Piyanee Klainin-Yobas

Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: A meta-analysis

OBJECTIVES Depression, a common mental health problem, is projected to be the second leading cause of disability for adults by year 2020. Mindfulness-based interventions (MFIs) have been integrated into therapeutic work on depression, but limited systematic reviews reported their efficacy on heterogeneous groups of mental disorders. This meta-analysis aimed to examine the efficacy of the MFIs on depressive symptoms in people with various mental disorders. DESIGN A meta-analysis of experimental and quasi-experimental studies was undertaken. DATA SOURCES Multiple search strategies were undertaken to identify published and unpublished studies conducted between 1995 and 2011. Electronic databases used were Scopus, CINAHL, PubMed, ScienceDirect, PsyINFO, Dissertation Abstract International, Web of Science Index, Controlled-trial.com, and clinicaltrials.gov. REVIEW METHODS Data were extracted and appraised by two reviewers. For each study, the Quality Rating Index (QRI) and Code Sheet for Randomized Controlled Trials (CS-RCT) were used to assess methodological quality and extract relevant data respectively. Data were analysed and synthesized using PASW statistic 17.0 and Comprehensive Meta Analyses Software 2.0. RESULTS Thirty-nine studies conducted in ten countries were included and 105 effect sizes were calculated. Most studies utilised single group pretest-posttest quasi-experimental design, convenience sampling, and self-reported questionnaires. Between-group comparisons indicated that MFIs are superior to standard care in reducing depressive symptoms and preventing relapse with effect sizes ranging from 0.11 to 1.65. Exposure-based cognitive therapy (d=2.09) appeared to be the most efficacious intervention, followed by mindfulness-based stress reduction programme (d=1.92), acceptance-based behaviour therapy (d=1.33), and stress less with mindfulness (d=1.31). Effect sizes were significantly associated with the length of intervention sessions but not related to methodological quality of studies. CONCLUSION The mindfulness-based interventions are efficacious for alleviating depressive symptoms in adults with mental disorders. The interventions could be used in conjunction with other treatments in clinical settings.

Assessment for simulation learning outcomes: A comparison of knowledge and self-reported confidence with observed clinical performance

BACKGROUND With extensive use of simulation in nursing education, researchers around the world are evaluating learning outcomes from simulation. Numerous studies reported the use of knowledge tests and self-reported measures to evaluate simulation outcomes. AIM To determine whether self-reported confidence and knowledge measures are indicators of clinical performance observed in a simulation-based assessment. METHOD Thirty-one third year nursing students were randomized into intervention and control group. The intervention group received a six hour simulation-based programme in care of a patient with physiological deterioration. Pre and post-tests using knowledge test, confidence scale and simulation-based assessment were conducted immediately before and after the simulation program. RESULTS The intervention group had a significantly higher post-test mean score than the control group for knowledge and clinical performances. Both groups demonstrated a significant improvement on post-test scores from pre-test scores for self-confidence with no significant differences detected among the two groups. Correlation tests indicated no significant correlation between self-confidence and clinical performance, and between knowledge and clinical performance. CONCLUSION The study did not provide evidence to support the validity of the knowledge test and self-confidence measures for predicting clinical performance. Most importantly, it revealed potential danger of a simulation-based assessment that could lead toward overestimation of self-confidence.

An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore

OBJECTIVES to explore the traditional birthing practices of Singaporean women. RESEARCH DESIGN a qualitative study using a phenomenological approach. Data were collected using individual interviews, which were audio-recorded and transcribed verbatim. Colaizzis phenomenological method was used to analyse the data. SETTING obstetric outpatient clinics in a tertiary hospital in Singapore. PARTICIPANTS a purposive sample of 30 women, 1-3 months postpartum. FINDINGS two broad themes emerged-following tradition and challenging tradition. KEY CONCLUSIONS Singaporean women experiencing pregnancy and childbirth follow tradition through the influence of their mother and mother-in-law and because of worry over consequences that may result if they do not. Tradition is also challenged through the modification or rejection of traditional practices and changing family roles and expectations. IMPLICATIONS health professionals need to provide accurate information on traditional birthing practices and scientific evidence to support or refute such practices with the aim of preventing women from adhering to practices that are hazardous to them and the baby.

Effects of relaxation interventions on depression and anxiety among older adults: a systematic review

Objectives: This systematic review examined empirical evidence of the effects of relaxation interventions on anxiety and depression among older adults. Method: A comprehensive literature search identified studies that satisfied the pre-set inclusion and exclusion criteria. We focused on 15 published and non-published studies – 12 randomised controlled trials and three non-randomised controlled trials – undertaken in the past 20 years (1994–2014). Three reviewers selected studies, extracted data, and appraised the methodological quality. We then computed Hedges’ effect sizes and used these to represent the effects of intervention. Results: Our findings suggested that older adults who received relaxation interventions experienced greater reductions in depression and anxiety than controls in most studies. Progressive muscle relaxation training, music intervention, and yoga had the strongest intervention effects on depression. Music intervention, yoga, and combined relaxation training most effectively reduced anxiety symptoms among older adults. Furthermore, the impact of some relaxation interventions remained in effect for between 14 and 24 weeks after the interventions. Conclusion: This systematic review supported the positive effects of relaxation interventions on depression and anxiety among older adults. Health care providers may integrate relaxation interventions into standard care for older adults in community and hospital settings, taking into consideration the participants preference and health care policy.

The mediating effects of coping on the stress and health relationships among nursing students: a structural equation modelling approach

AIMS To test the impact of stress on psychological and physical health, and examine the mediating effects of coping on the stress-health relationships among nursing students. BACKGROUND Stress is associated with various physical and psychological symptoms in nursing students. Numerous studies examined the relationships among stress, coping and health; nevertheless, a mechanism of coping has not been fully explored in Thai nursing students. DESIGN This study adopted a cross-sectional, descriptive correlational research design. METHODS A convenience sample of 335 nursing students were recruited from a University in Thailand from 2005-2007. We used self-reported questionnaires to collect information; and analysed data using descriptive statistics and structural equation modelling. RESULTS Nursing students with high levels of stress reported poorer physical health and higher psychological distress. Stress had a stronger effect and explained more variances on psychological distress than on poor physical health. The partial mediation of coping was observed. Specifically, 77·00% of the effects of stress on poor physical health and 11·30% on psychological distress were mediated by coping. CONCLUSION Evidence from this study contributes to the nursing science and has implications to nursing practice. Stress among nursing students should be monitored and effectively managed to prevent deleterious effects on their health. Nursing interventions focusing on coping skill training could be developed and delivered. Future research may examine the effectiveness of the interventions and/or to further explore variables associated with psychological distress in nursing students.

Maternal, Infant Characteristics, Breastfeeding Techniques, and Initiation: Structural Equation Modeling Approaches.

Objectives The aim of this study was to examine the relationships among maternal and infant characteristics, breastfeeding techniques, and exclusive breastfeeding initiation in different modes of birth using structural equation modeling approaches. Methods We examined a hypothetical model based on integrating concepts of a breastfeeding decision-making model, a breastfeeding initiation model, and a social cognitive theory among 952 mother-infant dyads. The LATCH breastfeeding assessment tool was used to evaluate breastfeeding techniques and two infant feeding categories were used (exclusive and non-exclusive breastfeeding). Results Structural equation models (SEM) showed that multiparity was significantly positively associated with breastfeeding techniques and the jaundice of an infant was significantly negatively related to exclusive breastfeeding initiation. A multigroup analysis in the SEM showed no difference between the caesarean section and vaginal delivery groups estimates of breastfeeding techniques on exclusive breastfeeding initiation. Breastfeeding techniques were significantly positively associated with exclusive breastfeeding initiation in the entire sample and in the vaginal deliveries group. However, breastfeeding techniques were not significantly associated with exclusive breastfeeding initiation in the cesarean section group. Maternal age, maternal race, gestations, birth weight of infant, and postnatal complications had no significant impacts on breastfeeding techniques or exclusive breastfeeding initiation in our study. Overall, the models fitted the data satisfactorily (GFI = 0.979–0.987; AGFI = 0.951–0.962; IFI = 0.958–0.962; CFI = 0.955–0.960, and RMSEA = 0.029–0.034). Conclusions Multiparity and jaundice of an infant were found to affect breastfeeding technique and exclusive breastfeeding initiation respectively. Breastfeeding technique was related to exclusive breastfeeding initiation according to the mode of birth. This relationship implies the importance of early effective interventions among first-time mothers with jaundice infants in improving breastfeeding techniques and promoting exclusive breastfeeding initiation.

Factors relating to perioperative experience of older persons undergoing joint replacement surgery: an integrative literature review

Abstract Purpose: The purpose of this literature review was to examine factors relating to the perioperative experience of older persons undergoing total hip and knee replacement surgery resulting from osteoarthritis. Method: A literature search was undertaken using databases CINAHL, PubMed, Scopus and Web of Science to provide relevant research articles. Articles were included if they examined the factors relating to the HRQOL, QOL and perioperative experience of older persons undergoing joint replacement surgery resulting from osteoarthritis. The use of Joanna Briggs Institute’s critical appraisal checklist facilitated a systematic appraisal of studies with regard to the scientific rigor of the studies. Results: Twenty-two publications were categorized into one main theme: “factors relating to perioperative experience” subcategorized into eight subthemes: “waiting time”, “pain and disability”, “mental health”, “race/ethnicity, age and gender”, “body image”, “coping and social support”, “patient education” and “care continuity”. Conclusion: There is a need to conduct further research to examine the perioperative experience of older persons undergoing joint replacement surgery, in particular, the lived perioperative experience of a diverse race, ethnicity and culture in an Asian population. Implications for Rehabilitation Healthcare services should remain focused on reducing waiting time as prolonged waiting time for joint replacement surgery was detrimental to patients’ HRQOL. Healthcare professionals need to identify strategies to improve the perioperative pain experience through patient education on pain management and positive social support to support the process of recovery. Patients’ expectations of pain and their process of recovery were closely linked to patient education. One model of patient education that was seen to be successful and linked to good post-operative outcomes was care continuity model. Being actively involved in the care continuity results in better post-operative outcomes for the patient and their family.

Efficacy of Psychoeducation and Relaxation Interventions on Stress-Related Variables in People With Mental Disorders: A Literature Review

This paper aimed to critically review and summarize empirical evidence concerning the efficacy of psychoeducation or relaxation-based stress management interventions on stress-related variables in people with mental disorders. Electronic databases were used during the literature search. Thirteen articles that fulfilled the preset eligible criteria were included in the review. Findings indicated that psychoeducation and relaxation-based interventions mitigated stress and depression; and enhanced relaxation intensity and knowledge on stress management. However, mixed results were obtained on anxiety. In addition, interventions using virtual reality technology revealed positive effects on depression, relaxation intensity and anxiety. Limitations and recommendations for future research are discussed.

Psychometric Properties of the Iowa Infant Feeding Attitude Scale among a Multiethnic Population during Pregnancy

Background: The Iowa Infant Feeding Attitude Scale (IIFAS) was developed to measure maternal attitudes toward infant feeding, but a number of validated studies on the IIFAS found that it was subject to methodological limitations. Objective: The purpose of this study was to evaluate the psychometric properties of the IIFAS among a multiethnic population in Singapore. Methods: A cross-sectional research design was used on a sample of 417 antenatal women. The internal consistency and stability of the IIFAS were evaluated using Cronbach’s α and test–retest reliability. Known-group comparisons discriminated certain group differences in a predictable way. A series of exploratory factor analyses (EFAs) was conducted to test the factor structure of the IIFAS using the maximum likelihood and principal axis factoring. The number of factors was selected according to theoretical and statistical considerations. A confirmatory factor analysis (CFA) was further performed to validate the factor structure constructed in the prior EFA. Results: The IIFAS had a Cronbach’s α and Pearson correlation of 0.79 and 0.85, respectively. The known-group comparisons among certain groups were supported. The EFA results showed that the 3-factor structure produced the most interpretable and theoretical sense. A second-order CFA was conducted to confirm the construct dimensionality of the 15-item IIFAS, with satisfactory fit indices found. Conclusion: The 15-item IIFAS is a psychometrically sound measurement tool that health care professionals can use to understand the diverse infant feeding attitudes and knowledge among different ethnic groups in order to provide breastfeeding interventions that are culturally sensitive.

Efficacy of Internet-Based Self-Monitoring Interventions on Maternal and Neonatal Outcomes in Perinatal Diabetic Women: A Systematic Review and Meta-Analysis

Background Self-monitoring using the Internet offers new opportunities to engage perinatal diabetic women in self-management to reduce maternal and neonatal complications. Objective This review aims to synthesize the best available evidence to evaluate the efficacy of Internet-based self-monitoring interventions in improving maternal and neonatal outcomes among perinatal diabetic women. Methods The review was conducted using Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsyINFO, Scopus, and ProQuest Dissertations and Theses to search for English-language research studies without any year limitation. A risk of bias table was used to assess methodological quality. Meta-analysis was performed with RevMan software. Cochran Q and I2 tests were used to assess heterogeneity. The overall effect was assessed using z tests at P<.05. Of the 438 studies identified through electronic searches and reference lists, nine experimental studies from 10 publications were selected. Results Half of the selected studies showed low risk of bias and comprised 852 perinatal diabetic women in six countries. The meta-analysis revealed that Internet-based self-monitoring interventions significantly decreased the level of maternal glycated hemoglobin A1c (z=2.23, P=.03) compared to usual care among perinatal diabetic women at postintervention. Moreover, Internet-based self-monitoring interventions significantly decreased the cesarean delivery rate (z=2.23, P=.03) compared to usual care among the mixed group at postintervention. Conclusions This review shows neonatal or other maternal outcomes are similar between Internet-based self-monitoring interventions and usual diabetes care among perinatal diabetic women. The long-term effects of the intervention must be confirmed in future studies using randomized controlled trials and follow-up data.