Objective-The objective was to conduct a systematic review and meta-analysis of studies that examined the effects of structured exercise on depressive symptoms in stroke patients.Methods-We searched for published randomized controlled trials which evaluated the effect of structured exercise programs (e.g., functional, resistance or aerobic training) on depressive symptoms. The mean effect size, a 95% confidence interval (CI) and I-squared (I 2 ) for heterogeneity were estimated. Sensitivity analyses were conducted.Results-Thirteen studies (n=1022) were included in the meta-analysis. Exercise resulted in less depressive symptoms immediately after the exercise program ended, SMD=−0.13 [95%CI = −0.26, −0.01], I 2 =6%, p=0.03, but these effects were not retained with longer term follow-up. Exercise appeared to have a positive effect on depressive symptoms across both the subacute (≤ 6 months post-stroke) and chronic stage of recovery (> 6 months). There was a significant effect of exercise on depressive symptoms when higher intensity studies were pooled, but not for lower intensity exercise protocols. Antidepressant medication use was not documented in the majority of studies and thus, its potential confounding interaction with exercise could not be assessed.Conclusions-Exercise may be a potential treatment to prevent or reduce depressive symptoms in individuals with sub-acute and chronic stroke.

Objective To compare family physicians', obstetricians' and midwives' self-reported practices, attitudes and beliefs about central issues in childbirth. Design Mail-out questionnaire.Setting/Population All registered midwives in the province, and a sample of family physicians and obstetricians in a maternity care teaching hospital. Response rates: 91% (n ¼ 50), 69% (n ¼ 97) and 89% (n ¼ 34), respectively. Methods A postal survey.Main outcome measures Twenty-three five-point Likert scale items (strongly agree to strongly disagree) addressing attitudes toward routine electronic fetal monitoring, induction of labour, epidural analgesia, episiotomy, doulas, vaginal birth after caesarean section (VBACs), birth centres, provision educational material, birth plans and caesarean section. Results Cluster analysis identified three distinct clusters based on similar response to the questions. The 'MW'cluster consisted of 100% of midwives and 26% of the family physicians. The 'OB' cluster was composed of 79% of the obstetricians and 16% of the family physicians. The 'FP' cluster was composed of 58% the family physicians and 21% the obstetricians. Members of the 'OB' cluster more strongly believed that women had the right to request a caesarean section without maternal/fetal indications (P < 0.001), that epidurals early in labour were not associated with development of fetal malpositions (P < 0.001) and that increasing caesarean rates were a sign of improvement in obstetrics (P < 0.001). The 'OB' cluster members were more likely to say they would induce women as soon as possible after 41 3/7 weeks of gestation (P < 0.001) and were least likely to encourage the use of birth plans (P < 0.001). The 'MW' cluster's views were the opposite of the 'OBs' while the 'FP' cluster's views fell between the 'MW' and 'OB' clusters. Conclusions In our environment, obstetricians were the most attached to technology and interventions including caesarean section and inductions, midwives the least, while family physicians fell in the middle. While generalisations can be problematic, obstetricians and midwives generally follow a defined and different approach to maternity care. Family physicians are heterogeneous, sometimes practising more like midwives and sometimes more like obstetricians.

This paper describes the development and psychometric assessment of a scale to measure satisfaction with intrapartum and postpartum care in hospital: The Care in Obstetrics: A Measure For Testing Satisfaction (COMFORTS) scale. A sample of 415 participants completed the 40-item scale. Cronbach's alpha for the scale was .95. Evaluation of construct validity through principal components factor analysis with varimax rotation yielded six subscales: confidence in newborn care, postpartum nursing care, provision of choice, the physical environment, respect for privacy, and labor/delivery nursing care. The COMFORTS scale was able to discriminate between multiparous versus primiparous women, and between women cared for in single room maternity care versus in separate labor/delivery and postpartum rooms. Pending further validation, the COMFORTS scale has potential to measure women's satisfaction with childbirth care and contribute to an assessment of the quality of care provided.