Family intimacy and adaptability and non-suicidal self-injury: a mediation analysis.

BACKGROUND: Current research has been focusing on non-suicidal self-injury (NSSI) behaviors among adolescents with depression. Although family intimacy and adaptability are considered protective factors for NSSI, evidence supporting this relationship is lacking. OBJECTIVE: This study aims to examine the mechanisms operating in the relationship between family intimacy and adaptability and NSSI behaviors among adolescents. METHODS: A self-administered general demographic information questionnaire, the Behavioral Functional Assessment Scale for Non-Suicidal Self-Injury, the Family Intimacy and Adaptability Scale, the Connor-Davidson Resilience Scale, and the Self-Assessment of Depression Scale were distributed among adolescents with depression in three tertiary hospitals in Jiangsu Province. RESULTS: The relationship between family intimacy and adaptability and NSSI was assessed among 596 adolescents with depression. The results revealed the following: (1) Family intimacy and adaptability were negatively correlated with NSSI behavior. (2) Psychological resilience and depression levels acted as chain mediators in the relationship between family intimacy and adaptability and NSSI behavior. CONCLUSIONS: Enhancing psychological resilience, controlling depressive symptoms, and reducing depression severity among adolescents by improving their family intimacy and adaptability are conducive to preventing and mitigating their NSSI behaviors.

Path analysis of influencing factors for maternal antenatal depression in the third trimester.

Maternal antenatal depression (AD) is a nonpsychotic depressive episode during pregnancy that can harm both the pregnant woman and the fetus. This study aimed to investigate the intrinsic interrelationships between AD and its influencing factors by constructing a path model. This survey-based cross-sectional study included 1071 pregnant women who underwent pregnancy examinations in three hospitals in Nantong City, China, between February and June 2023. General information and information regarding maternal AD, pregnancy stress, prenatal anxiety, social support, marital satisfaction, sleep quality, and resilience were collected. Multiple linear regression analysis using SPSS 25.0 was employed to determine the factors influencing pregnancy depression, and Amos25.0 was used to construct a structural equation model. AD incidence was 19.4% (208/1071). The independent risk factors affecting AD in pregnant women have been integrated into the established path analysis model. The model demonstrated a good fit (χ2/DF = 1.238, comparative fit index = 0.999, goodness-of-fit index = 0.998, normed fit index = 0.996, adjusted goodness-of-fit index = 0.990, incremental fit index = 0.999, and root mean square error of approximation = 0.015). While prenatal anxiety (0.230) and hyperthyroidism (0.048) only had direct effects on AD, mental resilience was the biggest factor affecting AD, followed by pregnancy stress, marital satisfaction, prenatal anxiety, sleep quality, social support, and hyperthyroidism. Improved mental resilience, social support, sleep quality, and marital satisfaction; reduced pregnancy stress and prenatal anxiety; and effective hyperthyroidism treatment might reduce AD. This study underscored the significance of delivering actionable strategies and tangible assistance to pregnant women to reduce AD.

The mediating role of social support and resilience between self-efficacy and prenatal stress: a mediational analysis.

BACKGROUND: Prenatal stress is a highly prevalent mental disorder experienced by pregnant women. This study assessed the prevalence and influencing factors of prenatal stress and investigated the mediating role of social support and resilience between self-efficacy and prenatal stress among pregnant women in China. METHODS: A convenience sample comprising 1071 pregnant women from three hospitals in Nantong, Jiangsu Province, China, was recruited between February and June 2023. These participants completed a set of general survey questionnaires and were assessed using the Pregnancy Pressure Scale, Perceived Social Support Scale, the 10-item Connor-Davidson Resilience Scale, and the Chinese version of the General Self-Efficacy Scale. Furthermore, a hierarchical multiple regression model was employed to investigate the relevant factors and mediators of prenatal stress symptoms. A structural equation model was used to examine the mediating role of social support and resilience in the relationship between self-efficacy and prenatal stress. RESULTS: The results of the multivariate regression analysis indicated significant associations between prenatal stress and parity, self-efficacy, social support, and resilience (P < 0.001). Self-efficacy accounted for 35.33% of the total effect, with a direct effect of -2.5306 (95% confidence interval [CI]: -4.0309 to -1,0303). Further examination through mediation analysis revealed the mediating roles of social support and resilience in the relationship between self-efficacy and prenatal stress. The mediating effect of social support was - 1.5933 (95% CI: -2.2907 to -0.9496), accounting for 22.24% of the total effect. Similarly, resilience exhibited a mediating effect of -3.0388 (95% CI: -4.3844 to -1.7135), accounting for 42.43% of the total effect. CONCLUSION: The mediation analysis revealed that among pregnant women in China, the influence of self-efficacy on prenatal stress is channelled through social support and resilience. Therefore, enhancing social support, resilience, and self-efficacy might alleviate prenatal stress.

Postpartum stress in the first 6 months after delivery: a longitudinal study in Nantong, China.

OBJECTIVES: The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors. DESIGN: A longitudinal study with follow-ups from 42 days to 6 months after delivery. SETTINGS AND PARTICIPANTS: A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis. METHODS: Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation. RESULTS: Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (ß=0.028, p=0.049), higher education level (ß=0.153, p=0.005) and higher body mass index (BMI) (ß=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (ß=0.030, p=0.033) and 6 months (ß=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms. CONCLUSIONS: Postpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.

Translation and validation of the Chinese version of the maternal postpartum stress scale.

OBJECTIVE: To translate the Maternal Postpartum Stress Scale (MPSS) into Chinese and validate its psychometric properties in postpartum women. METHODS: A total of 406 postpartum women were recruited from six hospitals in Nantong, Jiangsu Province, China. Cronbach's α co-efficient, split-half reliability, and test-retest reliability were used to evaluate the reliability of the translated scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The Edinburgh Postnatal Depression Scale, Depression Anxiety Stress Scale-21 anxiety dimension, and Perceived Stress Scale were used as calibration scales to measure the correlation of MPSS. All data were analyzed using SPSS 25.0 and Amos 24.0. RESULTS: The Cronbach's α co-efficient of the Chinese version of MPSS and its three dimensions were 0.940 and 0.882-0.911, respectively. The split-half reliability was 0.825, and the test-retest reliability was 0.912. The scale's content validity index was 0.926. Three common factors were extracted from the EFA. The CFA validated the explored 3-factor structure, and the indicators were fitted well (χ2/Df = 2.167, comparative fit index = 0.918, Tucker-Lewis index = 0.907, incremental fit index = 0.919, and root mean square error of approximation = 0.075). CONCLUSION: The translated Chinese version of MPSS had suitable reliability and validity in assessing postpartum stress in Chinese women. The translated scale can also help with the early identification of postpartum stress and provide a scientific basis for the formulation of early personalized intervention measures. Overall, the scale has certain clinical value and practical significance for enhancing the physical and mental health of postpartum women. However, future studies including large, diverse populations are warranted.

The effect of perceived social support on postpartum stress: the mediating roles of marital satisfaction and maternal postnatal attachment.

BACKGROUND: Multiple factors may be responsible for the development of postpartum stress, including perceived social support, marital satisfaction, and maternal postnatal attachment. However, the underlying mediation mechanisms remain unclear. This study examined the complex relationships between perceived social support and postpartum stress among Chinese women. METHODS: A convenience sample comprising 406 postpartum women was recruited from six hospitals in Nantong, Jiangsu Province, China. The participants completed general survey questionnaires and were evaluated using the Maternal Postpartum Stress Scale, the Perceived Social Support Scale, the Maternal Postnatal Attachment Scale, and the Marital Satisfaction Scale. Furthermore, we evaluated the relationship between postpartum stress and the various influencing factors by performing a multiple linear regression analysis. The potential mediating roles of marital satisfaction and maternal and infant attachment in the association between perceived social support and postpartum stress were explored by performing a mediation analysis. RESULTS: According to the multivariate regression analysis, perceived social support, marital satisfaction, and maternal postnatal attachment contributed to postpartum stress levels (P < 0.05). The mediation analysis revealed that marital satisfaction and maternal postnatal attachment played parallel mediating roles in the association between perceived social support and postpartum stress, and the mediating effect of marital satisfaction was - 0.1125 (95% confidence interval [CI]: -0.1784 to -0.0520), accounting for 33.20% of the total effect, and the mediating effect of maternal postnatal attachment was - 0.0847 (95% CI: -0.1304 to -0.0438), accounting for 25.00% of the total effect. CONCLUSION: Our study revealed that perceived social support could influence postpartum stress not only through direct effect (41.80% of the total effect), but also through the indirect effect (mediation effect) of marital satisfaction and maternal postnatal attachment (58.20% of the total effect), suggesting that improving postpartum women's social support, enhancing maternal and infant attachment, and improving their marital satisfaction could help lower postpartum stress.

Status and influencing factors of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury: a quantitative and qualitative study.

BACKGROUND: Disease uncertainty widely exists among family caregivers of patients with moderate and severe craniocerebral injury. This negative emotional reaction will reduce the ability of family caregivers to make decisions during the critical stage of the patient, causing serious effects on the rescue and prognosis of patients with moderate and severe craniocerebral injury. Therefore, this article aims to understand the state of the uncertainty of the disease of family caregivers of patients with moderate and severe craniocerebral injury in China, to analyze the influencing factors, and to explore the specific resource of the uncertainty of the disease combined with qualitative study. The outcomes will provide a theoretical basis for formulating an accurate clinical nursing intervention strategy. METHODS: This study was conducted in the neurosurgery ward. A total of 214 family caregivers were evaluated using five previously validated scales: (i) Mishel Uncertainty in Illness Scale for family member, (ii) Simplified Coping Style Questionnaire, (iii) Social Support Rating Scale, and (iv) Self-Rating Anxiety Scale, (v) Zarit Caregiver Burden Interview. Kolmogorov-Smirnov was used to test the normality of the data distribution. The potential determinants of disease uncertainty were evaluated using the univariate statistical analysis. A multivariate linear regression model was adopted to assess the predictors of disease uncertainty in family caregivers of patients with moderate and severe craniocerebral injury. Objective sampling method was used to conduct semi-structured interviews with 17 family caregivers of patients with moderate and severe craniocerebral injury, and Colaizzi 7-step analysis method was used to analyze and summarize the interview data. RESULTS: The evaluated participants exhibited critically high levels of perceived uncertainty. The results of multiple linear regression showed that the influencing factors of family caregivers' disease uncertainty were anxiety, number of other caregivers, GOS, negative coping style, and caregiver burden. The qualitative research focuses on two main topics: the sources of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury and experience to cope with the situation. CONCLUSION: The main cause of disease uncertainty of family caregivers of patients with moderate and severe craniocerebral injury is that patients' disease progression and prognosis as well as caregivers' own pressure of responsibility and negative mental status. Furthermore, caregivers' own pressure of responsibility and negative mental status are not clear. Therefore, helping family caregivers adopt positive coping approaches, guiding them to actively seek support from family and society, improving their nursing skills, and understanding of disease progression and prognosis all play an important role in alleviating the uncertainty of the disease.

Secondhand smoking exposure and quality of life among pregnant and postnatal women: a network approach.

OBJECTIVE: This study examined the prevalence of exposure to secondhand smoke, its correlates and its association with quality of life (QOL) among pregnant and postnatal Chinese women. DESIGN: This was a multicentre, cross-sectional study. SETTING: Participants were consecutively recruited from eight tertiary hospitals located in eight municipalities or provinces in China. PARTICIPANTS: A total of 1140 women were invited to join this study and 992 (87.02%) completed all measures. PRIMARY AND SECONDARY OUTCOME: Measures women's secondhand smoking behaviour (frequency and location of exposure to secondhand smoking), and their QOL measured by the WHO Quality of Life Questionnaire. RESULTS: A total of 211 women (21.3%, 95% CI 18.7% to 23.8%) had been exposed to secondhand smoking. Exposure to secondhand smoking was most common in public areas (56.4%), and residential homes (20.5%), while workplaces had the lowest rate of exposure (13.7%). Women with physical comorbidities were more likely to report secondhand smoking exposure, while older women, women living in urban areas, those with college or higher education level, and women in their second trimester were less likely to report exposure to secondhand smoking. Network analysis revealed that there were six significant links between secondhand smoke and QOL items. The strongest negative edge was the connection between secondhand smoke and QOL9 ('physical environment health', edge weight=-0.060), while the strongest positive edge was the connection between secondhand smoke and QOL3 ('pain and discomfort', edge weight=0.037). CONCLUSION: The prevalence of exposure to secondhand smoking is becoming lower among pregnant and postnatal women in China compared with findings reported in previous studies. Legal legislation should be maintained and promptly enforced to establish smoke-free environments in both public and private urban/rural areas for protection of pregnant and postnatal women, especially those who are physically vulnerable and less educated.

The clinical effect of WeChat-based MUST education model on patients with chronic heart failure.

OBJECTIVE: To explore the effect of WeChat-based MUST nursing intervention on self-care ability and quality of life in patients with chronic heart failure. METHOD: Convenient sampling was used to select CHF patients who received treatment in XX Hospital from January 1, 2020, to December 30, 2020, as the study subjects and was divided into the experimental group (n = 60) and the control group (n = 60) according to the random number table. The experimental group used the WeChat-based MUST nursing intervention, and the control group used the routine education and follow-up model. Cardiac function parameters, self-care ability, and other indicators were compared between the two groups before and after nursing. The clinical effect of two groups was evaluated. RESULTS: After the nursing intervention, LVEF levels were increased to different extents and NT-proBNP was decreased to different extents in both groups. LVEF level in the experimental group was higher than that in the control group, and the NT-proBNP level in the experimental group was lower than that in the control group. After the nursing intervention, the self-care ability and quality of life of the two groups were increased to varying degrees. Self-care ability was higher in the experimental group than in the control group, and quality of life was higher in the experimental group than in the control group. CONCLUSION: The WeChat-based MUST nursing intervention model in patients with chronic heart failure, compared with the conventional cardiology nursing model, can effectively improve the self-care ability of patients, improve the knowledge level and quality of life of patients with heart failure, and reduce the readmission rate.

Association of maternal diabetes during pregnancy with visual acuity development in offspring: a prospective cohort study.

AIMS: We aimed to investigate the association between maternal diabetes before or during pregnancy and visual acuity development in offspring at 1 and 4 years old. METHODS: This prospective cohort study comprised 301 individuals born in 2015-2017. Those who had maternal diabetes during or before pregnancy (type 1 diabetes, type 2 diabetes and gestational diabetes) were investigated. Two visual examinations were routinely performed on children relatively at the age of 1 at physical examination and at the age of 4 at admission to school to assess the possible effects of gestational exposure to diabetes on the visual system of the offspring. RESULTS: Data were collected on children aged 1 and 4, which consisted of 173 children of mothers exposed to diabetes and 128 children of mothers without diabetes). We found no significant association between maternal diabetes during pregnancy and visual acuity development in 1-year-old offspring. At 4 years old, the incidence of amblyopia and strabismus was similar in both groups. Prenatal exposure to maternal diabetes was associated with a 171% increased risk of high RE: OR 2.71 (95% CI 1.08, 6.81), p < 0.05. Astigmatism (13.3% vs 5.5%) was found to be significantly more prevalent in children born to mothers with GD than in the controls (p = 0.025 in both groups). Moreover, offspring exposed to PGDM had a higher overall risk of high RE than those exposed to GDM during pregnancy (25.0% vs 17.4%). We further found that in the offspring of diabetic mothers, the risk of high RE was significantly increased among children who were female or who spent more time using electronic devices daily. CONCLUSIONS: Our findings suggest that maternal diabetes during pregnancy is associated with an increased risk of high RE in offspring. Regular ophthalmological screening should be advised to offspring of mothers with diabetes diagnosed before or during pregnancy.

Prevalence, correlates, and network analysis of Internet addiction symptoms among Chinese pregnant and postpartum women.

OBJECTIVE: Excessive Internet use is a common health problem globally. This study aimed to assess the prevalence, correlates, and network structure of Internet addiction symptoms (Internet addiction hereafter) among Chinese pregnant and postpartum women. METHODS: This was a multicenter cross-sectional study using Internet Addiction Test (IAT) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate Internet addiction and quality of life (QOL), respectively. Univariate analyses, multivariate logistic regression analyses, and network analyses were performed. RESULTS: Of a total of 1,060 women who completed the study, 320 (30.19%, 95% CI=27.42%-32.96%) women reported Internet addiction during or after pregnancy. Women with previous adverse pregnancy experiences (OR=1.831, P=0.001) and physical comorbidities (OR=1.724, P=0.004) had a higher likelihood of developing Internet addiction. Internet addiction was significantly associated with poor QOL in all domains. Network analyses revealed that IAT item 16 (request an extension for longer time spent online) was the most central symptom in the analyses, and also one of the strongest bridging symptoms linking the Internet addiction and QOL communities. LIMITATIONS: This was a cross-sectional study, all study findings were based on self-reported data, and possible recall bias and selection bias may exist. CONCLUSION: Internet addiction is common among Chinese pregnant and postpartum women, and is significantly associated with lower QOL. Effective strategies, especially focusing on central symptoms, are needed to reduce the impact of Internet addiction and improve QOL in pregnant and postpartum women.

Construction and Evaluation of a Rat Model of Postpartum Fatigue.

OBJECTIVES: The aim of the study was to construct and evaluate a rat model of postpartum fatigue. DESIGN: This is an article about animal model building. METHODS: Sprague-Dawley rats on the 1st day after delivery were randomized into control group and fatigue group. The deep sleep of rats was interfered with by forcing them to stand in water, to make the rats experience mental and physical fatigue. To maintain galactosis and lactation, rats and pups were caged for 90 min after every 3 h of separation. The control group was separated routinely without any stimulus. The model was evaluated from mental and physical fatigue on the 8th day and 15th day. The mental fatigue was evaluated by a water maze test and the rat's 5-hydroxytryptamine (5-HT) level in hippocampus, while the physical fatigue was evaluated using lactic acid level in serum and duration of weight-loaded forced swimming. RESULTS: Among the 7-day and 14-day modeling groups, compared with the control group, the success rate of water maze landing was significantly decreased, the time for water maze landing was significantly prolonged and 5-HT level in hippocampus significantly decreased in the fatigue group. With respect to physical fatigue, among the 7-day and 14-day modeling groups, the lactic acid level in serum in the fatigue group was significantly increased, and the duration of exhaustive swimming of rats was significantly shortened. LIMITATIONS: A small sample size was the main limitation of this study. CONCLUSIONS: We have successfully constructed a rat model of postpartum fatigue by forcing postpartum rats to stand in water, which was similar to a level of stress that contributes to the development of postpartum fatigue. Our model opens the door for future studies evaluating the effectiveness of pharmacological and behavioral therapies.

The effects of cognitive bias modification for attention and interpretation on the postoperative psychological resilience and quality of life of patients with pituitary adenoma: a randomized trial.

BACKGROUND: Negative emotions such as anxiety and depression may have a bearing on patients' psychological resilience and quality of life (QoL) following surgery. Cognitive bias modification (CBM) for attention and interpretation has been confirmed to alleviate anxiety and depression. However, the psychological effects of CBM attention and interpretation on Chinese patients with pituitary adenoma have hardly received research attention. METHODS: This prospective interventional study enrolled 100 patients undergoing surgical treatment for pituitary adenoma. Participants were divided into an experimental group and a control group, with 50 cases in each group. Baseline characteristics of included patients were collected. Patients in the control group were given routine training, and those in experimental group received routine training plus CBM attention and interpretation training. The Connor-Davidson Resilience Scale (CD-RISC) was used to assess patients' psychological resilience. The patients' levels of anxiety and depression were assessed using the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). QoL was assessed based on the European Organization for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30). RESULTS: No statistical difference was found between the 2 groups in CD-RISC, SAS, SDS, or QoL score at baseline (P>0.05). After CBM training, psychological resilience and QoL in the experimental group improved, and the levels of anxiety and depression decreased (P<0.05). Furthermore, the experimental group showed statistically superior psychological resilience and QoL than the control group. The levels of anxiety and depression in the experimental group were statistically lower than those in the control group (P<0.05). CONCLUSIONS: CBM for attention and interpretation effectively improves the psychological resilience of patients and reduces the symptoms of anxiety and depression, thus improving patients' postoperative QoL. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2100045899.

The Prevalence of Depression and Its Association With Quality of Life Among Pregnant and Postnatal Women in China: A Multicenter Study.

Background: This study examined the prevalence of depressive symptoms (depression hereafter) and its association with quality of life (QOL) among pregnant and postnatal women in China. Methods: In this multi-center, cross-sectional study, 1,060 pregnant and postnatal women from eight hospitals were assessed. Depression and QOL were measured using the Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life Questionnaire - brief version, respectively. Results: The prevalence of depression was 7.45% (95% CI: 5.87-9.04%) in the sample. Women with depression had lower QOL in physical, psychological, social and environmental domains compared to those without. Women with physical comorbidities were more likely to suffer from depression (OR = 2.391, 95% CI = 1.384-4.130, P = 0.002). Conclusion: Due to its negative association with QOL, increased attention should be paid to depression in pregnant and postnatal women. Regular screening assessment and preventive measures should be adopted to reduce risk of depression in this population.

Are Prolactin Levels Linked to Suction Pressure?

BACKGROUND: Suction pressure has been reported to be a key driving force of lactation. An infant's sucking at its mother's breasts is the major stimulus to post-natal prolactin (PRL) secretion, and PRL is the essential hormone for lactation and milk production. It is unknown what role suction pressure has in PRL secretion and milk supply postnatally. OBJECTIVES: To explore the relationship between the suction pressure, PRL level, lactation, and milk supply in breastfeeding mother-infant dyads. METHODS: Healthy women with normal full-term infants were enrolled (n = 122). Data collection included suction pressure, PRL level, and the mother's perception of both the onset of her lactation and her milk supply at 1 month. Suction pressure was measured with a pressure sensor connected to a tube placed alongside the nipple. The chemiluminescence method was used to quantify maternal serum PRL level both before and after a breastfeed to explore the effect of suckling on PRL increment. The mother's perception of the onset of her lactation was evaluated by the mother's sense of fullness in her breast. The mother's perception of milk supply was evaluated by using the H&H Lactation Scale. RESULTS: Data from 117 participants were included in this analysis. Low suction pressure, a shorter gestational age, a high pre-gestational body mass index (BMI), and high infant birth weight were associated with a smaller than average PRL increment. High suction pressure, longer sucking duration, and a low gestational weight gain were related to a mother's perception of an earlier onset of her lactation. However, low suction pressure, a high frequency of giving formula, a small PRL increment, and the mother's perception of a later onset of her lactation were correlated with her perception of an insufficient milk supply. CONCLUSIONS: Suction pressure varied directly with the post-natal PRL increment. Suction pressure was associated with the timing of the mother's perception of her lactation. Strong suction pressure by the infant is likely to enhance the mother's confidence in her lactation. Additionally, sucking duration, frequency of giving formula, maternal BMI, and infant birth weight played a role in early breastfeeding success.

Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis.

AIM: To evaluate the relationship between mental and physical health in Chinese patients with ankylosing spondylitis (AS) and to identify the predictors of psychological status. METHODS: Patients with AS (n=103) and healthy controls (n=121) were surveyed between 2010 and 2011 (cross-sectional study). The Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, pain visual analog scale, Health Assessment Questionnaire, revised Self-Rating Anxiety Scale, revised Self-Rating Depression Scale, and Short-Form 36 questionnaire were administered. RESULTS: The frequency of anxiety and depression in patients with AS was higher than that in healthy controls (P<0.001). Severe disease status and reduced quality of life (QoL) were associated with anxiety and depression. Disease activity and somatic pain were more severe in the anxious and depressed subgroups. Impaired physical functioning (assessed by Bath Ankylosing Spondylitis Functional Index) was higher in the anxious and depressed subgroups, while measures of spinal mobility (assessed by Bath Ankylosing Spondylitis Metrology Index) were not associated with depression. Lower QoL was observed in the depressed subgroup. CONCLUSION: Low socioeconomic status, lack of health insurance, and fatigue contributed to depression in Chinese patients with AS. These patients may require a psychological care approach that is different from those of other countries.

Intraoral Vacuum of Breast-Feeding Newborns Within the First 24 Hr: Cesarean Section Versus Vaginal Delivery.

OBJECTIVES: To explore whether newborns born via Cesarean section have a weaker intraoral vacuum compared with those born vaginally and to determine whether a weaker intraoral vacuum is related to a delayed onset of lactation. METHODS: For this prospective cohort study, 71 mother-infant dyads were enrolled and divided into birthing groups, vaginal or Cesarean. The newborn intraoral vacuum was measured via a tube placed alongside the nipple and connected to a pressure sensor during a breast-feeding session within the first 24 hr after birth. Onset of lactation was confirmed by maternal perception of breast fullness. The intraoral vacuum and its relationship with the onset of lactation were analyzed. RESULTS: After adjustment for confounding factors, the peak intraoral vacuum was -19.50 kPa in the vaginal group, which was significantly stronger than the -13.78 kPa in the Cesarean group (p = .005). Additionally, the baseline intraoral vacuum in the vaginal group (-2.35 kPa) was significantly stronger than that in the Cesarean group (-1.18 kPa; p = .022). Strength of the newborn intraoral vacuum was associated with the time of onset of maternal lactation. CONCLUSION: Cesarean section may weaken newborns' intraoral vacuum within the first 24 hr after birth. Stronger intraoral vacuum was related to earlier onset of lactation. Early intervention aimed at the weaker intraoral vacuum should be provided to promote the onset of lactation.

EphA8 is a prognostic marker for epithelial ovarian cancer.

EphA8 is one of the Eph receptors in the Eph/ephrin receptor tyrosine kinase (RTK) subfamily. During tumorigenesis, EphA8 is involved in angiogenesis, cell adhesion and migration. In this study, we determined the mRNA and protein expression levels of EphA8 in cancerous and normal ovarian tissue samples by quantitative reverse transcription PCR (qRT-PCR) (N = 60) and tissue microarray immunohistochemistry analysis (TMA-IHC) (N = 223) respectively. EphA8 protein levels in cancer tissues were correlated with epithelial ovarian cancer (EOC) patients' clinical characteristics and overall survival. Both EphA8 mRNA and protein levels were significantly higher in EOC tissues than in normal or benign ovarian tissues (all P < 0.05). High EphA8 protein level was associated older age at diagnosis, higher FIGO stage, positive lymph nodes, presence of metastasis, positive ascitic fluid, and higher serum CA-125 level. High EphA8 protein level is an independent prognostic marker in EOC. We conclude that EphA8 acts as an oncogene in EOC development and progression. Detection of EphA8 expression could be a useful prognosis marker and targeting EphA8 represents a novel strategy for EOC treatment.

Investigating Factors Associated with Depression of Type 2 Diabetic Retinopathy Patients in China.

AIMS AND OBJECTIVES: To assess the depression status of type 2 diabetic retinopathy patients in Nantong China and to identify factors associated with depression. METHODS: Two hundred and ninety-four patients with type 2 diabetic retinopathy were recruited from the Affiliated Hospital of Nantong University. The severity of DR was measured in the worse eye. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D); the quality of life was measured with the Medical Outcomes Study Short Form 36 (SF-36). The logistic regression analyses were used to identify the independent factors of depression. RESULTS: The mean age of the study subjects was 57.77 years (SD: 9.64). Approximately 35.7% of subjects reported depressive symptoms (n = 105).Multiple logistic regression analyses showed that female gender (p = 0.014), low monthly income (p = 0.01), poor vision in the better eye (P = 0.002), laser treatment history (p = 0.01) were significant risk factors for depression. The quality of life of individuals with CES-D score<16 was significantly better compared with individuals with CES-D score≥16. CONCLUSION: The reported depressive symptoms among type 2 diabetic retinopathy population is higher in Nantong China. Gender, salary, vision acuity and treatment history were important risk factors linked to this disorder in the Chinese type 2 diabetic retinopathy population from Nantong. More attention by medical care personnel needs to be paid to the psychological health of this population.