Women's suggestions on how to improve the quality of maternal and newborn care during the COVID-19 pandemic in Italy: A co-occurrence network analysis.

Background: Recent evidence revealed significant gaps in the quality of maternal and newborn care in the World Health Organization (WHO) European Region (EUR) countries. Collecting and analyzing women's views on their needs and priorities is crucial for developing actions to improve the quality of maternal and newborn care. With this study from the IMAgiNE EURO Project, we aimed to add to previous quantitative studies by analysing emerging themes from women's suggestions on how to improve the quality of maternal and newborn care during facility-based birth in Italy during the COVID-19 pandemic. Methods: We collected data from mothers giving birth during the coronavirus 2019 (COVID-19) pandemic using a validated online anonymous WHO standard-based questionnaire consisting of open-ended questions. Using a word co-occurrence network (WCON), we analysed responses in Italian from women who gave birth between March 2020 and March 2022. This approach entails a graphical representation of word pairings that frequently co-occur across sentences and compose clusters. Results: The texts, produced by 2010 women participating in the study, consisted of 79 204 words and 3833 sentences. Eight clusters emerged with WCON, the three largest of which were related to companionship during childbirth, breastfeeding support, and physical resources. The term "swab", associated with other terms in the COVID-19 domain, had the highest degree of centrality, thus representing a core topic. Conclusions: The key emerging themes from women's suggestions can be used to shape policies to improve the quality of care for mothers and newborns. Our WCON analysis offers a valid approach to quickly screen large textual data on quality of care, providing a first set of major themes identified by clusters. As such, it could be used to improve documentation of service users' suggestions promoting the engagement of both researchers and policymakers. Registration: ClinicalTrials.gov: NCT04847336.

Increased risk of emergency department presentations for bronchiolitis in infants exposed to air pollution.

Air pollution has been linked to an increased risk of several respiratory diseases in children, especially respiratory tract infections. The present study aims to evaluate the association between pediatric emergency department (PED) presentations for bronchiolitis and air pollution. PED presentations due to bronchiolitis in children aged less than 1 year were retrospectively collected from 2007 to 2018 in Padova, Italy, together with daily environmental data. A conditional logistic regression based on a time-stratified case-crossover design was performed to evaluate the association between PED presentations and exposure to NO2 , PM2.5, and PM10. Models were adjusted for temperature, relative humidity, atmospheric pressure, and public holidays. Delayed effects in time were evaluated using distributed lag non-linear models. Odds ratio for lagged exposure from 0 to 14 days were obtained. Overall, 2251 children presented to the PED for bronchiolitis. Infants' exposure to higher concentrations of PM10 and PM2.5 in the 5 days before the presentation to the PED increased the risk of accessing the PED by more than 10%, whereas high concentrations of NO2 between 2 and 12 days before the PED presentation were associated with an increased risk of up to 30%. The association between pollutants and infants who required hospitalization was even greater. A cumulative effect of NO2 among the 2 weeks preceding the presentation was also observed. In summary, PM and NO2 concentrations are associated with PED presentations and hospitalizations for bronchiolitis. Exposure of infants to air pollution could damage the respiratory tract mucosa, facilitating viral infections and exacerbating symptoms.

Quality of maternal and newborn care around the time of childbirth for migrant versus nonmigrant women during the COVID-19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region.

OBJECTIVE: To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. METHODS: Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. RESULTS: Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. CONCLUSION: Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.