Features, measurements, determinants, treatments, and outcomes of musculoskeletal symptoms in postmenopausal women: A scoping review.

BACKGROUND: The literature lacks a consistent review of musculoskeletal symptoms in postmenopausal women. AIM: To identify features, measurements, determinants, treatments, and outcomes of musculoskeletal symptoms in postmenopausal women. METHOD: A scoping review was completed using six databases: Embase, Medline, Cochrane, CINAHL, Web of Science, and Scopus up to December 2022. Sixty-three articles were identified. RESULTS: Musculoskeletal symptoms in postmenopausal women include somatic symptoms of non-specific origin, upper and lower limb symptoms, spinal pain, and decline in physical performance. Measurements were categorized into four groups: musculoskeletal symptoms for menopause, general musculoskeletal symptoms, menopause-specific quality of life, and general quality of life questionnaires. The determinants were grouped into four themes: demographics, physical determinants, psychosocial determinants, and lifestyle. Pharmacological interventions, supplementation options, and exercise regimens exist for postmenopausal women with musculoskeletal symptoms. CONCLUSION: A comprehensive policy is needed to address musculoskeletal symptoms in postmenopausal women, promoting diverse treatments for improved quality of life.

Self-management system for postpartum women with hypertension disorders: an eHealth application intervention study.

BACKGROUND: Hypertension disorders are relatively common in pregnant women and often persist in the postpartum period. Few studies are available regarding the self-management of postpartum hypertension via the eHealth system. This study aimed to develop a self-management eHealth system for women with postpartum hypertension during the postpartum period. METHODS: We adopted a multi-platform system for this research, not only for use on the web interface but also on smartphones. The proposed system possessed three features: (1) the population was limited to postnatal women with hypertension; (2) a self-care record, which allowed postnatal women to keep track of their blood pressure, pulse, weight, medication record, exercise record, and risk factor assessment; and (3) through this system, nurse-midwives could keep track of postnatal women's health status maintaining the complete record and could communicate directly with the users if their health monitor values reach beyond normal range. RESULTS: Thirty-nine postnatal women with postpartum hypertension were recruited to the study. A survey to evaluate the usability and satisfaction of the proposed e-health application system was completed by these women. The usability rate of the system reached 92.4% (46.2% satisfied and 46.2% strongly satisfied), which suggested that the system was helpful to the users. The satisfaction rate of the system reached 94.9% (43.6% satisfied and 51.3% strongly satisfied), which suggested that the system was acceptable to the users. CONCLUSION: This proposed system has been developed completely with user experience and professional advice from experts. Postnatal women could gain important postpartum-related knowledge and access their related health records and other information easily via their smartphones or computers. During the postpartum period, an eHealth application system can effectively assist women with hypertension to manage their blood pressure and related postnatal healthcare issues.

Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis.

AIMS: To evaluate the effectiveness of the cold intervention on relieving migraine symptoms among adult patients with migraine. DESIGNS: A systematic review and meta-analysis of randomised controlled trials (RCT) and non-RCT studies were performed. DATA SOURCES: We searched five electronic databases including Cochrane Library and Cochrane CENTRAL, Embase, MEDLINE, Scopus and CINAHL from the date of inception to March 2021. REVIEW METHODS: Research was eligible for the systematic review if they included adult patients with migraine, using cold regimen as intervention, and outcomes measuring the symptom alleviation of migraine. Two researchers independently conducted the searching process and data extraction. The certainty of evidence was assessed using GRADE approach to the main outcomes was used. The PRISMA checklist was used to assure the quality and transparency of report. RESULTS: Six studies (4 RCTs and 2 non-RCTs) met the inclusion criteria. The cold interventions on migraine alleviation include a cold-gel headband, cold-gel cap, intraoral cooling, skin temperature biofeedback and cold wrap accompanied by massage. Compared to non-cold regimens, the cold interventions had a short-term effect on reducing migraine pain rated on the Visual Analog Scale (VAS) score at 30 min after intervention (Std. mean difference [SMD] -3.21; 95% CI -5.94, -0.48). Compared to the non-cold regimens, the cold interventions had marginal long-term effects on relieving migraine pain VAS score (SMD -0.44; 95% CI -0.91, 0.03) and nausea (SMD -0.56; 95% CI -1.17, 0.04) (24 h after intervention). The GRADE indicated that the certainty of evidence was rated from very low to moderate. Insufficient results on the outcomes of nausea and vomiting were discovered for the meta-analysis. CONCLUSIONS: Cold intervention is an effective regimen to reduce migraine pain instantly. The long-term effect of cold interventions on migraine is not demonstrated. The effects of cold interventions on nausea and vomiting need more studies to verify.

Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis.

OBJECTIVE: Migraine is a common disease worldwide and migraine prevention is primarily currently based on pharmaceuticals. The mechanism of Vitamin B2 may positively contribute to migraine. This systematic review and meta-analysis aimed to evaluate the impact of Vitamin B2 supplementation on the days, duration, frequency, and pain score of the migraine attack. METHODS: : The PRISMA guideline was used for the studying process. Five electronic databases, PubMed, Embase, Cochrane, CINAHL, and CEPS were searched from 1990 to March 2019. The search terms were Vitamin B2, migraine, and prophylactic. A meta-analysis was performed using Comprehensive Meta-Analysis (CMA) version. RESULTS: : Nine articles were included in systemic review and finally meta-analysis. Eight randomized controlled trials and one controlled clinical trial with 673 subjects were analyzed using meta-analysis. Vitamin B2 supplementation significantly decreased migraine days (p = .005, I2 = 89%), duration (p = .003, I2 = 0), frequency (p = .001, I2 = 65%), and pain score (p = .015, I2 = 84%). CONCLUSIONS: A pooled analysis of available randomized controlled clinical trials demonstrated that Vitamin B2 400 mg/day for three months supplementation had significant effect on days, duration, frequency, and pain score of migraine attacks.

[Metamorphosis of Nurses: The Development and Breakthroughs of Advanced Practice Registered Nurses].

BACKGROUND: The introduction and development of the advanced practice registered nurse (APRN) is a global trend in nursing. However, the development of APRNs in Taiwan remains uncertain and lacks necessary consensus. PURPOSE: This research study aimed to explore the views and suggestions of nursing experts in industry, government, and academia regarding the development of APRNs (clinical nurse specialists, case managers, certified clinical registered nurse anesthetists, and certified nurse-midwives) in Taiwan. METHODS: Data were collected from March to August 2017. Sixty-four experts participated in one of six focus group discussions held in northern, central, and southern Taiwan. These group discussions were recorded and transcribed verbatim with the consent of the participants. Content analysis was used to analyze the transcribed data. RESULTS: The comments and suggestions raised during the discussions were categorized into four major themes: professional development of necessity, core competencies, accreditation, and future promotion-related issues. Each theme was further divided into several subthemes. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The opinions of relevant experts regarding the current status of development of the roles, practical scope, and management and suggestions for APRNs were summarized to facilitate the future development of APRNs in Taiwan in terms of education, core competencies, certification, and practical scope. Furthermore, the results may be referenced in the establishment of a nursing consensus model and as a basis for promoting APRNs.

Factors associated with the intention to undergo Pap smear testing in the rural areas of Indonesia: a health belief model.

PURPOSES: This study aimed to understand the influence of health beliefs, demographic factors, and health characteristics on the intention to undergo Pap smear testing among women in rural areas of Indonesia. METHODS: A descriptive cross-sectional study was conducted and 687 married women participated in the study. A convenience sampling was applied to recruit the participants from community health centres in a rural region in Indonesia. Self-reported data using the Health Beliefs Model Scale for Cervical Cancer and Pap Smear Test was collected to assess the health beliefs. Independent t-tests, simple logistic regressions, and a hierarchical logistic regression with 3 steps were run. Statistical significance for analysis was set at p < 0.05. RESULTS: The mean age of the participants was 42 years (SD = 8.4). Among the participants, 81% of the women had never undergone a Pap smear test, and 61% (n = 422) of the women reported a high intention of receiving a Pap smear test. Income and education Health beliefs regarding Pap smear testing were different between women who had low and high intentions to undergo Pap smear testing. Health beliefs, such as perceived benefits, severity, barriers to Pap smear testing, and health motivation for a Pap smear test were associated with the intention to undergo Pap smear testing among rural Indonesian women. Overall, the hierarchical multiple regression with 3 steps containing demographic, health characteristics, and health belief variables accounted for 31% variance of the intention to undergo Pap smear test among the Indonesian rural women. CONCLUSIONS: Low screening rates of cervical cancer and high intentions to do the screening exist among rural Indonesian women. Health beliefs significantly affect the rural women's intention of Pap smear testing in Indonesia.

Cervical cancer is a leading cancer among women and a significant cause of mortality for females around the world, including Indonesia. Globally, the screening rate for cervical cancer among women in rural areas remains low. In Indonesia, the incidence and the mortality from cervical cancer remain high compared to other female cancers. The Indonesian government has offered a free Pap smear screening to women since 2014, but the screening rate is still low, around 28%.A total of 687 married women were included in the study. Approximately 80% of Indonesian women living in rural areas have never undergone a Pap smear test, and 60% of women reported a high intention of receiving a Pap smear test. Education, income, previous experience of Pap smear testing, a friend with a history of cervical cancer, perceived severity, perceived benefits, perceived barriers, and health motivations were significantly associated with the intention of Pap smear testing. Low screening rates of cervical cancer and high intentions toward the cervical cancer screening exist among rural Indonesian women. Health beliefs significantly affect the women's intention of Pap smear testing.

[Cross-Disciplinary Research in Nursing: Competency and Practice].

Cross-disciplinarity is a current trend in healthcare. With the advancement of science and technology, the expansion of care fields, and the complexity of health problems, cross-disciplinary research has been increasingly emphasized in nursing studies in order to introduce technology into patient care, expand the scope of healthcare research, and improve quality of care. The term cross-disciplinary research typically covers multidisciplinary, interdisciplinary, and transdisciplinary studies. Each of these types of studies differ in terms of connotation, level of research problem addressed, and degree of interaction involved. The main purpose of this article is to describe the significance of cross-disciplinary research in nursing and to distinguish the types and nature of cross-disciplinary studies. Furthermore, reflections and recommendations on cross-disciplinary nursing research are also proposed. The development of cross-disciplinary nursing research is phased in nature and requires the creation of a cross-disciplinary research center and excellent leadership. Conducting cross-disciplinary nursing research is challenging and affected by uncertainty. Researchers may select the type of cross-disciplinary research that best addresses the complexity and commonality of the research problem being addressed. In addition, researchers may expand, communicate, and interact with other disciplines to improve their interdisciplinary research capabilities and opportunities.

[Nursing Education Strategies During the COVID-19 Epidemic].

The ongoing new coronavirus disease (COVID-19) pandemic, which arose at the end of 2019, poses a severe challenge to world public health systems. Frontline medical staffs bear a great burden to provide health care services. The Taiwan government has taken rapid and decisive actions to reduce the risk of community transmission and campus cluster infection. Nursing education includes both classroom teaching and clinical practicum components. In preparing for their practicum, students must learn not only fundamental nursing care knowledge but also basic knowledge on emerging infectious diseases. All schools nationwide have complied with the Ministry of Education order to postpone the opening of the fall semester in response to the rapid evolution of the COVID-19 pandemic. Campus epidemic prevention measures were implemented through student counseling networks, and flexible teaching strategies, including online teaching and distance teaching, were implemented to protect the learning rights of students. This paper explores the strategies implemented in response to emerging infectious diseases in nursing education based on the core values of professional nursing. Examining the precautions taken at campuses and teaching strategies adopted in response to the COVID 19 pandemic may provide valuable insights that may be applied to the future development of nursing education.

[Social Impacts of International Nursing Education].

The objective of international nursing education in Taiwan is to prepare nursing elites to improve the quality of global healthcare. Nurses are on the frontlines in terms of helping the public through increasingly frequent climate-change disasters, helping care for the rising populations of older adults and patients with chronic diseases, and dealing with the emergence of new infectious diseases. Advancing the knowledge and capabilities of global nursing elites is imperative. The main purpose of nursing education is to educate future nursing leaders. This paper describes the internationalization of nursing education in the Department of Nursing at National Cheng Kung University as well as the process of establishing the Asia-Pacific Nursing Education Alliance to highlight the international characteristics of nursing education, the related global social influence, and the pursuit of sustainable development goals.

Psychometric evaluation of a Chinese version of Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema in women with gynaecological cancer surgery.

The prevalence of lower limb lymphoedema and its impact in gynaecological cancer patients is underestimated. However, a valid and reliable scale to measure lower leg lymphoedema in Taiwan has not been available. The purpose of the study was to translate the English version of Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema into a Chinese version (Lymph-ICF-LL-C), and evaluate the psychometric properties of the Lymph-ICF-LL-C in Taiwanese women with gynaecological cancer surgery. A total of 170 women with gynaecological cancer surgery were recruited to examine the Lymph-ICF-LL-C. The Lymph-ICF-LL-C shows satisfactory internal consistency (Cronbach's alphas ≥ 0.84) and stability test-retest reliability (Intraclass correlation coefficient ≥0.55-0.90) at a 2-week interval. Exploratory factor analysis showed that 68.53% of the total variance was explained by a five-factor solution. The concurrent validity of the Lymph-ICF-LL-C was evidenced by a significant correlation with a fatigue scale (r = 0.46, p < 0.01) and with the bilateral difference of lower limb circumference (r = 0.24-0.36, all p < 0.01). The Lymph-ICF-LL-C can be used for assessing the life impact of lower limb lymphoedema, allowing appropriate interventions to prevent further deterioration and complications.

Variations in the rancid-flavor compounds of human breastmilk under general frozen-storage conditions.

BACKGROUND: Human breastmilk provides the best nutrition for infants. When women or infants have difficulties in breastfeeding directly, breastmilk is usually pumped and frozen for later use. However, while frozen, breastmilk may develop a rancid flavor, which induces infant feeding stress and raises the mothers' concerns about the quality of frozen breastmilk. Nevertheless, few studies have investigated the variations in the compounds that cause the rancid flavor of breastmilk during frozen storage. METHODS: A repeated-measures design was adopted to quantify the variations in rancid-flavor compounds, namely acid value (AV), total free fatty acids (FFAs), and short-and intermediate-chain FFAs of breastmilk during frozen storage. Breastmilk was obtained from ten healthy mothers of full-term infants and each milk sample was divided into three aliquots: fresh, 7-day frozen and 30-day frozen samples. The fresh samples were immediately analyzed, while the others were frozen in a domestic fridge within a temperature range of -15 to -18 °C and analyzed 7 and 30 days later. RESULTS: The rancid-flavor compounds of the breastmilk, namely AV, total FFAs and intermediate-chain FFAs, significantly increased with storage time, all of which reached the sensory threshold for detecting the rancid flavor of milk. In addition, the FFAs of the breastmilk samples frozen for 7 days far exceeded the detection threshold for unpleased rancid flavor, while the 30-day samples were higher than the intolerable level for most people. CONCLUSIONS: This study revealed that the human breastmilk develops a rancid flavor during frozen storage. Therefore, we recommend that when infants refuse thawed milk, mothers can try to provide freshly expressed milk whenever possible or provide breastmilk frozen for less than 7 days. Future studies could explore the methods for slowing breastmilk lipolysis to maintain its fresh flavor.

Longitudinal psychosocial adjustment of women to human papillomavirus infection.

AIM: The aim of this study was to examine the psychosocial adjustment trajectory, focusing on psychological distress, sexual relationships and healthcare information, and factors which have an impact on adjustment on receiving a positive diagnosis of human papillomavirus infection. BACKGROUND: Human papillomavirus is a common sexually transmitted infection in females. To date, knowledge of the longitudinal psychosocial response to the diagnosis of human papillomavirus is limited. DESIGN: A prospective longitudinal design was conducted with a convenience sample. METHODS: Women aged 20-65 years old were followed at one, 6 and 12 months after a diagnosis of HPV. Participants completed measures of initial emotional distress and followed up psychosocial adjustment. A mixed-effects model was applied to analyse the longitudinal changes in psychosocial adjustment. RESULTS: Seventy human papillomavirus positive women participated in the study with nearly 20% of the women reporting emotional distress during their first visit. Mixed-effects model analyses showed that a trajectory of psychosocial adjustment in healthcare orientation, sexual relationship and psychosocial distress occur from one to 6 months after HPV diagnosis. However, a declining trend from 6 to 12 months was significant in healthcare orientation. Initial emotional distress was associated with changes in psychological adjustment. CONCLUSIONS: Psychosocial adjustment to human papillomavirus was worse at 1 month compared with 6 and 12 months after diagnosis. Healthcare providers should offer health information and psychosocial support to women according to their disease progression.

The effectiveness of multimedia education for patients with type 2 diabetes mellitus.

AIMS: The aim of this study was to explore the effectiveness of two types of health education on improving knowledge concerning diabetes and insulin injection, insulin injection skills and self-efficacy, satisfaction with health education and glycated haemoglobin (HbA1c) and creatinine levels among patients with type 2 diabetes who began insulin therapy using a pen injector. BACKGROUND: Insulin therapy is recommended to facilitate the regulation of plasma glucose; however, patient's acceptance of insulin therapy is generally low. Healthcare providers should help them improve their knowledge of diabetes and insulin injection, as well as their insulin injection skills. DESIGN: A randomized repeated measures experimental study design. METHODS: The experimental (n = 21) and control (n = 21) groups received multimedia and regular health education programmes, respectively from October 2013-August 2014. Four structured questionnaires were used and videotapes were applied to demonstrate injection skills. RESULTS: Generalized estimating equations showed that the experimental group's scores were significantly higher than those of the control group for diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. On the other hand, an analysis of covariance revealed glycated hemoglobin (HbA1c) and creatinine levels did not differ significantly between the two groups. CONCLUSIONS: Implementation of a multimedia diabetes education programme could improve patients' diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. Healthcare providers should improve quality of patient care by providing multimedia diabetes health education.

Parental intention regarding the administration of the HPV vaccine for adolescent daughters in Taiwan.

This study aimed to investigate parental intention regarding the human papilloma virus (HPV) vaccination for adolescent daughters. Parents or guardians of adolescent girls, aged 12-14 years, from junior high schools in Taiwan participated and completed a HPV vaccination intention survey based on the Theory of Planned Behavior. The survey was conducted from October to November, 2009. Most, 78%, of the respondents reported a high intention to vaccinate daughters against HPV. A high intention of vaccination was associated with a family history of gynecological tumors (adjusted odds ratio [OR]: 2.22, 95% confidence interval [CI]: 1.10-4.51) and HPV awareness (adjusted OR: 2.33, 95% CI: 1.45-3.76). Higher parental intention was reported by respondents with a positive attitude toward the HPV vaccine (adjusted OR: 6.83, 95% CI: 4.16-11.22), perceived greater influence of subjective norms (adjusted OR: 121.23, 95% CI: 42.69-344.21), greater perceived behavioral control (adjusted OR: 67.69, 95% CI: 16.40-279.41), and perceived that the vaccine had limited influence on adolescent sexual behavior (adjusted OR: 2.24, 95% CI: 1.41-3.78). Health-care professionals must be knowledgeable about the HPV and actively promote vaccination among adolescent girls. Improvements in vaccination can be achieved through recommendations by physicians and nurses.

Estimation of potential gain in quality of life from early detection of cervical cancer.

OBJECTIVE: To estimate the lifetime gain in the health-related quality of life (HRQOL) from early detection of cervical cancer. METHODS: A consecutive, cross-sectional sample of 421 patients with cervical cancer was administered the World Health Organization Quality of Life-brief version questionnaires. A nationwide sample of 22,543 patients with invasive cervical cancer (ICC) was collected from the national cancer registry for estimation of lifetime survival function from 1998 to 2007, which was further multiplied by the ratio of HRQOL score functions for patients with ICC and patients with carcinoma in situ (CIS), and summed up over lifetime to obtain expected relative-quality-adjusted survival. The difference between lifetime survival and the expected relative-quality-adjusted survival gives the expected total dissatisfied time during the life course. RESULTS: In comparison with patients with CIS postconization, patients with ICC showed consistently lower scores in the physical and psychological domains and that of sexual life after adjustment for other risk factors. The expected years of life lost for an invasive cancer was 6.48 years using the general population as the reference cohort, while the durations of equivalent to living with a very dissatisfied HRQOL were 1.71 and 0.25 for the physical and psychological domains, respectively, and 1.47 years for sexual life. Validation of the extrapolation method based on a subcohort followed from the 6th to the 13th year shows a relative bias of 0.4%. Sensitivity analysis with 37,000 CIS cases as the reference cohort yields a similar result. CONCLUSIONS: Early detection of cervical cancer not only avoids premature mortality but also prevents long-term living under lower HRQOL scores, including sexual life.

Effects of exercise on lower limb lymphedema in gynecologic cancer: A systematic review and meta-analysis.

PURPOSE: A systematic review investigated the effectiveness of physical activity in alleviating lower limb lymphedema among patients with gynecological cancer after surgery. METHODS: A systematic review of randomized controlled trials and quasi-experimental designs was conducted. Six databases, Cinahl, Cochrane, Embase, Medline, Scopus, and Web of Science, were searched for relevant publications from inception to October 2022 and updated in January 2024. RevMan software was used to perform meta-analysis using a random-effects model. RESULTS: Seven studies (5 randomized controlled trials) containing 261 subjects were synthesized. The risk of bias was low in the included studies. The exercise interventions for lower limb lymphedema included active, aerobic, aquatic, and weight-lifting exercises. Meta-analyses showed that active exercise had no effect on lymphedema symptoms of limb volume, pain, and heaviness. However, the effectiveness of exercise on limb volume had subthreshold borderline significance in 2 studies (standardized mean difference = 0.43, 95% confidence interval - 0.01, 0.88; I2 = 0%, p = 0.06). Three studies found that lymphedema symptoms were significantly improved after exercise interventions. The adherence rate of the exercise was 77-100%, with the only complication being cellulitis. CONCLUSIONS: Although the meta-analysis does not reveal a significant effect, the systematic review study demonstrated that exercise is feasible, safe, and has a clinical effect on alleviating lymphedema-related symptoms of women following gynecological cancer surgery.

The Effect of Pelvic Floor Muscle Training on Health-Related Quality of Life in Postmenopausal Women With Genitourinary Syndrome: A Systematic Review and Meta-Analysis.

BACKGROUND: Genitourinary syndrome is commonly reported in postmenopausal women. Kegel's exercise is a noninvasive therapy that improves pelvic floor muscle parameters. However, the effect of Kegel's exercise on health-related quality of life (HRQoL) in postmenopausal women with genitourinary syndrome has not been synthesized or shown. PURPOSE: This study was designed to systematically review and analyze the previous literature to determine whether Kegel's exercise enhances HRQoL in postmenopausal women with genitourinary syndrome of menopause. METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted, and six databases were searched, including Embase, MEDLINE, Cochrane, CINAHL, Web of Science, and Scopus, from their dates of inception to November 2021. Eligible studies evaluated the effects of Kegel's exercise on HRQoL in postmenopausal women with urinary, sexual, or genital symptoms. Review Manager software was used to perform the meta-analysis using a random-effects model. Chi-square and I2 tests were used to evaluate heterogeneity among the studies. Meta-analysis was performed based on the symptoms (i.e., urinary, sexual, and genital) identified in the quality-of-life questionnaires. RESULTS: This systematic review covered five studies with 268 participants. The research appraisal found most of these studies had a low risk of bias. The intervention periods ranged from 4 to 12 weeks. Compared with non-Kegel's exercise or regular activity, Kegel's exercise was found to significantly improve HRQoL-related urinary symptoms (three studies, standardized mean difference = -0.95, 95% CI [-1.35, -0.54], I2 = 0%). However, the effect of this exercise on HRQoL-related sexual symptoms did not differ from non-Kegel's exercise or regular activity (two studies, standardized mean difference = 1.11, 95% CI [-0.25, 2.47], I2 = 94%). None of the covered studies examined the effect of Kegel's exercise on HRQoL-related genital symptoms. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Kegel's exercise is an effective intervention for improving HRQoL-related urinary symptoms in postmenopausal women. However, there remains insufficient evidence to assess the effectiveness of Kegel's exercise on HRQoL-related genital symptoms in this population. The results support using Kegel's exercise as a useful intervention to manage urinary symptoms in postmenopausal women.

Exploring Discomfort Experienced During Chemotherapy in Thai Breast Cancer Patients.

INTRODUCTION: Breast cancer is the most common cancer in females worldwide, and a new era is prevalent in the early stage. A qualitative approach explores discomfort experienced during adjuvant chemotherapy among Thai breast cancer patients. METHOD: The participants were selected by purposive sampling with a variation of two comprehensive cancer centers. Individual in-depth interviews were conducted with fifteen patients who had completed the second cycle of adjuvant chemotherapy prior to the interview. RESULTS: A qualitative content analysis of data revealed two themes, six categories, and 23 sub-categories. The themes defined discomfort characteristics and factors leading to discomfort. Among all the categories were described physical discomfort, environmental discomfort, psychological discomfort, needing to relieve discomfort, lack of socio-cultural support, and lack of mental support. CONCLUSION: There is a need to alleviate discomfort, specifically due to Thai beliefs and culture related to patient self-management and nursing care. These findings may be extended to best practice nursing interventions to enhance comfort outcomes for breast cancer patients and elevate patient satisfaction.

Development and Psychometric Validation of Patient-Reported Outcome Measures (PROMs BCC-20) for Assessing Comfort during Chemotherapy in Breast Cancer Patients.

OBJECTIVE: The study aims to develop and psychometric validate Patient-Reported Outcomes Measures for Assessing Comfort during Chemotherapy in Breast Cancer Patients (PROMs BCC-20). METHODS: This study was conducted in two phases: 1) items were developed from the literature review and in-depth interviews, and 2) Exploratory factor analysis (EFA), Confirmatory factor analysis (CFA), and concurrent validity were performed to evaluate construct validity. The participants were cancer stage I-IIIC, adult females, performance status was assessed by Eastern Cooperative Oncology Group (ECOG) score ≤ 2 after receiving the second cycle of adjuvant chemotherapy and selected by purposive sampling method. For each group of EFA and CFA was 250 participants. RESULT: Five hundred breast cancer patients during adjuvant chemotherapy were recruited from three tertiary cancer centers. A succession of EFA using principal axis factoring with Promax rotation revealed four dimensions yielded a seven factors solution, explaining a 60.07 percent variance. CFA contains 20 items with five factors; 1) social function, four items; 2) digestive function, three items; 3) emotional function, six items; 4) environmental function, three items; and 5) sleep quality, four items via maximum likelihood with bootstrapping indicated a good fit model (SRMR = 0.045, RMSEA = 0.040, CFI = 0.947, and TLI = 0.935). The Cronbach's alpha of 0.86 demonstrated strong internal consistency reliability. Pearson's correlation coefficient showed acceptable criterion validity. CONCLUSION: The PROMS BCC-20 provides good psychometric properties and practical patients' direct reports of comfort in breast cancer patients during chemotherapy. The PROMs BCC-20 should be standardized for comfort measurement and tailor-made nursing care to provide patient satisfaction and good nursing outcomes.

Utilization of Maternal Healthcare Services among Adolescent Mothers in Indonesia.

Providing maternal healthcare services is one of the strategies to decrease maternal mortality. Despite the availability of healthcare services, research investigating the utilization of healthcare services for adolescent mothers in Indonesia is still limited. This study aimed to examine the utilization of maternal healthcare services and its determinants among adolescent mothers in Indonesia. Secondary data analysis was performed using the Indonesia Demographic and Health Survey 2017. Four hundred and sixteen adolescent mothers aged 15-19 years were included in the data analysis of frequency of antenatal care (ANC) visits and place of delivery (home/traditional birth vs. hospital/birth center) represented the utilization of maternal healthcare services. Approximately 7% of the participants were 16 years of age or younger, and over half lived in rural areas. The majority (93%) were having their first baby, one-fourth of the adolescent mothers had fewer than four ANC visits and 33.5% chose a traditional place for childbirth. Pregnancy fatigue was a significant determinant of both antenatal care and the place of delivery. Older age (OR 2.43; 95% CI 1.12-5.29), low income (OR 2.01; 95% CI 1.00-3.74), pregnancy complications of fever (OR 2.10; 95% CI 1.31-3.36), fetal malposition (OR 2.01; 95% CI1.19-3.38), and fatigue (OR 3.63; 95% CI 1.27-10.38) were significantly related to four or more ANC visits. Maternal education (OR 2.14; 95% CI 1.35-3.38), paternal education (OR 1.62; 95% CI 1.02-2.57), income level (OR 2.06; 95% CI 1.12-3.79), insurance coverage (OR 1.68; 95% CI 1.11-2.53), and presence of pregnancy complications such as fever (OR 2.03; 95% CI 1.33-3.10), convulsion (OR 7.74; 95% CI 1.81-32.98), swollen limbs (OR 11.37; 95% CI 1.51-85.45), and fatigue (OR 3.65; 95% CI 1.50-8.85) were significantly related to the place of delivery. Utilization of maternal healthcare services among adolescent mothers was determined by not only socioeconomic factors but also pregnancy complications. These factors should be considered to improve the accessibility, availability, and affordability of healthcare utilization among pregnant adolescents.