bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of an app for perinatal home visitation by nurses in preventing infant abuse in Japan
Authors: Isumi A , Doi S , Fujiwara T 
Published: October 2020

Abstract

Background
In Japan, public health nurses provide home visitation with pregnant women who are at high risk for child maltreatment, but its effectiveness in preventing child maltreatment has not been evaluated because contents and quality of home visitation vary from municipality to municipality. This study aims to evaluate whether the tablet app developed to standardize and assist perinatal home visitation by public health nurses is effective in preventing child maltreatment.

Methods
An intervention study was conducted in 2018 in Adachi City, Tokyo, Japan. Public health nurses at two public health centers used the tablet app when they support high-risk pregnant women through home visitation and interviews, while public health nurses at the other three public health centers provided support as in the past. Because two public health centers were different in usage of the app, the treatment group was further divided into two groups: active and inactive. As fatal abuse among infants, frequency of shaking and smothering was assessed as an outcome through a self-reported questionnaire at the 4-month health check, and compared between the active treatment group, inactive treatment group, and control group, using multiple logistic regression (N = 5,651).

Results
Prevalence of infant abuse was 0.82% in the active treatment group, 1.34% in the inactive treatment group, and 1.50% in the control group. When adjusted for parental demographics and parenting situations, mothers in the active treatment group were less likely to shake or smother their baby than those in the control group (Odds ratio: 0.51, p = 0.093).

Conclusions
It possibly suggests that the tablet app developed to assist perinatal home visitation by public health nurses was effective in preventing infant abuse.

Key messages
An intervention study was conducted at public health centers in Adachi City, Tokyo, Japan, using the tablet app developed to standardize and assist perinatal home visitation by public health nurses. The finding suggested that the tablet app may be effective in preventing shaking and smothering among 4-month old infants.
Pregnant women and risk factors: a cross-sectional study
Authors: Fauci V L a , Squeri R , Genovese C , Alessi V , Facciolà A 
Published: October 2020

Abstract

Background
Many investigations have shown the important role played by risk factors such as tobacco and alcohol in the development of congenital anomalies.

Methods
Through the administration of an hoc questionnaire, we evaluated the attitude towards smoking and alcohol of a sample of 200 pregnant women at the University Hospital of Messina. The questionnaire was structured to collect information about socio-demographic characteristics, type of gynaecological assistance and their lifestyles (smoking and alcohol). Statistical analysis was performed using version 10 of StatSoftVR software.

Results
14% of the women continued to smoke despite pregnancy; the majority of these were young adults, divorced, employed and with a high educational level. Correlating the smoking habit with the socio-demographic characteristics of the studied women, we found a statistically significant difference for the marital status, with a higher number of smokers among the single women (p &lt; 0.05).Moreover, we found a statistically significant difference also for the profession with a higher number of smokers in the worker women (p &lt; 0.05). About the drinking habit, the 4.3% declared to be moderate drinkers (occasional use of alcohol equal to 2-3 glasses a week) despite pregnancy, the 34.4% stated they do not drink alcohol during pregnancy and the 56% stated do not usually drink alcohol. Particularly, about the drinkers' socio-demographic characteristics, the 50% of them were 24-25 years old and the 75% were married. About the type of alcoholic beverages consumed, 86% stated they usually drink bier during the weekend.

Conclusions
Our study shows that the awareness of the women about the importance of these risk factors is still rather poor. In order to improve the awareness of pregnant women on the importance of avoiding these risk factors and prevent CAs, health education campaigns at various levels surely represent the public health cornerstone.

Key messages
In our sample 14% of the pregnant women continued to smoke and 4.3% to drink despite pregnancy and they generally were young or young adults and with a high educational level. Our results highlight the importance of continuous health education about the risk to smoke and drink during pregnancy.
Transition of care from paediatric to adult age for rare chronic disorders: an Italian experience
Authors: Olivero E , Bert F , Corezzi M , Corsi D , Dominici S , Scarmozzino A , Siliquini R 
Published: October 2020

Abstract

Background
Transition of care represents the transfer from child to adult care. An effective transition maintains continuity of care and presents better clinical outcomes. Thanks to improved survivorship of chronic paediatric patients to adulthood, this process has assumed growing relevance. Aim of the study was to evaluate quality and effectiveness of transition of care model of one of the biggest Hospitals of Northern Italy, that has organised a common structured model, differentiated according to patients' clinical and social complexity.

Methods
The sample consisted of patients with chronic rare diseases transited within the Hospital in the years 2016-2019. To analyse the evolution of all pathologies, for each patient the medical record was consulted; questionnaires were then administered to patients to investigate their illness perception and quality of life.

Results
The average age at transition of the retrospective study patients was 19.8±4.7 years. For most disorders, 100% of patients made the first post-transition visit. More than 90% of patients who did not make further post-transition visits were patients with Neurofibromatosis 1. Only 7 out of 18 patients with NF1 continued their treatment to the indicated specialist. One-year drop-out was 13%. Regarding the perception of one's own illness, 78% of respondents consider their health status from good to excellent, but more than 30% of respondents believe not to have currently adequate psychological and social support.

Conclusions
Transition of care represents an important phase in chronic diseases management. The proposed model assures a multidisciplinary approach, involving all specialists of both paediatric and adult teams. Preliminary data were positive and showed how this model could be an example for other institutions in Europe. Anyway, the transition model might be still be improved. Our data underlined the importance of a complete taking charge, with peculiar attention to psychological and social support.

Key messages
The study shows to the European Healthcare Providers the importance of a personalized planning of transition of care, that considers the complexity of clinical situation and concomitant social issues. A successful strategy of transition of care requires a multidisciplinary approach, that guarantees a complete taking charge, with peculiar attention to psychological and social support.
Tobacco smoking prevalence in pregnant women: metanalysis of cross sectional studies
Authors: Restivo V , Pizzo S , Marrella A , Caracci F , Vitale F , Casuccio A 
Published: October 2020

Abstract

Background
Notwithstanding tobacco smoking during pregnancy is associated with negative health outcomes, its prevalence was not included by worldwide surveillance system. The main objective was to estimate the number of women who had smoked at least one cigarette during her pregnancy in comparison to not smoking women.

Methods
A systematic review and metanalysis was conducted searching on MEDLINE, Pubmed and Scopus on the 2 January 2020. Keywords were searched with English language limits from 2017 to 2019. Three authors independently screened all titles and abstracts applying the inclusion criteria, extracted the data, filled a database and two other authors assessed doubt eligibility. Quality was assessed by the NOS scale and the prevalence of smoking during pregnancy was assessed dividing the number of women smoking by the total number of pregnant women reported in the studies.

Results
A total of 1424 articles were screened and 726 were evaluated to be included in the final database of 234 articles. Of these, 85 were properly designed as cross-sectional, 85 were conducted as secondary analysis of cohort, and 64 were population-based studies. The overall smoking prevalence during pregnancy was 12% (95% CI 11%-13%) with an increase to 14% (95%CI 12%-15%) for studies that had smoking as the primary endpoint. In the metaregression analysis, the risk of smoking increased in South America (meta regression coefficent [MC]=0.46, p = 0.02). On the other hand, smoking prevalence decreased during time (studies conducted from 2000 to 2010 MC=-0.15, p = 0.008 and studies conducted after 2010 MC=-0.11, p = 0.04).

Conclusions
This study revealed a high prevalence of smoking during pregnancy worldwide with higher values than reported in another metanalysis conducted from 1985 to 2016. However, prevalence decreased during the three years considered and was higher in some countries that need more preventive interventions.

Key messages
Women of childbearing age need to be educated about the potential detrimental effects of tobacco use on the developing fetus and infant. Evidence-based smoking cessation interventions should be integrated into routine prenatal care.
Preeclampsia and long-term health outcomes: preliminary results from an umbrella review
Authors: Giannakou K , Pittara T , Lamnisos D 
Published: October 2020

Abstract

Background
Preeclampsia (PE) is a common pregnancy disease, linked with several complications during and after pregnancy. Although its pathogenesis is not completely understood, evidence suggests that PE has long-term health effects of both the mother and the offspring.

Methods
An umbrella review was performed to identify systematic reviews and meta-analyses on the association of PE with long-term health outcomes in women and infants born to pregnancies complicated with PE. We searched PubMed, EMBASE, Scopus and ISI Web of Science from inception to March 2019. For each meta-analysis we estimated the summary effect size by random-effects and fixed-effects models, the 95% confidence interval, the 95% prediction interval (PI), the between-study heterogeneity, evidence of small-study effects and evidence of excess significance bias. To evaluate the credibility of the published evidence we preferred state-of-the-art approaches of predefined criteria.

Results
Twenty-two eligible meta-analyses were identified providing data on 71 associations. Forty-nine (69%) associations had nominally statistically significant findings at P &lt; 0.05, while nineteen (27%) remain significant at P &lt; 10-6 under the random-effects model. Forty (56%) associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in 4 (6%) and 7 (10%) associations, respectively. Only five associations presented robust evidence: cerebrovascular disease (cohort studies), cerebrovascular disease (overall), cardiac disease, cardiovascular mortality and attention deficit hyperactivity disorder (ADHD). These were supported by &gt; 1000 cases, 95% PI excluding the null, no large heterogeneity, small-study effects, or excess of significance.

Conclusions
Our findings suggest an increased risk for women to develop cerebrovascular, cardiovascular and cardiac diseases after a pregnancy complicated by PE, while offspring exposed to PE are at higher risk for ADHD.

Key messages
Our findings highlight the importance of promoting ongoing patient assessment practices for prevention and early diagnosis of these comorbidities. More research is required for the elevated risks of the reported outcomes to improve maternal health.
Heath care utilization after birth in Brazil: a national study
Authors: Domingues R , Dias B , Bittencourt S , Dias M , Torres J , Cunha E , Leal M 
Published: October 2020

Abstract

Background
The Brazilian Ministry of Health recommends primary health care actions for women and babies in the first week after birth, with the aim of monitoring health status, screening for diseases, vaccination, support for breastfeeding and promoting contraception. However, data on these actions are not available at the national level. This study aims to estimate the use of outpatient health services in the postpartum period and to verify the demographic, socioeconomic and obstetric factors associated with this use.

Methods
National hospital-based study, conducted in 2011-2012, with an interview of 23,894 women. Estimates were calculated for eight indicators of health service use with performance assessed as “satisfactory” (75-100%), “partial” (50-74%) and “unsatisfactory” (&lt;50%). Multiple logistic regression was performed to verify the association between women's characteristics and each of the analyzed indicators.

Results
”Demand for postpartum consultation” (73.9%; 95% CI: 72.4-75.3%), “demand for newborn consultation” (91.6%; 95% CI: 90.6% - 92.5%), “BCG vaccination” (99.0%; 95% CI 98.7% - 99.2%) and “Hepatitis B vaccination” (96.8%; 95% CI 96.0%-97.5%) were considered satisfactory. “Neonatal screening test in the first week of life” was considered partial (60.1%; 95% CI 57.6% - 62.6%), while “consultation of the woman in the first 15 days after delivery” (37.0% 95% CI 35.0-39.0%),”consultation of the newborn in the first seven days of life”(21.8% 95% CI 20.2% - 23.5%) and “receiving the result of neonatal screening in the first month of life” (29.8% CI 95% 27.6%-32.2%) were considered unsatisfactory. Regional and social inequalities were identified, with the worst performance of all indicators in the less developed North and Northeast regions and in the most vulnerable women.

Conclusions
There is a need for better organization and provision of services, aiming to increase the coverage of postpartum and childcare actions and to reduce health inequalities.

Key messages
Low coverage of postnatal actions limits access to effective health care practices, putting mothers and babies at greater risk of illness and death. Regional and social inequalities and worse performance of health actions that depend exclusively on primary care services suggest barriers to access and failures in the organization of services.
Maternal risk factors for childhood malnutrition in Pakistan: demographic health survey 2012-13
Authors: Zaheer S , Shah N , Safdar N 
Published: October 2020

Abstract

Background
In Pakistan, this is a catastrophe for 44% children combating with stunted growth; the third highest percentage of stunted children in the world and further 1 million children are underweight. Fifteen percent of children are wasted and half of them are anemic, and almost one-third of the children have iron deficiency anemia. The study aimed to collate all contributing factors that have been reported in the PDHS-2012-13 survey for child malnutrition.

Methods
Pakistan Demographic and Health Survey, 2012-13 data was used (n = 1967). Forty five factors were extracted from PDHS 2012-13 and factor analysis was performed to reduce these factors into similar potential factors by using principle component (PC) decomposition. Malnutrition status of children of age &lt; 5 years was assessed by using three indices: height-for-age, weight-for-height, and weight for age. To examine the associations between derived factors and childhood malnutrition, binary logistic regression was used.

Results
About 43% of under-five children are stunted, 26.9% are underweight and 12.6% are wasted. Multivariate adjusted results showed mothers who belong to poor quintile (OR: 1.50, p-value 0.02), who afraid of husband all the time (OR: 1.36, p-value 0.02), who had &gt; 4 children (OR: 1.47, p-value &lt;0.01), and who used tobacco (OR: 1.80, p-value 0.02) were more likely to have stunted children. However, mothers who had no education (OR: 1.82, p-value&lt;0.01), who were poor dweller (OR: 1.55, p-value 0.03), who used unprotected water (OR: 1.62, p-value&lt;0.01), mothers who had younger age at birth (OR: 1.37, p-value 0.02) were more likely have underweight children.

Conclusions
Maternal socio-demographics and environmental factors were more significantly associated with child malnutrition. This study will enable the public health professionals' workforce tier at a national level to gain expertise and formulate better planning in order to improve child health in Pakistan.

Key messages
This study will enable the public health professionals’ workforce tier to achieve gains in child health in Pakistan. Study findings may help to improved and to initiate evidence-based guidelines for maternal and child health.
Relationship between physical/sedentary activities and overweight/obesity in Modena primary schools
Authors: Paduano S , Greco A , Salvia C , Borsari L , Guadagnini I , Pinca J , Midili S , Tripodi A , Borella P 
Published: October 2020

Abstract

Background
Childhood overweight/obesity can be influenced by food habits, but also by poor physical activity and excessive use of screens. The aim of this study was to investigate physical exercise and sedentary behaviours of children attending the first year of primary schools in Modena, and their association with weight status of children and characteristics of family.

Methods
We involved 890 children attending the first classes of 15 primary schools in Modena. The physical and sedentary activities of child were examined through an anonymous questionnaire administered to the parents. Sociodemographic characteristics of family, weight and height of child and parents were also collected. Univariate logistic regression models, eventually adjusted for parents' sociodemographic characteristics, were used to analyse data.

Results
Filled questionnaires were 660 out of 890 families (74.2%), of which 72 without anthropometric data were excluded. The prevalence of overweight/obesity was 25.2% without difference of gender. Less than 25% of children did physical activity per ≥7 hours per week; most children (about 40%) did 2 to 4 hours per week. There was no association between time spent in physical activity and overweight/obesity of children. From multivariate analysis, the habit significantly affecting children's overweight/obesity was spending time on tablets, PCs, mobile phones, videogames (OR = 2.2, CI 95%: 1.4-3.6). Children screen time ≥2 hours daily (63.9%) was associated with parents' low education level and father's weight status.

Conclusions
Our results suggest the need of educational interventions aimed to increase time spent in physical activity, and to promote a responsible use of digital media, by actively involving both children and parents.

Key messages
Children screen time ≥2 hours daily is strongly associated with childhood overweight/obesity. High education level of parents can positively affect lifestyles of their children.
Cesarean Law: a turning point in the fight against the Brazilian epidemic of cesarean section?
Authors: Gervasio M , Malinverni C , Salim N , Cuenca A 
Published: October 2020

Abstract
In the opposite direction to the process that had been gradually changing birth forms and indicators in Brazil, in 2019 the State of São Paulo (located in southeastern Brazil) enacted Law 17. 137, which guarantees all pregnant women the choice of a cesarean section from the 39 weeks of pregnancy, regardless of the obstetric indication. That is a preliminary qualitative analysis of a doctoral investigation, we are looking for show some points of inflection of this law to combat the cesarean epidemic. Affiliated to the theoretical-methodological approach of discursive practices and the production of meanings in daily, it investigates the discourses that support the current policies to encourage humanized obstetric care based on scientific evidence, built over the last 20 years, and those who supported the approval of this legal norm, known as the Cesarean Law. One of the inflection points of Law concerns the quality of prenatal care and the way that women receive information about childbirth during pregnancy. Because lack of information and insecurity are important factors in the choice of women by the type of delivery. Iatrogenic prematurity is one of the biggest problems of Brazilian cesarean section epidemic. Thus, even after 39 weeks of pregnancy, there is no guarantee of baby's maturity. Since the 90's, the Brazilian government had been encouraging the insertion of midwives and nurse midwives in the childbirth care of all women at regular risk and encouraged the creating of childbirth centers as well an adequate classification of gestational risk. At this point, the law affronts the current organization of the system, as it prioritizes attendance by doctors over professional midwives. The cesarean rates and other health indicators are not available yet after the approval of the law in São Paulo state. However, we can postulate that it will mean a setback in the fight against the epidemic of cesarean sections in Brazil.

Key messages
The Cesarean law approved in the state of São Paulo / BR presents inflection points in the fight against the cesarean section epidemic. The Cesarean law approved in the state of São Paulo / BR ignores important issues in the Brazilian obstetric scenario.
Determinants of use of gonadotropin formulations to treat female infertility in an Italian region
Authors: Rosa A , Belleudi V , Addis A , Ciardulli A , Pacchiarotti A , Davoli M , Kirchmayer U 
Published: October 2020

Abstract

Background
Gonadotropins (Gona) are commonly used for infertility treatment in women. They are available as urinary purified extracts (u-Gona) and recombinants (r-Gona). Objectives:We investigated if socio-demographic characteristics of treated women, year of dispensation and type of prescriber may play a role in the choice of a treatment with respect to the other.

Methods
From administrative healthcare databases, we collected claims of Gona for women, aged 18-45, enrolled in the health care system in the year preceding the first prescription (years 2009-2018). Treatment cycles were defined as a 21-day mobile time window. We identified three groups: u-Gona, r-Gona and treatment with both formulations (m-Gona). To identify determinants, we linked women with the socio-economic position (SEP), a composite deprivation index, based on the 2011 Italian Census data,categorized in 4 levels (high, medium-high, medium-low, low). We associated prescriptions with the type of prescriber, distinguishing between specialists and general practitioners.

Results
We retrieved 38,598 Gona treatment cycles prescribed to 23,412 women and distributed between formulations as follows: r-Gona 47.4%, u-Gona 26.3% and m-Gona 26.3%. The median age was 38 years for r-Gona and u-Gona, 39 for m-Gona. Comparing the type of prescriber, specialists were more likely to prescribe u-Gona instead of r-Gona (OR: 2.14; 95%CI: 2.02-2.27) than general practitioners. No relation was found between SEP and Gona formulations, except for patients with the highest level who were more likely to be prescribed with r-Gona instead of u-Gona (OR: 1.12; 95%CI: 1.03-1.21). Time trends showed that treatment choices changed over time.

Conclusions
In the Lazio region, the choice of gonadotropin formulations varied over time and was found to be related to the prescriber and partly to socio-economic position. An analysis of outcomes related to different treatments is under way.

Key messages
More and more women are using artificial insemination techniques; it is important to monitor fertility drug use patterns and determinants of the choice of a treatment. The use of fertility drugs is a multifactorial phenomenon and a matter of public health interest.