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Stefana A, Fusar-Poli P, Vieta E, Gelso CJ, Youngstrom EA. Development and validation of an 8-item version of the Real Relationship Inventory-Client form. Psychother Res 2024:1-17. [PMID: 38497741 DOI: 10.1080/10503307.2024.2320331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To develop and validate a very brief version of the 24-item Real Relationship Inventory-Client (RRI-C) form. METHOD Two independent samples of individual psychotherapy patients (Nsample1 = 700, Nsample2 = 434) completed the RRI-C along with other measures. Psychometric scale shortening involved exploratory factor analysis, item response theory analysis, confirmatory factor analysis (CFA), and multigroup CFA. Reliability and convergent and discriminant validity of the scale and subscales were also assessed. RESULTS The 8-item RRI-C (RRI-C-SF) preserves the two-factor structure: Genuineness (k = 4, α = .86) and Realism (k = 4, α = .87), which were correlated at r = .74. CFA provided the following fit indices for the bifactor model: X2/df = 2.16, CFI = .99, TLI = .96, RMSEA = .07, and SRMR = .03. Multigroup CFA showed that the RRI-C-SF was invariant across in-person and remote session formats. The RRI-C-SF demonstrated high reliability (α = .91); high correlation with the full-length scale (r = .96); and excellent convergent and discriminant validity with measures of other elements of the therapeutic relationship, personality characteristics, current mental health state, and demographic-clinical variables. Clinical change benchmarks were calculated to serve as valuable tools for both research and clinical practice. CONCLUSION The RRI-C-SF is a reliable measure that can be used for both research and clinical purposes. It enables a nuanced assessment of the genuineness and the realism dimensions of the real relationship.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Charles J Gelso
- Department of Psychology, University of Maryland, College Park, MA, USA
| | - Eric A Youngstrom
- Institute for Mental and Behavioral Health Research, Nationwide Children's Hospital and Department of Psychiatry, The Ohio State University, Columbus, OH, USA
- Helping Give Away Psychological Science, 501c3
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Novak A, Dzelalija M, Goic-Barisic I, Kovacic A, Pirija M, Maravic A, Radic M, Marinovic J, Rubic Z, Carev M, Tonkic M. Phenotypic and Molecular Characterization of a Hospital Outbreak Clonal Lineage of Salmonella enterica Subspecies enterica serovar Mikawasima Containing blaTEM-1B and blaSHV-2 That Emerged on a Neonatal Ward, During the COVID-19 Pandemic. Microb Drug Resist 2024; 30:118-126. [PMID: 38330414 DOI: 10.1089/mdr.2023.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Nontyphoid salmonella can cause severe infections in newborns and is therefore declared a pathogen of major health significance at this age. The aim of the study was molecular and antimicrobial characterization of β-lactamase-producing Salmonella Mikawasima outbreak clone on a Neonatal ward, University Hospital of Split (UHS), Croatia during the COVID-19 pandemic. From April 2020, until April 2023, 75 nonrepetitive strains of Salmonella Mikawasima were isolated from stool specimens and tested for antimicrobial resistance. All 75 isolates were resistant to ampicillin and gentamicin, while 98% of isolates were resistant to amoxicillin/clavulanic acid. A high level of resistance was observed to third-generation cephalosporins (36% to ceftriaxone and 47% to ceftazidime). Extended-spectrum β-lactamase production was phenotypically detected by double-disk synergy test in 40% of isolates. Moderate resistance to quinolones was detected; 7% of isolates were resistant to pefloxacin and ciprofloxacin. All isolates were susceptible to carbapenems, chloramphenicol, and co-trimoxazole. Fourteen representative isolates, from 2020, 2021, 2022, and 2023, were analyzed with PFGE and all of them belong to the same clone. Whole-genome sequencing (WGS) analysis of three outbreak-related strains (SM1 and SM2 from 2020 and SM3 from 2023) confirmed that these strains share the same serotype (Mikawasima), multilocus sequence typing profile (ST2030), resistance genes [blaTEM-1B, aac(6')-Iaa, aac(6')-Im, and aph(2'')-Ib)] and carry incompatibility group C (IncC) plasmid. Furthermore, the gene blaSHV-2 was detected in SM1 and SM2. In summary, WGS analysis of three representative strains clearly demonstrates the persistence of β-lactamase-producing Salmonella Mikawasima in UHS during the 4-year period.
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Affiliation(s)
- Anita Novak
- Department of Clinical Microbiology, University Hospital of Split, Croatia, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
- ESCMID Food and Waterborne Infections Study Group - EFWISG, Basel, Switzerland
| | - Mia Dzelalija
- Department of Biology, Faculty of Science, University of Split, Split, Croatia
| | - Ivana Goic-Barisic
- Department of Clinical Microbiology, University Hospital of Split, Croatia, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Ana Kovacic
- Teaching Public Health Institute of Split and Dalmatia County, Split, Croatia
| | - Mario Pirija
- Department of Clinical Microbiology, University Hospital of Split, Croatia, Split, Croatia
| | - Ana Maravic
- Department of Biology, Faculty of Science, University of Split, Split, Croatia
| | - Marina Radic
- Department of Clinical Microbiology, University Hospital of Split, Croatia, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Jelena Marinovic
- Department of Clinical Microbiology, University Hospital of Split, Croatia, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Zana Rubic
- Department of Clinical Microbiology, University Hospital of Split, Croatia, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Merica Carev
- School of Medicine, University of Split, Split, Croatia
- ESCMID Food and Waterborne Infections Study Group - EFWISG, Basel, Switzerland
- Teaching Public Health Institute of Split and Dalmatia County, Split, Croatia
- Department of Health Studies, University of Split, Split, Croatia
| | - Marija Tonkic
- Department of Clinical Microbiology, University Hospital of Split, Croatia, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
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Tam MW, Davis VH, Ahluwalia M, Lee RS, Ross LE. Impact of COVID-19 on access to and delivery of sexual and reproductive healthcare services in countries with universal healthcare systems: A systematic review. PLoS One 2024; 19:e0294744. [PMID: 38394146 PMCID: PMC10889625 DOI: 10.1371/journal.pone.0294744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/01/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems. METHODS Following PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596). SYNTHESIS Eighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments. CONCLUSIONS Overall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.
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Affiliation(s)
- Michelle W. Tam
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Victoria H. Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Monish Ahluwalia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, 1 King’s College Circle, Toronto, ON, Canada
| | - Rachel S. Lee
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Lori E. Ross
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
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Vilca LM, Sarno L, Passoni D, Antonazzo P, Pellegrini E, Guida M, Cesari E, Cetin I. Impact of the COVID-19 Pandemic on Prenatal Care Utilization Among Italian and Immigrant Pregnant Women: A Multicenter Survey. Int J Public Health 2024; 69:1606289. [PMID: 38440081 PMCID: PMC10910076 DOI: 10.3389/ijph.2024.1606289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Objectives: To compare the utilization of prenatal services between immigrant and Italian women during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted at 3 maternity care centers in Italy. Results: We included 1,312 women, 1,198 (91.3%) were Italian and 114 (8.7%) were immigrants. A significantly higher proportion of Italians underwent 8 or more prenatal care visits (64.4% vs. 54.4%, p = 0.03) and more immigrants than Italians attended their appointments at hospital settings (45% vs. 18%, p < 0.001). Regarding prenatal course, Italians were more likely than immigrants to attend a non-hospital setting or an online class (49.6% and 30.2% vs. 34.9% and 11.6%, p = 0.008). A higher influenza vaccine uptake among immigrants compared with Italians was observed (39.5% vs. 19.8%, p < 0.001). Among women not receiving certain prenatal services, immigrants were more likely to state COVID-19 pandemic was the main reason for non-compliance. Conclusion: Immigrant pregnant women were more likely to receive prenatal services at a hospital setting than their Italian counterparts. Among women who did not comply with prenatal services, immigrants were more likely to cite the pandemic as their main reason.
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Affiliation(s)
- Luz Maria Vilca
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, Milan, Italy
- Chickahominy Health District, Virginia Department of Health, Ashland, VA, United States
| | - Laura Sarno
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Naples, Italy
| | - Davide Passoni
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Patrizio Antonazzo
- Unit of Obstetrics and Gynecology, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | | | - Maurizio Guida
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Naples, Italy
| | - Elena Cesari
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, Milan, Italy
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Muñoz-Chápuli Gutiérrez M, Prat AS, Vila AD, Claverol MB, Martínez PP, Recarte PP, Benéitez MV, García CA, Muñoz EC, Navarro M, Navarro PG, Álvarez-Mon M, Ortega MA, de León-Luís J. Post-COVID-19 condition in pregnant and postpartum women: a long-term follow-up, observational prospective study. EClinicalMedicine 2024; 67:102398. [PMID: 38274115 PMCID: PMC10809073 DOI: 10.1016/j.eclinm.2023.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Background Post-COVID-19 condition has recently been defined as new or persistent common COVID-19 symptoms occurring three months after disease onset. The pathology of the disease is unclear, but immune and vascular factors seem to play a significant role. The incidence, severity, and implications of the disease after COVID-19 infection in pregnancy have not been established. We aimed to study the incidence and main risk factors for post-COVID-19 condition in an obstetric population and their implications for maternal and perinatal morbimortality. Methods This is a prospective observational cohort study undertaken including women during pregnancy or at admission for labour with acute COVID-19 infection from March 9th, 2020 to June 11th, 2022. The inclusion criteria were confirmed acute COVID-19 infection during the recruitment period, a lack of significant language barrier and consent for follow-up. Patients were clinically followed-up by telephone via semi structured questionnaires. The exclusion criteria were loss to follow-up, spontaneous miscarriage, and legal termination of pregnancy. Patients were classified into groups according to the severity of symptoms at onset. We included patients from the first six first waves of the pandemic according to national epidemiological data in Spain. We studied the incidence of post-COVID-19 condition and their main demographic, clinical and obstetric risk factors. Findings A total of 409 pregnant women were recruited at acute diagnosis, and 286 were followed-up. The mean time to follow-up was 92 weeks (standard deviation ± 28 weeks; median 100 weeks (Interquartile range: 76; 112)). A total of 140 patients had at least one post-COVID-19 symptom at least three months after acute infection. Neurological (60%) and cutaneous (55%) manifestations were the most frequent findings. The following profiles were identified as presenting a higher risk of post-COVID-19 condition: migrant women born in countries with lower Human Development Index; multiparous women; women with COVID-19 during pregnancy, mainly during the first and third trimesters, and in the first and second waves of the pandemic; women who had a higher number of symptoms; women who had a higher incidence of moderate and severe symptoms; women who required hospitalisation due to COVID-19 complications; and women who were not vaccinated before disease onset. We did not find any significant difference in perinatal results, such as gestational week at delivery, birthweight, the need for neonatal care or 5-min Apgar score, and newborns benefited from a high rate of breastfeeding at discharge. Women who were infected during successive waves of the pandemic had a significant and constant decrease in the risk of post-COVID-19 condition comparing to estimated risk in the first wave (OR: 0.70; 95% CI: 0.62, 0.92). Symptoms tended to resolve over time heterogeneously. Symptoms of myalgia and arthralgia took longer to resolve (mean of 60 weeks and 54 weeks, respectively). In a small but significant proportion of patients, neurological and psycho-emotional symptoms tended to become chronic after 90 weeks. Interpretation At least 34.2% of obstetric patients from our cohort with acute COVID-19 infection presented post-COVID-19 condition symptoms. Demographic and acute disease characteristics as well as specific pregnancy-related risk factors were identified. This is the first study to assess post-COVID-19 condition in pregnant women. Further analysis on the biological pathophysiology of post-COVID-19 is needed to explain the characteristics of the disease. Funding This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project "PI21/01244" and co-funded by the European Union, as well as P2022/BMD-7321 (Comunidad de Madrid) and ProACapital, Halekulani S.L. and MJR.
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Affiliation(s)
- Mar Muñoz-Chápuli Gutiérrez
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, Madrid 28040, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ainoa Sáez Prat
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Durán Vila
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, Madrid 28040, Spain
- Department of Obstetrics and Gynecology, Hospital Quirón Salud Valle del Henares, Madrid, Spain
| | - Mireia Bernal Claverol
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Payá Martínez
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Pintado Recarte
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, Madrid 28040, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mamen Viñuela Benéitez
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, Madrid 28040, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Ausín García
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eva Cervilla Muñoz
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marisa Navarro
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, Madrid 28040, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III (ISCIII), Spain
| | - Pablo González Navarro
- Department of Maternal and Paediatric Research (Fundación Familia Alonso (UDIMIFFA)) – Institute of Health Investigation Gregorio Marañón (IiSGM), Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá°, Alcalá° de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research IRYCIS, Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, CIBEREHD, Alcalá° de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá°, Alcalá° de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research IRYCIS, Madrid, Spain
| | - Juan de León-Luís
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, Madrid 28040, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Health Research Institute, Hospital General Universitario Gregorio Marañón, Madrid 28009, Spain
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Gharacheh M, Khalili N, Ebrahimi Kalan M, Heidarzadeh M, Ranjbar F. Pregnancy-Related Complications During the COVID-19 Pandemic in Iran. ARCHIVES OF IRANIAN MEDICINE 2024; 27:30-35. [PMID: 38431958 PMCID: PMC10915933 DOI: 10.34172/aim.2024.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/24/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND The COVID-19 pandemic has profoundly affected healthcare systems worldwide, with significant collateral damage to vulnerable populations, including the perinatal population. This study sought to compare pregnancy-related complications before and during the COVID-19 pandemic in Iran. METHODS This retrospective data analysis was performed from February 20 to August 20, 2019 (prior to the onset of the COVID-19 pandemic) and from February 20 to August 20, 2020 (during the pandemic), encompassing the initial wave of the pandemic and the subsequent lockdown. To collect data, we utilized the medical records of 168,358 women obtained from the Iranian Maternal and Neonatal Network, which is a comprehensive electronic health record database management system specifically designed to store information pertaining to maternal and neonatal health. RESULTS A total of 168,358 medical records were analyzed, with 87388 (51.9%) and 80970 (48.1%) before and during the pandemic, respectively. The occurrence of pregnancy complications was found to be significantly more frequent during the pandemic compared to the pre-pandemic period. Notably, there was a higher likelihood of experiencing preeclampsia (odds ratio [OR]=1.14, 95% confidence interval [CI]: 1.07‒1.22, P=0.0001) and gestational diabetes (OR=1.14, 95% CI: 1.09‒1.19, P=0.0001) during the pandemic. Furthermore, cesarean section (CS) became more prevalent during the pandemic in comparison to vaginal delivery (OR=1.19, 95% CI: 1.17‒-1.22, P=0.0001). CONCLUSION Our findings demonstrated a significant association between the COVID-19 pandemic and an escalation in adverse pregnancy outcomes, notably preeclampsia, gestational diabetes, and CS deliveries. However, further research is warranted to gain a richer understanding of the intricate interplay between the COVID-19 pandemic and pregnancy complications. This is particularly crucial in light of the evolving landscape of new coronavirus variants.
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Affiliation(s)
- Maryam Gharacheh
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Heidarzadeh
- Department of Pediatrics, School of Medicine, Children Medical Research and Training Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahimeh Ranjbar
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Odendaal W, Chetty T, Goga A, Tomlinson M, Singh Y, Marshall C, Kauchali S, Pillay Y, Makua M, Hunt X. From purists to pragmatists: a qualitative evaluation of how implementation processes and contexts shaped the uptake and methodological adaptations of a maternal and neonatal quality improvement programme in South Africa prior to, and during COVID-19. BMC Health Serv Res 2023; 23:819. [PMID: 37525226 PMCID: PMC10391767 DOI: 10.1186/s12913-023-09826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Despite progress, maternal and neonatal mortality and still births remain high in South Africa. The South African National Department of Health implemented a quality improvement (QI) programme, called Mphatlalatsane, to reduce maternal and neonatal mortality and still births. It was implemented in 21 public health facilities, seven per participating province, between 2018 and 2022. METHODS We conducted a qualitative process evaluation of the contextual and implementation process factors' influence on implementation uptake amongst the QI teams in 15 purposively selected facilities. Data collection included three interview rounds with the leaders and members of the QI teams in each facility; intermittent interviews with the QI advisors; programme documentation review; observation of programme management meetings; and keeping a fieldwork journal. All data were thematically analysed in Atlas.ti. Implementation uptake varied across the three provinces and between facilities within provinces. RESULTS Between March and August 2020, the COVID-19 pandemic disrupted uptake in all provinces but affected QI teams in one province more severely than others, because they received limited pre-pandemic training. Better uptake among other sites was attributed to receiving more QI training pre-COVID-19, having an experienced QI advisor, and good teamwork. Uptake was more challenging amongst hospital teams which had more staff and more complicated MNH services, versus the primary healthcare facilities. We also attributed better uptake to greater district management support. A key factor shaping uptake was leaders' intrinsic motivation to apply QI methodology. We found that, across sites, organic adaptations to the QI methodology were made by teams, started during COVID-19. Teams did away with rapid testing of change ideas and keeping a paper trail of the steps followed. Though still using data to identify service problems, they used self-developed audit tools to record intervention effectiveness, and not the prescribed tools. CONCLUSIONS Our study underscores the critical role of intrinsic motivation of team leaders, support from experienced technical QI advisors, and context-sensitive adaptations to maximise QI uptake when traditionally recognised QI steps cannot be followed.
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Affiliation(s)
- Willem Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa / 491 Peter Mokaba Ridge Road, Durban, KwaZulu-Natal, South Africa.
- Department of Psychiatry, Stellenbosch University, Franzi van Zijl drive, Tygerberg, Cape Town, Western Cape, South Africa.
| | - Terusha Chetty
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa / 491 Peter Mokaba Ridge Road, Durban, KwaZulu-Natal, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Umbilo Road, Durban, KwaZulu-Natal, South Africa
| | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa / 491 Peter Mokaba Ridge Road, Durban, KwaZulu-Natal, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Steve Biko Academic Hospital, Pretoria, Gauteng, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Stellenbosch University, Franzi van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Yages Singh
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape, South Africa / 491 Peter Mokaba Ridge Road, Durban, KwaZulu-Natal, South Africa
| | - Carol Marshall
- South African National Department of Health, Voortrekker Road, Pretoria, Gauteng, South Africa
| | - Shuaib Kauchali
- Maternal, Adolescent and Child Health Institute (MatCH), Avondale Street, Durban, KwaZulu-Natal, South Africa
- Department of Paediatrics and Child Health, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Yogan Pillay
- Clinton Health Access Initiative, Francis Baard Street, Pretoria, Gauteng, South Africa
- Division of Public Health and Health Systems, Department of Global Health, Stellenbosch University, Franzi van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
| | - Manala Makua
- South African National Department of Health, Voortrekker Road, Pretoria, Gauteng, South Africa
- University of South Africa, Preller Street, Pretoria, Gauteng, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Stellenbosch University, Franzi van Zijl Drive, Tygerberg, Cape Town, Western Cape, South Africa
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SIngh T, Kaur R, Kant S, Yadav K, Gupta S. Voices From the Community: Maternal Healthcare Experiences During the COVID-19 Pandemic. Cureus 2023; 15:e38323. [PMID: 37261156 PMCID: PMC10227872 DOI: 10.7759/cureus.38323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on health services around the world. Many hospitals and clinics were overwhelmed by the influx of patients, leading to delays and disruptions in care. The fear of contracting the virus also led to a decrease in the number of people seeking medical care, even for urgent or life-threatening conditions. Various studies have reported a decrease in overall utilization of maternal health services. However, it remains vital to find the reasons for reduced utilization along with the experiences of the women as well as healthcare workers during the pandemic. Objective The objective of this study was to identify the facilitators and barriers to maternal healthcare services utilization during the COVID-19 pandemic. Methods It was a qualitative study conducted in a rural area of Haryana, India. Twelve in-depth interviews (IDIs) were conducted with health workers and four focused group discussions (FGDs) were conducted with pregnant women. Textual analysis was done for both IDIs as well as FGDs. Qualitative analysis was done manually. Results The identified themes were complete cessation of services, no outpatient department (OPD) services for many months, no antenatal care (ANC) services for two months, disruption of supply of medicines, unavailability of drugs, fear of getting COVID-19 infection, mandatory COVID-19 negative report for admission in hospital, and increased referral from government health facilities during the pandemic and lockdown. Conclusion Maternal healthcare services suffered during COVID-19 for various reasons including the closure of health facilities, limited supply of stocks, or fear of the disease among pregnant women. This evidence can be used to prepare as well as manage healthcare services in future.
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Affiliation(s)
- Tejbeer SIngh
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Sanjeev Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Psychosocial Difficulties Experienced By Parents Of Babies Treated In A Neonatal Intensive Care Unit During The Coronavirus Pandemic. Arch Psychiatr Nurs 2022; 41:295-299. [PMID: 36428063 PMCID: PMC9444850 DOI: 10.1016/j.apnu.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
AIM This study had two objectives: (1) to investigate the psychosocial difficulties experienced by parents of babies treated in a neonatal intensive care unit during the coronavirus pandemic and (2) to determine parent-infant attachment. MATERIALS AND METHODS This study adopted phenomenology, a qualitative research design in order to answer the research questions design. The sample consisted of 20 parents of babies treated in the neonatal intensive care unit (NICU) of a City Hospital in Turkey between July and August 2021. Participation was voluntary. Data were collected using a sociodemographic characteristics questionnaire and a semi-structured qualitative interview form. Each participant was interviewed face to face. Each interview was recorded and transcribed. The data were analyzed using content analysis. RESULTS Participants had a mean age of 32.2 ± 3.61 years and at least secondary school degrees. Babies were admitted to the NICU for congenital anomalies (n = 3) or preterm birth (n = 7). Participants experienced anxiety, worry, and loneliness and produced less milk because they could not see and touch their babies. Their greatest source of support was their spouses. CONCLUSION Parents of babies treated in the NICU during the COVID-19 pandemic experience anxiety, sadness, unhappiness, and loneliness. The preventive measures against the pandemic affect parents psychosocially. Healthcare professionals should plan and implement care practices and establish effective communication with parents to identify their physiological, psychological, and social needs and help them produce breastmilk and bond with their babies.
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10
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Stress-testing the resilience of the Austrian healthcare system using agent-based simulation. Nat Commun 2022; 13:4259. [PMID: 35871248 PMCID: PMC9308034 DOI: 10.1038/s41467-022-31766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractPatients do not access physicians at random but rather via naturally emerging networks of patient flows between them. As mass quarantines, absences due to sickness, or other shocks thin out these networks, the system might be pushed to a tipping point where it loses its ability to deliver care. Here, we propose a data-driven framework to quantify regional resilience to such shocks via an agent-based model. For each region and medical specialty we construct patient-sharing networks and stress-test these by removing physicians. This allows us to measure regional resilience indicators describing how many physicians can be removed before patients will not be treated anymore. Our model could therefore enable health authorities to rapidly identify bottlenecks in access to care. Here, we show that regions and medical specialties differ substantially in their resilience and that these systemic differences can be related to indicators for individual physicians by quantifying their risk and benefit to the system.
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Odendaal W, Goga A, Chetty T, Schneider H, Pillay Y, Marshall C, Feucht U, Hlongwane T, Kauchali S, Makua M. Early Reflections on Mphatlalatsane, a Maternal and Neonatal Quality Improvement Initiative Implemented During COVID-19 in South Africa. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200022. [PMID: 36316142 PMCID: PMC9622289 DOI: 10.9745/ghsp-d-22-00022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/20/2022] [Indexed: 08/02/2023]
Abstract
Despite global progress in reducing maternal and neonatal mortality and stillbirths, much work remains to be done to achieve the Sustainable Development Goals. Reports indicate that coronavirus disease (COVID-19) disrupts the provision and uptake of routine maternal and neonatal health care (MNH) services and negatively impacts cumulative pre-COVID-19 achievements. We describe a multipartnered MNH quality improvement (QI) initiative called Mphatlalatsane, which was implemented in South Africa before and during the COVID-19 pandemic. The initiative aimed to reduce the maternal mortality ratio, neonatal mortality rate, and stillbirth rate by 50% between 2018 and 2022. The multifaceted design comprises QI and other intervention activities across micro-, meso-, and macrolevels, and its area-based approach facilitates patients' access to MNH services. The initiative commenced 6 months pre-COVID-19, with subsequent adaptation necessitated by COVID-19. The initial focus on a plan-do-study-act QI model shifted toward meeting the immediate needs of health care workers (HCWs), the health system, and health care managers arising from COVID-19. Examples include providing emotional support to staff and streamlining supply chain management for infection control and personal protection materials. As these needs were addressed, Mphatlalatsane gradually refocused HCWs' and managers' attention to recognize the disruptions caused by COVID-19 to routine MNH services. This gradual reprioritization included the development of a risk matrix to help staff and managers identify specific risks to service provision and uptake and develop mitigating measures. Through this approach, Mphatlalatsane led to an optimization case using existing resources rather than requesting new resources to build an investment case, with a responsive design and implementation approach as the cornerstone of the initiative. Further, Mphatlalatsane demonstrates that agile and context-specific responses to crises such as the COVID-19 pandemic can mitigate such threats and maintain interventions to improve MNH services.
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Affiliation(s)
- Willem Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Terusha Chetty
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Helen Schneider
- School of Public Health and the South African Medical Research Council Health Services to Systems Research Unit, University of the Western Cape, Cape Town, South Africa
| | - Yogan Pillay
- Clinton Health Access Initiative, Pretoria, South Africa
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Ute Feucht
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Tsakane Hlongwane
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Shuaib Kauchali
- Maternal, Adolescent and Child Health Institute, Durban, South Africa
| | - Manala Makua
- National Department of Health, Pretoria, South Africa
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Testoni I, Ronconi L, Iacona E, Trainini A, Tralli N, Nodari L, Limongelli G, Cena L. The impact of the COVID-19 pandemic on perinatal loss among Italian couples: A mixed-method study. Front Psychol 2022; 13:929350. [PMID: 36172232 PMCID: PMC9510916 DOI: 10.3389/fpsyg.2022.929350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPerinatal bereavement is an event that greatly impacts the emotional, psychological, and psychosocial aspects of those who want to have a child.ObjectivesSince there are few studies on the psychological impact of the COVID-19 pandemic on couples grieving for perinatal loss, this research aimed to survey this experience.ParticipantsBetween 2020 and 2021, in Italian provinces highly affected by the COVID-19 pandemic, 21 parents participated: 16 mothers (76%; mean age 36.2; SD: 3.1) and 5 fathers (24%; mean age 40.2; SD: 3.4), among which there were 4 couples.MethodsA mixed-method design was used through self-report questionnaires and in-depth interviews. Accompanied by a sociodemographic form, the following questionnaires were administered: Prolonged Grief-13, the Parental Assessment of Paternal Affectivity (PAPA) (to fathers), the Parental Assessment of Maternal Affectivity (PAMA) (to mothers), the Dyadic Adjustment Scale short version, the Daily Spiritual Experiences Scale, and the Impact of Event Scale-Revised. The texts obtained through the in-depth interviews underwent thematic analysis.ResultsFifty per cent of participants suffered from Post-Traumatic Stress Disorders (PTSD) symptoms and 20% suffered from relational dyadic stress. Four areas of thematic prevalence emerged: psychological complexity of bereavement, the impact of the COVID-19, disenfranchisement vs. support, and spirituality and contact with the lost child. Participants interpreted their distress as related to inadequate access to healthcare services, and perceiving the pandemic restrictions to be responsible for less support and lower quality of care. Furthermore, they needed psychological help, and most of them were unable to access this service. Spirituality/religiosity did not help, while contact with the fetus and burial did.ConclusionIt is important to implement psychological services in obstetrics departments to offer adequate support, even in pandemic situations.
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Cena L, Trainini A, Tralli N, Nodari LS, Iacona E, Ronconi L, Testoni I. The Impact of the COVID-19 Pandemic on Perinatal Loss Experienced by the Parental Couple: Protocol for a Mixed Methods Study in Italy. JMIR Res Protoc 2022; 11:e38866. [PMID: 36044641 PMCID: PMC9472504 DOI: 10.2196/38866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/10/2022] [Accepted: 08/06/2022] [Indexed: 12/21/2022] Open
Abstract
Background At the beginning of 2020, mothers and fathers who experienced perinatal events (from conception to pregnancy and postpartum period) found themselves facing problems related to the emergency caused by the COVID-19 pandemic and the associated difficulties for health care centers in providing care. In the unexpected and negative event of perinatal loss (ie, miscarriage, stillbirth, and neonatal death) more complications occurred. Perinatal loss is a painful and traumatic life experience that causes grief and can cause affective disorders in the parental couple—the baby dies and the couple’s plans for a family are abruptly interrupted. During the COVID-19 pandemic, limited access to perinatal bereavement care, due to the lockdown measures imposed on medical health care centers and the social distancing rules to prevent contagion, was an additional risk factor for parental mental health, such as facing a prolonged and complicated grief. Objective The main aims of this study are as follows: to investigate the impact of COVID-19 on mothers and fathers who experienced perinatal loss during the pandemic, comparing their perceptions; to evaluate their change over time between the first survey administration after bereavement and the second survey after 6 months; to examine the correlations between bereavement and anxiety, depression, couple satisfaction, spirituality, and sociodemographic variables; to investigate which psychosocial factors may negatively affect the mourning process; and to identify the potential predictors of the development of complicated grief. Methods This longitudinal observational multicenter study is structured according to a mixed methods design, with a quantitative and qualitative section. It will include a sample of parents (mothers and fathers) who experienced perinatal loss during the COVID-19 pandemic from March 2020. There are two phases—a baseline and a follow-up after 6 months. Results This protocol was approved by the Ethics Committee of Psychological Research, University of Padova, and by the Institutional Ethics Board of the Spedali Civili of Brescia, Italy. We expect to collect data from 34 or more couples, as determined by our sample size calculation. Conclusions This study will contribute to the understanding of the psychological processes related to perinatal loss and bereavement care during the COVID-19 pandemic. It will provide information useful to prevent the risk of complicated grief and psychopathologies among bereaved parents and to promote perinatal mental health. International Registered Report Identifier (IRRID) DERR1-10.2196/38866
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Affiliation(s)
- Loredana Cena
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Science, University of Brescia, viale Europa 11 Brescia 25123, Brescia, IT
| | - Alice Trainini
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Science, University of Brescia, viale Europa 11 Brescia 25123, Brescia, IT
| | - Nella Tralli
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Science, University of Brescia, viale Europa 11 Brescia 25123, Brescia, IT
| | - Luisa Silvia Nodari
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Science, University of Brescia, viale Europa 11 Brescia 25123, Brescia, IT
| | - Erika Iacona
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, IT
| | - Lucia Ronconi
- IT and Statistical Services, Multifunctional Centre of Psychology, University of Padova, Padova, IT
| | - Ines Testoni
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, IT
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Bhuiyan AA, Brahmachari S, Ripa IJ, Noor R. Overview of dreadful consequences of SARS-CoV-2 invasion in Italy from March 2020 to March 2022. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:176. [PMID: 35756396 PMCID: PMC9207835 DOI: 10.1186/s42269-022-00867-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND The unpredicted pandemic disease COVID-19 first flared up adversely in Europe by imparting interminable force of infected and fatality cases to Italy. In late February 2020, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in northern Italy and swiftly proliferated to the entire country, albeit continuous to date (23 March 2022) with a lesser extent of deadliness. Current review focused on the invasions and the associated consequences by SARS-CoV-2 during the period of March 2020-March 2022. MAIN BODY OF THE ABSTRACT Initially, the lethality and transmissibility of the novel virus made Italy stunned within 1 month, the number of death cases reached 12,428 at the end of March 2020. The Italian Government announced an immediate emergency phase in entire country, educational institutions to local businesses, manufacturing works, cultural activities to elective activities were rescinded and all the hospitals to morgues were swamped, ensuing that fear of epidemic was impended. Besides, the Italian National Health System and Service coordinated massive public health interventions and conferred unprecedented efforts to limit the high mortality rate of the first wave of infection. Amidst 2 years of epidemic (as of 23 March 2022), Italy has documented 14,070,450 (23.74% of the population) confirmed infected cases, 12,685,306 (21.41% of the population) healed cases, 158,254 death cases (0.27% of the population) and ranking 9th worldwide in the number of deaths. SHORT CONCLUSION Based on publicly available Italian Ministry of Health COVID-19 data, current review has comprehended region-wise total infected cases, death cases and healed cases for three consecutive years 2020-2022 to foresee different patterns of the regional outbreak and gradual subservience. At a glance, we highlighted the overview of the exhaustion and exertion of COVID-19 crisis throughout the periods in Italy.
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Affiliation(s)
- Asma Akter Bhuiyan
- Molecular Biotechnology and Bioinformatics, Department of Industrial Biotechnologies, Universita Degli Studi di Milano, 20134 Milan, Italy
| | - Sreyashi Brahmachari
- Molecular Biotechnology and Bioinformatics, Department of Industrial Biotechnologies, Universita Degli Studi di Milano, 20134 Milan, Italy
| | - Israt Jahan Ripa
- Medical Biotechnology, Department of Pharmaceutical, Veterinary and Medical Biotechnologies, Università di Bologna, 40126 Bologna, Italy
| | - Rashed Noor
- Department of Life Sciences (DLS), School of Environment and Life Sciences (SELS), Independent University, Bangladesh (IUB), Plot 16, Block B, Bashundhara, Dhaka, 1229 Bangladesh
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Stefana A, Biban P, Padovani EM, Lavelli M. Fathers' experiences of supporting their partners during their preterm infant's stay in the neonatal intensive care unit: a multi-method study. J Perinatol 2022; 42:714-722. [PMID: 34471215 PMCID: PMC8409081 DOI: 10.1038/s41372-021-01195-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/07/2021] [Accepted: 08/20/2021] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To explore how the fathers experience their role as a support for their partner and the relationship with them during their preterm infant's stay in the NICU. STUDY DESIGN Multi-method longitudinal study involving ethnographic observation, semi-structured interviews, self-report questionnaires, and clinical information. Twenty fathers of preterm infants hospitalized in a level-III-NICU were included. Data were analyzed using thematic continent analysis. RESULTS Three main themes were identified: support for mother (subthemes: putting mother's and infant's needs first; hiding worries and negative emotions; counteracting the sense of guilt; fear that the mother would reject the child), mother's care for the infant (subthemes: observing mother engaged in caregiving; mother has "something extra"), and couple relationship (subthemes: collaboration; bond). CONCLUSION Fathers supporting their partners during the stay in the NICU experience emotional distress and the need for being supported that often are hidden. This demands a great deal of emotional and physical energy.
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Affiliation(s)
| | - Paolo Biban
- grid.411475.20000 0004 1756 948XNeonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Ezio Maria Padovani
- grid.411475.20000 0004 1756 948XNeonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Verona, Verona, Italy
| | - Manuela Lavelli
- grid.5611.30000 0004 1763 1124Department of Human Sciences, University of Verona, Verona, Italy
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16
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Cena L, Gigantesco A, Mirabella F, Palumbo G, Camoni L, Trainini A, Stefana A. Prevalence of comorbid anxiety and depressive symptomatology in the third trimester of pregnancy: Analysing its association with sociodemographic, obstetric, and mental health features. J Affect Disord 2021; 295:1398-1406. [PMID: 34583842 DOI: 10.1016/j.jad.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the prevalence of comorbid anxiety and depression (CAD) during pregnancy and its risk factors. The aims of this study are to determine the prevalence of CAD in the third trimester of pregnancy and analyse its association with socio-demographic, obstetric, and mental health features. METHODS In a sample of 934 Italian pregnant women, CAD was defined as having (1) a score of ≥ 10 on the EPDS - depression subscale and/or on the PHQ-9, and (2) a score of ≥ 40 on the State-Trait Anxiety Inventory State and/or a score of ≥ 6 on the EPDS - anxiety subscale. Logistic regression analyses were used to identify socio-demographic, obstetrics, and mental health risk factors of CAD. RESULTS The prevalence of CAD was 6.8%. Age between 30 and 35 years (OR=3.01, 95% CI: 1.22-7.45) compared to younger age, current sleep disorders (OR=7.88, 95% CI: 3.83-16.23), and preconception mood disorders (OR=2.76, 95% CI: 1.31-5.84) were associated with higher odds of CAD. Conversely, the presence of no or few economic problems (OR=0.21, 95% CI: 0.07-0.65; OR=0.26, 95% CI: 0.09-0.77) and the perception of enough or more than enough practical support from friends or relatives (OR=0.32, 95% CI: 0.13-0.80; OR=0.22, 95% CI: 0.09-0.53) were associated with lower odds of developing CAD. LIMITATIONS The cross-sectional design; the use of self-report questionnaires. CONCLUSION CAD is relatively common among third-trimester antepartum women. The provision of economic/practical support may reduce CAD prevalence and its direct and indirect costs.
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Affiliation(s)
- Loredana Cena
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy.
| | - Antonella Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Fiorino Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Gabriella Palumbo
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Laura Camoni
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alice Trainini
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Alberto Stefana
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
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Psychological Distress in Healthcare Workers between the First and Second COVID-19 Waves: The Role of Personality Traits, Attachment Style, and Metacognitive Functioning as Protective and Vulnerability Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211843. [PMID: 34831598 PMCID: PMC8623543 DOI: 10.3390/ijerph182211843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has impacted the mental health of healthcare workers (HCWs) since its outbreak, but little attention has been paid to person-level vulnerability and protective factors. This study aims to determine the prevalence of both general and pandemic-related psychological distress among HCWs between the first and second COVID-19 waves in Italy and analyze associations between psychological distress and personality traits, attachment style, and metacognitive functioning. Between June and October 2020, 235 Italian HCWs completed questionnaires concerning psychological stress, personality traits, attachment style, and metacognitive functioning; 26.5% of respondents presented with moderate to extremely severe levels of general psychological distress and 13.8% with moderate to extremely severe levels of pandemic-related psychological distress. After controlling for demographic and occupational variables, significant associations emerged among high emotional stability as a personality trait and both general (aOR: 0.58, 95% CI: 0.41–0.79) and pandemic-related psychological stress (aOR: 0.62, 95% CI: 0.41–0.90). Additionally, higher scores regarding one’s ability to understand others’ emotional states were associated with lower odds of developing psychological distress (aOR: 0.78, 95% CI: 0.63–0.93). Lastly, when comparing those with fearful attachment styles to those with secure attachments, the aOR for psychological distress was 4.73 (95% CI: 1.45–17.04). These results highlight the importance of conducting baseline assessments of HCWs’ person-level factors and providing regular screenings of psychological distress.
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Merewood A, Davanzo R, Haas-Kogan M, Vertecchi G, Gizzi C, Mosca F, Burnham L, Moretti C. Breastfeeding supportive practices in European hospitals during the COVID-19 pandemic. J Matern Fetal Neonatal Med 2021; 35:8514-8520. [PMID: 34645354 DOI: 10.1080/14767058.2021.1986482] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION During the first year of the COVID-19 pandemic, international recommendations and guidelines regarding breastfeeding-supportive hospital practices changed frequently. For example, some recommended separation of mothers and infants; others, feeding pumped milk instead of milk fed directly from the breast. Many recommendations were inconsistent or in direct conflict with each other. Guidance from UENPS (the Union of European Neonatal and Perinatal Societies) published in April 2020 recommended rooming in and direct breastfeeding where feasible, under strict measures of infection control, for women who were COVID-19 positive or under investigation for COVID-19. KEY FINDINGS Our study assessed data from respondents from 124 hospitals in 22 nations, with over 1000 births per year, who completed a survey on practices during the COVID-19 epidemic, as they related to the World Health Organization (WHO) Ten Steps to Successful Breastfeeding, considered to be the gold standard for breastfeeding support. The survey was conducted in the fall of 2020/winter of 2021. Overall 88% of responding hospitals had managed COVID positive mothers, and 7% had treated over 50 birthing women with confirmed COVID-19. The biggest change to hospital policy related to visitation policies, with 38% of hospitals disallowing all visitors for birthing women, and 19% shortening the postpartum stay. Eight hospitals (6%) recommended formula feeding instead of breastfeeding for women who tested positive for COVID-19 or were under investigation, whereas 73% continued to recommend direct, exclusive breastfeeding, but with some form of protection such as a mask or hand sanitizer for the mother or cleaning the breast before the feed. While 6% of hospitals discontinued rooming in, 31% strengthened their rooming in policy (keeping mothers and their babies together in the same room) to protect infants against possible exposure to the virus elsewhere in the hospital . Overall, 72% of hospitals used their country's national guidelines when making policy, 31% used WHO guidelines and 22% UENPS/SIN guidelines. Many European hospitals relied on more than one accredited source. DISCUSSION Our most concerning finding was that 6% of hospitals recommended formula feeding for COVID positive mothers, a measure that was later shown to be potentially harmful, as protection against the virus is transmitted through human milk. It is encouraging to note that a third of hospitals strengthened rooming in measures. Especially given the emergence of the highly transmissible Delta variant, the situation around postnatal care in maternity hospitals requires ongoing monitoring and may require proactive investment to regain pre-COVID era practices.
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Affiliation(s)
- Anne Merewood
- Center for Health Equity, Education, and Research, Boston University School of Medicine, Boston, MA, USA
| | - Riccardo Davanzo
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maetal Haas-Kogan
- Center for Health Equity, Education, and Research, Boston University School of Medicine, Boston, MA, USA
| | | | - Camilla Gizzi
- Department of Pediatrics, "Sandro Pertini" Hospital, Rome, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Burnham
- Center for Health Equity, Education, and Research, Boston University School of Medicine, Boston, MA, USA
| | - Corrado Moretti
- Department of Pediatrics, Policlinico Umberto I, Sapienza University, Rome, Italy
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