Preterm Birth a Risk Factor for Postpartum Depression in Pakistani Women

A Pakistani cohort of 170 mothers of full-term infants and 34 mothers of preterm infants were screened at 6 weeks after delivery to compare the rate of PPD, and examine the contribution of parenting stress and mother-infant interaction to PPD among mothers of preterm infants. Mothers completed the Edinburgh postnatal depression scale, and a general questionnaire. Mothers of preterm infants also completed the parental stress scale and parental bonding questionnaire. The rate of PPD was significantly higher with the adjusted odds increasing by 2.68 (95% Confidence Interval 1.16 - 6.17, p = .015) in mothers of preterm in- fants. Significantly more depressed mothers of preterm infants did not receive some level of support from their husbands (p = .014), and had some level of difficulty feeding (p = .03) or identifying the amount to feed their infant (p = .02). A large proportion of mothers reported no support from friends in rearing children

Cultural practices of rearing preterm infants: A qualitative study in a tertiary care hospital, Karachi, Pakistan

The research work explores the cultural practices of feeding and hygiene of preterm infants in the Pakistani context. A Qualitative descriptive-exploratory design has been used. Purposive sampling was utilized to recruit 17 mothers, who met inclusion criteria from a largest government tertiary care hospital in Karachi, Pakistan. The semi-structured interview was used to collect the data, which lasted for approximately 45-60 minutes. Thematic analysis was conducted to analyze the key findings of the study. Welcoming newborn with \u27honey\u27 and herbal remedies were reported as a common ritual among mothers. Findings revealed differences in the time period of initial bath given to the preterm, ranges from 3 days to 1 month. These custom variations of rearing preterm have its own meaning in the prescribed culture; however, these customs are the insights to explore more on its effects on infants\u27 health. This study provides useful insights into several practices of cultures, which serve as the determinants of infants\u27 nutrition and health status. It provides an insight to the health care professionals to provide quality care to preterm infants

Complementary and alternative medicine in oncology nursing

Use of complementary and alternative medicine (CAM) has increased globally, particularly among oncology patients. This study investigated the knowledge, experience and attitudes of oncology nurses towards CAM. A quantitative study was conducted in tertiary care hospitals in Karachi, Pakistan, where 132 oncology nurses were surveyed. The survey revealed that more than 50% of nurses had never heard about many of the CAM therapies used in Pakistan. Approximately 65% of the nurses had knowledge about prayer and less than 30% had experience of CAM education or training. In addition, the majority of nurses had seen patients using CAM and felt that their health status could be enhanced with the use of CAM. This study showed that oncology nurses had a positive experience of and attitude towards CAM, although they needed to enhance their knowledge of it to maximise patient satisfaction and quality of care

Psychobiobehavioral model for preterm birth in pregnant women in low- and middle-income countries

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

eHealth Antenatal Coparenting Intervention to Prevent Postpartum Depression among Primiparous Women, Karachi, Pakistan: A Pilot Randomized Controlled Trial

Background: Postpartum depression is highly prevalent among women and a lack of partner support is a strong risk factor for PPD. Partner support has been shown to decline significantly during the transition to parenthood. The primary objective of this pilot randomized controlled trial was to examine the feasibility and acceptability of an eHealth antenatal coparenting intervention called eACoP and obtain preliminary estimates on clinical outcomes for a future larger trial. Methodology: 212 primiparous couples were recruited from the Aga Khan University Hospital and randomly allocated into the intervention group or the control group using sequentially numbered opaque sealed envelopes. Couples in the intervention group received the eACoP intervention during pregnancy which consists of eight 45-minute online videos. Primary outcomes were feasibility and acceptability measured through enrollment rates, intervention adherence rates, follow-up rates, and intervention satisfaction. Secondary outcomes were depressive symptomatology, anxiety, postpartum partner support, coparenting relationship, relationship satisfaction, postpartum childcare stress, child development, extrafamilial support, and healthcare services utilization. Results: Primary outcomes: The enrollment rate of eligible participants in this pilot study was 83.5%. One in five couples completed the minimum intervention dosage of watching at least five videos. Complete follow-up data was collected from 66.5 (n=137) of women and 56.7% of partners (n=117) at 4-6-weeks, decreasing slightly to 60.7% (n=124) of women and 50.4% of (n=104) partners at 12-weeks postpartum. The 24 couples who watched at least five videos and completed the satisfaction forms felt that the content of the videos was helpful and provided appropriate strategies for managing situations or problems. Participants provided important recommendations, including the inclusion of Pakistani cultural and religious aspects in the videos and making the videos shorter. Secondary Outcomes: At 4-6-weeks postpartum, 22.1% of women and 3.5% of partners in the intervention group showed depressive symptomatology while 32.8% of women and 7% of partners had anxiety symptoms. At 12-week postpartum, 14.1% of women and 5.7% of partners had depressive symptoms while 21.9% of women and 11.3% of partners had anxiety symptoms. Similarly, 13.11% of women and 9.6% of partners reported relationship dissatisfaction. There was no difference found between the intervention group and control group with respect to other secondary outcomes. Conclusion: This pilot trial found that a future randomized controlled trial of eACoP intervention is not feasible nor acceptable in the Pakistani context without modifications. .Ph.D

Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review

Introduction Total adverse childhood experiences (ACEs) are gaining prominence as a risk factor for preterm birth (PTB). The emerging literature examining this relationship reports inconsistent findings. The purpose of this systematic review was to summarize the available evidence exploring whether total ACEs predict PTB. Methods A total of 386 studies were returned from searches on PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Nine studies were selected for final analysis and synthesis based on reporting of total ACEs and preterm birth gestational weeks or standard definition of birth before 37 weeks’ gestational age. A systematic review rather than meta-analysis was selected to present the findings given the clinical and methodological (e.g., sample studied, measurement tools) heterogeneity of the retrieved studies and pregnancy outcomes measured. Results The nine studies report on birth outcomes for 6,087 women from a range of sociodemographic and ethnic backgrounds. Despite a wide range of study designs, measurement tools, and timings of ACEs exposure across studies, seven of the nine included studies showed significant relationships between ACEs and PTB. Conclusion Systematic review of the literature suggests that total ACEs are associated with PTB and provides an overview on the known associations. However, to date only nine studies have assessed this link, and more studies are needed, to explore the associations between ACEs and PTB using appropriate and valid instruments and doing so among more diverse populations. Future research should also explore possible biological mechanisms (allostatic load), and moderating and mediating variables

Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women

Background: We determined whether dimensions of psychosocial distress during pregnancy individually and collectively predicted preterm birth (PTB) in Pakistani women as it may be misleading to extrapolate results from literature predominantly conducted in high-income countries.Methods: This cohort study included 1603 women recruited from four Aga Khan Hospital for Women and Children in Sindh, Pakistan. The primary binary outcome of PTB (i.e.,livebirth before 37 completed weeks\u27 gestation) was regressed on self-reported symptoms of anxiety (Pregnancy-Related Anxiety (PRA) Scale and Spielberger State-Trait Anxiety Inventory Form Y-1), depression (Edinburgh Perinatal Depression Scale (EPDS)), and covariates such as chronic stress (Perceived Stress Scale) assessed with standardized question and scales with established language equivalency (Sindhi and Urdu).Results: All 1603 births occurred between 24 and 43 completed weeks\u27 gestation. PRA was a stronger predictor of PTB than other types of antenatal psychosocial distress conditions. Chronic stress had no effect on the strength of association between PRA and PTB and a slight but non-significant effect on depression. A planned pregnancy significantly lowered risk of PTB among women who experienced PRA. Aggregate antenatal psychosocial distress did not improve model prediction over PRA.Conclusions: Like studies in high-income countries, PRA became a strong predictor of PTB when considering interactive effects of whether the current pregnancy was planned. Women\u27s resilience and abilities to make sexual and reproductive health decisions are important to integrate in future research. Findings should be generalized with caution as socio-cultural context is a likely effect modifier. We did not consider protective/strength-oriented factors, such as resilience among women

Psychobiobehavioral Model for Preterm Birth in Pregnant Women in Low- and Middle-Income Countries.

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective

Psychobiobehavioral Model for Preterm Birth in Pregnant Women in Low- and Middle-Income Countries

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective.Peer Reviewe