|Year : 2020 | Volume
| Issue : 1 | Page : 1-6
Studies of nursing in acute mastitis in China: Bibliometric analysis
Hui Ju1, Ling Tang2, Hong Guo1
1 School of Nursing, Beijing University of Chinese Medicine, Beijing, China
2 Department of Nursing, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
|Date of Submission||20-Jan-2020|
|Date of Decision||17-Feb-2020|
|Date of Acceptance||18-Feb-2020|
|Date of Web Publication||03-Apr-2020|
Department of Nursing, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078
Source of Support: None, Conflict of Interest: None
Objective: To analyze the research hotspots of nursing related to lactation acute mastitis in China and provide guidance and reference for nursing researchers.
Methods: Papers from China National Knowledge Infrastructure, Wanfang Data, VIP Data, and SinoMed are collected. All papers were imported into Noteexpress software in the form of bibliography to check again and delete duplicate references. The remaining literature was screened by reading the title and abstract and finally included by reading the full text. The paper's information was analyzed using SPSS 22.0.
Results: 1275 papers are searched and 531 papers are included at last. Periodical literature accounted for the highest proportion, 96.80%. Moreover, the journal with the largest number of entries is China Health Care and Nutrition. In 2007, the number of literatures related to acute mastitis nursing began to increase rapidly, and the most articles were published in Henan. Among the literature types, the majority are literatures expert experience. Only 18 literature reports were funded.
Conclusions: Papers on acute mastitis nursing are increasing year by year and gradually become a research hotspot. However, the development of this study is uneven in different regions, with little financial support, and randomized controlled trials are still to be carried out.
Keywords: Acute mastitis, bibliometric analysis, health education, traditional Chinese medicine nursing technology
|How to cite this article:|
Ju H, Tang L, Guo H. Studies of nursing in acute mastitis in China: Bibliometric analysis. J Integr Nurs 2020;2:1-6
| Introduction|| |
Acute mastitis, also known as “Ru Yong” in traditional Chinese medicine (TCM), is a common and frequently occurring disease in lactating women. It usually occurs in the first 3 months of breastfeeding. Foreign studies reported that about 2%–33% of lactating women will develop mastitis. Chinese scholars investigated the incidence of acute mastitis and found that the incidence within 6 months was 6.3% and the cumulative incidence was 10.3%. With the opening of the two-child policy in China, the incidence of acute mastitis is on the rise, and its harm is gradually highlighted, which is valued by scholars in related fields. The results show that acute mastitis is an important factor, leading mothers to abandon breastfeeding. If acute mastitis is not treated actively in the early stage, it is very easy to cause further development of the disease, and then lead to mammary abscess, stop breastfeeding and other adverse consequences, which has a certain impact on maternal and child physical and mental health. A large number of studies have shown that nursing can significantly reduce the incidence of adverse reactions to acute mastitis, reduce anxiety and depression of patients, and promote breastfeeding.,, At present, there are no scholars to analyze the current research situation in the nursing field of acute mastitis. To present the current characteristics of nursing research more directly and provide reference to scholars, this study adopts bibliometric method to discuss the amount, structure, and change regular of papers of acute mastitis, in order to understand the status of the acute mastitis nursing research hotspot, and provide guidance and reference for nursing researchers.
| Methods|| |
Papers from China National Knowledge Infrastructure, Wanfang Data, VIP Data, and SinoMed are searched. The retrieval time is from establishment of the database to November 2018. We used the following search terms: (acute mastitis OR Ru Yong) AND (nursing).
Inclusion and exclusion criteria
Inclusion criteria were (1) papers were published from establishment to November 2018 and (2) contents are related to acute mastitis and nursing. Exclusion criteria were (1) repeated publication, (2) the full text which is not available, and (3) incomplete data.
Methods of input data and analysis
Import all references into Noteexpress software in the form of bibliography to check again and delete duplicate references. The remaining literature was screened by reading the title and abstract and finally included by reading the full text. The included literatures were extracted by Excel, including publication year, journals included, first author unit, research funding, author region, research design type, and subject words. The PivotTable function of Excel software was used to form a high-frequency subject word coterm matrix, which was transformed into a different matrix and then imported into SPSS 22.0 for cluster analysis, to analyze the research hotspots of nursing related to lactation acute mastitis in China.
| Results|| |
Literature search results
A total of 1,275 references were retrieved through the retrieval database, and 725 duplicate references were deleted after the retrieval, leaving 550 references. By reading title and abstract, 19 articles that had nothing to do with the research content were removed. Through reading and screening the full text of the remaining articles, 531 articles were finally enrolled, including 514 journal papers (96.80%), 13 conference papers (2.45%), 3 academic dissertations (0.56%), and 1 patent (0.19%).
Publication year distribution
The number of literatures related to nursing of acute mastitis was on the whole on the rise. The earliest published year was 1981, with a total of 1 article published. From 1981–2000, the number of literature publications increased slowly. No literature was published in 1982, 1985, 1986, and 1990–1993, for reasons that are unclear. Since 2001, the number of documents has increased significantly, and the number of articles published in 2007 has increased rapidly. The number of posts peaked at 66 in 2017 and has since declined.
There are 193 journals in China that included nursing-related studies of acute mastitis, among which 52 journals included more than 3 articles. The journal with the largest number of literature included was China Health Care and Nutrition, with 23 articles. The second is World Latest Medical Information and Medical Information, which included 18 and 15 articles, respectively. The largest number of nursing journals publishing nursing-related research on acute mastitis were Journal of Contemporary Nurses (9) and Journal of Qilu Nursing (9), followed by Chinese Nursing Research (8) and Journal of Clinic Nursing's Practicality (7). In general, the scope of journal publication is wide, with noncore journals in the majority, and the literature quality needs to be improved [Table 1].
|Table 1: The top 10 journals of nursing research on acute mastitis in China|
Click here to view
Through the statistics of the first author's province, the distribution of nursing-related research on acute mastitis was understood, and the concern of each province on this disease was analyzed. According to statistics, the province with the largest number of papers related to nursing of acute mastitis is Henan province, with a total of 46 (8.66%) papers published, among which 4 papers were written by theFirst Affiliated Hospital of Zhengzhou University, followed by Zhumadian Hospital of TCM of Henan province with 3 papers published. According to the results of literature statistics, Henan is an area of most concerned about acute mastitis. Shandong and Hubei provinces followed with 43 each, followed by Jiangsu with 40. In addition, the top 10 published articles include Sichuan (31), Guangdong (30), Zhejiang (27), Hebei (22), Heilongjiang (20), and Jilin (19), accounting for 63.65% of the total number of articles. It can be seen that the research related to the nursing of acute mastitis is concentrated in the relatively developed areas such as Central China, East China, and South China, while there is relatively little attention on the nursing of acute mastitis in the underdeveloped areas such as northwest and southwest [Table 2].
Information of the first author
As for the related studies in the nursing field of acute mastitis, the highest number of articles published by the same author as the first author was 3 (1.12%), and a total of 2 were from the breast department of maternal and child health hospital of Baoan district and the TCM department of Beichen district women and children health center, respectively. Seventeen authors published 2 articles (6.40%), and the rest published 1 article (92.47%). Core authors are those who have a certain depth of research in a certain field and publish a relatively large number of papers. Therefore, the number of their papers can reflect the depth of their research in this field. According to Price's law, the number of articles published by the core author should account for 50% or more of the literature volume. According to the statistical results of this study, the number of articles published by core authors is far <50%. It shows that there is no core author in the nursing field of acute mastitis and the core team of nursing research still needs to be developed. In addition, the depth of research in the nursing field of acute mastitis also needs to be further expanded.
Literature research types
After screening, the final included literature were all quantitative studies and lacked qualitative studies. Among the quantitative studies, the largest number of literature related to expert experience was 207 (38.98%), followed by the class test (188 [35.40%]) and case reports (87 [16.38%]). Overall, the literature type is relatively single, lacking qualitative studies, and high-quality randomized controlled trials [Table 3].
Of all the included literatures, only 18 (3.39%) were funded. The funds include 1 national project, 11 provincial projects, and 6 municipal projects. Among them, three documents were funded by the same fund for Social Welfare Projects of Science and Technology Plan of Baoan District, Shenzhen. The maximum number of funded projects is 4, a total of 1 paper. The fund support can reflect the government's attention to the nursing field of acute mastitis to some extent. It can be seen from the results of this study that the number of articles supported by funds is small, and the government's attention to acute mastitis is insufficient [Table 4].
High-frequency subject word statistics
The high-frequency and low-frequency limit formula is used to calculate the limit of high-frequency words. The extracted subject words in the literature were counted using Excel Pivot Tables. The number of subject words that appear only once is 71. According to the formula (i indicates the number of subject words that appear once), it is calculated that the limit of the number of high-frequency words is 11, and there are 26 high-frequency words with frequency of occurrence > 11. All high-frequency words were paired to form a 26 × 26 common word matrix, which was transformed into a different matrix and then imported into the statistical software (IBM SPSS Statistics 22, Armonk, New York) for clustering analysis, and the tree diagram was obtained as shown in [Figure 1]. The number on the horizontal axis represents the clustering distance between two keywords, and the shorter the distance, the closer the correlation between keywords. The common word cluster analysis method adopted Ward analysis method, and the analysis results are shown in [Figure 1]. As can be seen from the cluster analysis figure, there are three main topics of nursing research on acute mastitis by scholars, namely, factors related to acute mastitis, nursing intervention, and psychological nursing. The closer the two subject words are, the closer the relationship is. Combining with analysis of professional knowledge, acute mastitis Chinese medicine nursing technologies include external application of Chinese medicine, massage manipulation, massage and cupping according to the theme words 25, 5, 9, 15, 1. According to the key words 23, 24, 17, 10, Western medicine treatment measures include antibiotics, drainage incision, massage, hot compress, and so on. According to key words 7, 22, 6, 16, factors related to acute mastitis include cracked nipples, milk pooling, inverted nipples, Staphylococcus aureus, etc.
|Figure 1: Clustering of high-frequency keywords in nursing of acute mastitis|
Click here to view
| Discussion|| |
The statistical results of this study showed that the number of articles published in the nursing field of acute mastitis was increasing year by year, and the overall trend was on the rise. With the opening of China's two-child policy, lactation has been paid more and more attention by domestic scholars. On the one hand, the rate of exclusive breastfeeding is low in China. According to the survey results of the statistical information center of the ministry of health in 2008, only 27.6% of newborns in China were exclusively breastfed within 6 months, lower than the world average. The results of the study indicated that acute mastitis was an important factor leading the parturient women to stop breastfeeding. To promote breastfeeding and improve the rate of exclusive breastfeeding, Chinese scholars have carried out a series of relevant studies on acute mastitis.,, Another reason why the number of articles published in the field of nursing for acute mastitis is on the rise is that the incidence of acute mastitis is on the rise with the opening of China's fertility policy, and the adverse effects caused by it are gradually highlighted. The research results show that acute mastitis can seriously affect maternal confidence in breastfeeding, which is likely to lead to postpartum depression and other psychological diseases, and then lead to maternal stop breastfeeding. However, if acute mastitis cannot be treated timely and effectively, it may develop into mammary abscess, abscess rupture, and other serious complications, which not only causes the patient to stop breastfeeding but also seriously damages the patient's own health, leading to increased pain and other discomfort., Therefore, domestic attention to the nursing field of acute mastitis is gradually rising, the number of articles published in annual growth.
In this study, through the analysis of the core authors, it was found that the core authors and core research team in the field of acute mastitis care had not been formed. The core author and research core team often play a certain role in promoting the research field, and the research is also in-depth, which is an important indicator reflecting the research status. As can be seen from the results of this study, the depth and breadth of research in the nursing field of acute mastitis still need to be further expanded.
The research area and journals are widely distributed, the overall quality of literature is low, and the fund support is insufficient. According to the preset inclusion and exclusion criteria, this study finally included 531 papers in the nursing field of acute mastitis in China. According to statistics, the included articles were published in 193 journals in China, with the number of core journals accounting for 11.30%. Core journals often have strict control over the quality of manuscripts, and the number of published articles can reflect the quality of literature. Therefore, the quality of literature in the nursing field of acute mastitis is low. In addition, according to the statistics of literature types, the proportion of expert-experience literature is the highest, followed by category trials, which account for 74.38% in total, while there are few high-quality randomized controlled trials. There is a lack of qualitative research, evidence-based research, and other research types, and the research depth is insufficient. Fund support reflects the importance the government attaches to the disease. According to the statistics, only 3.39% of the articles are supported by funds, including national funds (0.19%), provincial funds (2.07%), and municipal funds (1.13%). With the rising incidence of acute mastitis, the government needs to increase support for the study of acute mastitis and promote the development of relevant studies in the nursing field of acute mastitis.
By extracting the subject words in the article, the current research hot spots can be analyzed intuitively and the trend of clinical research can be understood. In this study, clustering analysis was used to cluster high-frequency keywords and it was found that factors related to acute mastitis, nursing intervention, and psychological nursing were three hot topics in nursing research on acute mastitis. Studies have confirmed that acute mastitis is closely related to milk deposition, cracked nipples, history of breast trauma, history of mastitis, excessive pressure, fatigue, and difficulty in sucking infants. It is beneficial to prevent the occurrence of acute mastitis and promote breastfeeding by adopting correct nursing methods, effectively emptying the milk, cleaning the nipples, breast massage, psychological counseling, health education, and other methods. Wang et al. conducted a controlled study on 241 patients with acute mastitis and 241 women without mastitis and found that learning lactation knowledge, cracked nipples, and cleaning nipples were related factors of acute mastitis. Logistic regression results showed that abnormal nipple (inverted nipple, flat nipple, etc.) (odds ratio [OR] = 5.26, 95% confidence interval [CI]: 2.81–9.84), repeated milk deposition during lactation (OR = 17.65, 95% CI: 3.32–93.68), breastfeeding more than eight times a day (OR = 5.42, 95% CI: 1.95–15.08), and each feeding time exceeded 45 min (OR = 2.69, 95% CI: 1.27–5.68) were risk factors for the formation of acute mastitis. However, learning lactation knowledge (OR = 0.21, 95% CI: 0.13–0.35), cleaning nipple (OR = 0.26, 95% CI: 0.15–0.45), and daily milk secretion of a small amount (OR = 0.15, 95% CI: 0.08–0.29) were protective factors for acute mastitis. Some scholars carried out comprehensive nursing intervention such as breast massage nursing, physical therapy nursing, psychological nursing, and health education for patients with acute mastitis, and the results showed that the effective rate of treatment, the willingness, and behavior of breastfeeding were improved, and the rate of breastfeeding and recurrence were reduced (P < 0.05). Meanwhile, through blood examination, it was found that comprehensive nursing could effectively reduce the level of inflammatory factors in patients' bodies (P < 0.05), improve the satisfaction of treatment, and promote the recovery of patients.
| Conclusions|| |
This study conducted bibliometrics analysis on the nursing literature of acute mastitis collected from four major domestic databases and analyzed the contents such as time distribution, journal distribution, literature type distribution, fund support, and research hot spots. The results show that the number of articles is on the rise, and the attention to this field is increasing year by year. The core author and core team have not been formed yet. Periodicals are widely distributed, and noncore periodicals are in the majority. The literature type is single. At present, the research focus in the nursing field of acute mastitis mainly focuses on the factors related to acute mastitis, nursing intervention, and psychological nursing, the research depth and breadth are insufficient, and the research in this field needs further exploration.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wu L, Wan H. Progress of TCM treatment for acute mastitis in early stage. J Emerg Trad Chin Med 2014;24:1498-501.
Barbosa-Cesnik C, Schwartz K, Foxman B. Lactation mastitis. JAMA 2003;289:1609-12.
Tang L, Lee AH, Qiu L, et al
. Mastitis in Chinese breastfeeding mothers: A prospective cohort study. Breastfeed Med 2014;9:35-8.
Sun K, Chen M, Yin Y, et al
. Why Chinese mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first six months. J Child Health Care 2017;21:353-63.
Ruegg PL. A 100-year review: Mastitis detection, management, and prevention. J Dairy Sci 2017;100:10381-97.
Jin WN, Zhao MH. Research progress on risk factors and nursing prevention of acute mastitis during lactation. Chin Med Her 2019;16:66-9.
Zhang DM, Cui XM, Li YP, et al
. Influence of comprehensive nursing intervention on curative effect and body inflammatory factor level of breastfeeding acute mastitis. Chin Nurs Res 2018;32:1978-80.
Zhu QH, Zhou XY, Chen MM. Practice of nurse-led clinics in acute puerperal mastitis. J Nurs Sci 2018;33:35-7.
Yu XD. Bibliometrics. Beijing: Peking University Press; 1992.
Duan SL, Li Y, Tang L. Literature analysis on clinical teaching and research of evidence-based nursing in China. Chin J Mod Nurs 2014;20:3927-9.
He Q, Liu Y, Ma XL, et al
. Bibliometric analysis of research on postpartum depression care. Nurs J Chin People's Lib Army 2016;33:16-20.
Center for Health Statistics and Information, Ministry of Health. An Analysis Report of National Health Services Survey in China. Beijing: Peking Union Medical College Press; 2008.
Brown CR, Dodds L, Legge A, et al
. Factors influencing the reasons why mothers stop breastfeeding. Can J Public Health 2014;105:e179-85.
Wang HM, Huang XX, Chen ZW, et al
. Analysis of related factors in the formation of acute mastitis during lactation. J Fijian Univ Traci Chin Med 2016;50:423-7.
Hinic K. Predictors of breastfeeding confidence in the early postpartum period. J Obstet Gynecol Neonatal Nurs 2016;45:649-60.
Mawson AR, Xueyuan W. Breastfeeding, retinoids, and postpartum depression: A new theory. J Affect Disord 2013;150:1129-35.
Victora CG, Bahl R, Barros AJ, et al
. Breastfeeding in the 21st
century: Epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475-90.
He XJ, Qian DF, Lin ZP, et al
. Literature analysis on hospice care from the perspective of web of science in Jiangsu province. Acta Univ Med Nanjing Social Sci 2019;19:179-84.
Feng Y, Wang X, Shang F, et al
. Bibliometric analysis of related research on nursing quality indicators in China. Guid J Tradit Chin Med Pharmacol 2017;23:71-3.
Zhou W, Yu Y, Qian Z. Challenges of breastfeeding in China under its universal two-child policy. J Matern Fetal Neonatal Med 2019;32:2780-1.
[Table 1], [Table 2], [Table 3], [Table 4]