Purpose
To assess the effectiveness of emergency training compared with no training or other types of training for medical staff in the obstetrics ward.
Methods
We reviewed literature from PubMed, CINAHL Plus with Full Text, The Cochrane Library, Maternity and Infant Care, and Ichushi Web based on the Cochrane Handbook for Systematic Reviews of Interventions.
Results
Five randomized controlled trials met the inclusion criteria. All studies were classified as having a low risk of bias. We compared high-fidelity simulation versus no training, low-fidelity simulation or lectures. High-fidelity simulation improved skill performance in acute obstetric situations compared with low-fidelity simulation or lectures. However, high-fidelity simulation did not further improve knowledge and communication skills compared with low-fidelity simulation.
Conclusion
High-fidelity simulation improved the skill performance for the management of eclampsia and shoulder dystocia compared with no training or lecture. In addition, the effectiveness of high-fidelity simulation on knowledge and communication skills is still unclear because our study did not yield any clear evidence. Furthermore, assessments of long-term effects on clinical outcomes are necessary for obstetric complications.

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Objective
To examine optimal temperature environments for late preterm infants during the early postnatal period by simultaneously measuring the central and peripheral deep body and axillary temperatures, while discussing the current status of temperature control based on the axillary temperature.
Subjects and Methods
The central and peripheral deep body and axillary temperatures of 6 late preterm infants were simultaneously measured 4 to 12 hours after birth. The central and peripheral deep body temperatures were continuously measured at intervals of 1 minute using a deep body thermometer and attaching a temperature probe to the abdominal wall (central) and plantar (peripheral). The axillary temperature was measured at intervals of 2 to 3 hours. Subsequently, the means and standard deviations of the obtained temperature data were calculated, while visually analyzing the temperature fluctuation pattern in each infant.
Results
The axillary temperature ranged from 36.6 to 36.9 (mean: 36.8) degrees C; these values were within the range determined in the Guidelines for Late Preterm Infant Management. The central deep body temperature ranged from 36.9 to 37.2 (37.1) degrees C, showing a strong positive correlation at a temperature 0.3 degrees C higher compared to that of the axillary temperature (r=0.75 to 0.99). Furthermore, while the central deep body temperature was generally constant, showing a narrow range of fluctuation, the peripheral deep body temperature showed a wide range of fluctuation, and its pattern varied among infants. The infant in whom the difference between the central and peripheral deep body temperatures was the greatest had experienced mild birth asphyxia.
Conclusion
1. The axillary temperature showed a strong positive correlation at a temperature approximately 0.3 degrees C lower than that of the central deep body temperature.
2. It may be difficult to create optimal temperature environments for late preterm infants based on the axillary temperature only.
3. It may be effective to simultaneously measure the central and peripheral deep body temperatures during the early postnatal period in late preterm infants.

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Purpose
The Violence Against Women Screen (VAWS) is a Japanese screening tool for intimate partner violence. In order to revise the VAWS to be more accurate and applicable for clinical settings, we conducted an interview with postpartum women screened for IPV during pregnancy to clarify women's response and its situation for VAWS items.
Methods
Five new items inquiring about psychological violence were added to the seven items in the original VAWS. A total of 43 postpartum women who answered the 12-item VAWS during pregnancy were asked their response and its situation of the VAWS question items by semi-structured interview. The data was analyzed using content analysis. This study was approved by the Institutional Review Board of St. Luke's College of Nursing (Approval No. 11-039).
Results
Participants expressed a variety of perceptions concerning question items on psychological violence. For the question "Is it difficult to settle arguments by talking?", replies consisted of 2 categories: [Get into a quarrel] and [Lack of conversation]. The concept of "talking" included both one-way and two-way conversation depending on context. The psychological violence questions "Has he yelled at you?", "Do you feel safe?", "Do you feel controlled by your partner?" and "Does he have no respect for your feelings?" consisted of more than three categories of answers, including perceptions that researchers did not intend. In addition, some of the psychological violence questions had response categories [Chose wrong options] and [Felt hesitant about which option to choose]. On the other hand, for two psychological violence questions: "Have you felt afraid?" and "Has your partner thrown or punched things?", and for the physical violence and sexual violence questions, participants' perceptions were most consistent.
Conclusion
Various perceptions were expressed by participants concerning psychological violence questions. In accordance with our quantitative data analysis, the VAWS requires further revision to make it an accurate and applicable tool to screen IPV.

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Purpose
Focusing on the views on reproduction and women's bodies of women with a passive attitude toward bearing children, whose numbers are already high as of 2014 and are expected to increase in the future, the present study aims to reveal the views of these women based on their own narratives. Then, based on our findings about their views, the method of implementation of health support for such women is discussed.
Methods
A qualitative descriptive research design based on an interview survey was employed. The subjects consisted of 29 women in their 30s to 80s. Note that 16 women in their 30s and 40s, who were in the reproductive period of their lives, were the main focus of the present study, and we intentionally selected women with a passive or negative attitude toward bearing children, so that the characteristic aspects of such women, whose numbers are expected to continue to increase in the future, could be highlighted.
The survey focused on the following items: (1) numbers of children and grandchildren desired, and their satisfaction levels with these numbers; (2) menstrual history, and a body associated with menarche and menopause; (3) health-care behaviors; (4) experiences associated with (1) to (3), reasons for the attitudes associated with (1) to (3), and relationships with people around; (5) experiences and events which may be reflected on the interviewee's view of reproduction, women's body, and health.
Results
The results of the survey confirmed the following characteristics in the subjects' narratives:
1. choice not to bear a child forms the basis for the view on women's bodies that harms and makes light of the reproductive ability of their own bodies; 2. idea that menstruation gives no benefit; and 3. there is no information available on the biological features of women's bodies, especially about the physical risks.
These results revealed that the subjects' views on reproduction and women's bodies are in a phase of "women's body non-oriented to reproduction," as well as 4 challenges and 2 strengths, mentioned below, inherent in the "women's body non-oriented to reproduction."
Conclusion
The results suggested that nursing support based on the 4 challenges and 2 strengths inherent in the "women's body non-oriented to reproduction" may be able to help maintain the health of the "women's body non-oriented to reproduction" at some level.
The challenges included: 1. abandonment of the reproduction-related qualities of their bodies; 2. closed reproduction that is treated exclusively in the context of personal problems;
3. lifestyle that accepts negligence of reproduction and treats their own bodies as if they are reproductive; and 4. "women's body non-oriented to reproduction" that values bodies with no gender or neutral gender.
The strengths were: 1. sufficient motivation and desire for maintaining good health for the coming old age; and 2. holistic views on body and health, such as the view that nature's balance maintains the health of women's bodies.

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Purpose
The purpose of this study was to clarify changes in diaper rash and the relationships between diaper rash and skin hydration level in the buttocks of newborns , the process of mothers' diaper change at the time of hospital discharge and during the one month checkup.
Subjects and Methods
The subjects investigated were 69 mothers and 69 healthy newborns (male=31, female=38). Measurements of the diaper area were taken twice between July and October 2012: at four days after discharge and at the one month checkup. The following areas were investigated: the presence or absence of erythema, papules, swelling, erosions, desquamation and hydration of the stratum corneum of the buttocks using the Scalar moisture checker. We interviewed the mothers about the diaper changing process. Data analysis was conducted using SPSS Ver.20; the significance level was set to 5%.
Results
The results showed that erythema or papules were observed on four days (n=18, 26.1%) and at the one month checkup (n=30, 43.5%). These conditions were observed to be present in both the perianal region and the thigh at both intervals (n=38, 55.1%). There was significantly more diaper rash at the one month checkup (p=.03), and in the male group on four days (p=.04). The stratum corneum hydration of the buttocks was 31.9±1.0% at four days, and 32.2±1.0% at the one month checkup and significantly higher at four days (p=.04). How the mothers' changed the diapers was the same at both times: the baby's cry indicated that a diaper change was needed, the buttocks were gently wiped and the setting of the diaper was not too tight around the abdomen. There was no significant data on the relationship between the presence or absence of diaper rash and defecation frequency, diaper change frequency, presence of atopic dermatitis in the mothers' past, diaper change instruction during hospitalization, breast or bottle feeding, or how to wipe the buttocks. There was no difference in the method of diaper change at either of the study intervals.
Conclusion
No differences were discovered in the method of diaper change, the factors that are considered to result in diaper rash, or the presence or absence of diaper rash. Anyone may cause diaper rash in newborns. Mothers performed diaper changes after discharge in much the same way as in the hospital. This study points to the importance of leadership among nurses in hospitals.

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Objective
The purpose of this study was to describe the experiences of women who consult a gynecologist for menopausal symptoms.
Methods
The study used both qualitative and descriptive research designs. Ten women with menopausal symptoms who visited Clinic A in Prefecture A participated in approximately 1-hour-long semi-structured interviews regarding their experiences from the onset of subjective symptoms until consultation. For analysis, their experiences were classified by similarities, differences, and connections using a verbatim record to identify codes that were then placed into more abstract subcategories. These were then grouped into seven categories.
Results
Experiences of women who consulted a gynecologist for menopausal symptoms can be described as follows. Women "affected by others while hesitated to engage in a gynecology consultation regarding the menopause." Thus, they feel that they are "surrounded by situations they cannot control on their own" and begin to "agonize about being at the mercy of their symptoms day after day without hope of reprieve." They eventually "overcome situations or feelings that they cannot or do not want to discuss with a gynecologist," They see a gynecologist and their "symptoms diminish, but concerns about treatment remain." They then begin to "accept menopause and change their way of thinking." In addition, throughout the duration of their agony, they "seek others that share their pain."
Conclusions
After becoming aware that they have started menopause; women, burdened with various conflicts, consult with a gynecologist. However, despite recognizing the symptoms that accompany their aging, regardless if those symptoms diminish with menopause treatment, they continue to worry about treatment and seek counsel from others in order to gain understanding of the distress created by their symptoms.

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Purpose
This study clarified how to facilitate learning for midwife students acquiring knowledge of the pregnancy period and procedural techniques for prenatal checkups.
Methods
The study comprised 18 students learning midwifery in the same midwife training program (average age, 22.3 years). Students provided written, informed consent to participate in the study, and data were collected following established ethical procedures. Data consisted of students' free written responses to the question, "How did you learn about the pregnancy period?" Students studied the pregnancy period from April to July 2013, and data were collected in July 2013. Results have been analyzed qualitatively and inductively.
Results
The types of learning that midwife students engage in while studying the pregnancy period became clear. We identified two major categories of learning based on participants' responses. The first category was, "Applicable knowledge, and to solidify that knowledge," from which the following three subcategories were extracted: 1) Preparing for lessons and reviewing with a positive attitude while finding value in the content learned; 2) Recognizing gaps in knowledge and the need for basic information; and 3) Solidifying the knowledge by reviewing it. We also identified the category, "Learning to execute knowledge and techniques necessary for prenatal checkups," from which the following two subcategories were extracted: 1) Gaining the knowledge of proper examining and make an effort to understand pregnant woman oneself, and 2) Practically applying the techniques as part of real prenatal checkups.
Conclusion
The midwife students objectively self-analyzed and reflected on the process of learning about the pregnancy period. They independently prepared for lessons and reviewed with the goal of becoming a midwife in mind. In acquiring technical knowledge, they repeatedly practiced until they were able to assume confidence when applying techniques in a real setting. This study suggested that practicing midwifery techniques as a group taught the midwife students to value themselves and their group members, and motivated them to self-evaluate in order to improve their knowledge and techniques.

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Objective
The purpose of this study was to evaluate an e-learning program on postpartum hemorrhage (PPH) for midwives.
Methods
Participants were midwives who worked at an obstetrics ward at a hospital, birth clinic, or birth center in the Kanto area. The e-learning program consisted of four parts. We measured knowledge about PPH using a pre- and a posttest, and evaluated the program using questionnaires.
Results
We analyzed 48 midwives. Knowledge scores significantly increased from the pre- to posttest (t = 10.27, p < .001). The average total score on the knowledge pretest was 15.85 (range 11-21, SD 2.78) and posttest 20.02 (range 14-23, SD 2.21).
The percentage of questions correctly answered significantly increased with respect to 12 items: "characteristics of atonic bleeding," "clotting factors and hemorrhage," "percentage decrease of circulating blood volume as a cause of hemorrhagic shock," "circulating blood volume of adults," "support for patients with hemorrhagic shock," "characteristics of dilutional coagulopathy," "configuration of extracellular fluid," "characteristics of obstetric disseminated intravascular coagulation syndrome (DIC)," "causes of increased blood volume," "circulating hemorrhage volume according to the shock index," "blood infusion," and "components of blood plasma." No significant changes were found for two items: "colloid oncotic pressure" and "crystalloid pressure."
Furthermore, we analyzed the relationship of the average total score with participants' characteristics (two-way factorial analysis of variance). No significant associations were detected. The design of the e-learning program was useful because of the positive assessment by the trainees of the mode of operation, appropriateness of the program, and overall satisfaction.
Conclusion
An e-learning program is an effective method for improving trainees' knowledge. There are limitations with regard to the effectiveness of teaching of physiology related to fluid therapy. We are planning on modifying the program; it required longitudinal assessment of knowledge retention.

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Objective
This study aims to investigate and compare reasons for birthing facility selection from hospitals, obstetrics clinic and birthing centers using a marketing concept in order to explain and discuss the decreasing number of births at birthing centers.
Subjects and methods
A questionnaire survey was conducted on 725 mothers using health centers, birthing centers, and infant activity classes in Tokyo. Survey content comprised participant attributes, reasons for birthing facility selection, and influencing factors. Responses from 389 mothers (valid response rate, 53.7%) were analyzed. Participants were categorized based on their choice of birthing facility type as group A (hospital or university hospital), B (obstetrics clinic), or C (birthing center or home) and were compared regarding attributes and the marketing mix (the four Ps: Product, Price, Place, and Promotion). In the present medical context, Product referred to care, medical services, and medical practice. The survey was conducted between February and the end of March 2013.
Results
Group A comprised more elderly primipara than groups B and C (p=0.027), and "aged 35 years or older" was more commonly cited as a factor influencing facility selection in group A than groups B and C (p‹0.001). "Long and thorough prenatal checkups", "option for natural birth", "option for freestyle birth", "midwife in attendance throughout labor and delivery", "provision of breastfeeding support", "option for rooming-in", and "meals beneficial for breast milk" were stated as Product-related reasons for birthing facility selection in 70% of group C compared to around 30% of groups A and B. Reasons such as "every prenatal checkup includes examination by a doctor" and "facility is large-scale" were common in group A while reasons such as "every prenatal checkup includes examination by a doctor", "availability of private rooms", "lavish meals", and "celebration meal offered" were common in group B (p‹0.001).
With regard to Price, "low cost of birth" was a commonly stated reason for birthing facility selection in group A (p‹0.001), while "able to use government-issued coupons for prenatal checkups" was commonly stated by groups A and B (p=0.015). For Place, half of all three groups responded with "close to home" as a reason for facility selection"
Conclusion
Possible reasons for fewer births at birthing centers are being an elderly primipara (age≥35 years old) and the gap between What Product (Service Care) midwives are providing and what service care mothers in Group A (mothers at university hospital and obstetrics clinic) wanting to receive.

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