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Purpose The aim of this study was to examine the characteristics of users of postpartum care services and compare the factors associated with utilization of these services for users and non-users. The focus was on postpartum physical and mental discomfort, childcare anxiety, qualities of partners regarded as the closest supporters, and the use of instruction in childcare techniques. Methods A longitudinal study using a web-based self-administered questionnaire was conducted from May 2019 to February 2020 with study participants at 35 weeks gestation and one month postpartum. Of the 2,402 women given the research information leaflet at the time of their antenatal checkup, 667 (27.8%) responded to the first self-administered webbased survey, and 448 (18.7%) responded to the second one. The 448 respondents who answered at both time points and indicated whether they used the postpartum care services were included in the analysis. The respondents were divided into two groups: those who answered that they had used the postpartum care services and those who responded that they had not. Chi-square tests, Mann-Whitney U tests, and student t-tests were performed on the investigation variables. Results Characteristics significantly associated with users of postpartum care services included the following: annual household income of at least 9 million yen, status as an employed woman, desiring to be pregnant, receiving a negative reaction from one's partner when becoming pregnant, first breastfeeding was the day following the birth, a strained relationship with one's partner at one month postpartum, and low scores on the Short Form-8 (SF-8) Japanese version of the Physical Component Summary (PCS) at one month postpartum. Conclusion In this study, the use of postpartum care services was associated with decreased physical quality of life (QoL) after childbirth. In addition to the need for rest, the relationship with one's partner might be related, suggesting the need to consider the relationship with the partner as a factor in deciding whether to use postpartum care services. In addition, financial difficulties associated with using the current postpartum care services also existed. Therefore, physical QoL, the relationship with one's partner, and financial support should be considered so that those needing postpartum care services can access them. [ABSTRACT FROM AUTHOR]

Purpose Pregnancy and childbirth are the most common risk factors leading to pelvic floor disorders including pelvic organ prolapse (POP). POP is caused by the descent of pelvic organs due to increased intra-abdominal pressure and load on the birth canal. POP presents various symptoms. Therefore, it is difficult to diagnose through interview. If the relationship between the prevalence of specific POP symptoms and risk factors including habits that increase intra- abdominal pressure can be determined, the incidence of POP in women after childbirth may be prevented. This study aimed to clarify the prevalence of POP symptoms for each postpartum period during 5 years after childbirth and to determine the risk factors of these symptoms. Methods This cross-sectional study included participants who underwent vaginal delivery at the University of Tokyo Hospital in Japan. We used the Japanese version of the Pelvic Floor Distress Inventory -- short form 20, which includes the Prolapse Distress Inventory, to assess POP. The rate of women experiencing POP symptoms was calculated every 6 months after childbirth. Participants' characteristics including lifestyle, delivery records, and other variables were obtained from the questionnaire or medical records. The participants were divided into two groups: group with and without symptoms. Logistic regression analysis was performed using variables that showed a significant difference between the two groups. The research procedures were approved by the Research Ethics Committee of the Uni- versity of Tokyo. Results Questionnaires were distributed to 3776 women, and 1056 (28.0%) were returned. The number of valid re- sponses was 681. Approximately 36% and 43% of women had POP symptoms during 5 years and 6 months after childbirth, respectively. There was no significant difference in the rate of POP symptoms in each postpartum period. Women with POP symptoms were significantly more likely to experience incontinence, hard stools before and after pregnancy, and straining habits during defecation before pregnancy than those without. Conclusion Lifestyle habits before pregnancy and defecation conditions during the postpartum period were related to POP symptoms after childbirth. The study suggested the need for care to prevent the onset and worsening of POP symptoms, including advice on daily living behaviors such as early postpartum monitoring for the presence or absence of symptoms, voiding care, and avoiding increased intra-abdominal pressure that could stress the pelvic floor. [ABSTRACT FROM AUTHOR]

Purpose Cultural differences in complementary infant foods across countries and regions are unclear. Therefore, this study aimed to clarify the differences in guidelines and recommendations for complementary infant foods worldwide, especially focusing on foods that infants eat first and the order in which they are consumed. Methods Web questionnaires were sent to midwifery associations or nurses' associations in 166 countries that are members of the International Council of Midwives (ICM) or the International Council of Nursing (ICN). Midwives or nurses were asked about recommended foods for infants to eat first and recommendations for the order in which they should be eaten. For the analysis, we categorized the recommendations for complementary foods in each country, focusing on the order in which they were consumed. Chi-square test was used to analyze the differences in eating order classification and region. Results Responses were received from a total of 46 countries. Thirty-seven out of 46 countries, or 80.4%, responded that they had guidelines on complementary foods. Six patterns were found for complementary diets, including 2 patterns starting with grains and 3 with vegetables and patterns of parents' and infant-led diets. Grains were the most common starting pattern in Asia and Africa, while vegetables were the most common in Europe and America. Conclusion We believe that international nutritional intake and disease prevention guidelines should be considered as recommendations for complementary foods suitable for each country and region. [ABSTRACT FROM AUTHOR]

Purpose Many Japanese women continue to work during pregnancy, but half of them quit work. Several symptoms and discomfort during pregnancy are known to interfere with daily life and to be a reason for taking sick leaves or retiring during pregnancy. However, little is known about the factors behind their motivation to continue working throughout pregnancy. Work engagement is a concept defined as "a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption of workers", and can predict positive work outcomes, such as job performance, job satisfaction and motivation. This study has two hypotheses: (1) job resources would be positively associated with work engagement, and (2) the perceived symptoms during pregnancy would be negatively associated with work engage- ment. Then, this study aimed to explore the factors associated with work engagement among Japanese pregnant women. Methods Between July and November 2019, a cross-sectional study was conducted at two general hospitals in the urban area of Tokyo. Pregnant women were recruited during antenatal health check-ups and asked to answer self-ad- ministered questionnaires after obtaining written informed consent. The eligibility criteria were having a single preg- nancy, being at ≥16 weeks of gestation, and being able to read and write Japanese. The outcome variable was work engagement using the 3-item version of the Utrecht Work Engagement Scale. Furthermore, work-related variables, such as job demands and job resources, perceived physical and mental symptoms, and demographic characteristics were obtained. To examine the relationships between the independent variables and work engagement, a bivariate analysis was conducted. Then, multivariate regression analysis was performed on the variables that were significantly associated with work engagement in the bivariate analysis. Results Of 252 participants at ≥16 weeks' gestation who agreed to participate, 226 completed the questionnaires. After excluding 86 women who were not working at the time of recruitment, the data of 140 working pregnant women were included in the analyses. Participants' age (mean ± standard deviation) was 33.1 ± 4.3 years, and the mean score of work engagement was 3.6 ± 1.3. The results of the multivariate analysis showed that the factors associated with a higher level of work engagement were higher supervisor support (β = 0.259, p = 0.008), higher job demands (β = 0.267, p = 0.006), higher sense of coherence (β = 0.276, p = 0.001), and higher age (β = 0.188, p = 0.024). As for the hypotheses, this study revealed that (1) job resources were positively associated with work engagement, and (2) the perceived symptoms during pregnancy were not associated with work engagement. Conclusion Higher supervisor support was significantly associated with a higher level of work engagement. The finding demonstrates the importance of social support in the workplace in promoting work engagement among pregnant women. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study examined the relationship between degree of neonatal physiologic desquamation and skin barrier functionality. In addition, we identified factors associated with neonatal desquamation. Methods: This cross-sectional study assessed 4-day-old newborns. The desquamation level was evaluated and placed in one of the following categories based on the severity of the desquamation: no desquamation, a small amount, and severe (including cracked or bleeding). Skin barrier function was assessed by evaluating transepidermal water loss, stratum corneum hydration, skin pH, and sebum secretion. Results: Among study participants, 67 (39.9%) showed no desquamation, 82 (48.8%) displayed a small amount, and 19 (11.3%) had severe desquamation. The group with severe desquamation had significantly elevated facial transepidermal water loss levels and reduced levels of stratum corneum hydration throughout the body, indicating skin barrier dysfunction, than other groups. In addition, the group with severe desquamation had a significantly longer gestational age, lower temperature and humidity level, smaller vernix caseosa, and tended to be born during winter. Conclusions: To our knowledge, this is the first report indicating that infants with severe desquamation had worsened skin barrier function versus those with moderate and no desquamation. Future research should consider what kind of care should be provided to newborns with severe desquamation. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to evaluate the current state of intrapartum care practices in El Salvador and examine whether the presence or absence of care makes a difference in women's satisfaction with care, based on the recommendations listed in the "WHO recommendations: Intrapartum care for a positive childbirth experience" (hereafter, WHO guidelines). Methods Secondary analysis was performed on data from a baseline survey conducted to assess the effectiveness of the interventions of the Japan International Cooperation Agency (JICA) Technical Cooperation Project for "Humanization of Childbirth based on Scientific Evidence in the National Women's Hospital" (hereafter, project). In the project, pregnant women who were admitted to the National Women's Hospital of El Salvador for vaginal delivery were recruited to (1) a direct observation survey on care during labor, and to (2) an interview regarding satisfaction with obstetric care on postpartum women, from May to June 2021. Those who participated in both the survey and the interview were included in the secondary analysis. Of the 56 items of care specified in the WHO guidelines, 22 were examined and the relationships between the care items and the scores of the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale were analyzed by conducting a Mann-Whitney U test. Results Forty-four women were included in the study. The median COMFORTS scale score was 154 out of 200. Women with heavy postpartum hemorrhage were significantly less satisfied with the COMFORTS subscale of "Care during labor" (p=0.046). Further, women who were not administered prophylactic uterotonics for postpartum hemorrhage prevention as part of the active third stage of labor were also significantly less satisfied with obstetric care (p=0.042). Among the recommended care items, those routinized in El Salvador (including the use of prophylactic uterotonics for the prevention of postpartum hemorrhage and early skin-to-skin contact) were followed. However, vaginal examination at intervals of four hours and intermittent fetal heart rate auscultation were not followed. Non-recommended care including fundal pressure (Kristeller maneuver) and nasal or oral suctioning of the newborn was also observed. Conclusion Satisfaction was lower when women experienced postpartum hemorrhage or were not administered prophylactic uterotonics during the third stage of labor; these women may have felt that they did not receive adequate care. The results indicate that women who received the adequate care recommended in WHO guidelines and experienced better birth outcomes reported higher levels of satisfaction. The study suggests the need to ensure proper intrapartum care practices and provide adequate obstetric care to women in El Salvador to ensure proper satisfaction. [ABSTRACT FROM AUTHOR]

Purpose Humanization of childbirth refers to the concept of care that values the physiological processes of the mother and child. This concept has been introduced into the laws of Latin American countries. The present study aimed to analyze the care for maternal and child considered as humanization of childbirth in the relevant laws and regulations of Latin American countries. Methods Recent laws and regulations related to humanization of childbirth were researched from the government and ministry websites of 20 countries in Latin America with Spanish and Portuguese as the native language. The guaranteed laws in the care for women during pregnancy, childbirth, and postpartum and their newborns were extracted and compared with the itemized recommendations from the World Health Organization (WHO) guidelines about intrapartum care for a positive childbirth experience. Results Through online research, seven countries were found to mention laws and regulations about the care for women and newborns to promote humanization of childbirth. Specifically in Argentine law, 16 items in the care for women and newborns were guaranteed to promote humanization of childbirth. Additionally from other countries, 12 items in Chile, 18 items in Colombia, 16 items in Ecuador, 17 items in Nicaragua, 23 items in Panama, and 26 items in Peru were the respective number of guaranteed laws about the care for women and newborns. There were 22 items of care guaranteed by the laws from two or more countries from which 13 items overlapped with the itemized recommendations from the WHO guidelines. Although the care to achieve the humanization of childbirth differed from country to country, there was a common emphasis on respect for pregnant women, postpartum mothers, and newborns, as well as attitudes and postures as caregivers. However, there were fewer descriptions about clinical procedures and practices at each stage of labor. Conclusion The care in achieving the humanization of childbirth varies from country to country. The emphasis on the care and attitudes of health care providers in respecting women and newborns was common in the laws and regulations of the seven countries. As continuity is considered an important issue in humanization of childbirth, it is likely guaranteed that Latin American countries intend to ensure continuity of humanization of childbirth by enacting legislation. In prospect, Japan may have much to learn from this movement. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to review previous studies on infant skin problems and to summarize 1) the types of skin problems, 2) body area observed depends on the skin problem, and 3) the method of scoring for severity of skin problems. Method A search was conducted on PubMed for literature related to infant skin problems in August 2017. Among the 429 papers identified, 13 were included in this review. Result There were nine papers on diaper dermatitis, one on infant eczema, and three on seborrheic dermatitis. Four papers about diaper dermatitis used scales that were developed or used in previous studies, including the diaper rash and erythema scoring scale, Neonatal Skin Condition Score (NSCS), and Diaper Rash Severity Scale. Only the NSCS was validated. Although, erythema was assessed in all papers about diaper dermatitis, most of the types of skin problems were different among papers. Dryness, scaling, papules, and erythema were assessed in the literature on infant eczema, whereas erythema, scaling, and crusting were assessed in the literature about seborrheic dermatitis. Conclusion There was not the validated scale which was specialized the one skin problem. Also, the skin conditions related to each skin problem were different. Therefore, along with the scales for assessing the skin conditions of the entire body, the scales specialized for each skin problem or body area that have been examined for reliability and validity are preferable. [ABSTRACT FROM AUTHOR]

Purpose This study aims to understand the prevalence and factors associated with diaper dermatitis in infants to contribute to disseminating to nurses the characteristics of infants predisposed to developing diaper dermatitis through a research review. Methods A search was conducted using the Ichushi Web, version 5, of the Japan Medical Abstracts Society and MEDLINE databases from search engine PubMed using the following combinations of key words: infant and diaper rash. Two authors reviewed the articles based on the inclusion and exclusion criteria. Results were limited to original articles in Japanese and English within the past 30 years up to May 27, 2019. Statistically significant factors associated with the development and prevention of diaper dermatitis were extracted from the selected articles. Results Thirteen articles were selected. The point prevalence of diaper dermatitis ranged between 11.5 and 70.6%, while its period prevalence was between 15.2 and 90.6%, both showing a wide range. The definition of diaper dermatitis included whether diaper dermatitis was present and the evaluation of its degree of severity was performed. Diaper dermatitis was identified by the evaluator when certain symptoms were present or a case of dermatitis was clear, regardless of the type of symptoms and their severity (as well as without defining symptoms). Factors associated with the development and prevention of diaper dermatitis were attributed to infants, skin condition, digestive condition, health condition, nutrition method, skin care method, and childcare environment. Many risk factors were associated with infants' digestive or skin conditions, and a few studies focused on skin care, such as apply products as preventives. Conclusion Further studies are needed to standardize the methods for evaluating diaper dermatitis because of the wide range of prevalence caused by disagreements in methods of symptom evaluation. Few studies have indicated the relationship between diaper dermatitis and skin care methods used at home, and further research is required in this regard. [ABSTRACT FROM AUTHOR]

Purpose The World Health Organization (WHO) released "WHO recommendations: Intrapartum care for a positive childbirth experience" in 2018. The guideline is considered the revised edition of the "Care in Normal Birth: a practical guide" issued in 1996 dedicated to childbirth in healthy pregnant women. This study aimed to compare the old and new WHO guidelines, and to describe the changes that have been made. Methods First, the basic characteristics of both the guidelines were compared. Second, subheadings were created in Japanese to describe the contents of both the old and new guidelines. A comparable list of subheadings of the old and new guidelines was made, and the categories of recommendation were shown in the same table. Finally, we analyzed the following details: "newly added items in the new guideline", "items that were present in the old guideline but were not included in the new guideline", and "items in the new guideline for which the recommended levels have shifted". Then, the overall changes in the WHO recommendations for normal childbirth were described. Results The old and new WHO guidelines were similar with regard to promoting the respectful maternity care. The major points that were revised included the respect for diversity of the progress of labor and modification of the definitions and standard duration of the first and second stages of labor. Additionally, the new guideline included recommendations on the care for women who have undergone epidural anesthesia, and for newborns. Recommendations considered to have been widely accepted in several birth settings, such as the use of clean instruments was not included in the new guideline. The category levels that elevated from the old guideline were the items related to oxytocin administration at the third stage of labor, umbilical cord traction, and care for women who underwent epidural anesthesia. The new guideline emphasized the midwifery cares which promote women's positive childbirth experience. However, the contents of midwifery cares were consistently unchanged in the new and old guidelines, although there were differences in expressions. [ABSTRACT FROM AUTHOR]

Objective: this study aims to identify the aetiological relationships of psychosocial factors in postnatal traumatic symptoms among Japanese primiparas and multiparas. Design: a longitudinal, observational survey. Setting: participants were recruited at three institutions in Tokyo, Japan between April 2013 and May 2014. Questionnaires were distributed to 464 Japanese women in late pregnancy ( > 32 gestational weeks, Time 1), on the third day (Time 2) and one month (Time 3) postpartum. Measurements: The Japanese Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version A was used to measure antenatal fear of childbirth and social support, while the Impact of Event Scale Revised (IES-R) measured traumatic stress symptoms due to childbirth. Findings: of the 464 recruited, 427 (92%) completed questionnaires at Time 1, 358 (77%) completed at Time 2, and 248 (53%) completed at Time 3. Total 238 (51%) were analysed. A higher educational level has been identified in analysed group (p=0.021) Structural equation modelling was conducted separately for primiparas and multiparas and exhibited a good fit. In both groups antenatal fear of childbirth predicted Time 2 postnatal traumatic symptoms (β-0.33-0.54, p=0.002-0.007). Antenatal fear of childbirth was associated with a history of mental illness (β=0.23, p=0.026) and lower annual income (β =-0.24, p=0.018). Among multiparas, lower satisfaction with a previous delivery was related to antenatal fear of childbirth (β =-0.28, p < 0.001). Key conclusions: antenatal fear of childbirth was a significant predictor of traumatic stress symptoms after childbirth among both primiparous and multiparous women. Fear of childbirth was predicted by a history of mental illness and lower annual income for primiparous women, whereas previous birth experiences were central to multiparous women. Implication for practice: the association between antenatal fear of childbirth and postnatal traumatic symptoms indicates the necessity of antenatal care. It may be important to take account of the background of primiparous women, such as a history of mental illness and their attitude towards the upcoming birth. For multiparous women, focusing on and helping them to view their previous birth experiences in a more positive light are vital tasks for midwives. [ABSTRACT FROM AUTHOR]