The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis

INTRODUCTION

Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies.

METHODS

Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies.

RESULTS

Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs.

DISCUSSION

Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.

The use of hydrotherapy in the first stage of labour: A systematic review and meta-analysis

AIM

To explore the effect of hydrotherapy applied in the first stage of labour on the health of mother and newborn.

METHODS

This systematic review and meta-analysis was carried out by following PRISMA. The studies were obtained by scanning EBSCO, PubMed, Science Direct, Ovid, Web of Science and Scopus electronic databases. Twenty studies published between 2013 and 2023 were included.

RESULTS

The total sample size of the studies was 8254 (hydrotherapy: 2953, control: 5301). Meta-analyses showed that the perception of pain decreased, comfort level and vaginal birth rate were higher and assisted vaginal birth rate and APGAR scores in the first minute were lower in women who underwent hydrotherapy. There was no difference between groups in terms of the duration of the first and second stage of labour, episiotomy, perineal trauma, intrapartum and postpartum bleeding amounts, use of pain medication and labour augmentations, APGAR scores in the fifth minute, positive neonatal bacterial culture and neonatal intensive care unit need.

CONCLUSION

This study revealed that the results that hydrotherapy decreased the perception of pain and assisted birth, increased the rate of vaginal birth and comfort level and did not adversely affect the health of the mother and baby during the birth process.

Effectiveness of structured education and follow-up in the management of perceived breastmilk insufficiency: A randomized control trial

In this study, we examine the effectiveness of structured education and follow-up in the management of perceived milk insufficiency and in increasing the baby's amount of milk intake in breastfeeding mothers. We conducted a randomized controlled trial over the period December 2018-June 2019 at Family Health Centers in Turkey with 64 mothers (intervention group: 33 and control group: 31). We provided the intervention group with education using structured educational material. A Descriptive Information Form, a Breastfeeding Follow-up Form, and the Scoring System for Measuring a Baby's Intake of Breast Milk were the instruments we used in the data collection. Mothers in the intervention group started breastfeeding their babies in the first one hour after birth. We observed at each monitoring that a significantly greater percentage of the mothers in the intervention group believed their milk to be sufficient and that they fed their babies exclusively with breast milk in the three follow-ups. We found from the data we obtained that all three tracking times indicated that the baby's amount of milk intake in the intervention group was better than in the control group; the differences were statistically significant. We concluded that structured education and follow-ups increased the exclusive breastfeeding of 0-2-month-old babies, improved perceptions of sufficient milk intake, diminishing the perception of breast milk deficiency.Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.2007249.

Maternal and perinatal outcomes of pregnancy associated with COVID-19: Systematic review and meta-analysis

INTRODUCTION

This study explored maternal and infant outcomes in the periods of pregnancy, birth and the postpartum, in women with COVID-19.

METHODS

After PROSPERO registration (CRD42020191106), scanning for the studies was carried out over the period 5-15 May 2020 in the PubMed, Science Direct, EBSCO and Web of Science databases with the search string: ['COVID-19' AND ('pregnancy' OR 'pregnant' OR 'maternal outcomes' OR 'infant outcomes' OR 'fetal outcomes' OR 'birth')]. Studies reporting maternal and perinatal outcomes of pregnant women with COVID-19 were included. Data were extracted independently by two researchers and combined with meta-analysis and pooled analysis.

RESULTS

The 54 studies included in this analysis contained data on 517 pregnant women diagnosed with COVID-19 and 385 infants. Of the pregnant women, 18% had gone into preterm labor and 77% had given birth by caesarean. Of the newborns, 19% had low birth weight, 14% had fetal distress, and 24% were admitted into the neonatal intensive care unit. Nine maternal and eight baby mortalities were reported in the studies.

CONCLUSIONS

The study revealed that COVID-19 in pregnant women appeared to be negative maternal and infant outcomes, with mortalities as well.

The impact of adolescent pregnancy on maternal and infant health in Turkey: Systematic review and meta-analysis

OBJECTIVES

To examine the impact of adolescent pregnancy on maternal and infant health on the basis of studies conducted in Turkey.

MATERIAL AND METHODS

Systematic reviews and meta-analyses of cross-sectional and case-control. A systematic scan was performed in January 2020 based on the keywords "adolescent pregnancy or teenage pregnancy and Turkey" in the electronic databases PubMed, Clinical Key, Science Direct, Web of Science, Google Scholar, National Thesis Center, DergiPark, Ulakbim, Turkish Medline and Turkish Clinics. Two of the authors carried out a scan independently of each other, making a selection of articles, performing data extraction and quality assessment procedures under the supervision of the senior researcher.

RESULTS

The results of a total of 38 studies, of which twenty-three were cross-sectional and 15 were case-control, were compiled for the meta-analysis (adolescents: 20,768; control: 59,481). The results of the meta-analysis showed that the more common effects of adolescent pregnancies were preterm birth (OR: 2.12, p < 0.001), early membrane rupture (OR: 1.49, p < 0.001), anemia (OR: 2.60, p < 0.001), low birthweight/intrauterine growth retardation (OR: 2.06, p < 0.001), and fetal distress (OR: 1.78, p = 0.003). On the other hand, it was observed in the meta-analysis that childbirth by cesarean section (OR: 0.70, p < 0.001), gestational diabetes (OR: 0.35, p < 0.001), placenta previa (OR: 0.52, p = 0.01), polyhydramnios (OR: 0.52, p = 0.04) and macrosomia (OR: 0.54, p < 0.001) were less common among adolescents compared to adults.

CONCLUSION

Our review revealed that adolescent pregnancy had an adverse impact on maternal and infant health in terms of preterm childbirth, early membrane rupture, anemia, low birthweight/intrauterine growth retardation, low Apgar scores and fetal distress.

Comparison of blood pressure and pulse readings measured on a bare arm, a clothed arm and on an arm with a rolled-up sleeve

BACKGROUND

Although there are standards for measuring blood pressure and pulse, nurses and other health professionals implement different practices. It has been observed that these measurements are sometimes taken over sleeves or with rolled-up sleeves due to various cultural factors or as a matter of convenience. There is a need to investigate whether measurements taken in this form can be counted on to be reliable.

OBJECTIVE

This study aimed to compare blood pressure and pulse readings measured on a bare arm, a clothed arm and on an arm with a rolled-up sleeve.

METHODS

This study, of analytical design, was conducted with 200 individuals at the Adnan Menderes University Research and Practice Hospital in January and December 2017. A questionnaire and a measurement recording form were used in collecting the data. The participants' blood pressure and pulse readings were taken and the circumference of the clothed and bare arm and arm skinfold thickness was measured. The data were analyzed using descriptive statistics, the independent samples t-test, and Pearson's correlation test.

RESULTS

The mean age of the individuals participating in the study was 33.38 ± 9.14 (range: 19-51). It was observed that in the measurements taken over a bare and clothed arm, mean systolic (114.48 ± 13.18 and 114.72 ± 12.21, respectively) and diastolic (70.42 ± 8.72 and 70.24 ± 8.63, respectively) blood pressure readings were statistically similar (t = -0.41, p = 0.682; t = 0.45, p = 0.653, respectively). On the other hand, in the measurements taken over an arm with a rolled-up, constricting sleeve, it was observed that mean systolic (116.76 ± 13.00) and diastolic (71.99 ± 9.15) blood pressure readings were statistically higher than measurements taken over a bare arm (t = -3.88, p = 0.000; t = -3.75, p = 0.000, respectively) and a clothed arm (t = -3.43, p = 0.001; t = -4.31, p = 0.000, respectively). Similarly, pulse readings taken from an arm with a rolled-up, constricting sleeve (82.40 ± 12.15) were found to be statistically higher than pulse readings taken from a bare arm (79.68 ± 12.30) and a clothed arm (80.44 ± 11.10) (t = -6.78, p = 0.000; t = -5.50, p = 0.000, respectively). The analysis indicated blood pressure and pulse readings were positively correlated with arm thickness but not correlated with the arm skinfold thickness or the thickness of the clothing.

CONCLUSION

The study revealed that constricting rolled-up sleeves and the thickness of the circumference of the arm were factors that produced higher systolic and diastolic blood pressure and pulse readings.

The prevalence and risk factors of gestational diabetes mellitus in Turkey: a systematic review and meta-analysis

OBJECTIVE

To identify the prevalence and related risk factors of gestational diabetes mellitus (GDM) based on studies on the condition conducted in Turkey.

METHODS

The study is a systematic review and meta-analysis and was conducted over the period November-December 2017 by performing a search of the Turkish and English literature. The international databases were accessed using the keywords "gestational diabetes" and "Turkey" and the national databases were scanned using the word groups, "gestational diabetes", "diabetes in pregnancy", "pregnancy and diabetes," and "pregnancy diabetes". Forty-one complete articles on research carried out in Turkey over the period 2004-2016 and published in 2006-2018 on the prevalence of GDM and/or a reported risk factor were included in the study. Combined percentage calculations were employed to determine GDM prevalence.

RESULTS

It was found in this systematic review and meta-analysis of the studies examined that out of the total of 50,767 pregnant women included in the studies, 3891 had GDM. Based on these data, combined GDM prevalence was calculated as 7.7% (range: 1.9-27.9%). It was observed that the highest combined GDM prevalence was 17.6% in the black Sea Region and the lowest was 5.1% in the Central Anatolian Region. Fourteen risk factors had been reported as statistically significant in the studies included in the systematic review. The most commonly reported of these was advanced maternal age, being overweight prior to pregnancy, gaining weight in pregnancy, diabetes in the family, a history of GDM or giving birth to a large baby.

CONCLUSIONS

It was observed in this meta-analysis that the prevalence of GDM in Turkey is notably high and risk factors are similar to what has been reported in current international literature. The continuation of routine screening tests to detect GDM may contribute to controlling the condition while ensuring that risk groups take special preventive measures and mother-child health is protected.

IMPLICATIONS FOR PRACTICE

Results of this study might be used in the organization of prenatal care, especially high-risk pregnant women for GDM. Nursing researchers and health care managers should consider this situation in the implementing of prenatal care serving.

Breastfeeding problems and interventions performed on problems: systematic review based on studies made in Turkey

To determine the breastfeeding problems encountered in the postpartum period and effect of interventions done in relation to the problems based on breastfeeding studies in Turkey. This study is a systematic review and was conducted by performing a scan of the Turkish and English literature over the period October 2016-February 2017. The study included 27 articles and seven theses, which were published in 2000-2015 in Turkey and published in 2008-2017. Data are presented tabulating and the aggregate percentages were calculated for some data showing common characteristics. A total of 6736 parents and 592 babies were included in these studies. As a result of the combined percentage calculation based on the data of cross-sectional and case-control studies, the most frequently reported problems were having breastfeeding problem (24.5%), mother's milk deficiency/worry about milk deficiency/thinking her baby is not satisfied/baby's inadequate weight gain (15.7%), lack of knowledge and experience about breastfeeding/need for education and support (17.8%). Again, these studies showed that women stated the problems about have flat/depressed/small nipple (7.7%), pain/sensitivity (3.9%), swelling/fullness/engorgement (10.8%), redness (28.8%), crack/wound/bleeding (26.1%) and mastitis (5.6%). Methods of prenatal education/counselling/motivation/follow-up, strong motivation, proactive lactation management and social support, moist warm application, using of breast milk and olive oil and using of breast shield and feeding with container and pacifier using have been reported to be effective in the experimental/quasi-experimental and case report studies included in this systematic review. This study showed that women experienced a lot problem with breastfeeding and that more prenatal education/counselling/monitoring was used in reducing problems.

Present Status of Studies in the Field of Midwifery in Turkey

Purpose

The purpose of this study was to determine the present status of studies as midwifery published over the period 2000–2015 in Turkey.

Method

The study, based on the literature, is of retrospective and descriptive design and was carried out between January and June 2016. Five hundred and forty-three articles were included in the field of midwifery found in a scan of the Google Academic, PubMed, and National Thesis Center databases in search of the keywords “ebelik” (“midwifery” in Turkish) and “midwifery and Turkey.” Numbers and percentage calculations were used in the evaluation of the data.

Results

Of the articles included in the study, 30.6% were published in a journal that concerned all health-care professions, 84.7% were of observational studies, 24.2% were conducted by academics in the midwifery departments, 19.0% were thesis studies, and 75.0% were published in the Turkish language. Of academic authors in the midwifery departments, 31.6% were midwives. In an examination of the subject fields of the articles, 25.8% pertained to midwifery professional development, knowledge, opinions, roles, ethics, and malpractice in the sampling of midwives and student midwives, whereas 26.7% of the sample groups comprised midwifery and other students.

Conclusion

This study revealed that studies made in the field of midwifery education and practice were inadequate. Increasing studies in this area might contribute to ensuring improvements in the professional development of midwifery in Turkey and more globally.

Evaluating the content and quality of intrapartum care in vaginal births: An example of a state hospital

Objective:

The purpose of the research was to assess the content and quality of the intrapartum care offered in vaginal births in Turkey, based on the example of a state hospital.

Materials and Methods:

This cross-sectional study was conducted between January 1^st, 2013 and December 31^st, 2014 at Aydın Maternity and Children’s Hospital. The study sample consisted of 303 women giving vaginal birth, who were recruited into the study using the method of convenience sampling. Research data were collected with a questionnaire created by the researchers and assessed using the Bologna score. Numbers and percentages were assessed in the data analysis.

Results:

The mean age of the women was 25.14±5.37 years and 40.5% had given one live birth. Of the women, 45.2% were admitted to hospital in the latent phase, 76.6% were administered an enema, 3.3% had epidural anesthesia, 2.6% delivered using vacuum extraction, and 54.1% underwent an episiotomy. Some 23.8% of the women experienced spontaneous laceration that needed sutures. The babies of two women exhibited an Apgar score below 7 in the fifth minute. When the quality of the intrapartum care given to the women was assessed with the Bologna score, it was found that 92.7% went into labor spontaneously, 100% of the births were supervised by midwives and doctors, 97.7% of the women had no supporting companion, and the nonsupine position was only used in 0.3% of the women. A partogram was used to follow up on the birth process in 72.6% of the women, and 82.5% achieved contact with their babies within the first hour after birth. Induction was applied in 76.6% of the women and fundal pressure in 27.4%.

Conclusion:

The study revealed that the quality of intrapartum care in vaginal births was inadequate. Reformulating the guidelines regarding intrapartum care in accordance with World Health Organization recommendations and evidence-based practices may contribute to improving mother and infant health.

Effectiveness of Structured Education in Reduction of Postpartum Depression Scores: A Quasi-Experimental Study

The aim of this study was to evaluate effectiveness of structured education in reduction of postpartum depression scores among women. This was a quasi-experimental study with a pre-post tests and a control group. Non-random sampling was used and the study included a total of 103 Turkish women, 52 of whom were in the intervention group and 51 were in the control group. The women in the intervention group were offered structured education for postpartum depression and given structured education material. Effectiveness of the education given was evaluated by comparing scores for Edinburg Postpartum Depression Scale obtained before and after delivery between the intervention and the control groups. Before education, median score (8.0±4.8) for Edinburg Postpartum Depression Scale of the intervention group were significantly higher the than the control group (6.0±6.0, p=0.010), but the groups were statistically similar in terms of having depression (intervention: 17.3%, control: 11.8%, p=0.425). After education, the median score for Edinburg Postpartum Depression Scale and the ratio of the women having depression in the intervention group were significantly lower than in the control group (respectively intervention: 4.0±3.0, control: 10.0±4.0, p=0.000; intervention: 7.7%, control: 25.5%, p=0.015). Besides, the median score (8.0±4.8) of the intervention group before education were significantly higher than the score (4.0±3.0) obtained after education (p=0.000), while the median score (6.0±6.0) of the control group before education were lower than the score (10.0±4.0) obtained after education (p=0.000). This study revealed that structured education offered to women by nurses was effective in reducing the postpartum depression scores and the numbers of women having depression.

Evaluation of observational research reports published in Turkish nursing journals

AIM

The aim of this literature-based descriptive study was to examine the reporting of the observational research studies published in peer-reviewed nursing journals in Turkey.

METHODS

Eleven peer-reviewed nursing journals printed on a regular basis in Turkey between 2007 and 2012 were selected. These journals were searched for observational research studies, and 502 studies were selected and examined by using the Strengthening the Reporting of Observational Studies in Epidemiology Statement.

RESULTS

Of the 502 studies, 495 were cross-sectional, 3 were cohort, and 4 were case controlled. Summary and introduction and aim sections were sufficient in most of the studies. The methods sections of the reports were mostly not reported: 64.3% of the reports did not indicate eligibility/inclusion criteria; sampling method, 67.0%; possible sources of bias, 99.2%; ways to reach sample size, 92.6%. In the results section, the number of individuals participating in each stage of the studies (44.0%) and in other analyses made (39.2%) was not reported. In the discussion section, a main comment about research findings was partly made (97.4%), and limitations of the studies and possible sources of bias were not written in 99.0% of the studies.

CONCLUSIONS

This study clearly revealed that the observational research studies published in nursing journals in Turkey did not fulfil the important criteria and needed to be improved.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Information obtained from this study can contribute to improvement of the quality of reporting observational studies in nursing and thus using obtained findings in practice.

Factors concerning the attitudes of married women toward family planning in Aydύn, Turkey: A cross-sectional study

BACKGROUND

Because of unemployment and inadequate education and health services, high rate of maternal and infant mortalities, a rapidly growing population is a serious problem in Turkey. Social values and attitudes of women might be effective in using modern family planning methods. Our aim in this study was to evaluate the factors concerning the attitudes of married women toward family planning.

MATERIALS AND METHODS

Four hundred and twenty-seven women were randomly selected among 29,874 women and included in this cross-sectional study. The study was conducted between June 2008 and September 2008, and included married women between 15 and 49 years of age, living in the provincial centre of Aydin, a city in western Turkey. The study data were obtained using a questionnaire and the Family Planning Attitude Scale.

RESULTS

Of the women participating in the study, 60.4% used modern methods and 26.0% used conventional methods. These variables included, in a descending order of contribution to the model's power, having a college degree, being a primary school graduate, the longest period of rural life, use of conventional methods, discussing with one's spouse issues about family planning, and age and high perception of income level.

CONCLUSIONS

Reorganization of family planning services by giving priority to women living in rural areas with low income and education level and conventional contraception method use could contribute to positive attitudes toward family planning. Including their spouses to this reorganization may enhance the impact.

Prevalence of episiotomy in primiparas, related conditions, and effects of episiotomy on suture materials used, perineal pain, wound healing 3 weeks postpartum, in Turkey: A prospective follow-up study

BACKGROUND

Despite current recommendations against routine use of episiotomy, its incidence is still high in Turkey. The study aimed to identify the prevalence of episiotomy in primiparas, related conditions, and effects of episiotomy on suture materials used, perineal pain, and wound healing 3 weeks postpartum.

MATERIALS AND METHODS

This study was designed as a prospective follow-up study. Data were collected via a questionnaire form between March 2007 and February 2009 in Aydın Government Hospital, Turkey. Three hundred ninety-six primiparas were included in the study by convenience sampling.

RESULTS

It was determined that 56.3% of the women had episiotomies. The results of the study revealed that the probability of receiving an episiotomy was decreased in women with lack of legal marriage and unplanned pregnancies, and increased in women who had ineffective pushing efforts approximately four times, miscellaneous two times and baby's head circumference 1.27 times. Moreover, the results of the study demonstrated that an episiotomy increased the number of the suture materials used by approximately five-fold, as well as the prevalence of pain on the first postpartum day. On the third postpartum week evaluation, it was determined that the probability of problems with wound healing and experiencing pain was approximately two times higher among women who received episiotomies than those who did not receive episiotomies.

CONCLUSION

The study revealed that episiotomies in primiparas increased the number of suture materials used and the probability of having perineal pain on the first postpartum day, as well as perineal pain and wound-healing problems during the third postpartum week.

Sexual problems in women during the first postpartum year and related conditions

AIM

The aim of this study was to evaluate the sexual problems in women during the first postpartum year and related conditions.

BACKGROUND

In the postpartum period, women encounter numerous physical, psychological and sociocultural factors. These factors negatively affect both the sexual function and the quality of life of woman.

DESIGN

A descriptive survey.

METHODS

In this study, 230 women were included. The study was conducted between September 2007 and December 2008 in Izmir, Turkey. A questionnaire form developed by authors, the Arizona Sexual Experience Scale-female version and the Beck depression inventory were applied for participants.

RESULTS

The women began to have sexual intercourse within 7·06 weeks after delivery. Of the women, 58·3% reported that they had dyspareunia in the postpartum period. According to Arizona Sexual Experience Scale, the total score was ≥ 11 in 91·3% of women and they had sexual problems in the first postpartum year. The results of the multivariate analysis revealed that the increase in age, the presence of sexual problems during pregnancy and the increase in time after delivery significantly increased the possibility of postpartum sexual problems.

CONCLUSION

This study revealed that the majority of the women had postpartum sexual problems and the possibility of postpartum sexual problems increased with the increase in age, the presence of sexual problems during pregnancy and the increase in time after delivery.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should evaluate women in terms of their sexual functions during both pregnancy and postpartum period. Health education, counselling, referral services for early diagnosis and treatment might contribute to the protection and improvement of the sexual health of women during the postpartum period.

Effects of unplanned pregnancy on neonatal health in Turkey: a case-control study

The aim of this study was to investigate effects of unplanned pregnancy on neonatal health. This is a retrospective case-control study and included 314 babies selected with a non-probability method. Data were collected with a questionnaire of descriptive characteristics and neonatal health and Parent Infant Interaction Assessment Scale. A significantly higher rate of the babies born to the women with unplanned pregnancy had meconium in their amniotic fluid (14.6% vs. 7.0%; P = 0.029), needed special care (20.4% vs. 11.5%; P = 0.031) and were kept in the incubators (12.7% vs. 4.5%; P = 0.009). Both the babies born to the women with unplanned pregnancy and the babies born to the women with planned pregnancy were first fed with breast milk (96.8% of the unplanned group; 98.1% of the planned group), but a higher rate of the babies born to the women with unplanned pregnancy had problems with breast-feeding. (19.1% vs. 5.1%; P = 0.000). The babies born to the women with unplanned pregnancy got significantly lower scores on Parent Infant Interaction Assessment Scale (4.86 ± 1.98 in the unplanned group; 8.52 ± 1.43 in the planned group; P = 0.000). We found that a higher rate of the babies born to the women with unplanned pregnancy needed special care, had problems with breast-feeding and negative parent-infant interaction. We recommend that women with unplanned pregnancy should be given priority on prenatal, intrapartum and postpartum care and that measures which protect and promote neonatal health should be taken.

[The Postpartum Depression Screening Scale: its reliability and validity for the Turkish population]

OBJECTIVE

The aim of this study was to determine the reliability and validity of the Postpartum Depression Screening Scale (PDSS) for the Turkish population.

METHOD

The research was conducted in the province of Ankara between 15 June 2003 and 15 February 2004. The study sample included 445 women in their 2nd-13th postpartum week. Data were collected with a sociodemographic form, PDSS, Beck Depression Inventory (BDI), and Edinburgh Postpartum Depression Scale (EPDS).

RESULTS

The internal consistency coefficient (Cronbach's alpha) of PDSS was 0.94, its test-retest reliability was r=0.86 and the coefficient of the two-halves test was r=0.91. Factor analysis of the scale revealed that it was composed of 6 factors with Eigenvalues >1, accounting for 54.69% of the total variance. All items of the Turkish PDSS had a factor load ranging from 0.34 to 0.77 and they all belonged to 1 factor. There was a strong relationship between PDSS, and BDI (r=0.71) and EPDS (r=0.71). Item-to-total correlation coefficients of the Turkish PDSS ranged from 0.35 to 0.68 and item-to-total correlation coefficients of its subscales ranged from 0.31 and 0.71, and they were sufficiently discriminative.

CONCLUSION

The research suggests that the validity and reliability of the Turkish PDSS are satisfactory, and that it can be used in Turkey.

Factors affecting exclusive breastfeeding of healthy babies aged zero to four months: a community-based study of Turkish women

AIM

The purpose of this study was to determine the factors that affect exclusive breastfeeding of healthy babies aged 0-4 months.

BACKGROUND

Both the World Health Organization (WHO) and UNICEF recommend feeding babies of 0-6 months exclusively with breast milk and starting complementary foods after the sixth month. In Turkey, however, a vast majority of babies 1-5 months of age (89.4%) are given complementary foods.

METHODS

This cross-sectional study was conducted in central Ankara province, with a sampling of 514 individuals who were selected using the convenience sampling method.

RESULTS

Of the 514 mothers who participated in my research, 260 (50.6%) were found to be feeding their babies exclusively with breast milk; 77 (15.0%), with breast milk + water; 87 (16.9%), with breast milk + baby formula; 70 (13.6%), with breast milk + baby formula + other foods; and 20 (3.9%), baby formula + other foods. Based on multivariate logistic regression analysis results, the mother's employment [odds ratio (OR) = 0.488; 95% confidence interval (CI) = 0.288-0.827) considerably reduced the incidence of complementary foods, while frequent crying of the baby (OR = 1.687; 95% CI = 1.125-2.530) significantly increased the use of supplementary foods in infant nutrition.

CONCLUSION

This study concluded that frequent crying of the baby increases the likelihood of giving the baby complementary foods. Midwives and nurses can encourage exclusive breastfeeding behaviour by providing individual education and counselling to women whose babies cry frequently.

RELEVANCE TO CLINICAL PRACTICE

Exclusive breastfeeding of babies aged 0-6 months is crucial for the development and growth of the baby and instrumental in reducing infant morbidities and mortalities. One factor that increases the likelihood of provision of complementary foods is frequent crying of the baby. Midwives and nurses can encourage exclusive breastfeeding behaviour by providing individual education and counselling to women whose babies cry frequently.

Depression, anxiety and influencing factors in pregnancy: a study in a Turkish population

OBJECTIVES

to determine the prevalence of depression in pregnancy and the factors that influence the development of depression and anxiety in pregnancy in a Turkish population.

DESIGN

a descriptive, correlational study.

SETTING

a public hospital in Ankara Province Centre, Ankara, Turkey.

PARTICIPANTS

1,039 pregnant women selected using a convenience sampling method.

FINDINGS

27.9% (n=290) of the 1,039 women were found to be experiencing depression at a level requiring treatment. In a stepwise multiple linear regression analysis model developed for depression and anxiety, the following were found to be statistically significant factors influencing the experience of both depression and anxiety: perceived social support; recent experience of marital or emotional problems during and before this pregnancy; recent experience of life stress; having a negative self-perception; experience of physical violence; and experience of physical problems during pregnancy. Statistically significant factors influencing depression were marital dissatisfaction, being a housewife, having an unwanted pregnancy, and having a formal marriage. The correlation between total anxiety and depression scores was at a medium level (Pearson correlation=0.592).

KEY CONCLUSIONS

many factors influenced the development of depression and anxiety in pregnancy, and a positive correlation was found between depression and anxiety. Midwives and nurses can evaluate pregnant women for these risk factors, and arrange for additional follow-up. They can also offer preventive care and, when necessary, assist with early diagnosis and treatment to improve the health of mothers and babies.

Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women

OBJECTIVES

The aim of this study was to investigate factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women.

METHODS

This is a cross-sectional study and included 886 women. Data were collected with a questionnaire including questions about demographics and independent variables tested, the Menopause Symptom Checklist and The MOS 36-Item Short Form Health Survey.

RESULTS

The mean age of the women included in the study was 48.62 years (standard deviation (S.D.)=5.75, range: 40-60 years). Of all women, 32.1% were premenopausal, 23.9% perimenopausal and 44.2% postmenopausal. Stepwise multiple regression analyses, performed to determine factors associated with menopausal symptom score, revealed 12 statistically significant variables which increased the strength of the model. These variables were as follows in the order of their contribution to the strength of the model: health problems, recent life stresses, being a primary school graduate, absence of relaxation methods, number of pregnancy, financial problems, tea consumption, inadequate and unbalanced nutrition, coffee consumption, age, being a secondary school graduate and dissatisfaction in marriage. Besides, there was a significant and moderately negative relation between total menopausal symptom scores and quality of life scores.

CONCLUSIONS

A large number of factors were associated with experiencing menopausal symptoms and menopausal symptoms had negative effects on the quality of life among Turkish women. Stress management and health promoting practices should be incorporated into menopausal care programs to improve health and quality of life of middle-aged women.

What do midwives and nurses in Turkey know about nutrition in the first six months of life

OBJECTIVE

to discover what midwives and nurses in Turkey know and advise about nutrition in the first 6 months of life.

DESIGN

a descriptive, cross-sectional study.

SETTING

health clinics and mother and baby health and family planning centres in the municipality of Ankara.

PARTICIPANTS

301 midwives and nurses selected by stratified, random sampling.

FINDINGS

nine questions related to the features and benefits of breast milk. The mean number of questions answered correctly was 7.55 (standard deviation [SD]=1.25). Participants agreed that the babies should be breast fed for the first 6 months of life (n=184; 61.1%) and that complementary food could be introduced at 6 months of age (n=291; 96.7%). Most participants (n=223; 74.1%) recommended that mothers who have to resume work should express and store breast milk, and their babies should be fed with it. Many participants noted that there may be one or more situations when artificial milk should be given in the first 6 months of life (n=286; 95.0%). Almost all of the participants (n=292; 97.0%) gave one or more suggestions of when breast milk was sufficient or insufficient.

CONCLUSIONS

most midwives and nurses in this research had adequate knowledge related to babies in the first 6 months of life. However, with continuing education, knowledge deficits can be corrected, and awareness of their roles and responsibilities can be increased in achieving one of Turkey's priority goals for the 21st Century, that of decreasing the baby death rate.

Effects of episiotomy on bonding and mothers' health

BACKGROUND

Historically, episiotomy has been carried out during labour to facilitate delivery, shorten the duration of the second stage and prevent spontaneous lacerations. However, recent studies of episiotomy have recommended that it be carried out only when necessary. In Turkey, midwives are authorized to perform episiotomy.

AIM

To analyse the effects of episiotomy on mothers' health and mother-infant bonding.

DESIGN

A cohort study of 100 women who gave birth by normal vaginal delivery in a Turkish hospital between 15 March 1999 and 6 April 2000.

METHODS

Participants were divided into episiotomy (n = 50) and control (n = 50) groups. Data on biographical characteristics and the process of labour were collected in hospital, and follow-up was conducted at home 1, 3 and 12 weeks after labour.

RESULTS

Mean duration of the second stage was longer in the episiotomy group than the control group, but the difference was not significant. The number of spontaneous lacerations was significantly lower in the episiotomy group. Mean time from delivery to maternal rest and time taken to bond with the infant were significantly longer in the episiotomy group. There were significantly higher scores for overall incidence and severity of pain on the first day, and pain incidence and severity at 1 week in the episiotomy group. Significantly fewer women in the episiotomy group were able to do chores and to sit/stand up comfortably in the first postpartum week

CONCLUSION

Episiotomy should not be used unless indicated. Measures should be taken to avoid perineal trauma during labour, establish bonding between mother and infant as soon as possible, and minimize perineal discomfort after delivery.