The relationships between mobile phone use and depressive symptoms, bodily pain, and daytime sleepiness in Hong Kong secondary school students.

INTRODUCTION: Studies have found that increased mobile phone use (MPU) is associated with multiple health issues such as depression, disordered sleep and pain. However, the current situation and interrelationships of these problems remain unexplored in the Hong Kong population. OBJECTIVES: This study aimed to understand the situation and problematic use of mobile phones by Hong Kong secondary school students and to investigate depressive symptoms, bodily pain and daytime sleepiness and the associations of these factors with MPU in Hong Kong secondary school students. METHODS: This quantitative cross-sectional design study was based on self-administered questionnaires completed at five secondary schools. The questionnaire comprised five sections: MPU as measured by the Chinese version of the 10-Item Mobile Phone Problem Use Scale (CMPPUS-10); depressive symptoms according to the Depression Anxiety Stress Scale-21 Chinese Version (DASS-21); bodily pain according to the Brief Pain Inventory Short Form Chinese (BPISF-C); daytime sleepiness as measured using the Chinese version of the Epworth Sleepiness Scale (CESS) and socio-demographic questions. RESULTS: A total of 686 students were recruited. The CMPPUS-10 score correlated positively with the average daily duration of MPU and the presence of depression, daytime sleepiness and bodily pain. Problematic mobile phone users received significantly higher scores for depression severity, bodily pain and daytime sleepiness. Health problems were significantly more severe in female than in male students. Bodily pain and daytime sleepiness mediated the relationship of MPU with depression. CONCLUSIONS: Problematic MPU was associated with depression, bodily pain and daytime sleepiness. These findings will inform further studies of MPU-related health problems.

Endurance with partnership: a preliminary conceptual framework for couples undergoing in vitro fertilisation treatment.

BACKGROUND/OBJECTIVES: Infertility affects both women and men in the physical, emotional, existential, and interpersonal realms. When couples seek in vitro fertilisation (IVF) treatment, they further suffer from the difficulties of the treatment and the uncertainty of its outcome. The aim of this study was to develop a preliminary conceptual framework for couples undergoing IVF treatment to give health professionals a better understanding of the experiences of such couples, and to guide the development of an intervention. METHODS: The process of identifying frameworks adopted in intervention studies confirmed that there is no established framework for infertile couples undergoing IVF treatment. A skeletal framework identified from previous studies provides an internal structure for the proposed framework for couples undergoing IVF treatment, filled out with concepts drawn from a concept analysis and a qualitative study, knitting the structure together. RESULTS: This preliminary framework is the Endurance with Partnership Conceptual Framework (P-EPCF). It consists of four domains: the impacts of infertility and stressors, dyadic mediators, dyadic moderators and dyadic outcomes. According to the P-EPCF, the impacts of infertility and IVF treatment can be mediated by the couples' partnership and dyadic coping. Improvements in the psychological well-being and marital functioning of IVF couples can then be expected. CONCLUSIONS: The P-EPCF would be potentially valuable in guiding the development of a complex, couple-based intervention, which could focus on enhancing the partnership of couples and their coping strategies.

A Partnership and Coping Enhancement Program for Couples Undergoing In Vitro Fertilization Treatment: An Intervention Study.

This is a feasibility study to examine the effects of a partnership and coping enhancement program (PCEP) on improving the psychological well-being and marital functions of couples undergoing in vitro fertilization treatment. A total of 100 couples were recruited consecutively and assigned to a PCEP intervention group or a routine care control group. The couples in the PCEP group received an additional face-to-face, couple-based, 90-minute session on enhancing partnership and coping on the day of the embryo transfer (ET). The outcome measures were assessed at baseline (T0), 10 days after the ET (T1), and one month after the ET (T2). The level of anxiety of the women was lower in the intervention than in the control group at T1. Significant improvements in partnership and dyadic coping were seen in women at T2. The men of infertile couples reported a significant improvement in the scores for partnership at T2. The PCEP had no significant effects on marital satisfaction and marital adjustment for both the females and males of the infertile couples. The findings indicated that the PCEP is feasible and acceptable. Before a larger simple-size randomized controlled trial with participants drawn from multiple reproductive medical centers is conducted to further confirm its effectiveness.

The Partnership and Coping Enhancement Programme for couples undergoing in vitro fertilization treatment: the development of a complex intervention in China.

PURPOSE: Couples as dyads suffer from the diagnosis of infertility and related treatment. These couples commonly experience emotional and physical pain and tension in their marital lives. The purpose of this study is to report on the process of developing a potentially feasible and effective complex intervention for couples undergoing in vitro fertilization treatment in China. METHODS: The Medical Research Council (MRC) framework for developing and evaluating the complex intervention was adopted to guide the development of the Partnership and Coping Enhancement Programme (PCEP). In developing the PCEP, three steps were taken, namely, (1) identifying evidence by conducting literature reviews, a concept analysis and a qualitative study; (2) identifying/developing a theory-in this case, a preliminary Endurance with Partnership Conceptual Framework (P-EPCF) was proposed; and (3) modelling the process and outcomes of the PCEP. RESULTS: The PCEP that was developed is targeted mainly at the domains of the partnership mediators of stress in the P-EPCF. It consists of two sections-partnership and coping-and will be delivered to infertile couples on the day of embryo transfer. The main focuses of the programme are to facilitate mutual sharing and support in infertile couples, and to improve their individual and dyadic coping strategies while undergoing IVF treatment, especially in the period when they are waiting for the results of a pregnancy test and after the disclosure of a negative treatment outcome. The programme is couple-based, consisting of experience sharing, psychoeducation, meditation exercise, skill practise and supplemental written materials. CONCLUSIONS: The Partnership and Coping Enhancement Programme (PCEP) for couples undergoing in vitro fertilization treatment was developed according to the guideline of the MRC framework. It is recommended that a pilot study be conducted to evaluate its feasibility and to model the process and outcomes of the programme.

The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review.

PURPOSE: The purpose of this study was to examine the effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization (IVF), as determined through RCT studies. METHODS: Using the electronic databases PubMed, EMBase, Cochrane Library, CINAHL, PsycInfo, and CAJ, a systematic literature search was conducted in July 2015. MeSH terms, key words, and free words such as "infertility," "fertilization in vitro," "psychotherapy," "intervention," "anxiety," "depression," and "marital satisfaction" were used to identify all potential studies. The quality of the studies that were included was assessed using the risk of bias assessment tool developed by the Cochrane Back Review Group. Descriptive analysis was adopted to synthesize the results. RESULTS: A total of 20 randomized controlled trials were included in this review. There were reports of positive effects on the anxiety levels, pregnancy rates, or marital function of infertile couples in six studies that adopted different psychosocial approaches, including mind body intervention (Eastern body-mind-spirit, Integrative body-mind-spirit, and Mind/body intervention), cognitive behavioral therapy, group psychotherapy, and harp therapy. However, there were methodological or practical issues related to measurement points and attrition rates in these studies. None of these interventions were found to be efficacious in relieving the depression or stress of individuals or couples undergoing IVF treatment. None of the included studies tackled or measured the mental health status of the couples during the most stressful time of waiting for the pregnancy results of their treatment. CONCLUSIONS: A complex intervention, based on sound evidence, should be developed targeting both females and males of infertile couples undergoing IVF treatment, particularly during the stressful period of waiting for the results of the pregnancy test result and after failed cycles.

Gender differences in emotional reactions to in vitro fertilization treatment: a systematic review.

PURPOSE: The purposes of this paper are to provide a comprehensive picture of men and women's emotional reactions to infertility treatment, specifically In Vitro Fertilization (IVF) pursued by heterosexual couples, and to identify any differences between the genders. METHODS: Nonexperimental studies exploring the psychological effects of IVF treatment on infertile couples were included. Six electronic databases were used to conduct a systematic search from the years 2000 to 2014. The references of the articles selected for review and other related systematic reviews were also screened to retrieve additional relevant articles. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Descriptive analysis was adopted to synthesize the results. RESULTS: A total of 22 quantitative and 4 qualitative studies were identified and included in this review. Although both men and women experienced psychological distress during the treatment, gender differences existed. Women had elevated anxiety and depression levels prior to the treatment, which became even higher on the day of the oocyte retrieval, pre- and post embryo transfer, and during the waiting period before the pregnancy test. Men of the infertile couples reported elevated depression scores before treatment, which usually increased during the time spent waiting for the outcome of the IVF treatment. Both men and women had lower scores on positive affect before the pregnancy test. A failed IVF cycle had long-term negative psychological consequences for both spouses. CONCLUSIONS: The results of this review pointed to the need for a couple-based support program, aimed at improving the psychological well-being of couples.

The Experience of Chinese Couples Undergoing In Vitro Fertilization Treatment: Perception of the Treatment Process and Partner Support.

BACKGROUND: Couples undergoing In Vitro Fertilization (IVF) Treatment suffer as dyads from the stressful experience of the painful treatment and the fear that the IVF cycle will fail. They are likely to report that their marital relationship has become unstable due to the prolonged period of treatment. METHODS: This is a qualitative study that was conducted to explore the experiences that Chinese couples have had with IVF treatment, especially their perceptions of the process and the support between couples. RESULTS: The interviews revealed that couples suffered from the process, experiencing physical and emotional pain, struggling with the urgency and inflexibility of bearing a child, and experiencing disturbances in their daily routines and work. The participants described how they endured the hardships as a couple and how it affected their relationship. The couples felt that sharing feelings and supporting each other contribute to psychological well-being and improves the marital relationship. They also identified some unfavorable aspects in their partner relationship. They were ambivalent about receiving social support from friends and family members. CONCLUSIONS: With the couples indicating that the support that they received from each other affected their experience during the treatment process, it is suggested that a supportive intervention that focuses on enhancing the partnership of the couples and dealing with their inflexibility on the issue of bearing a child might result in improvements in the psychological status and marital relationship of infertile couples undergoing IVF treatment.

Gender differences in experiences with and adjustments to infertility: A literature review.

BACKGROUND: It has been widely recognized that infertility and its treatment affects a couple as a dyad. Given biomedical differences and differences in socialization processes and gender-role expectations, it is reasonable to suspect that females and males may experience and respond to infertility in different ways. OBJECTIVE: To explore gender differences among infertile couples with regard to experiences with and adjustments to infertility. DESIGN: A literature review. DATA SOURCES: A literature search was performed using the following databases: PubMed, CINAHL, PsycInfo, Web of Science, Scopus, and the China Academic Journal Full-text Database. REVIEW METHODS: The studies that were included were those published in English or Chinese from the years 2000 to 2014. The references of all of the studies selected for this review were also searched. An author search was also performed to retrieve relevant articles. Experiences with and adjustments to infertility were explored from the perspective of gender. RESULTS: A total of 33 studies were included in this review. The experiences with infertility can be grouped under the five domains of the biopsychosocial theory, namely: existential stressors, physical stressors, emotional stressors, interpersonal stressors, and the moderators of stress. In general, females had more negative experiences with infertility than men in most of the domains, including lower levels of identity, self-esteem, and physical health; and higher levels of depression, stress, anxiety, stigma, and shame. Infertile couples experienced stress in their married life, although there were no gender differences in the areas of marital adjustment, marital satisfaction, and sexual satisfaction. Females were likely to perceive themselves as being less confident than their partners in coping with infertility. For both men and women, partner support was found to be negatively related to stress due to infertility. CONCLUSIONS: This review revealed that while there were gender differences in the experience with infertility in many realms, both men and women were subject to a stressful married life. Partner support was an important element of coping with infertility. Therefore, a supportive intervention, focusing on enhancing a sense of partnership among infertile couples is a way of helping them to cope.

Development and evaluation of a nurse-led hypertension management model in a community: a pilot randomized controlled trial.

This study aims to develop a nurse-led hypertension management model in the community setting and pilot it to an experimental trial. A total of 73 recruited participants were randomly allocated into two groups. The study group received a home visit and 2-4 telephone follow-ups from the trained community nurses assisted by nursing student volunteers. The control group received doctor-led hypertension management. Data was collected at recruitment and immediately after the 8-week program. Outcome measures included blood pressure readings, self-care adherence, self-efficacy, quality of life, and patient satisfaction. Participants from the study group led by nurses had significant improvement in self-care adherence, patient satisfaction post-intervention than those from the control group led by doctors. However, there were no statistical significant differences in blood pressure readings, quality of life and self-efficacy between the two groups. The findings show that the nurse-led hypertension management appears to be a promising way to manage hypertensive patients at the community level, particularly when the healthcare system is better integrated.

The global burden of cardiovascular disease.

Cardiovascular disease (CVD) today is responsible for approximately one-third of deaths worldwide, and that figure will surely increase in both developing and developed countries as risk factors for the disease--primarily dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking--continue to increase. Although these risk factors are modifiable, to date there is a relative paucity of measures to prevent or control them, particularly in developing countries. A population strategy combined with a high-risk strategy for CVD prevention could greatly reduce the burden of disease in the coming decades. Many initiatives are working, but many more are needed. This chapter provides background on the global burden of CVD and provides the context for the subsequent chapters addressing nurses' roles in reversing the bleak predictions for the ravages of CVD if risk factors are left unchecked in the coming decades.

The global burden of cardiovascular disease.

Cardiovascular disease (CVD) today is responsible for approximately one-third of deaths worldwide, and that figure will surely increase in both developing and developed countries as risk factors for the disease-primarily dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking-continue to increase. Although these risk factors are modifiable, to date there is a relative paucity of measures to prevent or control them, particularly in developing countries. A population strategy combined with a high-risk strategy for CVD prevention could greatly reduce the burden of disease in the coming decades. Many initiatives are working, but many more are needed. This chapter provides background on the global burden of CVD and provides the context for the subsequent chapters addressing nurses' roles in reversing the bleak predictions for the ravages of CVD if risk factors are left unchecked in the coming decades.

Investigating factors associated with nurses' attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong.

AIMS: To explore nurses' attitudes towards perinatal bereavement care and to identify factors associated with these attitudes. BACKGROUND: It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and that nurses with positive attitudes to bereavement care can help bereaved parents to cope during their grieving period. DESIGN: Survey. METHOD: Data were collected through a structured questionnaire; 657 nurses were recruited from Obstetrics and Gynaecology units in Hong Kong and Shandong during 2006. Outcome measures included attitudes towards perinatal bereavement care, importance of hospital policy and training support for bereavement care. RESULTS: The majority of nurses in this study had a positive attitude to bereavement care. Results show that only 21.6% (n = 141) of the nurses surveyed had bereavement-related training. In contrast, about 89.8% (n = 300) believed they needed to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88.5% (n = 592) would share their experiences with their colleagues and seek support when feeling under stress. A regression model showed that age, past experience in handling grieving parents, recent ranking and nurses' perceived attitudes to hospital policy and training provided for bereavement care were the factors associated with nurses' attitudes to perinatal bereavement care. CONCLUSIONS: Nurses in both cities emphasised their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. RELEVANCE TO CLINICAL PRACTICE: These findings may be used by nursing educators to educate their students on issues related to delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.

Investigating factors associate to nurses' attitudes towards perinatal bereavement care.

AIM: The purpose of this study was to explore nurses' attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. BACKGROUND: Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. METHOD: Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May-August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. RESULTS: Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39.3% (n = 130) of nurses had bereavement related training. By contrast, about 89.8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88.0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses' perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses' attitudes towards perinatal bereavement care. CONCLUSIONS: Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. RELEVANCE TO CLINICAL PRACTICE: These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.

Attitudes of midwives towards perinatal bereavement in Hong Kong.

OBJECTIVE: to explore attitudes towards perinatal bereavement care among midwives working in Hong Kong through examination of relationships between attitudes towards bereavement support, need for bereavement education and appropriate hospital policy. DESIGN: a descriptive correlational survey. SETTING: the obstetric and gynaecology units at two hospitals. INSTRUMENT: a structured self-report questionnaire on attitudes towards perinatal bereavement support; required support and education needs for midwives on bereavement care. PARTICIPANTS: 154 out of 202 midwives (76.2% response rate) working at the two units. FINDINGS: two-step cluster analysis yielded two clusters. Cluster 1 consisted of 91 (59.1%) midwives and cluster 2 consisted of 63 (40.9%) midwives. Cluster 2 midwives were younger, had less obstetric and gynaecology experience, junior ranking and less post-qualification education than cluster 1 midwives. Cluster 1 midwives had additional personal grieving experiences and experience of caring for grieving parents. Attitudes towards bereavement care were positively correlated with educational needs (r(s)=0.55, p< 0.001) and hospital policy support (r(s)=0.50, p< 0.001). CONCLUSIONS: Hong Kong midwives require increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team member support. Findings may be used to improve support of midwives, to ensure sensitive bereavement care in perinatal settings and to reflect training needs in the midwifery education curricula. Study findings highlight the universality of grief for a lost baby, irrespective of cultural differences in approaching emotional topics. This study may help midwives internationally to gain a broader perspective in this area.

Attitudes of nurses toward perinatal bereavement: findings from a study in Hong Kong.

AIM: Nurses' attitudes toward perinatal bereavement care are explored by identifying profiles of nurses working in 2 obstetrics and gynecology units in Hong Kong. Relationships between nurses' attitudes toward bereavement supports, need for bereavement education, and hospital policy are explored. RESEARCH METHOD: A descriptive, correlational survey design was used, and 169 nurses recruited from an obstetric and gynecology (ob-gyn) unit at 2 local public hospitals in Hong Kong completed a structured questionnaire. OUTCOME MEASURES: Attitudes toward perinatal bereavement support; required support and education needs for nurses on bereavement care. FINDINGS: Two-step cluster analysis yielded 2 clusters. Cluster 1 consisted of 55.6% (n = 94) and cluster 2 consisted of 44.3% (n = 75) of nurses. Cluster 2 nurses were younger and had less ob-gyn experience, more junior ranking, and less education than cluster 1 nurses. Cluster 1 nurses had additional midwifery and bereavement care education, personal grieving experiences, and experience handling grieving clients. The majority held positive bereavement care attitudes, but only 29.6% (n = 50) had bereavement-related education. Attitudes toward bereavement care were positively correlated with educational needs (r(s) = 0.52) and hospital policy support (r(s) = 0.56). CONCLUSIONS: Hong Kong nurses emphasized the need for increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team members' support. Findings may be used to improve support of nurses, to ensure sensitive bereavement care in perinatal settings, and to enhance nursing curricula. The desire of Hong Kong nurses for bereavement education highlights the universality of grief for a lost infant, regardless of cultural differences in approaching emotional topics. This study may help nurses in the United States and elsewhere gain a broader perspective in this area.