Why women do not ask for information on preconception health? A qualitative study.

BACKGROUND: Preconception care involves health promotion to reduce risk factors that might affect women and couples of childbearing age. The risk factors of adverse reproductive outcomes include recognized genetic diseases in the family or the individual, previous congenital diseases, miscarriage, prematurity, fetal growth restriction, infertility, chronic maternal diseases, lifestyle, and occupational or environmental factors. Effective preconception care involves a range of preventive, therapeutic and behavioural interventions. Although in Italy there are national preconception care recommendations concerning the general population, they are usually encouraged informally and only for single risk factors. At present there is increasing interest in offering a global intervention in this field. The aim of this study was to investigate attitudes and behaviours of Italian women of childbearing age and healthcare professionals regarding preconception health. METHODS: We conducted a qualitative study among women of childbearing age and healthcare professionals between February 2014 and February 2015. Five focus groups were held: 2 with non-pregnant women aged 22 to 44 years and 3 with healthcare professionals. Discussion topics included women's questions about preconception health, worries and barriers regarding preconception care interventions, attitudes and behaviours of women and healthcare professionals towards preconception health, women's information sources. In the analysis of the focus groups priority was given to what was said by the women, supplemented by information from the healthcare professionals' focus groups. RESULTS: Fourteen women of childbearing age (8 nulliparae and 6 multiparae) and 12 healthcare professionals (3 nurses, 4 midwives, 5 doctors) participated in the focus groups. The results indicate the presence of many barriers and a lack of awareness of preconception health relating to women, healthcare professionals and policies. Women's knowledge and attitudes towards primary preconception care information are described. The main reference source of information in this field for Italian women seems to be their obstetric-gynaecologist. CONCLUSIONS: The study indicates that several barriers influence preconception care in Italy. Moreover, a lack of awareness of preconception health and care among Italian women of childbearing age and healthcare professionals emerges. The findings might contribute to strategies for the implementation of preconception care guidelines

Why women do not ask for information on preconception health? A qualitative study.

BACKGROUND: Preconception care involves health promotion to reduce risk factors that might affect women and couples of childbearing age. The risk factors of adverse reproductive outcomes include recognized genetic diseases in the family or the individual, previous congenital diseases, miscarriage, prematurity, fetal growth restriction, infertility, chronic maternal diseases, lifestyle, and occupational or environmental factors. Effective preconception care involves a range of preventive, therapeutic and behavioural interventions. Although in Italy there are national preconception care recommendations concerning the general population, they are usually encouraged informally and only for single risk factors. At present there is increasing interest in offering a global intervention in this field. The aim of this study was to investigate attitudes and behaviours of Italian women of childbearing age and healthcare professionals regarding preconception health. METHODS: We conducted a qualitative study among women of childbearing age and healthcare professionals between February 2014 and February 2015. Five focus groups were held: 2 with non-pregnant women aged 22 to 44 years and 3 with healthcare professionals. Discussion topics included women's questions about preconception health, worries and barriers regarding preconception care interventions, attitudes and behaviours of women and healthcare professionals towards preconception health, women's information sources. In the analysis of the focus groups priority was given to what was said by the women, supplemented by information from the healthcare professionals' focus groups. RESULTS: Fourteen women of childbearing age (8 nulliparae and 6 multiparae) and 12 healthcare professionals (3 nurses, 4 midwives, 5 doctors) participated in the focus groups. The results indicate the presence of many barriers and a lack of awareness of preconception health relating to women, healthcare professionals and policies. Women's knowledge and attitudes towards primary preconception care information are described. The main reference source of information in this field for Italian women seems to be their obstetric-gynaecologist. CONCLUSIONS: The study indicates that several barriers influence preconception care in Italy. Moreover, a lack of awareness of preconception health and care among Italian women of childbearing age and healthcare professionals emerges. The findings might contribute to strategies for the implementation of preconception care guidelines

Il fattore di rischio \u201cet\ue0 dei genitori\u201d \ue8 un determinante non modificabile?

Tradizionalmente l\u2019et\ue0, insieme al sesso e al patrimonio genetico dell\u2019individuo, viene categorizzata come un fattore biologico non modificabile dello stato di salute. La promozione della salute riproduttiva vede nell\u2019et\ue0 della madre, ma anche del padre, un determinante non trascurabile che pu\uf2 influire sulla fertilit\ue0, l\u2019andamento della gravidanza e la salute del bambino. L\u2019et\ue0 della donna gioca un ruolo determinante sulla capacit\ue0 riproduttiva, con una fertilit\ue0 che \ue8 massima tra i 20 e i 30 anni, decresce rapidamente dopo i 35 anni, per essere vicina allo zero gi\ue0 qualche anno prima della menopausa. Con l\u2019aumento dell\u2019et\ue0 paterna il numero degli spermatozoi, la loro motilit\ue0 e la loro qualit\ue0 diminuiscono, aumentando la possibilit\ue0 dell\u2019infertilit\ue0 di coppia. Aumentano inoltre anche le probabilit\ue0 di aborto spontaneo e di complicanze della gravidanza. A differenza dell\u2019et\ue0 materna, quella paterna sembra giocare un ruolo importante ma meno pronunciato e i suoi effetti sull\u2019infertilit\ue0 e gli esiti avversi della gravidanza si rendono evidenti oltre i 50 anni. In Italia per il 2015, se consideriamo le sole cittadine italiane, queste hanno dato vita mediamente a 1,28 figli, a un\u2019et\ue0 media di 32,2 anni. Un\u2019offerta attiva di informazioni da parte degli operatori sul ruolo giocato dall\u2019et\ue0, pu\uf2 contribuire a sostenere anche in questo ambito una scelta consapevole da parte della coppia

Association of Rewarming Rate on Neonatal Outcomes in Extremely Low Birth Weight Infants with Hypothermia

Objective To explore the possible association between rewarming rate and neonatal outcomes in extremely low birth weight infants (ELBWIs) with hypothermia. Study design All ELBWIs with hypothermia (temperature <36.0\ub0C) on neonatal intensive care unit (NICU) admission were retrospectively evaluated. Rewarming rate was analyzed as both a dichotomous ( 650.5\ub0C/h rapid group; <0.5\ub0C/h slow group) and a continuous variable. Multivariable analysis was performed to explore the relation between rewarming rate and several outcomes, adjusting for clinically relevant confounders. Results Hypothermia on NICU admission was present in 182 out of 744 ELBWIs (24.5%). The rewarming rate was slow in 109 subjects (59.9%) and rapid in 73 subjects (40.1%), with a median rewarming rate of 0.29\ub0C/h (IQR 0.2-0.35) and 0.76\ub0C/h (IQR 0.61-1.09), respectively (P <.0001). The median rewarming time was 340 minutes (IQR 250-480) and 170 minutes (IQR 110-230), respectively (P <.0001). After adjusting for clinically relevant confounders, we did not find significant associations between rewarming rate group ( 650.5\ub0C/h vs <0.5\ub0C/h) and neonatal outcomes. When we considered the rewarming rate as continuous variable, a higher rewarming rate was identified as a protective factor for respiratory distress syndrome (OR 0.39, 95% CI 0.17-0.87; P =.02). Conclusions In ELBWIs with hypothermia upon NICU admission, there were no significant differences between rapid or slow rewarming rate and major neonatal outcomes. A higher rewarming rate was associated with a reduced incidence of respiratory distress syndrome

Viral encephalitis: A controversies diagnosis

Objective: Encephalitis is an uncommon neurological syndrome with not clearly defined diagnostic criteria. The incidence reaches 16/100.000 children. This is a case series of viral encephalitis in an Italian paediatric hospital, focusing on diagnostic controversies. Methods: Children aged 3 months-14 years admitted for presumed or proven viral encephalitis in 2016 were retrospectively analyzed to determine demographic, clinical, laboratory, electroencephalografic (EEG) and neuroradiological features. Results: The incidence of viral encephalitis was 10,4/100.000 in our area (65.197 children). Ten patients (8 males, median age 72 months IQR25-75:18-99) were included. None of them had comorbidities. Encephalopathy was present in 8/10 patients (80%), cerebellar ataxia in 3/10 (30%) and meningeal signs in 2/10 (20%). Two out of 10 children (20%) had also generalized seizures and 1/10 (10%) transient monoparesis. Blood tests did not show abnormalities. Lumbar Puncture (LP) was performed in 8/10 patients (80%): 4/8 had pleocytosis and none of the viral Polymerase Chain Reaction (PCR) for herpesviridae resulted positive. LP was not performed in two patients because of rapid clinical improvement (<24 hours). Serology was positive in 3/10 (EBV, Mumps and Echovirus). One patient was positive for HSV IgM two weeks after recovery. PCR for enterovirus was screened in 6/10 patients' stools (60%) and it was positive in 4/6 (67%). EEG was performed in 8/10 children showing no abnormalities. Head CT (5/10, 50%) or MRI (7/10, 70%) scans did not present significant alterations. None of the patients had sequelae after discharge. Conclusion: The number of observed cases is in-keeping with the current epidemiology of paediatric viral encephalitis. Despite extensive diagnostic testing, only a presumptive diagnosis is possible in most patients, probably due to the difficulty to collect an adequate volume of cerebrospinal fluid to perform multiple viral PCR. Therefore, further microbiological investigations are needed to define the encephalitis etiology in a pediatric setting