Birth ball for pregnant women in labour research protocol: a multi-centre randomised controlled trial.

BACKGROUND: Birth ball is one of the non-pharmacologic pain relief methods to help mothers cope with the labouring process. A randomised controlled trial (RCT) is conducted to evaluate the effectiveness, safety and harm of birth ball use by pregnant women in labour compared to treatment as usual group. METHODS: A prospective multi-centre randomised controlled trial (RCT) will be conducted in Obstetrics and Gynaecological units of five public hospitals in Hong Kong, China. Data will be collected from March 2016 onward for 2 years. The target population is Chinese women with an uncomplicated singleton pregnancy at gestational age of 37 to 42 weeks. Participants are randomised based on parity (nulliparous and multiparous) and type of labour onset (spontaneous and induced). Women in the intervention group are actively offered and taught how to use a birth ball; those in the control group receive the usual midwifery care. The target sample size is 512. The primary outcome measures are maternal pain intensity, satisfaction with pain relief, sense of control in labour, assisted delivery and satisfaction with childbirth experience. Labour pain relief is measured by visual analogue scale (VAS). Other outcomes will be measured through four different validated questionnaires. To control for potential cluster effects, a linear mixed model will be used. An intention-to-treat analysis is adopted and performed by researchers unknown to subjects' group allocation. DISCUSSION: Results will provide rigorous scientific evidence for policy development and practice. We are using stratified randomisation according to potential confounders of parity and type of labour onset to give four possible combinations. If the results are favourable, it will facilitate systematic implementation to promote birth ball use for women in labour. TRIAL REGISTRATION: Chinese Clinical Trial Register (ChiCTR), Registration number: ChiCTR-IIC-16008275 , Date of registration 12 April 2016 (retrospectively registered), Date of enrolment of the first participant to the trial 1 March 2016.

The Effect of Upper Limb Massage on Infants' Venipuncture Pain.

The purpose of the study was to investigate the effect of upper limb massage on relieving pain among infants undergoing venipuncture in Hong Kong. This study was a crossover, double-blind, randomized controlled trial. Eighty infants at the neonatal intensive care unit were randomly assigned to 2 groups in different order to receive interventions. The massage first group (N = 40) received 2-minute massage before venipuncture on the first occasion then received usual care (control) on the second occasion, and vice versa in the massage second group (N = 40). The infants' behavior and physiological responses were recorded on two occasions: (1) right after the intervention and (2) during the first 30 seconds of venipuncture procedure. The mean pain scores (Premature Infant Pain Profile) were significantly lower in infants who received massage (massage first: 6.0 [standard deviation = 3.3]; massage second: 7.30 [standard deviation = 4.4]) versus control (massage first: 12.0 [standard deviation = 4.3]; massage second: 12.7 [standard deviation = 3.1]). The crude and adjusted generalized estimating equations model showed that the infants had significantly lower pain score when receiving massage as compared to receiving the control treatment, and there were no significant time and carryover effects: -6.03 (95% confidence interval: -7.67 to -4.38), p < .001 and -5.96 (95% confidence interval: -7.56 to -4.36), p < .001, respectively. Upper limb massage may be effective in decreasing infants' venipuncture pain perception.

Self-Care Strategies among Chinese Adolescent Girls with Dysmenorrhea: A Qualitative Study.

Little is known about how Chinese adolescent girls manage dysmenorrhea. This study aims to explore self-care strategies among Chinese adolescent girls with dysmenorrhea. The study uses a mixed methods design with two phases: a cross-sectional survey in phase I and semistructured interviews in phase II. This paper reports phase II. In line with the phase I findings, 28 adolescent girls with different characteristics (high or low levels of self-care behavior and pain intensity, who did or did not self-medicate, and who had or had not received menstrual education) were recruited for interviews. Content analysis was used for data analysis. Four categories emerged from the data: lifestyle changes, symptom management, communicating dysmenorrhea with others, and seeking medical advice. Girls selected their diets carefully and reduced physical activity during menstruation to avoid aggravating symptoms. Heat therapy commonly was employed for symptom management. A few girls self-medicated to obtain immediate relief from pain, but the majority expressed reservations about using medication because they worried about dependence and side effects. Some girls communicated dysmenorrhea with their family and friends, but the majority did not seek medical advice. The present study showed that girls employed various self-care strategies for dysmenorrhea, including some strategies stemming from traditional Chinese medicine. The findings revealed menstrual etiquette among Chinese adolescent girls with dysmenorrhea, and demonstrated that self-medication was not part of most girls' self-care. Understanding the self-care strategies of these girls is important, as it can help nurses develop a culturally-specific intervention to promote self-care among adolescent girls with dysmenorrhea.

Examining Self-Care Behaviors and Their Associated Factors Among Adolescent Girls With Dysmenorrhea: An Application of Orem's Self-Care Deficit Nursing Theory.

PURPOSE: To test a hypothesized model that examines the relationship between selected basic conditioning factors, self-care agency, and self-care behaviors among adolescent girls with dysmenorrhea using Orem's self-care deficit nursing theory as a framework. DESIGN: This was a predictive correlational study conducted with a total of 531 secondary school girls. METHODS: Self-care agency, self-care behaviors, and 11 variables that have been theoretically or empirically justified in previous studies as relevant to basic conditioning factors were selected and collected by means of structured questionnaires. Path analyses were performed to test the hypothesized linkages among variables. FINDINGS: Path analysis revealed that age and received menstrual education had both direct and indirect effects through self-care agency on self-care behaviors. Mother's and father's educational level, pain intensity, and self-medication used when experiencing dysmenorrhea only affected the self-care behaviors directly. CONCLUSIONS: This is the first study that provided information about the relationship between basic conditioning factors, self-care agency, and self-care behaviors among adolescent girls with dysmenorrhea. Knowledge of the factors influencing self-care behaviors in these adolescent girls will assist healthcare professionals in developing effective interventions to promote self-care and ameliorate the adverse impact of this condition. CLINICAL RELEVANCE: Interventional strategies that aim at promoting self-care behaviors among adolescent girls with dysmenorrhea should strengthen girls' self-care agency and should target those with a younger age, higher pain intensity, mother with a higher educational level, father with a lower educational level, and those who do not take self-medication for dysmenorrhea.

Impact of oral mucositis on short-term clinical outcomes in paediatric and adolescent patients undergoing chemotherapy.

PURPOSE: The purpose of this study is to determine the burden of the peak severity of oral mucositis and severity over time on selected clinical outcomes in paediatric and adolescent patients receiving chemotherapy. PATIENTS AND METHODS: A multicentre study enrolled 140 patients between the ages of 6 and 18 years, who had been treated with chemotherapy and completed the self-report Mouth and Throat Soreness-related questions of the Oral Mucositis Daily Questionnaire for 14 days. Clinical data were collected from patients' medical records during the first 14 days after starting chemotherapy. RESULTS: Forty-one percent developed oral mucositis. Multiple linear regression analysis revealed that oral mucositis was significantly associated with an increased loss of baseline body weight, after controlling for nausea/vomiting (ß = 0.34, p = 0.002). Multiple logistic regression analysis showed that severe mucositis was significantly associated with a higher probability of fluid replacement, after controlling for nausea/vomiting (adjusted OR = 12.8; 95 % CI = 2.7-61.0; p = 0.001). In addition, severe mucositis was significantly associated with a higher probability of fever, after controlling for neutropoenia (adjusted OR = 5.4; 95 % CI = 1.8-15.4; p = 0.002). No difference was observed for oral or systemic infections among the subgroups. About 5 % of the patients with oral mucositis had delays in chemotherapy (≤ 7 days). None of the patients had dose modification or unplanned hospitalization due to oral mucositis. The associations of peak severity and overall oral mucositis with adverse clinical outcomes in paediatric and adolescent patients were equivalent. CONCLUSION: Oral mucositis is associated with negative effects on clinical outcomes.

Translation and validation of the Chinese-Cantonese version of the Adolescent Dysmenorrhic Self-Care Scale in Hong Kong adolescent girls.

AIMS AND OBJECTIVES: To translate and evaluate the psychometric properties of the Chinese-Cantonese version of the Adolescent Dysmenorrhic Self-Care Scale. BACKGROUND: Adolescent girls prefer engaging in self-care activities for dysmenorrhoea. The Adolescent Dysmenorrhic Self-Care Scale is a reliable and valid scale for measuring the self-care behaviour of adolescent girls with dysmenorrhoea. However, it has not been validated in Hong Kong population. DESIGN: A cross-sectional design. METHODS: In phase one, the Adolescent Dysmenorrhic Self-Care Scale was translated into Chinese-Cantonese and was reviewed by an expert panel for the semantic equivalence and content validity. In phase two, the Chinese-Cantonese version of Adolescent Dysmenorrhic Self-Care Scale was administered to 396 girls with dysmenorrhoea. The construct validity was tested using confirmatory factor analysis and correlated with the Chinese version of the Generalized Self-Efficacy Scale. The reliability was assessed by Cronbach's alpha and test-retest reliability. RESULTS: Item 13 related to school nurses was deleted because of its poor relevance to the Hong Kong situation. Four items (items 26-29) related to the medical-orientated behaviours were considered by the expert panel as not relevant to the self-care construct in Hong Kong population. Therefore, confirmatory factor analyses were carried out to 39-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale (deletion of item 13) and the 35-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale (with further deletion of items 26-29). Confirmatory factor analysis did not confirm the 39-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale, but the results showed the goodness of fit in the 35-item of Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale (root-mean-square error of approximation = 0·075, standardised root-mean-square residual = 0·078, normed fit index = 0·95, non-normed fit index = 0·96, comparative fit index = 0·96). Significant correlations with Chinese version of the Generalized Self-Efficacy Scale (r = 0·46, p < 0·01) were identified. The Cronbach's alpha of 35-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale was 0·94. The intraclass correlation coefficient was 0·93. CONCLUSION: The 35-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale had satisfactory validity and reliability. RELEVANCE TO CLINICAL PRACTICE: Nurses may use the 35-item Chinese-Cantonese-Adolescent Dysmenorrhic Self-Care Scale in assessing the self-care behaviour of adolescent girls with dysmenorrhoea, so that girls with a low level of self-care behaviour can be identified and appropriate intervention can be provided.

Translation and validation of the Hong Kong Chinese version of the breastfeeding self-efficacy scale-short form.

Healthcare providers do not have a validated instrument to measure breastfeeding self-efficacy among Hong Kong Chinese. In this study, we sought to translate the breastfeeding self-efficacy scale-short form (BSES-SF) into Hong Kong Chinese and to examine the psychometric properties in a sample of 185 breastfeeding mothers. The construct validity of the translated scale was supported by confirmatory factor analysis and known group analysis. The receiver operating characteristics analysis indicated that the total score of the translated scale at 48-72 hours after delivery could be a useful diagnostic tool for identifying mothers likely to discontinue breastfeeding prematurely, before 6 months postpartum. Further research to cross-validate the suggested cut-off value of the scale is recommended.

Promoting self-reflection in clinical practice among Chinese nursing undergraduates in Hong Kong.

This study evaluated the effect of a structured education programme on improving the self-reflection skills of Chinese nursing undergraduates in managing clinical situations. Johns' Structured Reflection Model was used as a framework for the development of the education programme. Thirty-eight nursing undergraduates attended a 3-hour interactive workshop on reflective skills and were encouraged to practise the skills learned under the guidance of a nurse instructor during their 4-week clinical practicum. The findings indicated that the programme was helpful in improving the undergraduates' reflective skills though only a few of them reached the highest level as critical reflectors. Some undergraduates identified time constraints and the lack of a trusting relationship with their nurse instructor as barriers to their reflective learning. The findings may help nurse educators develop education programmes with structured learning strategies to promote nursing undergraduates' self-refection in clinical practice.

Validation of the short form of the Chinese Childbirth Self-Efficacy Inventory in Mainland China.

Self-efficacy increasingly has been reported as an important outcome measure in childbirth care. The purpose of this study was to evaluate the psychometrics of the short form of the Chinese Childbirth Self-Efficacy Inventory (CBSEI-C32) in mainland China. A convenience sample of 297 pregnant Chinese women who were attending the out-patient clinic of the study hospital in Guangzhou participated in the study. The participants were asked to complete the CBSEI-C32, the Chinese Self-Rating Anxiety Scale (CSAS), the Chinese Self-Efficacy Scale (CSE) and the socio-demographic questionnaire. A subgroup of 75 pregnant women was selected randomly from the total sample using a table of random numbers for test-retest reliability assessment. The findings demonstrate high internal consistency (Cronbach's α = .96) and test-retest reliability (intraclass correlation coefficient = .88) for the CBSEI-C32. Confirmatory factor analysis showed some support for a two-factor structure of the CBSEI-C32, and construct validity was further supported by a significant relationship with CSAS. The CBSEI-C32 has the potential to be used as a clinical and research instrument for measuring childbirth self-efficacy in women in mainland China.

Knowledge of and attitude to contraception among migrant woman workers in mainland China.

AIMS: The aims of this paper were to determine the level of knowledge and attitude of contraception and their relationships among Chinese migrant woman workers. BACKGROUND: Studies on psychosocial variables that lead to reproductive health behaviours among Chinese migrant woman workers in China remain limited. DESIGN: A cross-sectional, descriptive and correlational design. PARTICIPANTS: One hundred and ninety young woman workers of a factory in Guangdong, a representative city of factory base in mainland China, voluntarily participated in the study with a response rate of 63%. METHODS: Data were collected through self-administered questionnaires consisting of a socio-demographic sheet, the Contraceptive Knowledge Scale and the Contraceptive Attitude Scale. Pearson product moment correlation coefficient test was employed to examine the relationships between the contraceptive knowledge and attitude, with level of significance set at p<0·05. RESULTS: The Chinese migrant woman workers demonstrated lower contraceptive knowledge and less favourable contraceptive attitude compared with previous studies of adolescents in Taiwan and women seeking abortion in Hong Kong. Although it was a weak correlation, contraceptive knowledge was statistically associated with contraceptive attitudes among the respondents (r=0·276, p<0·001). Respondents' age, education level and working experience were significantly positively correlated with the contraceptive knowledge. CONCLUSIONS: Young Chinese migrant workers reported in the current study are found to be at higher sexual risk, when compared to the adolescents in Taiwan and Hong Kong women seeking abortion. Early educational intervention for reproductive health in particular contraception and its usage to these young women is indicated. RELEVANCE TO CLINICAL PRACTICE: Migrant woman workers in mainland demonstrated poor knowledge and unfavourable attitudes towards contraception, especially for the younger, single and less educated group. Greater effort is necessary to promote young migrant women's knowledge and attitude towards contraception and sexual health.

Predictors and correlates of maternal role competence and satisfaction.

BACKGROUND: Developing a sense of competence and satisfaction in the maternal role enhances positive parenting and healthy development of the child. There is limited longitudinal research on the predictive factors influencing maternal role competence and satisfaction. OBJECTIVES: The aim of this study was to determine the predictive and concurrent associations of prenatal perceived maternal role competence, learned resourcefulness, social support, stress, and depression to perceived maternal role competence and satisfaction at 6 weeks postpartum. METHOD: A longitudinal, descriptive design was used. A convenience sample of 184 first-time pregnant women with a singleton and uneventful pregnancy were recruited from two regional public hospitals in Hong Kong. The Parenting Sense of Competence Scale, Self-control Schedule, Medical Outcomes Study Social Support Survey, Social Readjustment Rating Scale, and Edinburgh Postnatal Depression Scale were used to assess maternal role competence and satisfaction, learned resourcefulness, social support, stress, and depressive symptoms, respectively. Data were collected during pregnancy and at 6 weeks postpartum. RESULTS: Multiple regression analysis showed that perceived maternal role competence and satisfaction at 6 weeks postpartum were predicted by prenatal perceived maternal role competence and learned resourcefulness and were associated with postnatal learned resourcefulness and depression. Social support and stress were not associated directly with perceived maternal role competence and satisfaction at 6 weeks postpartum. DISCUSSION: The present findings suggest that maternal learned resourcefulness and depression are important factors affecting perceived maternal role competence and satisfaction at postpartum. Culturally competent healthcare should be developed to promote the psychological well-being of women and to equip women with the learned resourcefulness skills to facilitate maternal role taking and enhance women's sense of competence and satisfaction in the maternal role.

A survey of registered nurses' perceptions of the code of professional conduct in Hong Kong.

AIM: To examine the perceptions of the code of professional conduct among practising registered nurses in Hong Kong. BACKGROUND: A code of professional conduct is intended to guide nurses in their practice and to ensure congruence with nursing goals and objectives. Such a code for nurses in Hong Kong has been in effect for two decades but, to date, no study has examined the perceptions of it among practising nurses. DESIGN: A survey of 320 practising registered nurses working in a hospital cluster in Hong Kong (mean postregistration experience=11.8 years). METHODS: A questionnaire developed to assess nurses' perceptions of the Code of Professional Conduct devised by the Nursing Council of Hong Kong. RESULTS: Providing safe and competent care, practising in accordance with the law and maintaining agreed standards were ranked in order as the three most important aspects. Safeguarding informed decision-making for patients who were mentally incapacitated or unable to speak for themselves, participating in continuing nursing education and raising objections to practices that compromise safe and appropriate care were considered the most challenging aspects to achieve in professional nursing practice. CONCLUSIONS: To educate nurses to become more assertive in safeguarding patients' rights and to encourage and support lifelong learning remains a major challenge in professional nursing practice. The profession and statutory bodies need to consider how best to enable practising nurses to address these issues. RELEVANCE TO CLINICAL PRACTICE: Examining the perceptions of practising nurses about the professional code is necessary to ensure that the profession is prepared to meet the ever-changing demands and expectations of the public whom it claims to serve.

An educational intervention to improve women's ability to cope with childbirth.

AIM AND OBJECTIVE: To test the effectiveness of an efficacy-enhancing educational intervention to promote women's self-efficacy for childbirth and coping ability in reducing anxiety and pain during labour. BACKGROUND: The evidence of the effective application of the self-efficacy theory in health-promoting interventions has been well established. Little effort has been made by health professionals to integrate self-efficacy theory into childbirth care. DESIGN: Randomised controlled trial. METHODS: An efficacy-enhancing educational intervention based on Bandura's self-efficacy theory was evaluated. The eligible Chinese first-time pregnant women were randomly assigned to either an experimental group (n = 60) or a control group (n = 73). The experimental group received two 90-minute sessions of the educational programme in between the 33rd-35th weeks of pregnancy. Follow-up assessments on outcome measures were conducted within 48 hours after delivery. The short form of the Chinese Childbirth Self-Efficacy Inventory was used to measure maternal self-efficacy prior to labour. Evaluation of pain and anxiety during the three stages of labour and performance of coping behaviour during labour were measured by the Visual Analogue Scale and Childbirth Coping Behaviour Scale respectively. RESULTS: The experimental group was significantly more likely than the control group to demonstrate higher levels of self-efficacy for childbirth (p < 0.0001), lower perceived anxiety (p < 0.001, early stage and p = 0.02, middle stage) and pain (p < 0.01, early stage and p = 0.01, middle stage) and greater performance of coping behaviour during labour (p < 0.01). CONCLUSIONS: The educational intervention based on Bandura's self-efficacy theory is effective in promoting pregnant women's self-efficacy for childbirth and reducing their perceived pain and anxiety in the first two stages of labour. RELEVANCE TO CLINICAL PRACTICE: Relief of pain and anxiety is an important issue for both women and childbirth health professionals. The efficacy-enhancing educational intervention should be further developed and integrated into childbirth educational interventions for promoting women's coping ability during childbirth.

Contraceptive self-efficacy and contraceptive knowledge of Hong Kong Chinese women with unplanned pregnancy.

AIM AND OBJECTIVES: The purpose of this study was to explore contraceptive practice, the level of knowledge and self-efficacy of contraception among Chinese women with unplanned pregnancy and to determine the relationships between these variables. BACKGROUND: The construct of self-efficacy can be employed as a theory to design a nursing intervention to prevent sexually active women from unplanned pregnancy. Only a few western studies have investigated the relationships between self-efficacy and contraception behaviour yet none targeted at the Chinese population. DESIGN: Cross-sectional survey. METHODS: This study employed a cross-sectional survey design. A convenience sample of 117 eligible Chinese females completed all the questionnaires, which included the Chinese version of the Contraceptive Self-efficacy Scale and Contraceptive Knowledge Scale. RESULTS: The findings in this study suggested that younger, unmarried women at the lower income group, who adopted male condoms are at risk for unplanned pregnancy. The sample demonstrated an above medium level of knowledge and self-efficacy in contraception. However, no significant relationship was found between contraceptive self-efficacy and knowledge (p>0.05). CONCLUSIONS: Contraceptive obstacles were revealed by participants' moderate level of contraceptive self-efficacy and contraceptive knowledge. The relationship between contraceptive knowledge of specific methods and contraceptive self-efficacy need further exploration in future studies. RELEVANCE TO CLINICAL PRACTICE: The dominant use of male condoms by the sample of this study sheds light on future direction in the development of educational programmes and contraceptive promotion strategies appropriate for women with unplanned pregnancy.

Professional nursing values among baccalaureate nursing students in Hong Kong.

The development of a nursing code of professional conduct is to guide nurses to make appropriate clinical decision, in particular when facing ethical dilemma. It is of paramount importance that nurse educators understand baccalaureate nursing students' perceptions of the importance of the code of professional conduct and the level of difficulties in implementing this code while preparing them for future practicing nurses. The Code of Professional Conduct in Hong Kong has been developed to guide nursing practice for over two decades. Nevertheless, no study has examined Hong Kong baccalaureate nursing students' perception about this professional code. The aim of this paper was to examine the perceptions of 263 baccalaureate nursing students about this professional code using a cross sectional survey design. The results indicated that most items in the professional code were rated as important and "provide safe and competent care" was rated as the most important one. A few areas that the students perceived as difficult to implement were discussed and future research was recommended. The significant differences identified among students from different years of study also highlighted areas for consideration in planning educational program to further equip students with the ability to deal with challenges in professional practice.

Maternal intention to exclusively breast feed among mainland Chinese mothers: A cross-sectional study.

OBJECTIVE: to examine postpartum maternal recall of their intentions to exclusively breast feed among breastfeeding women and identify its predictors. DESIGN AND SETTING: a cross-sectional descriptive study was conducted in a regional teaching hospital at Guangzhou, China between April 1 and July 14, 2014. PARTICIPANTS: 571 mothers who were within four days after delivery were recruited to the study. MEASUREMENTS: data were collected by four research assistants with maternal intention to breast feed data sheet, the Network Support for Breastfeeding Scale (NSBS), and a socio-demographic data sheet. FINDINGS: greater than half of the mothers (69.5%) intended to exclusively breast feed. The logistic regression analysis revealed six variables which predicted postpartum maternal recall of their intentions to exclusively breast feed. They were support from husband, being breast-fed as an infant, previous breast feeding experience, attending antenatal breast feeding class, time of decision to breast feed, and the rating of the importance of my baby's health. CONCLUSION AND IMPLICATIONS FOR PRACTICE: health care professionals could develop strategies to enhance mothers' intention to exclusively breast feed, such as providing antenatal breast feeding class on internet, a strong focus on the benefits of exclusive breast feeding on the baby's health in the education programme, and more efforts directed toward educating school-aged children and adolescents to modify societal perceptions of what are considered normal infant feeding. Mothers' husband could be encouraged in supporting exclusive breast feeding.

Effects of therapeutic play on children undergoing cast-removal procedures: a randomised controlled trial.

OBJECTIVES: To examine (1) the effectiveness of therapeutic play in reducing anxiety and negative emotional manifestations among children undergoing cast-removal procedures and (2) the satisfaction of parents and cast technicians with cast-removal procedures. DESIGN: A randomised controlled trial. SETTING: An orthopaedic outpatient department of a regional teaching hospital in Hong Kong. PARTICIPANTS: Children (n=208) aged 3-12 undergoing cast-removal procedure were invited to participate. INTERVENTIONS: Eligible children were randomly allocated to either the intervention (n=103) or control group (n=105) and stratified by the two age groups (3-7 and 8-12 years). The intervention group received therapeutic play intervention, whereas the control group received standard care only. Participants were assessed on three occasions: before, during and after completion of the cast-removal procedure. OUTCOME MEASURES: Children's anxiety level, emotional manifestation and heart rate. The satisfaction ratings of parents and cast technicians with respect to therapeutic play intervention were also examined. RESULTS: Findings suggested that therapeutic play assists children aged 3-7 to reduce anxiety levels with mean differences between the intervention and control group was -20.1 (95% CI -35.3 to -4.9; p=0.01). Overall, children (aged 3-7 and 8-12) in the intervention groups exhibited fewer negative emotional manifestations than the control group with a mean score difference -2.2 (95% CI -3.1 to -1.4; p<0.001). Parents and technicians in the intervention group also reported a higher level of satisfaction with the procedures than the control group with a mean score difference of 4.0 (95% CI -5.6 to 2.3; p<0.001) and 2.6 (95% CI 3.7 to 1.6; p<0.001), respectively. CONCLUSION: Therapeutic play effectively reduces anxiety and negative emotional manifestations among children undergoing cast-removal procedures. The findings highlight the importance of integrating therapeutic play into standard care, in particular for children in younger age. TRIAL REGISTRATION NUMBER: ChiCTR-IOR-15006822; Pre-results.

Maternal anxiety and feelings of control during labour: a study of Chinese first-time pregnant women.

OBJECTIVE: to explore and examine the relationship between maternal anxiety levels and feelings of control during labour among Hong Kong Chinese first-time pregnant women. DESIGN: an exploratory descriptive correlation design. Data were collected on three occasions: during latent phase of labour, during active phase of labour and within 24-48 hrs after delivery. SETTING: an obstetric unit of a public teaching hospital in Hong Kong. PARTICIPANTS: a convenience sample of 90 Hong Kong Chinese first-time mothers. MEASUREMENTS AND FINDINGS: the Labour Agentry Scale (LAS) is a self-report scale designed to measure feelings of control during childbirth. A Visual Analogue Scale for anxiety (VAS-A) was used to measure women's self-reported level of anxiety during labour. Pearson Product Moment Correlation coefficient test indicated a significant negative relationship between the feelings of control and maternal anxiety during labour. No statistical relationships were detected between women's attendance at antenatal classes and feelings of control during labour. KEY CONCLUSIONS: the study showed a significant negative relationship between maternal anxiety and feelings of control during labour. IMPLICATIONS FOR PRACTICE: midwives should work with women to enhance their personal control during labour and satisfaction with their birth. The insignificant relationship between attendance at antenatal classes and feelings of control suggests the need to evaluate the content of childbirth education in order to empower women's control during labour.

Measuring Oral Mucositis of Pediatric Patients with Cancer: A Psychometric Evaluation of Chinese Version of the Oral Mucositis Daily Questionnaire.

OBJECTIVE: Oral mucositis is a frequent clinical condition that has been shown to affect pediatric cancer patients. Oral Mucositis Daily Questionnaire (OMDQ) is one of the few available patient-reported outcome measures to assess the extent and impact of oral mucositis. The objectives of the study were to translate the Mouth and Throat Soreness-Related Questions of the OMDQ into Chinese (OMDQ MTS-Ch) for children and adolescents aged 6-18 years receiving chemotherapy and to evaluate its psychometric properties. METHODS: This was part of a multicenter, prospective cohort study involving two phases. Phase I involved forward-backward translation to fit the cognitive and linguistic age level of the children and adolescents, followed by face and content validation, together with pretesting. In Phase II, which evaluated the internal consistency, test-retest reliability, and discriminant validity, a total of 140 patients completed the OMDQ MTS-Ch for 14 days. RESULTS: The OMDQ MTS-Ch had satisfactory face and content validities. The Cronbach's alpha coefficient of the OMDQ MTS-Ch was 0.984. All of the corrected item-total correlations were higher than 0.90. The test-retest intraclass correlation coefficient between consecutive days for the OMDQ MTS-Ch items ranged from 0.576 to 0.983; the only value that was not over 0.70 was that for the paired study days 7 and 8 for the item of talking. The mean area-under-the-curve OMDQ MTS-Ch item scores were significantly different among patients with different degrees of mucositis severity (P < 0.001), supporting the discriminant validity. CONCLUSIONS: It has been shown that the OMDQ MTS-Ch has a good level of reliability and discriminant validity and can be completed by children aged ≥6 years and adolescents on a daily basis to measure mucositis and its related functional limitations.

The Chinese version of the multidimensional health locus of control scale form C in pregnancy.

OBJECTIVE: The concept of locus of control (LOC) is an important psychological dimension within health research. The current study sought to establish the psychometric properties of the Chinese version of the Multidimensional Health Locus of Control Scale Form C (C-MHLC-C) on the third trimester of pregnancy to assess the potential usefulness of this measure within this clinical population. METHODS: Internal consistency and confirmatory factor analyses were conducted on C-MHLC-C data from 292 women on the third trimester of pregnancy. Case detection for significant psychological disturbance was assessed using the 12-item General Health Questionnaire. RESULTS: The best fit to the data was offered by a modified four-factor model comprising correlated dimensions of "internal," "chance," "doctors," and "powerful others" LOC. However, even this best-fit model offered a poor fit to the data. The subscales of the C-MHLC-C all demonstrated poor internal consistency. CONCLUSION: The C-MHLC-C cannot be recommended as a valid and reliable measure of LOC until a full translation and validation study has been conducted.