Search

A recent increase in screen time during early childhood has adversely affected the sleep and psychosocial health of children; however, limited information is available regarding effective interventions to reduce the screen time among them. This study aimed to investigate the effect of a parental educational program on screen use, sleep quality, and psychosocial adaptation among preschoolers.A clustered randomized controlled study with a parallel-group design was conducted. Preschoolers with a screen time of ≥2 h/day and their parents were recruited. In total, 14 kindergartens containing 129 parent-child dyads were randomly allocated to either the experimental group (receiving parental education, N = 63 dyads) or the control group (daily activities, N = 66 dyads). Data were collected before and after the intervention. A screen time questionnaire, the Children's Sleep Habits Questionnaire, and the Pediatric Symptom checklist-17 were provided to the participants. A linear mixed-model analysis was performed to examine the efficacy of the intervention.After the intervention, the screen time of children in the experimental group was significantly reduced (effect size: 0.83, p .001), and they presented improved sleep quality (effect size: 0.57, p = .01) and attention score (effect size: 0.77, p = .02) for psychosocial adaptation.Parental education is an effective intervention for reducing screen time and improving sleep quality and attention among preschoolers.Healthcare professionals should consider implementing parental educational programs to reduce screen time, and thus improve the sleep quality and psychosocial health of preschoolers.

Objectives The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents. Methods A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants’ knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention. Results After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of Conclusions An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents. Practice implications In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age.

Background High rates of early initiation and exclusive breastfeeding have been reported in Malawi, yet the underlying factors are unknown. Our objective is to examine the determinants of breastfeeding practices for mothers of infants less than 24 months old in Malawi. Methods A cross-sectional study was conducted using nationally representative data from the 2010 Malawi Demographic and Health Survey. Multivariate logistic regression analysis was used. Results Of 7282 women, 95.4% initiated breastfeeding within 1 hour after birth; thereafter 71.3% of women practiced exclusive breastfeeding, 6.1% predominantly breastfed, and 1.9% chose bottle feeding exclusively. The odds of early initiation were higher among women with frequent antenatal care visits and multiparous mothers. Similarly, frequent antenatal care visits and hospital delivery were positive determinants for exclusive breastfeeding. Infants at 6 months of age were more likely to predominantly breastfeed than they were at 1 month. The odds of bottle feeding were higher among women who were educated, who delivered at a hospital. Conclusions Optimal breastfeeding practices are highly prevalent in Malawi. Health care practice emphasizing frequent antenatal care visits that provide breastfeeding education and breastfeeding support in hospital care after childbirth are important for sustaining breastfeeding.

Background Breast engorgement and breast pain are the most common reasons for the early cessation of exclusive breastfeeding by mothers. Research Aims (1) To examine the influence of breastfeeding educational interventions on breast engorgement, breast pain, and exclusive breastfeeding; and (2) to identify effective components for implementing breastfeeding programs. Methods Randomized controlled trials of breastfeeding educational interventions were searched using five English and five Chinese databases. Eligible studies were independently evaluated for methodological quality, and data were extracted by two investigators. In total, 22 trials were identified, and 3,681 participants were included. A random-effects model was used to pool the results, and a subgroup analysis and meta-regression analysis were conducted. Results Breastfeeding education had a significant influence on reducing breast engorgement at postpartum 3 days (odds ratio [OR]: 0.27, 95% CI [0.15, 0.48] p < .001), 4 days (OR: 0.16, 95% CI [0.11, 0.22], p < .001), and 5–7 days (OR: 0.24, 95% CI [0.08, 0.74], p = .013) and breast pain (standardized mean difference: −1.33, 95% CI [−2.26, −0.40]) at postpartum 4–14 days. Participants who received interventions had higher odds of exclusive breastfeeding. Breastfeeding educational interventions provided through lecture combined with skills practical effectively reduced breast engorgement (OR: 0.21; 95% CI [0.15, 0.28]; p = .001) and improved exclusive breastfeeding at postpartum 1–6 weeks (OR: 2.16; 95% CI [1.65, 2.83]; p = .001). Conclusions Breastfeeding educational interventions have been effective in reducing breast engorgement, breast pain, and improved exclusive breastfeeding. A combination of knowledge and skill-based education has been beneficial for sustaining exclusive breastfeeding by mothers.

Background Perceived milk supply is an important modifiable factor for optimal breastfeeding. However, little is known about maternal perception of milk supply or how it impacts breastfeeding practices. The aim of this study was to examine relationships of perceived milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact with early initiation and exclusive breastfeeding among mothers of infants less than 6 months of age in Indonesia. Methods This was a cross-sectional study conducted in Yogyakarta City, Indonesia between August and October 2015. Maternal perception of milk supply was assessed using the Hill and Humenick Lactation Scale. Data on breastfeeding practices, and maternal and infant factors were collected using a structured questionnaire. Multiple regression and multivariate logistic regression analyses were performed to obtain estimates of associations. Results Thirty four percent of mothers had initiated breastfeeding within an hour after birth, and 62.4% of mothers were exclusively breastfeeding. High levels of perceived breast milk supply were reported in mothers who practiced skin-to-skin contact or rooming-in with their infants, experienced positive infant sucking behavior, or had high breastfeeding self-efficacy (p Conclusions In this study, skin-to-skin contact and breastfeeding self-efficacy are important determinants of perceived milk supply. Higher perception of milk supply was positively linked with exclusive breastfeeding. Our study highlights the importance of the assessment for mother’s perception of milk supply, maternal breastfeeding self-efficacy, and skin-to-skin contact in achieving optimal breastfeeding outcomes.

Low self-efficacy affects new mothers' ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding.To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers' breastfeeding self-efficacy and attitudes.A single-blind, randomised controlled trial.A prenatal clinic of a teaching hospital.First-time mothers with a singleton pregnancy (12-32 weeks' gestation) and their support partners were selected by convenience sampling (N = 104) and allocated by block-randomization to an intervention or control group.A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breastfeeding Self-Efficacy Scale-Short Form, the Iowa Infant Feeding Attitude Scale, and a structured questionnaire, respectively. Repeated data measurements were collected at baseline, 36-weeks' gestation, and postpartum at 1-week, and 1-, 3-, and 6-months.Ninety-three mothers completed the study. Data were compared for the self-efficacy intervention group (n = 50) with the control group (n = 43). Baseline measures did not differ between groups. The intervention group had significantly higher breastfeeding self-efficacy at 36 weeks' gestation (mean difference (MD): 7.3, p.001), and postpartum at 1-week (p.001), 1-month (p.001) and 3-months (p.01) with MD: 6.7, 7.9, and 8.1, respectively; differences in scores from baseline were also significantly greater from 36 weeks' gestation to 3-months (MD from 9.1~9.9, p.001) and 6-months postpartum (MD: 7.0, p.05). Infant feeding attitude scores significantly improved from 36 weeks' gestation to 6-months postpartum for the intervention group (MD from 3.5~7.4, p.05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p.02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR = 4.7, 95% Confidence interval (CI), 1.2 -18.6; p = .05) and for exclusive breastfeeding at 6-months (OR: 2.82, 95% CI 1.0-8.1; p = .05).The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. The breastfeeding education program could be effective for sustaining breastfeeding in new mothers.Registered with www.clinicaltrials.gov (NCT03807726).

Background Fear of childbirth is a common health concern for women during pregnancy. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is widely used to measure childbirth fear during pregnancy. However, this instrument is yet to be validated in Malawi, Africa. Our study aimed to assess the psychometric properties of the W-DEQ questionnaire in Malawi. Methods Healthy pregnant women in the third trimester (N = 476) at a district hospital in Malawi were included. Fear of childbirth, depressive symptoms, and quality of life were assessed using the W-DEQ, the Edinburg Postnatal Depression Scale, and the World Health Organization Quality of Life scale, respectively. The construct validity, reliability, and convergent validity of the W-DEQ were examined using exploratory and confirmatory factor analyses, Cronbach’s alpha, and Pearson correlations. Results The mean age of participants was 28.2 (standard deviation = 6.8) years. Exploratory and confirmatory factor analysis of the Malawian version of the W-DEQ indicated a multidimensional structure with three factors: fear, negative appraisal, and a lack of self-efficacy, with acceptable goodness of model fit. The Malawian version of the W-DEQ showed a satisfactory internal consistency (α = 0.84) and was significantly correlated with depressive symptoms (r = 0.23, p r = − 0.17 ~ -0.26, ps Conclusions Our findings support the Malawian W-DEQ version being a reliable and valid instrument for measuring childbirth fear in African women.

The primary purpose of this study was to investigate changes in exercise intentions and behaviors among children across time. Then, we investigated how determinants in the Theory of Planned Behavior (TPB) predicted exercise intentions and behaviors, and explored if demographic predictors contributed to predicting behaviors.A three-wave, 12-month longitudinal study was conducted. A proportional stratified random sampling method was adopted, and 1997 children from 11 elementary schools in Taipei City were recruited. Numbers of participants were 1074, 1064, and 995 at times 1, 2, and 3, respectively.Children's exercise intentions and behaviors significantly changed (both p .05) during a 6-month interval. Attitudes, subjective norms, and perceived behavioral control (PBC) at time 1 could respectively explain 51.0% and 17.1% of the variance in time 1 and 2 intentions (FThe findings support the TPB model being suitable for use in longitudinal studies; its core constructs significantly predicted children's exercise intentions and behaviors.This study highlights that clinical practitioners and school nurses working with children can help youth engage in regular exercise by enhancing their intentions and perceived behavioral control, and cultivating positive attitudes and subjective norms when planning exercise intervention programs.

Objectives The primary goals of this study were to determine the effects of a physical activity intervention on the set-shifting aspect of executive function and to explore the potential mechanistic role of cardiac autonomic control, as assessed by heart rate variability (HRV), in the relationship between physical activity and executive function in obese young adolescents. Method Obese young adolescents were randomized either to participate in a physical activity program (n = 25) or to serve as the wait-list control (n = 25) for a 3-month intervention. Outcome measures included physical fitness, obesity status, executive function, and HRV; these measures were assessed at baseline and within 1 week of the conclusion of the intervention. Results The physical activity program improved the participants' physical fitness and obesity status. The program also improved executive function-related set-shifting performance, as measured by the total number of errors, and increased the HRV indices of normalized low frequency (nLF) and normalized high frequency (nHF). A positive correlation between the nHF time changes and the total number of errors was also observed. Conclusion These findings suggest that 3 months of a physical activity intervention effectively increase physical fitness and improve the set-shifting aspect of executive function in obese young adolescents. Furthermore, the physical activity-related alterations in cardiac autonomic control, particularly the parasympathetic response, may be associated with enhanced executive function. (PsycINFO Database Record

Background Enhancing breastfeeding self-efficacy and intention is crucial for successful breastfeeding. Educational interventions highlighting breastfeeding self-efficacy and breastfeeding plans have been developed to help mothers initiate and sustain breastfeeding practices. Research aim This study aimed to determine whether the use of theory-based educational interventions, i.e., the theory of breastfeeding self-efficacy or theory of planned behavior, is associated with improved breastfeeding outcomes and to identify key factors of effective breastfeeding educational programs. Methods We used electronic databases and reference lists of articles to identify published randomized controlled trials of educational programs that adopted the breastfeeding self-efficacy theory or theory of planned behavior. Results In total, 24 randomized controlled trials were identified, and 5678 mothers were included in those studies, with 4178 mothers in the breastfeeding self-efficacy group and 1500 mothers in the theory of planned behavior group. Mothers who received theory-based interventions had better breastfeeding outcomes for up to 6 months postpartum (standardized mean difference =0.63, 95% confidence interval: 0.34~0.92 for self-efficacy scores at 1~2 months; odds ratio =1.82, 95% confidence interval: 1.27~2.61 for the exclusive breastfeeding rate at 1~2 months; and odds ratio =2.19, 95% confidence interval: 1.24~3.89 for the exclusive breastfeeding rate at 3~6 months). Mothers who were from non-Organization for Economic Co-operation and Development countries, were of older age, had participated in an educational program in a hospital setting, or had used an integrative class format had higher levels of self-efficacy and longer breastfeeding durations to 6 months. Conclusions Theory-based educational interventions are effective in improving breastfeeding self-efficacy and exclusive breastfeeding rates at 6 months. Future breastfeeding educational programs incorporating the theories of breastfeeding self-efficacy and planned behavior would be helpful in promoting sustained breastfeeding practices among mothers.

Objective To explore the quality of life (QOL) and related factors in early postnatal women. Design A descriptive, cross-sectional study. Setting Liwonde, Malawi. Participants Women who underwent a normal vaginal birth (N = 173) were included from August to September 2018. Measurements The QOL of participants was assessed using a World Health Organization QOL instrument. Demographic, obstetric, and health variables were collected using a structured questionnaire. Childbirth fear and depression were respectively assessed using the Wijma Delivery Experience Questionnaire and the Edinburgh Postnatal Depression Scale. A multiple linear regression was used to examine factors associated with the QOL. Results The mean age of participants was 29 (standard deviation 6.7) years. The overall QOL and health were satisfactory. The mean score of the QOL was highest in the psychological health and social relationships domains, followed by the environmental and physical health domains. A higher educational level was negatively related to the physical health of QOL (p ≤ 0.01), with physician care positively related (p = 0.01). The employment status was positively related to psychological health and the environmental QOL (p ≤ 0.01). Furthermore, a higher income, and physician care were positively related to the environmental QOL (p ≤ 0.05). High levels of childbirth fear and depressive symptoms were negatively related to all domains of the QOL (p ≤ 0.05), except for the social relationships domain. Conclusion and implications for practice The physical health QOL was lower in postnatal mothers in Malawi. Measures to improve physical health aspects and address women's fears and depressive symptoms during postpartum care are warranted. The findings should alert the health providers of the importance of assessing and improving women's physical health and psychological well-being during postpartum care.

Medication administration errors are common among new nurses. Nursing students might be less willing to speak up about errors because of a lack of knowledge and experience.To examine the effects of simulation training and problem-based scenarios on speaking up about medication errors among graduating nursing students.Prospective, controlled experimental study design.A university four-year nursing program in Taiwan.In total, 93 graduating nursing students in their last semester were recruited. Sixty-six students who received both a problem-based scenario and medication administration simulation training comprised the experimental group, while 27 students who received problem-based scenarios alone comprised the control group.Experimental group students underwent 2 h of simulation training. This training class was designed based on Kolb's experiential learning theory for knowledge development and speaking up about errors. Students in both groups administered medications in problem-based scenarios with eight embedded errors. Students' performance in speaking up about medication errors was directly observed and graded using an objective structured checklist. The McNeamer Chi-squared test, paired t-test, Z test, t-test, and Hedges' g effect size were conducted.The number of times participants spoke up about medication errors significantly improved in both the experimental group (pre-test: 2.05 ± 1.12 and post-test 6.14 ± 1.25, t = 22.85, p0.001) and control group (pretest: 2.04 ± 1.16 and post-test: 4.26 ± 1.63, t = 6.33, p0.001). However, after the intervention, the mean number of times participants spoke up about medication errors in the experimental group was significantly higher than that in the control group (t = 5.99, p0.001) in the post-test.Simulation training exhibited more-significant improvements than problem-based scenarios. Nursing schools and hospitals should incorporate simulation training or at least problem-based scenarios to improve medication safety.

Background Childbirth fear is a health concern in women living in high-income countries; however, little is known about childbirth fear among women living in low-income countries like Malawi. In this study, we explored childbirth fear and associated factors among pregnant and postpartum women in Malawi. Methods A cross-sectional study of 152 pregnant and 153 postpartum women was conducted at a district hospital in Malawi. Participants were assessed for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Demographic and obstetric variables were collected using a structured questionnaire. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Using a multinomial logistic regression, factors related to childbirth fears were examined, namely demographic and obstetric characteristics, and social support. Results The mean age of participants was 26 (standard deviation: 6.4) years. During pregnancy, 39% women reported a low level of fear, 41% reported moderate fear, and 20% reported high fear; while after birth, 49, 41, and 10% women reported low, moderate, and high fear, respectively. Pregnant women who were illiterate (odds ratio (OR): 5.0, p

Purpose This study aims to evaluate the executive function and learning attention in children with internet addiction (IA). Design and methods Children aged 10-12 were screened by Chinese Internet Addiction Scale to compose the IA group and internet nonaddiction group. Their executive functions were evaluated by Stroop color and word test, Wisconsin card sorting test, and Wechsler digit span test. Learning attention was evaluated by Chinese concentration questionnaire. Findings Executive function and learning attention were lower in the IA group than in the internet nonaddiction group. Practice implications Executive function and learning attention are compromised by IA in children. Early interventions into the IA should be planned to maintain the normal development of executive function and learning attention in childhood.

Background Sleep disturbances, such as insomnia, excessive daytime sleepiness, and poor-quality sleep, are common among nursing students and are closely linked with academic performance. Objectives To examine the prevalence of sleep disturbances and academic performances in male and female nursing students and to determine gender-specific effects on the relationship between sleep disturbances and academic performance. Design A cross-sectional study design was adopted. Settings This study was conducted in a school of nursing in Indonesia. Participants A total of 492 undergraduate students (103 males and 389 females) were included. Methods Data pertaining to the biosociodemographic characteristics, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Morningness-Eveningness Questionnaire, and Beck Depression Inventory were collected from July 1, 2018 to September 30, 2018. Academic performance was measured using grade point average of the academic year 2017–2018. A multivariate logistic regression model was used for data analyses. Results The prevalence of poor sleep quality, insomnia, and daytime sleepiness was 66.0%, 45.6%, and 24.3%, respectively, in male nursing students and 71.5%, 52.4%, and 28.8%, respectively, in female nursing students. For circadian rhythm preferences, 66% male and 51.7% female nursing students were categorized as intermediate- and morning-type people, respectively. Insomnia was the only variable among sleep disturbances that significantly correlated with the risk of poor academic performance in female nursing students even after adjustment of covariates. Conclusions Sleep disturbances were highly prevalent among female and male nursing students, and insomnia was substantially associated with poor academic performance in female nursing students. Identifying sleep disturbances among nursing students and designing effective interventions to specifically target them are required to improve academic performance of female nursing students.

Mixed-handedness, which has been associated with schizotypy in recent studies, might exist for at least two different reasons: it is innate or it has been forced. We examined whether the association between mixed-handedness and schizotypy differs depending on its source. We enrolled 3485 college students in Taiwan. We used both the Perceptual Aberration Scale and Schizotypal Personality Questionnaire to assess schizotypy, and the Annett Hand Preference Questionnaire to assess handedness. Two ways of classifying handedness were examined: the three-way classification based on Annett's categories and mixed- vs. non-mixed-handedness based on Degree of Handedness. Both mixed-handedness groups showed higher positive schizotypy scores. Among mixed handers, those who had been required to change their writing hand from left to right had higher positive schizotypy scores. Being forced to change writing hand seemed to be related to a higher level of schizotypy. The potential effect of the social pressure against using the left hand for writing is discussed.

Anxiety and fatigue adversely affect women's postpartum recovery, but few effective non-pharmacological interventions are known to relieve these two common and unpleasant symptoms.To examine the efficacy of an auricular acupressure intervention provided during early postpartum in reducing anxiety, fatigue levels, cortisol levels, blood pressure, and heart rate.A single-blind, randomised controlled trial.A 40-bed postpartum unit.Women who underwent caesarean section were randomly allocated to two groups: intervention (auricular pressure, n=40), and control (usual care, n=40).The intervention group received auricular acupressure on the shenmen acupoint twice a day (9 AM and 5 PM), and the control group received usual postpartum care. Serum cortisol levels were assessed by immunochemiluminescence, with blood pressure and heart rate assessed by electric sphygmomanometer. Anxiety and fatigue symptoms were assessed using the State Anxiety subscale of the State-Trait Anxiety Inventory and the Fatigue Continuum Form, respectively.Of the 76 women who completed the study, those who received auricular acupressure had significantly lower mean cortisol levels (mean difference=4μg/dl, p0.05), heart rate (mean difference=9.2 beats/min, p0.001), anxiety symptoms (mean difference=3.8, p0.01), and fatigue symptoms (mean difference=7.1, p0.01) than women in the control group at 5 days postpartum.Auricular acupressure is an effective non-pharmacological method for reducing cortisol levels, heart rate, anxiety, and fatigue in early postpartum after caesarean section.