bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breastfeeding and Birth mode: comparative analysis between elective and in-labor caesarean section
Authors: Napolitani M , Lorenzini C , Kundisova L , Crescenzo F , Alaimo L , Nante N 
Published: November 2019

Abstract

Introduction
Evidence in literature suggests that the outcomes of children born by in-labor non-emergency caesarean section (CS) are better if compared to those born by programmed CS. The aim of this work was to evaluate impact of type of CS on neonatal outcomes and breastfeeding.

Materials and methods
The cross-sectional study was performed in the Siena province (hospital of Siena and Poggibonsi) during the period January-December 2015. All females that gave birth by CS were included, except those that had emergency CS from severe medical indication (pre-eclampsia/eclampsia, fetal distress, intrauterine growth retardation, etc) or due to multiple pregnancy.
The sample was divided in two groups (programmed CS/CS in the presence of labor). The outcome variables were: necessity of hospitalization in neonatal intensive therapy unit (NITU) or resuscitation; weight loss after birth (%), hours passed between birth and first attack to the breast, type of breastfeeding at discharge (exclusive/mixed). The statistical analysis was performed with Stata 12.

Results
In total 446 females were included (53.6% programmed CS). Any association between the type of CS and admission to NITU or resuscitation was observed.
Among the newborns born by CS in the presence of labor, there was a greater proportion of babies who attached to the breast immediately after birth (82% vs. 71%; p &lt; 0.05) and also those exclusively breastfed at the moment of discharge (71% vs. 60%; p &lt; 0.05).
The weight loss was lower in babies born by CS in the presence of labor (8%±1.8; 95% CI 7.7%-8.2% vs. 8.53%±1.7%; 95% CI: 8.3%-8.8%; p &lt; 0.05).

Conclusions
Our study confirmed the negative impact of the CS in the absence of labor on the breastfeeding initiation, probably due to incomplete activation of neuroendocrine mechanisms (release of oxytocin; etc). The CS in the presence of labor is more stressful from the organizational point of view, but it helps promotion of health through the facilitation of breastfeeding.

Key messages
In-labor non-emergency caesarean section is more physiological and helps to initiate and maintain breastfeeding. The CS in the presence of labor is more stressful from the organizational point of view, but it helps promotion of health through the facilitation of breastfeeding.
Maternal obesity and severe preeclampsia among immigrant women: a mediation analysis
Authors: Siddiqui A , Deneux-Tharaux C , Luton D , Schmitz T , Mandelbrot L , Estellat C , Howell E A , Khoshnood B , Bertille N , Azria E 
Published: November 2019

Abstract

Background
Severe preeclampsia is known to be associated with both maternal place of birth and obesity. However, the role of prepregnancy obesity has not been well elucidated on the causal pathway between maternal origin and severe preeclampsia. We aimed to test for and quantify a mediation effect of obesity in this association.

Methods
A secondary analysis of the PreCARE prospective French cohort of pregnant women (n = 9,579). Adjusted path analysis logistic regression models tested for a mediation effect of obesity in the association between maternal place of birth and severe preeclampsia. Adjusted odds ratios and 95% confidence intervals for the total exposure-outcome association and for the direct and indirect/obesity-mediated components were calculated in addition to an estimate of the indirect/obesity-mediated effect.

Results
95 (0.99%) women developed severe preeclampsia: 47.6% were non-European immigrants, 16.3% were born in Sub-Saharan Africa, and 12.6% were obese. Obesity was both associated with Sub-Saharan African place of birth and severe preeclampsia. Women from Sub-Saharan Africa had an increased risk of severe preeclampsia compared to European-born mothers (aOR 2.53, 95% CI 1.39-4.58). The obesity-mediated effect of the association was 18% (aOR 1.18, 95%CI 1.03-1.35).

Conclusions
Sub-Saharan African immigrant women have a two-fold higher risk of developing severe preeclampsia as compared to European-born women, one-fifth of which is mediated by prepregnancy obesity. Our results provide estimates of the benefit of decreasing obesity among at-risk women.

Key messages
Obesity, a modifiable risk factor, is a target for interventions to prevent severe preeclampsia among immigrant women from Sub-Saharan Africa. Future investigations should focus on better elucidating the role of other modifiable mediators such as interaction with the health care system and quality of prenatal care.
Combined effect of adverse childhood experiences and young age on self-harm ideation after birth
Authors: Doi S , Fujiwara T 
Published: November 2019

Abstract

Background
Suicide among postpartum women is a new and emerging issue in developed countries. However, little is known about the combined effect of risk factors on self-harm ideation, although various risk factors have been found. The aim of this study is to examine the combined effect of maternal adverse childhood experiences and maternal age on self-harm ideation among postpartum women.

Methods
The study comprised a cross-sectional study of 8,074 mothers participating in a 3-month health checkup between September 2013 and August 2014 in City A, Prefecture A, Japan. Main outcome was self-harm ideation assessed using the Edinburgh Postnatal Depression Scale (EPDS), item 10. Possible risk factors were maternal adverse childhood experiences (ACEs), maternal characteristics, relationship with husband/partner (e.g., feelings when pregnancy was confirmed), household characteristics, child characteristics (e.g., age, sex, birth weight), and postpartum characteristics, and postpartum depression status other than self-harm ideation.

Results
Postpartum women with 3 or more ACEs and younger age (&lt;25 years old) were 10.3 times more likely than those with no ACEs and older age to have self-harm ideation (95%CI=5.3-20.2). This combined effect was also found in first-time mothers (OR = 7.6, 95%CI=3.2-17.9).

Conclusions
Postpartum women with 3 or more ACEs and who were younger than 25 years old were at a high risk for self-harm ideation. Providing prevention strategies aimed at mothers with multiple risk factors, especially younger age and ACEs, is warranted.

Key messages
Mothers with 3 or more ACEs and younger age had a high self-harm ideation risk. Providing prevention strategies for mothers with multiple risk factors is warranted.
Maternal dietary patterns during early pregnancy and birth weight in Japan
Authors: Yamashita T , Yonezawa Y , Obara T , Ishikuro M , Usuzaki T , Murakami K , Noda A , Ueno F , Suganuma H , Kuriyama S 
Published: November 2019

Abstract

Background
The average birth weight in Japan has decreased by 200 g in the last 40 years. Only three studies were reported for the association between maternal dietary patterns and birth weight in East Asia, whose results were inconsistent. We examined what maternal dietary patterns were associated with the birth weight in Japan.

Methods
Totally 22,493 pregnant women were recruited between July 2013 and September 2016 into the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. We included 17,287 women who had a full-term single healthy baby into the analysis. Consumption of food and beverage items was evaluated based on food frequency questionnaire at the first-trimester. Dietary patterns were analyzed using a machine learning method of k-means clustering algorithm. Birth weight was obtained from the medical record. The association between dietary patterns and birth weight was analyzed using multiple liner regression model adjusted for potential confounders with multiple imputation method for missing values.

Results
Dietary patterns were classified into seven groups by cluster analysis: “high in rice (reference) (n = 8046)”, “middle in vegetables, beans, mushrooms, seaweeds and miso-soup (n = 4842)”, “high in fruits (n = 1176)”, “high in bread, dairy and alcohol (n = 1091)”, “high in meat and fish (n = 1049)”, “high in coffee, black tea, soft drinks and confections (high in coffee) (n = 585)”, and “high in vegetables, beans, mushrooms, seaweeds and miso-soup (n = 498)” groups. In multiple liner regression models, birth weight was 22.6 g (95%CI: 0.1 to 45.2 g) heavier in “high in fruits” group than in reference group and 39.4 g (95%CI: 8.6 to 70.3 g) lighter in “high in coffee” group than in reference group. The other groups were not statistically significant.

Conclusions
High consumption of fruits and high consumption of coffee, black tea, soft drinks and confections during early pregnancy were associated with increased and decreased birth weight, respectively.

Key messages
We found maternal dietary patterns during early pregnancy using a machine learning method of k-means clustering algorithm. We found maternal dietary patterns which associated with the birth weight in Japan.
Breastfeeding-related social media: an online survey of UK mothers’ perceptions
Authors: Visram S , Hunter T 
Published: November 2019

Abstract

Background
Breastfeeding is beneficial for both maternal and infant health, contributing to reduced risk of infections and chronic disease. Despite public health efforts, just 1% of mother-infant dyads in the UK meet international recommendations to breastfeed exclusively until six months. Numerous studies have investigated the influences on suboptimal breastfeeding rates, exposing a myriad of interconnected physiological, psychological and social barriers. Conversely, social support has been shown to be positively associated with breastfeeding duration. The objective of this study was to determine whether and how UK mothers use social media to access breastfeeding advice and support.

Methods
An online survey was developed, piloted and distributed via social media using a snowball sampling approach. Responses to closed questions were analysed using SPSS and appropriate statistical tests performed. Free-text responses were analysed manually using thematic analysis.

Results
The survey was completed by 1012 mothers, with 992 (98%) reporting use of social media for breastfeeding advice and/or support. Responses revealed a largely positive perception of breastfeeding-related social media. Supportive peer networks and easily accessible information were highlighted as unique features that help to encourage and normalise breastfeeding. Non-university educated mothers were significantly more likely to report this support as “very influential” with regard to how comfortable they felt breastfeeding in public (p = 0.006). Peer-led groups were preferentially used over professional-led groups, particularly by younger women (p = 0.007).

Conclusions
There is growing interest in social media as a health platform, particularly in light of recent funding cuts impacting on access to formal support services. By supporting mothers and normalising breastfeeding, social media may help to increase UK breastfeeding rates and reduce health inequalities.

Key messages
Many mothers successfully use breastfeeding-related social media for information and support, with a preference for peer-led as opposed to professional-led groups. Future research should explore how public health services can update their practice to better harness these platforms for breastfeeding promotion.
Monitoring air pollution effects on children for supporting public health policies (MAPEC_LIFE study)
Authors: Ceretti E , Donato F , Feretti D , Carducci A , Moretti M , Donno A De , Carraro E , Biggeri A , Gelatti U 
Published: November 2019

Abstract

Background
Children are at high risk of suffering health consequences of air pollution and childhood exposure can increase the risk of developing chronic diseases in adulthood. The MAPEC_LIFE project, funded by EU Life+ Programme (LIFE12 ENV/IT/000614), aimed to evaluate the association between air pollution exposure and biomarkers of early effect in children and to propose guidance for implementing environmental policies.

Methods
The study was carried out on 6-8-year-old children. Micronucleus (MN) frequency was investigated in buccal cells of children and its association with air pollution exposure was assessed applying multiple Poisson regression mixed models, including socio-demographic and lifestyle factors as confounders. We also dichotomize air pollutants concentration according to the EU Ambient Air Quality Directives and WHO Air Quality Guidelines in all Poisson regression models to assess their risk predictive capacity.

Results
The project involved 1149 children providing buccal cells in winter and spring. 2139 biological samples were included in the analysis (1093 collected in winter, 1046 in spring). The analysis of the association between MN frequency and air quality parameters found positive associations for PM10, PM2.5, benzene, SO2 and ozone. Considering EU Directives, an association was found between MN frequency and PM10 exposure higher than the annual limit value, with an increase of the risk of 17.9% (95%CIs: 0.6-38.1%). Considering WHO Guidelines, the exposures to levels of PM10, benzene and BaP higher than the annual limits were associated with MN frequency, with a risk increase of 22.5%, 27.8% and 59.8% (95%CIs: 3.9-44.3%, 3.8-57.3%, 21.0-111.1%), respectively.

Conclusions
The analyses conducted showed an association between MN frequency in buccal cells of children and levels of some air pollutants, even at concentration below EU and WHO thresholds, which hence seemed to be insufficient for protecting children from this type of damage.

Key messages
Air pollution exposure induced chromosomal damage in buccal cells of children, even at concentration below the law limits. Early biological damage detected might be predictive of the occurrence of future harmful effects in humans, at a population level.
Unpaid carer inequalities: a public health concern
Authors: Carr S , Woklowski A , Parkinson M 
Published: November 2019

Abstract

The number of unpaid carers is rising globally and is anticipated to grow given predictions on life expectancy, morbidities and limitations on care alternatives. The estimated number in England is 5.5 million. Significant international evidence exists of potential negative impact on employment, health and wellbeing which have individual and societal consequences. This presents a major public health concern, especially as much of the experience and health consequences remain a largely hidden issue.
Drawing on two doctoral studies undertaken in the UK we expose the potential for significant health and social inequalities to be experienced by unpaid carers and offer models to enhance understanding and potentially more effective responses. The presenting author provided supervision and continues to research the topic.
Both studies were set in a translational paradigm to maximise timely utility. The experiences of the participants were privileged while attempting to ensure that the clinical, education and policy potential of the research was incorporated. Study participants were care givers for family members with life limiting illnesses, principally cancers and dementia. Qualitative methodologies were employed in both studies; one drawing significantly on realist approaches and the other on grounded theory.
There is generally a lack of consensus concerning when and how carers can best be supported. Although some support interventions were valued there are some fundamental tensions in service models which limit their potential. Specifically the centrality of the relationship is needs to be acknowledged and nurtured. Often, professionals often predominately draw on a medical model as the default intervention position when attempt to tackle carers’ health inequalities. These findings suggest that greater attention should be afforded to the potential of social coping strategies to create a more enabling rather than burden dominated perspective.

Key messages
unpaid (family)carers are at risk of being exposed to a range of health inequalities which can have individual and societal consequences. Interventions that acknowledge the relationship and draw on social dimensions may off coping may offer effective ways forward.
Shifting the Gravity of Spending: Assessing the impact of PHE’s Prioritisation Framework
Authors: Maniatopoulos G , Hunter D J , Gray J 
Published: November 2019

Abstract

Background
Findings are presented from the evaluation of Public Health England’s (PHE) new Prioritisation Framework (PF) conducted between September 2017 and December 2018 aimed to help local authority commissioners with their public health investment and disinvestment decisions. The study explored the take up of the PF in three early adopter local authority settings.

Methods
Data collection was based on semi-structured interviews (n = 30) across three local authorities supplemented by participant observation of workshops and data concerning the implementation process as well as spend and outcomes both before and, where possible, after using the PF.

Results
Participants acknowledged that the PF provided a systematic way to guide prioritisation decisions and one that encouraged transparency over investment and disinvestment decisions. The role performed by PHE and its regional teams in facilitating the process was especially welcomed and considered to be critical to the adoption process. However, uptake of the PF required a significant investment of time and commitment from public health teams at a time when resources were stretched. The impact of the political environment in local government was a major factor determining the likely uptake of the PF. Ensuring committed leadership and engagement from senior politicians and officers was regarded as critical to success.

Conclusions
The study assessed the value of the PF and the processes surrounding its implementation and use. Further research could further explore the value of the tool in aiding investment and disinvestment decisions and its impact on spending.

Key messages
The PF provides a platform for engaged and informed deliberation about priorities and does so in an open, structured and transparent manner. Organisational and political context in which prioritisation occur shape the adoption of the PF tool.
Are midwives ready to fight vaccine hesitancy? First results from an Italian cross-sectional study
Authors: Massimi A , Rosso A , De Vito C , Marzuillo C , Baccolini V , Pitini E , Barbato D , Villari P 
Published: November 2019

Abstract

Background
Pregnancy is widely recognized as a ’teachable moment’ since attitudes and beliefs about childhood vaccines are not completely structured. Among healthcare workers (HCWs), midwives play a pivotal role in the maternal care pathway and should have a key role also in promoting opportunities of discussion and correct information about vaccinations.

Methods
We conducted a cross-sectional survey to assess knowledge and attitudes of a sample of Italian midwives towards vaccinations. A questionnaire was designed ad hoc and sent electronically to midwives members of the professional register of Rome.

Results
Preliminary results on data collected from 140 midwives (mean age 37.32, DS ± 11.61; mean years on the job: 11.94 DS ± 12.78) who completed the survey showed a heterogeneous level of knowledge: only 50% of the sample indicated the correct threshold of vaccination coverage for herd immunity, while safety of multiple shots and of the additives contained in vaccines was reported by 61% and 31% of respondents, respectively. Only 41% of midwives had identified the pertussis vaccine as one of the vaccinations recommended during pregnancy. Attitudes were generally positive: 84% of respondents recognized recommended vaccines as effective and 86% as one of the safest health interventions. However, vaccinations against MMR and Varicella were perceived as useful by 86% and 71% of the midwives, while 89% and 77%, respectively, would recommend them to parents (compared to 96% in case of hexavalent). Globally, 79% of respondents would agree with the introduction of mandatory vaccinations for HCWs in maternity wards.

Conclusions
Midwives show some gaps in the knowledge on vaccinations. The final results of this study will be used to build specific and tailored training programs directed to midwives involved in pregnancy management. This may help them to transfer the correct vaccination information for the empowerment and the growth of vaccine literacy.

Key messages
Pregnancy is a strategic teachable moment to influence attitudes regarding childhood vaccinations and healthcare professionals must be trained to be the vehicle of the most accurate information. Specific under- and post-graduate training courses on vaccinations directed to midwives are strongly needed to ensure good level of knowledge on this topic.
Impact of hepatitis B vaccine in Tunisia 20 years after its introduction
Authors: Lahchaichi A , Hadj M Ben , Bouguerra H , Talmoudi K , Bahrini A , Bahri O , Letaief H , Hazgui O , Hannachi N , Bouafif N Ben Alaya 
Published: November 2019

Abstract

Introduction
Vaccination against hepatitis B represents the most effective preventive measure to reduce the global impact of this infection. In Tunisia hepatitis B vaccination was introduced for health professionals in 1992 and for the general population in 1995. The objectives of this study were to evaluate the impact of vaccination twenty years after its introduction.

Methods
It was a descriptive study of data provided by the national survey of prevalence of Hepatitis B in Tunisia, which was a household-based study conducted in 2015. Blood samples sent to the reference laboratory to test markers of hepatitis B virus infection. The Vaccine effectiveness rate was calculated using the following formula: VE = 1 - Odds-ratio (OR), where OR = ratio of odds of being vaccinated among subjects with positive HBsAg test results to the odds of being vaccinated among subjects with negative HBsAg test results.

Results
Approximately a quarter of our population reported having been vaccinated against HBV, a coverage rate of 26.9%. Among subjects above 20 years of age, this rate was 85.3%. Besides, 83.7% of vaccinated subjects had received the three required doses of the HBV vaccine. Analysis of vaccination status by great regions of the country showed that the vaccination coverage rate was higher in the southern region. Regarding HBsAg prevalence, the rate was significantly higher among unvaccinated subjects 0.3% vs 2.2% in those vaccinated (OR = 0.11 [0.07-0.18]). We found that among vaccinated subjects, the serologic response rate at vaccination was only 63.2% which represented 16.2% of the total population. The vaccine effectiveness indicated that vaccination reduced by 88.6% the risk of HBV infection.

Conclusions
These results demonstrate that vaccination against hepatitis B introduced in the national immunization schedule since 1995 has reduced the infection although the vaccination coverage rate remains below 90%.

Key messages
Importance of vaccination that reduced by 88.6% the risk of HBV infection. More effort required to raise awareness about vaccination against HBV.