护士产后返岗喂养行为抉择的质性研究

目的了解护士产后返岗喂养行为的抉择,分析其影响因素,为提高护士6个月纯母乳喂养率及持续母乳喂养率提供参考。方法采用质性研究中的现象学研究法,对13名产后返岗的初产妇护士进行深入访谈。结果在6个月内有2名坚持纯母乳喂养,5名配方奶喂养,6名混合喂养。采用Colaizzi分析法进行资料分析,得出知识缺乏、环境压力、社会支持、政策制度4个主题。结论产后返岗护士在6个月内纯母乳喂养比例较低,喂养行为的抉择与喂养态度、环境压力及自我效能、政策制度有关,可通过利用医院环境资源,提高母乳喂养知识,加强人性化管理,促进母乳喂养自我效能建设及政策支持来提高母乳喂养的行为。     

母乳哺育支持系统对初产妇产后母乳喂养的影响

目的探讨母乳哺育支持系统对初产妇产后母乳喂养的影响。方法将69例自然分娩的初产妇随机分为观察组35例和对照组34例,观察组新生儿出生后给予持续性母婴皮肤接触1h,由母乳哺育支持团队成员提供母乳喂养护理支持,出院后哺乳顾问持续跟踪并给予帮助;对照组则行皮肤接触至产妇会阴伤口缝合并检查完毕,给予常规产后护理。比较产后不同时间纯母乳喂养率及母乳喂养率。结果观察组出院时、产后7d、4个月及6个月的纯母乳喂养率显著高于对照组(P0.05,P0.01),观察组产后7d、4个月及6个月的母乳喂养率显著高于对照组(均P0.05)。结论医院母乳哺育支持系统能有效提高初产妇产后纯母乳喂养率和母乳喂养率。     

家庭赋权护理对初产妇母乳喂养的影响

目的提高初产妇母乳喂养率。方法采取前瞻性非同期成组对照设计,将2020年4~6月建档并分娩的38例初产妇纳入常规组,2020年7~10月建档并分娩的39例初产妇纳入干预组。常规组给予常规护理,干预组给予家庭赋权护理。比较两组母乳喂养知识、家庭支持得分、母乳喂养自我效能、纯母乳喂养率。结果产后1周,干预组母乳喂养知识、家庭支持得分显著优于常规组(均P<0.01);干预组产后1周、1个月、6个月母乳喂养自我效能得分显著高于常规组,产后1个月、6个月纯母乳喂养率显著高于常规组(均P<0.01)。结论实施基于家庭赋权的护理能够改善初产妇母乳喂养自我效能,提高纯母乳喂养率。     

孕前身体质量指数对母乳喂养持续时间影响的前瞻性队列研究

目的 探讨孕前身体质量指数对母乳喂养持续时间的影响,筛选早期中断母乳喂养的高危人群和时间节点,为实施针对性母乳喂养指导提供依据。 方法 便利抽取370例孕妇为研究对象,入院待产时建立研究队列,电话随访2年内母乳喂养情况。 结果 研究对象总体母乳喂养持续时间为11.0（7.0,13.0）个月,12个月内母乳喂养中断速度较快;孕前消瘦组的母乳喂养持续时间较孕前体质量正常组短2.0个月;多因素Cox回归分析显示,调整混杂因素后,孕前消瘦会增加早期中断母乳喂养的风险［HR=1.429,95%CI（1.028,1.985）,P＜0.05］;孕前超重对母乳喂养持续时间无显著影响［HR=1.105,95%CI（0.813,1.502),P＞0.05］。 结论 孕前消瘦是早期中断母乳喂养的高危因素,12个月内是母乳喂养中断的时间节点。建议育龄期女性孕前将体质量控制在正常范围内,卫生保健人员进行母乳喂养指导时需考虑产妇的孕前营养状态,行个性化的母乳喂养指导,合理延长母乳喂持续时间。     

孕前身体质量指数对母乳喂养持续时间影响的前瞻性队列研究

目的 探讨孕前身体质量指数对母乳喂养持续时间的影响,筛选早期中断母乳喂养的高危人群和时间节点,为实施针对性母乳喂养指导提供依据。方法 便利抽取370例孕妇为研究对象,入院待产时建立研究队列,电话随访2年内母乳喂养情况。结果 研究对象总体母乳喂养持续时间为11.0(7.0,13.0)个月,12个月内母乳喂养中断速度较快;孕前消瘦组的母乳喂养持续时间较孕前体质量正常组短2.0个月;多因素Cox回归分析显示,调整混杂因素后,孕前消瘦会增加早期中断母乳喂养的风险[HR=1.429,95%CI(1.028,1.985),P<0.05];孕前超重对母乳喂养持续时间无显著影响[HR=1.105,95%CI(0.813,1.502),P>0.05]。结论 孕前消瘦是早期中断母乳喂养的高危因素,12个月内是母乳喂养中断的时间节点。建议育龄期女性孕前将体质量控制在正常范围内,卫生保健人员进行母乳喂养指导时需考虑产妇的孕前营养状态,行个性化的母乳喂养指导,合理延长母乳喂持续时间。     

孕产妇母乳喂养自我调节动机现状及影响因素研究

目的 了解孕产妇母乳喂养自我调节动机现状及其影响因素，为开展母乳喂养干预以延长母乳喂养时间提供依据。方法 采用便利抽样法抽取在围生期保健门诊就诊的孕产妇（处于孕晚期或产后42 d）201例，应用简体中文版母乳喂养自我调节问卷进行母乳喂养自我调节动机的横断面调查。结果 孕产妇母乳喂养自我调节动机得分为（18.26±3.29）分；多元线性回归分析显示，年龄、孕产期、孕期是否接受过母乳喂养指导是影响孕产妇母乳喂养自我调节动机的主要因素（均P<0.01）。结论 孕产妇母乳喂养自我调节动机水平处于中等，医护人员应评估母亲母乳喂养自我调节动机水平，确定对母乳喂养自我调节动机有积极影响的关键因素，并实施相应的干预措施，提高母乳喂养动机，延长母乳喂养持续时间。     

晚期早产儿出院后母乳喂养质量现状与影响因素分析

目的 探讨晚期早产儿出院后母乳喂养质量及其影响因素,为针对性干预提供参考.方法 采用一般资料调查表、爱丁堡产后抑郁量表及母乳喂养质量评定量表对NICU出院的123例晚期早产儿母亲进行调查和影响因素分析.结果 晚期早产儿出院后母乳喂养质量总分(16.8±2.7)分,有效喂养65例,占52.8％;多元线性回归分析显示,早产...     

社会支持期望落差及喂养方式对高危妊娠产妇育儿胜任感的影响

目的了解高危妊娠产妇的社会支持期望落差及喂养方式现状,并分析其对产妇育儿胜任感水平的影响。方法对160例高危妊娠产妇于产后6~8周复查时采用中文版育儿胜任感量表(C-PSOC)和中文版产后社会支持量表(C-PSQ)进行调查。结果高危妊娠产妇的育儿胜任感总分68.88±12.75,其中育儿自我效能得分34.17±6.08,育儿满意度得分34.11±8.81;产后社会支持期望落差为27(6.0,54.5)。纯母乳喂养率26.9%,纯母乳喂养产妇的育儿胜任感水平及各维度评分显著高于其他喂养方式的产妇(均P<0.05)。多元线性逐步回归分析显示,纯母乳喂养、产后抑郁得分、信息支持落差是影响高危妊娠产妇育儿胜任感水平的主要因素(调整R^2=0.393)。结论产科工作者应重视高危妊娠产妇抑郁的筛查,提供促进产妇康复、早产儿育儿知识与母乳喂养指导等方面的信息支持,提高早产儿的纯母乳喂养率,以提高高危妊娠产妇的育儿胜任感水平。     

同伴教育对母乳喂养结局影响的Meta分析

目的评价同伴教育对母乳喂养结局的影响。方法计算机检索从建库至2017年3月Cochrane Library、PubMed、Web of Science、Embase、中国知网、万方数据库、中国生物医学文献数据库(CBM)研究同伴教育对母乳喂养结局影响的文献。纳入相关的随机对照试验或类实验性研究。将纳入的文献进行质量评价及Meta分析。结果纳入17项随机对照试验和1项类实验性研究。Meta分析结果表明,同伴教育可以提高母乳喂养启动率和产后6周、产后3个月的纯母乳喂养率和产后3个月任何母乳喂养率(均P0.01);但对产后6个月的任何母乳喂养状况及对纯母乳喂养的持续时间无明显影响(均P0.05)。结论从孕期持续到产后的同伴教育可以提高母乳喂养启动率,促进产后3个月内的母乳喂养状况,对产后6个月或更长期的母乳喂养促进效果并不明显,但在中国延长母乳喂养时间的促进作用已逐渐凸显。     

产妇母乳喂养自我效能与母婴依恋的相关性研究

目的 探讨产妇母乳喂养自我效能与母婴依恋的相关性,为针对性干预提供参考。 方法 采用母乳喂养自我效能简式量表、母婴依恋量表、匹兹堡睡眠质量指数量表、产后疲乏量表及产后抑郁量表,对433例产后42 d内的产妇进行调查。 结果 母乳喂养自我效能总分为（50.42±13.58）分。回归分析结果显示,母婴依恋、出院2周内是否添加奶粉、每天哺乳次数、产后抑郁、喂养期间是否遇到困难、是否自感母乳充足是母乳喂养自我效能的影响因素（均P＜0.05）。 结论 母婴依恋是母乳喂养自我效能的重要影响因素,应采取针对性措施促进母婴依恋,提高产妇喂养自我效能,从而提高母乳喂养率。     

影响哺乳时限的社会人口学因素分析

在影响哺乳的诸多因素中，社会经济及人口学因素不容忽视，本研究旨在探讨社会人口学因素对哺乳时限的影响。应用来自“中国农村已婚育龄妇女使用避孕方法变化”调查资料经生命表方法结果表明，江苏省农村产后妇女哺乳率为９７，６％，平均哺乳时限为１４．４个月，其中苏北地区为２０．７个月，苏南地区为１２．６个月。比例风险模型分析结果进一步表明，居住地区、妇女生育年龄、婴儿性别、分娩地点、妇女文化程度及其职业和丈夫的职业是主要的影响因素。经济落后地区、大生育年龄组妇女、男婴、丈夫从事农业、妇女为文盲、婴儿在家分娩的妇女哺乳时限长。在控制了其他社会人口学因素后，仍存在着地区间哺乳时限的差异，这可能与苏南、苏北文化风俗不同有关。针对影响因素采取相应措施，使之利于妇女延长完全哺乳时限。     

High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique

Introduction

Acute infection with HIV in the postpartum period results in a high risk of vertical transmission through breastfeeding. A study was done to determine the HIV incidence rate and associated risk factors among postpartum women in Southern Mozambique, where HIV prevalence among pregnant women is 21%.

Methods

A prospective cohort study was conducted in six rural health facilities in Gaza and Maputo provinces from March 2008 to July 2011. A total of 1221 women who were HIV-negative on testing at delivery or within two months postpartum were recruited and followed until 18 months postpartum. HIV testing, collection of dried blood spot samples and administration of a structured questionnaire to women were performed every three months. Infant testing by DNA-PCR was done as soon as possible after identification of a new infection in women. HIV incidence was estimated, and potential risk factors at baseline were compared using Poisson regression.

Results

Data from 957 women were analyzed with follow-up after the enrolment visit, with a median follow-up of 18.2 months. The HIV incidence in postpartum women is estimated at 3.20/100 women-years (95% CI: 2.30–4.46), with the highest rate among 18- to 19-year-olds (4.92 per 100 women-years; 95% CI: 2.65–9.15). Of the new infections, 14 (34%) were identified during the first six months postpartum, 11 (27%) between 6 and 12 months and 16 (39%) between 12 and 18 months postpartum. Risk factors for incident HIV infection include young age, low number of children, higher education level of the woman''s partner and having had sex with someone other than one''s partner. The vertical transmission was 21% (95% CI: 5–36) among newly infected women.

Conclusions

Incidence of HIV is high among breastfeeding women in Southern Mozambique, contributing to increasing numbers of HIV-infected infants. Comprehensive primary prevention strategies targeting women of reproductive age, particularly pregnant and postpartum women and their partners, will be crucial for the elimination of paediatric AIDS in Africa.     

Early predictors of long-term work disability after major limb trauma

BACKGROUND: A better understanding of the factors influencing return to work (RTW) after major limb trauma is essential in reducing the high costs associated with these injuries. METHODS: Patients (n = 423) who underwent amputation or reconstruction after limb threatening lower extremity trauma and who were working before the injury were prospectively evaluated at 3, 6, 12, 24, and 84 months. Time to first RTW was assessed. For individuals working at 84 months, the percentage of time limited in performance at work was estimated using the Work Limitations Questionnaire. RESULTS: Estimates of the cumulative proportion returning to work at 3, 6, 12, 24, and 84 months were 0.12, 0.28, 0.42, 0.51, and 0.58. Patients working at 84 months were, on average, limited in their ability to perform the demands of their job 20 to 25% of the time. In the context of a Cox proportional hazards model, differences in RTW outcomes by treatment (amputation versus reconstruction) were not statistically significant. Factors that were significantly associated (p < 0.05) with higher rates of RTW include younger age, being White, higher education, being a nonsmoker, average to high self efficacy, preinjury job tenure, higher job involvement, and no litigation. Early (3 month) assessments of pain and physical functioning were significant predictors of RTW. CONCLUSIONS: Return to work after severe lower extremity trauma remains a challenge. Although the causal pathway from injury to impairment and work disability is complex, this study points to several factors that influence RTW that suggest strategies for intervention.     

Forearm bone mineral density changes during postpartum and the effects of breastfeeding, amenorrhea, body mass index and contraceptive use

Summary

Prospective cohort study performed to evaluate bone mineral density (BMD) changes up to 12?months postpartum of healthy women and its association with breastfeeding, contraceptive methods, amenorrhea, and body mass index (BMI). There is a trend in bone loss during the first 6?months with posterior recovery, with evidence of a protective effect of hormonal contraception.

Introduction

This study was conducted to evaluate bone mineral density (BMD) changes during postpartum period among healthy women and its association with breastfeeding, use of contraceptive methods, amenorrhea and body mass index (BMI).

Methods

A prospective cohort study including 100 healthy women. Distal BMD was measured 7–10?days, 3, 6, and 12?months postpartum at the nondominant forearm using dual-energy X-ray absorptiometry. Data about breastfeeding duration, amenorrhea, contraceptive use and BMI were collected.

Results

Seventy-eight women had a complete set of BMD measurements. The mean duration of exclusive breastfeeding was 125.9 (±66.6) days, with a median total lactation period of 263.5?days. The mean duration of amenorrhea was 164.2 (±119.2) days. BMD measurements showed a significant decrease in the distal radius, however with no significance in the ultradistal radius. When considering only the nonhormonal contraceptive users, the difference at 12?months was significant. Multivariate analysis of variance showed that both BMI and contraceptive use were significantly correlated with BMD. Multiple linear regression analysis showed significant correlation of distal radius with baseline BMD at the same site, pregestational BMI, age, years of schooling and difference in BMI. For ultradistal radius, there was a significant direct correlation with its baseline BMD and pregestational BMI.

Conclusions

There was a trend in bone loss during the first 6?months postpartum with posterior recovery. Also, hormonal contraceptive methods provided protection of bone loss. However, the long duration of breastfeeding and the follow-up were not sufficient to draw definitive conclusions on postweaning BMD conditions.     

Long-Term Protective Effect of Lactation on the Development of Type 2 Diabetes in Women With Recent Gestational Diabetes Mellitus

Women with gestational diabetes mellitus (GDM) have a high risk of developing postpartum type 2 diabetes. Strategies to prevent postpartum type 2 diabetes are important to reduce the epidemic of diabetes and its societal impact. Breastfeeding was reported to improve early postpartum glucose tolerance and reduce the subsequent risk of type 2 diabetes. To investigate whether breastfeeding influences short- and long-term postpartum diabetes outcomes, women with GDM (n = 304) participating in the prospective German GDM study were followed from delivery for up to 19 years postpartum for diabetes development. All participants were recruited between 1989 and 1999. Postpartum diabetes developed in 147 women and was dependent on the treatment received during pregnancy (insulin vs. diet), BMI, and presence/absence of islet autoantibodies. Among islet autoantibody-negative women, breastfeeding was associated with median time to diabetes of 12.3 years compared with 2.3 years in women who did not breastfeed. The lowest postpartum diabetes risk was observed in women who breastfed for >3 months. On the basis of these results, we recommend that breastfeeding should be encouraged among these women because it offers a safe and feasible low-cost intervention to reduce the risk of subsequent diabetes in this high-risk population.Gestational diabetes mellitus (GDM) occurs in around 4% of pregnancies and is defined as glucose intolerance with an onset or first diagnosis during pregnancy (1). GDM is known to increase the risk for postpartum type 2 diabetes (2). Of potential relevance for the protection against postpartum diabetes, an analysis of large cohort studies in the U.S. found that the duration of lactation was inversely associated with the incidence of type 2 diabetes (3–5). The risk reductions were particularly marked when breastfeeding was continued for 1 to 2 years or ≥2 years. However, women with GDM are less likely to breastfeed and, if they do, breastfeeding usually is continued for a shorter duration than among women without diabetes (6–10). Nevertheless, women with GDM who do breastfeed have improved lipid and glucose metabolism during the first 3 months after birth (11–13). These findings suggest that breastfeeding may not only have a short-term effect on postpartum glucose tolerance, as previously shown (11–13) but may also delay the long-term development of type 2 diabetes among women with GDM. Nevertheless, few studies have assessed these possibilities (3,12).The prospective German GDM study has followed patients with GDM from delivery for up to 19 years postpartum to determine the risk of developing diabetes and to identify factors that modify long-term risk for postpartum diabetes. Here, we examined the risk of postpartum diabetes and tested the hypothesis that breastfeeding protects against postpartum type 2 diabetes in women with GDM.     

四川彭县山区妇女母乳喂养及哺乳期闭经情况调查

作者于１９９２年３月对四川彭县山区１０４０名妇女产后哺乳期闭经、母乳喂养持续时间以及使用避孕措施的情况进行了调查和分析。结果产后１、６、１２个月的哺乳妇女分别为１００％、９５％、８２％。产后！、３、６、１２个月闭经妇女分别为９０％、７４％、６２％、３６％。产后２、６、１２个月避孕的妇女分别为１９％、４８％、９１％。认为妇女产后３个月采用避孕措施是适当的，并建议哺乳妇女首选不含激素宫内节育器。     

Psychological stress reduces the immunological benefits of breast milk

Our study aimed to assess the impact of maternal psychological stress on the immunological components of breast milk. Eighty‐nine women participated in the study. We assessed general stress, postpartum‐specific stress, negative affectivity, salivary cortisol of mother, and secretory immunoglobulin A (sIgA) levels of breast milk 4–6 weeks after delivery. Controlling for the effects of women's age, weight, number, and duration of feedings, postpartum‐specific stress was related to reduced sIgA concentration (R² = .206, beta = ?.275, p = .020). This study suggests that the established link between psychological stress and immunity may also extend to the immunity of the newborn by reducing the immunological benefits of breast milk. It also suggests that breastfeeding might be a potential mechanism of the relationship between maternal stress and the health of the offspring. Findings highlight the need for interventions addressing women during the postpartum period, in order to ensure the mother's well‐being and the infant's optimal development.     

Influence of reproductive factors on hip fracture risk in Chinese women

To assess the relationships between reproductive factors and the risk of hip fractures in postmenopausal Chinese women, the authors analyzed data from a matched case-control study conducted in the Beijing metropolitan area among women aged 50 years and older. One hundred and fifty-six cases who sustained a hip fracture after minor trauma between January 1994 and May 1996 were identified from hospital records, of whom 121 could be located (78%). All cases agreed to be interviewed. Two controls were selected from the neighbors of each hip fracture case and matched to the cases by age within a 5-year range. Information on reproductive factors and potential confounders was obtained through personal interviews. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed using conditional logistic regression. Multiple imputation procedure was also employed to account for item non-response. Although univariate analyses revealed that later age at menopause, parity and breastfeeding were protective factors, only breastfeeding was statistically associated with risk of hip fracture after adjusting for potential confounding in multivariable logistic models. As compared with women with average duration of breastfeeding per child 6 months, women with average duration of breastfeeding per child 7–12 months, 13–23 months, and 24 months had odds ratios of 1.14 (95% CI: 0.48, 2.72), 0.28 (95% CI: 0.10, 0.82) and 0.34 (95% CI: 0.13, 0.92), respectively. Among parous women, 13% reduced risk was associated with every 6 months increase in breastfeeding per child. The authors conclude that extended breastfeeding is associated with a reduced hip fracture risk among Chinese women in Beijing.