Il parto extra-ospedaliero: un'indagine quanti-qualitativa presso una casa maternità di Roma

A quantitative-qualitative study was performed to describe outcomes and experiences of women who gave birth in an out-of-hospital setting in Rome, Italy, between 2016 and 2018. A retrospective observational study was carried out through the collection of clinical and healthcare data of 96 women assisted in these 3 years. Among them 9 were transferred to hospital during labour. The main outcomes of the out-of-hospital deliveries (n = 87) were: intact perineum and no third- or fourth-degree perineal tear in 44,8% of cases, delayed cord clamping in 100% of cases (of which 26.4% were lotus birth) and exclusive breastfeeding in 94.3% of cases at 7 days after delivery and 93.3% at 3 and 6 months. The qualitative phase was conducted on 15 women and involved focus groups and in-depth interviews. It emerged that the choice to give birth in an out-of-hospital setting was mainly due to either the couple's respect for birth physiology and intimacy or a previous negative experience of hospital birth

Taking care of minor migrants' health. The professionals' perception and training needs

Introduction: In Italy, minor migrants represent 21.8% of the non-EU citizens. The care of minor migrants might be challenging as this population is characterized by higher vulnerability and special needs. The study aim was to describe the perceptions on the provision of care, the bio-psycho-social needs of migrant children and the professional training needs. Methods: The study is qualitative descriptive. In May 2019 three focus group, involving health and social professionals, cultural mediators and NGOs operators, were organized. Results: The study explored different areas of the provision of care to minor migrants including bio-psycho-social needs, care provision, barriers to care and professionals' training needs. Discussion and conclusions: The provision of care should consider the specific migration journey and narrative. In some cases healthcare is fragmented, generating obstacles to access especially in minors with lower levels of health literacy. Training plays a key role in the development of cultural competence

Sindrome della morte improvvisa del lattante (SIDS) in Sicilia: una valutazione dei principali determinanti di accudimento

Aim: to evaluate certain caring behaviors associated with the onset of sudden infant death syndrome (SIDS). Methods: a telephone questionnaire was administered between May and July 2017 to a sample of 1055 Sicilian mothers within 30 days of delivery. A multivariate logistic analysis was conducted considering outcome variables: the sleeping position of the children, exclusive breastfeeding and passive smoking. Results: 62% of the participants place their children in the supine position, 37.9% practice exclusive breastfeeding and 89.0% are not smokers. Being aged < 32 years, having a low level of education and limited economic resources are risk factors for the non-supine positioning of children during sleep. A low level of education, primiparity, non-participation to an antenatal course expose mothers to a greater risk of not practicing exclusive breastfeeding at one month. Postpartum smoking is positively associated with a low level of education. Conclusions: the assessment of the main caring behaviors towards newborns and infants is essential for an effective campaign for reducing the risk of SIDS

Health needs and perception of health care quality among Asylum Seekers and Refugees in an Italian local health authority: A qualitative study

BackgroundMigrants, Asylum Seekers and Refugees (ASRs) represent a vulnerable diversified population with increased risks of developing health problems, and in the hosting countries several barriers often hamper their access to the health services. Gathering information about ASRs’ experiences and perceptions of host country health care systems may contribute to improve the quality of health care provided. The aim of this study was to explore the health needs in their bio-psycho-social meaning, and the quality of health care as perceived from the ASRs’ perspective.MethodsThe qualitative descriptive study was conducted as part of the Project “G-START – testing a governance model of receiving and taking care of the Asylum Seekers and Refugees.” Through purposeful and snowball sampling, four Focus Groups conducted in English, Italian and French were carried out between July and August 2019, involving 50 ASRs hosted by four reception centers located on the territory pertaining to an Italian Local Health Authority covering a general population of 500.000 people. The analysis of data was categorical, and was performed using N-Vivo software.ResultsThe macro-categories emerged were the ASRs’ bio-psycho-social health needs, including mental health, sexual and reproductive health, food and nutrition, knowledge of the health care system, need for inclusion; healthcare services access, including barriers before and after the access and the ability of the local health system to respond to existing and evolving demands; strengths of the healthcare and reception systems, and suggestions for improving them in the future.Discussion and conclusionsASRs present vulnerabilities and specific health needs, and the health care system is not always able to guarantee access or to respond to these needs. Several obstacles have been highlighted, such as linguistic barriers and lack of cultural mediation, bureaucratic and administrative barriers, lack of knowledge of the Italian health care system. An effective reorganization of services driven by a more detailed output analysis of the target population needs, together with the use of cultural mediation, peer to peer education and support, and the training of health professionals are recommended to ensure a more accessible, equitable and effective health care system at local level

Use of medications during breastfeeding: a multi-perspective approach

It is widely believed that many medications are dangerous for infants if taken by nursing mothers. So, they often choose to give up the drug in order to continue breastfeeding or, conversely, to discontinue breastfeeding to take the medication. This occurs even for medications considered as compatible by strong scientific evidence. The lack of coherent official information on the use of medications during lactation is probably one of the main reasons inducing an excess of prudence, based on presumption of risk rather than on evidence. In addition, literature suggests that breastfeeding training has a crucial role to increase healthcare professionals’ knowledge, skills and attitudes and to improve professional support for breastfeeding. This applies also for the use of medications during breastfeeding. Objectives. The objectives of this doctoral program are: (1) to assess the coherence and consistence of the sources of information on the use of medications during breastfeeding, (2) to explore opinions, attitudes and practices of the women about the use of medications during lactation, and (3) to assess the effectiveness of an e-learning training on breastfeeding (included the use of medications) in improving attitudes and self-declared practices of healthcare professionals. Methods. Three different studies were carried out to test these doctoral objectives. First, we conducted a study to compare the information about the use of medications during breastfeeding. Information contents were retrieved by the Package Leaftles (PLs) and Summary of Product Characteristics (SPCs), Hale and Rowe's manual and the LactMed database. Second, a mixed-methods study with a sequential exploratory design was carried out. In the first qualitative phase, we conducted focus groups and in-depth interviews with mothers attending community services. On this basis, we built a questionnaire administered to pregnant women and new mothers. Third, we conducted a pre-post study, comparing healthcare professionals’ attitudes and practices before and after an online course on breastfeeding. Results. Regarding the information on the safety of the medications during lactation, the PLs and SPCs report a higher risk profile than the one expressed by Hale and Rowe's manual and the LactMed database and they often suggest the interruption of lactation even for compatible medications, sometimes defined inappropriately as "not recommended". In cases of pharmacotherapy, women show three main attitudes: (1) to stop breastfeeding in order to take the medication, (2) to “endure the pain”, or (3) to use natural products, perceived safer than drugs. Furthermore, women expressing an “endure the pain” opinion and women who considered natural products to be safer than medications had a higher probability of knowing that babies should be exclusively breastfed for the first 6 months (respectively, odds ratio [OR] = 2.24; 95% confidence interval [CI], 1.26-3.97; OR = 4.77; 95% CI, 2.56-8.88). Finally, the online course on breastfeeding (N = 15004) improved healthcare professionals’ attitudes, while minor changes were observed on practices (p<.05). Considering each item, the main effects were observed on use of medications during breastfeeding (3.02 ± 1.29 at T0, 1.88 ± 1.08 at T1). Conclusion. In the dilemma of the mothers needing drug treatment, health professionals play a crucial role to provide individualized treatments, tailored to the single mother–baby case. To achieve this goal, health professionals need accurate and comprehensive information about medications, breastfeeding management and pharmacovigilance to help their decision-making process. A non-interactive, high coverage e-learning approach seems a useful tool to improve awareness and positive attitude towards breastfeeding but also towards use of medications during lactation among the healthcare professionals. On the basis of these findings, we hypothesize two line of development of the doctoral project. First, the building of a specific online training on use of medications during lactation, management of breastfeeding and pharmacovigilance for healthcare professionals. Second, follow-up studies in collaboration with an important Italian drug information service to explore mothers’ practices after contacting this service

Soddisfazione materna ed evento nascita: una web-based survey

Introduction: Maternal satisfaction regarding care during delivery is an indicator of maternity service's quality. Methods: We conducted an observational study between May and August 2018, using an online questionnaire for women who have delivered in the last 3 years. Data was processed using descriptive and bivariate analysis, considering satisfaction as outcome (p<0.05). Results: Sample includes 1229 women. About 73% had a spontaneous vaginal delivery, of which 29.3% received a Kristeller manoeuvre and 34,4% episiotomy. Three women out of 10 complaint about lack of involving in the decision-making process, 13.9% of women believe that their delivery's experience can negatively influence their decision to have another child, and 19.8% would like not to give birth again in the same hospital. Four women out of 10 are only partially satisfied with the care received and 6.4% is not satisfied at all. Satisfaction is significantly associated to the following variables: age ≥ 25 years old, positive environment during labour, gentle attitude of healthcare provider, respect of needs, respect of dignity, woman's inclusion in the decision making process, presence of a trustworthy person during the labour/delivery, vaginal delivery, positive delivery's experience, episiotomy, Kristeller manoeuvre, skin-to-skin contact, support during breastfeeding and postpartum period, choice to come back in the hospital for another delivery. Conclusion: We should implement strategies to promote the mother-partner-child triad as a central focus during delivery and allocate human resources in more efficient ways. Key words: Satisfaction; Birth; Quality of care; Midwifery careIntroduzione: La soddisfazione materna rispetto all’assistenza ricevuta nel punto nascita è un indicatore della qualità dei servizi sanitari. Obiettivo: Valutare la soddisfazione materna in merito all’evento nascita, prendendo in esame alcune pratiche assistenziali e come sono state percepite dalle donne. Metodo: È stato condotto uno studio osservazionale tra maggio e agosto 2018 tramite questionario online proposto a donne che avessero partorito negli ultimi 3 anni. I dati sono stati sottoposti ad analisi descrittiva e bivariata, considerando la soddisfazione come outcome (p<0,05). Risultati: Il campione è costituito da 1229 donne. Circa il 73% ha partorito spontaneamente e rispettivamente nel 29,3% e 34,4% dei casi sono state praticate manovra di Kristeller ed episiotomia. Tre donne su 10 lamentano un mancato coinvolgimento nelle decisioni assistenziali, il 13,9% afferma che il parto abbia influito negativamente sulla volontà di avere altri figli e il 19,8% non tornerebbe a partorire nella stessa struttura. Quattro donne su 10 sono soddisfatte solo in parte e il 6,4% non lo è affatto. La soddisfazione è associata in modo statisticamente significativo alle variabili: età≥25 anni, ambiente di travaglio sereno, atteggiamento cordiale del personale, personale rispettoso dei bisogni, rispetto della dignità, coinvolgimento nelle decisioni assistenziali, persona di fiducia durante travaglio e parto, parto vaginale, esperienza positiva del parto, episiotomia, manovra di Kristeller, contatto pelle-a-pelle, supporto per l’allattamento nel post partum, scelta di tornare al prossimo parto. Conclusioni: È necessario attuare strategie finalizzate a garantire la centralità della triade madre-partner-bambino nell’evento nascita e rendere più efficiente l’allocazione delle risorse umane. Parole chiave: Soddisfazione; Nascita; Qualità dell’assistenza; Assistenza ostetric

Experiences of Birth during COVID-19 Pandemic in Italy and Spain: A Thematic Analysis

Becoming parents during the pandemic of coronavirus disease 2019 (COVID-19) has been a challenge. The purpose of this study was to describe the impact of the pandemic on new and expectant parents in both Italy and Spain. A descriptive qualitative study was carried out by collecting social media posts written by parents between March 2020 and April 2021. The posts were inserted in a data collection form and assessed separately by two authors. The coding was performed manually using the long table analysis method and a thematic analysis was performed. Three main themes were identified: (1) care; (2) overcoming difficulties and problem-solving strategies; and (3) legislation and anti-COVID-19 measures. The main issues for parents were the limited access of partners to antenatal care services and mother–newborn separation. Due to restrictive measures, many parents adopted different coping skills. Some hospitals were able to maintain high standards of care; however, a lot of discretion in legislation and the application of anti-COVID-19 measures in healthcare services was perceived by parents. The COVID-19 pandemic has heavily affected the way parents experienced pregnancy and birth. Becoming parents during the pandemic has exacerbated some fears that usually characterize this event, but it has also triggered new ones, especially in the first months

Experiences of Birth during COVID-19 Pandemic in Italy and Spain: A Thematic Analysis

Becoming parents during the pandemic of coronavirus disease 2019 (COVID-19) has been a challenge. The purpose of this study was to describe the impact of the pandemic on new and expectant parents in both Italy and Spain. A descriptive qualitative study was carried out by collecting social media posts written by parents between March 2020 and April 2021. The posts were inserted in a data collection form and assessed separately by two authors. The coding was performed manually using the long table analysis method and a thematic analysis was performed. Three main themes were identified: (1) care; (2) overcoming difficulties and problem-solving strategies; and (3) legislation and anti-COVID-19 measures. The main issues for parents were the limited access of partners to antenatal care services and mother-newborn separation. Due to restrictive measures, many parents adopted different coping skills. Some hospitals were able to maintain high standards of care; however, a lot of discretion in legislation and the application of anti-COVID-19 measures in healthcare services was perceived by parents. The COVID-19 pandemic has heavily affected the way parents experienced pregnancy and birth. Becoming parents during the pandemic has exacerbated some fears that usually characterize this event, but it has also triggered new ones, especially in the first months

Cross-Cultural Adaptation and Validation of the Pregnancy Mobility Index for the Italian Population: A Cross-Sectional Study

Introduction: Pregnancy is a specific condition that modifies the mobility of women. In this population, it seems important to use specific tools to properly assess them. The Pregnancy Mobility Index (PMI) was created in 2006 with the aim of assessing mobility in pregnant women. The goal of this study was to translate, adapt, and evaluate the statistical properties of the questionnaire in the Italian pregnant population. Methods: The PMI underwent translation and transcultural adaptation. Reliability and concurrent validity, compared to the Oswestry Disability Index (ODI), was investigated on a sample of pregnant women. An ANOVA was performed to detect differences in the PMI score considering the Body Mass Index (BMI) and age of the sample. Results: The PMI was forward translated, back translated, and transculturally adapted. A consensus meeting accepted the final version of the questionnaire. The PMI was given to 93 pregnant women. PMI showed excellent reliability for every item and the total score (Cronbach’s alpha of 0.945). Concurrent validity compared with ODI items 2–9 was strong considering the total score, with r = 0.726, but moderate comparing the first item of the ODI and the total score of the PMI, r = 470, and considering the total score of both questionnaires (r = 0.683). The ANOVA showed statistical difference in pregnant women with lower BMI for every subscale and total score of PMI (p = 0.009) and for outdoor mobility considering age (p = 0.019). Conclusions: The PMI seems to be a valid and reliable tool to assess mobility in the pregnant population. Pregnant women with a lower BMI showed a greater mobility score in the PMI. In turn, younger pregnant women presented a lower mobility score compared to older pregnant women

Effectiveness of dyadic interventions to improve stroke patient–caregiver dyads’ outcomes after discharge: A systematic review and meta-analysis study

Background: Because of the importance of a dyadic approach, it is necessary to conduct a systematic review to identify which dyadic intervention could be implemented for stroke survivor–caregiver dyads after discharge from the rehabilitation hospital to improve outcomes. Aims: The aims were to systematically review the evidence to identify which dyadic interventions have been implemented in stroke survivor–caregiver dyads to improve stroke survivor–caregiver dyads’ outcomes and to analyse, through a meta-analysis, which intervention was found to be the most effective. Methods: A systematic review and meta-analysis were conducted using the following electronic databases: PubMed, CINAHL and PsycInfo. Randomized controlled trials (RCTs) and quasi-RCT studies published within the last 10 years were included. Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Pooled effects were analysed between the experimental and control groups for each outcome. Results: Sixteen studies involving 2997 stroke survivors (male gender=58%) and 2187 caregivers (male gender=25%) were included in this review. In 16 studies, which were subdivided into three quasi-RCTs and 13 RCTs, the application of dyadic interventions for stroke survivors and caregivers was systematically reviewed, but only a few of these identified a significant improvement in the stroke survivors’ and caregivers’ outcomes of its intervention group. Dyadic interventions showed a significant effect on stroke survivors’ physical functioning (p=0.05), memory (p<0.01) and quality of life (p=0.01) and on caregivers’ depression (p=0.05). Conclusions: This study provides moderate support for the use of a dyadic intervention to improve stroke survivors’ physical functioning, memory and quality of life and caregiver depression