Socio-demographic and psychological determinants of exclusive breastfeeding after six months postpartum - a Polish case-cohort study.

OBJECTIVES: The purpose of this study was to explore the socio-demographic and psychological factors connected with exclusive breastfeeding after 6 months postpartum. MATERIAL AND METHODS: A total of 251 women filled in questionnaires in the first week postpartum, then again after 3 and 6 months. The questionnaires included socio-demographic and medical questions, as well as psychological tools: the NEO-FFI Personality Inventory, the Berlin Social Support Scales (BSSS), and the Edinburgh Postnatal Depression Scale (EPDS). Further detailed questions concerning breastfeeding were relevant to this study. RESULTS: The rate of exclusive breastfeeding after 6 months was 39.68%. It was found that exclusive breastfeeding was most strongly connected with attending prenatal classes (ORa = 2.84, CI 1.18-6.87, p = 0.01), formula supplementation after 3 months (ORa = 0.01, CI 0.002-0.08, p < 0.001) and the mother's subjective satisfaction with feeding the infant after 3 months (ORa = 1.44, CI 1.01-2.06, p = 0.04). No other psychological (as far as personality, social support or risk of postpar-tum depression are concerned), demographic or medical factors were significant. Only factors pertaining to breastfeeding were significant. CONCLUSIONS: The prevalence of exclusive breastfeeding in Poland is unsatisfactory. Women should have easy access to prenatal classes with the most up-to-date knowledge on lactation and be advised against supplementing with formula, whenever possible. This could lead to higher satisfaction with breastfeeding.

Medical and psychosocial determinants of risk of postpartum depression: a cross-sectional study.

OBJECTIVE: The aim of this study was to investigate the degree of risk of maternal postpartum depression during the second month of puerperium. METHOD: In total, 387 postnatal women filled out a questionnaire concerning their health and social status, as well as the following tests: the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire-9 (PHQ-9), the Neo Five-Factor Inventory (NEO-FFI) Personality Inventory and the Berlin Social Support Scales. After 4-8 weeks, patients responded to another questionnaire with the EPDS and the PHQ-9. RESULTS: In total, 48 patients (12.40%) were found to be at risk of postpartum depression between the fourth and eighth weeks after delivery. Premenstrual syndrome [adjusted odds ratio (ORa)=2.93, confidence interval (CI) 1.30-6.63] and EPDS>12 points during the first week after the delivery (ORa=3.74, CI 1.59-9.04) increased the risk of postnatal depression. A similar role is played by a high result in neuroticism scale of the NEO-FFI (ORa=1.50, CI 1.17-1.92) and a positive family history of any psychiatric disorder (ORa=1.03, CI 1.01-1.06). CONCLUSION: A history of premenstrual syndrome and a higher risk of affective disorder soon after a childbirth are associated with greater chances of depressive symptoms in the second month postpartum. This is also the case if a patient is neurotic and has a relative with a history of any psychiatric disorder. Such women should have their mental status carefully evaluated.

Relationship, social support, and personality as psychosocial determinants of the risk for postpartum blues.

OBJECTIVES: The purpose of the study was to identify factors increasing or decreasing the risk for postpartum blues. MATERIAL AND METHODS: A total of 101 women in their first week postpartum were included in the study. The Edinburgh Postnatal Depression Scale, questions concerning their medical and social status, and psychological tests (the Personality Inventory NEO-FFI, The Mieczyslaw Plopa and Jan Rostowski Marriage Questionnaire, and the Berlin Social Support Scales) were used. RESULTS: The probability of postpartum blues was detected in 16.8% of the respondents. The risk decreased with higher satisfaction with intimacy (OR = 0.81), partner similarity (OR = 0.78), and the overall satisfaction with the relationship (OR = 0.94), while higher disappointment elevated that risk (OR = 1.12). As far as social support is concerned, further inde-pendent factors included perceived available social support (OR = 0.31), perceived instrumental social support (OR = 0.24), need for support (OR = 2.74), and protective buffering support (OR = 3.41). High level of neuroticism as well as fear of childbirth increased the risk for postpartum blues (OR = 2.17 and OR = 1.30, respectively). High level of extraversion and better quality of sleep constituted protective factors (OR = 0.74 and OR = 0.60, respectively). CONCLUSIONS: Maternal disappointment with marriage/relationship, neuroticism and introversion, poor quality of sleep, fear of childbirth, and seeking social support are among the factors signaling the need for careful observation for signs of possible postpartum mood disorders both, during hospitalization and the follow-up visits.

Personality type, social support and other correlates of risk for affective disorders in early puerperium.

OBJECTIVES: The purpose of this study was to assess the prevalence of risk for postpartum mood disorders in mothers during the early postnatal period and to search for coexisting conditions. MATERIAL AND METHODS: We studied 546 women in the first week after delivery. The subjects filled out a questionnaire concerning their health, social and demographic status, the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire, the NEO-FFI Personality Inventory and the Berlin Social Support Scales. RESULTS: Probable mood disorders affected 15.85% of these patients. The risk increased with a current cesarean section (ORa = 2.54), a higher level of neuroticism (ORa = 1.65), greater fear of childbirth (ORa = 1.18), a lower level of extraversion (ORa = 0.77) and greater need for social support (ORa = 2.68). CONCLUSIONS: High level of neuroticism and introversion, as well as higher fear of delivery and the need of social support are among factors increasing the probability of mood disturbances in early postpartum period. A cesarean section might elevate the risk similarly. The mental health of such patients should be carefully examined.

Tertiary prevention strategies for micrometastatic lymph node cervical cancer: A systematic review and a prototype of an adapted model of care.

PURPOSE: We found a need for balancing the application of clinical guidelines and tailored approaches to follow-up of cervical cancer (CC) patients in the lymph node micrometastatic (MICs) setting. This review aimed to determine the current knowledge of management of MIC-positive CC cases. METHODOLOGY: We addressed prognostic and risk of recurrence monitoring impacts associated with MIC+ cases. The electronic databases for literature and relevant articles were analysed. RESULTS: Fifteen studies, (4882 patients), were included in our systematic review. While the results show that MICs significantly worsen prognosis in early CC. A tertiary prevention algorithm for low volume lymph node disease may stratify follow-up according to the burden of nodal disease and provide data that helps improve follow-up performance. CONCLUSION: MICs worsen prognosis and should be managed as suggested by the algorithm. However, this algorithm must be externally validated. The clinical impact of isolated tumor cells (ITC) remains unclear.

Screening for maternal postpartum depression and associationswith personality traits and social support. A Polish follow-upstudy 4 weeks and 3 months after delivery. / Ryzyko depresji poporodowej a cechy osobowosci i wsparcie spoleczne. Polskie przesiewowe badanie obserwacyjne matek 4 tygodnie i 3 miesiace po porodzie.

OBJECTIVES: To investigate the likelihood of postpartum depression and to explore maternal characteristics in terms of personality, social support and other medical and psychological data. METHODS: A sample of 548 patients was investigated 4 weeks and 3 months after delivery. They responded to questionnaires containing sociodemographic questions: the EPDS (Edinburgh Postnatal Depression Scale), the PHQ-9 (Patient Health Questionnaire-9), theNEO-FFI (Personality Inventory), and the BSSS (Berlin Social Support Scales). RESULTS: Probable depression any time during first 3 months postpartum was prevalent among 6.38% of women, based on the following criteria: EPDS > 12 points and PHQ-9 > 9 points. A score of EPDS > 9 in the first week after delivery (ORa = 4.16; CI 1.59-10.86), a history of hospitalisation during pregnancy (ORa = 3.51; CI 1.32-9.20), a high level of neuroticism (ORa = 1.37; CI 1.05-1.77), and high buffering-protective social support (ORa =2.56; 1.25-5.23) were significantly associated with depressive symptoms. Potential protective factors were initial breastfeeding (ORa = 0.31; CI 0.11-0.90) and high satisfaction with currently received social support (ORa=0.41;CI 0.22-0.79). The total dropout rate was 23%. CONCLUSIONS: New mothers who are neurotic and who suffered from physical or mental problems during pregnancy and puerperium might experience depressive symptoms more easily. They would also protect those close to them from negative information about themselves. A lack of initial breastfeeding and unsatisfactory social support played a similar role.