Tools to study the severity of itch in 8- to 17-year-old children: Validation of TweenItchyQoL and ItchyQuant.

BACKGROUND/OBJECTIVES: Validated pruritus-specific quality of life and self-reported severity instruments exist primarily for adults. Clinical trials to develop therapeutics for children with chronic pruritus are hampered by the paucity of appropriate outcome measures. To address this gap, we aimed to develop validated instruments to measure itch-specific quality of life and self-reported severity in children. METHODS: We conducted in-depth, open-ended interviews of itchy children and generated concepts to develop TweenItchyQoL. We administered TweenItchyQoL, ItchyQuant, a cartoon-annotated self-reported pruritus severity numeric rating scale (NRS), and a non-cartoon NRS to 175 itchy children aged 8-17 years. We analyzed the data for feasibility, preference, reliability, construct validity, and responsiveness. RESULTS: Average completion time was 4.8 minutes for TweenItchyQoL and 33 seconds for ItchyQuant. The majority of patients either preferred ItchyQuant or found no difference between ItchyQuant and the NRS. Cronbach's alpha for TweenItchyQoL total and subscales ranged from 0.84 to 0.95. Test-retest reliability coefficients were ≥0.7 for TweenItchyQoL and 0.4 for ItchyQuant. A 3-dimensional bifactor model was most appropriate (RMSEA = 0.048) on the confirmatory factor analyses. As a function of those reporting worsening, improvement, or no change at their final visit, TweenItchyQoL and ItchyQuant scores in those cohorts changed as expected. CONCLUSIONS: This new set of validated and feasible instruments shows promise to quantify itch severity and QoL impact in older children.

Pruritus assessment tools for 6 to 7-year-old children: KidsItchyQoL and ItchyQuant.

BACKGROUND/OBJECTIVES: Measures of pruritus severity and quality of life (QoL) are necessary for the development of therapeutics for children with chronic pruritus. In children, questionnaires need to be developed for specific age groups given the differences in cognitive levels. In this study, we aimed to develop tools to assess QoL and pruritus severity in children 6 to 7-years-old with chronic pruritus. METHODS: Based on open interviews with children, we developed a cartoon-annotated QoL instrument, KidsItchyQoL, and validated an existing pruritus severity instrument, ItchyQuant, that measures pruritus impact and severity for the preceding week. Both instruments were administered to 100 children aged 6-7 years with chronic pruritus. The data were analyzed for reliability, reproducibility, construct validity, and responsiveness. RESULTS: We found the 14-item KidsItchyQoL to be reliable (Cronbach's α = 0.846) and reproducible (intraclass correlation coefficient (ICC) = 0.66) as was the ItchyQuant (ICC = 0.47). With respect to construct validity, examination of eigenvalues of the inter-item polychoric correlation matrix suggested three dominant factors. A subsequent confirmatory factor analysis suggested that a 3-dimensional simple structure model with correlated factors provided a reasonable data representation. The responsiveness of KidsItchyQoL and ItchyQuant (P = .005, GLM procedure) were demonstrated with scores changing as expected with the self-reported change of itch severity. CONCLUSIONS: These results demonstrate promise for a new set of reliable research tools to assess QoL and pruritus severity in children 6 to 7 years of age.

Relationships between body image, sexual dysfunction, and health-related quality of life among middle-aged women: A cross-sectional study.

OBJECTIVES: To examine whether body image, sexual function, and relationship with a partner influence health-related quality of life (HRQoL) among middle-aged women, as well as to identify the association with menopausal symptoms. MAIN OUTCOME MEASURES: Physical component summary and mental component summary of HRQoL. METHODS: This was an analysis of 1026 women (2013-2014); data regarding demographic characteristics, sexual function, body image, relationship with partner, menopausal symptoms and HRQoL during middle age were collected. HRQoL, sexual function, body image, relationship with partner, and menopausal symptoms were measured using the Medical Outcomes Study SF-12, Female Sexual Function Index (FSFI), Multidimensional Body-Self Relations Questionnaire-Appearance Scale, the Relationship Assessment Scale, and the Greene Climacteric Scale, respectively. A multivariate regression was used to examine factors influencing HRQoL. RESULTS: After adjusting for covariates, significant factors predicting the physical component summary (PCS) of HRQoL among middle-aged women included the orgasm domain of the FSFI (ß = 0.69; p = 0.023), appearance evaluation (ß = 0.93; p = 0.037), and menopausal symptoms (ß = -0.25; p < 0.001). The factors predicting the mental component summary (MCS) of HRQoL included the satisfaction domain of the FSFI (ß = 0.70; p = 0.014), appearance evaluation (ß = 2.09; p < 0.001), self-classified weight (ß = 1.21; p < 0.001), relationship with partner (ß = 0.16; p = 0.034), and menopausal symptoms (ß = -0.36; p < 0.001). CONCLUSION: The results indicated that negative appearance evaluation and menopausal symptoms predicted poor HRQoL among middle-aged women. Higher frequency of orgasm predicted better PCS; sexual satisfaction and satisfaction with relationship with a partner predicted better MCS of HRQoL.

Salivary levels of angiopoietin-2 in infants with infantile haemangiomas treated with and without systemic propranolol.

Infantile haemangiomas (IHs) with functional or cosmetic concerns necessitate systemic treatment for which propranolol is the preferred treatment. However, the mechanism of action is unknown. Mouse models suggest the angiopoietin-2 (Ang2)/Tie-2 system is implicated. Ang2 can promote endothelial growth or induce apoptosis depending on the presence of vascular endothelial growth factor. This pilot study investigates the saliva Ang2 levels in infants with IH treated with and without systemic propranolol. Patients with clinically confirmed IHs were recruited from an academic paediatric dermatology centre. Treatment was based on clinical evaluation. Saliva samples were collected over 6 months. An enzyme-linked immunosorbent assay determined Ang2 levels. Ang2 levels were detectable in 45% of samples. However, by the late time point, only 28% had detectable levels. There were no changes of Ang2 over time, and there were no differences in Ang2 levels between groups. However, Ang2 levels were correlated with baseline size and changes in size from baseline. Ang2 is detectable in saliva of affected infants, but does not decrease with propranolol treatment. However, Ang2 levels are positively correlated with size and changes in size. Thus, Ang2 is not the primary factor in the mechanism of propranolol resulting in IH reduction.

Racial disparities in the impact of chronic pruritus: A cross-sectional study on quality of life and resource utilization in United States veterans.

BACKGROUND: Chronic pruritus has a lifetime prevalence of up to 26% in the worldwide population. Research has shown that the incidence and quality of life (QoL) impact of chronic pruritus varies by race. OBJECTIVE: We sought to explore the effects of race on specific pruritus-related QoL factors and resource utilization. METHODS: We performed a cross-sectional, national telephone survey of 6000 US veterans randomly sampled from the Veterans Hospital Patient Database. We administered surveys to assess QoL impact and resource utilization of chronic pruritus. RESULTS: Nonwhites overall reported higher levels of burning and scarring with their pruritus. African Americans had a significantly greater emotional impact and use of special soaps, lotions, and clothes. African Americans were also more likely to visit their primary care provider for pruritus (P = .03), yet had similar numbers of specialty care visits. LIMITATIONS: Because our sample was drawn from a veteran population, generalizability may be limited. CONCLUSION: The data indicate a racial disparity in specific QoL impact and resource utilization from pruritus. These findings merit further exploration into explanations, such as access, communication, trust of the medical system, and biologic differences.

Validation and Banding of the ItchyQuant: A Self-Report Itch Severity Scale.

Because of the significant emotional and psychosocial impact of chronic pruritus, it is important to accurately assess and measure itch severity. This study aims to validate and apply clinically meaningful bands to the ItchyQuant, an illustrated self-report numeric rating scale (NRS) for itch severity. A total of 76 adults with chronic pruritus were recruited. Participants rated their itch on the ItchyQuant, on a traditional 11-point NRS, and with verbal categorizations (no, mild, moderate, or severe). There was a significant, high correlation between the ItchyQuant and NRS (>0.92, P < 0.0001), demonstrating concurrent validity. Significantly more patients (47.2%) preferred the ItchyQuant than the NRS (23.6%) or had no preference (29.2%), P = 0.0015. Significantly more patients found the ItchyQuant easier to use (45.8%) than the NRS (20.8%) or had no preference (33.3%), P = 0.008. The set of clinically meaningful bands with the highest weighted kappa coefficient of agreement (κ = 0.69) was as follows: 0 (no itch), 1-3 (mild itch), 4-7 (moderate itch), 8-10 (severe itch). The ItchyQuant is a clinically meaningful measure of itch severity, demonstrating face and concurrent validity, that many patients prefer and find easier to use when compared with a traditional NRS. We suggest that the ItchyQuant can be added to the existing armamentarium of itch severity scales. We plan to investigate the ItchyQuant further in cognitively challenged populations.

Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study.

BACKGROUND: The relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period. OBJECTIVES: We investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms. DESIGN: A prospective cohort study design was used. SETTING: Maternity unit of a medical center. PARTICIPANTS: This study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected. METHODS: Pain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression. RESULTS: After adjusting for covariates, women who had perineal pain at 4-6 weeks postpartum showed an increased risk for depression at 4-6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4-6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (ß=0.63, p=0.02). Any pain intensity score at 3-5 days postpartum predicted depression at 3 months (ß=0.01, p=0.04). Women with high depression scores at 3-5 days had a two- or three-fold higher risk for depression at 4-6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively). CONCLUSIONS: Our study provides robust evidence that perineal pain 4-6 weeks postpartum is associated with depressive symptoms 4-6 weeks and 6 months postpartum; pain at 3-5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3-5 days postpartum, predict depressive symptoms during the 6-month postpartum period.

A video-based educational pilot for basal cell carcinoma (BCC) treatment: A randomized controlled trial.

INTRODUCTION: Several treatment options exist for uncomplicated basal cell carcinoma. Standardized and effective informed consent is difficult in busy dermatology clinics. OBJECTIVE: We investigated whether an educational video depicting 3 treatment options for uncomplicated basal cell carcinoma-excision, electrodessication and curettage, and topical therapy-before standard in-office informed consent affected patient knowledge and consent time compared with standard in-office consent alone. METHODS: Patients were randomized to receive video education plus verbal discussion (video) or standard verbal discussion alone (control). Both groups completed baseline and final knowledge assessments. The primary outcome measure was change in knowledge scores between groups. Secondary outcomes were patient satisfaction, physician satisfaction, and informed consent time. RESULTS: In all, 32 eligible patients (16 control, 16 video) from an academic institution and affiliate Department of Veterans Affairs Medical Center dermatology clinics participated. The video group had significantly greater gains in knowledge compared with the control group (mean ± SD: 9 ± 3.6 vs 2.9 ± 2.2) (P = .0048). There was no significant difference in total consent time between groups. Patients and physicians were highly satisfied with the video. LIMITATIONS: Small sample size and slight methodological difference between recruitment sites are limitations. CONCLUSION: Video-based education for basal cell carcinoma improved patient knowledge with no additional physician time when compared with standard communication.

Depressive symptoms, pain, and sexual dysfunction over the first year following vaginal or cesarean delivery: A prospective longitudinal study.

BACKGROUND: Childbirth has a significant impact on maternal health, and the high rate of cesarean delivery is a global health concern. Few studies have used validated measures to explore depression, pain, and sexual dysfunction following vaginal or cesarean delivery over a prolonged time period. OBJECTIVE: We examined the associations between vaginal and cesarean delivery and depressive symptoms, pain, and sexual function during the 1-year postpartum period. DESIGN: A prospective, five-time-point longitudinal study. SETTING: Maternity unit at a medical center. PARTICIPANTS: A total of 351 of 736 women completed a questionnaire that described demographic characteristics, depressive symptoms, and pain levels at 3-5 days postpartum, and updated personal data, depressive symptoms, pain levels, and sexual function at 4-6 weeks and at 3, 6, and 12 months after delivery. METHODS: Differences between the vaginal and cesarean groups in depressive symptoms, pain, and sexual function and trends of changes in these factors over the first postpartum year were examined. RESULTS: Compared with the vaginal birth group, the cesarean birth group had a significantly higher prevalence of depressive symptoms at 3 months (p=0.03); higher scores for non-localized pain at 3-5 days (p<0.001), 4-6 weeks (p=0.03), and 3 months (p=0.046); higher scores for abdominal pain at 3-5 days (p<0.001), 4-6 weeks (p<0.001), and 6 months (p=0.01); lower perineal pain scores at 3-5 days (p <0.001); and higher sexual desire scores (p=0.04) but lower sexual satisfaction scores (p=0.02) at 4-6 weeks. Differences between the vaginal and cesarean groups were significant (p=0.01, p=0.049, respectively) in terms of the decrease in non-localized pain from 3-5 days to 4-6 weeks postpartum and the increase in sexual desire from 4-6 weeks to 3 months postpartum. CONCLUSIONS: Cesarean delivery was associated with an increased prevalence of depressive symptoms at 3 months and higher pain levels that persisted at 6 months postpartum in Taiwan. We found no difference in sexual function between vaginal and cesarean delivery after 6 weeks postpartum, and no differences in the trends related to depressive symptoms or in sexual functioning (except for desire) within 1 year postpartum.

A repeated measures study of changes in health-related quality of life during pregnancy and the relationship with obstetric factors.

AIMS: To examine changes in health-related quality of life throughout the course of pregnancy and among three pairs of consecutive periods (pre-pregnancy to early pregnancy, early to middle pregnancy and middle to late pregnancy), as well as to identify associated obstetric factors during the entire period of pregnancy. BACKGROUND: Only sparse data are available concerning the profiles of health-related quality of life throughout pregnancy. DESIGN: A within-subject comparison was undertaken. METHODS: In total, 358 women completed the Taiwanese version of the Medical Outcomes Study Short Form-36 Health Questionnaire and a demographic-obstetric questionnaire at three stages of pregnancy at a medical centre. The participants were recruited between 2009-2010. A generalized estimating equation regression model was employed for the repeated measures. RESULTS: The scores for physical component summary decreased significantly throughout early, middle and late pregnancy. The scores for mental component summary increased. The scores for physical, mental component summary and the eight domains of health-related quality of life decreased significantly from pre-pregnancy to early pregnancy. After adjusting for demographic and clinical factors, significant factors predicting physical component summary during pregnancy included stage of pregnancy and previous infertility. The factors predicting mental component summary included stage of pregnancy, parity and medical condition. CONCLUSIONS: The results revealed the dynamic pattern of perceived health status by the Taiwanese pregnant women in their surrounding socio-cultural context and identified the stage of pregnancy and obstetric factors predicting health-related quality of life.

Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum.

OBJECTIVE: To examine the association between vaginal or cesarean delivery and urinary incontinence (UI) and identify the trend in the change in UI within the first 12 months postpartum. METHODS: This was a prospective longitudinal study of 330 of 749 women who completed a UI questionnaire and a personal characteristics questionnaire over five visits in a medical center. RESULTS: The vaginal delivery group had a significant higher prevalence of any UI at 4-6 weeks and at 3, 6, and 12 months (29.1-40.2% vaginal compared with 14.2-25.5% cesarean); stress urinary incontinence (SUI) at 4-6 weeks and 3 and 12 months (15.9-25.4% vaginal compared with 6.4-15.6% cesarean); and moderate or severe UI at 3-5 days, 4-6 weeks, and 6 months (7.9-18.5% vaginal compared with 4.3-11.3% cesarean); and a significant higher score for interference in daily life at 3-5 days and 4-6 weeks (1.0, 0.7 vaginal compared with 0.7, 0.4 cesarean) compared with those in the cesarean delivery group. Prevalence increased for any UI, SUI, and slight UI (all P<.02) and daily life interference score decreased (P=.02) for women who had a vaginal delivery through 1 year postpartum. CONCLUSION: Vaginal delivery was associated with higher UI prevalence that persisted for 1 year postpartum, but there was no association with interference in daily life after 6 weeks postpartum. Variation was observed in UI changes within the first year in the vaginal delivery and cesarean delivery groups.

Sexual Activity during Pregnancy in Taiwan: A Qualitative Study.

BACKGROUND: Pregnancy is a special period in a woman's life that involves physical and mental changes. These changes are influenced by cultural, social, religious, and emotional factors among others. AIM: The aims of this article were to gather information, to describe the changes and behavior of sexual experiences in pregnancy, and to identify the reasons why pregnant women from central Taiwan decrease coital frequency during pregnancy. METHODS: This phenomenological qualitative research was intended to respond to open-ended questions that allowed the respondents to elaborate on the individuals' experiences. We collected data from in-depth, tape-recorded, and semi-structured interviews conducted in a cross-sectional study of 62 healthy pregnant women. The investigation ended when three consecutive interviewed subjects could not offer any new activities, which indicated that the study had reached its saturation point. MAIN OUTCOME MEASURES: We performed data collection and content analysis to ensure standards of rigor and reliability. Credibility was enhanced by prolonged engagement, triangulation, referential adequacy, member checking, and expert review; we categorized meaningful unit-codes in a mutually exclusive and exhaustive manner into perceptions, experiences, and practices such that common themes were grouped into categories. RESULTS: THREE THEMES EMERGED: negative aspects of sexual experiences; stress and emotional responses; and changes in sexual practices. The majority of the women stopped engaging in coital activities during pregnancy. We determined that in most cases, the 62 participants obtained information regarding sexual activity during pregnancy from postpartum women and the Internet. CONCLUSIONS: The current evidence-based findings encourage the provision of sexuality education to newlyweds and the discussion of sex-related issues during pregnancy. We propose developing strategies for increasing sexual knowledge and focusing on emotional support to decrease pregnant women's anxiety regarding sexuality in Taiwan. Liu HL, Hsu P, and Chen KH. Sexual activity during pregnancy in Taiwan: A qualitative study. Sex Med 2013;1:54-61.

Depressive symptoms as a predictor of sexual function during pregnancy.

INTRODUCTION: Biopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy. AIM: To determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI). METHODS: Pregnant women undergoing prenatal examinations were randomly selected for this cross-sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D), FSFI, and a demographic questionnaire during pregnancy. MAIN OUTCOME MEASURES: CES-D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS: After adjusting for demographic factors, CES-D scores during the first trimester negatively predicted overall sexual function (P=0.0004), arousal (P=0.0104), lubrication (P=0.0016), orgasm (P=0.0022), and pain (P<0.0001). Moreover, CES-D scores during the third trimester negatively predicted sexual desire (P=0.0005) and satisfaction (P<0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P<0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P<0.0005). Medical conditions were positive predictors of sexual desire (P=0.0023). CONCLUSIONS: The present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy.

Resource utilization and quality of life associated with congenital ichthyoses.

We explored resource utilization (ResUtil) and quality of life (QOL) associated with congenital ichthyoses (CI). Subjects completed an online survey related to clinical severity, demographics, ResUtil, and QOL as measured according to the Dermatology Life Quality Index (DLQI). Validated Likert scales were used to evaluate severity of hyperkeratosis, erythema, and alopecia. ResUtil was determined according to time spent daily treating CI symptoms (TimeTx) and number of ichthyosis-related dermatology visits (DermVisits) per year. We used linear regression to investigate predictors of a transformed DLQI (sqrtDLQI) and logistic regression for ResUtil. Of 235 subjects, 60.2% were female, 83.8% were Caucasian, 42.3% had a family history (FamHx) of CI, and the mean age was 28.7 years (SD 20.3). Predictors for worse QOL were hyperkeratosis severity (ß = 0.27, p < 0.01), erythema (ß = 0.27, p < 0.01), TimeTx (ß = 0.21, p < 0.01), ichthyosis type (ß = 0.09, p < 0.01), and age (ß = 0.01, p = 0.02). Predictors for DermVisits were hyperkeratosis severity (odds ratio [OR] = 1.38, 95% confidence limit [CL] = 1.01, 1.87), FamHx (OR = 0.28, 95% CL = 0.09, 0.85), age (OR = 0.97, 95% CI = 0.96, 0.99), and alopecia severity (OR = 1.43, 95% CL = 1.12, 1.82). Predictors for treatment duration were erythema (OR = 1.35, 95% CL = 1.02, 1.78), age (OR = 0.98, 95% CL = 0.96, 0.99), and DLQI (OR = 1.09, 95% CL = 1.03, 1.15). Increased hyperkeratosis severity and erythema negatively impact QOL in the CI. Furthermore, increased disease severity predicted greater ResUtil, whereas increased age and FamHx predicted less ResUtil. Our findings suggest that better therapies and increased patient education may improve QOL and decrease ResUtil.

Comparison of overall sexual function, sexual intercourse/activity, sexual satisfaction, and sexual desire during the three trimesters of pregnancy and assessment of their determinants.

INTRODUCTION: Pregnancy affects women's sexual function. However, few reports have addressed this phenomenon. AIM: To examine overall sexual function and three dimensions of the Taiwan version of the Female Sexual Function Index and to assess their determinants during the three trimesters of pregnancy. METHODS: Cross-sectional investigation of 663 pregnant women using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Body Image Scale for Pregnant Women, and demographics questions. MAIN OUTCOME MEASURES: Urinary incontinence, body image, obstetrical history, demographics, and other factors potentially influencing overall sexual function, intercourse/activity, satisfaction, and desire during pregnancy. RESULTS: Mean scores for overall sexual function, intercourse/activity, and satisfaction differed significantly among the three trimesters (P = or <0.02), whereas mean scores for sexual desire did not. Mean scores for overall sexual function and intercourse were significantly lower during the third trimester than during the first trimester (P < 0.001) or second trimester (P < 0.001). Mean score for satisfaction was significantly higher during the third trimester than during the first trimester (P = 0.01). Significant effects included the following: (i) the discomfort and infertility experiences on overall sexual function and on intercourse, the interaction between body image and artificial abortion on satisfaction, spontaneous abortion on desire during the first trimester; (ii) the full-time work and infertility experiences on overall sexual function and on intercourse, the interactions between body image and medical condition on desire during the second trimester; and (iii) the interaction between gestational age and HoLou ethnicity on overall sexual function, the interaction between body image and discomfort on overall sexual function and on intercourse, the interactions between body image and infertility experiences and gravidity on satisfaction, urinary incontinence on desire during the third trimester. CONCLUSIONS: Results demonstrated that biopsychosocial and cultural factors affected Female Sexual Function Index (FSFIT) scores throughout pregnancy.

A Taiwanese version of the International Consultation on Incontinence Questionnaire--Urinary Incontinence Short Form for pregnant women: instrument validation.

AIM: To translate the International Consultation on Incontinence Questionnaire--Urinary Incontinence Short Form (ICIQ-UI SF) from English to Taiwanese and to evaluate its reliability and validity for pregnant Taiwanese women. BACKGROUND: Urinary incontinence in pregnant women has been little investigated in Taiwan. A validated assessment instrument for urinary incontinence is needed for pregnant Taiwanese women. DESIGN: A non-experimental design was used to test the psychometric properties of the Taiwanese version of the ICIQ-UI SF. METHOD: The internal consistency reliability and construct validity of the Taiwanese version of the ICIQ-UI SF for pregnant women were evaluated in a random sample of 121 pregnant women at a medical center in Taiwan. Test-retest reliability was assessed for a sample of 55 pregnant women who completed this version at two time points in four weeks. Construct validity was verified with three questions and seven urinary-leakage situations by factor analysis. RESULTS: The Taiwanese version of the ICIQ-UI SF showed adequate test-retest reliability in pregnant Taiwanese women. The Pearson's correlation coefficient of the total score was 0.75, kappa statistics showed excellent or good reproducibility for most items and McNemar's test confirmed that there was no significant difference in the test-retest pair for each item of the scale. The internal consistency reliability of the scale was good, with Cronbach's α = 0.80. Three factors were extracted and identified with an eigenvalue ≥ 1.04, explaining 65.64% the total variance. The first, second and third factors were 'symptom and quality of life', 'stress incontinence or other types' and 'urge or overflow incontinence'. CONCLUSIONS: The results provide evidence of the validity and reliability of the psychometric properties of the Taiwanese version of the ICIQ-UI SF for pregnant women. RELEVANCE TO CLINICAL PRACTICE: This questionnaire is a suitable instrument for evaluating urinary incontinence in pregnant Taiwanese women.

Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: a prospective follow-up study.

BACKGROUND: The episiotomy rate has declined worldwide but remains high in several countries such as Taiwan. The effects of episiotomy on women's health should be a constant concern. Few data are available on the effect of episiotomy by validated measures. OBJECTIVE: The present study examined the effect of episiotomy on pain, urinary incontinence, and sexual function up to 3 months postpartum. DESIGN, SETTING AND PARTICIPANTS: A prospective follow-up study of 243 women who completed the Taiwanese versions of the Short Form McGill Pain Questionnaire, International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form, Female Sexual Function Index, and a demographic questionnaire after vaginal delivery in a Taiwanese medical center. METHODS: Differences between those who did and did not have an episiotomy were tested using ANCOVA, adjusting for age, parity, newborn weight, and vacuum delivery. The reliability and validity of the measuring instruments were assessed using Cronbach's α coefficient and factor analysis. RESULTS: Women who delivered without an episiotomy had significantly lower perineal pain scores at weeks 1, 2 and 6 postpartum compared to women who had an episiotomy (p=0.0065, 0.0391, 0.0497, respectively). Women in the no-episiotomy group had significantly lower non-localized pain scores at week 2 postpartum compared to women in the episiotomy group (p=0.0438). The mean urinary incontinence score was significantly higher in the episiotomy group 3 months postpartum (p=0.0293). No significant difference in sexual function score was found between groups. CONCLUSIONS: The results indicate that episiotomy increased pain at weeks 1, 2 and 6 postpartum, and urinary incontinence at 3 months postpartum. Awareness of the relationship between episiotomy and women's health will help health care professionals develop policy and promote the application of restrictive episiotomy.

Sexual function in women 3 days and 6 weeks after childbirth: a prospective longitudinal study using the Taiwan version of the Female Sexual Function Index.

INTRODUCTION: Childbirth impacts sexual function in women, but few reports have addressed sexual function shortly after childbirth. AIM: Using the Taiwan version of the Female Sexual Function Index (FSFIT), this study aimed to describe women's sexual function and to examine differences between groups in sexual function shortly after delivery. METHODS: A prospective longitudinal investigation was performed in women who completed the FSFIT, a numeric analog scale, the Taiwan version of the Center for Epidemiologic Studies Depression Scale (CES-D), and a demographic questionnaire in a Taiwanese medical center at 3 days and 6 weeks postpartum. MAIN OUTCOME MEASURES: Using a general linear model, differences were tested between groups, including those defined by delivery mode, type of feeding, depression score, pain score, and birth history. RESULTS: After adjusting for covariates, (i) significant differences in sexual function and desire were found between the vaginal delivery and Cesarean section groups at day 3 and week 6 postpartum (P = 0.0419 and <0.0001, respectively); (ii) differences in desire and satisfaction between the tubal ligation and not groups were significant at both time points (P = 0.0346 and 0.0338); (iii) differences in sexual function and sexual activity or intercourse between low and high CES-D scores were significant at 6 weeks postpartum (P = 0.0040 and 0.0043, respectively); and (iv) differences between pain level groups in sexual activity or intercourse and desire were significant at 6 weeks (P = 0.0493 and 0.0004). At 3 days postpartum, significant differences between educational level and ethnic groups were observed (P = 0.0002 and 0.0414). CONCLUSIONS: The results showed significant differences in sexual function shortly after delivery between groups based on delivery method, tubal ligation, depression, pain, ethnicity, and educational level. This information may help health professionals to be more aware of women's perception of sexuality and may foster sensitivity in assessing their sexual function after childbirth.