, and women). Limitation includes the difficulty to generalize the findings of the study, and not exploring women's sexual orientation. CONCLUSION: PLHIV in long-term treatment with ART presented alarming rates of depression/anxiety which in turn is correlated with sexual and physical health problems. Scanavino MDT, Mori E, Nisida VV, et al. Sexual Dysfunctions Among People Living With HIV With Long-Term Treatment With Antiretroviral Therapy. Sex Med 2022;10:100542.

Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a qualitative systematic review.

OBJECTIVE: This systematic review aimed to identify and synthesize available qualitative evidence regarding the experiences of the transition to motherhood among pregnant women following assisted reproductive technology. INTRODUCTION: Pregnant women experience unique challenges to their identity when transitioning to motherhood following assisted reproductive technology. It is important that health care professionals understand the context and complexity of emotional adaptation to pregnancy following assisted reproductive technology. INCLUSION CRITERIA: Any qualitative data from empirical studies that described experiences of the transition to motherhood during pregnancy among women who conceived through assisted reproductive technology were considered for inclusion. METHODS: Several databases were searched for published and unpublished studies in English or Japanese from 1992 to 2019, including MEDLINE, CINAHL, PsycINFO, ProQuest Health and Medical Collection, Google Scholar, and Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). All included studies were assessed by two independent reviewers. Any disagreements were resolved through discussion. We used the recommended JBI approach to critical appraisal, data extraction, and data synthesis. RESULTS: This review included seven studies that considered pregnant women's (n = 110) experiences of transition to motherhood following assisted reproductive technology. The studies were assessed as moderate to high quality (scores 7-10) based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies or methods including phenomenology, narrative approach, qualitative description, and qualitative content analysis. There were two studies from Japan, one from Brazil, one from Iran, one from Israel, one from the UK, and one from the USA. In total, 51 supported findings were aggregated into 14 categories, and five synthesized findings: i) Pregnant women following assisted reproductive technology require support to decrease anxiety and improve their belief in pregnancy to internalize a maternal identity; ii) Pregnant women following assisted reproductive technology need reassurance of their lifestyles to ensure a safe passage through pregnancy because of ambivalent feelings about becoming a mother; iii) Pregnant women following assisted reproductive technology develop a maternal identity with affection for the fetus if they switch their mindset from infertility to pregnancy; iv) Pregnant women following assisted reproductive technology need to review their self-image of being infertile and prepare for childbirth or motherhood; v) Pregnancy following assisted reproductive technology contributes to the emergence of positive feelings and changing the women's sense of self and other personal relationships. Based on the ConQual approach, the confidence in the synthesized findings was rated as moderate to low. CONCLUSIONS: The synthesized findings highlight the importance of understanding the uncertainty and ambivalent feelings women have about their pregnancy, delayed development of attachment to their fetus and formation of a maternal identity, alteration in their relationships, and the social context of pregnancy via assisted reproductive technology among pregnant women following assisted reproductive technology. Health care professionals need to be aware of the specific care needs of these women relating to the unique pathway in the identity transition to motherhood following assisted reproductive technology. More research on development and implementation of specific intervention programs for expectant mothers following assisted reproductive technology is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019138200.

Ethical support to psychiatry residents: a report of a Brazilian ethics consultation group.

OBJECTIVE: It is not uncommon for medical residents to deal with critically ill patients who frequently show several ethical and human dilemmas, highlighting the need for a consultation with ethical specialists. The objective of this article is to present a description of a Brazilian Ethics Consultation group designed to attend psychiatry residents. METHODS: This article reports a case of a critically ill patient with Borderline Personality Disorder with multiple intervention failures and several ethical conflicts who was seen by a resident and supported by an ethics consultation group. RESULTS: When medical residents and medical staff face severe and unusual ethical dilemmas, they might feel unprepared and have ones' mental health impaired. Thus, this article reports a successful ethics consultation and discusses its development in other academic institutions. CONCLUSION: Medical educators and staff from academic hospitals should pay attention to the needs of the medical residents. The development and support of ethics consultation groups must be provided to fulfill the need of those residents who face serious ethical and human dilemmas.

Effectiveness of parenting education for expectant primiparous women in Asia: a systematic review.

OBJECTIVE: This review evaluated the effectiveness of antenatal parenting education versus usual care for maternal confidence, maternal depressive symptoms, and parenting stress among expectant primiparous women in Asia. INTRODUCTION: Previous reviews on parenting education have mostly examined practices in non-Asian countries and found that no single parenting education program met the needs of all parents. Given that there may be some common characteristics in Asian cultures, such as grandparents' involvement with child care, this review focused on specific interventions in determining the effects of practices on particular outcomes in these populations, so that providers of antenatal education can tailor interventions that are more culturally appropriate for Asian women. INCLUSION CRITERIA: Studies published in English or Japanese that included expectant primiparous women and couples in Asia who received antenatal parenting education were considered. The outcomes were maternal confidence, maternal depressive symptoms, and parenting stress. METHODS: The authors searched for English-language articles up to February 2019 using MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and PsycINFO. They also searched Ichushi-Web for Japanese articles. A gray literature search was conducted using Google Scholar and ProQuest Health and Medical Collection. Two independent reviewers selected studies, and a critical appraisal was undertaken using appropriate JBI tools. Data were presented in narrative form owing to the heterogeneity of the included studies. RESULTS: Four studies involving 652 pregnant women were included: three were randomized controlled trials, and one was a quasi-experimental study. The studies were conducted in China, Hong Kong, and Taiwan, and included the following antenatal parenting education interventions: interpersonal, psychotherapy-oriented childbirth education; childbirth psychoeducation based on the concept of learned resourcefulness; and Internet newborn-care education based on self-efficacy theory. Overall, the methodological quality of the included studies was moderate. Meta-analysis was not possible owing to the heterogeneity, including small sample sizes and differences in intervention content, populations, and follow-up times. A subsequent narrative synthesis was undertaken for each outcome. Of three studies with maternal confidence as an outcome (n = 496), two showed significantly higher maternal confidence at six weeks' (P = 0.000, Cohen's d = 1.41) and three months' postpartum (P = 0.016, Cohen's d = 0.35) in the intervention groups; however, one study showed no significant group differences. Of three studies with maternal depressive symptoms as an outcome (n = 534), two found significantly fewer depressive symptoms at three months' (P = 0.018, Cohen's d = -0.34) and six months' postpartum (P = 0.005, Cohen's d = -0.42) in the intervention groups; however, one study revealed no significant group differences. Parenting stress was examined in one study (n = 156); it showed significantly lower parenting stress (P = 0.017, Cohen's d = 0.38) immediately after the intervention. CONCLUSIONS: There is insufficient evidence to support the effectiveness of a specific type of antenatal parenting education for maternal confidence, maternal depressive symptoms, and parenting stress for expectant primiparous women in Asia. However, the findings suggest that specific theory-oriented antenatal parenting education is potentially effective for those women. Further high-quality studies are needed for antenatal parenting education among expectant primiparous women, especially in Asia.

Application of Continuous Glucose Monitoring for Assessment of Individual Carbohydrate Requirement during Ultramarathon Race.

BACKGROUND: The current study intended to evaluate the feasibility of the application of continuous glucose monitoring to guarantee optimal intake of carbohydrate to maintain blood glucose levels during a 160-km ultramarathon race. METHODS: Seven ultramarathon runners (four male and three female) took part in the study. The glucose profile was monitored continuously throughout the race, which was divided into 11 segments by timing gates. Running speed in each segment was standardized to the average of the top five finishers for each gender. Food and drink intake during the race were recorded and carbohydrate and energy intake were calculated. RESULTS: Observed glucose levels ranged between 61.9-252.0 mg/dL. Average glucose concentration differed from the start to the end of the race (104 ± 15.0 to 164 ± 30.5 SD mg/dL). The total amount of carbohydrate intake during the race ranged from 0.27 to 1.14 g/kg/h. Glucose concentration positively correlated with running speeds in segments (P < 0.005). Energy and carbohydrate intake positively correlated with overall running speed (P < 0.01). CONCLUSION: The present study demonstrates that continuous glucose monitoring could be practical to guarantee optimal carbohydrate intake for each ultramarathon runner.

Nursing intervention for preventing postpartum depressive symptoms among Chinese women in Japan.

AIM: We evaluated the effectiveness of a nursing intervention program for Chinese women who are giving birth in Japan to reduce cross-cultural stressors during the postpartum period and prevent postpartum depressive symptoms. METHODS: A prospective, before-and-after study incorporating a longitudinal mixed-method design was conducted. Thirty-eight participants underwent this program from August 2016 to July 2017. The program comprised a maternity class, conversation cards, and a social-network group. Data collection was initially performed using questionnaires administered in the third trimester (T1)-before the intervention-to obtain participants' basic information, stress levels, depressive symptoms, and cognitive appraisals. Then, stress levels, depressive symptoms, and social support were measured during hospitalization after having given birth (T2) and during the first month postpartum (T3). Finally, through semi-structured interviews, cognitive appraisal, coping, stress, social support, participants' evaluations of the intervention were determined. RESULTS: Post-intervention, all participants showed positive cognitive appraisals, although eight also showed some negative appraisals. At T3, 36 participants did not report experiencing stress owing to cross-cultural stressors. Furthermore, post-intervention, participants who returned scores that were suggestive of depression remained identical to that at pre-intervention (21.1%). Among the eight participants who showed postpartum depressive symptoms during T3, seven did not report experiencing cross-cultural stressors, but did report encountering maternity stressors. CONCLUSION: The nursing intervention program may be effective for preventing postpartum depressive symptoms in Chinese women who give birth in Japan. Since this was a pre-post study in which one group was measured pre-intervention and again post-intervention, we did not register in a publicly assessible database.

Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a systematic review protocol of qualitative evidence.

OBJECTIVE: This systematic review aims to identify and synthesize available qualitative evidence related to the experiences of transition to motherhood during pregnancy in women who conceived through assisted reproductive technology (ART). INTRODUCTION: Women who conceived through ART experience pregnancy-specific anxiety and paradoxical feelings, and face unique challenges in their identity transition to motherhood. It is important for healthcare professionals working with these women to understand the context and complexity of this special path to parenthood, including the emotional adaptation to pregnancy following ART. A qualitative systematic review can provide the best available evidence to inform development of nursing interventions to meet the needs of pregnant women after ART. INCLUSION CRITERIA: This review will consider any qualitative research data from empirical studies published from 1992-2019 in English or Japanese that described experiences of transition to motherhood during pregnancy in women who conceived with ART. METHODS: This review will follow the JBI approach for qualitative systematic reviews. Databases that will be searched for published and unpublished studies include MEDLINE, CINAHL, PsycINFO, ProQuest Health & Medical Collection, Google Scholar and Open Access Theses and Dissertations (in English), and Ichushi-Web, CiNii and the Institutional Repositories Database (in Japanese). Titles and abstracts will be screened by two independent reviewers in full. The full-text of selected studies will be assessed in detail, and findings and their illustrations will be extracted and aggregated. Any disagreements between the reviewers that arise at each stage will be resolved through discussion, or by a third reviewer.

The Effect of Grandmothers' Presence on the Provision of Multidisciplinary Perinatal Support for Pregnant and Postpartum Women with Psychosocial Problems.

BACKGROUND: Pregnant and postpartum women with psychosocial problems are prone to face limited or absent perinatal functional support from biological grandmothers due to familial dysfunction. The study aimed to investigate whether the involvement and presence of biological maternal grandmothers providing practical support for their pre/postnatal daughters (ie, pregnant women) during the perinatal period may influence the number of support services provided by multidisciplinary agencies, including child consultation centers and municipal offices. PARTICIPANTS AND METHODS: This is a retrospective cohort study based on the medical records of all pregnant women with psychosocial problems that visited, gave birth, and received intervention from the hospital-based child protection unit at the Chiba University Hospital between February 2018 to March 2019. The primary outcome was to identify whether there was a difference in the number of multidisciplinary agencies providing perinatal support between pregnant women with and without the presence of functional support from biological maternal grandmothers during the perinatal period. RESULTS: We identified 114 pregnant and postpartum women with psychosocial problems. Seventy-six of these participants (66.7%) had functional support from their biological maternal grandmothers during the perinatal period, and 38 participants (33.3%) did not. The number of agencies involved with participants who lacked functional support was significantly higher than participants with functional support (t(55.14) = 2.98, p < 0.01). This finding was consistent among pregnant and postpartum primipara participants (n = 70) (t(68) = 3.87, p < 0.001), but not multipara (n = 44). CONCLUSION: The findings indicate that the presence and functional support of biological maternal grandmothers influence the support that is needed from multidisciplinary perinatal support systems by pregnant and postpartum women with psychosocial problems. Primipara mothers without support from their own mothers may need greater multidisciplinary support.

Cytokine analysis on a countable number of molecules from living single cells on nanofluidic devices.

Analysis of proteins released from living single cells is strongly required in the fields of biology and medicine to elucidate the mechanism of gene expression, cell-cell communication and cytopathology. However, as living single-cell analysis involves fL sample volumes with ultra-small amounts of analyte, comprehensive integration of entire chemical processing for single cells and proteins into spaces smaller than single cells (pL) would be indispensable to prevent dispersion-associated analyte loss. In this study, we proposed and developed a living single-cell protein analysis device based on micro/nanofluidics and demonstrated analysis of cytokines released from living single B cells by enzyme-linked immunosorbent assay. Based on our integration method and technologies including top-down nanofabrication, surface modifications and pressure-driven flow control, we designed and prepared the device where pL-microfluidic- and fL-nanofluidic channels are hierarchically allocated for cellular and molecular processing, respectively, and succeeded in micro/nanofluidic control for manipulating single cells and molecules. 13-unit operations for pL-cellular processing including single-cell trapping and stimulation and fL-molecular processing including fL-volumetry, antigen-antibody reactions and detection were entirely integrated into a microchip. The results suggest analytical performances for countable interleukin (IL)-6 molecules at the limit of detection of 5.27 molecules and that stimulated single B cells secrete 3.41 IL-6 molecules per min. The device is a novel tool for single-cell targeted proteomics, and the methodology of device integration is applicable to other single-cell analyses such as single-cell shotgun proteomics. This study thus provides a general approach and technical breakthroughs that will facilitate further advances in micro/nanofluidics, single-cell life science research, and other fields.

Enzyme-linked immunosorbent assay utilizing thin-layered microfluidics.

A rapid and sensitive enzyme-linked immunosorbent assay (ELISA) is required for on-site clinical diagnosis. Previously, a microfluidic ELISA in which antibody-immobilized beads are packed in a microchannel for a high surface-to-volume (S/V) ratio was developed, but utilizing beads led to complicated fluidic operation. Recently, we have reported nanofluidic ELISA that utilizes antibody-immobilized glass nanochannels (102-103 nm) to achieve a high S/V ratio without beads, enabling even single-molecule detection, but it is not applicable to clinical diagnosis owing to its fL sample volume, much smaller than the nL-µL sample volume in clinical diagnosis. Here, we propose an antibody-immobilized, thin-layered microfluidic channel as a novel platform. Based on the method of nanofluidic ELISA, the channel width was expanded from 103 nm to 100 mm to expand the volume of the reaction field to 102 nL, while the channel depth (103 nm) was maintained to retain the high S/V ratio. A device design which incorporates a taper-shaped interface between the thin-layered channel and the microchannel for sample injection was proposed, and the uniform introduction of the sample into the high-aspect-ratio (width/depth ∼ 200) channel was experimentally confirmed. For the proof of concept, a thin-layered ELISA device with the same S/V ratio as the bead-based ELISA format was designed and fabricated. By measuring a standard C-reactive protein solution, the working principle was verified. The limit of detection was 34 ng mL-1, which was comparable to that of bead-based ELISA. We believe that the thin-layered ELISA can contribute to medicine and biology as a novel platform for sensitive and rapid ELISA.

Effectiveness of parenting education for expectant primiparous women in Asian countries: a quantitative systematic review protocol.

REVIEW QUESTION: What is the effect of antenatal parenting education on parenting stress, maternal depressive symptoms and maternal confidence, compared to usual care, for expectant primiparous women in Asian countries?

Relationship between the mode of conception and depressive symptoms during the first 6 months post-partum in Japan.

PURPOSE: To determine whether conventional treatment and assisted reproductive technology for infertility are associated with depressive symptoms and to identify the predictors of depressive symptoms during the first 6 months' post-partum. METHODS: A prospective cohort design was used, with the participants being recruited from 13 Japanese hospitals. Using self-report questionnaires, a total of 2709 women (response rate: 71.9%) provided longitudinal data at five time points: during their hospital stay and at 1, 2, 4, and 6 months' post-partum. The depressive symptoms were measured by using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). A logistic regression analysis was used to examine the association between the mode of conception and depressive symptoms and to identify the predictors of the depressive symptoms. RESULTS: There was no significant association between the mode of conception and the depressive symptoms at any time point. Six factors that were associated with the EPDS score were first-time childbirth, emergency cesarean delivery, infant feeding, financial burden, having a male infant, and dissatisfaction with social support. CONCLUSION: There was no significant relationship between the mode of conception and depressive symptoms. Nursing care should be based on individual assessments that focus on parity, the delivery method, infant feeding method, financial burden, the infant's sex, and social support, rather than on the mode of conception.

Shoulder stiffness, back pain, and wrist pain: Are older primiparas more vulnerable?

AIM: To describe changes in prevalence of shoulder stiffness, back pain, and wrist pain during the first 6 months postpartum, and to examine the association of these symptoms with maternal age and parity. METHODS: Participants were recruited from 13 Japanese hospitals between 2012 and 2013. A total of 2709 (response rate 71.9%) women provided longitudinal data, using self-report questionnaires at 5 time points: during their hospital stay, and at 1, 2, 4, and 6 months postpartum. Shoulder stiffness, back pain, and wrist pain were measured, using checklists with yes-no responses. The effects of age and parity were assessed in 4 groups of younger (<35 years) and older (≥35 years) mothers: 983 younger primiparas, 481 older primiparas, 649 younger multiparas, and 596 older multiparas. Chi-square tests and Cochran's Q tests were used to assess effects of group and time. RESULTS: Prevalence of shoulder stiffness, back pain, and wrist pain during the hospital stay significantly increased up to 1 month postpartum for older primiparas, who were also the most vulnerable to back pain and wrist pain at 1 month postpartum. CONCLUSION: Special attention should be given to older primiparas in assessing and providing nursing care for physical symptoms, especially during the first month postpartum.

Course of maternal fatigue and its associated factors during the first 6 months postpartum: a prospective cohort study.

Aims: To identify the course of maternal fatigue during the first 6 months postpartum and to determine factors associated with it. Design: A prospective cohort study. Methods: Women (N = 2,697) in 13 Japanese hospitals provided longitudinal data using self-report questionnaires at five time points. Maternal fatigue was assessed using the Postnatal Accumulated Fatigue Scale. We focused on the effect of maternal age and parity on the course of maternal fatigue and used a mixed between/within-subjects analysis of variance. Factors associated with maternal fatigue were analysed using stepwise multiple regression. Results: In the 6-month postpartum period, the level of fatigue was highest at 1 month and significantly decreased from 1-4 months postpartum. Primiparas showed a significantly higher level of fatigue than multiparas during hospital stay and their levels of fatigue more closely approximated the 1-month peak. Multiparas showed significantly higher levels of fatigue than younger primiparas at 6-month postpartum. Factors associated with maternal fatigue included satisfaction with sleep, concerns about child-rearing, satisfaction with social support, financial burden and meal times per day.

Association between physical and depressive symptoms during the first 6 months postpartum.

AIM: To examine the relationship between physical symptoms and depressive symptoms among new mothers during the first 6 months postpartum. METHODS: Prospective cohort study design was used in this study. Participants were recruited in 13 Japanese hospitals between 2012 and 2013. A total of 2709 women (response rate of those invited 71.9%) provided longitudinal data using self-report questionnaires at 5 time points: during the hospital stay and at 1, 2, 4, and 6 months postpartum. Depressive symptoms were measured using the Japanese version of the Edinburgh Postnatal Depression Scale. Also, 37 physical symptoms were measured using a yes-or-no checklist. To examine the association between physical symptoms and depressive symptoms, logistic regression analysis was used. RESULTS: There was a significant positive association between physical symptoms and depressive symptoms during the first 6 months postpartum. Fifteen physical symptoms were associated with significantly increased odds of depression at 1, 2, 4, and 6 months post-partum. These symptoms included: loss of appetite, tiredness/languor, and palpitation/shortness of breath. CONCLUSION: Multiple physical symptoms after childbirth were associated with depressive symptomatology. Health professionals should assess for postpartum depression when puerperal women report multiple physical symptoms as independent complaints.

Postpartum maternal function and parenting stress: Comparison by feeding methods.

AIM: This cross-sectional and longitudinal study explored primiparous mothers' functioning and parenting stress on the basis of infant-feeding method over the first 6 months postpartum. METHODS: Participants were Japanese primiparae who delivered live singleton infants (N = 1120). Questionnaires, completed at 1, 2, 4, and 6 months postpartum, included demographics, feeding method, frequency of feedings, time required from infant's feeding to falling asleep, mother's sleep time, Postnatal Accumulated Fatigue Scale, and the original Japanese version of Parenting Stress Short-Form Scale. Chi-square tests and Welch F tests for one-way analysis of variance were conducted. RESULTS: Exclusively breastfeeding mothers fed their infants more frequently, but required less time from infant's feeding to falling asleep than either mixed or formula-feeding mothers. Mixed feeding mothers required more time for infant feeding and reported more severe fatigue and greater parenting stress than breastfeeding mothers at 1 and 2 months postpartum. Exclusively formula-feeding mothers required more time to get their infant back to sleep and reported greater parenting stress than the other groups at 6 months postpartum. Nearly 25% of mothers continued breastfeeding exclusively through the first 6 months postpartum. Mothers often changed feeding methods, with many exclusively breastfeeding by 6 months. CONCLUSION: Feeding methods may affect maternal functioning and parenting stress across the postpartum period.

Fatigue, depression, maternal confidence, and maternal satisfaction during the first month postpartum: A comparison of Japanese mothers by age and parity.

The aim of the study was to assess fatigue, depressive symptoms, and maternal confidence or satisfaction among older primiparae during the first month postpartum. The number of older Japanese primiparae has rapidly increased. Older primiparae are believed to be at high risk for puerperal morbidity. A multicentre prospective cohort study design was used. Data were examined from 2854 Japanese women who participated in a 6-month prospective cohort study conducted between May 2012 and September 2013. The women were classified into 4 groups based on maternal age and parity. All participants completed the Postnatal Accumulated Fatigue Scale, Japanese Edinburgh Postnatal Depression Scale, Postpartum Maternal Confidence Scale, and Postpartum Maternal Satisfaction Scale. Primiparae in all age groups were more severely fatigued and had a higher risk of postpartum depression than multiparous mothers during the first month postpartum. Older primiparae had significantly lower scores on maternal confidence and maternal satisfaction than the other 3 groups at 1 month postpartum. These findings suggest that postpartum nursing should focus on promoting adequate sleep, providing emotional support, and fostering the process of maternal role adaptation among older Japanese primiparae, particularly during the first postpartum month.

Prevalence of postpartum depressive symptoms during the first 6 months postpartum: Association with maternal age and parity.

BACKGROUND: Depressive symptoms are common in postpartum women. The present study aimed to describe changes in the prevalence of depressive symptoms during the first 6 months postpartum, and their association with maternal age and parity. METHODS: A prospective cohort study was conducted with 3769 women at 13 hospitals in Japan. Depressive symptoms were measured during hospital stay and at 1, 2, 4, and 6 months postpartum, using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). The effects of maternal age and parity were assessed by comparing four groups: younger primiparas (aged <35 years); older primiparas (≥35 years); younger multiparas (<35 years); and older multiparas (≥35 years). Data were analyzed using a mixed between/within-subjects analysis of variance, Cochran's Q tests, and chi-square tests. RESULTS: Mean EPDS scores significantly decreased from 1 to 2 months postpartum in all groups. The proportion of women with EPDS scores ≥9 significantly decreased during the same period for primiparas but not for multiparas. Primiparas also had significantly higher EPDS scores than multiparas during hospital stay and at 1 month postpartum. LIMITATIONS: As we used convenience sampling, our study sample was not fully representative of Japanese mothers. This study was also limited by our focus on the postpartum period. CONCLUSIONS: The first month postpartum represented peak prevalence for depressive symptoms. Primiparity was a risk factor for depressive symptoms only during the first month postpartum. Healthcare professionals should be sensitive to postpartum duration and parity when monitoring depressive symptoms.