The effect of stress management training on perceived stress, anxiety and hopelessness levels of women with high-risk pregnancy.

The aim of this study was to investigate the effect of stress management training on the perceived stress, anxiety and hopelessness levels of women with high-risk pregnancy. The sample of this experimental study consisted of 206 high-risk pregnant women (intervention = 103; control = 103). Data were collected using a Personal Information Form, the Perceived Stress Scale, the Beck Hopelessness Scale and the State-Trait Anxiety Inventory. In the second follow-up after the training, there was a statistically significant difference amongst the Perceived Stress Scale, Beck Hopelessness Scale and State-Trait Anxiety Inventory mean scores in the intervention and control groups (p < .05). Perceived stress scores of the control group who did not receive training during discharge increased. The state and trait anxiety scores and hopelessness scores of the intervention group received training decreased compared with the control group.IMPACT STATEMENTWhat is already known on this subject? Mental problems such as anxiety and stress are more common in high-risk pregnancies compared with healthy pregnancies.What do the results of this study add? After the training 51.4% of women in the intervention group, 75.7% of women in the control group had stress. The state and trait anxiety and hopelessness scores of the intervention group having training decreased compared to the control group.What are the implications of these findings for clinical practice and/or further research? Health professionals should provide stress management training in high-risk pregnant women to reducing perceived stress, anxiety and hopelessness levels.

Development and validation of the prenatal activity restriction stress questionnaire: a Rasch rating scale analysis.

BACKGROUND: Antepartum activity restriction (AAR) is a common recommendation given to women at risk for preterm delivery. However, such treatment has been shown to cause heavy emotional burdens on the women receiving it since it requires them to face many challenges derived from the intervention. Nevertheless, current existing scales lack effective items that can reflect the distress of these women. The aim of this study was to develop a reliable instrument to assess the distress of women experiencing AAR. METHOD: The Prenatal Activity Restriction Stress Questionnaire (PARSQ) was developed according to comprehensive literature review, women's interviews, and existing pregnancy-special stress scales from August 2016 to July 2017 in southern Taiwan. Six experts evaluated its content validity; the Rasch rating scale model (RSM) was used to examine its item-fit, dimensionality, and reliability with 200 women with AAR experience. Furthermore, the concurrent validity was assessed through computing the correlation of AAR women's scores on the PARSQ and Perceived Stress Scale (PSS), and discriminant validity of the PARSQ was assessed to compare the scores' differences between the AAR women and the healthy pregnant women. RESULTS: The PARSQ was constructed with 23 items in the 4-dimensional scale: Role function changes (8 items), Fetal safety and health (5 items), Physical and psychological care issues (5 items), and Socioeconomic and medical issues (5 items). It was confirmed to have satisfactory content vitality (CVI = 0.78 to 1.0), reasonable item-fit (0.77 to 1.51), and good reliability in RSM model, as well as adequate concurrent validity (p = 0.005) and discriminant validity (p < 0.001). CONCLUSIONS: Understanding the distress of women undergoing AAR is necessary for developing appropriate prenatal care to assist women in coping with their situation to alleviate their emotional burdens. The developed PARSQ with satisfied psychometric properties can be an informative instrument for clinicians/researchers to assess the specific stress of pregnant women with AAR.

Exercise-induced changes in brain activity during memory encoding and retrieval after long-term bed rest.

Episodic memory depends decisively on the hippocampus and the parahippocampal gyrus, brain structures that are also prone to exercise-induced neuroplasticity and cognitive improvement. We conducted a randomized controlled trial to investigate the effects of a high-intensity exercise program in twenty-two men resting in bed for 60 days on episodic memory and its neuronal basis. All participants were exposed to 60 days of uninterrupted bed rest. Eleven participants were additionally assigned to a high-intensity interval training that was performed five to six times weekly for 60 days. Episodic memory and its neural basis were determined four days prior to and on the 58th day of bed rest using functional magnetic resonance imaging (fMRI). We found increased BOLD signal in the left hippocampus and parahippocampal gyrus in the non-exercising group compared to the exercising bed rest group whereas the mnemonic performance did not differ significantly. These findings indicate a higher neuronal efficiency in the training group during memory encoding and retrieval and may suggest a dysfunctional mechanism in the non-exercising bed rest group induced by two months of physical inactivity. Our results provide further support for the modulating effects of physical exercise and adverse implications of a sedentary lifestyle and bedridden patients.

Effects of yoga on anxiety and depression for high risk mothers on hospital bedrest.

BACKGROUND: and purpose: In recent years, yoga practitioners have joined forces with medical programs to approach patients' well-being holistically. This study is a randomized controlled trial to assess the effects of a specialized adapted yoga program on anxiety and depression for high-risk expectant mothers on bedrest in a hospital setting. MATERIALS AND METHODS: Seventy-nine pregnant subjects on physician ordered hospitalized bedrest were randomized into two groups: receiving biweekly yoga sessions (intervention group) or receiving no yoga (control group). Data collection tool was the Hospital Anxiety and Depression Scale (HADS) to assess outcomes after delivery. RESULTS: Yoga, even as little as three sessions, showed significant impact in reducing anxiety and depression high-risk pregnant women on hospitalized bedrest. Perceived anxiety and depression overall scores were lower in the intervention group than in the control group (p < 0.001). CONCLUSION: Results demonstrated that yoga is an effective intervention to decrease anxiety and depression in high-risk antepartum women on hospitalized bedrest.

Electrocortical Evidence for Impaired Affective Picture Processing after Long-Term Immobilization.

The neurobehavioral risks associated with spaceflight are not well understood. In particular, little attention has been paid on the role of resilience, social processes and emotion regulation during long-duration spaceflight. Bed rest is a well-established spaceflight analogue that combines the adaptations associated with physical inactivity and semi-isolation and confinement. We here investigated the effects of 30 days of 6 degrees head-down tilt bed rest on affective picture processing using event-related potentials (ERP) in healthy men. Compared to a control group, bed rest participants showed significantly decreased P300 and LPP amplitudes to pleasant and unpleasant stimuli, especially in centroparietal regions, after 30 days of bed rest. Source localization revealed a bilateral lower activity in the posterior cingulate gyrus, insula and precuneus in the bed rest group in both ERP time frames for emotional, but not neutral stimuli.

Perceived acceptability and preferences for low-intensity early activity interventions of older hospitalized medical patients exposed to bed rest: a cross sectional study.

BACKGROUND: Hospitalized older patients spend most of their time in bed, putting them at risk of experiencing orthostatic intolerance. Returning persons to their usual upright activity level is the most effective way to prevent orthostatic intolerance but some older patients have limited activity tolerance, supporting the need for low-intensity activity interventions. Consistent with current emphasis on patient engagement in intervention design and evaluation, this study explored older hospitalized patients' perceived acceptability of, and preference for, two low-intensity early activity interventions (bed-to-sitting and sitting-to-walking), and characteristics (gender, illness severity, comorbidity, illnesses and medications with orthostatic effects, and baseline functional capacity) associated with perceived acceptability and preference. METHODS: A convenience sample was recruited from in-patient medical units of two hospitals in Ontario, Canada and included 60 cognitively intact adults aged 65+ who were admitted for a medical condition within the past 72 h, spent ≥ 24 consecutive hours on a stretcher or in bed, presented with ≥ 2 chronic diseases, understood English, and were able to ambulate before admission. A cross-sectional observational design was used. Participants were presented written and oral descriptions and a 2-min video of each intervention. The sequence of the interventions' presention was randomized. Following the presentation, a research nurse administered measures of perceived acceptability and preference, and collected health and demographic data. Perceived acceptability and preference for the interventions were measured using the Treatment Acceptability and Preferences Scale. Illness severity was measured using the Modified Early Warning Score. Comorbidity was assessed with the Age Adjusted Charlson Comorbidity Scale and the Cumulative Illness Rating Scale - for Geriatrics. Baseline functional capacity was measured using the Duke Activity Status Index. RESULTS: Participants' perceived acceptability of both interventions clustered above the scale midpoint. Most preferred the sitting-to-walking intervention (n = 26; 43.3%). While none of the patient characteristics were associated with intervention acceptability, illness severity (odds ratio = 1.9, p = 0.04) and medications with orthostatic effects (odds ratio = 9.9, p = 0.03) were significantly associated with intervention preference. CONCLUSIONS: The interventions examined in this study were found to be acceptable to older adults, supporting future research examining their feasibility and effectiveness.

PlanHab study: assessment of psycho-neuroendocrine function in male subjects during 21 d of normobaric hypoxia and bed rest.

Immobilization and hypoxemia are conditions often seen in patients suffering from severe heart insufficiency or primary pulmonary diseases (e.g. fibrosis, emphysema). In future planned long-duration and exploration class space missions (including habitats on the moon and Mars), healthy individuals will encounter such a combination of reduced physical activity and oxygen tension by way of technical reasons and the reduced gravitational forces. These overall unconventional extraterrestrial conditions can result in yet unknown consequences for the regulation of stress-permissive, psycho-neuroendocrine responses, which warrant appropriate measures in order to mitigate foreseeable risks. The Planetary Habitat Simulation Study (PlanHab) investigated these two space-related conditions: bed rest as model of reduced gravity and normobaric hypoxia, with the aim of examining their influence on psycho-neuroendocrine responses. We hypothesized that both conditions independently increase measures of psychological stress and enhance neuroendocrine markers of stress, and that these effects would be exacerbated by combined treatment. The cross-over study composed of three interventions (NBR, normobaric normoxic horizontal bed rest; HBR, normobaric hypoxic horizontal bed rest; HAMB, normobaric hypoxic ambulatory confinement) with 14 male subjects during three sequential campaigns separated by 4 months. The psychological state was determined through three questionnaires and principal neuroendocrine responses were evaluated by measuring cortisol in saliva, catecholamine in urine, and endocannabinoids in blood. The results revealed no effects after 3 weeks of normobaric hypoxia on psycho-neuroendocrine responses. Conversely, bed rest induced neuroendocrine alterations that were not influenced by hypoxia.

Computerized spatial navigation training during 14 days of bed rest in healthy older adult men: Effect on gait performance.

Prolonged physical inactivity or bed rest (BR) due to illness or other factors can result in significant declines in physical health and even cognitive functions. Based on random selection, 7 healthy older adult men received computerized spatial navigation training, while 8 served as active controls during 14-day BR. Greater post-BR declines were seen in normal and complex (dual-task) walking for the control as compared to intervention group, suggesting that computerized spatial navigation training can successfully moderate detrimental BR effects. Findings underline the generalization of cognitive-based intervention to the motor domain and potentially support their use to supplement BR interventions (e.g., exercise and nutrition).

Psychological strain: examining the effect of hypoxic bedrest and confinement.

The aim was to assess the effect of a 10-day exposure to the environmental stressors anticipated in future lunar habitats on indices of psychological strain. In addition to the reduced gravity of the Moon, future habitats on the Moon will likely maintain a hypobaric hypoxic environment. The hypobaric environment will eliminate the need for long decompression profiles prior to each extra-vehicular activity. We investigated the indices of psychological strain during three 10-day conditions, designed to assess the separate and combined effects of inactivity/unloading and normobaric hypoxia on several physiological systems. Eleven male participants underwent three 10-day campaigns in a randomised manner: 1) normobaric normoxic bed rest (NBR), 2) normobaric hypoxic bed rest (HBR) and 3) normobaric hypoxic ambulatory confinement (HAMB). The most negative psychological profile appeared on day 10 of the HBR and HAMB (hypoxic) conditions. Concomitantly, a decrease in positive emotions was observed from baseline to day 10 of the HBR and NBR conditions. Thus, confinement in a hypoxic environment seems to exert a negative effect on an individual's psychological mood.

Maternal activity restriction in pregnancy and the prevention of preterm birth: an evidence-based review.

Activity restriction is one of the most common practices used for the prevention of preterm birth. Despite the lack of evidence to support the efficacy of activity restriction, and newer data that highlight potential harms to the mother, the intervention is still prescribed. This review of the literature describes the potential benefits, harms, and efficacy of activity restriction in the prevention of preterm birth.

Pulmonary thromboembolism after operation for bilateral open distal radius fractures: a case report.

BACKGROUND: Pulmonary thromboembolism after upper extremity operation is rare. We report a patient with thromboembolism after debridement open reduction and internal fixation for bilateral open distal radius fractures. CASE PRESENTATION: The Japanese patient was an 80-year-old previously healthy female who was able to walk on her own. She fell down and was taken to our hospital. She was diagnosed with bilateral open distal radius fractures and we performed debridement open reduction and internal fixation on the same day. Although she could not walk and was depressed, she was discharged on the ninth postoperative day. However, on the eleventh postoperative day, she returned to our emergency department with complaints of dyspnea and cold sweat. Her serum D-dimer level was 19.0 µg/dl, troponin T was positive, and urgent contrast computed tomography scan of her thorax revealed thrombosis in the bilateral main pulmonary artery. She was diagnosed with pulmonary thromboembolism and admitted to our hospital again. On the second admission, although she had breathing problems, she did not require a respirator. Oxygen was supplied as well as anticoagulants. On the seventh day after being diagnosed with embolism, thrombosis in the bilateral main pulmonary arteries had disappeared. CONCLUSION: The patient did not have any "strong" risk factors as reported in the Japanese Orthopedic Association Clinical Practice Guideline on the Prevention of Venous Thromboembolism in Patients Undergoing Orthopedic Treatments. In general, upper extremity operation carries a low risk for pulmonary thromboembolism. For patients with decreased activity of daily living and depression, we should consider postponing discharge and performing rehabilitation until activity of daily living is improved.

Maternal development experiences of women hospitalized to prevent preterm birth.

OBJECTIVE: To examine ways that women's experience of hospitalization with bed rest to prevent preterm birth impacts prenatal maternal development. METHOD: Interviews based on the Interview Schedules for Dimensions of Maternal Development in Psychosocial Adaptation to Pregnancy were conducted at a hospital in the southwestern United States with a convenience sample of 41 women during confinement to bed rest to prevent preterm birth. The interviews were recorded, and verbatim transcripts were submitted to thematic analysis. RESULTS: Five themes were mapped from the women's narratives: (1) acceptance of pregnancy, but with fears specific to elevated risks to self and baby; (2) heightened identification with motherhood and fatherhood protector roles; (3) renewal or deepening of mother-daughter closeness intensified by high-risk pregnancy; (4) enhanced couple support and collaboration; and (5) acceptance of responsibility to perform in remaining pregnant and preparing for labor, but willingness to accept help from doctors and nurses. CONCLUSIONS: This study of hospitalization to prevent preterm birth showed that women experience hospitalization as a burden to be endured to meet future goals, but that it also can facilitate prenatal maternal development in psychosocial adaptation to high risk pregnancy. Implications for research and practice are discussed.

Outcome measure to assess head-down bed rest subject performance.

BACKGROUND: The purpose of the present study was to develop an objective outcome measure to assess the performance of head-down bed rest subjects. The rationale behind the development was that the current outcome measure is subjective and dependent upon how much the clinical psychologist knows about subject behaviors during the study to rate them accurately. METHODS: The behaviorally anchored rating scales (BARS) were developed through the use of the critical incident technique, along with traditional BARS development procedures, and the use of focus groups. RESULTS: Use of these methodologies yielded 86 usable critical incidents, which were used as anchors for the scales. DISCUSSION: Further research will be necessary to determine whether or not associations exist between data from the BARS and psychological screening data.

Women's experience of hospitalized bed rest during high-risk pregnancy.

OBJECTIVE: To describe the lived experience of the hospitalized pregnant woman on bed rest. DESIGN: A qualitative, phenomenological design. SETTING: Three high-risk antepartum units in the midwestern United States. PARTICIPANTS: A self-selected, convenience sample of 11 high-risk pregnant women. METHOD: Phenomenological study using thematic analysis of completed handwritten journals and/or online blogs. RESULTS: Women described the battles that they fought each day for the lives of their unborn children. Using an imagery of war, three categories emerged: (a) the war within, (b) fighting each battle, and (c) bringing in reinforcements. CONCLUSIONS: Women experience many different emotions and stressors during restricted bed rest. A nurse's understanding of this experience is essential to provide adequate care and coping strategies for women at this time.

Bed rest in pregnancy.

The use of bed rest in medicine dates back to Hippocrates, who first recommended bed rest as a restorative measure for pain. With the formalization of prenatal care in the early 1900s, maternal bed rest became a standard of care, especially toward the end of pregnancy. Antepartum bed rest is a common obstetric management tool, with up to 95% of obstetricians utilizing maternal activity restriction in some way in their practice. Bed rest is prescribed for a variety of complications of pregnancy, from threatened abortion and multiple gestations to preeclampsia and preterm labor. Although the use of bed rest is pervasive, there is a paucity of data to support its use. Additionally, many well-documented adverse physical, psychological, familial, societal, and financial effects have been discussed in the literature. There have been no complications of pregnancy for which the literature consistently demonstrates a benefit to antepartum bed rest. Given the well-documented adverse effects of bed rest, disruption of social relationships, and financial implications of this intervention, there is a real need for scientific investigation to establish whether this is an appropriate therapeutic modality. Well-designed randomized, controlled trials of bed rest versus normal activity for various complications of pregnancy are required to lay this debate to rest once and for all.

Differences in sleep complaints in adults with varying levels of bed days residing in extended care facilities for chronic disease management.

This cohort study examined differences in perceived insomnia and daytime sleepiness in 67 adults residing in extended care facilities for chronic disease management who had varying levels of bed days. One bed day was defined as spending 24 hours in bed. Planned pairwise comparisons, using Bonferroni adjustment, were made between participants who spent 0 (n = 21), 2 to 4 (n = 23), and 5 to 7 (n = 23) days in bed during 1 week of monitoring. Participants who spent 5 to 7 days in bed had significantly greater insomnia than those who spent 2 to 4 days in bed. No group differences were found in daytime sleepiness. Based on the findings, nurses may assess subjective insomnia and explore sleep hygiene strategies, such as increasing time out of bed with patients who have high levels of 5 to 7 bed days.

Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography.

Control of stress and anxiety and the promotion of comfort are challenges facing health practitioners involved in catheterization. The aim of this case-control study was to examine the effect of music on the levels of anxiety, stress, and depression experienced by patients undergoing coronary angiography, as measured by the 21-item Depression Anxiety Stress Scales. Differences in pre- and post-intervention scores demonstrated that there were significant decreases in mean scores of state anxiety (P = 0.006), stress (P = 0.001) and depression P = 0.02) in the intervention group, who listened to 20 minutes of relaxing music, as compared with the control group who had 20 minutes of bed rest.