Associations of psychological status in the early postpartum period with resumption of menstruation and degree of menstruation-related symptoms

The aim of this prospective study was to clarify the associations of psychological status in the early postpartum period with resumption of menstruation and degree of menstruation-related symptoms. This study was conducted from February in 2017 to July in 2018 in Japan. We conducted self-administered questionnaire surveys for 229 postpartum women at 3 days postpartum, 2 weeks postpartum, one month postpartum, 3 months postpartum and 6 months postpartum. The proportion of women who resumed menstruation in the period up to 6 months postpartum was 38.8%. The Edinburgh Postnatal Depression Scale (EPDS) score at 6 months postpartum in women who resumed menstruation in the period up to 6 months postpartum was significantly higher than that in women who did not resume menstruation. EPDS scores during the postpartum period in women in whom menstruation-related symptoms became worse than those before pregnancy were significantly higher than those in women in whom menstruation-related symptoms did not change compared to those before pregnancy. In multiple regression analysis, there was no significant difference between EPDS score at 6 months postpartum and degree of menstruation-related symptoms. Additional research is needed to clarify the association of psychological condition during the postpartum period with resumption of menstruation. Impact Statement Postpartum psychological symptoms such as depression and anxiety during the postpartum period may affect degrees of menstruation-related symptoms after resumption of menstruation, and there also may be a bidirectional relationship between psychological symptoms and menstrual pain. Resumption of menstruation occurred in 38.8% of 121 women within 6 months postpartum, and poor psychological condition during the postpartum period was associated with early resumption of menstruation. The psychological condition in women with earlier resumption of menstruation might affect menstruation-related symptoms. Management of a stable psychological status during the early postpartum period should be implemented for women's health care in the future.


子育てをする父親の育児不安の実態と背景要因の探索

子育てをする父親の育児不安の実態と背景要因の探索


Development and Psychometric Testing of the Mental Health Scale for Childrearing Fathers


Comparison of management skills that are required for middle managers at present and in the next generation in advanced midwives

International Journal of Nursing and Midwifery


Relationship between maternal mental status and social supports during pregnancy and until one month after childbirth in a local city

The aim of this study was to clarify the relationship between maternal mental status and social supports during pregnancy and until one month after childbirth in order to evaluate the actual situation in a local city. A survey was conducted on 78 pregnant women who completed the CES-D (depression score), STAI (anxiety score) and Social Support Scale. Data were collected four times : during the second trimester, the third trimester, postpartum hospitalization, and 1 month after childbirth. The CES-D and STAI scores were initially high during pregnancy and decreased during the postpartum period. The Social Support Scale score, however, was initially low during pregnancy and increased during the postpartum period. The CES-D and STAI scores was significantly and negatively correlated with The Social Support Scale score during all four time periods. Participants ≧ 35 years of age scored lower on The Social Support Scale than did participants < 35 years of age in the second trimester, third trimester, and 1 month after childbirth. These findings should assist with the implementation of a comprehensive support center and may be useful for a local city in Japan. J. Med. Invest. 68 : 265-270, August, 2021.

The Journal of Medical Investigation : JMI


Management skills required for nursing middle managers in the next generation in perinatal medical care


Transition of Depressive Symptoms and Anxiety Symptoms According to Parity and Associations of These Symptoms with Feelings for Involvement with Newborn Infants during a 6-Month Postpartum Period

Open Journal of Obstetrics and Gynecology


Prevalence and factors related to hot flashes and night sweats in postpartum women in Japan


The experiences of husbands present at their wives' emergency cesarean sections

The aim of this study was to clarify the experiences of husbands present at their wives' emergency cesarean sections. Semi-structured interviews were conducted for nine husbands who attended their wives' emergency cesarean sections. The results were analyzed using a qualitative inductive approach. Several categories such as [wife's labor pain will be unbearable if I look], [situation was beyond one's control], and [sense of relief experienced by midwife care] were extracted from the husbands' experiences the need for an emergency cesarean section was established. Additional categories such as [sense of relief at cesarean section decision], [convincing oneself], and [anxiety for life and hope for safety] were extracted at the time of the emergency cesarean section decision. Other categories [anxiety while waiting for prolonged periods], [ease of mind with family], and [pleasure in meeting the baby] were extracted from the husbands' experiences while waiting for their wives' cesarean section. Finally, the categories of [unloading of responsibilities], [to thank my wife], and [remaining anxious and fearful] were extracted from the husbands' experiences on their wives return to their hospital rooms. Husbands were anxious about the life and safety of their wife and child, and considered their futures in case of an unexpected occurrence. J. Med. Invest. 65:268-273, August, 2018.


Association of Low Back and Pelvic Pain with Mental Health Condition during Pregnancy and Postpartum


Possible Predictive Factors for Low Back and Pelvic Pain at Three Months Postpartum -Assessed in a Prospective Study from Early Pregnancy until the Postpartum Period


Association of Low Back and Pelvic Pain at the Second Trimester with that at the Third Trimester and Puerperium in Japanese Pregnant Women


Development of Breastfeeding Support Scale for Couples

The aim of this study was to develop a Breastfeeding Support Scale for Couples (BSSC) and to examine its reliability and validity. The BSSC was designed to evaluate current state of mutual support necessary for breastfeeding from the perspective of wife as support recipient, and husband as support provider. Subjects were 324 wives who came for their 1-month postpartum checkup and their husbands. Valid responses obtained from 159 husbands (97.0%) and 303 wives (93.5%) were then subjected to analysis. The BSSC for husbands comprised of 10 questions and two factors, and a scale for wives comprised of 14 questions and three factors were ultimately created. Cronbach's alpha reliability coefficient ranged from 0.72 to 0.89 for all factors for both husbands and wives. The internal consistency and criterion-related validity of the scale were also confirmed. The model fitted the data satisfactory. Its reliability and validity were confirmed. The BSSC focused on mutual support among married couples, and may reveal new directions for breastfeeding support by shedding light on the differences in the perception of reciprocity support. The BSSC can evaluate couples and the appropriate support necessary for breastfeeding from the perspective of reciprocity support. J. Med. Invest. 63: 96-103, February, 2016.


Factors related with low back pain and pelvic pain at the early stage of pregnancy in Japanese women.


Experiences of husbands attending their wives' childbirth

立ち会い分娩をした夫の体験

目的:本研究では，立ち会い分娩をした夫の体験を明らかにすることを目的とする． 方法:本研究に同意の得られた，初産婦の夫11名を対象として，妻の産褥入院期間中に，インタビューガイドに基づき，入院から分娩後2時間までの体験についてインタビューを行い，質的記述的に分析した． 結果:立ち会い分娩における夫の体験として，171のエピソード，44のコード，16のサブカテゴリーが抽出され，【わが子を迎える喜びと感動が湧く】，【無力な自分にとにかくできることを手探りでやってみる】，【母親となる妻へ称賛の念を抱く】，【父親としての意識が芽生える】，【医療者にさまざまな感情を抱きながら，任せる】，【自分なりに分娩の様相を読み取ろうとする】の6つのカテゴリーが抽出された． 結論:夫は，わが子を迎える喜びと感動が湧く中で，自分の無力さを感じながら，それでも自分にできることを手探りでやろうとしている様子が伺えた．医療者には，苦しむ妻を前にして，自分の辛さや不安を表出することなく，ひたすら立ち会い続けている夫の心情を酌み取り，夫にとってもよい分娩体験となるような関わりが求められる．

JNI : The Journal of Nursing Investigation


Professional Identity Establishment Process of the Nurse Manager

看護管理者の職業的アイデンティティ確立プロセス

看護管理者(看護師長)の職業的アイデンティティ確立プロセスを明らかにするため，A県内の病院の看護師長11名を対象に，インタビューを行い，舟島の「看護概念創出法」に沿って分析した．結果，職業的アイデンティティを確立する12の概念が創出され，アイデンティティ確立プロセスを明らかにすることができた． 看護管理者の職業的アイデンティティ確立プロセスは以下のとおりである． 昇任の辞令を突然受けた者は，【役割移行への戸惑いによる受諾前の葛藤】を経験しながらも受諾し，当初は【師長イメージと現実との違いを経験することによる予想外の孤独と役割変化への戸惑いや実践から離れる一抹のさみしさ】を感じていた．その後，1年の間に【前任者の管理方法の回想からの学びや師長イメージと実際の差異を発見することによる師長役割の理解】をし，【クレーム対応を経験することによる最終責任者としての自覚の萌芽】や，【他者からのアドバイスやサポートを受けることによる師長役割を果たす行動】【看護管理者研修からの学びによる師長役割の再認識】【自己の看護観に基づいたケアが実践できるスタッフを育成することによる師長としてのやりがいと役割実践】【時代の要請による業務変化に対応することで新たな役割への気づき】【自己の看護観を基盤に管理する上での失敗や成功を内省し続けることによる自己成長】を経験していた．その後，1∼2年間に，【スタッフとの信頼関係を構築し，やりたい看護，作りたい病棟づくりができたことによるやりがいの感受】や【日々の積み重ねによる自信と他者からの承認による役割取得の実感】を経験し，職業的アイデンティティを確立していた．


FKBP5, SERT and COMT mRNA expressions in the peripheral leukocytes during menstruation cycle in healthy reproductive females.

There have been several evidences that the mRNA expressions in the peripheral leukocytes may indicate not only physical but also psychological states. The purpose of this study is whether the mRNA expressional changes in the leukocytes are related to the mental states across the menstrual cycle in reproductive healthy female subjects. Thirty-eight female subjects (22.4+/-1.4 year-old) were participated in this study at three menstruation cycle periods (menstrual, follicular and luteal phase). The FKBP5 (FK506-binding protein gene), SERT (serotonin transporter gene) and COMT (catechol-o-methyltransferase gene) mRNA expressions in the leukocytes were determined with hormonal data. The psychological changes were assessed with self-rating hospital anxiety and depression scale (HADS). Only one thirds of subjects (n=12) had regular menstrual cycles during the experiment. So we analyzed the data from these 12 subjects. The anxiety score of each subject was changed across the menstrual cycle (Friedman test: P<0.05). The FKBP5 mRNA expression was significantly lower in the follicular phase than in the other phases but no changes were seen in either SERT or COMT mRNA expressions among the phases. In conclusion, there are differences of HADS anxiety score and FKBP5 mRNA expression in the leukocytes across the menstrual cycle but there is no correlation between anxiety scores and FKBP5 mRNA.


Anxieties and Care Needs of Fathers with Multiple-Birth Children

Purpose: The purpose of this study was to ascertain the feelings of uneasiness that fathers of multiple births may have had during their wives' pregnancy, labor, and post-delivery periods. Method: For this study, questionnaires related to anxiety were distributed to 50 fathers-to-be of multiple births, of which 29 gave valid responses. Result and Conclusion: Of this number, 26 were expecting twins, and 3 were awaiting triplets. Fifteen were becoming fathers for the first time, and 14 already had children. According to the questionnaire responses, the fathers were most worried about the safe delivery of their babies and the care of their wives during pregnancy. The support of the grandparents was considered indispensable due to time and cost involved, especially in cases where older siblings existed. In addition, the fathers felt they needed advice concerning pre- and post-partum childcare to make the difficult but necessary decisions. Based on these results, we feel it is necessary to provide sufficient information to new fathers concerning multiple birth pregnancy care and parturition resulting from sterility treatment. In addition to being present to support their wives, fathers-to-be also require support themselves, either from family members or other parents with multiple birth experience.


Factors associated with the discontinuation of breastfeeding until 3 months after delivery

Study Purpose : The purpose of this study was to calculate the degree of the influences of factors affecting the discontinuation of breastfeeding until 1 month after delivery on that until 3 months after delivery, and to identify indicators of the discontinuation of breastfeeding until3months. Methods : The subjects were 60 mothers who delivered a single infant and initiated breastfeeding in an early puerperal stage after full-term vaginal delivery. As possible indicators of breastfeeding until 3 months after delivery, 3 breast morphological factor variables(``nipple morphological abnormalities : flat nipples, true inverted nipples, and large nipples ≥17 mm in diameter'', ``nipple fissures'', and ``mammary gland tissue thickness ≤21 mm'')and5factors (bleeding volume at delivery, birth weight, the absence of breastfeeding in the last child, a smoking habit, and the absence of breastfeeding at discharge)were surveyed. The 8 factors were surveyed at the time of puerperal discharge. The continuation of breastfeeding 3 months after delivery was ascertained by telephone. The degree of the influences of each factor on the milk feeding form was analyzed by Fisher's exact method and logistic regression analysis. Results and conclusion Factors affecting the milk feeding form 3 months after delivery Among the 8 possible factors leading to the discontinuation of breastfeeding, the absence of breastfeeding at discharge(Fisher p＝0．003)alone compared with its presence resulted in mixed/ bottlefeeding 3 months after delivery. The odds ratio of each factor in the mother/child was 1．931 for the thickness of mammary gland tissue, 1．677 for bleeding volume at delivery, 2．502 for the absence of breastfeeding in the last child, and 7．337 for the absence of breastfeeding at discharge. By logistic regression analysis, only the absence of breastfeeding at discharge was correlated with mixed/bottlefeeding 3 months after delivery(odds ratio, 7．337 ; p＝0．017). These results suggest that the absence of breastfeeding at discharge is an indicator of the discontinuation of breastfeeding until 3 months after delivery.


Analysis of basic conditioning factors in the mother/child affecting breast-feeding

Purpose : The purpose of this study was to clarify basic conditioning factors affecting the continuation of breast‐feeding until1month after delivery and find parameters for its continuation and the assessment of care need. Methods : As basic conditioning factors in the mother/child affecting the continuation of breast‐feeding, 5 factors(age, number of children previously cared for, delivery time, bleeding volume at delivery, and birth weight), which were suggested to affect breast‐feeding by the literature, were analyzed by logistic regression analysis, and the degrees of their influences were calculated. In addition, to evaluate the influences of3factors(absence of breast‐feeding in the last child, smoking habit, and absence of breast-feeding at discharge), which were major influential factors but had to be deleted in the process of the production of a questionnaire of breast‐feeding limitation factors(Haku, M.2004), on the feeding method1 month after delivery, differences were analyzed by Fisher's direct method and the ▯2 test. Results : 1．Basic conditioning factors affecting the milk feeding method1month after delivery The odds ratio for each factor in the mother/child was1．033for age,0．872for the number of children previously cared for, 1．012 for delivery time, 1．659 for bleeding volume at delivery, and 2．861 for birth weight. Bleeding volume at delivery(p＝0．042)and birth weight(p＝0．021)were significantly correlated with mixed/bottle‐feeding1month after delivery. 2．Three factors affecting breast‐feeding1month after delivery Mixed/bottle‐feeding1month after delivery was significantly more frequently observed in mothers with the absence of breast‐feeding in the last child(Fisher p＝0．0006), a smoking habit(Fisher p＝0．04), and the absence of breast‐feeding at discharge(▯2＝7．28, p＝0．007)than in those otherwise. Conclusion : These results suggest that5basic conditioning factors ``bleeding volume at delivery ≥500ml'', ``birth weight<25,00g'', ``absence of breast‐feeding in the last child'', ``smoking habit'', and ``absence of breast‐feeding at discharge'' can be parameters for the assessment of breast‐feeding limitation factors.


Evaluation of the breast-feeding limitation scale as a useful tool for prediction of continuing breast-feeding

Purpose : The purpose of this study was to develop a questionnaire for gathering information about the factors restricting the continuation of breast-feeding at the time of discharge from the maternity hospital after childbirth. As a first step, a statistical analysis was conducted regarding the predictability at the time of hospital discharge of the breast-feeding limitation factors which were collected during a survey at the health checkup1month after childbirth. Methods : The information regarding the factors limiting breast-feeding, gathered from mothers who could not continue breast-feeding at one month after childbirth, was analyzed using the dependent-care model proposed by Orem, a nursing theoretician. Based on the analysis results, a questionnaire consisting of 36 items 4 point Likert-type scale was prepared. This draft questionnaire was pre-tested, and finally a questionnaire consisting of 30 items(▯ coefficient＝0．81)was prepared. Using the re-testing method, an examination was undertaken to see the extent to which the limitation factors gleaned through the questionnaire survey can be predicted at the time of hospital discharge. The subjects were 70 mothers who had experienced rooming-in upon normal delivery. The survey was conducted twice : at the time of hospital discharge and at the time of the health checkup1month after delivery. Results:1．Regarding the prepared questionnaire, the correlation between items was determined through the re-test method, according to which the subjects were surveyed at the time of hospital discharge and at the time of the health checkup 1 month after delivery. As a result, an extremely strong correlation, that is，0．9 or upward, was observed in 1 item of the questionnaire survey, a strong correlation, that is，0．7 or upward, was observed in 5 items, and no correlation was observed in 8 items. 2．The constructive concept of the questionnaire survey at the time of hospital discharge was analyzed based on the 22 for which there was a strong or extremely strong correlation ; the other8items for which no correlation was observed were left out. After 3 varimax rotations, a model with 13 items and 4 factors was verified. Cronbach's ▯ coefficient for the entire questionnaire was 0．81，and that for the subscale ranged from 0．58 to 0．83． 3．The correlation between the questionnaire scores at the time of hospital discharge and at the time of the health checkup 1 month after delivery was 0．65(p<0．0001)for the entire questionnaire, while that for the subscale ranged from 0．37(p＝0．0015) to 0．76(p<0．0001)． 4．The mean score of the breast-feeding group and that of the mixed-feeding group at the time of the health checkup 1 month after delivery were 27．3±7．0 and 31．7±6．8，respectively ; that is, a significant difference(p<0．05)was observed between the two groups. It has been found that the mixed-feeding group has more factors limiting breast-feeding in comparison with the breast-feeding group, and it has been suggested that the information gathered by the questionnaire can indeed constitute a firm basis for predicting difficulties in continuing breast-feeding. Conclusion : Some of the limitation factors discovered at the time of the health checkup 1 month after delivery could be predicted at the time of hospital discharge ; thus, it has been suggested that those limitation factors can be included in a questionnaire survey on factors limiting breast-feeding. The questionnaire to be filled out at the time of hospital discharge after childbirth will be prepared upon further review of its reliability and validity. We expect that the questionnaire will constitute a firm basis for predicting the presence of factors limiting breast-feeding already at the time of hospital discharge, will help staff evaluate the feasibility of self-care, which is said to be necessary for puerperal women, and will help staff elucidate the necessity of nursing-care intervention.


Basic study of new diagnostic modality according to non-invasive measurement of the electrical conductivity of tissues

The purposes of this study were to estimate the electrical conductivity of tissues by non-invasively measuring the electrical bio-impedance, to develop a new method for tissue diagnosis, i.e., electrical impedance tomography (EIT). Tissue models were first designed taking into consideration the distribution of the fat tissue, muscle and bone in the human forearm, and then the intra-tissue distributions of electrical potential and field, and the electrical impedance in the models was theoretically analyzed by the three-dimensional finite element method. The electrical impedance of both forearms was measured in healthy human subjects, and estimated the electrical conductivity of individual local tissues. The results of the analysis showed that the distributions of electrical potential and field were affected by the presence of fat tissue but not by the presence or absence of bone. In addition, as a result of calculation of the electrical resistance of the extracellular fluid (Re) in each model, it was found that the value of bio-impedance was influenced by the presence of fat tissue, and the value of bio-impedance was increased by the intervention of a fat layer. The electrical conductivity estimated by fitting the observed values to the values obtained by finite element analysis was 0.40 S/m and 0.15 S/m for male muscle and fat tissue, and 0.35 S/m and 0.11 S/m for female muscle and fat tissue, respectively. The sex difference in the slope of linear approximation in the estimation of electrical conductivity of the males and females was thought to be due to sex differences in the properties and structure of fat tissue. These results suggest that local tissues can be diagnosed differentially and electrically by percutaneous measurement of local bio-impedance and subsequent estimation of the electrical conductivity of each tissue.

The Journal of Medical Investigation : JMI


Pursuit of factor limiting breastfeeding continution, using Orem's dependent care model

オレムの依存的ケアモデルを適用した母乳哺育継続制限要因の探究


Relationship between mammary gland structures during pregnancy and breast-feeding

Study Purpose Diagnostic indices for prediction of breast milk production and assessment of care necessary for mammary gland structure during the pregnancy period were investigated. Methods Development of mammary gland during the pregnancy period was examined via ultrasound methodology. Each subject underwent three measurements once per trimester. Quantity of post-partum breast milk production was also measured ; furthermore, the relationship between mammary gland image and production quantity was evaluated. Results and conclusion As previously reported, mammary gland reaches a certain level of development during the course of pregnancy. Four distinct types of developmental pattern were observed. Mammary gland exhibited remarkable development up to the 15th week of pregnancy in comparison with non-pregnant adult females in type 1. In type 2, mammary gland displayed significant development from the 16th to the 35th week of pregnancy. In types 3 and 4, mammary gland tissue development, which was apparent from 35 weeks, was characterized by gland thickness of > 20 mm and < 20 mm, respectively. Among these four types, type 1 mammary gland demonstrated the largest level of breast milk production. Therefore, we suggest that understanding with respect to mammary gland structure during pregnancy contributes toward individual support in breast-feeding following childbirth.

JNI : The Journal of Nursing Investigation


Temperature effect of a disinfectant in operative field during surgery under local anesthesia


研究に関する男女共同参画・ダイバーシティの推進状況に関するアンケート調査-全国の集計結果との比較から見える徳島大学の現状-

本調査では，全国ダイバーシティネットワークの幹事機関である大阪大学と，日本学術会議科学者委員会男女共同参画分科会・同アンケート検討小分科会が共同で実施した「大学・研究機関における男女共同参画・ダイバーシティの推進状況調査」のうち「大学・研究機関における男女共同参画の推進状況に対する意見・感想」について，徳島大学回答分(男性60 件，女性21 件)のみ抽出されたデータを用いて，本学における男女共同参画・ダイバーシティ推進に関する研究者の意識調査を実施した．男女別に集計し，公開されている全国集計結果(計10，105 件)と比較検討することで，全国における本学の位置付けについて分析した． 調査項目は， 1 ．男女共同参画の推進(全般) 2 ．男女共同参画の取り組み 3 ．ワークライフバランス・育児支援サービス 4 ．ダイバーシティ対応 5 ．ハラスメント防止体制 6 ．医学系 の6 項目にわたる．全国と徳島での回答差，また男女間の回答差から，現在の徳島大学の研究者における男女共同参画に対する意識について考察する．

徳島大学人と地域共創センター紀要

徳島大学人と地域共創センター紀要


徳島県妊産婦メンタルケア対策 早期発見と支援のポイント(解説)

徳島県妊産婦メンタルケア対策 早期発見と支援のポイント(解説)