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研究生:蔡立儀
研究生(外文):Li-Yi Tsai
論文名稱:I.接近足月早產兒於出生18個月時降低母親健康相關生活品質:一個以台灣人口為基礎的世代研究II.接近足月早產兒母親健康相關生活品質的縱向變化
論文名稱(外文):I.Mothers with late preterm infant decrease health-related quality of life at 18 months of age: A population-based cohort studyII.Longitudinal change of health-related quality of life experienced by mother with late preterm infants
指導教授:陳保中陳保中引用關係
指導教授(外文):Pau-Chung Chen
口試委員:謝武勳穆淑琪李永凌
口試日期:2013-05-28
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:職業醫學與工業衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2013
畢業學年度:101
語文別:英文
論文頁數:37
中文關鍵詞:接近足月早產兒健康相關生活品質
外文關鍵詞:late preterm infanthealth-realted quality of life
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I.
研究目的: 探討接近足月早產兒於出生18個月大對父母親健康相關生活品質的影響

研究方法: 經由台灣國家出生登記資料庫進行分層抽樣,選出於2005年出生的孩童與母親,2007年1月至2008年2月於孩童18個月大時進行家戶訪談,進行父母親生活品質測量,測量工具為Medical Outcomes Study 36-itemShort-Form (SF-36),共有14,578位家長納入研究其中包含13,765位足月兒父母及813位接近足月早產兒父母。

研究結果: 接近足月早產兒相較於足月兒會降低母親生活品質的分數,在適當矯正相關的干擾因子後,在Medical Outcomes Study 36-itemShort-Form (SF-36)八個面向的分數,有四個面向包括身體生理功能、一般健康狀況、活力及生理健康於兩組母親的分數有統計學上顯著的差異 (P < 0.005)。有趣的是,接近足月早產兒的父親生活品質的分數相較於足月兒父親並無顯著的降低。

結論:就我們所知,這是第一篇主要探討接近足月早產兒與足月兒父母親健康相關生活品質差異的研究,在我們研究中,在18個月大時,近足月早產兒的母親有較差的健康相關生活品質,其中包含了生理及心理面向。
II.
題目: 接近足月早產兒母親健康相關生活品質的縱向變化
研究目的: 探討接近足月早產兒對其母親健康相關生活品質的影響隨時間的變化

研究方法: 經由台灣國家出生登記資料庫進行分層抽樣,選出於2005年出生的孩童與母親,分別於孩童6個月、18個月及3歲大時進行家戶訪談,進行父母親生活品質測量,測量工具為Medical Outcomes Study 36-itemShort-Form (SF-36),共有13,077位家長納入研究其中包含12,347位足月兒父母及730位接近足月早產兒父母。

研究結果: 接近足月早產兒會與母親生活品質的分數在6個月及18個月會呈負相關,在適當矯正相關的干擾因子後,6個月時在Medical Outcomes Study 36-itemShort-Form (SF-36)八個面向的分數,有三個面向包括身體生理功能、情緒角色受限及生理健康於兩組母親的分數有統計學上顯著的差異 (P < 0.005)。18個月時在Medical Outcomes Study 36-itemShort-Form (SF-36)八個面向的分數,有兩個面向包括一般健康狀況及生理健康於兩組母親的分數有統計學上顯著的差異 (P < 0.005)。到了3歲大時,接近足月早產兒與足月兒母親健康相關生活品質的差異就消失了。

結論:就我們所知,這是第一篇主要探討接近足月早產兒與足月兒母親健康相關生活品質隨時間變化的研究,在我們研究中,直到孩童18個月大時,近足月早產兒的母親仍有較差的健康相關生活品質,其中包含了生理及心理面向。

I.
Objective:
To determine the health-related quality of life (HRQOL) in parents after the birth of a late preterm infant at 18 months.
Methods:
Mother and child were chosen via a stratified sampling from Taiwan national birth registration database in 2005.Subjects underwent a home interview 18 months after their deliveries between Jan 2007 and Feb 2008.We used the Medical Outcomes Study 36-itemShort-Form (SF-36) to measure the HRQOL of 14,578 parents of 813 late preterm infants versus 13,765 term infants.
Results:
The mothers with late preterm infants lowered on score of HRQOL compared to those with full-term infants. After controlling for potential confounding factors, of the eight domains score of the SF-36, the four domains including role limitations due to physical health, general health perception, energy vitality and mental health, the HRQOL were significantly different between these two groups of mothers (P < 0.05). Interestingly, no significant decreasing scores of the HRQOL were noted between the father with a late preterm infant and those with a term infant.
Conclusion:
In our knowledge, this is the first study to primarily explore the difference in the HRQOL among the parents with LPIs and the parents with term infants. In our study, being a mother of LPIs decreased the health-related quality of life included physical and mental domains as compared to those of full-term infants at 18 months of age.
II.
Objective:
To determine the change of health-related quality of life (HRQOL) experienced over time by mother with late preterm infants (LPIs).
Methods:
The mother and infant were chosen via a stratified sampling from Taiwan national birth registration database in 2005. Longitudinal prospective follow-up study of mothers with late preterm infants and infants from birth to 3 years was performed. We used the Medical Outcomes Study 36-itemShort-Form (SF-36) to measure the health-related quality of life by 13,077 parents of 730 late preterm infants versus 12,347 term infants.
Results:
There was negative association with LPIs and maternal quality of life at 6 months and 18 months after birth. The differences among three out of the eight domains at 6 months were statistically significant (P<0.05) including physical functioning, role limitation due to Emotional problems and mental health. The differences among two out of the eight domains at 18 months were statistically significant (P<0.05) including general health perception and mental health. The difference with regards to maternal quality of life between LPIs and full-term infant was disappeared at 36 months after birth.
Conclusion:
In our knowledge, this is the first study to primarily explore the longitudinal change in the HRQOL experienced over time by mother with LPIs. In our study, being a mother of LPIs decreased the health-related quality of life included physical and mental domains as compared to those of full-term infants at 6 and 18 months of age.

I.
中文摘要 i
英文摘要 ii
Table of Content iii
Introduction 1
Material and Methods 3
Study Population: Taiwan Birth Cohort Study 3
Data Collection 3
Health-related Quality of Life measures 4
Potential confounding variables 4
Statistical analysis 4
Results 6
Parental and Infant Characteristics 6
Comparisons of quality of life among late preterm and term infants 6
Determinants of quality of life for all parents 6
Discussion 7
Conclusion 10
Reference 11
List of Table
Table 1. Characteristics of study subjects 16
Table 2. Parental SF-36 scores of study subjects at 18 months after delivery 18
Table 3. Parental SF-36 scores of study subjects at 18 months after delivery 19
Table 4 Regression model to predict quality of life in mothers 20
II.
中文摘要 i
英文摘要 ii
Table of Content iii
Introduction 21
Material and Methods 22
Study Population: Taiwan Birth Cohort Study 22
Data Collection 22
Health-related Quality of Life measures 23
Potential confounding variables 23
Statistical analysis 23
Results 25
Parental and Infant Characteristics 25
Comparisons of quality of life among late preterm and term infants 25
Discussion 26
Conclusion 29
Reference 30
Figure 1. Process of Data Collection 33
Table of Contents
Table 1. Characteris of Study Population 34
Table 2. Longitudinal change of maternal SF-36 36
Table 3. Longitudinal chagne of adjusted maternal SF-36 37

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II.
1.Engle, W.A., A recommendation for the definition of "late preterm" (near-term) and the birth weight-gestational age classification system. Semin Perinatol, 2006. 30(1): p. 2-7.
2.Raju, T.N., et al., Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics, 2006. 118(3): p. 1207-14.
3.Davidoff, M.J., et al., Changes in the gestational age distribution among U.S. singleton births: impact on rates of late preterm birth, 1992 to 2002. Semin Perinatol, 2006. 30(1): p. 8-15.
4.Tsai, M.L., et al., Prevalence and morbidity of late preterm infants: current status in a medical center of northern taiwan. Pediatr Neonatol, 2012. 53(3): p. 171-7.
5.Shapiro-Mendoza, C.K., et al., Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics, 2008. 121(2): p. e223-32.
6.Woythaler, M.A., M.C. McCormick, and V.C. Smith, Late preterm infants have worse 24-month neurodevelopmental outcomes than term infants. Pediatrics, 2011. 127(3): p. e622-9.
7.Singer, L.T., et al., Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA, 1999. 281(9): p. 799-805.
8.Chen, Y.C., et al., The association between infant feeding pattern and mother''s quality of life in Taiwan. Qual Life Res, 2007. 16(8): p. 1281-8.
9.HC, S., Transnational marriage and internationalization of capital: The case of ‘‘foreign bride’’ phenomenon in Taiwan. Taiwan: Radical Q Soc Stud, 2000. 39: p. 45-92.
10.Hsieh, W.S., et al., Favorable neonatal outcomes among immigrants in Taiwan: evidence of healthy immigrant mother effect. J Womens Health (Larchmt), 2011. 20(7): p. 1083-90.
11.Tseng, H.M., J.F. Lu, and B. Gandek, Cultural issues in using the SF-36 Health Survey in Asia: results from Taiwan. Health Qual Life Outcomes, 2003. 1: p. 72.
12.Brandon, D.H., et al., Emotional responses of mothers of late-preterm and term infants. J Obstet Gynecol Neonatal Nurs, 2011. 40(6): p. 719-31.
13.Voegtline, K.M. and C.A. Stifter, Late-preterm birth, maternal symptomatology, and infant negativity. Infant Behav Dev, 2010. 33(4): p. 545-54.
14.Zanardo, V., et al., Psychological distress and early lactation performance in mothers of late preterm infants. Early Hum Dev, 2011. 87(4): p. 321-3.
15.Eiser, C., et al., Parenting the premature infant: balancing vulnerability and quality of life. J Child Psychol Psychiatry, 2005. 46(11): p. 1169-77.
16.Witt, W.P., et al., Health-related quality of life of mothers of very low birth weight children at the age of five: results from the Newborn Lung Project Statewide Cohort Study. Qual Life Res, 2012. 21(9): p. 1565-76.
17.Bird, T.M., et al., Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics, 2010. 126(2): p. e311-9.
18.Darlow, B.A., et al., Admissions of all gestations to a regional neonatal unit versus controls: 2-year outcome. J Paediatr Child Health, 2009. 45(4): p. 187-93.
19.McLaurin, K.K., et al., Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics, 2009. 123(2): p. 653-9.
20.Robson, A.L., Low birth weight and parenting stress during early childhood. J Pediatr Psychol, 1997. 22(3): p. 297-311.
21.Singer, L.T., et al., Longitudinal predictors of maternal stress and coping after very low-birth-weight birth. Arch Pediatr Adolesc Med, 2010. 164(6): p. 518-24.
22.Gross, D., L. Rocissano, and M. Roncoli, Maternal confidence during toddlerhood: comparing preterm and fullterm groups. Res Nurs Health, 1989. 12(1): p. 1-9.
23.Miles, M.S., et al., Distress and growth outcomes in mothers of medically fragile infants. Nurs Res, 1999. 48(3): p. 129-40.
24.Teti, D.M., C.R. Hess, and M. O''Connell, Parental perceptions of infant vulnerability in a preterm sample: prediction from maternal adaptation to parenthood during the neonatal period. J Dev Behav Pediatr, 2005. 26(4): p. 283-92.
25.Witt, W.P., et al., Stress-mediated quality of life outcomes in parents of childhood cancer and brain tumor survivors: a case-control study. Qual Life Res, 2010. 19(7): p. 995-1005.


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