Association of frailty with activity levels and sedentary behaviours in patients with hepatitis B cirrhosis: A cross-sectional study.

BACKGROUND AND AIMS: Research on the association between activity levels and sedentary behaviour with frailty in patients affected by hepatitis B cirrhosis is sparse. This study aimed to explore the association of frailty with activity levels and sedentary behaviours in patients with hepatitis B cirrhosis. DESIGN: This cross-sectional study followed the STROBE checklist. METHODS: This study was conducted in Guangzhou, China, between August 2021 and October 2022. The frailty condition of patients with hepatitis B cirrhosis was assessed using the liver frailty index (LFI). Their physical activity levels and sedentary time were assessed using the International Questionnaire of Physical Activity. Pearson correlation and binary logistic regression were used to analyse the data. RESULTS: Among the 503 patients with hepatitis B cirrhosis in the final analysis, 107 (21.3%) were identified as frail. Frailty was negatively correlated with walking time (r = -0.174, p < 0.001), moderate-intensity activity time (r = -0.185, p < 0.001), high-intensity activity time (r = -0.243, p < 0.001) and total activity time (r = -0.256, p < 0.001). Patients with insufficient activity (<150 min/week) and sedentary behaviour (≥420 min/day) were found to have 2.829 times higher risk of frailty than those with sufficient activity (≥150 min/week) and no sedentary behaviour (<420 min/day) (95% CI: 1.380, 5.799). CONCLUSION: Patients with hepatitis B cirrhosis who exhibited frailty demonstrated limited physical activity and engaged in sedentary behaviours. NO PATIENT OR PUBLIC CONTRIBUTION: Patients with hepatitis B cirrhosis contributed their data to the study.

Effects of vaginal microbiota transfer on the neurodevelopment and microbiome of cesarean-born infants: A blinded randomized controlled trial.

The microbiomes of cesarean-born infants differ from vaginally delivered infants and are associated with increased disease risks. Vaginal microbiota transfer (VMT) to newborns may reverse C-section-related microbiome disturbances. Here, we evaluated the effect of VMT by exposing newborns to maternal vaginal fluids and assessing neurodevelopment, as well as the fecal microbiota and metabolome. Sixty-eight cesarean-delivered infants were randomly assigned a VMT or saline gauze intervention immediately after delivery in a triple-blind manner (ChiCTR2000031326). Adverse events were not significantly different between the two groups. Infant neurodevelopment, as measured by the Ages and Stages Questionnaire (ASQ-3) score at 6 months, was significantly higher with VMT than saline. VMT significantly accelerated gut microbiota maturation and regulated levels of certain fecal metabolites and metabolic functions, including carbohydrate, energy, and amino acid metabolisms, within 42 days after birth. Overall, VMT is likely safe and may partially normalize neurodevelopment and the fecal microbiome in cesarean-delivered infants.

Effectiveness of telehealth interventions on depression symptoms after stroke: A systematic review and meta-analysis.

BACKGROUND: Depression symptoms are common after stroke, and affect survivors' recovery of neurological function, ability to return to society, and quality of life. Telehealth has been shown to improve depression symptoms and quality of life among patients post-stroke. However, evidence from clinical trials has not previously been systematically synthesized. OBJECTIVE: This study aimed to systematically evaluate the effectiveness of telehealth interventions in reducing depression symptoms among patients post-stroke. METHODS: Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of telehealth interventions for post-stroke depression symptoms. The quality of included studies was assessed using the Cochrane risk of bias tool. RevMan 5.4 software was used for the meta-analysis. Data were synthesized by fixed (I2 ≤ 50 %) or random (I2 > 50 %) effects models based on a heterogeneity test. RESULTS: In total, ten studies with 1717 participants were included, eight of which were eligible for the meta-analysis. There were no significant differences in efficacy between the telehealth and control groups for depression symptoms (standardized mean difference [SMD] = -0.16, 95 % confidence interval [CI] -0.67 to 0.36; P = .54), quality of life (SMD = 0.00, 95%CI -0.18 to 0.18; P = .99), limb function (SMD = 0.46, 95%CI -0.26 to 1.18; P = .21), and daily living ability (SMD = 0.38, 95%CI -1.39 to 2.15; P = .67). The telemedicine group had significantly lower anxiety scores than the control group (SMD = -1.05, 95%CI -1.22 to -0.89; P < .001). LIMITATIONS: The number of randomized controlled trials (RCTs) included in the review was relatively small. CONCLUSIONS: This study suggests that telehealth interventions have comparable effects to usual nursing care in improving depression symptoms after a stroke. However, large-scale, high-quality RCTs are needed to further explore the potential of telehealth interventions in improving mental health among patients post-stroke.

The incidence of post-traumatic stress disorder following traumatic childbirth: A systematic review and meta-analysis.

BACKGROUND: Although birth trauma may be a risk factor for postpartum post-traumatic stress disorder (PTSD), no systematic review regarding the incidence of postpartum PTSD in women with traumatic childbirth has been reported. OBJECTIVE: To estimate the incidence of PTSD in women following traumatic childbirth by systematically reviewing and synthesizing all available evidence. SEARCH STRATEGY: Six databases were searched using a combination of related terms for birth trauma and PTSD. SELECTION CRITERIA: Cohort and cross-sectional studies that were related to traumatic childbirth and PTSD were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened potentially relevant studies and extracted key data elements. A series of meta-analyses were conducted using STATA 17.0 software, with pooled incidence rates estimated using random effects models. MAIN RESULTS: A total of nine studies were included in this study. The pooled incidence of PTSD after traumatic childbirth was 19.4% (95% confidence interval 11.9%-26.5%). The incidence of PTSD varied with the scales used to assess traumatic birth and PTSD, evaluation times of PTSD after childbirth, and types of study participants. CONCLUSIONS: The incidence of PTSD in women with traumatic childbirth is about 19%, higher than the general obstetric population, suggesting that trauma-related care for them should be enhanced.

Association between exclusive breastfeeding and postpartum post-traumatic stress disorder.

BACKGROUND: Research on the association between breastfeeding and postpartum post-traumatic stress disorder (PTSD) is sparse. This study aimed to examine the association between exclusive breastfeeding up to 42 days after childbirth and postpartum PTSD. METHODS: An epidemiologic study was conducted in a tertiary hospital in China between October 2019 and October 2020. Eligible mothers were recruited at 3 days after childbirth and assessed using the Post-Traumatic Stress Disorder Checklist - Civilian version (PCL-C) for PTSD at 42 days postpartum. The independent association between exclusive breastfeeding up to 42 days after childbirth and postpartum PTSD was estimated using log-binomial regression models, after adjusting for potential confounders. RESULTS: Ninety-two of 759 (12.1%) mothers developed postpartum PTSD within 42 days after childbirth. Compared with partially breastfeeding mothers, exclusively breastfeeding mothers had lower risks of postpartum PTSD (relative risk [RR] 0.28; 95% confidence interval [CI] 0.13, 0.59), re-experience (RR 0.48; 95% CI 0.30, 0.76), avoidance (RR 0.55; 95% CI 0.32, 0.97), and hyperarousal (RR 0.52; 95% CI 0.34, 0.78). After adjustment for family support, parity, mode of delivery, perceived birth trauma, early contact / suckling, and rooming-in, associations between exclusive breastfeeding and postpartum PTSD remained significant: the overall PTSD adjusted relative risk [aRR] was 0.31; (95% CI 0.15, 0.66), with a re-experience aRR of 0.48; (95% CI 0.30, 0.77) and hyperarousal aRR of 0.56; (95% CI 0.37, 0.85). CONCLUSION: Exclusive breastfeeding up to 42 days after childbirth was associated with reduced risk of postpartum PTSD. While the potential for reverse causation cannot be ruled out, strategies to improve rates of exclusive breastfeeding through teaching, counselling, and support may benefit mothers and their infants by reducing the risk of postpartum PTSD.

Effectiveness of Low-Frequency Electrical Stimulation for Radical Hysterectomy Women: Systematic Review and Meta-Analysis.

INTRODUCTION: The aim of the study was to explore the effects of low-frequency electrical stimulation (LFES) in preventing urinary retention after radical hysterectomy (RH) in women with cervical cancer. METHODS: Seven electronic bibliographic databases were searched from inception to December 25, 2021. The mean difference (MD) or risk ratio (RR) with its corresponding 95% CI was selected as effect size. The meta-analysis of all data was conducted using RevMan 5.4 and the evidence was summarized according to GRADE (the grading of recommendation, assessment, development, and evaluation). RESULTS: Twelve randomized control trials consisting of 1,033 women with cervical cancer who had undergone RH were included. Compared with women in the control group, women receiving LFES had improved therapeutic effect (RR = 0.22, 95% CI: 0.16-0.29) and reduced residual urine volume (MD = -32.27, 95% CI: -34.10 to -30.43) and catheter retention time (MD = -4.46, 95% CI: -5.17 to -3.76) following treatment. Muscle strength scores of pelvic floor type I and type II muscle fibers in the LFES group were also higher than in the control group (MD = 1.07, 95% CI: 0.91-1.24). CONCLUSION: LFES may be an effective auxiliary treatment for women with cervical cancer after hysterectomy, which can help reduce the duration of indwelling urethral catheter and residual urine volume.

Prevalence of eczema between cesarean-born and vaginal-born infants within 1 year of age: a systematic review and meta-analysis.

This study aims to quantify the difference in prevalence of eczema between cesarean-born and vaginal-born infants within 1 year of age through a systematic review and meta-analysis. Six electronic databases were searched from inception to August 31, 2021. Studies were included if they reported the prevalence of eczema in infants within 1 year of age with specified mode of delivery. The quality of included studies was assessed using the Joanna Briggs Instrument Critical Appraisal Checklist. Pooled prevalence and odds ratio (OR) were estimated by meta-analyses of included studies. Meta-regression was conducted to explore factors affecting heterogeneity of the prevalence of eczema. Nine studies were included with 3,758 cesarean-born infants and 9,631 vaginal-born infants. The prevalence of eczema in cesarean-born infants [27.8%; 95% confidence interval (CI): 17.7-39.2] was higher than in vaginal-born infants (20.1%; 95% CI: 13.9-28.1), with a pooled OR of 1.31 (95% CI: 1.04-1.65). Subgroup analyses showed that the prevalence of eczema in cesarean-born infants varied according to country, study design, and method of ascertainment. Additionally, the pooled prevalence of eczema in vaginal-born infants differed by age at which eczema was identified. Meta-regression analysis showed that study design and eczema ascertainment method were significant sources of heterogeneity. CONCLUSION: About 28% of cesarean-born infants within 1 year of age developed eczema, significantly higher than the 20% rate or occurrence seen in vaginal-born infants. PROTOCOL REGISTRATION: CRD 42,020,152,437. WHAT IS KNOWN: • Eczema, a complex inflammatory cutaneous disorder characterized by immune mediated inflammation and epidermal barrier dysfunction, is one of the most common allergic disorders in infants. • Eczema may increase the risk of immune-mediated inflammatory disease such as food allergy, asthma, and allergic rhinitis, leading to psychological and social burdens on affected individuals and their families. • Mode of delivery may be associated with the risk of developing eczema, although further studies are needed to clarify such differences. WHAT IS NEW: • This is the first systematic review designed to estimate the prevalence of eczema in cesarean- and vaginal-born infants within 1 year of age. • Cesarean delivery may increase the risk of developing eczema in infants within the first year of life.

Association between perceived birth trauma and postpartum depression: A prospective cohort study in China.

OBJECTIVE: To assess the association between women's perceived birth trauma and risk of postpartum depression (PPD). METHODS: We conducted a prospective cohort study in China between December 2018 and November 2019. Women aged 18-45 years who had a singleton live birth at a university teaching hospital were enrolled after written consent was obtained. PPD was defined as a score of 13 or more on the Chinese version of the Edinburgh Postnatal Depression Scale. We used multiple log-binomial regression analysis to estimate the independent association between perceived birth trauma and PPD. RESULTS: A total of 650 eligible women were included in the final analysis. Of them, 245 (37.69%) had self-reported perceived birth trauma and 188 (28.92%) developed PPD. The PPD rate was 42.04% in women with perceived birth trauma, compared with 20.99% in women without perceived birth trauma (crude relative risk [RR] 2.46, 95% confidence interval [CI] 1.48-3.72). The increased risk of PPD for women with perceived birth trauma remained after adjustment for sociodemographic and obstetric factors (adjusted RR 2.13, 95% CI 1.69-3.28). CONCLUSION: Perceived birth trauma may be an important risk factor for PPD in Chinese women. Supportive care for women who perceived childbirth as a trauma may help to reduce the risk of PPD.

Treatment for grade 4 peripheral intravenous infiltration with type 3 skin tears: A case report and literature review.

Grade 4 peripheral intravenous infiltration with skin tears has seldom been reported. On 4 August 2020, a 35-year-old female patient was admitted to the emergency department of our hospital because of postprandial abdominal pain for 2 hours. She was diagnosed with a severe acute pancreatitis with type II diabetes mellitus. On 7 August, a vein detained needle was inserted into the dorsal vein of her right foot to infuse drugs. On 9 August, a grade 4 infiltration, discoloured and bruised skin with a swollen area of 11 cm × 9 cm around the infusion part of her right foot, was discovered. The infusion was stopped immediately and the residual drug was aspirated at the infusion site. When removing the vein detained needle, the skin surrounding the infusion site on the right foot was torn by the adhesive dressing. The size of the skin tears was 6 cm × 3 cm (type 3). The patient was provided with appropriate dressing, manual lymphatic drainage, and surgical intervention. Two months later, she was fully recovered with no functional impairment of the affected foot. Timely local wound interventions could lead to a satisfactory outcome for severe peripheral intravenous infiltration with skin tears.

The prevalence of food allergy in cesarean-born children aged 0-3 years: A systematic review and meta-analysis of cohort studies.

Purpose: Previous studies reported a higher risk of food allergy for cesarean-born children than vaginal-born children. This study aims to systematically compare the prevalence of food allergy among cesarean-born and vaginal-born children aged 0-3 years. Methods: Three English and two Chinese databases were searched using terms related to food allergies and cesarean sections. Cohort studies that reported the prevalence of food allergy in cesarean-born and vaginal-born children aged 0-3 years were included. Two reviewers performed study selection, quality assessment, and data extraction. The pooled prevalence of food allergy in cesarean-born and vaginal-born children was compared by meta-analysis. Results: Nine eligible studies, with 9,650 cesarean-born children and 20,418 vaginal-born children aged 0-3 years, were included. Of them, 645 cesarean-born children and 991 vaginal-born children were identified as having food allergies. The pooled prevalence of food allergy was higher in cesarean-born children (7.8%) than in vaginal-born children (5.9%). Cesarean section was associated with an increased risk of food allergy [odds ratio (OR): 1.45; 95% confidence interval (CI): 1.03-2.05] and cow's milk allergy (OR: 3.31; 95% CI: 1.98-5.53). Additionally, cesarean-born children with a parental history of allergy had an increased risk of food allergy (OR: 2.60; 95% CI: 1.28-5.27). Conclusion: This study suggests that cesarean sections was associated with an increased risk of food and cow's milk allergies in children aged 0-3 years. Cesarean-born children with a parental history of allergy demonstrated a higher risk for food allergy than did vaginal-born children. These results indicate that caregivers should be aware of the risks of food allergies in cesarean-born children, reducing the risk of potentially fatal allergic events. Further research is needed to identify the specific factors affecting food allergies in young children. Systematic Review Registration: http://www.crd.york.ac.uk/prospero, identifier: International Prospective Register of Systematic Reviews (NO. CRD42019140748).

Effectiveness of Telehealth Interventions for Women With Postpartum Depression: Systematic Review and Meta-analysis.

BACKGROUND: Postpartum depression (PPD) is a prevalent mental health problem with serious adverse consequences for affected women and their infants. Clinical trials have found that telehealth interventions for women with PPD result in increased accessibility and improved treatment effectiveness. However, no comprehensive synthesis of evidence from clinical trials by systematic review has been conducted. OBJECTIVE: The aim of this study is to evaluate the effectiveness of telehealth interventions in reducing depressive symptoms and anxiety in women with PPD. To enhance the homogeneity and interpretability of the findings, this systematic review focuses on PPD measured by the Edinburgh Postnatal Depression Scale (EPDS). METHODS: PubMed, The Cochrane Library, CINAHL, PsycINFO, CNKI, and Wanfang were electronically searched to identify randomized controlled trials (RCTs) on the effectiveness of telehealth interventions for women with PPD from inception to February 28, 2021. Data extraction and quality assessment were performed independently by two researchers. The quality of included studies was assessed using the Cochrane risk-of-bias tool, and meta-analysis was performed using RevMan 5.4 software. RESULTS: Following the search, 9 RCTs with a total of 1958 women with PPD were included. The EPDS (mean difference=-2.99, 95% CI -4.52 to -1.46; P<.001) and anxiety (standardized mean difference=-0.39, 95% CI -0.67 to -0.12; P=.005) scores were significantly lower in the telehealth group compared with the control group. Significant subgroup differences were found in depressive symptoms according to the severity of PPD, telehealth technology, specific therapy, and follow-up time (P<.001). CONCLUSIONS: Telehealth interventions could effectively reduce the symptoms of depression and anxiety in women with PPD. However, better designed and more rigorous large-scale RCTs targeting specific therapies are needed to further explore the potential of telehealth interventions for PPD. TRIAL REGISTRATION: PROSPERO CRD42021258541; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258541.

Maternal and neonatal outcomes in women undergoing Roux-en-Y gastric bypass: A systematic review and meta-analysis.

BACKGROUND: To summarize evidence of benefits and risks of maternal and neonatal outcomes among pregnant women after Roux-en-Y gastric bypass surgery. METHODS: A systematic search was conducted in MEDLINE, EMBASE, Web of Science, Ovid and Cochrane Library until 24th May 2021. Inclusion criteria were randomized trails or observational studies including at least one of maternal or neonatal outcomes from pregnant women who had a history of Roux-en-Y gastric bypass surgery with a control group of pregnant women with no history of bariatric surgery. Non-English studies were excluded. Both fixed-effect and random-effect models were used in the meta-analyses. Newcastle-Ottawa Scale was used to assess quality of studies. RESULTS: Twelve retrospective articles were eligible including 13 848 pregnant women with a history of Roux-en-Y gastric bypass surgery and 255 008 pregnant women without a history of bariatric surgery. The results of meta-analysis showed a lower incidence of preterm premature rupture of membranes (OR 0.53, 95% CI [0.47, 0.60], p < 0.00001), large gestational age infants (OR 0.28, 95%CI [0.22, 0.37], p < 0.00001) or macrosomia (OR 0.26, 95%CI [0.23, 0.30], p < 0.00001) in women after Roux-en-Y gastric bypass surgery. On the other hand, infants born to mothers with a history of Roux-en-Y gastric bypass surgery had an increased risk of small gestational age (OR 2.24, 95% CI [1.55, 3.24], p < 0.00001). CONCLUSION: Roux-en-Y gastric bypass surgery reduces significantly of risks of preterm premature rupture of membranes and large for gestational age/ macrosomia, but increase the risk of small for gestational age.

Comparison of Adverse Maternal and Neonatal Outcomes in Women Affected by Placenta Previa With and Without a History of Cesarean Delivery: A Cohort Study.

OBJECTIVE: Comprehensive comparison of maternal and neonatal outcomes between placenta previa with and without a history of caesarean delivery is sparse in the literature. The objective of this study was to conduct such an analysis. METHODS: We conducted a retrospective cohort study involving all cases of placenta previa among 56 070 singleton births at two tertiary care hospitals in Guangdong, China, between January 2014 and December 2018. Placenta previa cases were divided into two groups: those with a history of caesarean delivery and those without. We first compared baseline characteristics and then compared maternal and neonatal outcomes between the two groups. Multiple log binomial regression and multiple linear regression analyses were performed to estimate independent association between a history of caesarean delivery and adverse maternal and neonatal outcomes. RESULTS: A total of 773 placenta previa cases were included in the final analysis. Of them, 546 had a history of cesarean delivery and 227 did not. Compared with placenta previa cases without a history of cesarean delivery, placenta previa cases with a history of caesarean delivery were at increased risks of placenta accrete and increta, uterine rapture, shock, severe anemia, hysterectomy, and increased bleeding and hospital costs. No differences in neonatal outcomes between the two groups were observed. CONCLUSIONS: History of caesarean delivery is associated with an increased risk of adverse maternal outcomes but not with neonatal outcomes with placenta previa.

The Effects of Traditional Chinese Medicine as an Auxiliary Treatment for COVID-19: A Systematic Review and Meta-Analysis.

Background: Coronavirus disease 2019 (COVID-19) has become a pandemic with no specific and widely accepted effective drug or vaccine. However, studies have shown that Traditional Chinese Medicine (TCM) may play a significant role as an auxiliary treatment for COVID-19. Objective: This study aimed to assess the effects of TCM as an auxiliary treatment for COVID-19 through a systematic review of randomized-controlled trials (RCTs). Methods: Four English and three Chinese language databases were searched from December 1, 2019, to June 30, 2020. RCTs comparing TCM in combination with Western medicine (WM) with the same WM therapies alone for confirmed COVID-19 patients were included. The outcome measures were cure rate, lowering of body temperature, cough relief, improvement in chest computed tomography (CT) images, deterioration of condition, and adverse effects. Methodological quality was assessed using the Cochrane risk-of-bias tool. A series of meta-analyses were conducted for selected outcomes using RevMan 5.3 software. The quality of evidence was appraised using the grading of recommendation, assessment, development, and evaluation (GRADE) recommendations. Results: Ten RCTs with a total of 1,285 patients were included. Compared with WM alone in treating COVID-19, WM with auxiliary treatment by TCM appears to have increased the cure rate (risk ratio [RR] 1.15 [95% confidence interval (CI) 1.04-1.26]), relieved cough (RR 1.32 [95% CI 1.15-1.52]), improved chest CT images (RR 1.23 [95% CI 1.11-1.37]), and reduced the number of cases transitioning from a moderate to severe condition (RR 0.58 [95% CI 0.43-0.77]). The authors are uncertain whether TCM combined WM has effects on fever normalization (RR 1.10 [95% CI 0.94-1.29]) or adverse effects (RR 0.81 (95% CI 0.42-1.57]). Although they evaluated the certainty of evidence for lowering body temperature and adverse effects as very low, and low for cure rate, certainty was evaluated as moderate for improvement in chest CT images, cough relief, and deterioration of condition. Conclusion: TCM may be an effective auxiliary treatment for COVID-19 patients, which is likely to help improve the main symptoms and reduce disease progression. However, due to the limited number of studies and apparent heterogeneity among them, a more definitive conclusion on the effect of TCM on lowering body temperature and adverse effects cannot be drawn at this time.

The impact of pregnancy on postoperative outcomes among obese women who underwent bariatric surgery: A systematic review and meta-analysis.

OBJECTIVES: Women who had a history of bariatric surgery are increasingly becoming pregnant. There is growing evidence showing that increased risk of postoperative complications may be associated with the gestation after bariatric surgery.The objective of this systematic review was to evaluate the potential impact of pregnancy on weight loss and postoperative complications in obese women after bariatric surgery. STUDY DESIGN: PubMed, Embase, Medline and Cochrane Central Register of Controlled Trails were searched from inception through October 2018. Selection criteria included observational or randomized trial examining weight loss and medical complications in pregnant compared to non-pregnant women after bariatric surgery. Two reviewers extracted information and performed quality appraisal of eligible articles. Meta-analysis was performed to ascertain the certainty of the evidence when possible. RESULTS: Seven observational cohort studies with a total of 27,369 obese women were included in the final analysis. The mean difference (95 % confidence interval) in percent excess weight loss between pregnant and non-pregnant subjects was -9.5 (-19.9, 0.9). The odds ratio (95 % confidence interval) for postoperative complications in pregnant relative to non-pregnant subjects was 0.85 (0.33, 2.18). CONCLUSIONS: Pregnancy may have little or no effect on weight loss or postoperative complications in women who have undergone bariatric surgery.

Prevalence of Post-Traumatic Stress Disorder Following Caesarean Section: A Systematic Review and Meta-Analysis.

Background: While caesarean section (CS) can be a lifesaving intervention when performed in a timely manner to overcome dystocia or other complications, it is a traumatic event and may increase the risk of post-traumatic stress disorder (PTSD). No attempt has been made to assess prevalence of PTSD after CS specifically. This study aimed to quantify pooled prevalence of PTSD after CS through a systematic review and meta-analysis. Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL were searched using PTSD terms crossed with CS terms. Studies were included if they reported the prevalence of PTSD after CS using an instrument based on Diagnostic and Statistical Manual of Mental Disorders-criteria to identify PTSD. The pooled prevalence was then estimated by meta-analysis in overall eligible studies and in subgroups. Results: Nine studies were included with a total of 1,134 postpartum women, of which 136 were identified as having PTSD. Pooled prevalence of PTSD after CS was 10.7% (95% confidence interval [CI]: 4.0-20.2). Pooled prevalence of PTSD after emergency CS (10.3% [95% CI: 1.7-24.9]) was higher than that after elective CS (7.1% [95% CI: 0.7-19.4]), but the difference was not statistically significant. Subgroup analysis showed that pooled prevalence of PTSD after CS differed according to study setting, time interval of PTSD assessment, and type of participants. Meta-regression analysis showed that study setting and type of study participants were significant sources of heterogeneity. Conclusions: Women with CS apparently have higher rates of PTSD as compared with women without CS. However, the susceptibility to PTSD appears to vary based on emergency/elective CS, study methodology, self-perceived traumatic birth, and country of study. Further targeted research is needed to elucidate the role of these factors in relationship between CS and PTSD.

Risk factors and consequences of undiagnosed cesarean scar pregnancy: a cohort study in China.

BACKGROUND: The historically high cesarean section rate and the recent change in second-child policy could increase the risk of cesarean scar pregnancy (CSP) in China. This study aims to assess risk factors and consequences of undiagnosed CSP in China. METHODS: We conducted a retrospective cohort study between January 2013 and December 2017 in Qingyuan, Guangdong, China. Independent risk factors for undiagnosed CSP at the first contact with healthcare providers were assessed by log binomial regression analysis. Occurrence of serious complications was compared between undiagnosed and diagnosed CSP cases. RESULTS: A total of 195 women with CSP were included in the analysis. Of them, 81 (41.5%) women were undiagnosed at the first contact with healthcare providers. Women initially cared in primary or secondary hospitals were at increased risk for undiagnosed CSP: adjusted relative risks (95% confidence intervals) were 3.28 (2.06, 5.22) and 1.91 (1.16, 3.13), respectively, compared with women initially cared in the tertiary hospital. Undiagnosed CSP cases had higher incidences in serious complications (11 versus 0) and post-surgery anemia (23 (28.4%) versus 8 (7.0%)), stayed longer in hospital, and cost higher than diagnosed CSP cases. CONCLUSIONS: Initial care provided at primary or secondary maternity care facilities is an important risk factor for undiagnosed CSP, with serious consequences to the affected women.

Using Video Feedback Through Smartphone Instant Messaging in Fundamental Nursing Skills Teaching: Observational Study.

BACKGROUND: Video feedback has been shown to be an effective teaching tool that can improve student learning when having them view their own performance. However, the literature on the effect of integrating smartphones with video feedback in fundamental nursing skills teaching is sparse. OBJECTIVE: This study aimed to explore the potential effects of video feedback through smartphone-based instant messaging on teaching undergraduate nursing students fundamental nursing skills. METHODS: We conducted a study on teaching fundamental nursing skills to 6 classes of second-year undergraduate nursing students. In 2 classes (the intervention group), the instructor elected to use smartphone-based video feedback to facilitate teaching; instructors in the other 4 classes (the control group) elected to use routine methods of teaching without video feedback. Scores from the final examination, in-class assignments, and the General Self-Efficacy Scale questionnaire were collected and compared between the two groups. Multiple linear regression analysis was performed to estimate the independent effect of video feedback after adjusting for gender, age, and prior experience in the use of WeChat/QQ in learning applications. An ad hoc questionnaire was used for student evaluation of the novel smartphone-based video feedback teaching method. RESULTS: A total of 195 nursing students (65 in the video feedback group and 130 in the control group) completed the study and were included in the final analysis. Mean and standard deviation of scores on the final examination, bed making, aseptic procedure, vital signs measurement, and oxygen therapy were 91.29 (SD 2.36), 90.52 (SD 3.18), 93.23 (SD 3.16), 91.65 (SD 4.21), and 92.06 (SD 3.58), respectively, in the video feedback group and 89.99 (SD 3.12), 81.71 (SD 8.63), 87.12 (SD 5.50), 87.45 (SD 8.00), and 90.37 (SD 6.36), respectively, in the control group (differences were statistically significant). The mean and standard deviation of scores for assignments in catheterization and enema and General Self-Efficacy Scale were 89.69 (SD 3.22), 91.14 (SD 3.15), and 24.52 (SD 5.35), respectively, in the video feedback group and 88.82 (SD 7.48), 90.79 (SD 6.08), and 24.50 (SD 6.16), respectively, in the control group (differences were not statistically significant). The majority (over 98%) of nursing students were satisfied with this smartphone-based video feedback teaching method. CONCLUSIONS: Video feedback through smartphone-based instant messaging may be an effective way to improve nursing students' academic performance and professional skills.

Neighborhood Income and Cesarean Section Rates at a Tertiary Care Center in Canada.

Background: With rising rates of cesarean sections (CSs) in Canada and worldwide, nonclinical factors for CS warrant consideration. Objective: To determine the association between a primigravid woman's neighborhood income and rates of CSs. Materials and Methods: A retrospective cohort study was conducted at an Ontario tertiary care center from January 2003 to December 2013. Rates of CSs were determined using data collected from the Discharge Abstract Database. Women with singleton live births were included. The main exposure variable was the neighborhood income quintile. A multivariable model was used to adjust for covariates and provide an estimate of the independent effect of neighborhood income on the CS rate. Results: The study cohort comprised 32,714 women. Compared with the lowest quintile, women in the highest quintile had increased rates of CSs (relative risk, RR 1.06, 95% confidence interval, CI [1.02-1.11]). Following adjustment for important confounders, there was no longer an association between the neighborhood income and CS rate (adjusted RR 1.00, 95% CI [0.99-1.01]). Women in the highest quintile were more likely to have greater maternal age (p < 0.01). Conclusions: Although differences in CS rates are seen by the neighborhood income quintile, they appear to be mediated through a combination of maternal age and other clinical factors. Neighborhood income does not appear to be an independent predictor of CS.