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• Using ChatGPT in education may reduce students' thinking abilities, and those who rely too much on technology may tend to abuse the technology. • As suggested by some educators, "Don't Ban ChatGPT in Schools. Teach With It," but this involves requiring students be educated against the malicious use of ChatGPT but ensure that they are taught to distinguish between fact and fiction and the consequences that could come with the use of ChatGPT. • Nurse educators may need to create more personalized and engaging learning experiences for students while streamlining administrative tasks and improving the quality of student feedback. • Nurse educators must be forward-thinkers and educate students to embrace AI and ChatGPT to optimize their potential and the cautions needed in using this technology. Chat Generative Pre-trained Transformer (ChatGPT), trained on big data, has the potential to be an excellent starting point resource for nursing students to expand their knowledge of basic information. This contemporary paper provides the responses given by ChatGPT for the authors' prompt on nursing education, teaching, and learning. The authors explored the challenges and opportunities of using ChatGPT in nursing education with four key prompts given to ChatGPT related to teaching and learning. The response from ChatGPT was supported by evidence of benefits and risks to nursing education and practice. Although ChatGPT is considered controversial, given the changing landscape, rather than banning ChatGPT, educators could adopt ChatGPT as a learning assistant. [ABSTRACT FROM AUTHOR]

To evaluate the effects of the Parent-Child Sandplay Therapy (PCST) Program on autism behaviors, social responsiveness and sleep quality among preschool children with autism spectrum disorder (ASD), and their mothers' parenting stress. A prospective, randomized controlled, parallel-group trial was employed. Fifty-two child-mother dyads were randomly assigned to an intervention group (n = 26) or a control group (n = 26) from February 2017 to February 2019. The intervention group was treated with a 20-week PCST Program plus an Applied Behavior Analysis-based program (ABA-based program), whereas the control group received only the ABA-based program. Outcome measures included the Autism Behavior Checklist total scores, Social Responsiveness Scale scores, Children's Sleep Habits Questionnaire scores, and Parenting Stress Index-Short Form scores, measured at baseline, post-intervention (20 weeks after baseline) and follow-up assessments (32 weeks after baseline). Finally, 43 dyads completed the study. The linear mixed model analysis resulted in a significant group*time interaction effect of ABC score (Est = 2.027, t = 3.277; p < 0.01), SRS score (Est = 3.377, t = 6.095; p < 0.01), PSI-SF score (Est = 3.873, t = 4.253, p < 0.01), and CSHQ score (Est = 3.158, t = 6.485; p < 0.05). Our findings suggested that the PCST Program could potentially improve social interaction and sleep quality of preschool children with ASD while decreasing parenting stress. The PCST Program was found to be a feasible and a promising treatment for children with mild-to-moderate ASD as well as for their parents. It was a nurse-led program, which could be integrated into the usual nursing care of children with autism spectrum disorder in special education schools. Trial registration: Chinese Clinical Trials Registry, ChiCTR2100047699. [ABSTRACT FROM AUTHOR]

To explore the underlying beliefs of preventive health behaviours among women with a history of GDM who had low levels of preventive health behaviours during their postpartum period in Singapore. This paper reports on the qualitative arm of a mixed method study. The qualitative descriptive design was adopted. Individual interviews were conducted between 7th September 2020 and 25th September 2020 using a semi-structured interview guide. Data collected were analysed using thematic analysis. A total of 18 women completed the interview. The participants' ages ranged from 26 to 40 years with a mean age of 33.17 years (SD= 4.09). The duration since childbirth was 8.78 months (SD = 1.35). Through thematic analysis, five themes were developed: lifestyle adjustment, self-motivation, supportive environment, barriers to practising a healthy lifestyle, and risk perception. A total of 14 subthemes emerged from the five main themes. The beliefs of women with a history of GDM were described according to the Theory of Planned Behaviour. Having a newborn brings changes to the lifestyle of a woman and her family, which can affect the health behaviours in the postpartum period. This study revealed several novel findings relating to the unmet needs of women who had GDM, specifically to the need for information and emotional support to safely resume healthy behaviours after childbirth, for which participants have provided suggestions on how to enhance the continuity of care in the postpartum period. [ABSTRACT FROM AUTHOR]

To explore the perceptions of parents regarding the preparation of their children for surgery. A qualitative descriptive study was conducted. Sixteen parents of children who were undergoing various types of elective surgery in a public tertiary hospital in Singapore were recruited. Data were collected through face-to-face interviews and analyzed using thematic analysis. Five themes were derived: (1) assumed roles of the parents; (2) communication, decision-making, and emotional challenges; (3) factors facilitating the preparation of children for surgery; (4) surgery-related and financial concerns; and (5) the desire for more information and better management. While preparing their children for surgery, parents undertook several roles to ensure readiness and to provide support. Parents faced challenges while communicating with their children regarding their surgeries, experiencing negative emotions and dilemmas in making decisions for surgery. Factors such as previous experiences, children's positive mentality, and access to information helped to facilitate their preparation. Parents expressed surgery-related concerns such as anesthesia and a successful outcome of the surgery, the timing of the surgery, and postoperative care. Parents expressed a desire for easier to understand information through the use of visual materials, and improvements in current practices and management. This study provides a greater understanding of parents' perceptions of their roles, challenges, influencing factors, concerns, and needs when preparing their children for surgery. The study findings provide insightful aspects for improving current healthcare practices and informing future research studies in exploring better surgery preparation programs for both parents and children. • Parents undertook several roles to ensure readiness and gave support to their children. • Parents faced challenges in communicating with children, experiencing negative emotions and dilemmas in decision-making. • Factors like prior experiences, children's positive mentality, and access to information helped facilitate preparation. • Parents expressed surgery-related concerns such as anesthesia, the outcome of the surgery, and postoperative care. • Parents needed easier to understand information and suggested improvements in current practices and management. [ABSTRACT FROM AUTHOR]

To explore the experiences and needs of parents while waiting for their children undergoing surgery. A descriptive qualitative study was conducted. A purposive sample of 11 parents who went through their first waiting experiences during their children's surgeries in a Singapore public hospital was recruited. Children younger than or equal to 16 years of age were included. A semi-structured interview guide facilitated the individual face-to-face interviews. Thematic analysis was used. Four themes were identified: "Care and care provision affecting waiting experiences", "Parental concerns and surgery affecting waiting experiences", "Coping strategies used during waiting periods" and "Recommendations to improve waiting experiences". Pre-operative instructions, the professionalism of medical teams, and a lack of timely updates affected parental experiences. Parents expressed their worries. The complexities and types of surgery influenced how they felt. Their concerns included potential complications, surgical outcomes, anesthesia-related side effects, and post-operative care including pain. They spent their waiting times eating, resting, using their smart devices, and coping with a support system. Environmental improvements, more updates, and mobile applications were recommended by the participants. For a parent, the wait during his/her child's surgery can be unsettling. Our results give insights into parental waiting experiences and needs during their children's surgeries. These findings can guide the improvement of the current practise based on our evidence or the implementation of newer technology to provide better waiting experiences for parents during their children's surgeries and to enhance the quality of clients' experiences in the hospital. • Parents expressed anxiety because of perioperative factors like risks of surgery and lack of timely updates from surgeons. • Communication between healthcare team and parents affects the waiting experience. • Parents recommended a dedicated waiting room that better suited adult needs such as adult-sized comfortable chairs and privacy. • Early dissemination of information helped parents prepare for their child's surgery. • Parents recommended the use of technology such as mobile applications and text messages for communication. [ABSTRACT FROM AUTHOR]

Objective To examine factors influencing first-time fathers’ involvement in their wives’ pregnancy and childbirth in Singapore. Design and setting A cross-sectional descriptive correlational study was conducted in a public tertiary hospital in Singapore. Participants A total of 182 first-time fathers whose wives were hospitalized at four obstetric wards were recruited from November 2015 to January 2016. Measurements Data were collected by three newly developed and validated instruments, namely Father's Involvement in Pregnancy and Childbirth, Father's Informational and Sources of Support, and Father's Attitude Towards Involvement in Pregnancy and Childbirth, as well as the 16-item Couple Satisfaction Index and Family of Origin Questionnaire. Findings The participants were generally involved in their wives’ pregnancy and childbirth, with 35.2% being highly involved. There was no significant difference in fathers’ levels of involvement between or among any sociodemographic subgroups. Significant Spearman's correlations were found between fathers’ levels of involvement and levels of informational support as well as fathers’ attitudes towards involvement. However, the logistic regression showed the level of informational support was the only significant factor that influenced first-time fathers’ high levels of involvement in their wives’ pregnancy and childbirth. Key conclusion The study revealed the importance of providing sufficient informational support to first-time fathers so that they can be highly involved in their wife's pregnancy and childbirth. Future studies can develop technology-based intervention programmes to improve fathers’ involvement in their wife's pregnancy and childbirth. Implications for practice Healthcare professionals should examine and improve the existing informational support for first-time fathers and ensure its relevance and convenient access. [ABSTRACT FROM AUTHOR]

Objective To provide an overview of existing literature on the current perceived levels of paternal involvement during the pregnancy and childbirth periods and the factors influencing this involvement. Design An integrative literature review. Data Sources A systematic search was conducted using the databases of PubMed, CINAHL, PsycINFO, Web of Science, and Scopus. Review methods Studies were included for the review if they were published in English from the period of 2005–2015. Studies that focused on fathers’ involvement until one-year postpartum were also included and information on parental involvement during the pregnancy and childbirth periods was extracted. A report of the search outcomes was guided by the Preferred Reporting Items for Systematic Reviews and Meta Analyses. The studies were appraised using the Joanna Briggs Institute's Critical Appraisal Checklists. Findings Thirty-one studies (17 quantitative, 9 qualitative, and 5 reviews) were included in this appraisal. While fathers desired to be actively involved in the antenatal and intrapartum periods, they cited several barriers that impeded their involvement. These barriers were examined as part of the factors influencing their levels of involvement, including the levels of informational support, attitudes towards involvement, qualities of marital relationship, relationships with their own parents, and sociodemographic factors. Key conclusions There was a lack of literature that focused on enhancing fathers’ involvement during pregnancy and childbirth. Few studies attempted to evaluate fathers’ levels of involvement in association with its influencing factors. Instruments that were used by the studies to measure paternal involvement did not comprehensively capture the actual phenomenon of fathers’ involvement. Implications for practice Prospective studies examining the factors influencing fathers’ involvement in greater depth will help to inform interventions to increase their involvement during pregnancy and childbirth. The effects of the interventions can be evaluated based on improved paternal involvement, maternal satisfaction, and relevant health outcomes. Future research can also focus on the development of a more robust tool to measure fathers’ involvement. [ABSTRACT FROM AUTHOR]

Background Despite the increasing use of implantable cardioverter defibrillators (ICDs) as a preventive approach for high-risk patients with arrhythmias, little is known about the perceptions of ICD recipients regarding these devices and their impact on quality of life. Objectives To explore perceptions towards quality of life, coping strategies, and learning needs of patients living with ICDs in Singapore. Methods 16 participants (age ranges 52 to 84 years old) were purposively recruited and interviewed individually for this exploratory qualitative study. Data collected was analyzed using thematic analysis. Results Seven themes emerged: experiencing ICD shocks, ambivalent “love-hate” relationship with ICD, receiving support from healthcare professionals and social networks, attaining acceptance and returning to normalcy, physical coping, emotional coping, and readiness and need for enhanced patient education. Conclusions With an insight to the perceptions of ICD recipients in Singapore, future practice can focus on addressing their concerns and improve post-implantation quality of life. [ABSTRACT FROM AUTHOR]

Objective: to summarise research evidence on the impact of father-infant skin-to-skin contact on infant and paternal outcomes. Design: an integrative literature review. Data sources: PubMed, ScienceDirect, PsycINFO, and Cumulative Index to Nursing & Allied Health. Review methods: studies included were: (1) published in English between January 1995 to September 2015; (2) primary researches; and (3) focused on fathers providing skin-to-skin contact with their infants and its impact on infant and paternal outcomes. The Joanna Briggs Institute's Critical Appraisal Checklists were used to appraise the scientific rigour of the studies. Findings: twelve studies (10 quantitative and two qualitative) were included in this review. Father-infant skin-to-skin contact had positive impacts on infants' outcomes, including temperature and pain, bio-physiological markers, behavioural response, as well as paternal outcomes, which include parental role attainment, paternal interaction behaviour, and paternal stress and anxiety. Conclusions: a father's involvement in providing skin-to-skin contact seems to be feasible and beneficial to both infants and fathers. However, there has been a scarcity of literature that exclusively examines fathers' involvement and perceptions related to skin-to-skin contact in the postpartum period. Future research should examine skin-to-skin contact by fathers and its associated benefits, as well as fathers' perceptions on father-infant SSC among varied populations. Implications for practice: a father's involvement in providing skin-to-skin contact should be promoted during the postnatal period. Father-infant skin-to-skin contact is a valuable alternative, especially during the unavailability of mothers due to special circumstances, including medical emergencies and caesarean section. [ABSTRACT FROM AUTHOR]

Objectives The objectives of the study were to investigate awareness, knowledge, healthy lifestyle behaviors, and their correlates to coronary heart disease (CHD) among working women in Singapore. Background CHD is the leading cause of death for women globally, yet women are unaware of this or the associated risk factors that make them vulnerable to CHD. Methods A cross-sectional descriptive study with a quota sample of 200 working women was conducted in Singapore. Data were collected using self-administered questionnaires, including the Heart Disease Fact Questionnaire-2, Behavioral Risk Factor Surveillance System, and a section on Awareness of CHD. Results Participants demonstrated suboptimal awareness of CHD being the leading cause of death among women and the risk factors associated with morbidity. Healthy lifestyle behaviors were found to be affected by age, ethnicity, marital status, income status, presence of chronic diseases, and working groups. Conclusion Health care providers should systematically evaluate women at risk for CHD and provide both gender-sensitive and age-specific education. [ABSTRACT FROM AUTHOR]

Summary Background Health behaviour is of great importance for nursing students to achieve optimal health. Healthy students tend to complete their study and remain in the nursing workforce. They will also serve as a role model of for patients. However, there is limited research concerning physical fitness and health behaviour (such as sleep problems) in this population. Objectives This study aims to examine the relationships among health behaviour, personal variables, physical fitness, perceived physical health and psychological health. Design A cross-sectional descriptive correlational study was used. Participants A total of 335 nursing students who were enrolled in a university in Thailand. Methods Data were collected by self-administered questionnaires and physical fitness tests. Independent variables were personal variables and health behaviour. Outcome variables included physical fitness, perceived physical health and psychological health. Descriptive statistics and path analyses were used to analyse data. Results Nursing students had poor to moderate levels of total physical fitness, with cardiovascular fitness and body flexibility components having the lowest scores. Students who exercised regularly tended to have better physical fitness, perceived physical health and psychological health. Those who did not have sleep problems had better psychological health. Conclusion Some personal variables and health behaviours were associated with health among nursing students. Appropriate interventions are required to promote positive health behaviour in this population. [ABSTRACT FROM AUTHOR]

Modern Singaporean mothers still embrace traditional confinement practices after childbirth, which often marks a significant milestone in maternal experiences. However, limited studies have explored in-depth the collective confinement experiences of mothers in Singapore. This study hence aimed to explore the postpartum confinement experiences of first-time mothers from the three major ethnic groups in Singapore, namely Chinese, Malay, and Indian. A descriptive qualitative study was conducted. Purposive sampling was adopted to recruit participants. Individual semi-structured face-to-face/telephone interviews were used to collect data, which were analysed using thematic analysis. Sixteen first-time mothers were recruited from two obstetric clinics in a tertiary hospital in Singapore. Five themes emerged: "Specific diets adopted and avoided for different purposes", "Complexity of various traditional confinement practices (TCPs) adopted", "Reasons for adopting TCPs", "Reasons for modifying TCPs", and "Postpartum challenges". Our study provided unique insights about Singapore's Chinese, Malay and Indian first-time mothers' postpartum confinement experiences. While confinement practices were still observed, many mothers no longer subscribed to guidelines followed by previous generations and were modifying or forgoing practices they deemed impractical. Mothers faced challenges adapting to new motherhood and often felt restrained or stressed by confinement practices. Healthcare professionals should take the lead to educate mothers and their families on harmful traditional confinement practices and their misconceptions. Future studies could explore alternative methods of postpartum check-up to improve first-time mothers' confinement experiences, and focus specifically on lower-income families to explore their unique confinement experiences. [ABSTRACT FROM AUTHOR]

Children undergoing surgical procedures commonly experience stress and anxiety, exhibit negative behaviors, and complain of postoperative pain. Parents also experience anxiety when their children undergo surgery. Therapeutic play intervention has been used to prepare hospitalized children for invasive medical procedures for decades. However, there has been no systematic review to examine the effectiveness of therapeutic play intervention for improving children's health-related outcomes such as perioperative anxiety and postoperative pain. The aim of this review was to synthesize current empirical evidence on the effectiveness of therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and postoperative pain in children undergoing elective surgery and in reducing their parents' perioperative anxiety. Systematic searches of electronic databases of the Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest Dissertations and Theses, Scopus, and Web of Science and screening of the reference lists of included articles from these databases identified studies on the topic. Relevant studies were methodologically assessed and appraised by two independent reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Six studies were identified. The outcome measurements were heterogeneous across all six studies. These studies had conflicting outcomes regarding the effectiveness of therapeutic play intervention in children's perioperative anxiety, negative behaviors, and postoperative pain. Two studies showed that the intervention significantly reduced parents' preoperative anxiety. The current empirical evidence on the effectiveness of therapeutic play intervention in children's perioperative anxiety, negative behaviors, and postoperative pain is inconclusive. More studies on the effectiveness of therapeutic play intervention using rigorous designs and involving parents are needed. [ABSTRACT FROM AUTHOR]

Involving parents in children's pain management is essential to achieve optimal outcomes. Parents need to be equipped with sufficient knowledge and information. Only a limited number of studies have explored nurses' provision of parental guidance regarding the use of nonpharmacologic methods in children's pain management. This study aimed to examine nurses' perceptions of providing preparatory information and nonpharmacologic methods to parents, and how their demographics and perceived knowledge adequacy of these methods influence this guidance. A descriptive correlational study using questionnaire surveys was conducted to collect data from a convenience sample of 134 registered nurses working in seven pediatric wards of two public hospitals in Singapore. Descriptive statistics, independent-samples t test, and multiple linear regression were used to analyze the data. Most nurses provided various types of cognitive information to parents related to their children's surgery, whereas information about children's feelings was less often provided. Most nurses provided guidance to parents on positioning, breathing technique, comforting/reassurance, helping with activities of daily living, relaxation, and creating a comfortable environment. Nurses' provision of parental guidance on preparatory information and nonpharmacologic methods was significantly different between subgroups of age, education, parent or not, and perceived knowledge adequacy of nonpharmacologic methods. Nurses' perceived knowledge adequacy was the main factor influencing their provision of parental guidance. More attention should be paid to nurses who are younger, have less working experience, and are not parents. There is a need to educate nurses about nonpharmacologic pain relief methods to optimize their provision of parental guidance. [ABSTRACT FROM AUTHOR]

The onset of maternal perinatal depression poses many challenges for fathers, yet in Singapore and Asia, the topic remains largely unexplored. This study aimed to gain insight into the experiences of fathers whose partners suffer from perinatal depression in the Asian milieu. A descriptive qualitative study design was adopted. Purposive and snowball sampling methods were used to recruit participants. Semi-structured, face-to-face interviews were conducted individually with participants to collect data, which were analysed using thematic analysis. Twelve fathers were recruited for the study. Eleven were from a perinatal mental health service in a tertiary hospital in Singapore, while 1 father was recruited via snowball sampling. Five themes describing the fathers' journey through their partners' perinatal depression emerged from the analysis. The themes are: (1) feeling their world collapse; (2) struggling with the depression; (3) enduring the emotional toll; (4) coping with the situation; and (5) emerging from the other side. The findings of this study highlighted the struggles, coping methods, and support needs of fathers whose partners suffer from perinatal depression. Fathers were often unable to identify perinatal depression in their partners. Notably, they testified to the need to tolerate verbal and sometimes violent outbursts from their partners, and requested for more available information, resources, and peer support groups. The findings underscore a need for pre-emptive education on maternal perinatal depression and more accessible resources. Healthcare professionals should assess fathers' emotional responses to parenthood and their partners' depression. [ABSTRACT FROM AUTHOR]

Workplace violence encompasses physical violence, verbal abuse, sexual harassment, bullying, and threatening behaviors. Reviews indicate that it is widely prevalent among healthcare professionals, but there is a lack of well-designed reviews specifically focusing on nursing students. This review aimed to synthesize the global prevalence and factors associated with workplace violence against nursing students, and prevalence estimates based on the different types of violence and perpetrators. A three-step search strategy included studies since inception from six electronic databases. Studies meeting eligibility criteria were included. Meta-analyses, subgroup, and meta-regression analyses were used to synthesize pooled prevalence rates. Thirty studies involving 10,955 nursing students were included. This review revealed that 55.1 % of nursing students have encountered workplace violence. Nursing undergraduates exhibited a significantly higher prevalence rate compared to a mixed group of undergraduates with diverse nursing or student profiles. Verbal abuse (53.3 %) and bullying (43.6 %) emerged as the most widespread forms of workplace violence, with nurses (24.2 %) and patients (22.8 %) being the most frequent perpetrators. This study suggests that academic and healthcare organizations develop stringent policies to combat workplace violence against nursing students. Future research may also focus on workplace violence risk factors and their long-term impacts on nursing students. • More than half of nursing students experienced workplace violence. • Verbal abuse and bullying were the most prevalent type of workplace violence. • Nurses and patients were the most common perpetrators of workplace violence. [ABSTRACT FROM AUTHOR]

Background The effects of cold cabbage leaves and cold gel packs on breast engorgement management have been inconclusive. No studies have compared the effects of these methods on breast engorgement using a rigorous design. Objectives To examine the effectiveness of cold cabbage leaves and cold gel packs application on pain, hardness, and temperature due to breast engorgement, the duration of breastfeeding and satisfaction. Design A randomised controlled three-group pre-test and repeated post-test study. Setting A private maternal and children’s hospital in Singapore. Participants Mothers (n = 227) with breast engorgement within 14 days after delivery. Methods The mothers were randomly assigned into either cold cabbage leaves, cold gel packs, or the control group. Pain, hardness of breasts, and body temperature were measured before treatment. Two sets of post-test assessments were conducted at 30 min, 1 h, and 2 h after the first and second application. The duration of breastfeeding was measured up to 6 months. IBM SPSS 23.0 was used to analyse the data. Results Mothers in the cabbage leaves and gel packs groups had significant reductions in pain at all post-intervention time points compared to the control group, starting from 30 min after the first application of cabbage leaves (mean difference = −0.38, p = 0.016) or gel packs (mean difference = −0.39, p = 0.013). When compared to the control group, mothers in the cabbage leaves group had significant reductions in the hardness of breasts at all post-intervention time points, and mothers in the gel packs group had significant reductions in the hardness of breasts at two time points (1 h and 2 h after the first and second application, respectively). Mothers in the cabbage leaves group had significant reductions in pain (mean difference = −0.53, p = 0.005) and hardness of breasts (mean difference = −0.35, p = 0.003) at 2 h after the second application compared to those in the gel packs group. Both interventions had no impact on body temperature. There was no significant difference in the durations of breastfeeding for mothers among the three groups at 3-month and 6-month follow-up. More mothers were very satisfied/satisfied with the breast engorgement care provided in the cabbage leaves group compared to the other groups. Conclusion While cold cabbage leaves and cold gel packs can relieve pain and hardness in breast engorgement, the former had better effect, which can be recommended to postnatal mothers to manage breast engorgement. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine whether a transtheoretical model-based exercise stage-matched intervention (ESMI) has positive effects on the exercise behavior of sedentary patients with coronary heart disease (CHD). Methods: The study was a randomized controlled trial with a repeated measures design. Participants (N =196) were randomly allocated to either a conventional (C) group, a patient education (PE) group, or an ESMI group. Exercise behavior was measured by exercise stages of change, exercise self-efficacy, exercise decisional balance, and duration of moderate exercise at baseline, immediate post-intervention, and at 3- and 6-month follow-up. Results: Our results showed that the ESMI group demonstrated a more positive shift in exercise stages of change (p <0.01), higher exercise self-efficacy (p <0.01), greater exercise benefits (p <0.01), fewer exercise barriers (p <0.01), and longer moderate exercise duration (minutes/week) (p <0.01) after completion of the 8-week intervention compared with the C and PE groups. These significantly positive effects were maintained at 3- and 6-month follow-up. Conclusion: The transtheoretical model-based ESMI had significantly positive effects on the exercise behavior of sedentary CHD patients. Practice implications: It is important to provide a structured education program for CHD patients, preferably guided by the transtheoretical model. [Copyright &y& Elsevier]

A few positive effects of mothers' voice on physiological outcomes have been studied and limited studies have focused on the level of cortisol. In addition, white noise has recently been found to be beneficial for human sleep, but studies in premature infants were limited and no study has compared the effects of mothers' voice and white noise on premature infants. To examine the effects of mothers' voice and white noise on sleep-wake patterns, salivary cortisol levels, weight gain, heart rate, and oxygen saturation of premature infants in a neonatal intensive care unit (NICU). This was a three-group randomized controlled trial. A total of 103 medically stable premature infants in incubators were recruited from the NICU of a women's and children's hospital in China between March and December 2017 and were randomized into three groups: the mothers' voice group (n = 34), the white noise group (n = 34), and the routine care group (n = 35). Mothers' voice, white noise, and no voice were provided to the three groups for 20 min at a time, three times a day for four consecutive days. The sound levels of the mothers' voice and white noise were controlled between 50 and 55 dB. Sleep-wake patterns, salivary cortisol level, and weight were measured at pre-test and post-test whereas heart rate and oxygen saturation were measured every five-minute at 11am, 2pm, 5pm for four-consecutive days. A group difference was found only in weight gain (p = 0.003), with weight gain in the white noise group being significantly higher than the mothers' voice group (Z =-3.447, p = 0.001). Significant declines in total sleep time and sleep efficiency and increases in wake time after sleep onset and average awakening time were only found in the routine-care group between the pre-test and post-test (p <0.05). No significant differences were found in the salivary cortisol levels, heart rates, and oxygen saturation levels among the three groups (p >0.05). A significant increase in oxygen saturation during the 20-min intervention was found in white noise group. Non-significant decreases in the heart rate during the 20-min intervention and salivary cortisol levels at post test were noted in all the three groups. White noise is more useful for encouraging weight gain in preterm infants compared with mothers' voices. White noise might be introduced for use in the care of premature infants in NICUs, and more high-quality randomized controlled trials are needed to confirm these findings. Trial Registration No: ChiCTR-INR-17012755. [ABSTRACT FROM AUTHOR]

Besides physical and mental changes from childbirth, first-time mothers are also confronted with challenges associated with the demands of adapting to their roles as new parents. While positive effects of home-based psychoeducation intervention for mothers have been demonstrated, limited studies have developed and examined more accessible and cost-effective web-based psychoeducational interventions for mothers. To examine the effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. A randomized controlled three-group pre-test and post-tests experimental design was adopted. Data were collected over five months, from October 2016 to August 2017, in a public tertiary hospital in Singapore from 204 primiparas who were randomly allocated to the web-based psychoeducation group, the home-based psychoeducation group, or the control group. The measured outcomes included maternal parental self-efficacy, social support, psychological well-being, satisfaction with postnatal care, and cost-effectiveness evaluation. Data were collected at four time points: the baseline, and three post-tests at one month, three and six months post-delivery. When compared to the control group, the web-based intervention improved self-efficacy at post-test 1 (mean difference = 2.68, p = 0.028) and reduced postnatal depression at post-test 3 (mean difference = −1.82, p = 0.044), while the home-based intervention did not show significant effect on these two outcomes at all post-tests. Both web-based and home-based interventions helped mothers to get better social support at all post-tests than those in the control group. Mothers in both web-based and home-based intervention groups were more satisfied with the postnatal care than those in the control group at all post-test time points (except for web-based group at post-test 1). There were no differences in anxiety scores among the three groups. When compared to the home-based intervention, the web-based intervention showed noninferior effect on all outcomes at all post-tests. The web-based intervention had better effects on improving self-efficacy, social support, and postnatal depression, which should be introduced to first-time mothers for better postnatal care. [ABSTRACT FROM AUTHOR]