Association between socioeconomic and motherhood characteristics with receiving community-based treatment services among justice-involved young female drug users: a retrospective cohort study in Taiwan.

BACKGROUND: Drug-involved individuals who contact treatment services in Taiwan are mostly driven by criminal justice systems either as an alternative or adjunct to criminal sanctions for a drug offence. With a focus on justice-involved young female drug users, the present study examines the extent to which socioeconomic and motherhood characteristics are associated with receiving deferred prosecution, a scheme diverting drug offenders to community-based addiction treatment. METHODS: We identified a cohort of 5869 women under the age of 30 arrested for using Schedule II drugs (primarily amphetamine-like stimulants) from the 2011-2017 National Police Criminal Records in Taiwan. Information concerning socioeconomic characteristics, pregnancy and live birth history, and deferred prosecution was obtained through linkage with the 2006-2019 National Health Insurance, birth registration, and deferred prosecution datasets. Multinomial logistic regression was used to evaluate the association with stratification by recidivism status. RESULTS: Within six months of arrest, 21% of first-time offenders (n = 2645) received deferred prosecution and 23% received correction-based rehabilitation; the corresponding estimates for recidivists (n = 3224) were 6% and 15%, respectively. Among first-time offenders, low/unstable income was associated with lower odds of deferred prosecution (adjusted odds ratio [aOR] = 0.71; 95% CI: 0.58, 0.88). For recidivists, those with low/unstable income (aOR = 1.58) or unemployment (aOR = 1.58) had higher odds of correction-based rehabilitation; being pregnant at arrest was linked with reduced odds of deferred prosecution (aOR = 0.31, 95% CI: 0.13, 0.71) and correction-based rehabilitation (aOR = 0.50, 95% CI: 0.32, 0.77). CONCLUSIONS: For the young women arrested for drug offences, disadvantaged socioeconomic conditions were generally unfavored by the diversion to treatment in the community. Childbearing upon arrest may lower not only the odds of receiving medical treatment but also correctional intervention. The criminal prosecution policy and process should be informed by female drug offenders' need for treatment and recovery.

Care and management of stillborn babies from the parents' perspective: A phenomenological study.

AIM: To explore parents' perspective on hospital's care and management of the remains of stillborn babies. BACKGROUND: Each year, 2.6 million of pregnancies end as stillbirth. Recent literature began to understand parents' traumatic experience in stillbirth and its profound impact on parents' mental health and psychosocial effect. But there is limited understanding on the actual care and management of the stillborn baby, nor is there an agreement on how hospitals should care for the stillborn baby to mitigate parents' profound loss. DESIGN: A descriptive phenomenological approach was applied to conduct this study. METHODS: A purposive sample of twenty couples (40 individuals) who had encountered how to care for the remains of their stillborn babies participated in the study. The data were collected through in-depth interviews, which involved semi-structured and open-ended questions. The phenomenological methods of Giorgi were applied to analyse the data. The COREQ checklist was used preparing the manuscript. RESULTS: Parents felt unprepared and lack of support when they had to handle their stillborn babies' remains. The research results revealed two major themes: (1) Handling stillborn babies remain ignorantly; (2) Pacifying the disturbed soul on both sides. CONCLUSIONS: It was found in the study that reflection and identification were the emerging themes, which can enable healthcare professionals to understand parents' concerns in a meaningful way, as they deal with the remains of stillborn babies. Moreover, it is hoped that hospital administration and health care personnel should consider stillborn parents' concerns and incorporate their needs into nursing assessment and treatment practices. RELEVANCE TO CLINICAL PRACTICE: Given stillbirth's profound implication for parents' identity and psychosocial role, hospitals need to be more sensitive and proactive to parents' cultural and religious needs when they care for stillborn baby and handle its body.

Multivariate analysis of the factors associated with live births during in vitro fertilisation in Southeast Asia: a cross-sectional study of 104,015 in vitro fertilisation records in Taiwan.

PURPOSE: To investigate the factors associated with live births and the interaction between age and the number of embryos transferred after in vitro fertilisation (IVF) treatment. METHODS: This study analyses data from a population-based-assisted reproductive database of all registered artificial reproduction institutions (n = 80) from 2010 to 2016 in Taiwan. The probability of a live birth in correlation with the treatment parameters was measured with multivariate logistic regression analyses using the generalised additive model (GAM) and Pearson's chi-square exact test. RESULTS: A total of 104,015 IVF treatments performed between 2010 and 2016 were included in our analysis. From these treatments, 31,467 (30.3%) were successfully delivered, and 40,565 test-tube babies were born. Pearson's chi-square exact test indicated that parents' age, cause of infertility, type of ovarian stimulation, additional assisted reproductive technology techniques, donated egg or sperm, fresh or frozen embryo, presence or absence of ovarian hyperstimulation syndrome, and day of embryo transfer were significantly associated with live births after an IVF cycle (p < 0.05). Multiple logistic regression analysis with the GAM revealed that the odds of a live birth with IVF treatment in patients < 34 years of age were 2.55 times higher than that in patients ≥ 45 years of age (odds ratio = 2.55, 95% confidence interval = 1.69-2.90) for patients who underwent a single-embryo transfer (SET); a similar pattern was observed when two or more embryos were transferred. Egg donation, the assisted hatching technique, oral ovarian stimulation agents, and implantation of frozen embryos during SET were shown to improve the chance of a live birth by 29-90%. Implantation of the embryo after the 5th day of culture yielded the highest odds of a live birth. The interaction plot revealed that maternal age, especially < 40 years, was associated with the probability of a live birth. SET and double-embryo transfer showed similar associations with the probability of a live birth across age groups. Transferring more than two embryos might reduce the probability of a live birth during IVF treatment for women ≥ 40 years of age. CONCLUSIONS: Implanting a greater number of embryos did not improve the age-related decrease in fertility for patients undergoing IVF. Therefore, we suggested that ≤ 2 blastocysts could be transferred during IVF treatments for women ≥ 40 years. Transferring a blastocyst on day 5 of culture was associated with a significant increase in the odds of a live birth resulting from IVF.

Contraceptive use and method among immigrant women in France: relationship with socioeconomic status.

OBJECTIVES: We investigated the relationship between socioeconomic status and the use and method of contraception among immigrant, second-generation immigrant, and non-immigrant women in France. METHODS: We analysed data from the 2008-2009 survey 'Trajectories and origins: Survey on the diversity of populations in France'. A total of 7070 women aged 18 to 45 years were identified, and information concerning contraceptive use and choice was obtained by self-report. Polytomous logistic regression models were used to assess association estimates. RESULTS: Recent contraceptive use among immigrant and second-generation immigrant women was significantly lower than that of non-immigrant women. Lower educational attainment and unemployment were associated with an estimated 31˜59% reduction in odds of contraceptive use for immigrant and second-generation immigrant women; however, this was not the case for non-immigrant women. Among the latter, lower educational attainment appeared to be associated with increased use of oral contraceptives. CONCLUSIONS: Our findings suggest the need to advance our understanding of potential barriers to contraceptives created by socioeconomic forces across different societal/cultural contexts.

The Experiences of Fathers Whose Spouses Are Hospitalized for Pregnancy Termination Due to Fetal Chromosome Abnormality in Taiwan.

BACKGROUND: Hospitals, where most births and terminations of pregnancy take place in modern society, tend to focus on addressing the perinatal loss experiences of mothers rather than fathers. Healthcare providers often overlook the loss experiences of fathers when pregnancy has been terminated because of chromosome abnormality. Little literature exists on the perceptions of these losses from the point of view of fathers in Taiwan. PURPOSE: The aims of this study were to explore and reveal the essence and structure of the experiences of Taiwanese fathers whose spouses are hospitalized for pregnancy termination due to fetal chromosome abnormality. METHODS: A descriptive phenomenological approach was applied to collect data. In-depth interviews using individualized, semistructured, open-ended questions were conducted with 20 fathers whose spouses were hospitalized for termination of pregnancy due to fetal chromosomal abnormalities. Data were analyzed according to Giorgi's methods. RESULTS: The participants described their experiences as distressing and involving painful decisions. Four themes emerged: (a) "a dismayed father: the unexpected process of terminating pregnancy," (b) "a hidden source of grief: neglected care," (c) "a stressful decision: difficulty handling the deceased offspring," and (d) "a regretful father: inadequate treatment of the baby's remains." CONCLUSIONS: Health professionals must better understand the experiences of fathers, learn to be sensitive and empathetic, and keep communication lines open to create and maintain a more compassionate and caring environment. Health professionals should provide the opportunity for fathers to discuss the decisions that they face, treat the deceased infant with dignity, and acknowledge the grief of both parents as qualitatively equal. Both mother and father should receive appropriate care while the mother is in the hospital for a pregnancy termination.

Seeing or not seeing: Taiwan's parents' experiences during stillbirth.

BACKGROUND: The findings of most quantitative studies and the clinical guidelines for encouraging or discouraging parents to see their stillborn babies remain diverse depending on country and culture of residence. There is still a lack of research comprehensively exploring the situational or cultural meanings of parents' decisions to face their stillborn infants. OBJECTIVES: Understanding the essence and structure of decision-making and seeing phenomena that parents go through during stillbirth of their child adds to the body of nursing knowledge and provides insight into how to care for this group of clients. DESIGN: A descriptive phenomenological approach with multi-setting, multistage, and paired design was used. SETTING: The study was conducted in maternity units in Taoyuan, Taiwan. PARTICIPANTS: A purposive sample of 12 couples (total=24 subjects) who experienced stillbirth deliveries following a diagnosis of fetal death participated in this study. METHODS: The participants' observations and in-depth interviews were recorded and analyzed according to Giorgi's methods. RESULTS: Most parents expressed a sense of deep upset, of never anticipating seeing their deceased babies while some had no fear of how their babies' bodies would look. Two constituted patterns with five themes each emerged from the study: 1.(a) "Deciding to see the stillborn baby" shows the seeing event as an experience of "believing", (b) "avoiding regret", (c)"an opportunity to say farewell", (d) "a chance for imprinting the stillborn infant in one's memory", and (e) "shock of seeing". 2.(a) "Deciding not to see the stillborn baby" demonstrates the meaning of not seeing is "cutting the attachment to the stillborn baby," (b) "preventing memory imprinting," (c) "avoiding guilt and suffering", (d) "pretending event closure", and (e) "the act of following a cultural taboo". CONCLUSIONS: Participants experienced acts of seeing and not seeing throughout their denial or facing of ongoing bereavement, which was influenced by their personal beliefs, readiness for the event, and social values. Health professionals need to understand the powerful interpretation of the "visual" meaning of the stillbirth experience and learn to be sensitive, empathetic and keep communication lines open in order to create and maintain a compassionate and caring environment.