Implementing group care in Dutch and Surinamese maternity and child care services: the vital importance of addressing outer context barriers.

BACKGROUND: By addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation. METHODS: Contextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree. RESULTS: Outer setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname. INNOVATION: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners. PROCESS: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs. CONCLUSIONS: While the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.

Factors associated with the absence of postpartum consultations in a high-risk population.

Objective: To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods: This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results: A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion: This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.

Nascer no Brasil II: protocolo de investigação da saúde materna, paterna e da criança no pós-parto / Nacer en Brasil II: protocolo de investigación en salud materna, paterna e infantil posparto / Birth in Brazil II: a postpartum maternal, paternal and child health research protocol

Resumo: A gravidez, o parto e o nascimento são momentos de grandes mudanças na vida das mães e dos pais. Este artigo tem como objetivo apresentar o protocolo da pesquisa para estimar a prevalência dos desfechos em saúde mental nas mães e pais no pós-parto, dos maus tratos e satisfação na atenção ao parto/abortamento, e as inter-relações entre eles e fatores socioeconômicos, obstétricos e da saúde da criança. A pesquisa tem dois componentes: estudo de coorte prospectiva com todas as puérperas entrevistadas nas 465 maternidades incluídas na linha de base da pesquisa Nascer no Brasil II realizada entre 2021 e 2023, e estudo seccional com os companheiros/pais dos bebês. As entrevistas são realizadas por ligação telefônica ou link de autopreenchimento enviado por WhatsApp com as puérperas aos 2 e 4 meses após o parto/aborto. Os companheiros são abordados três meses após o nascimento (excluídos os abortos, natimortos e neomortos), a partir do telefone informado pela puérpera na maternidade. As entrevistas abordam, entre as puérperas, sintomas de depressão, ansiedade e transtorno de estresse pós-traumático, maus-tratos na atenção na maternidade e qualidade do vínculo mãe-bebê. São investigados também a presença de morbidade materna e neonatal, utilização de serviços pós-natais, e satisfação com o atendimento na maternidade. Entre os pais, é abordada a ocorrência de sintomas de depressão e ansiedade, e a qualidade do relacionamento com a esposa/companheira e o bebê. As informações coletadas nessa etapa da pesquisa poderão subsidiar o planejamento e melhoria do cuidado voltado para a saúde da tríade mãe-pai-filho após o nascimento.

Resumen: El embarazo, el parto y el nacimiento son momentos de grandes cambios en la vida de madres y padres. Este artículo tiene como objetivo presentar el protocolo de investigación para estimar la prevalencia de los resultados de la salud mental en madres y padres en el posparto, maltratos y la satisfacción durante la atención del parto/aborto, y las interrelaciones entre ellos y los factores socioeconómicos, obstétricos y de salud infantil. La investigación tiene dos componentes: un estudio de cohorte prospectivo con todas las puérperas entrevistadas en las 465 maternidades incluidas en la línea de base de la encuesta Nacer en Brasil II realizada entre 2021 y 2023, y un estudio seccional con las parejas/padres de los bebés. Las entrevistas se efectúan mediante llamada telefónica o enlace de autocumplimentación enviado vía WhatsApp a las puérperas a los 2 y 4 meses después del parto/aborto. El contacto con la pareja se hace a los tres meses del nacimiento (excluyendo abortos, mortinatos y muertes de recién nacidos), a través del teléfono facilitado por la puérpera en la sala de maternidad. Las entrevistas abordan, entre las puérperas, los síntomas de depresión, ansiedad y trastorno de estrés postraumático, maltrato durante la atención en la maternidad y la calidad del vínculo madre-bebé. También se investiga la presencia de morbilidad materna y neonatal, uso de servicios posnatales y satisfacción con la atención en la maternidad. Entre los padres, se aborda la ocurrencia de síntomas de depresión y ansiedad, y la calidad de la relación con la esposa/pareja y el bebé. La información recopilada en esta etapa de la investigación puede apoyar la planificación y mejora de la atención dirigida a la salud de la tríada madre-padre-hijo después del nacimiento.

Abstract: Pregnancy, parturition and birth bring major changes to the lives of mothers and fathers. This article presents a research protocol for estimating the prevalence of postpartum mental health outcomes in mothers and fathers, abuse and satisfaction in delivery/abortion care, and the correlations between them and socioeconomic, obstetric, and child health factors. As a 2-component research, it consists of a prospective cohort study with all postpartum women interviewed in the 465 maternity hospitals included at the Birth in Brazil II baseline survey conducted from 2021 to 2023, and a cross-sectional study with the newborns' fathers/partners. Interviews will be conducted via telephone or self-completion link sent by WhatsApp with the mother at 2 and 4 months after delivery/abortion. Partners will be approached three months after birth (excluding abortions, stillbirths and newborn death) using the telephone number informed by the mother at the maternity ward. Postpartum women will be inquired about symptoms of depression, anxiety and post-traumatic stress disorder, abuse during maternity care and quality of the mother-newborn bond. Maternal and neonatal morbidity, use of postnatal services, and satisfaction with maternity care are also investigated. Fathers will be asked to report on symptoms of depression and anxiety, and the quality of the relationship with the partner and the newborn. The information collected in this research stage may help to plan and improve care aimed at the postpartum health of the mother-father-child triad.

Factors associated with the absence of postpartum consultations in a high-risk population

Abstract Objective: To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods: This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results: A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion: This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.

Health education website on home care for newborns: construction, validation, and evaluation / Sitio web educativo en salud sobre cuidados domiciliarios del recién nacido: construcción, validación y evaluación / Sitio Website educacional em saúde sobre cuidados domiciliares com recém-nascidos: construção, validação e avaliação

Objective: to build, validate, and evaluate an educational health website on home care for newborns for use by pregnant women, postpartum women, and family members. Method: methodological study developed according to the Analyze, Design, Develop, Implement, and Evaluate model. After construction, the website was validated by 20 experts and evaluated by 20 individuals from the target audience, and the data wasanalyzed according to the Concordance Index with a cut-off point equal to or greater than 0.7 (70%). Results: in the validation, the Concordance Index for all the items was higher than 0.7 (70%), with a variation between 0.75 (75%) and 1 (100%), reaching an overall average value of 0.91 (91%). In the evaluation, all the items got top marks, with anoverall average value of 1 (100%). Conclusion: the educational website was built, validated, and evaluated in a satisfactory manner. It can be considered an appropriate tool for its purpose, with benefits in the teaching-learning process for families regarding postnatal home care fornewborns through its use. It can also be used to educate students and health professionals. The website is available for free access via laptops, computers, smartphones, or tablets.

Objetivo: construir, validar y evaluar un sitio web educativo en salud sobre cuidados domiciliarios del recién nacido para uso de mujeres embarazadas, puérperas y sus familias. Método: estudio metodológico desarrollado según el modelo Analyze, Design, Develop, Implement and Evaluate . Luego de su construcción, el sitio web fue validado por 20 expertos y evaluado por 20 personas del público objetivo, y los datos analizados según el Índice de Concordancia con un punto de corte igual o superior a 0,7 (70%). Resultados: en la validación, el Índice de Concordancia para todas las cuestiones fue superior a 0,7 (70%), con una variación entre 0,75 (75%) y 1 (100%), alcanzando un valor promedio general de 0,91 (91%). En la evaluación, todos los ítems obtuvieron la máxima puntuación, con un valor medio global de 1 (100%). Conclusión: el sitio web educativo fue construido, validado y evaluado de manera satisfactoria y puede ser considerado una herramienta adecuada para su objetivo, aportando beneficios al proceso de enseñanza-aprendizaje de las familias sobre el cuidado domiciliario posparto del recién nacido por medio de su uso. Además, también se puede aplicar a la educación de estudiantes y profesionales de la salud. El sitio web está disponible para acceso libre y gratuito por medio de notebooks , computadoras, smartphones o tablets .

Objetivo: construir, validar e avaliar um website educacional em saúde sobre os cuidados domiciliares com os recém-nascidos para uso de gestantes, puérperas e familiares. Método: estudo metodológico desenvolvido conforme o modelo Analyze, Design, Develop, Implement and Evaluate . Após a construção, o website foi validado por 20 experts e avaliado por 20 indivíduos do público-alvo e os dados analisados conforme Índice de Concordância com ponto de corte igual ou maior a 0,7 (70%). Resultados: na validação, o Índice de Concordância de todos os quesitos foi maior do que 0,7 (70%), com variação entre 0,75 (75%) e 1 (100%), alcançando valor médio global de 0,91 (91%). Na avaliação, todos os itens obtiveram nota máxima, com valor médio global de 1 (100%). Conclusão: o website educacional foi construído, validado e avaliado de maneira satisfatória, pode ser considerado uma ferramenta adequada ao seu objetivo, com benefícios no processo de ensino-aprendizagem das famílias, quanto ao cuidado pós-natal domiciliar com os recém-nascidos mediante sua utilização. Além disso, também pode ser aplicada na educação de estudantes e profissionais de saúde. O website encontra-se disponível para o acesso livre e gratuito por meio de notebooks , computadores, smartphones ou tablets .

Sociodemographic factors associated with immediate puerperal control: A cross-sectional study based on the Peruvian demographic and health survey, 2019.

Introduction: Peru is the fifth country in Latin America with the highest maternal mortality. In Peru, immediate puerperal control (IPC) was established in 2013 as a measure to improve postnatal control, with a view in reducing maternal mortality. This study aimed to evaluate the frequency and sociodemographic factors associated with compliance with IPC in Peru, 2019. Methods: We conducted an analytical cross-sectional study based on the Demographic and Family Health Survey (ENDES, for its acronym in Spanish) of Peru, 2019. The dependent variable was compliance with IPC (control in the first 2 h) in women aged 15-49 years who had delivered within the last five years preceding the survey. To evaluate the associated factors, Poisson family generalized linear models were used to calculate crude (cPR) and adjusted (aPR) prevalence ratios, with their respective 95% confidence intervals (95%CI). Results: Data from 11,854 women were analyzed. The frequency of IPC was 59.6% (95%CI: 58.3-60.9). We found a lower proportion of IPC in urban areas (58.8%) and in the highlands (57%) and jungle (57.2%) of Peru. Residing in rural areas (aPR:1.13; 95%CI:1.08-1.19), having undergone appropriate antenatal care (ANC) (aPR:1.05; 95%CI:1.01-1.10) and having delivered a low-birth-weight newborn (aPR:1.20; 95%CI:1.12-1.29) were associated with a higher frequency of IPC, while living in the highlands (aPR:0.86; 95%CI:0.80-0.92) or jungle (aPR:0.86; 95%CI:0.80-0.92) was associated with a lower frequency of IPC. Conclusions: Approximately four out of ten women did not have IPC. There was a lower proportion of IPC in urban areas and in the highland and jungle regions.

[Integrated mother-child care. Effects on adherence and knowledge of contraceptive methods]. / Atención integrada madre-niño. Efectos sobre adherencia y conocimientos de métodos anticonceptivos.

INTRODUCTION: Scientific evidence suggests that mother-child joint care strategies would facilitate knowledge of contraceptive methods (MAC) and their access. The objective was to evaluate the effect of the Integrated Mother and Child Care Model on adherence and knowledge of CAM in women during the first postpartum semester. METHODS: An intervention study was carried out, 2 groups were formed, GI: intervention group (3 controls up to 6 months postpartum) and GC: control group (one control at 6 months postpartum). The intervention consisted of face-to-face counseling about MAC combined with informative brochures and WhatsApp⌖ messages. Sociodemographic data, gynecological and obstetric history, use and knowledge of contraceptive methods were collected. Adherence to the use and knowledge of MAC were compared in both groups at 6 months postpartum. The analysis was performed using R software version 4.0.3. RESULTS: Thirty-nine women were incorporated into each group. A difference was found in the use of MAC between groups at 6 months (92.3% vs. 64.1%), its use being higher in GI. Significant differences were found in the knowledge of some MAC at 6 months. A higher percentage of women in GI knew about birth control pills (p = 0.009), tubal ligation (p = 0.04) and vasectomy (p = 0.010), compared to GC. DISCUSSION: Early postpartum intervention with various communication and information strategies can be useful to choose the MAC that is considered most appropriate for each woman and its correct use.

Introducción: La evidencia científica sugiere que estrategias de atención conjunta madre-hijo facilitarían el conocimiento de métodos anticonceptivos (MAC) y su acceso. El objetivo fue evaluar el efecto del Modelo de atención integrada de la madre y el niño sobre la adherencia y conocimientos de MAC en mujeres durante el primer semestre postparto. Métodos: Se realizó un estudio de intervención, se conformaron 2 grupos, GI: grupo de intervención (3 controles hasta los 6 meses postparto) y GC: grupo control (un control a los 6 meses postparto). La intervención consistió en asesoramiento presencial acerca de MAC combinada con folletería informativa y mensajes de WhatsApp⌖. Se recabaron datos sociodemográficos, antecedentes gineco-obstétricos, uso y conocimientos de MAC. Se comparó la adherencia al uso y el conocimiento de MAC en ambos grupos a los 6 meses post parto. El análisis se realizó mediante el software R versión 4.0.3. Resultados: Se incorporaron 39 mujeres en cada grupo. Se halló una diferencia en el uso de MAC entre grupos a los 6 meses (92.3% vs. 64.1%), siendo más elevado su uso en el GI. Se hallaron diferencias significativas en el conocimiento de algunos MAC a los 6 meses. Un mayor porcentaje de mujeres del GI conocía las pastillas anticonceptivas (p = 0.009), ligadura de trompas (p = 0.04) y la vasectomía (p = 0.010), en comparación con el GC. Discusión: La intervención en el postparto temprano con diversas estrategias de comunicación e información pueden ser útiles para elegir el MAC que se considere más adecuado para cada mujer y su utilización correcta.

Anticipated benefits and challenges of implementing group care in Suriname's maternity and child care sector: a contextual analysis.

BACKGROUND: Suriname is a uppermiddle-income country with a relatively high prevalence of preventable pregnancy complications. Access to and usage of high-quality maternity care services are lacking. The implementation of group care (GC) may yield maternal and child health improvements. However, before introducing a complex intervention it is pivotal to develop an understanding of the local context to inform the implementation process. METHODS: A context analysis was conducted to identify local needs toward maternity and postnatal care services, and to assess contextual factor relevant to implementability of GC. During a Rapid Qualitative Inquiry, 63 online and face-to-face semi-structured interviews were held with parents, community members, on-and off-site healthcare professionals, policy makers, and one focus group with parents was conducted. Audio recordings were transcribed in verbatim and analysed using thematic analysis and Framework Method. The Consolidated Framework for Implementation Research served as a base for the coding tree, which was complemented with inductively derived codes. RESULTS: Ten themes related to implementability, one theme related to sustainability, and seven themes related to reaching and participation of the target population in GC were identified. Factors related to health care professionals (e.g., workload, compatibility, ownership, role clarity), to GC, to recipients and to planning impact the implementability of GC, while sustainability is in particular hampered by sparse financial and human resources. Reach affects both implementability and sustainability. Yet, outer setting and attitudinal barriers of health professionals will likely affect reach. CONCLUSIONS: Multi-layered contextual factors impact not only implementability and sustainability of GC, but also reach of parents. We advise future researchers and implementors of GC to investigate not only determinants for implementability and sustainability, but also those factors that may hamper, or facilitate up-take. Practical, attitudinal and cultural barriers to GC participation need to be examined. Themes identified in this study will inspire the development of adaptations and implementation strategies at a later stage.

Atención integrada madre-niño. efectos sobre adherencia y conocimientos de métodos anticonceptivos / Integrated mother-child care. Effects on adherence and knowledge of contraceptive methods

Resumen Introducción : La evidencia científica sugiere que es trategias de atención conjunta madre-hijo facilitarían el conocimiento de métodos anticonceptivos (MAC) y su acceso. El objetivo fue evaluar el efecto del Modelo de atención integrada de la madre y el niño sobre la adherencia y conocimientos de MAC en mujeres durante el primer semestre postparto. Métodos : Se realizó un estudio de intervención, se conformaron 2 grupos, GI: grupo de intervención (3 con troles hasta los 6 meses postparto) y GC: grupo control (un control a los 6 meses postparto). La intervención consistió en asesoramiento presencial acerca de MAC combinada con folletería informativa y mensajes de WhatsApp®. Se recabaron datos sociodemográficos, an tecedentes gineco-obstétricos, uso y conocimientos de MAC. Se comparó la adherencia al uso y el conocimiento de MAC en ambos grupos a los 6 meses post parto. El análisis se realizó mediante el software R versión 4.0.3. Resultados : Se incorporaron 39 mujeres en cada grupo. Se halló una diferencia en el uso de MAC entre grupos a los 6 meses (92.3% vs. 64.1%), siendo más eleva do su uso en el GI. Se hallaron diferencias significativas en el conocimiento de algunos MAC a los 6 meses. Un mayor porcentaje de mujeres del GI conocía las pastillas anticonceptivas (p = 0.009), ligadura de trompas (p = 0.04) y la vasectomía (p = 0.010), en comparación con el GC. Discusión : La intervención en el postparto temprano con diversas estrategias de comunicación e información pueden ser útiles para elegir el MAC que se considere más adecuado para cada mujer y su utilización correcta.

Abstract Introduction : Scientific evidence suggests that moth er-child joint care strategies would facilitate knowledge of contraceptive methods (MAC) and their access. The objective was to evaluate the effect of the Integrated Mother and Child Care Model on adherence and knowl edge of CAM in women during the first postpartum semester. Methods : An intervention study was carried out, 2 groups were formed, GI: intervention group (3 controls up to 6 months postpartum) and GC: control group (one control at 6 months postpartum). The intervention con sisted of face-to-face counseling about MAC combined with informative brochures and WhatsApp® messages. Sociodemographic data, gynecological and obstetric history, use and knowledge of contraceptive methods were collected. Adherence to the use and knowledge of MAC were compared in both groups at 6 months post partum. The analysis was performed using R software version 4.0.3. Results : Thirty-nine women were incorporated into each group. A difference was found in the use of MAC between groups at 6 months (92.3% vs. 64.1%), its use being higher in GI. Significant differences were found in the knowledge of some MAC at 6 months. A higher percentage of women in GI knew about birth control pills (p = 0.009), tubal ligation (p = 0.04) and vasectomy (p = 0.010), compared to GC. Discussion : Early postpartum intervention with vari ous communication and information strategies can be useful to choose the MAC that is considered most ap propriate for each woman and its correct use.

Domestic violence: A cross-sectional study among pregnant and postpartum women.

AIM: To assess the prevalence of domestic violence/intimate partner violence, aggressors, types of violence and associated factors in women who attend an antenatal and postnatal care service in a public hospital in Brazil. DESIGN: Cross-sectional study. METHODS: We interviewed women attending antenatal and postpartum care services in a Brazilian public tertiary woman's hospital in Campinas, São Paulo, between July 2019 and September 2021. Data were collected through interviewer-administered questionnaires previously used in healthcare settings: Abuse Assessment Screen (AAS); Woman Abuse Screening Tool (WAST); Hurt, Insulted, Threatened with Harm and Screamed (HITS). We evaluated the relationship between the sociodemographic characteristics of women and domestic/intimate violence using bivariate and multivariable logistic regression analyses. RESULTS: Of the 600 pregnant and postpartum women interviewed, 138 (23%) had suffered any abuse. Some participants disclosed physical violence during pregnancy (2.3%) and during the last 12 months (5.3%). The partner was identified as the main aggressor in most of the cases (60%). When women had a partner, 3.5% reported domestic violence and 6.7% disclosed intimate partner violence during pregnancy or postpartum period. Women with non-white skin colour (OR = 1.53; 95% CI 1.01-2.34; p = .048), gestational age ≤ 13 weeks (OR = 3.41; 95% CI 1.03-11.25; p = .044) and in postpartum period (OR = 2.81; 95% CI 1.32-5.99; p = .008) were more likely to experience domestic violence at some time in their lives. Women interviewed before the COVID-19 pandemic were more likely to disclose that they had suffered any abuse. CONCLUSION: Experience of violence during pregnancy and postpartum period was more frequent in women with non-white skin colour, in their first gestational trimester and in the postpartum period, and was more reported before the COVID-19 pandemic. Antenatal and postpartum care services could be safe places to support violence survivors. IMPACT: Pregnant and postpartum women are a vulnerable group to experiencing domestic violence/intimate partner violence. Violence can negatively affect women's and children's health and well-being. Antenatal and postpartum care should be considered as a moment to routinely inquiry women about past and current violence experiences. Regular contact among healthcare professionals and women during this period offers a window of opportunities for implementing psychosocial interventions among women at risk of violence. Healthcare providers (i.e., physicians, psychologists, social workers, nurses and midwives) have an important role in identifying survivors, offering support and providing quality information to women.

Prácticas culturales de cuidado en el binomio madre-hijo durante el puerperio: Revisión integrativa / Cultural practices of care in the binomial mother-child during the puerperium: Integrative review / Práticas culturais de cuidado no binômio mãe-filho durante o puerpério: Revisão integrativa

Resumen Objetivo: identificar en la literatura las prácticas culturales de cuidado postnatal que realizan las mujeres y su familia durante el puerperio. Metodología: se realizó una revisión integrativa a través de búsqueda en las bases de datos: Gale Cengage Learning, Scielo, Redalyc, Dialnet, EBSCO, Proquest, Science Direct, PubMed y Medigraphic en idiomas inglés, español y portugués entre 2014 y 2019, utilizando los términos: prácticas de cuidado cultural, cuidado en el puerperio, cuidado al recién nacido y cuidado de enfermería materno perinatal; los datos se analizaron a partir de la construcción de una matriz en Excel. Resultados: se obtuvieron 70 artículos, de los cuales emergieron cuatro categorías temáticas de prácticas de cuidado cultural: cuidado de la mujer consigo misma, cuidado del neonato por la madre/familia, cuidado institucional de la puérpera y del neonato, siendo la lactancia materna el factor común entre las ellas. Conclusiones: la identificación de diversas prácticas de cuidado postnatal en el ámbito hospitalario y ambulatorio varían por aspectos sociales, económicos y culturales, pero la mayoría de ellas favorecen el vínculo con el neonato. Es difícil establecer prácticas culturales generalizadas y estáticas en Colombia, debido a la diversidad cultural dentro de cada país.

Abstract Objective: To identify in the literature the cultural practices of postnatal care carried out by women and their families during the puerperium. Methodology: an integrative review was carried out through a search in the Gale Cengage Learning, Scielo, Redalyc, Dialnet, EBSCO, Proquest, Science Direct, PubMed and Medigraphic databases in English, Spanish and Portuguese between 2014 and 2019, using the terms: cultural care practices, puerperium care, newborn care and maternal and perinatal nursing care. The data were analyzed from the construction of a matrix in Excel. Results: A total of 70 articles were obtained, from which four thematic categories of cultural care practices emerged: self-care of the woman, care of the newborn by the mother/family, institutional care of the puerperal woman and the newborn, with breastfeeding being the common factor among them. Conclusions: the identification of different postnatal care practices in the hospital and outpatient settings varies according to social, economic and cultural aspects, but most of them favor bonding with the newborn. It is difficult to establish generalized and static cultural practices in Colombia due to the cultural diversity within each country.

Resumo Objetivo: identificar na literatura as práticas culturais de cuidado post natal que realizam as mulheres e sua família durante o puerpério. Metodologia: Realizou-se uma revisão integrativa a través de busca nas bases de dados: Gale Cengage Learning, Scielo, Redalyc, Dialnet, EBSCO, Proquest, Science Direct, PubMed e Medigraphic em idiomas inglês, espanhol e português entre 2014 e 2019, utilizando os termos: práticas de cuidado cultural, cuidado no puerpério, cuidado ao recém-nascido e cuidado de enfermaria materna perinatal; os dados se analisaram a partir da construção de uma matriz em Excel. Resultados: obtiveram-se 70 artigos, dos quais emergiram quatro categorias temáticas de práticas de cuidado cultural: cuidado da mulher consigo mesma, cuidado do neonato pela mãe/família, cuidado institucional da puérpera e do neonato, sendo a lactância materna o fator comum entre elas. Conclusões: a identificação de diversas práticas de cuidado pós-natal no âmbito hospitalário e ambulatório variam por aspeitos sociais, econômicos e culturais, mas a maioria de elas favorece o vínculo com o neonato. É difícil estabelecer práticas culturais generalizadas e estáticas na Colômbia, devido à diversidade cultural dentro de cada país.

Parental Behavior in Carnivores.

The mammalian order Carnivora is generally defined as species that feed exclusively or to some degree by eating other animals. The Carnivora comprise around 280 species, divided into 16 families, 13 of which are terrestrial and 3 aquatic. Carnivores are spread across the entire planet, including the two polar regions and on land and sea. Consistent with such diverse ecologies, there is no typical pattern of parental care distinguishing carnivores from other mammals. Using examples from different taxonomic families, our aim is to illustrate the diversity of parental care in Carnivora. Major topics include parental care before and after birth of the young, paternal, and alloparental care and the process of weaning. Given the position of many carnivores at the apex of food chains, a greater understanding of their patterns of parental care as a vital part of reproductive biology is essential to conservation programs.

Traditions and trust: a qualitative study of barriers to facility-based obstetric and immediate neonatal care in Chiapas, Mexico.

Poor access and quality of intrapartum and postpartum health care contribute to high global maternal and neonatal mortality rates and intracountry inequity. We examined barriers to careseeking and health care utilization for obstetric and immediate neonatal care in Chiapas, a state with one of the largest indigenous populations and poorest health indicators in Mexico. We conducted 74 in-depth interviews with recently delivered women, their male partners, and traditional birth attendants, and 27 interviews with health facility and hospital staff in rural Chiapas. Interviews were conducted and recorded in Tzeltal and Ch'ol; data were transcribed, coded and analyzed in Spanish using thematic analysis techniques. Barriers to utilization of facility delivery that were reported in order of frequency were: (1) economic and geographic barriers; (2) traditions incompatible with facility policies; (3) fear or previous experience of mistreatment or abuse; (4) perceived poor quality care at facilities; (5) language and political barriers. Commonly reported barriers included distance, cost, lack of vehicles, and poor perceived quality of care, as well as linguistic barriers, lack of space, and fears of surgery or mistreatment. Some women reported obstetric violence and rights violations, including two cases of possible forced sterilizations, an unauthorized transfer of a newborn to another facility without consent or accompaniment of a guardian, and one failure to discharge a newborn because the family could not pay. Political conflict in the region contributed to additional barriers such as reduced trust in government facilities, and physical roadblocks during political activities. Improving geographic and economic access to obstetric and neonatal care can contribute to improved service utilization, but uptake of services can only be improved if quality of care, including communication and consent, are addressed. Historical and current relationships between various stakeholder and political groups should be considered when planning programs, which should be created as collaboratively as possible.

"Why would I go if the infant was healthy?": Factors Influencing Postnatal Care Utilization in Chiapas, Mexico.

Despite global efforts, postnatal care utilization remains low. There is almost no research on factors influencing postnatal care utilization in Latin America. Chiapas has one of the highest rates of maternal and neonatal mortality in Mexico. In 2014, we conducted 101 interviews with recently delivered women, male partners, traditional birth attendants (TBAs), and health staff, to assess factors influencing postnatal care utilization. Data underwent content analysis and thematic coding. Travel costs, postnatal seclusion practices, and a low perceived need for postnatal care were found to be disincentives to seek care. Providers ascribed low care adherence to cultural beliefs and low health literacy, while families indicated that their decision to seek facility care was mediated by the TBA's recognition of danger signs and perceived ability to manage complications. TBAs should be leveraged as gatekeepers, health literacy programs should emphasize the importance of primary care, and structural barriers to care should be reduced.

Association of Dietary Intake of Polyphenols with an Adequate Nutritional Profile in Postpartum Women from Argentina.

HJ-Biplot analysis is a multivariate graphic representation that collects data covariation structure between variables and individuals to represent them in a low-dimensional space with the highest quality in the same reference system. Consequently, it is a promising technique for evaluating dietary exposure to polyphenols and accurately characterizing female nutrition. Herein, we hypothesized that polyphenol intake defines specific clusters with dietary impacts, which can be assessed using HJ-Biplot, based on a cross-sectional study in Argentina. The study included 275 healthy postpartum women who provided information about their food frequency intake and other conditions, which were then used to evaluate polyphenolic intake using the Phenol-Explorer database. Outcomes were established using HJ-Biplot for clustering and ANOVA to compare their impact on diet quality indicators. Two HJ-Biplot models were run (for intakes >20 mg/d and 5∼20 mg/d, respectively) to identify three clusters per model with excellent statistical fitness to explain the data. Thus, specific polyphenolic clusters with potentially bioactive and safe compounds were defined despite significant interindividual variability. In fact, women with the lowest polyphenolic intake exhibited worse dietary quality, body fat, and physical activity. As a result, HJ-Biplot proved to be an effective technique for clustering women based on their dietary intake of these compounds. Furthermore, cluster membership improved the intake of antioxidants, water, fiber, and healthy fats. Additionally, women with formal jobs and a higher educational level showed a better diet. Dietary polyphenols are critical during postpartum because they exert beneficial effects on women and breastfed infants.

[Factors associated with a lack of postnatal care]. / Factores asociados a la falta de control posnatal materno.

Background: Postnatal care is essential to identify and treat at the appropriate time adverse health events in the puerperium. In Mexico, the factors that affect postnatal care have not been documented. Objective: To identify the factors associated with the lack of postnatal care. Material and methods: Cross-sectional study of 202 women of reproductive age affiliated with six primary care clinics of the Mexican Institute for Social Security. We analyzed these factors: (1) sociodemographic: age, education, schooling, distance between home and clinic; (2) psychosocial: social support; (3) obstetric and gynecologic: number of pregnancies, type of delivery, presence of comorbidity and suspected depression, and (4) health services: deficient prenatal control and incomplete postpartum hospital care. We performed multiple Poisson regression with a robust variance. Results: 49.5% of women had postnatal control. Factors associated with a higher probability of lack of postnatal control were: distance ≥ 5 km between home and clinic (adjusted prevalence ratio [aPR] 1.48, 95% confidence interval [95% CI] 1.16-1.88, p = 0.001), poor prenatal care (aPR 1.21, 95% CI 1.001-1.46, p = 0.049), and incomplete postpartum care (aPR 1.42, 95% CI 1.23-1.63, p < 0.001). Conclusions: The low attendance of postnatal care in primary care clinics highlights the need to seek and implement feasible healthcare alternatives, such as home care or telemedicine, to women who cannot attend to postnatal consultations.

Introducción: el control posnatal es esencial para identificar y tratar oportunamente las afecciones de salud de la mujer en el puerperio. En México no se han documentado los factores que limitan la atención posnatal. Objetivo: identificar los factores asociados a la falta de control posnatal. Material y métodos: estudio transversal con 202 mujeres en edad reproductiva adscritas a seis clínicas de atención primaria del Instituto Mexicano del Seguro Social. Analizamos los siguientes factores: (1) sociodemográficos: edad, escolaridad, distancia entre domicilio y clínica de atención; (2) psicosociales: apoyo social; (3) ginecoobstétricos: número de embarazos, tipo de parto, presencia de comorbilidad y sospecha de depresión; (4) servicios de salud: control prenatal deficiente y atención hospitalaria posparto incompleta. El análisis incluyó regresión múltiple de Poisson con varianza robusta. Resultados: 49.5% de las mujeres acudieron a control posnatal. Los factores asociados con mayor probabilidad de falta de control prenatal fueron: distancia ≥ 5 km entre domicilio y clínica de atención (razones de prevalencia ajustadas [RPa] 1.48, intervalo de confianza del 95% [IC 95%] 1.16-1.88, p = 0.001), control prenatal deficiente (RPa 1.21, IC 95% 1.001-1.46, p = 0.049) y atención posparto incompleta (RPa 1.42, IC 95% 1.23-1.63, p < 0.001). Conclusiones: la baja asistencia a control posnatal en las clínicas de atención primaria destaca la necesidad de buscar e implementar alternativas factibles, como teleasistencia y consultas a domicilio, para facilitar que las mujeres que viven lejos de su clínica de atención primaria reciban atención posnatal.

Bladder function in children with posterior urethral valves: impact of antenatal versus postnatal diagnosis

ABSTRACT Purpose: Posterior urethral valves (PUVs) are the most common cause of congenital bladder obstruction in boys. Our aim was to assess the impact of early diagnosis and fulguration of PUVs on bladder function and compare their functional and urodynamic outcome with children who underwent delayed intervention. Materials and Methods: We retrospectively evaluated 153 patients who underwent primary valve ablation from two tertiary hospitals between 2001 and 2018. Patients have been divided into 2 groups, group 1 included 69 patients who were detected antenatally and underwent early fulguration of PUVs while group 2 included 84 children presented postnatally and underwent delayed valve ablation. The recorded data throughout follow-up in renal function tests, urodynamics and changes in the upper urinary tracts were evaluated and compared. Results: Median age at time of valve ablation was 10 days in group 1 and 7 months in group 2. The median follow-up period was 6.5 and 7 years in group 1 and 2, respectively. Chronic kidney disease (CKD) developed in 15 (22%) boys in group 1 while in group 2 it was observed in 31 (37%), p=0.04. While Q-max, mean bladder capacity and post-void residual (PVR) volumes were comparable in both groups, percent PVR was significantly higher in group 2 (3.27 vs. 1.44, p=0.002). Detrusor overactivity was slightly different in both groups (p = 0.07). Conclusions: Compared to delayed intervention, primary ablation of PUVs during the early neonatal life possibly provides the optimum chance to have optimum renal function without impact on bladder function.

Gastroschisis: a systematic review of diagnosis, prognosis and treatment.

OBJECTIVES: The present systematic review aims to investigate the diagnosis, prognosis, delivery assistance, pregnancy results and postnatal management in gastroschisis. STUDY DESIGN: The following data sources were evaluated: The CINAHL, Embase and MEDLINE/PubMed databases were searched, observational and intervention studies published over the past 20 years. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS: A total of 3770 infants diagnosed with gastroschisis were included (44 studies); 1534 fetuses were classified as simple gastroschisis and 288 as complex gastroschisis. Intrauterine fetal demise occurred in 0.47% and elective termination occurred in 0.13%. Preterm delivery occurred in 23.23% and intrauterine growth restriction in 4.43%. Cesarean section delivery was performed in 54.6%. Neonatal survival was 91.29%. The main neonatal complications were: sepsis (11.78%), necrotizing enterocolitis (2.33%), short bowel syndrome (1.37%), bowel obstruction (0.79%), and volvulus (0.23%). Immediate surgical repair was performed in 80.1% with primary closure in 69%. The average to oral feeding was 33 (range: 11-124.5) days. Average hospital duration was 38 days and 89 days in neonates with simple and complex grastroschisis, respectively. CONCLUSIONS: The present systematic review provides scientific data for counseling families with fetal gastroschisis.

Bladder function in children with posterior urethral valves: impact of antenatal versus postnatal diagnosis.

PURPOSE: Posterior urethral valves (PUVs) are the most common cause of congenital bladder obstruction in boys. Our aim was to assess the impact of early diagnosis and fulguration of PUVs on bladder function and compare their functional and urodynamic outcome with children who underwent delayed intervention. MATERIALS AND METHODS: We retrospectively evaluated 153 patients who underwent primary valve ablation from two tertiary hospitals between 2001 and 2018. Patients have been divided into 2 groups, group 1 included 69 patients who were detected antenatally and underwent early fulguration of PUVs while group 2 included 84 children presented postnatally and underwent delayed valve ablation. The recorded data throughout follow-up in renal function tests, urodynamics and changes in the upper urinary tracts were evaluated and compared. RESULTS: Median age at time of valve ablation was 10 days in group 1 and 7 months in group 2. The median follow-up period was 6.5 and 7 years in group 1 and 2, respectively. Chronic kidney disease (CKD) developed in 15 (22%) boys in group 1 while in group 2 it was observed in 31 (37%), p=0.04. While Q-max, mean bladder capacity and post-void residual (PVR) volumes were comparable in both groups, percent PVR was significantly higher in group 2 (3.27 vs. 1.44, p=0.002). Detrusor overactivity was slightly different in both groups (p = 0.07). CONCLUSIONS: Compared to delayed intervention, primary ablation of PUVs during the early neonatal life possibly provides the optimum chance to have optimum renal function without impact on bladder function.

The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from "Birth in Brazil".

BACKGROUND: The mistreatment of women during pregnancy, childbirth, and the puerperium is a global public health problem besides being a violation of human rights. However, research exploring the consequences of mistreatment of women and newborns is scarce. QUESTION: To shed light on this issue, we investigated the association between the mistreatment of women during childbirth and the subsequent use of postnatal health services by women and their newborns. METHODS: We used data from the study "Birth in Brazil", a national hospital-based survey of puerperal women and their newborns, carried out in 2011/2012. This analysis involved 19,644 women. Mistreatment was a latent variable composed of seven indicators. We assessed the attendance of women and newborns to a review consultation following birth, and the timing of this appointment. We applied multigroup structural equation modeling (based on childbirth payment source) and considered separate analysis for women (vaginal births and0 caesarean-sections) and newborns. FINDINGS: We found a causal association between mistreatment during childbirth and decreased and/or delayed use of postnatal health services, for both women and their newborns. These results also revealed that women who use the public sector are affected more than those who pay for private healthcare. CONCLUSION: Mistreatment during childbirth has broader implications than "maternal mental health", and it would be useful to understand that experience of care has vast implications for families. In Brazil, the mistreatment must be mitigated via the implementation of public policy. This is part of the path to dignified and respectful childbirth care for all women.