MiR-483-3p promotes dental pulp stem cells osteogenic differentiation via the MAPK signaling pathway by targeting ARRB2.

Human dental pulp stem cells (DPSCs) have become an important component for bone tissue engineering and regenerative medicine due to their ability to differentiate into osteoblast precursors. Two miRNA chip datasets (GSE138180 and E-MTAB-3077) of DPSCs osteogenic differentiation were analyzed respectively to find the expression of miR-483-3p significantly increased in the differentiated groups. We further confirmed that miR-483-3p continued to overexpress during osteogenic differentiation of DPSCs, especially reaching its peak on the 7th day. Moreover, miR-483-3p could significantly promote the expression of osteogenic markers including RUNX2 and OSX, and activate MAPK signaling pathway by inducing phosphorylation of ERK, p38, and JNK. In addition, as a significant gene within the MAPK signaling pathway, ARRB2 was identified as the target gene of miR-483-3p by bioinformatic prediction and experimental verification. In conclusion, we identified miR-483-3p could promote osteogenic differentiation of DPSCs via the MAPK signaling pathway by targeting ARRB2.

Psychological pathway to emotional exhaustion among nurses and midwives who provide perinatal bereavement care in China: a path analysis.

BACKGROUND: A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives. METHODS: A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit. RESULTS: Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion. CONCLUSIONS: This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential.

Parents' experiences and need for social support after pregnancy termination for fetal anomaly: a qualitative study in China.

OBJECTIVE: The aim of this study was to explore the experiences and need for social support of Chinese parents after termination of pregnancy for fetal anomalies. DESIGN: A qualitative study using semistructured, in-depth interviews combined with observations. Data were analysed by Claizzi's phenomenological procedure. SETTING: A large, tertiary obstetrics and gynaecology hospital in China. PARTICIPANTS: Using purposive sampling approach, we interviewed 12 couples and three additional women (whose spouses were not present). RESULTS: Four themes were identified from the experiences of parents: the shock of facing reality, concerns surrounding termination of pregnancy, the embarrassment of the two-child policy and the urgent need for social support. CONCLUSION: Parents experienced complicated and intense emotional reactions, had concerns surrounding the termination of pregnancy and an urgent need for social support. Paternal psychological reactions were often neglected by healthcare providers and the fathers, themselves. These findings suggest that both mothers and fathers should receive appropriate support from family, medical staff and peers to promote their physical and psychological rehabilitation.

Predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery: a cross-sectional study in China.

BACKGROUND: Psychological birth trauma exhibits a high incidence worldwide, resulting in a wide range of negative impacts on mothers, infants, couples, families and society at large through the maternal-centered ripple effect. However, there is currently limited research on psychological birth trauma in China. Social support and pregnancy stress are important influencing factors of psychological birth trauma. Consequently, this study aimed to explore predictors of pregnancy stress and psychological birth trauma in women undergoing vaginal delivery in China. METHODS: This cross-sectional study was performed at a single medical center between December 2021 and May 2022 in Hangzhou, China. Participants were selected using a convenience sampling technique. A total of 351 postpartum women within one week after vaginal delivery were included. Questionnaires were used to collect sociodemographic and obstetric characteristics and scores on the Pregnancy Stress Rating Scale (PSRS), City Birth Trauma Scale (City BiTS), Social Support Rating Scale (SSRS) and Family Adaptation Partnership Growth Affection and Resolve index (Family APGAR). Both univariate analysis and multiple linear regression analysis were conducted to assess predictors of pregnancy stress and psychological birth trauma. RESULTS: The median (IQR) of PSRS and City BiTS scores were 10.00 (14.00) and 3.00 (9.00), respectively. The incidence of postpartum posttraumatic stress disorder was 4.0% (14/351). Parity, social support, family support and level of education were predictors of pregnancy stress. Delivery complications, psychological traumatic event, pregnancy stress and family support were predictors of psychological birth trauma (P < 0.05). CONCLUSION: Pregnancy stress is related to social support, family support and some sociodemographic and obstetric characteristics. Psychological birth trauma is correlated with delivery complications, psychological traumatic event, pregnancy stress and family support. Consequently, enhancing social support, especially family support, for pregnant women as a means of reducing pregnancy stress can effectively prevent psychological birth trauma.

The effect of exercise intervention on improving sleep in menopausal women: a systematic review and meta-analysis.

Background: Sleep disturbance is common in menopausal women and negatively affects their quality of life and could cause increased risks of other menopause-related diseases. Objective: This systematic review aims to synthesize evidence regarding the effects of exercise interventions on improving sleep in menopausal women. Methods: A comprehensive search in seven electronic databases for randomized controlled trials (RCTs) was performed on June 3, 2022. The systematic review included seventeen trials, ten of which provided data for the meta-analysis. The effects on outcomes were presented as mean differences (MDs) or standard mean differences (SMDs) and their 95% confidence intervals (CI). Cochrane risk-of-bias tool was used in quality assessment. Results: The results suggest that exercise intervention significantly reduces insomnia severity (SMD = -0.91, 95% CI = -1.45 to -0.36, Z = 3.27, P = 0.001) and alleviates sleep problems (MD = -0.09, 95% CI = -0.17 to -0.01, Z = 2.20, P = 0.03). For sleep quality, the results showed that insignificant differences were found between the exercise intervention and the control groups (MD = -0.93, 95% CI = -2.73 to 0.87, Z = 1.01, P = 0.31). The results of the subgroup analysis indicated that more apparent effects of exercise intervention were found among women with sleep disorders than among women without sleep disorders. Which exercise intervention duration was more beneficial to sleep outcomes could not be judged. Overall, there was a moderate risk of bias in the primary studies. Conclusion: According to this meta-analysis, exercise interventions can be recommended for menopausal women to improve their sleep. High-quality RCTs applying different types of exercise (e.g., walking, yoga, meditative exercise and so on) with different intervention durations as well as subjective and objective sleep assessment are warranted. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342277, identifier: CRD42022342277.

Experiences of obstetric nurses and midwives receiving a perinatal bereavement care training programme: A qualitative study.

Aim: To explore obstetric nurses and midwifery professionals' experiences with the Perinatal Bereavement Care Training Programme (PBCTP) after implementation. Design: A qualitative descriptive design was used. Method: This qualitative study was conducted at a tertiary level maternity hospital in China. The PBCTP was implemented at Women's Hospital School of Medicine, Zhejiang University from March to May 2022. A total of 127 nurses and 44 midwives were invited to participate in the training. Obstetric nurses and midwives studied a 5-module training programme comprised of eight online theoretical courses and submitted a reflective journal after each session. Semi-structured interviews were conducted with 12 obstetric nurses and four midwives from May to July 2022 as a post-intervention evaluation. Thematic analysis was used in data analysis. Findings: A total of 16 participants in this study ranged in age from 23 to 40 years [mean age (SD), 30 (4) years]. Six main themes within participants' experiences of PBCTP intervention were identified: participants' aims of undertaking the training; personal growth and practice changes after training; the most valuable training content; suggestions for training improvement; directions for practice improvement; influencing factors of practice optimization. Conclusion: Nursing and midwifery professionals described the PBCTP as satisfying their learning and skills enhancement needs and supporting positive changes in their care providing for bereaved families. The optimized training programme should be widely applied in the future. More efforts from the hospitals, managers, obstetric nurses, and midwives are needed to jointly contribute to forming a uniform care pathway and promoting a supportive perinatal bereavement care practice.

Art-based interventions for women's mental health in pregnancy and postpartum: A meta-analysis of randomised controlled trials.

Objective: Pregnant and postpartum women are vulnerable to psychological problems with a high estimated prevalence. To date, there is no meta-analysis that specifically assesses the effectiveness of art-based interventions to improve mental health in pregnant and postpartum women. The objective of this meta-analysis was to assess the efficacy of art-based interventions when delivered to pregnant and postpartum women. Methods: Systematic literature searches were conducted from the inception to 6 March 2022 in seven English databases, including PubMed, Embase, Cochrane Central Register, CINAHL, ProQuest, Scopus, and Web of Science. Randomised controlled trials (RCTs) reporting art-based interventions targeting the improvement of women's mental health in pregnancy and postpartum were included. Cochrane risk of bias tool was applied to assess evidence quality. Results: Twenty-one randomised controlled trials (RCTs) involving 2,815 participants were eligible for data analysis. A pooled analysis demonstrated that art-based interventions significantly reduced anxiety (SMD = -0.75, 95% CI = -1.10 to -0.40) and depression symptoms (MD = -0.79, 95% CI = -1.30 to -0.28). However, art-based interventions did not alleviate stress symptoms as expected in our findings. Subgroup analysis demonstrated that intervention implementation time, intervention duration and music selected by the participants vs. not could have influence on the efficacy of art-based intervention for anxiety. Conclusion: In perinatal mental health, art-based interventions may be effective in alleviating anxiety and depression. In the future, we still need to conduct high-quality RCTs to validate our findings and enrich clinical application of art-based interventions.

Impact of contact with the baby following stillbirth on parental mental health and well-being: A systematic review and meta-analysis.

AIM: This study aims to identify and synthesize available research reporting parental mental health outcomes related to contact with a stillborn baby. BACKGROUND: Stillbirth is devastating events for parents. The effects of contact with the stillborn baby on parental mental health are uncertain. METHODS: This was a systematic review and meta-analysis carried out by searching six international electronic databases including PubMed, EMBASE, Cochrane, Web of Science, PsycINFO and CNKI databases from inception to 15 January 2023. Review Manager software was used for data analysis. RESULTS: Ten studies were included (n = 3974). Contact with a stillborn baby increased the risks of anxiety, depression and post-traumatic stress disorder in the short term and increased the risks of anxiety and post-traumatic stress disorder in the long term. Parents who had contact with a stillborn baby were more satisfied with their decision. Subgroup analysis showed that seeing a stillborn baby had no significant effect on anxiety or depression, but holding a stillborn baby increased the risks of anxiety. CONCLUSIONS: Caregivers should respect the parents' decision on whether to have contact with the stillborn baby and provide parents with continuous information, emotional and behavioural support after they have contact with stillborn babies.

Nonpharmacological pain management interventions in medical and surgical abortion: A scoping review.

AIMS: The study aimed to present a broad overview of the research conducted and to synthesize evidence of the utility of nonpharmacological interventions for pain management in medical and surgical abortions. BACKGROUND: High-quality care for medical and surgical abortion requires pain to be managed effectively. However, women reported low satisfaction with pain management in abortion care. DESIGN: A scoping review design was employed. DATA SOURCES: No date limit was set. PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL, PsycINFO, ProQuest and Scopus were searched in April 2021. REVIEW METHODS: Arksey and O'Malley's framework was used. The Preferred Reporting Items for Systematic reviews and Meta-analysis extension-Scoping Reviews was followed. RESULTS: Fifteen studies were included. The results revealed that support interventions, music therapy, acupoint stimulation and hypnotic analgesia were nonpharmacological interventions used to decrease abortion pain. CONCLUSIONS: Clinical nurses, nurse managers and policymakers should attach full importance to the pain management in abortion and may use the study findings to guide the pain management practice.

Effectiveness of the implementation of a perinatal bereavement care training programme on nurses and midwives: protocol for a mixed-method study.

INTRODUCTION: The psychological outcomes for many parents who experience perinatal loss depend on nursing staff's ability to provide effective bereavement support. However, most nurses and midwives lack the ability to provide bereavement care and suffer from heavy emotional burden. The study aims to investigate the effectiveness of the perinatal bereavement care training programme on nurses and midwives to increase their perinatal bereavement care confidence (PBCC) and to reduce secondary traumatic stress and emotional exhaustion. METHODS AND ANALYSIS: This study will follow a mixed methodology consisting of two stages. The first stage will adopt a pre/post repeated quasi-experimental design without a control group. The second stage will use a qualitative interview study. This study will be conducted in a tertiary maternity hospital in China in 2022-2023. Ethical approval was obtained from the institutional review board in January of 2020. Outcome measures will be assessed using the Chinese version of the PBCC, STS and the EE subscale of Chinese Burn-out Inventory at baseline, postintervention and at the 3-month follow-up. Participants will be interviewed to understand their perceptions of the training programme. ETHICS AND DISSEMINATION: This research protocol was approved by the Ethics Committee of the Women's Hospital School of Medicine, Zhejiang University (IRB no. 20210091). The results will be disseminated through peer-reviewed journals and academic conferences. TRIAL REGISTRATION NUMBER: ChiCTR2100049730.

Influencing factors of perinatal bereavement care confidence in nurses and midwives: A cross-sectional study.

BACKGROUND: Most nurses and midwives are not prepared to provide bereavement care. The conflict between the need for high-quality care of bereaved parents and the lack of confidence in providing perinatal bereavement care among nursing staff is becoming increasingly prominent in China. OBJECTIVE: To describe the current situation and identify influencing factors of perinatal bereavement care confidence (PBCC) among nurses and midwives in China. METHODS: This descriptive and cross-sectional survey was conducted in 2021. A convenience sample was created by recruiting 571 nurses and midwives in 11 hospitals in Zhejiang Province. Collected the data of PBCC, secondary traumatic stress (STS) and emotional exhaustion (EE) in this study. RESULTS: The average score of the PBCC was 67.83 ± 10.78. Average levels of STS were (23.32 ± 7.39) and EE (17.87 ± 8.62). PBCC was found to be most often associated with self-awareness, organisational support and training in perinatal bereavement care. CONCLUSIONS: Managers should take measures to improve PBCC and optimise perinatal bereavement care practice from the perspective of enhancing self-awareness of nursing staff, strengthening organisational support and providing training in perinatal bereavement care. The mental health of nursing professionals in the context of perinatal bereavement care needs to be emphasised. Nursing managers should make clear policies and establish a communication platform for nursing staff. Professional training should be conducted in the future.

Factors influencing parental posttraumatic stress disorder in cases of fetal abnormality requiring pregnancy termination in China.

PURPOSE: To estimate the prevalence of posttraumatic stress disorder (PTSD) among parents in cases of fetal abnormalities and associated factors. DESIGN AND METHODS: A cross-sectional study. The study sample comprised 169 couples who experienced fetal abnormalities. FINDINGS: We observed a high prevalence of PTSD. Fathers had similar levels of PTSD to those of mothers. Social support was an important protective factor against parental PTSD. In addition, a negative psychological reaction to the loss of a child in either the father or the mother affects the other spouse. PRACTICE IMPLICATIONS: This study emphasizes recognizing the importance of social support and of psychological interactions between mothers and fathers in PTSD intervention for parents.

Incidence and predictors of paternal anxiety and depression following fetal abnormalities requiring pregnancy termination: a cross-sectional study in China.

BACKGROUND: China is a country with a high prevalence of fetal abnormalities. Termination of pregnancy for fetal abnormalities (TOPFA) is a devastating traumatic event for parents and families, resulting in serious and lasting psychological problems. The impact of TOPFA on mothers has been extensively explored, but little research has been conducted on the resulting paternal psychological problems. This study sought to determine the prevalence and predictors of paternal anxiety and depression following TOPFA. METHODS: We analysed cross-sectional data from 169 Chinese couples (169 mothers and 169 fathers) who experienced TOPFA. Anxiety was assessed with the Self-Rating Anxiety Scale (SAS), and depression was measured with the Self-Rating Depression Scale (SDS) for fathers and the Edinburgh Postnatal Depression Scale (EPDS) for mothers. We used the Social Support Rating Scale (SSRS) to assess levels of social support. RESULTS: Overall, 19.5% of fathers and 24.3% of mothers had symptoms of anxiety, but there was no significant difference in the incidence of anxiety between fathers and mothers. However, depression was more common in mothers (50.3%) than in fathers (24.9%). Level of income (ß = -2.945, 95% CI: -5.448 to -0.442), worry about the pregnancy (ß = 3.404, 95% CI: 1.210 to 5.599) and objective support (ß = -0.668, 95% CI: -1.163 to -0.173) were predictors of anxiety in fathers. Worry about the pregnancy (ß = 4.022, 95% CI: 1.630 to 6.414), objective support (ß = -0.652, 95% CI: -1.229 to -0.075) and maternal depression (ß = 0.497, 95% CI: 0.159 to 0.836) were predictors of paternal depression. CONCLUSION: Anxiety and depression were prevalent among parents following TOPFA in China, and fathers had similar levels of anxiety as mothers. Strategies to support fathers should consider social support and psychological interaction and draw upon father-inclusive intervention recommendations.

Exploring interactions between women who have experienced pregnancy loss and obstetric nursing staff: a descriptive qualitative study in China.

BACKGROUND: Contradictory interactions between bereaved women who have experienced pregnancy loss and obstetric nursing staff are becoming increasingly prominent. The aim of the present study was to gain an understanding of how women who have experienced pregnancy loss and obstetric nursing staff perceive their interactions, what influencing factors impacted their experiences. METHODS: A qualitative, exploratory study was conducted in a delivery room and six maternity wards of a tertiary hospital. Semi-structured interviews were performed with six nurses, 13 midwives and seven women who experienced pregnancy loss to collect rich information about how they make sense of their interactions. Thematic analysis was adopted to analyse the data. RESULTS: Five overarching themes were identified: (1) interaction characteristics, (2) interactive contradiction, (3) influencing factors of the interaction, (4) training needs and (5) suggestions for benign interactions. CONCLUSIONS: Healthcare providers should be instructed in adopting a respectful and sympathetic attitude in communication, strengthening information support and offering patient-centred care for benign interactions. Ignoring women's needs and using disrespectful words should be avoided. Training for preparing nurses and midwives in perinatal bereavement care and addressing heavy emotional burden is necessary. Additional efforts are needed to improve medical services and to facilitate benign interactions in induced abortion care.

Psychometric properties of the Chinese version of the Perinatal Bereavement Care Confidence Scale (C-PBCCS) in nursing practice.

BACKGROUND: The Perinatal Bereavement Care Confidence Scale (PBCCS) was designed to evaluate midwives' and nurses' confidence and its psychosocial factors to provide bereavement care in Ireland. However, it is unknown whether this scale is valid and reliable for use with midwives and nurses in China. The aim of this study was to translate the English version into Chinese (C-PBCCS) and determine its validity and reliability in a population of Chinese midwives and nurses. METHODS: In this cross-sectional observational study, after translating the English version of the PBCCS into Chinese and ensuring the linguistic adequacy and clarity of the language, we evaluated the validity and reliability of the C-PBCCS with Chinese midwives and nurses (n = 608). Participants were recruited using convenience sampling from 10 maternity hospitals in Zhejiang and Jiangsu Provinces. Exploratory factor analysis (EFA) was conducted to determine the construct validity (n = 304). Another sample of 304 midwives and nurses was used for confirmatory factor analysis (CFA) to verify the quality of the factor structures. Cronbach's alpha coefficient and Guttman split-half coefficient were adopted for the evaluation of internal consistency. The STROBE was followed in reporting the results. RESULTS: The 43-item PBCCS was reduced to 40 items. Bereavement support knowledge (13 items, three factors), Bereavement support skills (eight items, two factors), Self-awareness (eight items, two factors), and Organizational support (11 items, two factors). The CFA suggested that the four scales in the C-PBCCS had acceptable fit indices. The Cronbach's alpha ranged from 0.835-0.901. The Guttman split-half coefficient was between 0.868-0.933. CONCLUSION: The C-PBCCS was found to be a psychometrically sound measurement tool to evaluate Chinese-speaking midwives' and nurses' confidence and the psychosocial factors that affect their confidence in providing perinatal bereavement care.

Interventions to reduce post-traumatic stress disorder symptoms in health care professionals from 2011 to 2021: a scoping review.

OBJECTIVES: This scoping review aimed to describe available interventions for decreasing (post-traumatic stress disorder) PTSD symptoms among healthcare professionals in hospital care. METHOD: A scoping review was conducted following Arksey and O'Malley's framework. PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest were searched for original research published in English from 2011 to 2021, on 8 July 2021. We included studies that described interventions that focused on reducing the PTSD symptoms of healthcare professionals. A narrative synthesis was adopted to synthesise the data. RESULTS: A total of eight studies out of 2558 articles were identified. Six used a quantitative study design and two adopted qualitative methods. cognitive behavioural therapy and mindfulness-based interventions were the most commonly adopted. Most studies used a combination of different intervention strategies. Trauma-related knowledge, emotion regulation and relaxation skill training, and psychological support from peers and psychologists were three core intervention components. The duration ranged from 2 weeks to 6 months. Healthcare professionals who participated in training programmes reported both positive experiences and suggestions for the improvement of PTSD-reducing interventions in their qualitative feedback. CONCLUSIONS: The scoping review provides a practical summary of the intervention characteristics for reducing the PTSD symptoms of healthcare professionals. Hospitals and managers could use the overview of interventions to assist healthcare professionals with PTSD symptoms. More research investigating the effects of PTSD symptom-reducing interventions for healthcare professionals with appropriate follow-up assessments is needed in the future.

Effectiveness of non-pharmacological interventions for reducing postpartum fatigue: a systematic review protocol.

INTRODUCTION: Postpartum fatigue is a common symptom among new mothers after their pregnancy. It has a considerable negative impact on women's functional and mental status as well as the development of babies. Identifying effective interventions to prevent or reduce postpartum fatigue is meaningful to improve the quality of life and avoid adverse outcomes of this vulnerable population. This systematic review aims to synthesise non-pharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperas. METHODS AND ANALYSIS: This review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will systematically search the Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases to identify clinical trials implementing non-pharmacological interventions conducted during 0-78 weeks postpartum for fatigue reduction. An additional search of OpenGrey will be conducted to identify grey literature. The search will be performed on 30 March 2021 without restrictions on time and language. Two independent reviewers will be responsible for study selection, data extraction and study quality assessment. The Cochrane risk-of-bias tool will be adopted to evaluate the risk biases of the included randomised controlled trials, and the Risk of Bias in Non-randomised Studies of Interventions will be applied to evaluate non-randomised controlled trials. Any disagreements will be referred to a third reviewer to reach a consensus. Findings will be qualitatively synthesised, and a meta-analysis will be conducted for the statistical combination if outcome data are sufficient and available. ETHICS AND DISSEMINATION: This systematic review will not involve the collection of primary data and will be based on published data. Therefore, ethics approval is not required. The final findings will be disseminated through peer-reviewed journals and academic conferences. PROSPERO REGISTRATION NUMBER: CRD42021234869.

Effectiveness of nonpharmacological interventions for reducing postpartum fatigue: a meta-analysis.

BACKGROUND: Postpartum fatigue is the most common issue among postnatal women and it could not only seriously affect the health of mothers but also bring about adverse impacts on their offspring. This meta-analysis aims to synthesize nonpharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperae. METHODS: The Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases were searched for papers published from inception until June 2021. Grey literature was searched using OpenGrey. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) evaluating nonpharmacological interventions conducted during 0 ~ 78 weeks postpartum for fatigue reduction were eligible for inclusion. The methodological quality of the included studies was independently assessed by two reviewers using the Cochrane risk-of-bias tool and the risk of bias in nonrandomized studies of interventions. Cohen's kappa coefficient was used to measure inter-rater agreement. The meta-analysis was conducted using Review Manager 5.3. RESULTS: Seventeen published clinical trials matched the eligibility criteria and ten studies involving 1194 participants were included in this meta-analysis. The intervention start time varied from immediately postpartum care to 1 year after delivery, and duration ranged from 1 day to 3 months. The results revealed that exercise (SMD = - 1.74, 95% CI = -2.61 to - 0.88) and drinking tea (MD = - 3.12, 95% CI = -5.44 to - 0.80) resulted in significant improvements in women's postpartum fatigue at postintervention. Drinking tea may have beneficial effects on depression (MD = - 2.89, 95% CI = -4.30 to - 1.49). Positive effects of psychoeducational interventions on postpartum fatigue or depression were not observed. Physical therapies including mother-infant skin-to-skin contact, taking warm showers and breathing lavender oil aroma were used for reducing postpartum fatigue. No significant risk of publication bias was found. Small number of included studies and sample sizes, not time-matched conditions of control groups, high heterogeneity and the risk of bias within the included studies were the main limitations of our review. CONCLUSIONS: This review provides evidence that exercise and drinking tea may be effective nonpharmacological interventions for relieving postpartum fatigue. More effective and targeted exercise programs need to be further studied. Rigorous RCTs of drinking tea are needed. Caution is required when interpreting the findings due to the limitations of our study. Further studies are still needed to validate our findings and increase confidence in the results.

Effects of an expressive writing intervention in Chinese women undergoing pregnancy termination for fetal abnormality: A randomized controlled trial.

OBJECTIVE: To explore the efficacy of an expressive writing intervention on promoting psychological well-being of women who have had a diagnosis of fetal abnormality. DESIGN AND SETTING: An open, randomized controlled trial with parallel group design was conducted at a tertiary hospital in China. 100 women were randomly assigned into either the expressive writing (EW) intervention group or the control group, and 80 women eventually took part in all the phases of the study. Psychological variables including post-traumatic growth (PTG), post-traumatic stress disorder (PTSD) and resilience were assessed at baseline, immediately after the intervention and 1-month follow-up. PARTICIPANTS: Women who have had a diagnosis of fetal abnormalities and decided to terminate pregnancies. INTERVENTION: Women in the intervention group were asked to write three 15 min essays in regard to their experiences with the fetal abnormalities. FINDINGS: The intervention group had significantly higher level of PTG (p = 0.003) and lower level of PTSD symptoms (p = 0.023) immediately after the intervention, as compared with the control group. In 1-month follow-up, intervention participants demonstrated significant improvement in PTG (p = 0.014) but insignificant reduction for PTSD symptoms. No significant effects were observed in both groups in terms of changes over time in resilience. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: EW is efficacious for improving women's PTG and easing their symptoms of PTSD to some extent. Medical staff should pay more attention to this population's psychological status. In the future, EW interventions need to be conducted in larger samples with more severe symptoms of PTSD to validate its effectiveness. The efficacy of longer and more frequent writing interventions should also be investigated.

Preparing nurses and midwives to provide perinatal bereavement care: A systematic scoping review.

OBJECTIVES: To provide a comprehensive cross-sectional overview of published studies on perinatal bereavement care education programmes developed and tested with nurses and midwives. DESIGN: A scoping review following the Arksey and Malley's framework. DATA SOURCES: Eight electronic databases were searched in December 2020 without restriction on language and publication date: PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest. REVIEW METHODS: All identified studies were reviewed by two reviewers based on the article title and abstract screening. Full-text articles were assessed according to the inclusion criteria. Original studies that reported on perinatal bereavement care education for nursing and midwifery students or clinical nurses and midwives were included. RESULTS: Eighteen studies out of 817 articles were included. Perinatal bereavement care knowledge and skills, improvement in clinical skills in abortion care and psychological support for nurses and midwives are three core elements of the education content. Workshops and debriefing are the most frequently used formats. The duration mostly ranges from a half day to 3 days. Knowledge, confidence, satisfaction and relevant psychological variables such as posttraumatic stress symptoms are frequently used to evaluate the education programme's effectiveness. Most studies chose to use self-designed questionnaires as measurement tools. Nurses and midwives reported both positive experiences and improvement suggestions for perinatal bereavement care education programmes. CONCLUSIONS: This scoping review highlights the benefits of implementing education programmes for preparing nurses and midwives for perinatal bereavement care in the context of universities and hospitals. Longitudinal randomized controlled trials or quasi-experiments could further investigate the effectiveness of a more enhanced perinatal bereavement care education programme with a longer intervention time using valid and reliable evaluation tools.