The influence of doctor-patient and midwife-patient relationship in quality care perception of Italian pregnant women: An exploratory study

BACKGROUND: The study focuses on the perceived nature / technique opposition in pregnancy and delivery emerging from gynaecologist/ midwife/ pregnant woman relationships. We developed a cross-sectional survey to identify, by means of a multidimensional data-driven approach, the main latent concepts structuring the between items correlation correspondent to the different general opinions present in the data set. The obtained results can set the basis to improve patient satisfaction while decreasing healthcare costs. METHODS: The sample is made of 90 pregnant women within 24-48 hours after natural or operative birth, from three maternity units in Italy. Women filled in a questionnaire about their relationship with gynaecologist and midwife during pregnancy and hospital stay for delivery. RESULTS: Participation rate approached 100%. The emerging factorial structure gave a proof-of-concept of the hypothesis of 'nature vs. technique' as the main dimension shaping women opinions. The results highlighted the role of midwife as the 'link' between the natural and technical dimension of birth. The quality of welcome and the establishing of an empathic relation between mother and healthcare professional was shown to decrease further request of care in the post-partum period. CONCLUSIONS: The "fault plane" between nature and technique is a very critical zone for litigation. Women are particularly sensitive to the consideration and attention they receive at their admission in the hospital, as well as to the quality of human relationship with midwife. The perceived quality of welcome scaled with a decreased need of additional care and, more in general, with a more faithful attitude towards health professionals. We hypothesize that increasing the quality of welcome can exert an effect on both welfare costs and litigation. This opens the way (through an extension of this pilot study to wider populations) to relevant ameliorative actions on quality of care at practically null cos

Placental and maternal serum activin A in spontaneous and induced labor in late-term pregnancy

Purpose: Feto-placental unit represents an important source of activin A, a member of transforming growth factors-β involved in the mechanisms of labor. No evidences are available on activin A in pregnancies beyond 41 weeks of gestation, where induction of labor is often required. The present study aimed to evaluate activin A maternal serum levels and placental mRNA expression in term and late-term pregnancy, with spontaneous or induced labor, and its possible role to predict the response to labor induction. Methods: Maternal serum samples and placental specimens were collected from women with singleton pregnancy admitted for either term spontaneous labor (n = 23) or induction of labor for late-term pregnancy (n = 41), to evaluate activin A serum levels and placental mRNA expression. Univariate and multivariate analyses on activin A serum levels, maternal clinical parameters, and cervical length were conducted in women undergoing induction of labor. Results: Maternal serum activin A levels and placental activin A mRNA expression in late-term pregnancies were significantly higher than at term. Late-term pregnancies who did not respond to induction of labor showed significantly lower levels of activin A compared to responders. The combination of serum activin A and cervical length achieved a sensitivity of 100% and a specificity of 93.55% for the prediction of successful induction. Conclusion: Late-term pregnancy is characterized by hyperexpression of placental activin A and increased maternal activin A secretion. By combining maternal serum activin A levels with cervical length, a good predictive model for the response to induction of labor was elaborated

Effect of sacubitril/valsartan on cardiac remodeling compared with other renin-angiotensin system inhibitors: a difference-in-difference analysis of propensity-score matched samples

Background: In patients with heart failure with reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan (S/V) may reverse left ventricular remodeling (rLVR). Whether this effect is superior to that induced by other renin-angiotensin system (RAS) inhibitors is not well known. Methods: HFrEF patients treated with S/V (n = 795) were compared, by propensity score matching, with a historical cohort of 831 HFrEF patients (non-S/V group) treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RAS inhibitors). All patients were also treated with beta-blockers and shared the same protocol with repeat echocardiogram 8-12 months after starting therapy. The difference-in-difference (DiD) analysis was used to evaluate the impact of S/V on CR indices between the two groups. Results: After propensity score matching, compared to non-S/V group (n = 354), S/V group (n = 354) showed a relative greater reduction in end-diastolic and end-systolic volume index (ESVI), and greater increase in ejection fraction (DiD estimator =  + 5.42 mL/m2, P = 0.0005; + 4.68 mL/m2, P = 0.0009, and + 1.76%, P = 0.002, respectively). Reverse LVR (reduction in ESVI ≥ 15% from baseline) was more prevalent in S/V than in non-S/V group (34% vs 26%, P = 0.017), while adverse LVR (aLVR, increase in ESVI at follow-up ≥ 15%) was more frequent in non-S/V than in S/V (16% vs 7%, P < 0.001). The beneficial effect of S/V on CR over other RAS inhibitors was appreciable across a wide range of patient's age and baseline end-diastolic volume index, but it tended to attenuate in more dilated left ventricles (P for interaction = NS for both). Conclusion: In HFrEF patients treated with beta-blockers, sacubitril/valsartan is associated with a relative greater benefit in LV reverse remodeling indices than other RAS inhibitors

Inflammatory Lung Disease in Rett Syndrome

Rett syndrome (RTT) is a pervasive neurodevelopmental disorder mainly linked to mutations in the gene encoding the methyl-CpG-binding protein 2 (MeCP2). Respiratory dysfunction, historically credited to brainstem immaturity, represents a major challenge in RTT. Our aim was to characterize the relationships between pulmonary gas exchange abnormality (GEA), upper airway obstruction, and redox status in patients with typical RTT (n = 228) and to examine lung histology in a Mecp2-null mouse model of the disease. GEA was detectable in ~80% (184/228) of patients versus ~18% of healthy controls, with “high” (39.8%) and “low” (34.8%) patterns dominating over “mixed” (19.6%) and “simple mismatch” (5.9%) types. Increased plasma levels of non-protein-bound iron (NPBI), F2-isoprostanes (F2-IsoPs), intraerythrocyte NPBI (IE-NPBI), and reduced and oxidized glutathione (i.e., GSH and GSSG) were evidenced in RTT with consequently decreased GSH/GSSG ratios. Apnea frequency/severity was positively correlated with IE-NPBI, F2-IsoPs, and GSSG and negatively with GSH/GSSG ratio. A diffuse inflammatory infiltrate of the terminal bronchioles and alveoli was evidenced in half of the examined Mecp2-mutant mice, well fitting with the radiological findings previously observed in RTT patients. Our findings indicate that GEA is a key feature of RTT and that terminal bronchioles are a likely major target of the disease

Loading pattern for Opinion variables (bolded values point to variables relevant for component meaning, Italics to borderline items).

<p><b>Variable codes</b>: <b>AOP</b> = How much did you need physician during pregnancy?; <b>BOP</b> = How much did you need midwife during pregnancy?; <b>COP</b> = How much did you think the physician gender is important?; <b>DOP</b> = Did you prefer a male or female doctor? (1 = Male, 0 = Female); <b>NOP</b> = ‘How should be the perfect doctor/patient relationships? (High values: Mostly based on human relationships; Low Values: Mostly based on technical proficiency; Intermediate Values: Balance between human and technical); <b>LOP</b> = ‘How should be the perfect midwife/patient relationships? (High values: Mostly based on human relationships; Low Values: Mostly based on technical proficiency; Intermediate Values: Balance between human and technical); <b>FOP</b> = Are you used to verify the doctor or midwife suggestions on Internet?; <b>HOP</b> = Do you think midwife alone is sufficient for care?; <b>IOP</b> = How much dialogue is important in the patient/doctor(midwife) relation?; <b>GOP</b> = How much privacy is important in the relation with healthcare professionals?; <b>MOP</b>: How much consideration is important in the relationships with healthcare professionals?; <b>POP</b>: How much human virtues of the physician are important?; <b>QOP</b>: How much human virtues of the patient are important?.</p><p>Loading pattern for Opinion variables (bolded values point to variables relevant for component meaning, Italics to borderline items).</p

Pearson correlations between OP and EVAL components (bolded values correspond to statistically significant correlations at p < 0.05).

<p>Pearson correlations between OP and EVAL components (bolded values correspond to statistically significant correlations at p < 0.05).</p

Loading pattern for Evaluation variables (bolded values point to variables relevant for component meaning, Italics to borderline items).

<p><b>Variables codes</b>: <b>AVAL</b> = ‘Did your physician ever answered to phone calls?’; <b>BVAL</b>: ‘During pregnancy did you feel the need of more visits/exams?’; <b>CVAL</b> = ‘Did you receive all the necessary information during pregnancy/birth/post-birth periods?’; <b>DVAL</b> = ‘Was ever it possible to express your opinion during visits?’; <b>FVAL</b> = ‘Which is your evaluation of the technical skills of gynecologist?’; <b>GVAL</b> = ‘Which is your opinion of the patience demonstrated by your gynecologist?’; <b>HVAL</b>: ‘Which is your opinion about the clarity of the information given by gynecologist?’; <b>IVAL</b>: ‘Which is your opinion about the tact demonstrated by gynecologist in the relationships?’; <b>JVAL</b> ‘Which is your opinion about the professional ethics of your gynecologist?’; <b>KVAL</b>: ‘During your relationships with doctors did you ever felt considered/understood?’; <b>LVAL</b>: ‘Did the physician ever made all that it was possible to meet your needs?’; <b>MVAL</b> ‘Give a global score to your relationship with gynecologist’; <b>NVAL</b> ‘Did the physician made you to participate in the different choices?’; <b>OVAL</b>: ‘‘At the end of the birth, post-birth period how much your expectations were met?’; <b>PVAL, QVAL, RVAL</b>, are the possible answers to the question ‘Which of the virtues of your gynecologist did you appreciate most?’ correspondent to technical skills, patience, cheerfulness respectively; <b>SVAL</b>: ‘Did the midwife ever made all that it was possible to meet your needs?’; <b>TVAL</b> ‘Did you feel sometimes inappropriate in your questions and/or judged for your choices? (physician)’; <b>UVAL</b> ‘When arrived at the hospital had you to wait a long (<i>low values</i>) or short (<i>high values</i>) time?’; <b>VVAL</b>: ‘Did you think healthcare professionals put effort into establishing a positive human relationship with you?’; <b>WVAL</b>: ‘The relational environment you found among healthcare professionals did make you to feel safe?; <b>XVAL</b> ‘At admittance time did you feel yourself embraced?’; <b>YVAL</b>: ‘During your relationships with midwife did you ever felt considered/understood as well as supported in your decisions?’; <b>ZVAL:</b> ‘‘Did you feel sometimes inappropriate in your questions and/or judged for your choices? (midwife)’; <b>A2VAL</b> ‘Did you feel the need of more assistance during the first hours after delivery?’; <b>B2VAL</b>: ‘Did you judge as sufficient the information and the received assistance after you went back home?’; <b>C2VAL</b> ‘Did you receive a psychological support from health care professionals?.</p><p>Loading pattern for Evaluation variables (bolded values point to variables relevant for component meaning, Italics to borderline items).</p

Time Dependence of the electron and positron components of the cosmic radiation measured by the PAMELA experiment between July 2006 and December 2015

Cosmic-ray electrons and positrons are a unique probe of the propagation of cosmic rays as well as of the nature and distribution of particle sources in our Galaxy. Recent measurements of these particles are challenging our basic understanding of the mechanisms of production, acceleration, and propagation of cosmic rays. Particularly striking are the differences between the low energy results collected by the space-borne PAMELA and AMS-02 experiments and older measurements pointing to sign-charge dependence of the solar modulation of cosmic-ray spectra. The PAMELA experiment has been measuring the time variation of the positron and electron intensity at Earth from July 2006 to December 2015 covering the period for the minimum of solar cycle 23 (2006-2009) until the middle of the maximum of solar cycle 24, through the polarity reversal of the heliospheric magnetic field which took place between 2013 and 2014. The positron to electron ratio measured in this time period clearly shows a sign-charge dependence of the solar modulation introduced by particle drifts. These results provide the first clear and continuous observation of how drift effects on solar modulation have unfolded with time from solar minimum to solar maximum and their dependence on the particle rigidity and the cyclic polarity of the solar magnetic field