Effectiveness of a Digital Decision Aid for Nutrition Support in Women with Gynaecological Cancer: A Comparative Study.

This study aimed to examine the effects of an animated Patient Decision Aid (PtDA) about dietary choices on decisional conflict and decision regret. A prospective, observational, two-group comparative effectiveness study was conducted with patients (n = 90) from a southern Taiwan oncology inpatient unit. Data included the Malnutrition Universal Screening Tool (MUST), laboratory results, 16-item Decisional Conflict Scale (sf-DCS), and 5-item Decision Regret Scale (DRSc). Data were collected at admission (T0), after the first-cycle of chemotherapy but before discharge (T1), and after the six-cycle chemotherapy protocol (T2) (around 3 months). Group A received standardized nutrition education and a printed brochure, while Group B watched a 10-minute information video during a one-on-one inpatient consultation and engaged in a values clarification exercise between T0 and T1. The percentage of women with a MUST score ≧1 in Group A sharply increased over time, but not in Group B. Decision aid usage significantly increased patients' hemoglobin and lymphocyte values over time (p < 0.05). The digital PtDA contributed to less decisional conflict and decision regret in at-risk patients and improved their nutritional well-being. Decision-aids help patients make healthcare decisions in line with their values, and are sustainable for use by busy clinicians.

Impact of disrespectful maternity care on childbirth complications: a multicentre cross-sectional study in Ethiopia.

BACKGROUND: Globally, disrespectful, and abusive childbirth practices negatively impact women's health, create barriers to accessing health facilities, and contribute to poor birth experiences and adverse outcomes for both mothers and newborns. However, the degree to which disrespectful maternity care is associated with complications during childbirth is poorly understood, particularly in Ethiopia. AIM: To determine the extent to which disrespectful maternity care is associated with maternal and neonatal-related complications in central Ethiopia. METHODS: A multicentre cross-sectional study was conducted in the West Shewa Zone of Oromia, Ethiopia. The sample size was determined using the single population proportion formula. Participants (n = 440) were selected with a simple random sampling technique using computer-generated random numbers. Data were collected through face-to-face interviews with a pretested questionnaire and were entered into Epidata and subsequently exported to STATA version 17 for the final analysis. Analyses included descriptive statistics and binary logistic regression, with a 95% confidence interval (CI) and an odds ratio (OR) of 0.05. Co-founders were controlled by adjusting for maternal sociodemographic characteristics. The primary exposure was disrespectful maternity care; the main outcomes were maternal and neonatal-related complications. RESULTS: Disrespectful maternity care was reported by 344 women (78.2%) [95% CI: 74-82]. Complications were recorded in one-third of mothers (33.4%) and neonates (30%). Disrespectful maternity care was significantly associated with maternal (AOR = 2.22, 95% CI: 1.29, 3.8) and neonatal-related complications (AOR = 2.78, 95% CI: 1.54, 5.04). CONCLUSION: The World Health Organization advocates respectful maternal care during facility-based childbirth to improve the quality of care and outcomes. However, the findings of this study indicated high mistreatment and abuse during childbirth in central Ethiopia and a significant association between such mistreatment and the occurrence of both maternal and neonatal complications during childbirth. Therefore, healthcare professionals ought to prioritise respectful maternity care to achieve improved birth outcomes and alleviate mistreatment and abuse within the healthcare sector.

An evaluation of Neuroprotective Developmental Care (NDC/Possums Programs) in the First 12 Months of Life.

BACKGROUND: Transitioning to motherhood is an important life event. Stress often arises due to feeding concerns, infant crying, and sleep problems. Neuroprotective Developmental Care (NDC) also known as the Possums programs provides an evidence-based, consistent and holistic approach to maternal and infant wellbeing. OBJECTIVES: To understand maternal characteristics at point of services access and an exploratory evaluation of effectiveness of NDC/Possums services. METHODS: All mothers accessing NDC/Possums services via clinical services or self-paced online modules were invited to participate in a baseline survey. Follow up occurred when infants were 6 and 12 months of age. Participants who completed the 6-month survey were compared against their own baseline surveys. Those who completed the survey at 12-months were compared against their own baseline surveys. A pseudo-control group who had completed the baseline survey with infants 12 months of age was also compared to those who had accessed NDC/Possums services prior to 12 months of age (termed 'intervention' group). RESULTS: Crying time, mothers' perceptions of infant sleep problems, mothers' own sleep, mothers' Acceptance and Action Questionnaire (AAQ) scores and the mothers' Edinburgh Postnatal Depression Scale (EPDS) scores showed statistically significant improvements from baseline to 12-month old follow-up. Significant differences were also found between the pseudo-control group and 'intervention' groups. CONCLUSIONS FOR PRACTICE: This results indicate that accessing NDC/Possums services is efficacious in addressing infant's crying, the mother's perceptions of their baby's sleep problems, the mother's own sleep satisfaction, the mother's experiential avoidance, and the mother's risk of postnatal depression. NDC is relevant to public health, clinical service delivery and education for health professionals.

Prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China: a cross-sectional study.

OBJECTIVES: To determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China. METHODS: A cross-sectional study was conducted in a tertiary hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0. RESULTS: A total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18-54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39-6.29), had low social support (aOR = 2.95, 95% CI 1.39-6.29), were non-local residents (aOR = 2.51, 95% CI 1.15-5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15-5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18-3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67-47.09), had completed higher education (aOR = 12.28, 95% CI 1.24-121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37-8.32). CONCLUSIONS: The magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women.

Development of a co-designed, evidence-based, multi-pronged strategy to support normal birth.

Australia's caesarean section (CS) rate has been steadily increasing for decades. In response to this, we co-designed an evidence-based, multi-pronged strategy to increase the normal birth rate in Queensland and reduce the need for CS. We conducted three workshops with a multi-stakeholder group to identify a broad range of options to reduce CS, prioritise these options, and achieve consensus on a final strategy. The strategy comprised of: universal access to midwifery continuity-of-care and choice of place of birth; multi-disciplinary normal birth education; resources to facilitate informed decision-making; respectful maternity care and positive workplace culture; and establishment of a Normal Birth Collaborative.

Development of the Woman-Centred Care Scale- Midwife Self Report (WCCS-MSR).

BACKGROUND: Woman-centred care is recognised as a fundamental construct of midwifery practice yet to date, there has been no validated tool available to measure it. This study aims to develop and test a self-report tool to measure woman-centred care in midwives. METHODS: A staged approach was used for tool development including deductive methods to generate items, testing content validity with a group of experts, and psychometrically testing the instrument with a sample drawn from the target audience. The draft 58 item tool was distributed in an online survey using professional networks in Australia and New Zealand. Testing included item analysis, principal components analysis with direct oblimin rotation and subscale analysis, and internal consistency reliability. RESULTS: In total, 319 surveys were returned. Analysis revealed five factors explaining 47.6% of variance. Items were reduced to 40. Internal consistency (.92) was high but varied across factors. Factors reflected the extent to which a midwife meets the woman's unique needs; balances the woman's needs within the context of the maternity service; ensures midwifery philosophy underpins practice; uses evidence to inform collaborative practice; and works in partnership with the woman. CONCLUSION: The Woman-Centred Care Scale-Midwife Self Report is the first step in developing a valid and reliable tool to enable midwives to self-assess their woman-centredness. Further research in alternate populations and refinement is warranted.

Australian hospital staff perceptions of barriers and enablers of domestic and family violence screening and response.

BACKGROUND: Hospital presentations provide unique opportunities to detect DFV. However, up to 70% of women experiencing Domestic and Family Violence (DFV) go undetected by hospital staff. While routine DFV screening is internationally encouraged, there is still much debate surrounding its implementation. The aim of the study was to determine staff perceptions of barriers and enablers of DFV screening and response. METHODS: A cross-sectional survey was conducted at a tertiary level public hospital and health service. Health care staff in allied health, maternity and mental health divisions (n = 615) were invited to participate by email and through team meetings. 172 responses were analysed. RESULTS: Less than a third of respondents reported routinely asking patients about DFV, with 34.9% reporting they did not have sufficient training to assist with DFV. Increased levels of training were positively correlated with screening practices, preparedness and knowledge. Major barriers were presence of partner and language barriers, while written protocols and supportive work environment were the principal enablers of screening. CONCLUSION: Staff generally believed that routine screening was important and should encompass all forms of abuse. Many felt ill-equipped to ask about or manage disclosure of DFV. More training improves staff capacity for DFV detection and response, and written guidelines should be made available to all staff.

Effects of a mobile phone application for graduate nurses to improve central venous catheter care: A randomized controlled trial.

AIM: To develop and test a mobile phone application (app) for graduate nurses on the use and care of central venous catheters. DESIGN: A randomized controlled trial was conducted at a teaching hospital in the central east coast of Taiwan. METHODS: Recruitment occurred from 1 August 2019 -31 October 2019. All graduates (N = 90) attending a 2-week induction program attended a lecture and completed a 10-item questionnaire on central venous catheter assessment and care at the end of Week 1 (Time 1). Volunteers were then randomly allocated to receive a link to the learning app on their mobile phone (n = 39 Group A) or control condition (N = 40 Group B). One week later, all graduates completed the knowledge assessment (Time 2) and a simulated clinical assessment with a mannequin. Skills were assessed using an 11-item, direct observation of procedural skills form. Only data from consenting participants were analysed. RESULTS: Compared with controls, nurses receiving the intervention reported significantly better knowledge (t = -7.98, p < .001, CI = 20.9~34.8) and skill scores (t = 2.83, p = .006, CI = 1.14~6.61). More frequent use of the mobile phone app was associated with higher knowledge (r = 0.39, p = .02, CI = 0.11~0.99) and skills (r = 0.42, p = .008, CI = 0.17~1.03). CONCLUSION: Mobile app instruction for graduate nurses on central venous catheter care increased specific knowledge and skills compared with conventional methods of instruction. IMPACT STATEMENT: Implementation of mobile phone application technology can be considered a feasible means to proactively provide training and education. Mobile phone apps could be developed for a range of clinical procedures and various settings. Future studies with a larger sample and a longitudinal follow-up are warranted to confirm results.

Quality of measures on respectful and disrespectful maternity care: A systematic review.

This systematic review aimed to critique the process of development and psychometric properties of tools measuring respectful or disrespectful maternity care experienced by women during labor and birth in low- and middle-income countries. The MEDLINE, Embase, CINAHL, Web of Science, PubMed, and Cochrane Library electronic databases were systematically searched from their inception to February 2020. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. Six tools measuring respectful maternity care during the intrapartum period were identified. Measurement error, cross-cultural validity, and responsiveness were not evaluated by any tool developers, while structural validity, internal consistency, and hypothesis testing were the most frequently assessed measurement properties. Interestingly, this review could not identify any measures of disrespectful care even though most included measures focused on disrespect and abuse. No measure was of sufficient quality to determine women's experiences of disrespectful and respectful maternity care in low- and middle-income countries. New valid and reliable measures using rigorous approaches to tool development are required.

Reducing caesarean delivery: An economic evaluation of routine induction of labour at 39 weeks in low-risk nulliparous women.

BACKGROUND: Clinical interventions known to reduce the risk of caesarean delivery include routine induction of labour at 39 weeks, caseload midwifery and chart audit, but they have not been compared for cost-effectiveness. OBJECTIVE: To assesses the cost-effectiveness of three different interventions known to reduce caesarean delivery rates compared to standard care; and conduct a budget impact analysis. METHODS: A Markov microsimulation model was constructed to compare the costs and outcomes produced by the different interventions. Costs included all costs to the health system, and outcomes were quality-adjusted life years (QALY) gained. A budget impact analysis was undertaken using this model to quantify the costs (in Australian dollars) over three years for government health system funders. RESULTS: All interventions, plus standard care, produced similar health outcomes (mean of 1.84 QALYs gained over 105 weeks). Caseload midwifery was the lowest cost option at $15 587 (95% confidence interval [CI] 15 269, 15 905), followed by routine induction of labour ($16 257, 95% CI 15 989, 16 536), and chart audit ($16 325, 95% CI 15 979, 16 671). All produced lower costs on average than standard care ($16 905, 95% CI 16 551, 17 259). Caseload midwifery would produce the greatest savings of $172.6 million over three years if implemented for all low-risk nulliparous women in Australia. CONCLUSIONS: Caseload midwifery presents the best value for reducing caesarean delivery rates of the options considered. Routine induction of labour at 39 weeks and chart audit would also reduce costs compared to standard care.

Comparison of screening accuracy of the Patient Health Questionnaire-2 using two case-identification methods during pregnancy and postpartum.

BACKGROUND: Variation exists regarding perinatal depression screening. A two-step screening method has been recommended. According to a maternity-focused core outcome set developed by the International Consortium for Health Outcomes Measurement, women who score 3 or more on the PHQ-2 then complete the Edinburgh Postnatal Depression Scale (EPDS). Limited evidence exists regarding the screening accuracy of the PHQ-2 in childbearing women. An alternative case-identification method may be more sensitive for perinatal women. We aimed to [1] evaluate the screening accuracy of the PHQ-2 during the perinatal period using two case-identification methods, and [2] measure the variability of accuracy over four time-points during pregnancy and postpartum. METHODS: A prospective, longitudinal cohort study was conducted with 309 consecutive women who completed the PHQ-2 and EPDS during pregnancy (booking, 36-weeks) and postpartum (6-, 26-weeks). EPDS was the reference standard using cut-off scores for 'at least probable minor depression' during pregnancy (≥ 13) and postpartum (≥ 10) and for 'probable major depression' during pregnancy (≥ 15) and postpartum (≥ 13). PHQ-2 was analysed using two methods: [1] scored (cut-points ≥ 2 and ≥ 3), [2] dichotomous yes/no (positive response to either question) against EPDS cut-points for at least probable minor and probable major depression. Receiver operating characteristic analyses determined accuracy. RESULTS: Probable major depression: Over four timepoints PHQ-2 ≥ 3 revealed lowest sensitivity (36-79%) but highest specificity (94-98%). An alternative case-identification method revealed high sensitivity (93-100%), but lowest specificity (58-71%). Minor depression: PHQ-2 ≥ 3 revealed the lowest sensitivity (19-50%) but highest specificity (95-98%). An alternative case-identification method revealed the highest sensitivity (81-100%) and moderate specificity (60-74%). CONCLUSIONS: Recommended method of case-identification (PHQ-2 ≥ 3) missed an unacceptable number of women at-risk of depression. As a clinical decision-making tool, an alternative, dichotomous method maximized case-identification and is recommended. Further, the literature identified inconsistent reporting of the PHQ-2 and the alternative case-identification method hindering the ability to synthesise data. The future use and reporting of consistent question wording and response format will improve outcome reporting and synthesis. Further research in larger and diverse maternity populations is recommended.

Impact of traumatic birth on Australian obstetricians: A pilot feasibility study.

BACKGROUND: Traumatic stress can adversely affect obstetricians' mental health and may affect care provision. Little is known about the impact of traumatic birth on the Australasian obstetric workforce. AIM: To assess the feasibility of conducting a binational survey of Australia and New Zealand obstetricians, trainees, and general practitioner obstetricians, to determine the prevalence of trauma exposure and associated factors. MATERIALS AND METHODS: Feasibility was assessed using a convergent mixed-methods design. The pilot online survey assessed traumatic exposure and included the Posttraumatic Diagnostic Scale, Copenhagen Burnout Inventory (work subscale), and Posttraumatic Growth Inventory (short form). Qualitative data were generated from survey comments and telephone interviews and thematically analysed. RESULTS: Using various recruitment strategies, 32 participants completed the survey, and eight completed interviews. Most participants were consultant obstetricians. Nearly all (n = 31, 96.9%) had been exposed to traumatic birth(s). Three-quarters had current symptoms of traumatic stress, one-quarter had symptoms of work-related burnout, but over two-fifths reported significant post-traumatic growth. Thematic analysis revealed perceptions that 'obstetricians experience substantial trauma', there is a 'culture of blame in obstetrics', and only 'in some workplaces it's supportive and safe'. Feasibility issues included the need to identify the respondent's level of training at the time when their most traumatic birth occurred, ensure anonymity of responses, and use a different tool to assess traumatic stress symptoms. CONCLUSIONS: Conducting a full study of this important topic appeared feasible. Standardised measures were acceptable. Revision of some questions is required. Anonymity needs to be promoted.

Nonpharmacological interventions to improve the psychological well-being of women accessing abortion services and their satisfaction with care: A systematic review.

How women perceive and experience abortion impacts their subsequent psychological well-being. This systematic review evaluated nonpharmacological interventions designed to support women undergoing abortion services and improve their psychological well-being and satisfaction with care. Searches were conducted in MEDLINE, CINAHL, the Cochrane Library, PsycINFO, Sociological Abstracts, Social Services Abstracts, and PTSD Pubs. All searches were limited to peer-reviewed articles published in English from January 2010 to February 2020. Two reviewers independently assessed study eligibility. Ten studies were included, involving four types of interventions: music therapy; social support; information support; and mandated waiting and counseling requirements on abortion access. Outcome measures were divided into four categories comprised of cognitive domains, emotional and psychological well-being, clinical symptoms, and satisfaction with care. However, there is limited evidence on intervention effects. Most studies report null or mixed intervention effects. Even though some positive effects on women's cognitive outcomes and satisfaction with care were seen, findings across studies were inconclusive. Findings also show that methodological limitations such as lack of theoretical basis, inadequate reporting and no power sample size calculation were apparent across studies. There is limited evidence about nonpharmacological interventions designed to improve women's satisfaction with abortion services or psychological outcomes subsequent to accessing abortion services. Well-designed interventions that meet the needs of service-users should be developed and rigorously tested.

Evaluating the "possums" health professional training in parent-infant sleep.

Infant sleep problems are among the most common issues reported by parents in the postnatal period. Yet, infant sleep and infant sleep interventions remain controversial. This study evaluated health professional training in a novel approach to parent-infant sleep: the Possums Sleep Intervention. Health professionals (n = 144) completed a short survey before and after the training, which focused on the sleep component. The Possums Sleep Intervention training included the following topics: sleep science, cued care, sleep hygiene, relaxation for parents and babies, problem solving, and acceptance and commitment therapy (ACT). Health professionals reported: improvements in knowledge on infant sleep regulation, the mother-infant relationship and ACT; improvements in health professionals' own sleep quality; improvements in psychological flexibility; and a reduction in professional burnout and secondary traumatic stress. Moreover, the health professional training was received positively. Overall, this study is supportive of the Possums Sleep Intervention health professional training.

Los problemas infantiles para dormir están entre los asuntos más comúnmente reportados por los padres en el período postnatal. Aun así, el dormir del infante y las intervenciones en el caso del dormir del infante se mantienen controversiales. Este estudio evaluó el entrenamiento de profesionales de la salud a través de un acercamiento novedoso al dormir de progenitor-infante: la Intervención 'Possums' (Zarigüeyas) del Dormir. Los profesionales de la salud (n = 144) completaron una encuesta corta antes y después del entrenamiento, el cual se enfocó en el componente de dormir. El entrenamiento de la Intervención 'Possums' del Dormir incluyó los siguientes temas: la ciencia del dormir; el cuidado señalado; la higiene de dormir; la relajación para padres y bebés; el resolver problemas; y la terapia de aceptación y compromiso (ACT). Los profesionales de la salud reportaron: mejoras en el conocimiento acerca de la regulación del dormir del infante, la relación madre-infante y ACT; mejoras en la calidad del propio dormir de los profesionales de la salud; mejoras en la flexibilidad sicológica; y una reducción en el agotamiento profesional y el estrés traumático secundario (STS). Es más, se recibió positivamente el entrenamiento a los profesionales de la salud. En general, este estudio apoya el entrenamiento de profesionales de la salud en la Intervención 'Possums' del Dormir. Palabras claves: dormir, infancia, postnatal, terapia de aceptación y compromiso, profesionales de la salud.

Les problèmes de sommeil du nourrisson se trouvent parmi les problèmes les plus fréquents dont font état les parents durant la période postnatale. Cependant le sommeil du nourrisson et les interventions en sommeil du nourrisson demeurent à controverse. Cette étude a évalué la formation de professionnels de la santé dans une nouvelle approche du sommeil parent-nourrisson: l'Intervention Sommeil Possums. Des professionnels de la santé (n = 144) ont rempli un questionnaire court avant et après la formation, portant sur l'aspect du sommeil. La formation de l'Intervention Sommeil Possums a inclus les sujets suivants: science du sommeil; soin déclenché; hygiène du sommeil; relaxation pour les parents et les bébés; résolution de problèmes; et la Thérapie d'Acceptation et d'Engagement (ACT). Les professionnels de la santé ont fait état d'améliorations des connaissances sur la régulation du sommeil du bébé, la relation mère-bébé et l'ACT; améliorations dans leur propre qualité de sommeil; amélioration dans la flexibilité psychologique; et une réduction du burnout professionnel et du stress traumatique secondaire (STS). De plus la formation des professionnels de la santé a été reçu de manière positive. Dans l'ensemble cette étude soutient la formation des professionnels de la santé de l'Intervention Sommeil Possums. Mots clés: sommeil, nourrisson, postnatal, thérapie d'acceptation et d'engagement, professionnels de la santé.

Perinatal incontinence: Psychometric evaluation of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and Wexner Scale.

AIM: The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Wexner Scale have been included in the International Consortium for Health Outcomes Measurement core outcome set during pregnancy and childbirth, to measure urinary and anal incontinence. The reliability and validity of these instruments have not been fully evaluated in maternity populations. The aim of this study was to conduct a psychometric evaluation of the ICIQ-UI SF and Wexner Scale. METHODS: Consecutive pregnant women (n = 309) who booked for care at one Australian birth facility between August 2017 and April 2018 completed the online surveys. Women who screened positive for urinary and/or anal incontinence were administered the ICIQ-UI SF and/or Wexner Scale during pregnancy ( <27 and 36-weeks) and postpartum (6 and 26-weeks). Scale internal consistency, construct validity, and responsiveness were evaluated. FINDINGS: In women with urinary incontinence, the ICIQ-UI SF demonstrated good internal consistency during pregnancy (baseline and 36 weeks) and 6-weeks postpartum (mean inter-item correlation: 0.47, 0.39, and 0.46, respectively), recorded significant change across three time-points, and was sensitive to group differences in age and obesity during pregnancy. Wexner Scale was unsuitable for psychometric analysis due to insufficient numbers of women with anal incontinence. CONCLUSION: The ICIQ-UI SF is a valid and reliable instrument to measure urinary incontinence during pregnancy and postpartum. The findings support the inclusion of the ICIQ-UI SF in the International Consortium for Health Outcomes Measurement core outcome set for use during the perinatal period. Psychometric analysis of the Wexner Scale in larger maternity populations is recommended.

Auricular acupressure: reducing side effects of chemotherapy in women with ovarian cancer.

PURPOSE: Many women with ovarian cancer may experience adverse effects from adjuvant chemotherapy after surgery. Non-pharmacological interventions can be used to reduce these side effects. We tested auricular acupressure to reduce treatment side effects in this population. METHODS: A prospective, quasi-randomized controlled trial was carried out at a publicly-funded hospital in southern Taiwan. Thirty-four women in the intervention group received auricular acupressure at four points (Shenmen, subcortex, endocrine, and heart), three times per day for 3 min per time, for 6 weeks. Thirty-one women in the control group received routine nursing care alone. The M. D. Anderson Symptom Inventory (MDASI) was completed at four time points. RESULTS: After receiving the third cycle of chemotherapy, side effect severity was elevated among both groups. Auricular acupressure reduced side effects such as disturbed sleep (t = - 11.99; p < .001, eta squared = 0.69), fatigue (t = - 2.57; p < .01, eta squared = 0.10), and lack of appetite (t = - 2.37; p = .024, eta squared = 0.08). CONCLUSION: Auricular acupressure can reduce adverse side effects of chemotherapy in women with ovarian cancer. Future studies with a larger sample and using some laboratory-based tests (such as C-reactive protein, interleukin-6) are warranted to confirm the results.

Measuring physical and mental health during pregnancy and postpartum in an Australian childbearing population - validation of the PROMIS Global Short Form.

BACKGROUND: Health related quality of life is a critical concept during the perinatal period but remains under-researched. The International Consortium for Health Outcomes Measurement have included the Patient Reported Outcomes Measurement Information System (PROMIS®) Global Short Form (GSF) in their core outcome set for pregnancy and childbirth to measure health related quality of life. The PROMIS GSF has not been fully evaluated as a valid and reliable instrument in this population. This study assessed the psychometric properties of the PROMIS GSF during pregnancy and postpartum period. METHODS: PROMIS GSF was administered to a sample of 309 pregnant women at four time-points during pregnancy (≤ 27 and 36-weeks) and postpartum (6- and 26-weeks). The structural validity, internal consistency reliability, construct validity, and responsiveness of the PROMIS GSF were evaluated. The internal structure of the PROMIS GSF was explored using Rasch Measurement Theory. Response format, item fit, differential item functioning (item bias), dimensionality of the scale and its targeting were assessed. RESULTS: Two revised subscales (Mental Health: four items; and Physical Health: five items) showed good fit to the Rasch model. The revised mental health subscale demonstrated good internal consistency reliability during pregnancy and postpartum period (α = .88 and .87, respectively). The internal consistency reliability of the physical health subscale was adequate (α = .76 and .75, respectively). The revised mental health subscale was sensitive to group differences according to a history of mental health disorder, income, smoking status, drug use, stress levels and planned versus unplanned pregnancy. Differences in scores on the revised physical subscale were detected for groups based on obesity, income, drug use, smoking status, stress, and history of mental health disorders. Scores on both subscales recorded significant changes across the four time-points, spanning pregnancy and postpartum period. CONCLUSIONS: The revised version of the PROMIS GSF was better able to measure mental and physical health during pregnancy and postpartum period compared to the original version. Findings support the clinical and research application of the PROMIS GSF within the International Consortium for Health Outcomes Measurement Standard Set of Outcome Measures for Pregnancy and Childbirth. Ongoing psychometric analysis of the PROMIS GSF is recommended in other maternity populations.

Empathy in pregnant women and new mothers: a systematic literature review.

OBJECTIVE: This systematic review explores changes in perinatal empathy and influence on maternal behaviours and child development. BACKGROUND: The well-being and development of infants are commonly linked to their mothers' capacity for empathy. However, characteristic changes during pregnancy and childbirth including sleep deprivation, mood and cognitive difficulties may disrupt empathic processing. METHODS: Original research papers (n = 7413) published in English language peer-reviewed academic journals were obtained by searching four electronic databases PsycINFO, PubMed, Scopus and CINAHL. Inclusion criteria were studies reporting empathy of women in the period from pregnancy to 12 months postpartum. Empathy was operationalised as a general tendency of empathic emotional responding and cognitive perspective taking. Thirteen studies were systematically assessed using the Critical Appraisal Skills Programme criteria. RESULTS: Impaired empathy in mothers, due most notably to high personal distress, was associated with risk of neglect or maltreatment of children and was partially explained by mothers' aversive response to infant crying. CONCLUSION: Few studies present empathy as a central theme. There is a paucity of definitional parameters and theoretical linkages and over-reliance on brief self-report indices of empathy. Future studies need to be theory based, incorporate experimental approaches, and provide greater sampling diversity toadvance our understanding of empathy in perinatal women.

Personal, professional and workplace factors that contribute to burnout in Australian midwives.

AIM: This study aimed to identify personal, professional and workplace factors that contribute to burnout in midwives. BACKGROUND: Burnout is prevalent in the midwifery workforce. Burnout adversely affects the well-being of midwives, diminishes the quality of care they provide and can shorten career duration. DESIGN: Self-administered online survey. The survey included the Copenhagen Burnout Inventory and personal and professional variables related to age, children, years of experience, role, model of care and satisfaction with work life. Midwives were invited to participate via an email sent from the Australian College of Midwives and through professional networks between June and July 2014. Variables associated with burnout were entered in a multinomial logistic regression. RESULTS: A total of 1,037 responses were received and 990 analysed. The prevalence of moderate to severe personal (N = 643; 64.9%) and work-related burnout (N = 428; 43.8%) were high. Having children, providing caseload midwifery care and working in a regional area were associated with low burnout. However, midwives registered for 5-10 years were more likely to report work and client-related burnout. Similarly, midwives reporting a lack of satisfaction with work-life balance were also more likely to report personal and work-related burnout. CONCLUSIONS: Family-friendly work environments that facilitate work-life balance can help to reduce the personal and organizational costs of burnout. Similarly, providing continuity of midwifery care in a caseload model can facilitate work-life balance and provide significant mental health benefits to participating midwives.

Postpartum depression symptoms among Syrian refugee women living in Jordan.

Postpartum depression (PPD) is recognized as a common maternal health problem, but few studies have investigated the postpartum mental health of refugee women. In this cross-sectional study, we investigated the prevalence of PPD symptoms and associated factors among Syrian refugee women living in north Jordan. Women (N = 365) were recruited from four health care centers in Ramtha and Jarash, cities in northern Jordan. Participants completed a demographic data form, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Social Support Scale at 6-8 weeks postpartum. Half (49.6%; n = 181) of the Syrian refugee women scored >12 on the EPDS. PPD symptoms were significantly associated with low social support, low monthly income, and recent immigration (less than 2 years). There is a high level of PPD symptoms among Syrian refugee women, many of whom are living in poverty and with limited social support. The results highlight the need for immediate action by governments to support childbearing refugee women with early screening for psychosocial risk and respond to women's physical and mental health, and social needs through interservice collaboration. Social support programs would meet an important need for these women, as would ongoing assessment by health professionals and early intervention for women who screen positive for PPD.