Effect of tibolone versus hormone replacement therapy on lower urinary tract symptoms and sexual function.

BACKGROUND: Few studies have compared the effects of tibolone versus hormone replacement therapy (HRT) on lower urinary tract symptoms and female sexual function. The current study aimed to compare these treatments. METHODS: Women with climacteric symptoms were recruited consecutively and allocated to receive tibolone (2.5 mg) or estradiol valerate (1 mg) and medroxyprogesterone acetate (2.5 mg). Patients were followed up at 4 weeks and 12 weeks after treatment. RESULTS: Overall, there were no significance of improvement in the International Prostate Symptoms Score (IPSS) scores in the HRT group. However, nocturia and the IPSS storage score improved after tibolone treatment. In addition, orgasm, satisfaction and pain improved after HRT. However, desire, lubrication, and Female Sexual Function Index (FSFI) total scores improved after tibolone treatment. There was a between-group difference in the change from baseline in the nocturia score after 4 weeks of treatment (0.1 ± 0.9 for HRT vs. -0.4 ± 1.2 for tibolone, p = 0.02). Nonetheless, there were no significant differences of the changes from baseline in the other IPSS and FSFI domains between the tibolone and HRT groups. CONCLUSIONS: Despite the limited effect, tibolone seems to have more benefit in nocturia than HRT. In addition, tibolone seems to have benefits on overall low urinary tract storage symptoms; and both tibolone and HRT seem to have beneficial effects on female sexual function, despite there were no significant differences between tibolone and HRT.

[Experience of Body Changes and Role Awakening in Postpartum Women].

BACKGROUND: The reduced number of postpartum hospitalization days and decrease in providing intensive parenting guidance experienced in Taiwan in recent years may impact negatively on postpartum mothers. Moreover, these changes have reduced the opportunities available to professional caregivers to learn about the physical impacts of the postpartum period on new mothers. PURPOSE: This study was designed to explore how postpartum women perceive their feelings and experience their bodies and roles after childbirth. METHODS: Based on Merleau-Ponty's theory, this qualitative study included purposive sampling at two medical centers in northern Taiwan. Information on bodily changes and self-perceptions during postpartum care was collected using in-depth, open-ended interviews with women between two and six months postpartum and was analyzed using interpretative phenomenological analysis. RESULTS: Two major themes were identified. The first theme, "My postpartum body is not my own", indicates that postpartum women perceive their bodies as no longer belonging to themselves. The second theme, "Refamiliarization with the postpartum body", describes how the participants adapted, accepted, recognized, and gave new meaning to the changes in their bodies during the postpartum period. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Although women may feel that they lose their identity and become "objects" after childbirth, this experience may trigger an opportunity for transformation that allows them to re-identify as "subjects. " By listening with respect, clinicians can help postpartum women understand they are in control of their lives. This may help postpartum women identify their capabilities and embrace postpartum life with greater optimism.

The relationship between body dissatisfaction and postpartum depressive symptoms: A cross-sectional study.

BACKGROUND: Women are least satisfied with their bodies during the postpartum period. There is a potential correlation between body dissatisfaction and depressive symptoms post delivery.The aim of this study was to explore the relationship of appearance and body areas satisfaction with depressive symptoms and examine the risk factors of depressive symptoms at 4-6 weeks postpartum. METHODS: A total of 330 postpartum women participated in the study. Body dissatisfaction was measured using the Appearance Evaluation (AE) scale and Body Areas Satisfaction Scale (BASS), while depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS), 4-6 weeks postpartum. RESULTS: The prevalence of postpartum depressive symptoms among postpartum women was 40 % while 12.1 % of the women had thoughts of self-harm. Those with depressive symptoms or thoughts of self-harm had lower AE and BASS scores. Body dissatisfaction was significantly associated with factors such as postpartum weight retention of >5 kgs, no exercise, lower education level, and cesarean delivery. The three body areas that women were most dissatisfied with were weight, mid-torso, and lower torso. Education level, delivery method, and BASS score significantly predicted postpartum depressive symptoms. LIMITATIONS: The selection bias might have occurred if those with depressive symptoms neglected routine postpartum care visits due to emotional distress. CONCLUSIONS: The results indicate an association between body dissatisfaction and depressive symptoms at 4-6 weeks postpartum. Awareness of this relationship and focus on these risk factors will help healthcare providers plan peripartum programs to decrease the likelihood of postpartum depressive symptoms.

Factors associated with providers' culturally competent care for sexual and gender minority older adults in Taiwan: A qualitative study applying the social ecological model.

BACKGROUND: Sexual and gender minority older adults receive less social support than does the general population, leading to reliance on long-term care services. On May 24, 2019, Taiwan became the first country in Asia to legalise same-sex marriage. Sexual and gender minority older adults are becoming more visible in Taiwanese society. However, healthcare providers' behaviour and intention to offer culturally competent care to sexual and gender minority older adults and factors affecting their behaviour and intention in Asian culture remain unclear. OBJECTIVE: This study determined factors associated with healthcare providers' behaviour and intention to offer culturally competent care to Taiwanese sexual and gender minority older adults and identified related training requirements. DESIGN: A qualitative descriptive study was conducted. SETTING(S): This study recruited participants from 14 lesbian, gay, bisexual, and transgender organisations; long-term care facilities; and community healthcare centres. This study was approved by the Research Ethics Committee of National Taiwan University Hospital (Ref. 201811049RIND). PARTICIPANTS: A total of 25 providers were interviewed: 12 nurses, 10 social workers, and 3 staff members from lesbian, gay, bisexual, and transgender organisations. METHODS: Semistructured interviews were conducted between May 2019 and September 2019. Interview data were analysed using the socio-ecological model and the constant comparative technique. FINDINGS: Factors associated with the providers' behaviour and intention to offer culturally competent care to sexual and gender minority older adults were categorised by the socio-ecological model level: 1) intrapersonal factors, namely providers' attitudes towards sexual and gender minority older adults, knowledge regarding sexual and gender minority populations, and experiences of providing care for sexual and gender minority older adults; 2) interpersonal factors, namely providers' concerns regarding interactions among staff, sexual and gender minority older adults, nonsexual and gender minority residents, and nonsexual and gender minority residents' families; 3) community factors, namely resources, training courses, and support from managers and organisations; and 4) societal factors, namely social environment and policies. CONCLUSIONS: This study identified multilevel factors associated with the providers' cultural competence in caring for sexual and gender minority older adults in Taiwan. These factors may lead to disparities in quality of life and health for sexual and gender minority older adults. Recommendations to address multilevel barriers to reduce health disparities and improving quality of life in sexual and gender minority older adults have been provided.

Prevalence of and Associated Factors for Overactive Bladder Subtypes in Middle-Aged Women: A Cross-Sectional Study.

Background and Objectives: The living environment can manifest physiological responses in humans, with cohabiting couples often having similar health statuses. The aim of this study was to (1) examine the prevalence of the overactive bladder (OAB) with or without incontinence and (2) identify associated factors for OAB with and without incontinence (including environmental factors, such as living with a partner who has OAB) in middle-aged women. Materials and Methods: In this cross-sectional study, the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OBA) was administered to 970 couples. Data were analyzed using descriptive statistics, chi-square analyses, and multivariate logistic regression. Results: Responses to the ICIQ-OBA among middle-aged women generated a higher prevalence of OAB with incontinence (OABwet; 41%) than OAB without incontinence (OABdry; 26%; p < 0.001). The factors associated with OABwet were as follows: being age ≥ 55 years (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.02−1.95), having a body mass index (BMI) ≥ 27 kg/m2 (OR, 1.50; 95% CI, 1.03−2.17), having vaginitis (OR, 1.89; 95% CI, 1.28−2.80), and having partners with OABwet (OR, 2.35; 95% CI, 1.74−3.19). Having partners with OABdry (OR, 1.81; 95% CI, 1.34−2.44) was an associated factor for OABdry. Conclusions: This study identified the associated factors for OAB subtypes (OABwet and OABdry) in middle-aged women. These findings can support treatment and preventive strategies for health providers who care for patients with OAB. As part of the treatment and preventative strategies, the risk that partners may introduce to the development of OAB in women should also be considered.

Overactive Bladder during Pregnancy: A Prospective Longitudinal Study.

Background and Objectives: Overactive bladder (OAB) is a serious urination-related symptom of unknown pathogenesis that affects one's everyday activities. The objective of this study was to examine how OAB prevalence, symptom severity, and degree of distress caused by OAB symptoms evolved throughout the course of pregnancy. Materials and Methods: A total of 659 pregnant women were recruited from 2015 to 2020, and were evaluated through the International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) on OAB symptoms, administered in the early, middle, and late stages of pregnancy. Results: Generalized estimating equation analysis revealed that the odds of OAB occurring in the middle and late stages of pregnancy were 1.90 and 2.33 times higher, respectively, than in early pregnancy. The corresponding odds for OAB-wet were 1.63 and 2.07 higher, respectively, and the odds of OAB-dry occurring during late pregnancy were 0.80 higher than during early pregnancy. Symptoms were more severe by 0.07 and 0.21 points (on a 4-point scale) in the middle and late stages of pregnancy, respectively, than in early pregnancy; distress was greater by 0.13 and 0.27 points (on a 10-point scale) in the middle and late stages of pregnancy, respectively, than in early pregnancy. The prevalence of OAB, OAB-dry, and OAB-wet was significantly higher in early pregnancy than pre-pregnancy. Conclusions: The prevalence of OAB and OAB-wet increased over the course of pregnancy, but the prevalence of OAB-dry decreased. Furthermore, symptom severity and degree of distress increased over time.

Cumulative incidence of urinary incontinence and associated factors during pregnancy and after childbirth: a cohort study.

INTRODUCTION AND HYPOTHESIS: This study examined the associated factors (i.e., obstetric and maternal-newborn factors) related to cumulative incidence of urinary incontinence and changes in urinary incontinence during pregnancy and the first year postpartum. METHODS: This prospective, longitudinal, within-subject study included 501 women who completed the Incontinence Questionnaire-Urinary Incontinence Short Form during pre-pregnancy, early pregnancy, mid-pregnancy, and late pregnancy and at five time points during the first year postpartum. Data were analyzed by multivariate logistic regression, McNemar's and analysis of variance (ANOVA) tests. RESULTS: According to the multivariate analysis, the gestational week and number of previous vaginal deliveries increased the risk of cumulative incidence of urinary incontinence (CIUI) during pregnancy (both p < 0.05). Full-time employment, higher body mass index, vaginal delivery and UI during early pregnancy and mid-pregnancy increased the risk of CIUI during the first year postpartum (all p < 0.05). CIUI tended to increase throughout the entire pregnancy (p < 0.001) and decrease from 3 to 5 days to 6 months postpartum (p = 0.028). The prevalence rates of UI at all postpartum visits were lower than those during late pregnancy (p < 0.001-0.009) but higher than those during pre-pregnancy (p < 0.001). CONCLUSIONS: The results identified the change patterns in UI and the risk factors associated with CIUI during the entire pregnancy (i.e., gestational age and number of previous vaginal deliveries) and the first year postpartum (i.e., full-time work, higher body mass index, vaginal delivery and UI during early and mid-pregnancy). Appropriate counseling should be provided to women preparing for pregnancy and during the prenatal and postpartum periods.

Suicide attempts among Taiwanese lesbian, gay, bisexual, and transgender adults during the 2018 Taiwan referendum on same-sex issues.

PURPOSE: To examine suicide attempts and the influencing factors among Taiwanese lesbian, gay, bisexual, and transgender (LGBT) adults during the 2018 Taiwanese referendum on same-sex issues. RESEARCH DESIGN AND METHODS: The 2018 Taiwanese referendum was held on November 24. A cross-sectional online survey was conducted between October 2018 and February 2019. A total of 1012 self-identified LGBT adults were included in the final sample. RESULTS: Among the 1012 Taiwanese LGBT adults, the rates of suicide attempts ranged from 9.1% to 24.4%. A younger age, being a student, having low income, having mental health issues, and having a high level of depressive symptoms were associated with a significantly higher risk of suicide attempts in the participants. Conversely, having a postgraduate degree, having high self-esteem, and perceiving support from friends and family were associated with a lower risk of suicide attempts. CONCLUSION: This is the first study to investigate suicide attempts among LGBT individuals and the influencing factors within the context of a same-sex marriage referendum in an Asian country. The results of this study demonstrate the importance of suicide prevention measures for the LGBT community, particularly during times of increased social stress and conflict between social groups with diverse sexual and gender identities. CLINICAL RELEVANCE: The results of this study suggest that nurses' and health-care providers' sensitivity toward LGBT patients and their knowledge and skills in providing culturally competent care are key factors in suicide prevention for LGBT adults. Therefore, nurses and health-care providers must be provided with training courses on culturally competent care.

Risk factors for stress and urge urinary incontinence during pregnancy and the first year postpartum: a prospective longitudinal study.

INTRODUCTION AND HYPOTHESIS: We examined obstetric and maternal-newborn factors and UI history for stress urinary incontinence (UI) and urge UI during pregnancy and the first year postpartum. METHODS: This prospective cohort study included 1447 pregnant women who underwent prenatal examinations and completed an Incontinence Questionnaire-Urinary Incontinence Short Form before pregnancy, during early, mid- and late pregnancy, and at five visits during the first year postpartum. Data were analyzed using univariate/multivariate generalized estimating equation (GEE) logistic regression analyses. RESULTS: The prevalence rates of stress UI during late pregnancy (42.5%) and urge UI at 3-5 days postpartum (10.4%) were the highest throughout pregnancy and the first year postpartum. After adjusting for covariates, gestational age increased the risks of stress UI (p < 0.001) and urge UI (p = 0.003); stress UI during pre-pregnancy, number of previous vaginal deliveries and concurrent high body mass index (BMI) increased stress UI (all p < 0.05); urge UI during pre-pregnancy and full-time work increased urge UI (both p < 0.05) during pregnancy. During the postpartum period, vaginal delivery increased stress UI (p < 0.001) and urge UI (p = 0.041); stress UI during pre-pregnancy and pregnancy, women aged ≥ 30 years and vacuum extraction/forceps delivery increased stress UI (all p < 0.05). Urge UI during early, mid- and late pregnancy increased stress UI (all p < 0.05). CONCLUSIONS: Gestational age increased stress and urge UI, while previous vaginal deliveries and high BMI increased stress UI; full-time work increased urge UI during pregnancy. Vaginal delivery increased both UIs, and vacuum/forceps delivery and maternal age increased stress UI during postpartum.

Health Status and Quality of Life of Middle-Aged and Older Taiwanese Sexual and Gender Minorities.

PURPOSE: To examine the health status and quality of life of middle-aged and older sexual and gender minority adults in Taiwan. RESEARCH DESIGN AND METHODS: A cross-sectional online survey was conducted between May and December 2019. A total of 535 self-identified lesbian, gay, bisexual, and transgender (LGBT) men and women ≥40 years of age were included in the final sample. An online questionnaire, which included the following three sections, was used to collect data in this study: (a) demographics, (b) the World Health Organization Quality of Life-Brief Taiwan version, and (c) physical and psychological health status. RESULTS: Middle-aged and older Taiwanese LGBT adults who were single, were unemployed, and earned monthly incomes of <20,000 New Taiwan Dollars reported poorer quality of life. Participants with one or more physical or psychological health problems also reported poorer quality of life than those who had no health problems. In addition, singlehood, unemployment, and poor quality of life and health were positively associated with mental health issues. CONCLUSIONS: It is important to attenuate health disparities and mitigate discrimination within Taiwanese society to enhance the quality of life and mental health of middle-aged and older Taiwanese LGBT adults. CLINICAL RELEVANCE: Healthcare providers should be attuned to and knowledgeable about the health issues and specific healthcare needs of middle-aged and older LGBT adults, and they should also provide culturally competent care to reduce health disparities of the LGBT adults.

Internalized homophobia, self-esteem, social support and depressive symptoms among sexual and gender minority women in Taiwan: An online survey.

WHAT IS KNOWN ON THE SUBJECT?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals. Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non-western countries. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To the best our knowledge, this is the first study examining internalized homophobia, self-esteem, social support and depressive symptoms among sexual minority women in Taiwan. Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self-esteem and fewer support from partners, friends, and families. Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self-esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation. LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. ABSTRACT: Introduction Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non-western countries. Aim This study examined internalized homophobia, self-esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method A total of 581 Taiwanese sexual minority women (Age range 20-48 years old, Mean 26.96, SD 5.718) completed an online survey. Results Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self-esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion Mental health interventions are essential for sexual minority women with internalized homophobia and low self-esteem. Implications for Practice Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms.

Taiwanese Nurses' Attitudes Towards and Knowledge About Sexual Minorities and Their Behavior of Providing Care to Sexual Minority Patients: Results of an Online Survey.

PURPOSE: To assess Taiwanese nurses' attitudes toward and knowledge about sexual minorities, and their awareness and behavior of providing care to sexual minority patients. DESIGN: A cross-sectional descriptive design was employed. METHODS: A total of 323 Taiwanese nurses 20 years of age or older completed an online questionnaire between September and November 2019. It included five sections: demographics, the Attitudes Toward Lesbians and Gay Men Scale, Knowledge About Homosexuality Questionnaire, Gay Affirmative Practice Scale, and nurses' needs for promoting culturally competent care. RESULTS: Taiwanese nurses held positive attitudes, and demonstrated high levels of awareness and behaviors of providing care to sexual minority patients. However, they had limited knowledge regarding homosexuality. More so, nurses who were older, self-identified as heterosexuals, were married, had more than 10 years' work experience, and were Buddhists had poor knowledge about homosexuality. Nurses reported that for providing culturally competent care they required knowledge about sexual minorities' physical and mental health issues; the populations' social and welfare resources; communication skills training; privacy; and safe space. CONCLUSIONS: Information on homosexuality and health issues among sexual minority populations, communication skills training, privacy, and safe space should be provided to Taiwanese nurses to improve their abilities to provide culturally competent care and to reduce health inequalities among sexual minorities. CLINICAL RELEVANCE: This study's results could be used as evidence for designing and providing training programs for nurses regarding culturally competent care, and thus promote quality nursing care and decrease difficulties of accessing healthcare services among sexual minority patients.

The Role of Butch versus Femme Identity in Body Image and Breast Health Among Lesbians in Taiwan: Results of an Online Survey.

PURPOSE: The views of butch- and femme-identified lesbians toward their own breasts, breast cancer, breast cancer screenings, and their behavior and intentions toward breast health care were examined and compared in this study. METHODS: A total of 208 Taiwanese lesbians (134 butch-identified lesbians and 78 femme-identified lesbians) completed an online survey. RESULTS: Butch-identified lesbians were more likely to hold negative views regarding their own breasts, which were found to be significantly and negatively associated with their actions in performing breast self-examinations when compared with femme-identified lesbians. CONCLUSIONS: Healthcare providers should be aware of and provide culturally competent care to lesbians with different identities. CLINICAL RELEVANCE: The results can be employed as evidence for promoting lesbians' breast health, particularly butch-identified lesbians. Healthcare providers should provide a supportive environment in order to promote a positive body image and improve breast health among lesbians.

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.

Sexual Problems of Patients With Breast Cancer After Treatment: A Systematic Review.

BACKGROUND: Sexual health is a crucial part of quality of life in breast cancer survivors, regardless of their relationship status. However, previous studies have rarely used qualitative methods to explore the postoperative experiences and feelings of patients with breast cancer. OBJECTIVE: The aim of this study was to examine the causes of changes in sexual relationships of breast cancer survivors, methods for adaptation to these changes, and healthcare interventions to facilitate the patients' return to a normal life. INTERVENTIONS/STUDY METHODS: A survey was performed by using five electronic databases and electronic journals accessed through the Internet. The following keywords were used: "breast cancer," "sexual problem," "sexual dysfunction," and "qualitative." RESULTS: Seven articles were included in the literature review. Three main domains were explored, namely, reasons for sexual relationship changes; the way patients used to adapt to sexual life after the diagnosis of breast cancer; and intervention by healthcare workers. CONCLUSIONS: The results of this study can facilitate and encourage health professionals to identify, examine, and solve most of the patient's sexual problems by using the functional and medical framework of the healthcare system. IMPLICATIONS FOR PRACTICE: One practical recommendation of this study is the incorporation of sexual counseling units into the national healthcare system. Counselors in these units can help breast cancer survivors solve problems and improve sexual satisfaction between couples.

The self-care coping process in patients with chronic heart failure: A qualitative study.

AIM: To understand the self-care coping process among chronic heart failure patients. BACKGROUND: Previous studies have been carried out to understand the experience and the challenges of living with chronic heart failure. However, the coping processes that patients use to overcome self-care challenges are less understood. DESIGN: A qualitative design with qualitative content analysis of data was employed. METHODS: Purposive sampling was conducted to recruit inpatients with chronic heart failure between March 1, 2014-March 1, 2015, in a teaching hospital in Taiwan. Semi-structured interviews (N = 27) were completed, and a content analysis was performed using an inductive method to explore the self-care coping processes in patients with chronic heart failure. RESULTS: The findings were categorised into three themes: (a) responding to chronic heart failure self-care (dealing with negative emotions, accepting reality and struggling between a self-care regime and self preference), (b) finding ways to live with chronic heart failure (enhancing understanding and knowledge about chronic heart failure, maintaining outer and inner self, engaging positively/negatively with others and relying on religious thoughts and seeking consolation) and (c) reinterpreting chronic heart failure and performing meaning-oriented coping (re-evaluating the meaning of life, assigning a new perspective for chronic heart failure and discovering a deeper meaning behind it). CONCLUSION: Self-appearance concerns should be given more attention by healthcare professionals. Meaning-oriented coping was found to be helpful to cope with the challenges of chronic heart failure. Thus, there is a need to develop interventions associated with meaning-oriented coping to enhance coping strategies for chronic heart failure patients. RELEVANCE TO CLINICAL PRACTICE: It is suggested for healthcare professionals to understand an individual's coping process and support people with chronic heart failure who struggle with self-care coping. Furthermore, specific interventions including meaning-oriented interventions might benefit people with chronic heart failure to cope more successfully.

Sexual dysfunction predicts depressive symptoms during the first 2 years postpartum.

BACKGROUND: The association between sexual function and depression has yet to be examined in a prospective cohort study with prolonged postpartum follow-up. AIM: We investigated whether sexual dysfunction predicted depressive symptoms during the 24-month postpartum period and examined the influence of obstetric factors. METHODS: This prospective 2-year cohort study with repeated measures included 196 participants who were recruited in a medical center in Taipei, Taiwan (2010-2011). Data on participants' personal characteristics, sexual function, and depression symptoms at 4-6 weeks and at 3, 6, 12, and 24 months postpartum were collected and then assessed using the Female Sexual Function Index and the Center for Epidemiologic Studies Depression Scale. RESULTS: After adjusting for time and covariates, women with sexual dysfunction had a 1.62-fold (95% confidence interval [CI]: 1.05-2.50-fold) higher estimated odds ratio (OR) for depressive symptoms during the entire 24 months after childbirth than did women without sexual dysfunction. Risk factors for depressive symptoms were a higher pain score (OR: 1.33, 95% CI: 1.13-1.57), a medical condition (OR: 1.65, 95% CI: 1.00-2.73), and severe perineal laceration (OR: 4.67, 95% CI: 1.37-15.92). Sexual satisfaction during the entire 24 months after childbirth (OR: 0.81, 95% CI: 0.70-0.95) and the highest personal income level (OR: 0.33, 95% CI: 0.11-0.99) were factors protecting against higher-scoring depressive symptoms. CONCLUSIONS: Our study provides robust evidence that sexual dysfunction and poor satisfaction, together with severe perineal laceration, greater pain, and a medical condition, predict depressive symptoms during the 24-month postpartum period.

[Is It Time to Implement a 12-Hour Shift for Nurses in Taiwan?]

The twelve-hour shift system, first introduced in the U.S. in 1967 to address a nursing shortage, is now the main system of shift rotation used in numerous countries. In recent years, several hospitals in Taiwan have implemented the 12-hour shift model as one initiative to improve the problems of overtime and high turnover rate among nursing staff. Under this model, nurses work only three to four days per week for 12-hour shifts per day. Despite the increase in numbers of days off, there is growing concern that long shift hours may harm both the safety of patients and the well being of the nurses. The aim of the present article is to explain the application of the 12-hour shift system and to review the potential impacts of this model. Benefits of the 12-hour shift system include improving quality of life for nursing staff, reducing the turnover rate, and increasing job satisfaction. Primary concerns regarding this system include patient safety, nurse fatigue, and the potential negative effects on the sleep quality of nurses. These findings may be referenced by policymakers considering the development / implementation of flexible work schedules in Taiwan. The government must set a ceiling on work hours allowed per week and impose limits on overtime in order to prevent burnout in nursing staff.

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.