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Objective: To increase the percentage of women who attend postpartum visits and decrease the number of days to the first postpartum visit by implementing a scheduling change., Design: Quality improvement project., Setting/local Problem: A small nurse practitioner maternity care clinic in an academic health center at which only 74% of the women who attended two or more prenatal visits attended postpartum clinic visits., Participants: A diverse sample of 25 publicly insured women who gave birth during the 5-month implementation period., Intervention/measurements: We added a 2- to 3-week postpartum appointment to our standard 6-week postpartum appointment. The measurable outcomes were the percentage of women who attended postpartum clinic visits and the number of days to the first postpartum visit., Results: During the first 4 months of the 5-month project implementation phase, 14 of the 20 (70%) women who gave birth attended postpartum visits. The attendance at postpartum visits in the last month of the project was 100% (all five women). Days to first postpartum visit decreased from a mean of 40.7 in the baseline year to a mean of 21.8 by the last month of project implementation., Conclusion: Despite the small scope of this project, our outcomes support continuing the practice of scheduling an earlier postpartum clinic appointment. The timing for when to preschedule postpartum appointments and contextual factors, such as the availability and use of telehealth technology and COVID-19 pandemic challenges, should be considered when implementing similar projects in other settings., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2022. Published by Elsevier Inc.)

Background: Nocturnal bladder symptoms and sleep disruption commonly coexist in middle-aged and older women. Although sleep disruption is often attributed to nocturnal bladder symptoms in women with overactive bladder syndrome, nonbladder factors also may influence sleep in this population. Many women with overactive bladder are eager to identify nonpharmacologic strategies for both bladder symptoms and sleep disruption, given the potential adverse effects of sedative and anticholinergic bladder medications in this population., Objectives: To provide greater insight into the complex relationship between nighttime overactive bladder symptoms and sleep disruption, and to evaluate the effects of a guided slow-paced respiration intervention on sleep outcomes in women with overactive bladder., Study Design: We conducted an ancillary study within a randomized trial of slow-paced respiration in women with overactive bladder symptoms. Ambulatory community-dwelling women who reported ≥3 episodes/day of urgency-associated voiding or incontinence were randomized to use either a portable biofeedback device (RESPeRATE; Intercure, Ltd) to practice guided slow-paced respiration exercises daily for 12 weeks (N=79) or an identical-appearing device programmed to play nonrhythmic music without guiding breathing (N=82). At baseline and after 12 weeks, bladder symptoms were assessed by voiding diary, sleep duration, and disruption were assessed by sleep diary corroborated by wrist actigraphy, and poor sleep quality was determined by a Pittsburgh Sleep Quality Index global score >5., Results: Of the 161 women randomized, 31% reported at least twice-nightly nocturia, 26% nocturnal incontinence, and 70% poor sleep quality at baseline. Of the 123 reporting any nighttime awakenings, 89% averaged 1 or more nighttime awakenings, and 83% attributed at least half of awakenings to using the bathroom. Self-reported wake time after sleep onset increased with increasing frequency of nocturnal bladder symptoms (P=.01 for linear trend). However, even among women without nocturia, average sleep quality was poor (Pittsburg Sleep Quality Index global score mean of 7.3; 95% confidence interval, 6.0-8.6). Over 12 weeks, women assigned to slow-paced respiration (N=79) experienced modest improvements in mean nocturnal voiding frequency (0.4 fewer voids/night), sleep quality (1.1 point score decrease), and sleep disruption (1.5% decreased wake time after sleep onset). However, similar improvements were detected in the music control group (N=81), without significant between-group differences., Conclusions: Many women with overactive bladder syndrome experience disrupted sleep, but not all nocturnal awakenings are attributable to bladder symptoms, and average sleep quality tends to be poor even in women without nocturia. Findings suggest that clinicians should not assume that poor sleep in women with overactive bladder syndrome is primarily caused by nocturnal bladder symptoms. Guided slow-paced respiration was associated with modest improvements in nocturia frequency and sleep quality in this trial, but the results do not support clinician recommendation to use this technique over other behavioral relaxation techniques for improving sleep., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To compare symptoms of depression, maternal adjustment, and perceived stress in late adolescent and young adult mothers and to examine the patterns of these symptoms during the first 3 months after birth., Design: Secondary analysis of existing longitudinal data., Setting: San Francisco Bay Area, with participants in their home environments., Participants: Ethnically diverse women expecting their first infants recruited during the third trimester from childbirth education classes and antenatal clinics. The final sample included 34 participants in the late adolescent group (18-20 years) and 48 participants in the young adult group (21-24 years)., Methods: The Center for Epidemiologic Studies Depression Scale was used to assess depression symptoms, the Maternal Adjustment and Maternal Attitudes Scale was used to assess maternal adjustment, and the 10-item Perceived Stress Scale was used to assess perceived stress. Repeated-measures analyses of variance were used to examine changes over time in depression, maternal adjustment, and perceived stress scores., Results: Compared with young adult participants, late adolescent participants had greater mean depression scores (F (1, 61)  = 8.02, p = .006) and perceived stress scores (F (1, 62)  = 9.45, p = .003) at all time points. Scores for maternal adjustment could not be compared because of the low internal validity of the instrument., Conclusion: Our results indicated that late adolescent mothers may have more symptoms of depression and stress in late pregnancy and the early postpartum period than young adult mothers. Clinicians in maternity and pediatric settings should be vigilant in screening for depression and stress in this vulnerable population during their transitions to motherhood., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Thoracic outlet syndrome (TOS) poses a difficult diagnostic entity with varied etiology and clinical presentation. We present a 35-year-old gentleman with unilateral long thoracic nerve palsy and contralateral subscapular paralysis caused by aberrant scalenus medius anatomy. TOS ought to be considered in patients presenting with isolated nerve palsies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To compare leukocyte telomere length (LTL) by race and describe demographic, health, and psychosocial factors associated with LTL in postmenopausal women., Design: Descriptive study with comparative analyses and correlations., Setting: Data were collected at the University of California-San Francisco, San Francisco Clinical and Translational Science Institute., Participants: Thirty-nine African American and White postmenopausal women between 58 and 65 years of age (mean age = 61.3 ± 1.83 years)., Methods: Measures included demographics, blood pressure, anthropometrics, scores on the Perceived Stress Scale and the Center for Epidemiologic Studies-Depression, and blood samples for LTL., Results: African American women (n = 14) had greater PSS-10 and CES-D scores, greater blood pressure, and greater body mass index than White women (n = 25; p < .05), but LTL did not significantly differ between the two groups. Age was inversely related to LTL (r = -.355, p < .05). After age and race were controlled, fewer children (p = .005) and greater perceived stress (p = .036) were related to shorter LTL., Conclusion: Findings from this small sample support the association between age and LTL. The association between perceived stress, number of children, and shorter LTL in postmenopausal women requires further research and replication of findings in a larger, more diverse sample., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the frequency, severity, distress, and correlates of common and rare symptoms reported by nulliparous women during the last month of pregnancy., Design: Secondary cross-sectional analysis of data obtained in a larger randomized clinical trial., Setting: San Francisco Bay area., Participants: Nulliparous, ethnically diverse, predominantly low-income pregnant women 18 to 47 years of age (N = 151)., Methods: Participants at or beyond 36 weeks gestation used the Memorial Symptom Assessment Scale (MSAS) to provide self-reports of general symptom experience. Other symptom measures were also completed for comparison. Demographic characteristics, including gestational weight gain, were also collected. Gestational weight gain was categorized in relation to the Institute of Medicine's 2009 recommendations for weight gain during pregnancy., Results: Women endorsed an average of 10.6 ± 5.6 symptoms on the MSAS. Prevalent symptoms (reported by at least half the sample) included lack of energy, pain, difficulty sleeping, worrying, irritability, drowsiness, shortness of breath, and nervousness. Among the women who reported these symptoms, relatively few described them as occurring with high frequency or severity or as causing much distress. One of the most prevalent symptoms (reported by 68% of women) was difficulty sleeping, which also had among the greatest ratings for frequency, severity, and distress. Although few maternal characteristics were associated with symptom experience, women who gained more weight than the Institute of Medicine's recommendation had worse MSAS total scores than women who gained the recommended amount or less., Conclusion: In nulliparas, symptom frequency, severity, and distress varied and were related to excessive gestational weight gain., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Context: Patients with breast cancer receiving chemotherapy (CTX) experience multiple concurrent symptoms, but little is known about how symptoms change during and after treatment. Knowledge of the identity and trajectory of symptom clusters (SCs) would enhance measurement and management., Objectives: We aimed to identify SCs and their change over time from baseline to completion of breast cancer CTX., Methods: SCs were identified and assessed for change in 219 women from Nebraska at four times: baseline, during cycles #3 and #4 of CTX, and one month after finishing CTX. Ten symptoms were measured: two using the Hospital Anxiety and Depression Scale and eight using the Symptom Experience Scale. Exploratory factor analysis was conducted at each time point, then changes in SCs were evaluated at different times., Results: Two SCs were identified before and after initiating CTX: gastrointestinal and treatment-related. The number and type of symptoms in each cluster differed over time. Clusters were dynamic during CTX with changes in the number and type of symptoms. Only one treatment-related SC, which consisted of fatigue, pain, and sleep disturbance, was identified after CTX completion., Conclusion: SCs during CTX appear to be dynamic, changing over time from before until after CTX completion. Repeated assessments of SCs reveal symptoms that are present and when patients are most burdened and in need of additional support., (Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Context: To accurately investigate diurnal variations in fatigue, a measure needs to be psychometrically sound and demonstrate stable item function in relationship to time of day. Rasch analysis is a modern psychometric approach that can be used to evaluate these characteristics., Objectives: To evaluate, using Rasch analysis, the psychometric properties of the Lee Fatigue Scale (LFS) in a sample of oncology patients., Methods: The sample comprised 587 patients (mean age 57.3 ± 11.9 years, 80% women) undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer. Patients completed the 13-item LFS within 30 minutes of awakening (i.e., morning fatigue) and before going to bed (i.e., evening fatigue). Rasch analysis was used to assess validity and reliability., Results: In initial analyses of differential item function, eight of the 13 items functioned differently depending on whether the LFS was completed in the morning or in the evening. Subsequent analyses were conducted separately for the morning and evening fatigue assessments. Nine of the morning fatigue items and 10 of the evening fatigue items demonstrated acceptable goodness-of-fit to the Rasch model. Principal components analyses indicated that both morning and evening assessments demonstrated unidimensionality. Person-separation indices indicated that both morning and evening fatigue scales were able to distinguish four distinct strata of fatigue severity., Conclusion: Excluding four items from the morning fatigue scale and three items from the evening fatigue scale improved the psychometric properties of the LFS for assessing diurnal variations in fatigue severity in oncology patients., (Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Psychosocial and behavioural interventions that address suicidal thoughts and behaviour during treatment (direct interventions) might be more effective in preventing suicide and suicide attempts than indirect interventions that address symptoms associated with suicidal behaviour only (eg, hopelessness, depression, anxiety, quality of life). To test this hypothesis, we did a systematic review and meta-analysis of psychosocial and behavioural interventions aimed at preventing suicide and suicide attempts., Methods: For this systematic review and meta-analysis, we searched MEDLINE and PsycINFO from inception to Dec 25, 2015, for randomised controlled trials that reported suicides or suicide attempts as an outcome, irrespective of participants' diagnoses or the publication language. We excluded studies with pharmacological or device-based interventions, those that targeted communities or clinicians, primary prevention trials, and trials that reported events of non-suicidal self-injury as suicide attempts. Trials that had no suicides or suicide attempts in both groups were also excluded. Data were extracted by one investigator and independently verified by a second investigator. We used random-effects models of the odds ratio (OR) based on a pooled measure of suicides and the number of individuals who attempted suicide, immediately post-treatment and at longer-term follow-up., Findings: Of 2024 unique abstracts screened, 53 articles met eligibility criteria and reported on 44 studies; 31 studies provided post-treatment data with 6658 intervention group participants and 6711 control group participants at baseline, and 29 studies provided follow-up data. The post-treatment difference between direct interventions and indirect interventions did not reach statistical significance at the 0·05 level (OR 0·62 [95% CI 0·45-0·87] vs 0·93 [0·77-1·12], p=0·06) and represented a large effect size (Cohen's d=0·77). At longer-term follow-up, the difference was not significant (OR 0·65 [0·46-0·91] vs 0·82 [0·70-0·96], p=0·25) but still represented a medium effect size (Cohen's d=0·47). These effect sizes emphasise the clinical importance of direct interventions. Post-hoc subgroup and sensitivity analyses showed that our results are robust and unlikely to be notably affected by between-study heterogeneity or publication bias., Interpretation: Psychosocial and behavioural interventions that directly address suicidal thoughts and behaviour are effective immediately post-treatment and long term, whereas treatments indirectly addressing these components are only effective long term. Moreover, although the differences shown between direct and indirect strategies were non-significant, the difference in favour of direct interventions represented a large post-treatment improvement and medium improvement at longer-term follow-up. On the basis of these findings, clinicians working with patients at risk of suicide should address suicidal thoughts and behaviours with the patient directly. Although direct interventions are effective, they are not sufficient, and additional efforts are needed to further reduce death by suicide and suicide attempts. Continued patient contact might be necessary to retain long-term effectiveness., Funding: National Institute of Nursing Research., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: This observational study aimed to determine the relationship between time of birth and maternal morbidity during childbirth hospitalization., Study Design: Composite maternal morbidities were determined using International Classification of Diseases, Ninth Revision, Clinical Modification and vital records codes, using linked hospital discharge and vital records data for 1,475,593 singleton births in California from 2005 through 2007. Time of birth, day of week, and sociodemographic, obstetric, and hospital volume risk factors were estimated using mixed effects logistic regression models., Results: The odds for pelvic morbidity were lowest between 11 PM-7 AM compared to other time periods and the reference value of 7-11 AM. The odds for pelvic morbidity peaked between 11 AM-7 PM (adjusted odds ratio [AOR], 1101-1500 = 1.07; 95% confidence interval [CI], 1.06-1.09; 1501-1900 = 1.08; 95% CI, 1.06-1.10). Odds for severe morbidity were higher between 11 PM-7 AM (AOR, 2301-0300 = 1.31; 95% CI, 1.21-1.41; 0301-0700 = 1.30; 95% CI, 1.20-1.41) compared to other time periods. The adjusted odds were not statistically significant for weekend birth on pelvic morbidity (AOR, Saturday = 1.00; 95% CI, 0.98-1.02]; Sunday = 1.01; 95% CI, 0.99-1.03) or severe morbidity (AOR, Saturday = 1.09; 95% CI, 1.00-1.18; Sunday = 1.03; 95% CI, 0.94-1.13). Cesarean birth, hypertensive disorders, birthweight, and sociodemographic factors that include age, race, ethnicity, and insurance status were also significantly associated with severe morbidity., Conclusion: Even after controlling for sociodemographic factors and known risks such as cesarean birth and pregnancy complications such as hypertensive disorders, birth between 11 PM-7 AM is a significant independent risk factor for severe maternal morbidity., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Sleep disturbance has been associated with inflammation and cytokine activity, and we previously described genetic associations between cytokine polymorphisms and sleep maintenance and duration among adults with HIV/AIDS. Although sleep onset insomnia (SOI) is also a commonly reported sleep problem, associations between cytokine biomarkers and SOI have not been adequately studied. The purpose of this study was to describe SOI in relation to cytokine plasma concentrations and gene polymorphisms in a convenience sample of 307 adults (212 men, 72 women, and 23 transgender) living with HIV/AIDS. Based on the Pittsburgh Sleep Quality Index item that asks the time it usually took to fall asleep in the past month, participants were categorized as either >30min to fall asleep (n=70, 23%) or 30min or less to fall asleep (n=237). Plasma cytokines were analyzed, and genotyping was conducted for 15 candidate genes involved in cytokine signaling: interferon-gamma (IFNG), IFNG receptor 1 (IFNGR1), interleukins (IL1R2, IL2, IL4, IL6, IL8, IL10, IL13, IL17A), nuclear factor of kappa light polypeptide gene enhancer in B cells (NFKB1 and NFKB2), and tumor necrosis factor alpha (TNFA). Demographic and clinical variables were evaluated as potential covariates. After adjusting for genomic estimates of ancestry, self-reported race/ethnicity and viral load, SOI was associated with higher IL-13 plasma levels and with six single nucleotide polymorphisms (SNPs): IL1B rs1143642 and rs1143623, IL6 rs4719714, IL13 rs1295686, NFKB1 rs4648110, and TNFA rs2857602. In addition, the IL1B rs1143642 polymorphism was associated with plasma levels of IL-1β in adjusted analyses. This study strengthens the evidence for an association between inflammation and sleep disturbance, particularly self-report of habitual SOI. In this chronic illness population, the cytokine polymorphisms associated with SOI provide direction for future personalized medicine intervention research., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To describe the use of social media during the antepartum and postpartum periods among first-time African American mothers and their support persons., Design: A qualitative critical ethnographic research design within the contexts of family life course development theory and Black feminist theory., Setting: Participants were recruited from community-based, public health, and home visiting programs., Participants: A purposive sample was recruited, consisting of 14 pregnant African American women and eight support persons., Methods: Pregnant and postpartum African American women and their support persons were interviewed separately during the antepartum and postpartum periods. Data were analyzed thematically., Results: Participants frequently used social media for education and social support and searched the Internet for perinatal and parenting information. Most participants reported using at least one mobile application during their pregnancies and after giving birth. Social media were typically accessed through smartphones and/or computers using different websites and applications. Although participants gleaned considerable information about infant development from these applications, they had difficulty finding and recalling information about infant feeding., Conclusion: Social media are an important vehicle to disseminate infant feeding information; however, they are not currently being used to full potential. Our findings suggest that future interventions geared toward African American mothers and their support persons should include social media approaches. The way individuals gather, receive, and interpret information is dynamic. The increasing popularity and use of social media platforms offers the opportunity to create more innovative, targeted mobile health interventions for infant feeding and breastfeeding promotion., (© 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Fatigue has been associated with inflammation and cytokine activity among adults, but this relationship has not been evaluated among adults living with HIV. Diurnal patterns of fatigue have been previously identified in adults with HIV/AIDS. Thus, the purpose of this study was to describe these fatigue patterns in relation to cytokine plasma concentrations and gene polymorphisms. A convenience sample of 317 adults living with HIV/AIDS completed a measure of fatigue in the morning and evening for three consecutive days; participants reporting low levels of both morning and evening fatigue (n=110) or high levels of fatigue in the morning and evening (n=114) were included in the analysis, resulting in a final sample of 224 adults (151 men, 55 women, and 18 transgender). Plasma cytokines were analyzed, and genotyping was conducted for 15 candidate genes involved in cytokine signaling: interferon-gamma (IFNG), IFNG receptor 1 (IFNGR1), interleukins (IL), nuclear factor of kappa light polypeptide gene enhancer in B cells (NFKB-1 and -2), and tumor necrosis factor alpha (TNFA). Demographic and clinical variables were evaluated as potential covariates. Controlling for genomic estimates of ancestry and self-reported race/ethnicity and gender, the high fatigue pattern was associated with five single nucleotide polymorphisms (SNPs): IL1B rs1071676 and rs1143627, IL4 rs2243274, and TNFA rs1800683 and rs1041981. The IL1B and TNFA polymorphisms were not associated with plasma levels of IL-1β or TNFα, respectively. This study strengthens the evidence for an association between inflammation and fatigue. In this chronic illness population, the cytokine polymorphisms associated with high levels of morning and evening fatigue provide direction for future personalized medicine intervention research., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Context: Fatigue is a prevalent symptom among adults living with HIV. There is increasing evidence that fatigue and energy are related, yet distinct constructs. Although HIV-related fatigue has been well studied, little is known about perceived energy and how it relates to fatigue, individual characteristics, and other symptoms., Objectives: To describe the experience of perceived energy in adults with HIV and evaluate its relationship to demographic and clinical characteristics as well as symptoms of fatigue, sleep disturbance, anxiety, depression, and daytime function., Methods: The design was descriptive, comparative, and correlational. The sample of 318 adults with HIV completed a demographic questionnaire; the Memorial Symptom Assessment Scale; and measures of fatigue, sleep disturbance, anxiety, depressive symptoms, and daytime function. Medical records were reviewed for disease and treatment data. Participants who reported a lack of energy were compared with those who did not on demographic, clinical, and symptom variables. Regression models of perceived energy and its interference with daytime function also were evaluated., Results: Perceived lack of energy was highly prevalent (65%) and more strongly related to interference with daytime function than more general measures of fatigue severity, even when controlling for other characteristics and symptoms. Like other aspects of fatigue, lack of energy was associated with sleep disturbance, anxiety, and depressive symptoms. Lack of energy was more strongly related to morning fatigue than to evening fatigue., Conclusion: Lack of energy interferes with daytime function and is not just the inverse of fatigue but a distinct perception that differs from fatigue., (Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)

Background: Previous reports indicate that preterm infants with higher baseline heart rate (HR) have greater weight gain than preterm infants with lower baseline HR. To verify this correlation and the potential utility of resting HR as a bench mark for risk of extrauterine growth restriction (EUGR), we studied preterm infants born between 32 and 36weeks gestation. Earlier gestation infants (27 to 31weeks) were included., Methods: In retrospective chart review we collected heart rate (HR) and growth data on 156 infants between 27.0 and 34.0weeks gestation from birth to hospital discharge., Results: There was a significant increase in weight gain from day 10 of life in infants with higher resting HR compared to infants with lower resting HR. However, upon controlling for birth weight and gestational age, there was no significant relationship between HR and weight gain for any gestational age group of premature infants., Conclusions: Contrary to previous reports, there was no significant relationship between HR and growth at any gestational age after controlling for birth weight and gestational age. It is important to continue to search for a clinical marker of risk for poor growth in preterm infants and to give an opportunity for nutritional interventions which may support better growth and developmental outcomes.

Personal characteristics that interact with both HIV diagnosis and its medical management can influence symptom experience. Little is known about how symptoms in populations with chronic illness vary by age, sex, or socioeconomic factors. As part of an ongoing prospective longitudinal study, this report describes symptoms experienced by 317 men and women living with HIV/AIDS. Participants were recruited at HIV clinics and community sites in the San Francisco Bay Area. Measures included the most recent CD4 cell count and viral load from the medical record, demographic and treatment variables, and the 32-item Memorial Symptom Assessment Scale to estimate prevalence, severity, and distress of each symptom and global symptom burden. The median number of symptoms was nine, and symptoms experienced by more than half the sample population included lack of energy (65%), drowsiness (57%), difficulty sleeping (56%), and pain (55%). Global symptom burden was unrelated to age or CD4 cell count. Those with an AIDS diagnosis had significantly higher symptom burden scores, as did those currently receiving antiretroviral therapy. African Americans reported fewer symptoms than Caucasians or Mixed/Other race, and women reported more symptom burden after controlling for AIDS diagnosis and race. Because high symptom burden is more likely to precipitate self-care strategies that may potentially be ineffective, strategies for symptom management would be better guided by tailored interventions from health care providers.

Objective: To examine the feasibility and level of acceptability of a mindful yoga intervention provided during pregnancy and to gather preliminary data on the efficacy of the intervention in reducing distress., Design: Baseline and post-treatment measures examined state and trait anxiety, perceived stress, pain, and morning salivary cortisol in a single treatment group. Postintervention data also included participant evaluation of the intervention., Setting: The 7 weeks mindfulness-based yoga group intervention combined elements of Iyengar yoga and mindfulness-based stress reduction., Participants: Sixteen healthy pregnant nulliparous women with singleton pregnancies between 12 and 32 weeks gestation at the time of enrollment., Methods: Outcomes were evaluated from pre- to postintervention and between second and third trimesters with repeated measures analysis of variance and post hoc nonparametric tests., Results: Women practicing mindful yoga in their second trimester reported significant reductions in physical pain from baseline to postintervention compared with women in the third trimester whose pain increased. Women in their third trimester showed greater reductions in perceived stress and trait anxiety., Conclusions: Preliminary evidence supports yoga's potential efficacy in these areas, particularly if started early in the pregnancy.

Objective: To evaluate for differences in subjective and objective measures of sleep between physically active and inactive female family caregivers of oncology patients at the initiation of their spouses' radiation therapy and evaluate for differences in demographic, clinical, and symptom characteristics between women in the 2 activity groups., Design: Descriptive, cross-sectional study., Setting: Two radiation treatment centers., Participants: Female family caregivers of patients who began radiation therapy for prostate, lung, or brain cancer., Methods: Women were categorized as inactive (n=38) or active (n=30) based on self-report ratings of activity over a period of 2 days. Activity groups were compared on demographic and clinical characteristics, self-reported measures of sleep and other symptoms, and objective measures of sleep using wrist actigraphy., Results: Inactive women had a higher number of comorbid conditions, lower levels of attentional function, less self-reported sleep time, a longer sleep onset latency, and a higher percentage of daytime sleep as measured by actigraphy compared with active women., Conclusions: Inactivity in female family caregivers of oncology patients is associated with poorer self-reported sleep and decreased attentional function.

Objective: To compare sleep and fatigue experiences of women before hysterectomy and at 3 and 6 weeks after surgery, to compare symptoms by type of surgical procedure, and to examine the biopsychosocial contextual factors related to symptoms., Design: A descriptive repeated measures study assessed sleep and fatigue using questionnaires and objective wrist actigraphy monitoring for sleep., Setting: Data were collected in women's homes at least 2 days before surgery, and at 3 and 6 weeks postoperatively., Participants: A convenience sample of 25 women scheduled for hysterectomy., Results: There was significantly higher self-reported sleep disturbance 3 weeks after surgery compared with baseline. Women who had vaginal hysterectomy continued to experience sleep disturbance and fatigue 6 weeks after surgery, while those who had abdominal hysterectomy reported better sleep and less fatigue at 6 weeks compared with baseline. The number of awakenings recorded with actigraphy increased postoperatively for both groups, and younger women experienced more wake time during the night than older women. Level of education was positively related to preoperative fatigue severity., Conclusions: Findings suggested poor sleep and fatigue during the postoperative period should be evaluated in light of women's ages, level of education, and type of surgical procedure.

Objective: The objective of the study was to examine the association between time of delivery and neonatal outcomes in term deliveries., Study Design: We conducted a retrospective cohort study of all term pregnancies delivered at an academic institution with 24-hour in-house obstetric and anesthesia coverage. Time of delivery was categorized as day (7 am to 6 pm), evening (6 pm to 12 midnight), and late night (12 midnight to 7 am). Outcomes included 5-minute Apgar less than 7, umbilical artery pH less than 7.0, base excess less than -12, admission to the neonatal intensive care unit (NICU), and neonatal death. We excluded patients delivered via cesarean delivery not in labor. We had greater than 80% power to detect a 25% difference in Apgar score, base excess, and admission to the NICU and 80% power to detect a 50% difference in umbilical artery pH less than 7.0., Results: Among the 34,424 deliveries meeting inclusion criteria, 15,664 were during the day, 8495 were during the evening, and 10,265 were during the night. In univariate comparisons, there were no statistically significant differences in neonatal outcomes. For example, the rate of pH less than 7.0 was 0.7% during the day, 1.0% in the evening, and 0.6% at night (P = .12). Admissions to the NICU were 3.6% during the day, 3.7% in the evening, and 3.5% at night (P = .81). When we controlled for obstetric history, demographic factors, and labor characteristics, there were still no differences in rates of either neonatal morbidity or mortality by time of delivery., Conclusion: At our institution, we could not demonstrate any significant differences in neonatal morbidity or mortality by time of day among neonates delivered at term. These data can be used to counsel patients and families concerned about differences in time of delivery and potential impact on their infant's health. Future research should include time of delivery in relation to maternal and neonatal outcomes in various types of inpatient settings.

Objective: To describe sleep characteristics in high-risk antepartum inpatients., Design: Prospective descriptive design., Setting: Tertiary hospital in southern California., Participants: A convenience sample of 39 antepartum women., Methods: Data were collected from participants' medical records, questionnaires (General Sleep Disturbance Scale), actigraphy on days 3 to 4 after admission, and a sleep diary that included reasons for awakening and morning and evening fatigue ratings., Results: Week gestation ranged from 24 to 35 weeks. Sleep time varied from 310 to 492 minutes and averaged 6.7 hours/night. The women were awakened 9 to 32 times/night and averaged 18 awakenings. They napped an average of 124 minutes throughout the day. Women averaged 3.9 on the General Sleep Disturbance Scale when retrospectively considering 7 days before hospitalization and scored 4.1 when considering the current 3 days of hospitalization. In the diary, most rated their sleep quality as Fairly Good or Very Good (62%-71%), but 29% said Very Bad on night 2, and 38% said Very Bad on night 3., Conclusion: Frequent interruptions during the night do not allow for mothers to receive the restorative sleep they need.

Actigraphy has become a valuable clinical and research tool to objectively evaluate sleep, daytime activity, and circadian activity rhythms in healthy individuals as well as persons with primary and comorbid insomnia. However, procedures used for sampling, data processing, and analysis are not consistently reported in the literature. The wide variability in how actigraphy is reported makes it difficult to compare findings across studies. The procedures and reporting methods from 21 studies that used actigraphs to assess sleep and wake in adult patients with cancer are reviewed to highlight the differences in reporting strategies. Patients with cancer were chosen to illustrate the methodological challenges related to procedures and reporting in one population. The aim of this article was to advance standards of information presented in publications to enable comparisons across research studies that use actigraphy. Specific methodological challenges when using actigraphy in research include instrumentation, selection of pertinent variables, sampling, and data processing and analysis. Procedural decisions are outlined and discussed, and suggestions are made for standardized actigraphy information to include in research reports. More consistent procedures and reporting will advance the science of sleep, daytime activity, and circadian activity rhythms and their association with other health-related variables.

Objective: To examine published evidence on the effectiveness of mind-body interventions during pregnancy on perceived stress, mood, and perinatal outcomes., Data Sources: Computerized searches of PubMed, Cinahl, PsycINFO, and the Cochrane Library., Study Selection: Twelve out of 64 published intervention studies between 1980 and February 2007 of healthy, adult pregnant women met criteria for review., Data Extraction and Synthesis: Studies were categorized by type of mind-body modality used. Progressive muscle relaxation was the most common intervention. Other studies used a multimodal psychoeducation approach or a yoga and meditation intervention. The research contained methodological problems, primarily absence of a randomized control group or failure to adequately control confounding variables. Nonetheless, there was modest evidence for the efficacy of mind-body modalities during pregnancy. Treatment group outcomes included higher birthweight, shorter length of labor, fewer instrument-assisted births, and reduced perceived stress and anxiety., Conclusions: There is evidence that pregnant women have health benefits from mind-body therapies used in conjunction with conventional prenatal care. Further research is necessary to build on these studies in order to predict characteristics of subgroups that might benefit from mind-body practices and examine cost effectiveness of these interventions on perinatal outcomes.

Objective: To describe levels of anxiety and self-efficacy for childbirth in nulliparous women during the late third trimester and to identify relationships among those variables, prehospitalization labor pain, management strategies, and hospital admission status., Design: A longitudinal, descriptive study., Participants: Thirty-five English-speaking nulliparous women, 18 to 40 years of age, more than or equal to 38 week's gestation, with uncomplicated pregnancies. All participants had a significant other (husband or partner) and attended childbirth education programs., Main Outcome Measures: Spielberger Trait Anxiety Inventory, Prenatal Self-Evaluation Questionnaire, Childbirth Self-Efficacy Inventory, McGill Pain Questionnaire-Short Form, postpartum interviews, and medical records review., Results: Prenatal anxiety was significantly related to self-efficacy for childbirth in late pregnancy, labor pain, number of hours at home in labor, and admitting cervical dilation. The number of management strategies used was related to pain scores during labor before hospital admission. Women who spent longer periods of time at home in labor arrived at the hospital with a greater cervical dilation., Conclusions: Antenatal characteristics influence intrapartal outcomes in nulliparas. Labor environment, at home and in the hospital, is recognized as an important component of the first childbirth experience.

Objective: To examine how sleep-wake cycles and social rhythms of Japanese parents are related to their sleeping arrangements before and after the birth of their first child., Design: Prospective longitudinal, time-series methods., Setting: Participants' homes in four geographical areas of Japan., Participants: Convenience sample of 101 Japanese first-time parent couples who completed antepartum and postpartum questionnaires., Main Outcome Measures: 24-hr sleep-wake rhythm from 7-day logs at 32 to 36 weeks gestation and 4 to 5 weeks postpartum and daily social rhythm from Monk's Social Rhythm Metric., Results: Mothers' total sleep time and activity level decreased after birth. Social rhythms became less regular for mothers and more consistent and regular for fathers. Although sleeping arrangement had no effect on parents' daily social rhythms, it had a significant effect on the 24-hr sleep-wake rhythm. Regularity of sleep-wake rhythms was more prominent for fathers sleeping with mother and baby than for fathers sleeping alone., Conclusions: Couples having their first child face great changes in their sleep-wake cycles and social rhythms. Nurses can counsel expectant parents to think about their sleeping habits and social activities and assist them in making informed decisions about the best sleeping arrangement during transition to parenthood.

Objective: The purpose of this study was to test the hypothesis that fatigue and sleep disturbance in late pregnancy are associated with labor duration and delivery type., Study Design: In a prospective observational study of 131 women in their ninth month of pregnancy, objective (48-hour wrist actigraphy) and subjective (sleep logs and questionnaires) measures were used to predict labor outcomes using analysis of variance and logistic regression., Results: Controlling for infant birth weight, women who slept less than 6 hours at night had longer labors and were 4.5 times more likely to have cesarean deliveries. Women with severely disrupted sleep had longer labors and were 5.2 times more likely to have cesarean deliveries. Fatigue was unrelated to labor outcomes., Conclusion: Health care providers should prescribe 8 hours of bed time during pregnancy to assure adequate sleep and should include sleep quantity and quality in prenatal assessments as potential predictors of labor duration and delivery type.