Perspectives on antenatal education associated with pregnancy outcomes: Systematic review and meta-analysis

BackgroundMany studies on the relation between maternal health and infant health, including the effect of structured antenatal education, have been published and expanded over the years.AimInvestigate the impact of various antenatal education programmes on pregnancy outcomes to aid the development of future guidelines related to maternal and foetal health.MethodsBibliographic databases (Cochrane, PubMed, EMBASE, CINAHL, Korean Studies Information Service System) were searched up to November 2018, following the PICO criteria: population (pregnant women), intervention (antenatal education), comparison (not specified), and outcome (maternal and foetal outcome including physical or mental health components).FindingsWe included 23 eligible studies consisting of 14 controlled trials and 9 observational studies. The maternal physical outcomes depending on participation in antenatal education were not significantly different; however, the caesarean birth rate was lower in the antenatal education group (relative risk, RR, 0.90; 95% confidence interval, CI, 0.82–0.99), as was the use of epidural anaesthesia (RR, 0.84; 95% CI, 0.74–0.96). The maternal mental health outcomes of stress and self-efficacy significantly improved in the antenatal education group, although there was no difference in anxiety and depression. The foetal outcomes of birth weight or gestational age at birth were also not different between the groups.ConclusionAntenatal education can reduce maternal stress, improve self-efficacy, lower the caesarean birth rate, and decrease the use of epidural anaesthesia; however, there is limited evidence of its effects on maternal or foetal physical outcomes. Therefore, antenatal education should be standardised to elucidate its actual mental and physical health effects.     

Social Support for Exercise by Experts in Older Women Post–Hip Fracture

ABSTRACT

Using the data of the Baltimore Hip Study 5 (a home-based exercise intervention), this study examined how social support for exercise by experts (SSE-E) affected the self-efficacy, outcome expectations, and exercise behavior among older women following a hip fracture. The total sample included 164 females aged 65 years (M = 81.0; SD = 6.9) who had surgical repair of a nonpathologic hip fracture. Model testing showed a direct relationship between SSE-E and outcome expectations for exercise. There was, however, no direct or indirect relationship between SSE-E and self-efficacy or exercise behavior. The positive effect of SSE-E on the outcome expectations for exercise in older women recovering from a hip fracture provides an opportunity for health care providers in improving physical activity in this population.     

Gender Differences in Physical Performance,Body Composition,and Dietary Intake in Homebound Elders

ABSTRACT

Considering that the most vulnerable subgroup of elders for poor nutritional status and functional decline is the increasing number of home-bound women, we examined gender differences in physical performance, body composition, and dietary intake in a randomly recruited sample of 345 home-bound elders (81% women, 48% black > 65% income < $750/month). After controlling for demographic and health-related factors, the results from multivariate analyses indicated that women were more likely than men to report the lowest nutrient intake and were 2.9 times more likely to be at the worst level of overall physical performance. These results suggest a heightened vulnerability of homebound older women to poor physical performance, low dietary intake, and increased Body Mass Index (BMI). Prospective research is now needed to examine the interrelationships between physical performance, dietary intake, and body composition among the growing homebound older population.     

Self-perceived health status,gender, and work status

ABSTRACT

This study analyzes the relationship between gender and self-perceived health status in Spanish retirees and housewives from a sample of 1,106 community-dwelling older adults. A multivariate linear regression model was used in which self-perceived health status was measured by the EQ-5D visual analogue scale and gender according to work status (retired men and women and housewives). Retired males reported a significantly better health status than housewives. Self-perceived health status was closely associated with physical, mental, and functional health and leisure activities. Finally, being a woman with complete dedication to domestic work is associated with a worse state of self-perceived health.     

Aging in precarious times: Exploring the role of gender in shaping views on aging

ABSTRACT

The present study explores views on aging and how these differ according to gender and precariousness status. Semistructured interviews were conducted with 10 men and 10 women with secure and insecure pensions. Themes like fear of illness and health decline were more present in men, while fear of losing their attractiveness in old age more present among women. For all participants, loss of autonomy and social roles represented a negative view of old age, while activity in the form of work, volunteering, or leisure represented positive views. Differences in views on aging were related to pension security and less to gender. Women with insecure pension plans displayed the most negative views of aging. Implications for practice and policy to prevent health and gender inequalities are discussed.     

Why do some health care providers disrespect and abuse women during childbirth in India?

BackgroundDisrespect and abuse during childbirth can result in fear of childbirth. Consequently, women may be discouraged to seek care, increasing the likelihood for women to choose elective cesarean section in order to avoid humiliation, postnatal depression and even maternal mortality. This study investigates the causes underlying mistreatment of women during childbirth by health care providers in India, where evidence of disrespect and abuse has been reported.MethodsQualitative research was undertaken involving 34 in-depth interviews with midwifery and nursing leaders from India who represent administration, advocacy, education, regulation, research and service provision at state and national levels. Data are analysed thematically with NVivo12. The analysis added value by bringing an international perspective from interviews with midwifery leaders from Switzerland and the United Kingdom.FindingsThe factors leading to disrespect and abuse of women relate to characteristics of both women and their midwives. Relevant woman-related attributes include her age, gender, physical appearance and education, extending to the social environment including her social status, family support, culture of abuse, myths around childbirth and sex-based discrimination. Midwife-related factors include gender, workload, medical hierarchy, bullying and powerlessness.DiscussionThe intersectionality of factors associated with mistreatment during childbirth operate at individual, infrastructural, social and policy levels for both the women and nurse-midwives, and these factors could exacerbate existing gender-based inequalities. Maternal health policies should address the complex interplay of these factors to ensure a positive birthing experience for women in India.ConclusionMaternal health interventions could improve by integrating women-centred protocols and monitoring measures to ensure respectful and dignified care during childbirth.     

Gender Differences in Disability-Free Life Expectancy for Selected Risk Factors and Chronic Conditions in Canada

SUMMARY

This article shows how mortality and morbidity patterns differ for women and men 45 years of age and older. The impact on disability-free life expectancy was calculated for selected risk factors and chronic conditions: low income, low education, abnormal body mass index, lack of physical activity, smoking, cancer, diabetes, and arthritis. For each factor, the expected number of years free of disability was calculated for men and women using multi-state life tables. In terms of disability-free life expectancy, the greatest impacts on affected women were for diabetes (14.1 years), arthritis (8.8 years), and physical inactivity (6.0 years), while for affected men, the greatest impacts were for diabetes (10.5 years), smoking (6.9 years), arthritis (6.5 years), and cancer (6.4 years). The implications of these results are discussed from the perspective of developing programs designed to improve population health status.     

Self-regulation in older Thai women with self-reported knee osteoarthritis: A path analysis

Abstract

This study aimed at testing factors influencing coping behavior and health status among older women with knee osteoarthritis. A total of 274 participants completed questionnaires. Model testing revealed that self-efficacy was the most powerful predictor of coping behavior. Illness representation had a significant direct and indirect effect on health status and was a better predictor of health status than were the other variables. Understanding the complex relationships among study variables should help to tailor future interventions to better address the symptoms of osteoarthritis and to promote optimal health in older Thai women who report knee osteoarthritis.     

社交活动对老年人口健康状况影响的量化分析

人口老龄化已成为中国社会的常态,老年人口健康及其相关问题研究日益成为政府、社会和学者共同关注的焦点。本文基于中国健康与养老追踪调查2015年数据,针对老年人口社交活动难以量化的问题,构建"社交活跃度"指标,利用OLS回归和IV-regress二阶段回归模型分析社交活动对中国老年人口健康状况的影响。实证结果表明:第一,我国老年人社交活动水平整体呈现低活跃型特征,社交形式比较单一。第二,社交活动确实会对中国老年人口的健康状况产生影响,老年人健康状况在各影响因素不同水平下表现出显著差异,尤其受教育程度较高、经济状况较好以及较高的社交活跃度会对老年人健康产生积极正向影响。第三,老年人积极参与社交活动能够显著改善其健康状况,参与多项社交活动且参与活动频率高对老年人口健康状况的优化作用尤其明显。因此,我们应提升中国老年人口的社交活跃度。老年人应积极主动参与丰富多彩的社交活动,社区、基层政府及社会企业应构建并完善与老年人社交活动及健康保障相配套的产品和服务体系,国家层面则应更加积极地完善相关的老龄化政策、制度。     

Fear of childbirth in nulliparous women: A cross-sectional multicentre study in China

ObjectiveFew studies have focused on the fear of childbirth (FOC) in China. This study aimed to explore the status of FOC and its associated factors among nulliparous women in China.MethodsUsing a cross-sectional study design, 1039 nulliparous women with singleton pregnancies were recruited from four public hospitals in four cities of China. FOC was evaluated using the Chinese version of the Childbirth Attitude Questionnaire scale. Associations of demographic, obstetric and social–psychological factors with the levels of FOC among nulliparous women were investigated.ResultsThe average score on the Childbirth Attitude Questionnaire scale was 31.30 (standard deviation = 8.43). Generalized linear regression analysis revealed that low self-rated health status (β = 2.26, P = 0.003), higher educational levels (β = 2.06, P = 0.010), lower levels of self-efficacy (β = −0.79, P < 0.001), and use of pregnancy-related smartphone applications (β = 2.42, P < 0.001) were associated with higher levels of FOC.ConclusionThe Childbirth Attitude Questionnaire scale is an appropriate tool to measure FOC. Education levels, self-rated health status, self-efficacy levels, and use of pregnancy-related smartphone applications were predictors of FOC among pregnant women in China. Healthcare professionals should identify the Chinese pregnant women with FOC and implement targeted interventions focused on the above factors.     

Differences in levels of stress,social support,health behaviours,and stress-reduction strategies for women pregnant before and during the COVID-19 pandemic,and based on phases of pandemic restrictions,in Ireland

BackgroundThe COVID-19 pandemic and related restrictions can adversely impact antenatal maternal well-being and health behaviours.AimTo examine antenatal stress and stress-reduction strategies, social support, and health behaviours between women pregnant before and during the pandemic in Ireland.Methods210 pregnant women were recruited online and in the antenatal department of a tertiary maternity hospital before the pandemic, and 235 women recruited online during the pandemic. Only women resident in Ireland were included in this study. Women completed measures of stress, social support, health-behaviours, and self-reported stress-reduction strategies. Differences in outcomes were examined between women pregnant before and during the pandemic, and between Phase 2 and Phase 3 of the Irish Government COVID-19 restrictions.FindingsWomen pregnant during the pandemic reported lower perceived social support, including support from a significant other, friends and family, than women pregnant before the pandemic. There were no significant differences in stress in health behaviours but women reported higher stress and less physical activity during the pandemic. Women reported a range of comparable stress-reduction strategies before and during the pandemic. No differences were observed between phases of pandemic-related restrictions for any outcome.DiscussionOur findings highlight negative impacts of the pandemic on social support, stress, and physical activity, which can have implications for maternal and child health. Lack of differences between restriction phases suggests on-going negative effects for antenatal well-being and behaviours.ConclusionDevelopment of supports for pregnant women during the pandemic should include social-support and stress-reduction components.     

Gender differences in health promotion behaviors and quality of life among community-dwelling elderly

The differences of basic attributes, health promotion behaviors, and quality of life between elderly males and females in Taiwan were compared. Several scales were used to examine the gender differences and the factors associated with quality of life. Regression analysis revealed that gender, education level, depression level, and healthy diet were key factors influencing the overall quality of life. The education level of females was lower, and their depression level was higher; however, females had healthier diets. With regards to their satisfaction in the quality of life, elderly males scored higher than females in both the physical and psychological domains.     

Recent Perspectives on Active Life Expectancy for Older Women

SUMMARY

This article provides a critical review of recent active life expectancy literature, describing trends of special interest to women. We review findings from leading perspectives used to study life expectancy and active life expectancy, including gender, racial and socioeconomic differences, disease-specific effects, and biodemography. We examine three competing theories of population health that frame active life expectancy research—compression of morbidity, expansion of morbidity, and dynamic equilibrium—concluding there is support for both the compression of morbidity and dynamic equilibrium theories. Policy implications for women include a greater understanding of the role of education and racial and ethnic diversity in active life trends, and an increased public policy emphasis on prevention and treatment of chronic disease, together with adoption of more healthy lifestyles.     

Prenatal stress,health, and health behaviours during the COVID-19 pandemic: An international survey

BackgroundPregnant women’s stress, mental and physical health, and health behaviours can have important implications for maternal and child health outcomes.AimTo examine pregnant women’s levels of stress, mental and physical health, and health behaviours during the COVID-19 pandemic.MethodsA cross-sectional survey was conducted online, with recruitment and data collection occurring between 16/6/20 and 17/7/20. Participants were pregnant women recruited via online pregnancy/parenting communities. Participants self-reported their levels of general stress, pregnancy-specific stress and COVID-19 related stress, mental and physical health, general health behaviours, and COVID-19 related health behaviours.Findings573 pregnant women participated in the survey. Participants were most commonly resident in the United States (42.6%, n = 243), Ireland (41.2%, n = 235) or the United Kingdom (10%, n = 57). The majority (80.0%, n = 457) were married and educated to degree level or above (79.3, n = 453). Pregnant women reported high levels of pregnancy-specific and COVID-19-related stress, and low levels of mental and physical health, during the pandemic. Encouragingly, pregnant women in this study generally reported high levels of adherence to public health advice and pregnancy health behaviours. Stress and general mental health outcomes were best predicted by well-being factors (including stress and social support). Health impairing behaviours (e.g. poor diet) were predicted by both well-being and demographic factors.DiscussionInterventions targeting pregnancy- and pandemic-specific stress at the population level will be essential to support mental health and minimise adverse outcomes for women and children during the pandemic.     

A review of pregnancy information on nutrition,physical activity and sleep websites

ProblemMost pregnant women report using the internet to source health information during pregnancy. However, little is known about the information presented on the internet and whether it is consistent with current evidence-based guidelines.BackgroundPregnancy is considered a risk period for women as it is associated with poorer health behaviours including an inadequate diet, decreased physical activity and reduced sleep. As a result, pregnant women and their unborn child are at a greater risk of adverse health outcomes.AimThe purpose of this study was to review pregnancy related information about nutrition, physical activity and sleep provided on Australian government and leading industry body websites, and to compare this information to current evidence-based guidelines.MethodsA systematic online search was conducted to identify Australian Government, and leading industry websites that provided information on nutrition, physical activity, or sleep during pregnancy. The content of each website was reviewed and compared against current nutrition, physical activity and sleep guidelines.Findings27 government and leading industry websites were included in this study. 18 websites included nutritional information, none of which aligned 100% with guidelines. Nine websites included physical activity information, only one of which was 100% in accordance with guidelines. Two websites included information on sleep during pregnancy, however neither were in accordance with guidelines.ConclusionWomen are accessing information via the internet that is not in accordance with current evidence-based guidelines. These results call to attention the need for government and leading industry websites to review and update their website information in accordance with current evidence-based guidelines.     

The Relationship Between Physical Activity and Perceived Health Status in Older Women: Findings from the Woman’s College Alumni Study

Using data collected from the Woman’s College (WC) Alumni Study, the purpose of this study was to determine whether perceived health status is related to physical activity in older women. A multiple linear regression analysis was conducted to examine the relationship between amounts of physical activity and self-reported health status. The results of the current study reveal that the level of physical activity is significantly correlated with perceived health status. The findings of this study have implications for the assessment of older individuals’ health and may lead to interventions that are tailored to increase physical activity among older women.     

Women and Retirement Planning: Towards the “Feminization of Poverty” in an Aging Hong Kong

ABSTRACT

Hong Kong's population is aging but retirement research is largely missing from the research agenda in Hong Kong. This study, based on a telephone survey of 1,078 respondents, examines middle-aged adult's retirement planning activities in Hong Kong. The findings show men are more likely to be involved in financial planning, while women are more likely to take part in some forms of health, living arrangement and psychological planning for retirement. Further, there are age, education and income differences in the various forms of retirement planning activities within genders. Women are living longer; because of their lack of financial retirement planning, they are prime candidates for poverty. The discussion concludes with policy implications related to assisting midlife individuals, in particular women, in planning for retirement.     

Health Needs and Experiences of a LGBT Population in Georgia and South Carolina

ABSTRACT

The 2016 Municipal Equality Index rated Augusta, the largest city in the Central Savannah River Area (CSRA), as one of the least lesbian, gay, bisexual, and transgender (LGBT) friendly cities in America. To understand the context of our region in relation to LGBT wellness, we conducted the first LGBT health needs assessment of the CSRA, assessing physical and mental health status and health care needs and experiences in the community. Participants (N = 436) were recruited using venue and snowball sampling and completed an anonymous online survey. Overall, the health problems experienced (i.e., obesity, depression) were not uniformly experienced across sexual orientation and gender identity; some groups experienced significantly higher rates of these conditions than others. Similarly, transgender individuals in particular reported higher rates of negative experiences with health care providers. Regional and national dissemination of these findings is critical to reducing health disparities and improving wellness of our local LGBT community.     

Validation of the Childbirth Attitudes Questionnaire in Greek and psychosocial characteristics of pregnant women with fear of childbirth

BackgroundFear of childbirth has been found to be a factor that influences women's decision about their choice of delivery. The investigation of psychological factors that relate to fear of childbirth as well as the validation of the Childbirth Attitudes Questionnaire (CAQ) can help identify pregnant women with high fear of childbirth.AimThis study aimed to (a) translate and validate the Childbirth Attitude Questionnaire in Greek and (b) explore how fear of childbirth was related to childbirth self-efficacy, state anxiety, depression, neuroticism, self-esteem and optimism.Methods145 nulliparous pregnant women, in late pregnancy, attending routine antenatal visit in a private maternity clinic participated. All participants completed the CAQ (fear of childbirth) and other self-report questionnaires that measured childbirth self-efficacy, self-esteem, optimism, neuroticism, state anxiety and depressive symptomatology. Factor structure was investigated using principal axis factoring. Cronbach's α was used to measure internal consistency reliability. Pearson's correlation coefficients were calculated between all study variables, followed by multiple linear regression.FindingsThe factor analysis suggested the existence of one-factor structure. Construct validity was confirmed by computing correlations between the CAQ and childbirth self-efficacy, self-esteem and optimism. Multivariate analysis showed that childbirth self-efficacy, self-esteem and optimism were negatively and significantly associated with fear of childbirth.Conclusion and implications for practiceThe Greek version of the CAQ is a reliable and valid measure. The clinical use of CAQ may enable midwives and other health care professionals to identify pregnant women with low childbirth confidence and to provide information and support.