Combined Aerobic and Resistance Training Improves Body Composition, Alters Cardiometabolic Risk, and Ameliorates Cancer-Related Indicators in Breast Cancer Patients and Survivors with Overweight/Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Breast cancer survivors with obesity are at a high risk of cancer recurrence, comorbidity, and mortality. This review aims to systematically evaluate the effects of combined aerobic and resistance training (CART) on body composition, lipid homeostasis, inflammation, adipokines, cancer-related fatigue, sleep, and quality of life in breast cancer patients and survivors with overweight/obesity. An electronic search was conducted in PubMed, Web of Science, Scopus, Science Direct, Cochrane, and Google Scholar databases from inception up to January 8, 2024. Randomized controlled trials (RCTs) meeting the inclusion criteria were selected for the analysis. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the quality of evidence. A random-effects model was used, and data were analyzed using mean (MD) and standardized mean differences (SMD) for continuous variables with 95% confidence intervals (CI). We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence. A total of 17 randomized controlled trials were included in the systematic review involving 1,148 female patients and survivors (mean age: 54.0 ± 3.4 years). The primary outcomes showed significant improvements in body mass index (SMD -0.57 kg/m2, p = 0.04), body fat (SMD -0.50%, p = 0.02), fat mass (SMD -0.63 kg, p = 0.04), hip circumference (MD -3.14 cm, p = 0.02), and fat-free mass (SMD 1.03 kg, p < 0.001). The secondary outcomes indicated significant increases in high-density lipoprotein cholesterol (MD -0.05 mmol/L, p = 0.008), natural killer cells (SMD 0.42%, p = 0.04), reductions in triglycerides (MD -81.90 mg/dL, p < 0.01), total cholesterol (SMD -0.95 mmol/L, p < 0.01), tumor necrosis factor α (SMD -0.89 pg/mL, p = 0.03), and leptin (SMD -0.63 ng/mL, p = 0.03). Also, beneficial alterations were found in cancer-related fatigue (SMD -0.98, p = 0.03), sleep (SMD -1.17, p < 0.001), and quality of life (SMD 2.94, p = 0.02) scores. There was very low to low confidence in the estimated effect of most of the outcomes. The present findings reveal that CART could be considered an adjunct therapy in supporting the conventional clinical approach observed following exercise. However, further high-quality research is needed to evaluate whether CART would be a valuable intervention to lower aggressive pharmacologic use in breast cancer patients with overweight/obesity.

Elagolix treatment in women with heavy menstrual bleeding associated with uterine fibroid: a systematic review and meta-analysis.

BACKGROUND: Elagolix is effective and safe for treating menorrhagia in women with uterine fibroid. However, it is reported to be associated with hypoestrogenism that can be alleviated by adding estradiol/norethindrone acetate. This systematic review and meta-analysis aimed to determine the effectiveness of elagolix treatment in women with heavy menstrual bleeding associated with uterine fibroid by comparing: elagolix versus placebo and elagolix versus estradiol/norethindrone acetate. METHODOLOGY: The Cochrane Central Register of Controlled Trials (CENTRAL 2021, Issue 3 of 12), MEDLINE databases (1980 to December week 1, 2020), and trial registries for relevant randomized clinical trials were used. All randomized clinical trials were reviewed and evaluated. Random effects models were used to estimate the dichotomous outcomes and mean differences with 95% confidence intervals. Data for risk of bias, heterogeneity, sensitivity, reporting bias and quality of evidence were assessed. RESULTS: Four randomized controlled trials with 1949 premenopausal women from 323 locations were included. Elagolix improved menstrual blood loss of less than 80 ml (RR 4.81, 95% CI 2.45 to 9.45; four trials, 869 participants; moderate quality evidence) or more than 50% reduction from baseline (RR 4.87, 95% CI 2.55 to 9.31; four trials, 869 participants; moderate quality evidence) compared to placebo. There was no difference in menstrual blood loss of less than 80 ml (RR 1.08, 95% CI 1.00 to 1.16; five trials, 1365 participants; moderate quality evidence) or more than 50% reduction from baseline between the elagolix (RR 1.08, 95% CI 1.01 to 1.15; five trials, 1365 participants; high quality evidence) and elagolix with estradiol/norethindrone acetate. In both comparisons, elagolix has reduced the mean percentage change in uterine and fibroid volume, improved symptoms, and health-related quality of life. More patients had hot flush, and bone mineral density loss in the elagolix treatment compared to both placebo and elagolix with estradiol/norethindrone acetate. CONCLUSIONS: Elagolix appeared to be effective in reducing heavy menstrual bleeding caused by uterine fibroid and combination with estradiol/norethindrone acetate was able to alleviate the hypoestrogenism side effects in premenopausal women. Review registration PROSPERO CDR 42021233898.

Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study.

BACKGROUND: The rate of neonatal mortality has declined but lesser than the infant mortality rate and remains a major public health challenge in low- and middle-income countries. There is an urgent need to focus on newborn care, especially during the first 24 h after birth and the early neonatal period. Neonatal near miss (NNM) is an emerging concept similar to that of maternal near miss. NNM events occur three to eight times more often than neonatal deaths. The objective of this study was to establish the prevalence of NNM and identify its associated factors. METHODS: A hospital-based cross-sectional study was conducted in Koshi Hospital, Morang district, Nepal. Neonates and their mothers of unspecified maternal age and gestational age were enrolled. Key inclusion criteria were pragmatic and management markers of NNM and admission of newborn infants to the neonatal intensive care unit (NICU) in Koshi Hospital. Non-Nepali citizens were excluded. Consecutive sampling was used until the required sample size of 1,000 newborn infants was reached. Simple and multiple logistic regression was performed using SPSS® version 24.0. RESULTS: One thousand respondents were recruited. The prevalence of NNM was 79 per 1,000 live births. Severe maternal morbidity (adjusted odds ratio (aOR) 4.52; 95% confidence interval (CI) 2.07-9.84) and no formal education (aOR 2.16; 95% CI 1.12-4.14) had a positive association with NNM, while multiparity (aOR 0.52; 95% CI 0.32-0.86) and caesarean section (aOR 0.44; 95% CI 0.19-0.99) had negative associations with NNM. CONCLUSIONS: Maternal characteristics and complications were associated with NNM. Healthcare providers should be aware of the impact of obstetric factors on newborn health and provide earlier interventions to pregnant women, thus increasing survival chances of newborns.

Psychometric properties of the Malay version Women's Views of Birth Postnatal Satisfaction Questionnaire using the Rasch measurement model: a cross-sectional study.

BACKGROUND: Maternal satisfaction must be assessed in order to reflect the quality of care, which is considered an outcome of healthcare services. It can also be used to contrast and compare satisfaction with various care models or service configuration or to assess overtime changes. The purpose of this study was to investigate the psychometric properties of the Malay version Women's Views of Birth Postnatal Satisfaction Questionnaire (WOMBPNSQ) based on the Rasch scale model of labour satisfaction. METHODS: This is a cross-sectional study. Postpartum women were identified from a tertiary hospital and evaluated at 1-month postnatal period using WOMBLSQ. The Rasch model was used to investigate the reliability, unidimensionality, item and person misfits and distribution map. RESULTS: A total of 195 women were involved. The Rasch analysis revealed that the 30 items had a high level of reliability at 0.99 and item separation at 9.02. It has a low level of reliability at 0.45 and persons separation at 0.90. All the items are considered fit. Five people have most misfitting response strings based on item IPS_Q15, 'I was given little advice on contraception following the birth of my baby', but extremely trivial differences were found in the parameter estimates after refitting the model. The more difficult item to endorse satisfaction is item CA_Q17 'I was given little advice on contraception following the birth of my baby'. CONCLUSIONS: The WOMBLSQ tested in postpartum women proved to have high item reliability index but with an adequate sample. The analysis shows that the 30 items target the right form of respondents, have similar latent characteristics of postpartum women and a shared sense of satisfaction. For future improvement, more difficult items endorsing satisfaction should be created, and the common items in which satisfaction is expected should be reduced.

Risk perceptions among high-risk pregnant women in Nepal: a qualitative study.

BACKGROUND: A woman's perception of risk affects her decisions about seeking obstetric care and following prescribed regimens of care. This study explored the perceptions of high-risk pregnancy among women with high-risk factors. METHODS: A qualitative study was conducted in the Morang district, Nepal. A phenomenological approach was used. In-depth interviews were conducted with 14 participants. Postpartum women with one risk factor for high-risk pregnancy who non-adhere to referral hospital birth were selected purposively. Thematic analysis was done to generate themes and categories. FINDINGS: Two main themes emerged in this study: (i) knowledge and understanding of risk and (ii) normalizing and non-acceptance of risk. The participants had inadequate knowledge of risk in pregnancy and childbirth. Their information source was their personal experiences of risk, witnessing their close relatives, and community incidents. The participants perceived pregnancy as a normal event and did not consider themselves as at risk. They tended to deny risk and perceived that everything was fine with their pregnancy. CONCLUSIONS: The findings of this study provide a glimpse into how women perceived risk and the reasons that lead them to deny the risks and gave home birth. In the presence of risk factors in pregnancy, some women were not convinced that they were at risk. An antenatal check-up should be utilized as a platform to educate women, explore their intentions, and encourage safer births.

Psychological impact of polygamous marriage on women and children: a systematic review and meta-analysis.

BACKGROUND: Over the last two decades, there has been significant growth in public, political, and academic awareness of polygamy. Polygamous families have distinct household problems, usually stemming from jealousy between co-wives over the husband's affections and resources. This study aimed to ascertain the psychological impact of polygamous marriage on women and children worldwide. METHODS: A systematic search was performed in MEDLINE (PubMed), Scopus, CINAHL (EBSCOhost), Google Scholar, and ProQuest using search terms such as "marriage" and "polygamy." Studies published from the inception of the respective databases until April 2021 were retrieved to assess their eligibility for inclusion in this study. The Joanna Briggs Institute Critical Appraisal Checklist was used for data extraction and the quality assessment of the included studies. The generic inverse variance and odds ratios with 95% confidence intervals (CI) were calculated using RevMan software. RESULTS: There were 24 studies fulfilling the eligibility criteria, and 23 studies had a low risk of bias. The pooled meta-analysis showed women in polygamous marriages had a 2.25 (95% CI: 1.20, 4.20) higher chance of experiencing depression than in monogamous marriages. Children with polygamous parents had a significantly higher Global Severity Index with a mean difference of 0.21 (95% CI: 0.10, 0.33) than those with monogamous parents. CONCLUSIONS: The psychological impact of polygamous marriage on women and children was found to be relatively higher than monogamous marriage. Awareness of the proper practices for polygamy should be strengthened so that its adverse effects can be minimized. The agencies involved in polygamous practices should broaden and enhance their understanding of the correct practice of polygamy.

Psychometric properties of the Malay version of the Women's Views of Birth Labour Satisfaction Questionnaire using the Rasch measurement model: a cross sectional study.

BACKGROUND: Birth satisfaction represents a complex construct of implicit and profound relevance to a woman's perceived birth experience. It correlates with the childbearing woman's experience of the quality of care received and stress during labor. This study aimed to examine the psychometric properties of the Malay language version of the Women's Views of Birth Labour Satisfaction Questionnaire (WOMBLSQ) on labor satisfaction using the Rasch rating scale model. METHODS: A cross-sectional study was conducted. The translated Malay version of the WOMBLSQ was completed by 200 postpartum women in a tertiary hospital. The Rasch model was applied to investigate the statistics, unidimensionality, item polarity and misfit, person misfit and person item distribution map. RESULTS: The Rasch analysis showed that the 27 items, in nine dimensions, had high item reliability and item separation at 0.98 and 7.65 respectively, while good person reliability and person separation were at 0.78 and 1.90, respectively. Item 6 ('My birth partner/husband couldn't have supported me any better') (outfit MnSq = 1.74, outfit z-std = 6.9, PtMea Corr = - 0.02) and Item 5 ('My birth partner/husband helped me to understand what was going on when I was in labor') (outfit MnSq = 1.65, outfit z-std = 2.9, PtMea Corr = 0.13) are misfit. Item 6 needs to be re-examined for removal or rephrasing, while Item 5 correlates poorly with the construct. Eight persons have the most misfitting response strings based on Item 6 but extremely trivial differences were found in the parameter estimates after refitting the model. Ten items easily endorse satisfaction from the respondents. CONCLUSION: The WOMBLSQ tested among postpartum women has been shown to have a good person reliability index and a high item reliability index. Items 5 and 6 do not contribute in the construction of scale but not degrading and suggested for refining. The spread of item difficulty should be improved in the future modification of items.

Effectiveness of an Antenatal-Exercise Counseling Module on Knowledge and Self-Efficacy of Nurses in Northeast Peninsular Malaysia: A Quasi-Experimental Study.

BACKGROUND: Because of their frequent, regular contact with antenatal mothers, healthcare providers play an important role in promoting the health benefits of antenatal exercise. This study aimed to determine the effectiveness of an antenatal-exercise counseling module on knowledge and self-efficacy of staff nurses. METHODS: A quasi-experimental design was conducted. The intervention and control groups consisted of 66 nurses randomly selected from the Tumpat and Pasir Mas districts, respectively, in Kelantan. The intervention group received an antenatal-exercise counseling module, and the control group performed counseling based on self-reading. Knowledge and self-efficacy were assessed at the baseline and at week 4. Analysis of variance and repeated measure analysis of covariance were performed using SPSS. RESULTS: There was a significant difference in the knowledge scores [estimated marginal mean (95% confidence interval, CI): 33.9 (33.29, 34.53) versus 27.4 (26.52, 28.29); P < 0.001)] and the self-efficacy scores [estimated marginal mean (95% CI): 31.3 (30.55, 32.03) versus 27.4 (26.03, 28.74); P = 0.005)] between intervention and control groups at week 4 after adjusting for duration of practice and formal training. CONCLUSION: The antenatal-exercise counseling module is recommended for use in routine counseling in health centers to promote healthy lifestyles among pregnant women.

The experiences of women with maternal near miss and their perception of quality of care in Kelantan, Malaysia: a qualitative study.

BACKGROUND: Maternal mortality has been the main way of ascertaining the outcome of maternal and obstetric care. However, maternal morbidities occur more frequently than maternal deaths; therefore, maternal near miss was suggested as a more useful indicator for the evaluation and improvement of maternal health services. Our study aimed to explore the experiences of women with maternal near miss and their perception of the quality of care in Kelantan, Malaysia. METHODS: A qualitative phenomenological approach with in-depth interview method was conducted in two tertiary hospitals in Kelantan, Malaysia. All women admitted to labour room, obstetrics and gynaecology wards and intensive care units in 2014 were screened for the presence of any vital organ dysfunction or failure based on the World Health Organization criteria for maternal near miss. Pregnancy irrespective of the gestational age was included. Women younger than 18 years old, with psychiatric disorder and beyond 42 days of childbirth were excluded. RESULTS: Thirty women who had experienced maternal near miss events were included in the analysis. All were Malays between the ages of 22 and 45. Almost all women (93.3%) had secondary and tertiary education and 63.3% were employed. The women's perceptions of the quality of their care were influenced by the competency and promptness in the provision of care, interpersonal communication, information-sharing and the quality of physical resources. The predisposition to seek healthcare was influenced by costs, self-attitude and beliefs. CONCLUSIONS: Self-appraisal of maternal near miss, their perception of the quality of care, their predisposition to seek healthcare and the social support received were the four major themes that emerged from the experiences and perceptions of women with maternal near miss. The women with maternal near miss viewed their experiences as frightening and that they experienced other negative emotions and a sense of imminent death. The factors influencing women's perceptions of quality of care should be of concern to those seeking to improve services at healthcare facilities. The addition of a maternal near miss case review programme, allows for understanding on the factors related to providing care or to the predisposition to seek care; if addressed, may improve future healthcare and patient outcomes.

Long-term postpartum effect of severe maternal morbidity on sexual function.

There was limited knowledge on the sexual function in women who have survived severe obstetric complications. The aim of this study was to compare the level of sexual functioning among women with and without severe morbidity at six months postpartum and to identify the factors associated with sexual function scores of women. A prospective double-cohort study design was applied at two tertiary hospitals over a six-month period. Postpartum women with and without severe maternal morbidity were selected as the exposed and the non-exposed group, respectively. The study included 145 exposed and 187 non-exposed women. Those with severe maternal morbidity were significantly ( P < 0.001) older (mean (SD): 31.6 years (6.26) vs. 29.2 years (5.65)) and had longer hospital stays (mean (SD): 5.9 days (3.79) vs. 3.6 days (2.23)). They were also more likely to have delivered preterm (75.9 vs. 93.0) and to have had a caesarean section (80.7 vs. 67.9) than those without severe maternal morbidity. After adjusting for age and mental health, there was no significant difference in Female Sexual Function Index scores ( P = 0.895) between the two groups. Both groups showed the highest sexual dysfunction in pain and the lowest dysfunction in orgasm. Linear regression analyses showed no association between Female Sexual Function Index scores and sociodemographic characteristics, reproductive history, or quality of life. Sexual function in women with severe maternal morbidity did not differ from that in women without severe maternal morbidity. In-depth qualitative studies of women who have experienced potentially life-threatening conditions may improve the understanding of their sexual function.

Factors associated with severe maternal morbidity in Kelantan, Malaysia: A comparative cross-sectional study.

BACKGROUND: Knowledge on the factors associated with severe maternal morbidity enables a better understanding of the problem and serves as a foundation for the development of an effective preventive strategy. However, various definitions of severe maternal morbidity have been applied, leading to inconsistencies between studies. The objective of this study was to identify the sociodemographic characteristics, medical and gynaecological history, past and present obstetric performance and the provision of health care services as associated factors for severe maternal morbidity in Kelantan, Malaysia. METHODS: A comparative cross-sectional study was conducted in two tertiary referral hospitals in 2014. Postpartum women with severe morbidity and without severe morbidity who fulfilled the inclusion and exclusion criteria were eligible as cases and controls, respectively. The study population included all postpartum women regardless of their age. Pregnancy at less than 22 weeks of gestation, more than 42 days after the termination of pregnancy and non-Malaysian citizens were excluded. Consecutive sampling was applied for the selection of cases and for each case identified, one unmatched control from the same hospital was selected using computer-based simple random sampling. Simple and multiple logistic regressions were performed using Stata Intercooled version 11.0. RESULTS: A total of 23,422 pregnant women were admitted to these hospitals in 2014 and 395 women with severe maternal morbidity were identified, of which 353 were eligible as cases. An age of 35 or more years old [Adj. OR (95 % CI): 2.6 (1.67, 4.07)], women with past pregnancy complications [Adj. OR (95 % CI): 1.7 (1.00, 2.79)], underwent caesarean section deliveries [Adj. OR (95 % CI): 6.8 (4.68, 10.01)], preterm delivery [Adj. OR (95 % CI): 3.4 (1.87, 6.32)] and referral to tertiary centres [Adj. OR (95 % CI): 2.7 (1.87, 3.97)] were significant associated factors for severe maternal morbidity. CONCLUSIONS: Our study suggests the enhanced screening and monitoring of women of advanced maternal age, women with past pregnancy complications, those who underwent caesarean section deliveries, those who delivered preterm and the mothers referred to tertiary centres as they are at increased risk of severe maternal morbidity. Identifying these factors may contribute to specific and targeted strategies aimed at tackling the issues related to maternal morbidity.

Immediate and long-term relationship between severe maternal morbidity and health-related quality of life: a prospective double cohort comparison study.

BACKGROUND: Given the growing interest in severe maternal morbidity (SMM), the need to assess its effects on quality of life is pressing. The objective of this study was to compare the quality of life scores between women with and without SMM at 1-month and 6-month postpartum in Kelantan, Malaysia. METHODS: A prospective double cohort study design was applied at two tertiary referral hospitals over a 6-month period. The study population included all postpartum women who delivered in 2014. Postpartum women with and without SMM were selected as the exposed and non-exposed groups, respectively. For each exposed case identified, a non-exposed case with a similar mode of delivery was selected. The main outcome measures used were scores from the Short Form-12 Health Survey (SF-12). RESULTS: The study measured 145 exposed and 187 non-exposed women. The group-time interaction of the repeated measure analysis of variance (RM ANOVA) showed no significant difference in the mean overall SF-12 physical component summary score changes (P = 0.534) between women with and without SMM. Similarly, the group-time interaction of the RM ANOVA showed no significant difference in the mean overall SF-12 mental component summary score changes (P = 0.674) between women with and without SMM. However, women with SMM scored significantly lower on a general health perceptions subscale at 1-month (P = 0.031), role limitations due to physical health subscale at 6-month (P = 0.019), vitality subscale at 1-month (P = 0.007) and 6-month (P = 0.008), and role limitations due to emotional problems subscales at 6-month (P = 0.008). CONCLUSIONS: Women with severe maternal morbidity demonstrated comparable quality of life during the 6-month postpartum period compared to women without severe maternal morbidity.

Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study.

BACKGROUND: Severe maternal conditions have increasingly been used as alternative measurements of the quality of maternal care and as alternative strategies to reduce maternal mortality. We aimed to study severe maternal morbidity and maternal near miss among women in two tertiary hospitals in Kota Bharu, Kelantan, Malaysia. METHODS: A cross-sectional study with record review was conducted in 2014. Severe maternal morbidity and maternal near miss were classified using the new World Health Organization criteria. Health indicators for obstetric care were calculated and descriptive analyses were performed using SPSS version 22.0. RESULTS: In total, 21,579 live births, 395 women with severe maternal morbidity, 47 women with maternal near miss and two maternal deaths were analysed. The severe maternal morbidity incidence ratio was 18.3 per 1000 live births and the maternal near miss incidence ratio was 2.2 per 1000 live births. The maternal near miss mortality ratio was 23.5 and the mortality index was 4.1 %. The process indicators for essential interventions were almost 100.0 %. Haemorrhagic disorders were the most common event for severe maternal morbidity (68.6 %) and maternal near miss (80.9 %) and management-based criteria accounted for 85.1 %. CONCLUSIONS: Comprehensive emergency care and intensive care as well as overall improvements in the quality of maternal health care need to be achieved to substantial reduce maternal death.

Severe Maternal Morbidity and Postpartum Depressive Symptomatology: A Prospective Double Cohort Comparison Study.

The adverse consequences to mothers of postpartum depression are well-documented, and risk factors are of interest. There is limited evidence on postpartum depression among women with severe maternal morbidity, defined as potentially life-threatening conditions during pregnancy, childbirth, or soon after termination of pregnancy. We compared postpartum depressive symptoms of postpartum women aged 18 and older who delivered in two tertiary referral hospitals in 2014 in Kelantan, Malaysia, and had (n = 145) or had not (n = 187) suffered severe maternal morbidity. A prospective double cohort study design was applied. Postpartum depressive symptoms were assessed at 1 and 6 months postpartum using the Malay version of the Edinburgh Postnatal Depression Scale. There was no significant difference in the mean Edinburgh Postnatal Depression Scale score changes (p = .803) between the two groups of women, after adjusting for age, social support, physical health, occupation, and education. Factors other than severe medical complications should be pursued as predictors of postpartum depressive symptomatology. © 2016 Wiley Periodicals, Inc.

Validation of the questionnaire "Pregnancy Vaccine Hesitancy Scale (pVHS)" toward COVID-19 vaccine for Malaysian pregnant women.

Background: Pregnancy is one of the risks for severe COVID-19 infection, and receiving a vaccination is one of the effective methods to reduce disease severity. However, COVID-19 vaccine hesitancy among pregnant women remains an issue. This study aims to develop and validate the pregnancy Vaccine Hesitancy Scale (pVHS) toward COVID-19 vaccine for Malaysian pregnant women. Method: An 8-item Malay language pregnancy Vaccine Hesitancy Scale (pVHS-M) for COVID-19 was adapted from the adult Vaccine Hesitancy Scale and validated using Exploratory Factor Analysis. Six expert panels were involved in content validity, and ten pregnant women were involved in face validity. A cross-sectional study on 200 pregnant women was conducted between October 2022 and March 2023 at the Obstetrics and Gynaecology Clinic, Universiti Sains Malaysia, Kelantan. Result: The item-level content validity index is 1.00, demonstrating good relevance of the eight items used to assess COVID-19 vaccine hesitancy. The item-level face validity index obtained is 0.99, indicating that the items were clear and comprehensible. The Cronbach alpha score was 0.944, with factor loadings ranging from 0.79 to 0.89. Conclusion: The pVHS-M demonstrated good internal consistency, indicating that it is a valid and reliable tool for assessing COVID-19 vaccine hesitancy among pregnant women.

Bacterial coinfection and antibiotic resistance in hospitalized COVID-19 patients: a systematic review and meta-analysis.

Background: There were a few studies on bacterial coinfection in hospitalized COVID-19 patients worldwide. This systematic review aimed to provide the pooled prevalence of bacterial coinfection from published studies from 2020 to 2022. Methods: Three databases were used to search the studies, and 49 studies from 2,451 identified studies involving 212,605 COVID-19 patients were included in this review. Results: The random-effects inverse-variance model determined that the pooled prevalence of bacterial coinfection in hospitalized COVID-19 patients was 26.84% (95% CI [23.85-29.83]). The pooled prevalence of isolated bacteria for Acinetobacter baumannii was 23.25% (95% CI [19.27-27.24]), Escherichia coli was 10.51% (95% CI [8.90-12.12]), Klebsiella pneumoniae was 15.24% (95% CI [7.84-22.64]), Pseudomonas aeruginosa was 11.09% (95% CI [8.92-13.27]) and Staphylococcus aureus (11.59% (95% CI [9.71-13.46])). Meanwhile, the pooled prevalence of antibiotic-resistant bacteria for extended-spectrum beta-lactamases producing Enterobacteriaceae was 15.24% (95% CI [7.84-22.64]) followed by carbapenem-resistant Acinetobacter baumannii (14.55% (95% CI [9.59-19.52%])), carbapenem-resistant Pseudomonas aeruginosa (6.95% (95% CI [2.61-11.29])), methicillin-resistant Staphylococcus aureus (5.05% (95% CI [3.49-6.60])), carbapenem-resistant Enterobacteriaceae (4.95% (95% CI [3.10-6.79])), and vancomycin-resistant Enterococcus (1.26% (95% CI [0.46-2.05])). Conclusion: All the prevalences were considered as low. However, effective management and prevention of the infection should be considered since these coinfections have a bad impact on the morbidity and mortality of patients.

Effect of yoga on anthropometry, quality of life, and lipid profile in patients with obesity and central obesity: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to determine the effectiveness of yoga on anthropometry, quality of life, and lipid profiles in patients with obesity and central obesity. METHODOLOGY: The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed (1985-January 2022) and trial registries for relevant randomised clinical trials were used. Relevant and published randomised clinical trials were reviewed and evaluated. The primary outcomes were anthropometry measurements, which were weight, waist circumference, body mass index (BMI), and body fat percentages. The secondary outcomes were changes in quality of life, psychological impact, lipid profile measurement, presence of adverse events, and changes in blood pressure and blood glucose. We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence. RESULTS: 15 studies are included, involving 1161 participants. The analysis performed is based on three comparisons. For the first comparison between yoga and control, yoga reduces the waist circumference (MD -0.84, 95% CI [-5.12 to 3.44]), while there is no difference in body weight, BMI, or body fat percentages. In the second comparison between yoga and calorie restriction, yoga reduces body weight (MD -3.47, 95% CI [-6.20 to -0.74]), while there is no difference in waist circumference, BMI, or body fat percentage. In the third comparison between yoga and exercise, yoga reduces the body weight (MD -7.58, 95% CI [-11.51 to -3.65]), while there is no difference in waist circumference or BMI. For the secondary outcomes, yoga intervention reduces total cholesterol (MD -17.12, 95% CI [-32.24 to -2.00]) and triglycerides (MD -21.75, 95% CI [-38.77 to -4.73]) compared to the control group, but there is no difference compared to the calorie restriction and exercise group. There is no difference in the rest of the outcomes, which are LDL, HDL, quality of life, psychological impact, adverse events, blood pressure, and blood glucose. However, findings are not robust due to a high risk of bias and low-quality evidence. CONCLUSION: From our review, there were methodological drawbacks and very low to moderate quality of evidence across all comparisons, and hence, it is inconclusive to say that yoga can significantly improve anthropometric parameters. More well-designed trials are needed to confirm and support the beneficial effects of yoga.

Tai Chi Exercise for Mental and Physical Well-Being in Patients with Depressive Symptoms: A Systematic Review and Meta-Analysis.

Tai Chi is a mindfulness-body practice that has physiological and psychosocial benefits and can be integrated into the prevention and rehabilitation of various medical conditions; however, the effectiveness of Tai Chi in the treatment of depression remains unclear. This review aimed to determine the effects of Tai Chi exercise on mental and physical well-being in patients with depressive symptoms. We searched databases for English language publications that appeared during January 2000-2022. The included trials were RCTs that involved people with depression with no other medical conditions, and included both adolescent and adult samples. A meta-analysis was performed using a random effects model and the heterogeneity was estimated using I2 statistics. The quality of each trial was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology. The eight trials were divided into two comparisons: (1) a combination of Tai Chi and antidepressants versus standard antidepressants; (2) Tai Chi versus no intervention. The Tai Chi intervention showed improvements in mental and physical well-being as evidenced by the reductions in depression and anxiety and improved quality of life (QOL) of the patients with depressive symptoms. Further well-controlled RCTs are recommended with a precision trial design and larger sample sizes.

Experiences, Challenges, and Coping Strategies of Frontline Healthcare Providers in Response to the COVID-19 Pandemic in Kelantan, Malaysia.

Introduction: In the fight against the COVID-19 pandemic, frontline healthcare providers who are engaged in the direct diagnosis, treatment, and care of patients face a high risk of infection and inadequate protection from contamination, overwork, frustration, and exhaustion. These impose significant psychological and mental health concerns for frontline healthcare providers. Objectives: This study aimed to explore the experiences and challenges faced and coping strategies adopted by frontline healthcare providers in response to the COVID-19 pandemic in Kelantan, Malaysia. Methodology: This phenomenological approach to qualitative study used a telephone-based in-depth interview that followed a semistructured interview guide. The number of frontline healthcare providers was based on saturation theory. All the participants recruited fulfilled the inclusion and exclusion criteria from May to July 2020 in Raja Perempuan Zainab II Hospital. All interviews were audio recorded and transcribed verbatim. Thematic data analysis using NVIVO version 10 was performed. Result: The 10 respondents involved in this study consisted of doctors, medical assistants, and nurses. The findings were divided into four main themes: invaluable experiences during the pandemic, challenges, coping strategies, and future expectations. The providers responded well in facing the disease even though they felt psychologically disturbed at the initial phase of the COVID-19 pandemic. Conclusion: Healthcare providers perceived themselves as being more resilient and less vulnerable to psychological impacts than they were before the pandemic.

Comparison of labour and postnatal satisfaction between women with and without severe maternal morbidity: a double-cohort study.

OBJECTIVE: To compare labour and postnatal satisfaction between women with and without severe maternal morbidity in a tertiary hospital in Kelantan, Malaysia. DESIGN: A prospective double-cohort study. SETTING: Hospital and community based. PARTICIPANTS: Women at childbirth and 1-month post partum. OUTCOME MEASURES: Labour satisfaction measured using the Malay version of the Women's Views of Birth Labour Satisfaction Questionnaire and postnatal satisfaction measured using the Malay version of the Women's Views of Birth Postnatal Satisfaction Questionnaire. RESULTS: A total of 198 participants responded following childbirth, while 193 responded 1-month post partum. Accordingly, although no significant difference in labour satisfaction scores following childbirth was observed between women with and without severe maternal morbidity, a significant difference in postnatal satisfaction score 1-month post partum had been noted (adjusted mean difference [95% CI]: 3 [0.54 to 5.45]; p=0.019). Moreover, domains for nursing a baby (0.08 [0.024] vs 0.06 [0.029]; p=0.022) and professional support (0.03 [0.022] vs 0.03 [0.029]; p=0.023) differed significantly between women with and without severe maternal morbidity. CONCLUSIONS: Healthcare professional support and nursing of babies influenced the relationship between satisfaction and severe maternal morbidity during the later postpartum period.