Evidence-based trends and association between symptom disturbance and physical activity among pregnant women: A longitudinal study.

BACKGROUND: Women usually decrease their physical activity (PA) after becoming pregnant. The change in PA may influence their symptom distress (SD). The changes and correlations between SD and PA throughout pregnancy remain unclear. AIMS: The aims of this study were to describe PA and SD trajectories across all three trimesters and examine their correlations during pregnancy. METHODS: A repeated-measure longitudinal study with convenience sampling at a hospital in Northern Taiwan was performed. Participants were recruited at 8-16 weeks of gestation, and two follow-up visits were performed at 24-28 weeks of gestation (second trimester) and after 36 weeks of gestation (third trimester). A total of 225 participants completed the study. The participants completed the Pregnancy Physical Activity Questionnaire (PPAQ) and Pregnancy-related Symptom Disturbance Scale (PSD), and sociodemographic and prenatal variables were recorded. RESULTS: Throughout pregnancy, SD decreased then increased, showing an overall upward trend, whereas PA showed the opposite pattern, increasing then decreasing, with an overall downward trend. Sedentary activity was positively correlated with both physical and psychological SD during the second and third trimesters. Exceeding the Institute of Medicine's recommendations for gestational weight gain, having childcare support, sport/exercise-type, and light-intensity PA were negatively associated with the physical and psychological SD, while a history of miscarriage and sedentary-intensity PA were positively associated with the physical and psychological SD. LINKING EVIDENCE TO ACTION: While several factors, including light-intensity PA, were found negatively associated with the physical and psychological SD, sedentary-intensity PA were positively associated with the physical and psychological SD, our findings shed light on future intervention strategies to relieve SD and decrease sedentary behavior among pregnant women.

Bi-dimensional acculturation and depressive symptom trajectories from pregnancy to 1 year postpartum in marriage-based immigrant women in Taiwan.

BACKGROUND: Childbirth may pose many challenges to the psychological well-being of marriage-based immigrant mothers in interracial marriages, who must negotiate bi-dimensional acculturation - adaptation to the host culture and maintenance of her own heritage culture. We examined the temporal relationships between bi-dimensional acculturation and depressive symptoms from pregnancy to 1 year postpartum among marriage-based immigrant mothers in Taiwan using the cross-lagged structural equation modeling. METHODS: This study recruited 310 immigrant mothers, who were examined in the second and third trimesters, and again at 1 month, 3 months, 6 months, and 1 year postpartum from March 2013 to December 2015. Depressive symptoms and bi-dimensional acculturation were measured using the Edinburgh Postnatal Depression Scale and Bidimensional Acculturation Scale for Marriage-Based Immigrant Women, respectively. RESULTS: The study found that adaptation to the host culture followed a downward linear trajectory, while maintenance of the mother's own heritage culture followed an upward linear trajectory from pregnancy to 1 year postpartum. All but one cross-lagged path between bi-dimensional acculturation and depressive symptoms was statistically insignificant, though almost all cross-sectional associations were significant. Adaptation to host culture was negatively associated with depressive symptoms at all time points. The association between maintenance of heritage culture and depressive symptoms reversed from positive to negative after 6 months postpartum. CONCLUSIONS: Adaptation to the host culture and maintenance of the mother's heritage culture differed in their associations with maternal depressive symptoms. Health professionals should assist immigrant mothers in adapting to the host culture while supporting their heritage culture in the childbearing period.

From job stress to intention to leave among hospital nurses: A structural equation modelling approach.

AIMS: The aim of this study was to examine the structural relationships linking job stress to leaving intentions through job satisfaction, depressed mood and stress adaptation among hospital nurses. BACKGROUND: High turnover among nurses is a global concern. Structural relationships linking job stress to leaving intentions have not been thoroughly examined. DESIGN: Two nationwide cross-sectional surveys of full-time hospital staff in 2011 and 2014. METHODS: The study participants were 26,945 and 19,386 full-time clinical nurses in 2011 and 2014 respectively. Structural equation modelling was used to examine the interrelationships among the study variables based on the hypothesized model. We used cross-validation procedures to ensure the stability and validity of the model in the two samples. RESULTS: There were five main paths from job stress to intention to leave the hospital. In addition to the direct path, job stress directly affected job satisfaction and depressed mood, which in turn affected intention to leave the hospital. Stress adaptation mitigated the effects of job stress on job satisfaction and depressed mood, which led to intention to leave the hospital. Intention to leave the hospital preceded intention to leave the profession. Those variables explained about 55% of the variance in intention to leave the profession in both years. CONCLUSION: The model fit was good for both samples, suggesting validity of the model. Strategies to decrease turnover intentions among nurses could focus on creating a less stressful work environment, increasing job satisfaction and stress adaptation and decreasing depressed mood. Hospitals should cooperate in this issue to decrease nurse turnover.

Depression and Social Support Trajectories During 1 Year Postpartum Among Marriage-Based Immigrant Mothers in Taiwan.

OBJECTIVES: This panel study examined the trajectories of depression and social support during the first year postpartum among marriage-based immigrant mothers in Taiwan, and the effect of social support on depression. METHODS: This panel study recruited South-Asia immigrant mothers (mean age: 27years) to complete structured questionnaire at 1month, 6month, and 1year postpartum. A total of 203 immigrant mothers completed structured questionnaires at 1 and 6months, and 163 completed the questionnaires at 1year postpartum. Postpartum depression was measured using the Edinburgh Postpartum Depression Scale. Social support was composed of 3 subscales, emotional, instrumental, and informational support. Hierarchical linear modeling was used to examine the relationships between trajectories and factors associated with depression. RESULTS: Depression and instrumental support followed downward curvilinear trajectories, while emotional and informational support followed upward curvilinear trajectories. Depression was highest at 1month, decreased sharply until 6months, and then leveled off between 6 and 12months. Emotional and instrumental support negatively covaried with postpartum depression over time. When the three-dimensional supports were considered together, only emotional support retained its significance. CONCLUSIONS: Our results demonstrated that depression was highest at 1month, then decreased, and then leveled off during 1year postpartum, though further study may be needed to confirm the trajectory. The 3 types of social support differed in postpartum trajectory, suggesting the needs to consider them separately in future studies. To decrease postpartum depression among immigrant mothers, strategies should be developed to increase emotional and instrumental support during postpartum period.

Clinical manifestations of pediatric obstructive sleep apnea syndrome: Clinical utility of the Chinese-version Obstructive Sleep Apnea Questionaire-18.

AIMS: Childhood obstructive sleep apnea syndrome (OSA) affects not only the children's physical health, but also their mental development, behavioral problems and learning difficulties. Therefore, an early diagnosis is important. However, the assessment tools of polysomnography are demanding. The Obstructive Sleep Apnea Questionnaire-18 (OSA-18) is designed to screen OSA and has good reliability and validity. The goal of this study was to validate the Chinese version of the OSA-18, to analyze the frequency of symptoms and find the most common symptoms of OSA in Taiwanese children. METHODS: We validated the OSA-18 in an ethnic Chinese group and compared the treatment outcomes to show the sensitivity of the questionnaire. The caregivers completed the questionnaire twice at an interval of 4 weeks to test reliability. In the validation study, we included 88 OSA children. The OSA-18 and follow-up polysomnography were performed before and 6 months after adenotonsillectomy. RESULTS: Results showed the excellent test-retest reliability (r = 0.84**) of the OSA-18. There was a statistically significant correlation between the OSA-18 and, respectively, the Apnea-Hypopnea Index (r = 0.29*), and the Hypopnea Index (r = 0.29*). Quality of life showed a significant correlation with the Apnea Index (r = 0.43**), central apnea count (r = 0.50***), and mixed apnea count (r = 0.36*). The cut-off point of the OSA-18 total scores for detecting pediatric OSA in children aged 6-12 years was 66. The common symptoms of pediatric OSA were poor attention span, loud snoring, caregiver worried about child's health, difficulty awakening, and mouth breathing. CONCLUSIONS: Our results show that the Chinese version of the OSA-18 is a reliable and valid instrument. The questionnaire also showed improvement in the quality of life of OSA children post-adenotonsillectomy.

Long-term effects of stimulants on neurocognitive performance of Taiwanese children with attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common behavioral and neurocognitive disorder in school-age children. Methylphenidate (MPH) is the most frequently prescribed CNS stimulant for ADHD. The aim of this study is to evaluate the changes in intelligence quotient and domains of neurocognitive function after long-term MPH treatment of Taiwanese children with ADHD. METHODS: The Wechsler Intelligence Scale (WISC-III) was administrated twice at an interval of at least one year for all 171 subjects (6-12 years) and 47 age- and gender-matched children without ADHD. The ADHD-Rating scale and Clinical Global Impression-Severity (CGI-S) were also used at the time of enrolment, and at 6 months and one year later. RESULTS: Taiwanese children with ADHD had lower Verbal IQ (VIQ) and Full IQ (FIQ) and performed poorly on several subtests of the WISC-III, including Similarities, Vocabulary, and Coding, compared to healthy children without ADHD. After one year of MPH treatment, significant decrements in all scores of the ADHD-Rating scale and CGI-S and increments in several domains of the WISC-III, including FIQ, VIQ, PIQ, Perceptual Organization Index (POI), Picture Completion, Picture Arrangement, Object Assembly, and Digit Span were observed. When the ADHD children under MPH treatment were subdivided into two age groups (6-8 years and 9-12 years), significantly better performance in some subtests and subscales of the WISC-III (such as Similarities, Comprehension, and Object assembly) was found in the 6-8 years age group. CONCLUSIONS: Long-term MPH treatment may improve the neurocognitive profiles of the ADHD children, as seen in their performance in several subtests and in the IQ scores on the WISC-III. And this improvement had no correlation with the decrement of ADHD symptoms. Starting stimulant treatment at as young an age as possible is advised due to the greater benefits in the 6-8 years age group, as seen in this study. More research in this area is also needed to confirm these results.

A structural model of the influence of immigrant mothers' depressive symptoms and home environment on their children's early developmental outcomes in Taiwan.

In this cross-sectional study of 61 immigrant mothers and their 6- to 24-month-old children in Taiwan, we examined the structure of relationships among maternal depressive symptoms, quality of the child-rearing home environment, and child development using a partial least squares approach. Maternal depressive symptoms as measured by the Edinburgh Postnatal Depression Scale had a direct and negative effect on the quality of the home environment as measured by the IT-HOME, which in turn had a direct and positive effect on child development as measured by the Comprehensive Developmental Inventory for Infants and Toddlers. Maternal depressive symptoms did not directly affect child development, suggesting that the quality of the home environment mediated the relationship between maternal depressive symptoms and child development.

Dynamic Structural Equation Modeling of the Relationship Among Daily Workplace Incivility, Daily Emotional Exhaustion, Self-Reported Health and Psychological Capital.

This was a daily diary study using intensive longitudinal methods to evaluate the dynamic structure of relationships among employees' self-reported health, psychological capital, daily workplace incivility, and daily emotional exhaustion. We recruited 200 participants working in health and fitness clubs for experience sampling and had them file the same questionnaires for 10 consecutive working days. A total of 179 participants (men = 57, 31.85%; women = 122, 68.15%) completed the questionnaires, with a response rate of 89.5%, leading to 1790 data points at the within-person level. We used a multilevel location-scale model of dynamic structural equation modeling (DSEM) for data analysis. We ran the model in Mplus software (version 8.4) and found an autoregressive 'carry over' relationship between the previous day's emotional exhaustion changes on current emotional exhaustion changes (γ10 = 0.067, CI = [0.003, 0.132]). Daily workplace incivility significantly and positively predicted daily emotional exhaustion at the within-person level (γ20 = 0.953, CI = [0.465, 1.489]). Self-reported health was negatively associated with a person's mean ratings of daily emotional exhaustion (γ20 = -0.256, CI = [0.465, 1.489]) and moderated the strength of the workplace incivility effect on emotional exhaustion (γ21 = -0.201, CI = [-0.292, -0.121]). Finally, psychological capital was negatively related to a person's mean ratings of daily emotional exhaustion (γ02 = -0.240, CI = [-0.377, -0.102]).

Cognitive ability, academic achievement and academic self-concept: extending the internal/external frame of reference model.

BACKGROUND: Marsh's internal/external (I/E) frame of reference model depicts the relationship between achievement and self-concept in specific academic domains. Few efforts have been made to examine concurrent relationships among cognitive ability, achievement, and academic self-concept (ASC) within an I/E model framework. AIM: To simultaneously examine the influences of domain-specific cognitive ability and grades on domain self-concept in an extended I/E model, including the indirect effect of domain-specific cognitive ability on domain self-concept via grades. SAMPLE: Tenth grade respondents (628 male, 452 female) to a national adolescent survey conducted in Taiwan. METHOD: Respondents completed surveys designed to measure maths and verbal aptitudes. Data on Maths and Chinese class grades and self-concepts were also collected. RESULTS: Statistically significant and positive path coefficients were found between cognitive ability and self-concept in the same domain (direct effect) and between these two constructs via grades (indirect effect). The cross-domain effects of either ability or grades on ASC were negatively significant. CONCLUSIONS: Taiwanese 10th graders tend to evaluate their ASCs based on a mix of ability and achievement, with achievement as a mediator exceeding ability as a predictor. In addition, the cross-domain effects suggest that Taiwanese students are likely to view Maths and verbal abilities and achievements as distinctly different.

The impact of maternal influences on childhood obesity.

There was a lack of detailed information about maternal influences on their children's body mass index (BMI) in Taiwan. The aim of this study was to find the evidence to describe how mothers' factors could affect their 2 to 9-year-old children's BMI, with data collected from May 2021 to June 2021. Anonymous self-administered questionnaires were completed by 1035 participants from Taiwan's six metropolitan cities and eight counties. After controlling for children's factors, such as number of children in a family, children's constitution, children's age and gender, hierarchical regression models were used to analyze the effects of five maternal factors on their children's BMI: maternal BMI, age, education level, monthly household income, and marital status (single parent or not). The results were found as follow: maternal BMI [ß = .24], maternal educational level [ß = -.141], and monthly household income [ß = .071], significantly (p < 0.05) influenced their children's BMI. Higher maternal BMI was associated with a higher children's BMI. Mothers with lower levels of education background were more likely to have children with a higher BMI. Monthly household income was a positive factor influencing children's BMI. In conclusion, this study is the first detailed description of maternal influences on their 2-9 years old children's BMI in Taiwan. Although the study could not cover all of the factors influencing Taiwan's childhood obesity, we have discovered maternal BMI, education level, and monthly household income were significant factors associated with children's BMI.

Development and validation of the questionnaire of satisfaction with perioperative anesthetic care for general and regional anesthesia in Taiwanese patients.

BACKGROUND: To fulfill the increasing demand of service quality improvement in recent years, it is imperative to develop a proper instrument to evaluate patient satisfaction with perioperative anesthetic care for many institutes in Taiwan. METHODS: We used a six-factor 32-item pilot questionnaire developed in our previous study as our starting point in this study. Exploratory factor analysis of the pilot questionnaire for factor structure generation was performed in general anesthesia patients (group 1, n = 320) and resulted in the generation of the Patient Satisfaction with Perioperative Anesthetic Care questionnaire (PSPACq). Confirmatory factor analysis of the PSPACq in general anesthesia (group 2, n = 565) and regional anesthesia (group 3, n = 225) patients was performed for validation and cross-validation of the PSPACq model, respectively. The confounding variables and the patient loyalty effects on PSPACq scores were analyzed to evaluate the nomological validity of the PSPACq. RESULT: Exploratory factor analysis of the pilot questionnaire in group 1 resulted in the development of the PSPACq (a seven-factor 30-item model). The standardized coefficients and indexes for the assessment of fit of the PSPACq model in group 2 (validation) and group 3 (cross-validation) patients revealed a well-fitting model. The results of the loyalty scores and confounding variables support the nomological validity of the PSPACq. CONCLUSIONS: A valid and reliable questionnaire (PSPACq) with Taiwanese culture characteristics was developed and is suitable for testing of patient satisfaction with perioperative anesthesia care for patients receiving general or regional anesthesia for their surgery.

Effectiveness of a brief intervention for managing hazardous drinking problems of inpatients in Taiwan.

AIMS: This paper is a report of a randomized control trial undertaken to evaluate the efficacy of the Brief Intervention for Alcohol Use in Taiwanese inpatients with hazardous drinking patterns. BACKGROUND: The Brief Intervention for Alcohol Use has been found to be as effective as medical and psychological treatments for individuals with alcohol use disorders in western countries. However, few studies have examined brief alcohol interventions for a Chinese population. METHODS: Patients from the medical and surgical wards of a medical centre in northern Taiwan were enrolled if they had an Alcohol Use Disorders Identification Test score >8. Participants were randomly assigned to the experimental group (n = 47), which received the Brief Intervention, and the control group (n = 48), which received no special psychosocial intervention except routine nursing care. Data were collected from February 2005 to March 2006 on hospitalized participants' demographic characteristics and alcohol use. Scores on the Alcohol Use Disorders Identification Test were re-assessed over the telephone 6 months later by a trained assistant blinded to the treatment group. RESULTS: The experimental group had a significantly higher mean improved Alcohol Use Disorders Identification Test score and better outcomes in all three dimensions of the test than the control group. CONCLUSIONS: The Brief Intervention for Alcohol Use is recommended for use in clinical settings to help Taiwanese inpatients with hazardous drinking patterns to improve their drinking problems.

The Association between Body Mass Index and Physical Fitness of Normal Weight/Overweight/Obese University Students.

This study aimed to apply longitudinal data (in four waves) to examine relationships between body mass index (BMI), flexibility, muscular endurance, and explosive power, and employed a random-intercept panel model (RIPM) to divide the variations of different waves into between- and within-person variations. Furthermore, a multi-group model test was conducted to explore whether an interaction effect existed between sex and these relationships. The data were collected from a university in Taiwan between August 2009 and July 2010, and 3863 freshman and junior students were recruited. Results showed that the between- and within-person relationships between BMI and explosive power, and between BMI and muscular endurance, were negative (independent of sex). The negative between- and within-person associations between BMI and muscular endurance were both invariant with respect to sex. The negative between-person associations between BMI and explosive power were not equivalent for both sexes, yet the within-person associations between BMI and explosive power were equivalent for both sexes. The between-person associations between BMI and flexibility were positive for both sexes, but the within-person associations of these two variables were negative for both sexes. The invariance test confirmed that the positive associations of between-person BMI and between-person flexibility were invariant for both sexes, yet the negative associations of within-person BMI and within-person flexibility were not equivalent for both sexes. Between-and within-person correlations among explosive power, muscular endurance, and flexibility were significantly positive. Only the auto-regressions of BMI and muscular endurance were significant and equivalent for both sexes.

The interrelationships among parenting stress and quality of life of the caregiver and preschool child with very low birth weight.

This study examined the interrelationships of quality of life (QOL) of primary caregivers and their preschool children with very low birth weight (VLBW) and parenting stress. Primary caregivers of 118 VLBW and 170 non-VLBW children completed questionnaires. Structural equation modeling suggested that the QOL of the primary caregivers was directly related to parenting stress, and that parenting stress was directly related to the children's QOL. The aforementioned relationship did not differ between VLBW and non-VLBW groups. Targeting the QOL and parenting skills of the primary caregiver could also improve the QOL of the preschooler.

The Chinese version of the drinking-related locus-of-control scale: a confirmatory factor analysis.

Internal control beliefs appear to be important factors in recovery from alcoholism. However, no instrument for assessing drinking-related locus of control has been developed in Taiwan. After translating the drinking-related locus-of-control scale (DRIE) into Chinese, we examined the psychometric properties of the Chinese version of the DRIE in alcohol-dependent patients. A total sample of 161 alcohol-dependent patients received treatment for alcoholism in psychiatric hospital outpatient and inpatient units. Confirmatory factor analyses were conducted on three-factor, two-factor, and one-factor measurement models of the DRIE based on prior studies. The results indicated that the one-factor model of the DRIE provided goodness of fit to the data in this study. The Chinese version of the DRIE has been demonstrated to be a reliable and valid tool for the assessment of locus-of-control beliefs in alcohol-dependent patients.

Neurocognition, sleep, and PET findings in type 2 vs type 1 narcolepsy.

OBJECTIVE: To analyze differences in functional brain images collected in patients with type 2 and type 1 narcolepsy compared to normal controls and the relationship among brain images, objective neuropsychologic tests, and sleep findings. METHODS: Data collection included comprehensive clinical investigation, study of sleep/wake with actigraphy, polysomnography, Multiple Sleep Latency Test, human leukocyte antigen typing, 18F-fluorodeoxyglucose PET, and cognitive tests obtained from 29 patients with type 2 narcolepsy, 104 patients with type 1 narcolepsy, and 26 sex- and age-matched normal control individuals. Conners' Continuous Performance Test (CPT II) and Wisconsin Card-Sorting Task were performed simultaneously with the FDG-PET examination. After analyses of variance, data between patients with type 1 and type 2 narcolepsy were compared by post hoc analysis, and correlation between functional brain imaging findings and results of neurocognitive tests was obtained. RESULTS: All patients with narcolepsy presented with at least 2 sleep-onset REM periods (SOREMP) and subjective sleepiness. Patients with type 2 narcolepsy compared to patients with type 1 narcolepsy had significantly less SOREMP, longer mean sleep latencies, and lower body mass indexes, apnea-hypopnea indexes, and frequency of human leukocyte antigen DQ-Beta1*0602. In patients with type 2 narcolepsy, FDG-PET studies showed significantly less hypermetabolism in the fusiform gyrus, striatum, hippocampus, thalamus, basal ganglia, and cerebellum than in patients with type 1 narcolepsy, and significantly less hypometabolism in the regions of frontal lobe, posterior cingulum, angular gyrus, and part of the parietal lobe; these changes were associated with fewer errors on the CPT. CONCLUSION: Young patients with type 2 narcolepsy have fewer clinical impairments and less distinct brain functional abnormalities than patients with type 1 narcolepsy, who are significantly more affected.

The Physical Activity Patterns of Pregnant Taiwanese Women.

BACKGROUND: Physical activity reduces the risk of maternal disorders during pregnancy. However, many pregnant women reduce their levels of physical activity while pregnant. PURPOSE: The purpose of this study was to examine and compare the physical activity (total amount, intensity, type) of Taiwanese women during each trimester. METHODS: This cross-sectional survey used purposive sampling to enroll 581 Taiwanese women as participants. The physical activity of participants was measured using the Mandarin version of the Pregnancy Physical Activity Questionnaire. RESULTS: The levels of household/caregiving activity and occupational activity differed significantly across trimesters. Household/caregiving (43.2%-54.5%) and occupational activity (42.0%-54.0%) accounted for the largest percentages of total energy expenditure for all three trimesters. In terms of total and household/caregiving activities, multiparous women had significantly higher mean energy expenditures than their primiparous peers. Moreover, income had a pervasive influence on all types and amounts of physical activity and energy expenditures, respectively, with the exception of sports/exercise. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Further careful assessment of the types and intensities of physical activity that are suitable for pregnant women in different parity and income categories in Taiwan is necessary. Furthermore, healthcare providers should encourage pregnant women to use strategies that promote their more regular participation in enjoyable physical activities. One of these potential strategies is to do activities together with children, family members, or friends.

Using the Theory of Planned Behavior to predict pregnant women's intention to engage in regular exercise.

OBJECTIVE: the objectives of this study were to use the Theory of Planned Behavior (TPB) in order to determine to what degree pregnant women intended to exercise regularly during pregnancy, and then to evaluate the TPB model fit. DESIGN: this study was based on a cross-sectional survey with a tool which was developed specifically for this study. SETTING: we identified and invited pregnant women from two medical center hospitals and one certified prenatal center in northern Taiwan to participate. PARTICIPANTS: using purposive sampling, we selected participants who were in at least the 12th week of gestation and did not have a high-risk pregnancy. 621 completed the instrument, their mean age was 31.76 (SD=3.87). METHODS: a self-administered instrument was used to determine the firmness of participants' intention to engage in regular exercise during pregnancy. The data were analyzed using SPSS 19.0 software and LISREL 8.72 software. FINDINGS: of the pregnant women in our study, 64.2% were found to be likely to exercise regularly up until delivery. The TPB was used to arrive at specific findings with regard to "intention to exercise regularly during pregnancy." Our participants demonstrated a positive intention to exercise regularly, a positive attitude (ATT), positive subjective norms (SN) and positive perceived behavioral controls (PBC) during pregnancy. The most influential factor in determining the participants' positive intention to exercise was found to be PBC (ß=0.68, p<0.01), followed by the SN (ß=0.12, p<0.01). The participants' ATT did not significantly influence their intention. Overall, the final model explained 59% of the variation in "intention to exercise regularly." KEY CONCLUSION AND IMPLICATION FOR PRACTICE: the most important factor in determining the participants' intention to exercise regularly was PBC, followed by the SN. Medical staff members should be able to help pregnant women overcome obstacles to regular exercise, for example, by assisting in providing appropriate resources.

Inflammatory cytokines in pediatric obstructive sleep apnea.

Pediatric obstructive sleep apnea (OSA) is associated with chronic systemic inflammation and with cognitive impairments. This study aimed to investigate the status of proinflammatory cytokines, particularly interleukin 17 (IL-17) and interleukin 23 (IL-23) and cognition in pediatric OSA.Controls and OSA children participated in the study. Exclusion criteria were adenotonsillectomy, heart, neurological and severe psychiatric diseases, craniofacial syndromes, and obesity. Polysomnogram was followed by serum testing for inflammatory markers and neurocognitive tests such as continuous performance task (CPT) and Wisconsin card sorting test, questionnaires, analyses of plasma high-sensitivity C-reactive protein (HS-CRP), tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1), interleukin 6 (IL-6), IL-17, and IL-23.Seventy-nine, 4 to 12-year-old subjects in 2 groups ended the study: 47 nonobese OSA children (mean age = 7.84 ±â€Š0.56 years, body mass index [BMI] = 16.95 ±â€Š0.47 kg/m, BMI z-score = 0.15 ±â€Š0.21, and mean apnea-hypopnea index [AHI] = 9.13 ±â€Š1.67 events/h) and 32 healthy control children (mean age = 7.02 ±â€Š0.65 years, with BMI = 16.55 ±â€Š0.58 kg/m, BMI z-score = -0.12 ±â€Š0.27, and mean AHI = 0.41 ±â€Š0.07 event/h) were enrolled. Serum cytokine analyses showed significantly higher levels of HS-CRP, IL-17, and IL-23 in OSA children (P = 0.002, P = 0.024, and P = 0.047). Regression test showed significant influence of HS-CRP, TNF-α, IL-6, IL-17, and specifically IL-23, with the continuous performance test and Wisconsin card sorting test.OSA children have abnormal levels of IL-17, an interleukin related to T helper 17 cells, a T helper cell involved in development of autoimmunity and inflammation. This high expression level may contribute to the complications of pediatric OSA; we also found a significant influence of inflammatory cytokines, particularly IL-23, on abnormal neurocognitive testing.

Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases.

BACKGROUND: Our objective was to analyze demographics and characteristics of Meckel's diverticulum with different manifestations in pediatric patients. METHODS: This is a retrospective study in children with symptomatic Meckel's diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckel's scan results, surgical and histological findings were analyzed. RESULTS: One hundred symptomatic Meckel's diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckel's scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckel's diverticulum with non-obstructive symptoms (p < 0.001). CONCLUSION: Diverse presentations in pediatric Meckel's diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with non-obstructive symptoms.