Infertility psychological distress in women undergoing assisted reproductive treatment: A grounded theory study.

BACKGROUND: While there exists an ample body of research in international contexts focused on the characterization and quantification of infertility psychological distress, the level of scholarly scrutiny directed towards this phenomenon within the context of China remains scant. AIMS AND OBJECTIVES: To investigate the formation and developmental processes of psychological distress associated with infertility and infertility treatment among women within the Chinese cultural context and to construct a theoretical framework that elucidates this phenomenon. DESIGN: Qualitative approach with grounded theory methodology. METHODS: This study was conducted within the reproductive medicine department of a tertiary-level hospital located in central China from May to August 2023. Twenty-seven women who experienced infertility and underwent assisted reproductive treatment (ART) were interviewed. The interview sessions spanned durations ranging from 20 min to 1 h and 35 min. Data analysis included open coding, axial coding and selective coding. The study is reported using the COREQ checklist. RESULTS: The infertility psychological distress experienced by women undergoing ART is a socially constructed phenomenon influenced by a dynamic interplay of forces that construct and conciliate it. The formation and progression of infertility psychological distress are rooted in the process of self-construction. A Middle-Ranged Theory titled 'self-reconstruction under the dome of infertility and infertility treatment' (SUDIT theory) was developed to explain this phenomenon. Within this framework, infertility psychological distress manifests across three distinct phases under the gambling of the constructive force and conciliative force: (1) distress of disrupting the former self; (2) distress linked to the struggling present self; and (3) the renewed-self harmonized with distress. CONCLUSIONS: It is imperative for healthcare professionals and policymakers to acknowledge the socially constructed nature of infertility psychological distress, and proactively implement measures aimed at ameliorating it. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

"I am not a good enough parent": The experience of self-stigma in parents of children with mental illness in China.

PROBLEM: Self-stigma in parents of children with mental illness is an area easily overlooked by mental health providers. Many studies have shown that self-stigma in parents may result in social interaction avoidance, lower self-esteem, increased psychological pressure, and so on. However, a comprehensive picture of how parents of children with mental illness in China experience self-stigma is lacking. METHODS: Individual semistructured face-to-face interviews were conducted with 20 parents from China during their child's psychiatric hospitalization. We followed the consolidated criteria for reporting qualitative research (COREQ) checklist. FINDINGS: Four main themes were identified that captured the experience of self-stigma in parents of children with mental illness: (1) losing face and fear, (2) internalizing affiliate stigma, (3) feeling of self-blame and self-doubt, and (4) keeping oneself away from society. CONCLUSIONS: These findings explain how Chinese parents of children with mental illness experience self-stigma. To better effect the treatment and rehabilitation of children with mental illness, it is necessary to recognize this self-stigma in parents and take action to improve their mental health.

The association between childbirth-related fear, childbirth readiness, and fertility intentions, and childbirth readiness as the mediator.

BACKGROUND: Fertility intentions have been proved to be a reliable predictor of actual fertility behaviour. Also, childbirth-related fear (CBRF) has been proven to be negatively associated with childbirth readiness and fertility intentions among women, while childbirth readiness was positively related to fertility intentions. However, the associations and potential mechanisms between CBRF, childbirth readiness, and fertility intentions remain unknown. This study aimed to investigate the unique association between CBRF, childbirth readiness, and fertility intentions and whether childbirth readiness would mediate the relationship between CBRF and fertility intentions. METHOD: A cross-sectional study of women (N = 1119, aged 16-53 years) who gave birth within 72 h was conducted. Using a convenience sampling, women were recruited from obstetric wards-10 comprehensive hospitals and 3 specialized hospitals in 7 provinces in mainland China. Pearson correlation was used to examine the relationship between CBRF, childbirth readiness, fertility intentions, and social support. Multivariate linear regression was further used to analyze the association between demographic and personal characteristics, CBRF, childbirth readiness, and fertility intentions. Mediation analysis was used to examine whether childbirth readiness mediates the relationship between CBRF and fertility intentions. RESULTS: Women with high childbirth readiness (ß = 0.09, P = 0.002) had higher fertility intentions. However, women with high CBRF (ß = - 0.17, P < 0.001) were more likely to have lower fertility intentions. CBRF had both direct and indirect effects on the level of fertility intentions. As predicted, childbirth readiness mediated the relationship between CBRF and the level of fertility intentions (estimate = - 0.012, 95% bootstrap CI: - 0.021 to - 0.005). Higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. CONCLUSIONS: This study established the evidence that CBRF had both direct and indirect effects on the level of fertility intentions and childbirth readiness mediated the relationship between CBRF and the level of fertility intentions. Specifically, higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. This finding suggested that it is important for health policymakers and health providers to pay more attention to improving women's childbirth readiness, which might reduce the negative influence of CBRF on fertility intentions, thus strengthening their fertility intentions.

Over the past two decades, fertility rates have been dropping steadily in most countries. Fertility intentions have been proven to be a reliable predictor of actual fertility behaviour. The worldwide sluggish fertility trend has brought about a series of issues, such as accelerated population ageing, shrinking workforce, and economic decline. China has the largest national population in the world, accounting for nearly one-fifth of the world's population, thus having a huge impact on global population trends. Therefore, in the context of significant fertility decline and population policy changes, timely research on fertility intention is of great significance for China and other low-fertility countries. CBRF has been proven to be negatively associated with childbirth readiness and fertility intentions among women, while childbirth readiness was positively related to fertility intentions. This study aimed to investigate the unique association between fertility intentions, CBRF, and childbirth readiness, and whether childbirth readiness would mediate the relationship between CBRF and fertility intentions. In this cross-sectional study, we found that women with high childbirth readiness had higher fertility intentions. However, women with high CBRF were more likely to have lower fertility intentions. Furthermore, CBRF had both direct and indirect effects on the level of fertility intentions. Childbirth readiness mediated the relationship between CBRF and the level of fertility intentions. Higher CBRF was associated with lower scores of childbirth readiness, which was associated with lower levels of fertility intentions. This finding suggested that it is important for health policymakers and health providers to pay more attention to improving women's childbirth readiness, which might reduce the negative influence of CBRF on fertility intentions, thus strengthening their fertility intentions.

Development and psychometric testing of a scale for assessing the psychological birth trauma.

Background: Psychological birth trauma is widespread in postpartum women, and its harms are serious to mothers' health. Existing tools rely on posttraumatic stress disorder to evaluate, which cannot effectively evaluate its connotation. The aim of this study was to develop a new instrument for use to comprehensively assess the psychological birth trauma level of women after birth and test the scale's psychometric properties. Methods: The scale was developed and evaluated through item generation, expert consultation, pre-survey, and psychometric evaluation. A literature review, focus group, and individual deep semi-structured interviews were utilized to identify the scale items. The expert consultation evaluated the content validity. Psychometric testing was conducted in a convenience sample of 712 mothers within the first 72 h postpartum who were recruited from three hospitals in China. Results: The total Cronbach alpha coefficient of the scale was 0.874. Exploratory factor analysis supported that the final scale consisted of four dimensions and fifteen items. The explanatory variance of the four factors was 66.724%. The four dimensions are named "being neglected," "out of control," "physiological emotional response," and "cognitive behavioral response." The results of the confirmatory factor analysis showed that the fit indices were all at acceptable and good levels. Conclusion: The 15-item Birth Trauma Scale is a valid and reliable tool to evaluate the psychological trauma of mothers who experienced spontaneous childbirth. The scale is a maternal self-assessment scale that can help women understand their mental health. Healthcare providers can identify key populations and intervene with them.

Analysis of the correlation between clinical nurses' professional quality of life and family care and organizational support.

Background and aim: Nurses' professional quality of life (ProQOL) is closely related to nursing life, and it is essential to clarify the professional quality of life of nurses and enhance it effectively. We aimed to explore the influence of family care and organizational support on the professional quality of life of clinical nurses and to improve the theoretical basis for improving the professional quality of life of clinical nurses in China. Methods: A single center, descriptive, cross-sectional design was used in this study. From February to April 2,022, 2,200 nurses from Tongji Hospital were selected as the study population, using the General Information Form, Family Care Scale, Professional Quality of Life Scale, Nurses' Sense of Organizational Support Questionnaire, and Work-Family Conflict Scale, and analyzing the relationship between professional quality of life and family care and organizational support among clinical nurses for correlation analysis as well as multiple linear regression to determine the factors affecting participants' Factors affecting ProQOL. P < 0.05 values were considered statistically significant. Results: The Cronbach coefficients of the scales were generally above 0.8, with good validity. All nurses had empathic satisfaction, burnout, and secondary trauma scores of 28.74 ± 3.83, 30.82 ± 3.45 and 29.40 ± 3.69, respectively, and correlation analysis, as well as multiple linear regression results, showed that the three dimensions of nurses' professional quality of life were associated with family care and organizational support (P < 0.05). Conclusions: The professional quality of life of nurses deserves to draw focused attention. The degree of family care and organizational support are predictive of professional quality of life, and nursing managers should pay attention to rationalizing tasks, pay attention to the physical and mental health of nursing staff, and improve the quality of life of nurses.

Why do pregnant women with fear of birth prefer vaginal birth? A qualitative study in China.

Background: Fear of birth (FOB) is becoming increasingly recognized as a mental health issue that may endanger maternal and infant health and affects women's subsequent fertility desires. It has also been shown to be related to the choice of delivery mode. Given the differences in healthcare systems and policies between countries, and the gaps in the exploration of women's experience of fear of birth and its association with the delivery mode in the Chinese cultural context, this study thus attempt to understand Chinese women's experience with fear of birth and their preferences for delivery mode through a qualitative study. Methods: A descriptive qualitative research was performed among twenty pregnant women from the obstetric outpatient of a tertiary hospital in China. Colaizzi's method was used to analyze the participants' data. Results: We proposed three themes and nine subthemes on the participants' experience with fear of birth: (1) an invisible dilemma: trapped in lingering fear (fear of all sides, the untold loneliness, and ambivalence with mixed feelings); (2) an unexpected decision: choose to give birth naturally (initiative selection and passive acceptance); and (3) A strength to confront challenges head-on: move forward with fear (awaken of maternal spirit, hope in bloom, Chinese tolerance culture, and obstetric analgesia). Conclusion: Fear of birth is a complex emotion, accompanied by feelings of loneliness and ambivalence in addition to fear. We found that women with fear of birth in this study prefer vaginal birth, and it was revealed to be the result of a combined action of intrinsic and extrinsic factors.

The influence of sense of coherence on psychological birth trauma: a parallel mediation model based on health Salutogenesis theory.

Background: Psychological birth trauma has been associated with a variety of negative consequences for mothers, partners, newborns, and midwives. While prior research has identified demographic and clinical factors that may contribute to the development of psychological birth trauma, interventions targeting these factors can prove challenging. Therefore, the aim of this study was to explore how psychological birth trauma is influenced by psychosocial factors including Sense of Coherence, Childbirth-related Fear, Social Support and Childbirth Readiness. Methods: A cross-sectional study was conducted in 13 tertiary or secondary hospitals in mainland China from November 2021 to June 2022. One thousand three hundred and sixty-six women were recruited totally. Data regarding basic characteristics, Sense of Coherence (SOC, Sense of Coherence Scale-3), Childbirth-related Fear (CBRF, Fear of Childbirth Scale), Social Support (SS, Medical Outcomes Study Social Support Survey), Childbirth Readiness (CR, Childbirth Readiness Scale) and Psychological Birth Trauma (PBT, Psychological Birth Trauma Scale) were collected. Parallel mediation analysis was adopted to identify the underlying mechanisms between study variables. Results: It was found that: (1) SOC has been found to have both direct and indirect effects on PBT. Women with higher level of SOC tend to report lower level of PBT; (2) the indirect effect of SOC on PBT was significantly exerted through CBRF, SS and CR; (3) CBRF was found to weaken the protective effect of SOC, whereas SS and CR were found to enhance it. No significant difference was found in contracts of the three specific indirect effects. Conclusion: SOC, CBRF, SS, and CR should be paid enough attention when designing intervention programs for women who might experience PBT. Interventions targeting SOC and CR are more likely to yield positive outcomes.

The unmet needs of older adults living in nursing homes in Mainland China: a nation-wide observational study.

BACKGROUND: The unmet needs of older adults in nursing homes could result in their poor health status physically and psychologically. The aim of this study was to understand the characteristics of unmet needs of older adults residing in nursing homes in China, and to probe into the contributing factors. METHODS: In this cross-sectional design, the demographic and health status questionnaire, Modified Barthel Index, the Numerical Rating Scale for pain assessment, Geriatric Depression Scale, Camberwell Assessment of Need for the elderly were employed to survey older adults living in 38 nursing homes in 13 cities in China from July 2017 to June 2018 through a multi-stage, stratified sampling scheme. The Short Portable Mental Status Questionnaire was adopted to exclude participants with severe cognitive impairment. Aside from descriptive analysis, a raft of hierarchical logistic regression models were run by sequentially controlling for the independent variables at 5 levels (demographic characteristics, health status, pain, ADL, and depression), aiming to identify the influencing factors of the unmet needs of the residents. RESULTS: The effective sample size involved 2063 older adults (63.4% female versus 36.6% male), with a response rate of 98.5%. The median and inter-quartile range of the total needs and unmet needs of the sample was 3(1, 4) and 0(0, 1) respectively, with 122 older participants having more than 3 unmet needs (high unmet need category) versus 1922 older ones having ≤ 3 unmet needs (low unmet need category). The unmet needs of older adults in nursing homes mainly fell into social domains. Gender, religion, educational background, marital status, living condition before admission, room type, incomes, staffing, number of diseases, pain, Barthel Index, and depression were contributive to unmet needs of older adults in long-term care facilities in the final model that was adjusted for all levels of variables (all p < 0.05). CONCLUSION: Understanding the influencing factors of the unmet needs of older adults in long term care provides clues for healthcare professionals to offer better care for this population. System-level support to nursing homes and training of staff are highlighted. Plus, taking measures to beef up social connections for the older adults to meet their social needs was suggested.

Relationship between perceived organizational support and professional values of nurses: mediating effect of emotional labor.

OBJECTIVES: Perceived organizational support was a benefit for the work performance of nurses, which may affect emotional labor and the development of professional values. This study aimed to explore the relationship between nurses' perceived organizational support and professional values, and investigate the mediating role of emotional labor. METHODS: This was a cross-sectional study. The study was conducted in 3 tertiary hospitals in Wuhan from October 2020 to January 2021. The data were collected by a questionnaire consisting of demographic characteristics, the Emotional Labor Scale for Nurses, the nurses' Perceived Organizational Support Scale, and the Nursing Professional Values Scale (NPVS-R). A convenience sample of 1017 nurses responded to the questionnaire survey. Pearson's correlation analysis was used to test the relationship between variables. Predictor effects were tested using hierarchical multiple regressions. The structural equation model (SEM) was used to test the mediation effect of emotional labor on the pathway from perceived organizational support to professional values. RESULTS: A positive moderate correlation was observed between the perceived organizational support and emotional labor (r = 0.524, P < 0.01), and a positive strong correlation was observed between perceived organizational support and professional values (r = 0.609, P < 0.01). Emotional labor and perceived organizational support were positive predictors of professional values (B = 0.531, 95%CI = 0.414 ~ 0.649; B = 0.808, 95%CI = 0.715 ~ 0.901, respectively). The association between perceived organizational support and professional values was mediated by emotional labor. CONCLUSIONS: Results showed that perceived organizational support was positively related to nurses' emotional labor, which was in turn associated with high professional values. For nurses, improving organizational support and training nurses to engage in emotional labor through providing multiple support systems, establishing appropriate incentive mechanisms, and training nurses to regulate emotions can be effective ways to promote nurses' professional values.

Relationship between Family Function, Anxiety, and Quality of Life for Older Adults with Hypertension in Low-Income Communities.

BACKGROUND: Effective functional family was beneficial for older adults' health, which may affect the quality of life (QoL) in hypertension patients. This study aimed to clarify the association between family function, anxiety, and QoL for older adults with hypertension in low-income communities. METHODS: A questionnaire survey was conducted on 363 older adults with hypertension in low-income communities in Wuhan from September 2019 to November 2019. The relationships among the variables were examined by Pearson's correlation analysis. Predictor effects were tested using hierarchical multiple regressions, controlling for demographic characteristics. The structural equation model (SEM) was used to test the mediation effects of anxiety on the pathway from family function to QoL. RESULTS: Family function was negatively correlated with the self-rating anxiety scale (SAS) score and positively correlated with the mental component score (MCS), but had no influence on the physical component score (PCS). Both PCS and MCS were negatively correlated with SAS. Anxiety was the negative predictor of MCS and PCS. Family function was the positive predictor of MCS, but had no influence on PCS. The path model indicated that anxiety significantly mediated the link between family function and QoL (R 2 = 32.8%), but only partially. CONCLUSION: A significant correlation between anxiety, family function, and QoL was found. Anxiety had a partial mediating effect on the relationship between family function and QoL. Further research should focus on increasing the level of family function and reducing the perceived anxiety of older adults with hypertension to improve their QoL level.

The illness experience for people with amyotrophic lateral sclerosis: A qualitative study.

AIMS AND OBJECTIVES: This study aims to gain a comprehensive understanding of the illness experience of amyotrophic lateral sclerosis (ALS) patients in China and the meaning they attach to those experiences. BACKGROUND: ALS is a progressive and fatal neurodegenerative disorder that significantly impacts individuals and families. There is a large number of patients with ALS in China. However, little is known about how they live with ALS. DESIGN: Phenomenological qualitative research was performed among twenty people with ALS from the neurology department of a tertiary hospital in China. Colaizzi's method was used to analyse the participants' data. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used as a guideline to secure accurate and complete reporting of the study. RESULTS: We proposed three themes and eight subthemes on the illness experience of participants: (1) life countdown: 'my body was frozen' (body out of control and inward suffering); (2) family self-help: 'we kept an eye on each other' (family warmth and hardship, and supporting the supporter); and (3) reconstruction of life: 'what was the meaning of my life' (learning to accept, rebuilding self-worth, resetting the priority list and living in the moment). CONCLUSIONS: In the family self-help model, patients are prompted to turn from negative mentalities to search for meaning in life actively. Healthcare providers need to attach importance to the family self-help model to alleviate the pressure on medical resources. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should encourage patients to play a supportive role in the family and provide more care support and professional care knowledge guidance to caregivers, to promote the formation of the family self-help model which might help to improve the experience of patients and families.

Women's experience of psychological birth trauma in China: a qualitative study.

BACKGROUND: The psychological birth trauma is a universal phenomenon in childbearing women. The influences could extend in a wide range, which includes the mothers' health, mother-infant relationship, partner relationship. The medical staff could even choose to quit playing their part in the birthing process. The phenomenon has gradually garnered attention around the world. However, it has rarely been discussed under Chinese special conditions. The study was to explore Chinese women's lived experiences of psychological birth trauma during labor and birth. METHODS: A descriptive phenomenological approach was adopted in this study. Twenty-four women were recruited, who reported having experienced psychological birth trauma. In-depth interviews were conducted within 1 week after birth. Colaizzi's method was used to analyze the data. RESULTS: Twenty-four women participated in the study. Four themes emerged to describe the women's experience of psychological birth trauma: "How am I supposed to relieve the endless pain?" " Can't I be weak?" "Am I not important?" "What uncertainties are waiting for me?" CONCLUSIONS: The findings provide deep insight into Chinese women's unique experience of psychological birth trauma. The social and health system could prevent psychological harm during birth and promote maternal health by measures of pain management, thoughtful attention, adequate caring, and prenatal preparation.

Effect of pain on depression among nursing home residents: Serial mediation of perceived social support and self-rated health. A cross-sectional study.

AIM: The aim of this study was to investigate how perceived social support and self-rated health together could mediate the relationship between pain and depression among Chinese nursing home residents with pain. METHODS: The study was conducted in 38 nursing homes in 13 cities in China. A convenience sample of 2154 older adults responded to the questionnaire survey. A mediation analysis was performed on the data of 990 participants with pain. The data were collected by a questionnaire consisting of socio-economic and demographic characteristics, the Geriatric Depression Scale-15, the Multidimensional Scale of Perceived Social Support, Self-rated Health Scale and the Numerical Rating Scale of pain. The sample was subdivided by sex. Descriptive analysis, t-tests, chi-squared tests, Mann-Whitney U-tests, Spearman correlation analyses and the bootstrap method were used to analyze data. RESULTS: The prevalence rate of pain and depression among nursing home residents were 46.0% and 20.7% respectively. Pain, perceived social support and self-rated health were all significantly correlated with depression (r = 0.217, P < 0.01; r = -0.216, P < 0.01; r = 0.385, P < 0.01, respectively). Perceived social support and self-rated health independently and in series partly explained the relationship between pain and depression. CONCLUSIONS: The results of the study showed that pain was associated with low perceived social support first, and then poor self-rated health, which was in turn related to the development of depression among nursing home residents with pain. For nursing home residents, perceived social support and self-rated health as an internal resource can affect the ability to overcome the suffering of pain and reduce the level of depression. Geriatr Gerontol Int 2020; 20: 1234-1240.

Nurses' Perceptions of Factors Influencing Elder Self-neglect: A Qualitative Study.

PURPOSE: Elder self-neglect is a global public health issue and should be taken seriously at large. Nurses, usually working directly with elderly patients, have a better understanding of what factors may cause elder self-neglect. In this qualitative study, we explored the influencing factors of elder self-neglect from the perception of nurses in the context of Chinese culture. METHODS: Face-to-face, in-depth interviews were conducted from November 2018 to December 2018. Purposive sampling was used. Twenty one participants recruited from eight geriatric wards of a general hospital located in Wuhan were interviewed. A content analysis of qualitative nature was performed to analyze the data. RESULTS: Our conceptual model illustrated the findings based on the three themes of the conflict between personal recognition and social judgment, the choice between current needs and individual beliefs, as well as the compromise between insufficient abilities and limited resources. CONCLUSION: Nurses together with family members and social workers can help older adults improve their awareness of self-neglect to bridge the gap with social judgment, learn to focus on their own needs, as well as seek as much support as possible. Nurses should also respect the autonomy and self-determination of elder self-neglecters because self-neglect is related to older adults' values. Furthermore, larger studies are needed to quantitatively test and refine the model.

Plasma 25-hydroxyvitamin D level and the risk of frailty among Chinese community-based oldest-old: evidence from the CLHLS study.

BACKGROUND: Vitamin D deficiency has been linked to the risk of frailty. However, there are limited methods for evaluations of the potential association of vitamin D with frailty in a longevous (80+) population. The aim of this study was to examine the association between plasma 25-hydroxyvitamin D [25(OH)D] levels and the risk of frailty among the Chinese community based oldest-old. METHODS: Secondary analysis of data compiled in the 2011 wave of the Chinese Longitudinal Healthy Longevity Survey (n = 1324) was performed. Frailty was assessed by the Study of Osteoporotic Fractures (SOF) index. Multivariate logistic regression and spline smoothing with threshold effect analysis were performed to investigate the association between 25(OH) D level and the risk of frailty after adjusting for socio-demographic variables, health characteristics and confounding biomarkers. RESULTS: The mean age was 92.89 ± 7.92 years, and 844 (63.7%) participants were women. In all, data from 426 (33.2, 95% confidence interval, CI: 29.66-34.69) frail participants were recorded. After adjustment for confounding covariates, the level of 25(OH) D was significantly related to frailty. By spline smoothing with threshold effect analysis, a monotonically negative association between 25(OH) D and frailty was identified. Subgroup analyses revealed that the association did not differ by sex or age. CONCLUSIONS: The 25(OH) D level was inversely associated with the risk of frailty among the Chinese community-based oldest-old.

Exploring Contributing Factors to Psychological Traumatic Childbirth from the Perspective of Midwives: A Qualitative Study.

PURPOSE: As midwives witness and attend the whole process of childbirth, they have a better understanding of which factors may cause traumatic childbirth. However, because most of the studies paid their attention on mothers, little is known about psychological birth trauma from the perspective of midwives. This study aims to gain a full understanding of which factors may contribute to psychological traumatic childbirth from the perspective of midwives. METHODS: A qualitative research was conducted using in-depth interviews, which involved fourteen midwives from the maternal ward of a tertiary hospital. The interviews were recorded and transcribed, and then, Colaizzi's method was used to analyze the contents of the interviews. RESULTS: We proposed four themes and eight subthemes on the influencing factors of psychological traumatic childbirth from the perspective of midwives: low perceived social support (lack of support from family and lack of support from medical staff), hard times (protracted labor in the first stage and futile efforts during the second stage), poor birth outcomes (poor birth outcomes of the mother and poor birth outcomes of the baby), and excruciating pain (unbearable pain of uterine contraction and labor pain was incongruent with the mother's expectations). CONCLUSION: Medical staff should pay attention to psychological traumatic childbirth and its effects, and emphasis on the screening and assessment of birthing women with negative feelings so that their psychological traumatic childbirth can be prevented and decreased.

Social support networks in Chinese older adults: health outcomes and health related behaviors: a path analysis.

Background: Population aging is a social and economic concern for China. It is essential to understand types of social support networks available to elderly people living in China. Objectives: The aim of this research was to identify network types among Chinese older adults and to examine the differential relationship of the network types, health outcomes and health-related behaviors. Methods: Secondary analysis of data compiled by the Chinese Longitudinal Healthy Longevity Survey (n = 9749) was extracted. Network types were derived through latent class analysis with Mplus 6.12 software. Statistical analysis included descriptive statistics, one-way ANOVA, multiple logistic regression and path analysis. Results: Four types of social networks were identified, these included private (16%), non-couple-focused (15%), couple-focused (47%) and diverse (22%). Compared with elders belonging to other networks, elders in diverse network possessed the healthiest status and the highest health-related behaviors score. Health-related behaviors played a role in mediating social network types to health outcomes was identified. Findings were aligned to the conceptual model pathway proposed by Berkman ( 2000 ). Conclusion: The findings demonstrate that types of social networks for elders are significantly correlated to health-related behaviors and health outcomes. Detail and understanding of the correlations are useful to inform healthcare practice and policy and to assist the development of appropriate interpersonal interventions.

The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a meta-analysis.

Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). However, whether the PFME guided by a therapist (G-PFME) can contribute to the recovery of urinary continence for patients after RP is still controversial. We performed this meta-analysis to investigate the effectiveness of G-PFME on UI after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone. Literature search was conducted on Cochrane Library, Embase, Web of Science, and PubMed, to obtain all relevant randomized controlled trials published before March 1, 2018. Outcome data were pooled and analyzed with Review Manager 5.3 to compare the continence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME. Twenty-two articles with 2647 patients were included. The continence rates of G-PFME were all superior to control at different follow-up time points, with the odds ratio (OR) (95% confidence interval [CI]) of 2.79 (1.53-5.07), 2.80 (1.87-4.19), 2.93 (1.19-7.22), 4.11 (2.24-7.55), and 2.41 (1.33-4.36) at 1 month, 3 months, 4 months, 6 months, and 12 months after surgery, respectively. However, there was no difference between additional preoperative G-PFME and postoperative G-PFME, with the OR (95% CI) of 1.70 (0.56-5.11) and 1.35 (0.41-4.40) at 1 month and 3 months after RP, respectively. G-PFME could improve the recovery of urinary continence at both early and long-term stages. Starting the PFME preoperatively might not produce extra benefits for patients at early stage, compared with postoperative PFME.