Jian Tao Lee

A randomized controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence

Introduction and hypothesisThe aim of the study was to evaluate the effect of antenatal pelvic floor muscle exercise (PFME) in the prevention and treatment of urinary incontinence during pregnancy and postpartum period.MethodsThree hundred women were randomly assigned to the PFME group and control group. Urinary symptoms were measured by Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and question of self-reported urinary incontinence. Questionnaire scores of the PFME and the control groups were compared and analyzed.ResultsDuring late pregnancy and the postpartum period, the PFME group had significantly lower total UDI-6 and IIQ-7 scores; their self-report rate of urinary incontinence was also less than the control group. Additionally, we found whether in PFME or control, women who delivered vaginally were more likely to develop postpartum urinary leakage than women who delivered by cesarean section.ConclusionsPFME applied in pregnancy is effective in the treatment and prevention of urinary incontinence during pregnancy, and this effect may persist to postpartum period.

Factors Related to Maternal Perception of Milk Supply While in the Hospital

Background: Perceived insufficient milk supply is a frequent concern and reason for early weaning in Taiwanese mothers. Purpose: The purpose of this study was to explore the factors related to maternal milk supply. Methods: A cross-sectional study was carried out at a medical center in northern Taiwan. A total of 205 healthy mother-infant pairs were recruited. A tool to assess insufficient milk supply developed by P.D. Hill and S.S. Humenick (1996) was used to gather breastfeeding information during each participants hospital stay. Results: Infant-feeding methods, planned breastfeeding duration, infant sucking behaviors, family support, and infant sucking patterns were found to explain 35.3% of variance in maternal perception of milk supply. Conclusions/Implications for Practice: Mothers in Taiwan are particularly sensitive to infant crying. To prevent mothers from perceiving inadequate milk supply, nurses should encourage postpartum mothers to suckle their infant on the breast and teach mothers breastfeeding skills and how to pacify crying babies. In addition, hospital managers should make policies to minimize bottle and supplementary formula feeding.

The meaning of sexual satisfaction in pregnant taiwanese women

The aim of this qualitative study was to explore Taiwanese womens experience of sexual satisfaction during pregnancy. Twelve participants were recruited through purposive sampling of outpatients registered in the antepartum clinic of a medical center in northern Taiwan. Data collection consisted of semi-structured interviews and tape recordings. A modified phenomenologic methodology and narrative analysis of transcripts yielded four essential themes related to the personal meaning of sexually satisfying experiences in pregnancy: 1) improvement of self-identity, 2) empowerment through sexual relations, 3) strengthening the marital bond, and 4) reinforcement of the value of sexuality. This woman-centered view of the significance of sexually satisfying experiences in pregnancy can help health care professionals understand and educate their clients about womens sexuality during pregnancy.

Sexual Positions and Sexual Satisfaction of Pregnant Women

The purpose of this study was to investigate the sexual positions and sexual satisfaction of women during pregnancy. The authors sampled pregnant women (N = 215) from outpatients registered at the antepartum clinic of a medical center in northern Taiwan. The authors gathered data on recent sexual satisfaction, general sexual satisfaction, and sexual position using a self-report, structured questionnaire. The results showed that coital frequency decreased from the first to third trimester (p < .05). The most common sexual position for pregnant women (67.6%) was man on top, face-to-face. Sexual position did not change significantly by trimester. More women with more sexual satisfaction than women with poor sexual satisfaction tended to adopt the woman-on-top, face-to-face, and abdominal-supportive sexual positions.

Factors Related to Milk Supply Perception in Women Who Underwent Cesarean Section

Background: Perceived insufficient milk supply is common among postpartum women and is a major reason for early weaning. Studies indicate a significantly higher incidence of insufficient milk supply in women who undergo cesarean section as compared with women who undergo vaginal delivery. Purpose: This study was designed to determine perceived milk supply in postpartum women who underwent a planned cesarean section, as well as related factors. Methods: Authors employed a descriptive correlational study design. Factors associated with milk supply perception in postpartum women (at 3 days postpartum) were collected from 141 postpartum women who planned to undergo cesarean section at a regional teaching hospital in northern Taiwan. A demographic data sheet, the Birth Practice Inventory, a visual pain analog scale, and the Hill and Humenick Lactation Scale were used to identify factors affecting the perceived milk supply of participants. Results: The study used multiple linear regression to identify significant predictors of milk supply perception. Four factors, including parity, type of anesthesia, time to initial breastfeeding, and use of formula, explained 23.1% of total variance among participants. Women who experienced epidural patient-controlled analgesia, those with delayed initial breastfeeding or lower breastfeeding frequency, and those who used formula supplementation earned relatively lower perceived milk supply scores. Conclusions/Implications for Practice: Study results indicate that medical staff should encourage postpartum women to commence breastfeeding, based on infant need, as early as possible and reduce formula use to increase breastfeeding frequency. Shifting to nonnarcotic analgesic medications from epidural patient-controlled analgesia as early as possible is also recommended to increase breastfeeding success.

Transtheoretical model-based postpartum sexual health education program improves women's sexual behaviors and sexual health.

INTRODUCTION Postpartum sexual health education was once routinely administered to postpartum women, but few interventions were specifically described or clearly based on theory, and few sexual interventions affected womens sexual behaviors. AIM To evaluate the effectiveness of a refined theory-based interactive postpartum sexual health education program (IPSHEP) in enhancing postpartum womens sexual behavior and health. METHODS For this prospective, randomized controlled trial, 250 participants were randomized to three groups. Experimental group A received our refined theory-based IPSHEP. Experimental group B received only an interactive, self-help pamphlet. The control group received routine education (a 10- to 15-minute educational talk and a sexual health pamphlet without an interactive design). Data were collected at baseline, 3 days, 2 months, and 3 months postpartum. MAIN OUTCOME MEASURE Postpartum womens sexual self-efficacy (SSE), diversity of sexual activity (DSA), return to sexual activity, and sexual satisfaction (SS). RESULTS Women who received our theory-based postpartum sexual health education program had significantly greater SSE (P < 0.05) and greater DSA (P < 0.05), and tended to resume their sexual life earlier than women in the routine teaching and interactive pamphlet-only groups (P < 0.05). However, the SS levels of postpartum women who received our program did not differ significantly from those of women who received routine teaching or the interactive pamphlet only. CONCLUSIONS   Our findings suggest that a theory-based postpartum sexual health education program improved womens sexual health and sexual behavior and that the transtheoretical model can be translated into practice, supporting its use to enhance the sexual health of postpartum women. Despite the lack of a significant effect on SS, women who received our theory-based postpartum sexual health education program tended to maintain their prepregnancy level of SS in early postpartum.

The Role of Xylitol Gum Chewing in Restoring Postoperative Bowel Activity After Cesarean Section

Aims: The goal of this study was to evaluate the effects of xylitol gum chewing on gastrointestinal recovery after cesarean section. Methods: Women who underwent cesarean section (N = 120) were randomly allocated into Group A (xylitol gum), Group B (nonxylitol gum), or the control group (no chewing gum). Every 2 hr post-cesarean section and until first flatus, Groups A and B received two pellets of chewing gum and were asked to chew for 15 min. The times to first bowel sounds, first flatus, and first defecation were then compared among the three groups. Results: Group A had the shortest mean time to first bowel sounds (6.9 ± 1.7 hr), followed by Group B (8 ± 1.6 hr) and the control group (12.8 ± 2.5 hr; one-way analysis of variance, p < .001; Scheffe’s post hoc comparisons, p < .05). The gum-chewing groups demonstrated a faster return of flatus than the control group did (p < .001), but the time to flatus did not differ significantly between the gum-chewing groups. Additionally, the differences in the time to first defecation were not significant. Conclusion: After cesarean section, chewing gum increased participants’ return of bowel activity, as measured by the appearance of bowel sounds and the passage of flatus. In this context, xylitol-containing gum may be superior to xylitol-free gum.

A Systematic Review and Meta-Analysis of the Effect of Lifestyle Modification on Metabolic Control in Overweight Children

Childhood obesity is associated with type 2 diabetes mellitus. We aimed to determine the effects of lifestyle modification programs on fasting plasma glucose (FPG) levels in overweight children. We queried six relevant electronic databases and manually searched for studies published before December 2016. Overweight/obese children who underwent a lifestyle modification for more than 6 months were included. A total of 3923 children from eight randomized controlled trials (RCTs) were included. Compared with the control group, the lifestyle modification group had significantly lower FPG levels by 1.3 mg/dL. The mean differences were significantly decreased for both secondary outcomes; BMI z-score decreased by 0.16 units and insulin levels decreased by 2.4 mU/L. The metaregression showed that the follow-up duration was associated with FPG levels and BMI and insulin levels and half year is a suitable follow-up duration for this population. This study showed that lifestyle modification programs may be effective in reducing the FPG levels of overweight/obese children. Further high-quality RCTs with longer follow-up periods are needed to evaluate the long-term effect of this complementary approach for diabetes mellitus prevention on overweight/obese children.

Transformation of Sexual Expression in Taiwanese Women After Treatment for Gynecological Cancer.

Background: Understanding the sexual experience of women after gynecological cancer is important for nurses caring for this population. Sexual experience should be studied within women’s sociocultural context because it influences the construction of sex. However, the sexual experience of Chinese women after gynecological cancer has not been examined qualitatively. Objective: The aim of this study is to explore the sexual experience of Taiwanese women after treatment for gynecological cancer. Methods: Data for this phenomenological study were collected during in-depth, semistructured interviews with 11 women purposively recruited from outpatients of the gynecological clinic of a medical center in northern Taiwan. Interview data were analyzed using the Colaizzi method. Results: Data analysis yielded 4 themes: (1) suffering from sexual changes and difficulties, (2) judgments and uncertainty about the appropriateness of sexual behavior, (3) maintenance and transformation of sexual expression, and (4) reinterpretation and reaffirmation of feminine value. Conclusions: This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate Chinese and Asian clients about women’s sexual expression during and after cancer treatment. Implications for Practice: This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate women about possible alternative ways of sexual expression during and after cancer treatment.