Returning to work after maternity leave: a systematic literature review.

PURPOSE: Working women often experience difficulties associated with balancing family and career, particularly if they choose to have children. This systematic literature review aimed at investigating women's experience in returning to work after maternity leave. METHODS: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification of 52 articles, which underwent data extraction and qualitative analysis. RESULTS: Results were organized in 5 categories: (1) Work-life balance; (2) Women's mental and physical health; (3) Job-related wellbeing and working experience; (4) Breastfeeding. Women's both mental and physical health seem connected to a longer maternity leave and a greater coworkers' and supervisors' support. Returning to work seems to constitute one of the most important barriers for exclusive breastfeeding or breastfeeding continuation. A shorter duration of maternity leave, a higher workload and the lack of occupational policies supporting breastfeeding seem to be hindering factors. Partner and family support, and the opportunity for fathers to work under a flextime system after childbirth seem to increase both breastfeeding initiation and duration. Women who continue breastfeeding after returning to work seem to experience more family-to-work conflict and overload. CONCLUSIONS: This paper show that there are still many understudied aspects in exploring women's experience of returning to work after maternity leave. This represents an important gap in the literature, since returning to work represents a particularly critical time in women's personal and occupational life, in which challenges and barriers may arise, potentially affecting their experience in the immediate future and years to come.

Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury.

BACKGROUND: We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH). METHODS: The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality. RESULTS: A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk. CONCLUSIONS: In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.

On the Effect of Bimodal Rehabilitation in Asymmetric Hearing Loss.

BACKGROUND: Bone conductive implants (BCI) have been reported to provide greater beneficial effects for the auditory and perceptual functions of the contralateral ear in patients presenting with asymmetric hearing loss (AHL) compared to those with single-sided deafness (SSD). The aim of the study was to assess the effects of wearing a conventional hearing aid in the contralateral ear on BCI in terms of an improved overall auditory performance. METHODS: eleven AHL subjects wearing a BCI in their worse hearing ear underwent an auditory evaluation by pure tone and speech audiometry in free field. This study group was obtained by adding to the AHL patients those SSD subjects that, during the follow-up, showed deterioration of the hearing threshold of the contralateral ear, thus presenting with the features of AHL. Four different conditions were tested and compared: unaided, with BCI only, with contralateral hearing aid (CHA) only and with BCI combined with CHA. RESULTS: all of the prosthetic conditions caused a significant improvement with respect to the unaided condition. When a CHA was adopted, its combination with the BCI showed significantly better auditory performances than those achieved with the BCI only. CONCLUSIONS: the present study suggests the beneficial role of a CHA in BCI-implanted AHL subjects in terms of overall auditory performance.

Safety and Outcome of Rheolytic Thrombectomy for the Treatment of Acute Massive Pulmonary Embolism.

BACKGROUND: Percutaneous rheolytic thrombectomy is an attractive alternative to thrombolytic therapy in patients with acute pulmonary embolism (PE), but its use is currently discouraged due to safety concerns. METHODS: We studied 33 consecutive patients (age, 43 ± 13 years; 20 men and 13 women) with acute PE and contraindications to thrombolytic therapy who had rheolytic thrombectomy with the AngioJet catheter (Boston Scientific). Acute massive PE was initially diagnosed by computed tomography and then confirmed by pulmonary angiography. Pulmonary thrombus location was evaluated prior to the procedure. Anemia was defined as a decrease in hematocrit level <39% for men and <36% for women. Renal failure was defined as oliguria (urine output <500 mL/24 hours) or an increase in creatinine (>25% over baseline or an overall increase by 1 g/dL). RESULTS: Catheter thrombectomy resulted in angiographic improvement in 32 patients (96%), with a rapid amelioration in functional class (from 3.3 ± 0.9 to 2.1 ± 0.7; P<.001) and an increase in oxygen saturation (from 71 ± 15% to 92 ± 17%; P<.001). No patient died. Side effects included transient heart block (n = 1), hypotension (n = 3), and bradycardia (n = 5). Anemia occurred in 4 patients, while renal failure was not detected. Clinical improvement was maintained during follow-up. At 1 year, systolic pulmonary pressure was significantly lower than at baseline (65 ± 31 mm Hg vs 31 ± 19 mm Hg; P<.001). CONCLUSIONS: Catheter thrombectomy with AngioJet in patients with acute massive PE and contraindications to thrombolysis is an effective therapeutic alternative that is not associated with relevant and persistent side effects, including the risk of death or developing anemia and renal failure.

Coronary Stents Underexpansion Successfully Treated With Shockwave Lithoplasty.

Calcified coronary plaque represents a challenging scenario for interventional cardiology. It is often associated with stent under-expansion during percutaneous coronary intervention. We report two cases of unexpected coronary stent under-expansion due to heavily calcified plaque, successfully treated with shockwave coronary lithoplasty.

342 Impact of temporary traffic bans on the risk of acute coronary syndromes in a large metropolitan area.

Aims: Strong epidemiologic evidence has highlighted the role of pollution, on top of adverse climate features, as a novel cardiovascular risk factor. However, mechanistic proof that reducing pollution may be beneficial to prevent atherothrombotic events is limited. We aimed at appraising the impact of temporary traffic bans in a large metropolitan area on the risk of acute coronary syndromes. Methods and results: Aggregate and anonymized data from 15 tertiary cardiac care centers were obtained detailing pre-coronarivus disease 2019 (COVID-19) daily cases of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), including those treated with percutaneous coronary intervention (PCI). Data on pollutants and climate were sought for the same days. Mixed level regression was used to compare the week before vs. after the traffic ban (Fortnight analysis), the 3 days before vs. after (Weekly analysis) and the Sunday before vs. after (Sunday analysis). A total of 8 days of temporary traffic bans were included, occurring between 2017 and 2020, totaling 802 STEMI and 1196 NSTEMI in the Fortnight analysis, 382 STEMI and 585 in the Weekly analysis, and 148 STEMI and 210 NSTEMI in the Sunday analysis. Fortnight and Sunday analysis did not disclose a significant impact of traffic ban on STEMI or NSTEMI (all P > 0.05). Conversely, Weekly analysis showed non-significant changes for STEMI but a significant decrease in daily NSTEMI when comparing the 3 days before the traffic ban with the ban day (P = 0.043), as well as the 3 days before vs. the 3 days after the ban (P = 0.025). No statistically significant effect of traffic ban was found at Fortnight, Weekly or Sunday analyses for daily mean concentrations of benzene, carbon monoxide, nitric oxide, nitrogen dioxide, ozone, sulfur dioxide, particulate matter (PM) <2.5 µm or PM < 10 µm (all P > 0.05). However, minimum daily concentrations showed a significant reduction of ozone during the ban in comparison to the week preceding it (P = 0.034), nitric oxide during the ban in comparison to the 3 days preceding it (P = 0.046), and an increase in benzene during the ban in comparison to the Sunday before (P = 0.039). Conclusion: Temporary traffic bans may favorably reduce coronary atherothrombotic events, and in particular NSTEMI, even if not globally and immediately impacting on environmental pollution. Further controlled studies are required to confirm and expand this hypothesis-generating results.

Vitamin C May Help to Reduce the Knee's Arthritic Symptoms. Outcomes Assessment of Nutriceutical Therapy.

INTRODUCTION: Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, changes in the physico-chemical properties of the synovial fluid and macroscopical modifications of the joint. Patients with Classes I and II of Knee OA can be treated with pharmacologic therapy. Vitamin C is key for both preventing inflammatory arthritis and maintaining healthy joints with OA. AIM: The aim of our paper is to verify the effectiveness of the addition of vitamin c in nutriceutical drugs for the therapy of the knee arthritis in the young adult. RESULTS: Group B has a lower VAS score at 6 and 12 months with p<0.05. Not statistical difference we found in KSS during all follow up. A better quality of life was founded in Group B at 12 months in group B(p<0.05) and less use of pain killers/monthly(p<0.05). CONCLUSION: There is no denying that vitamin C benefits everybody, whether they have arthritis or not. Therefore, it is a good idea to maintain a healthy balance of vitamin C. Without a doubt, vitamin C benefits most people with early OA.

Transitions in auditory rehabilitation with bone conduction implants (BCI).

BACKGROUND: The bone conductive implants (BCI) are nowadays a reliable alternative for rehabilitation of specific forms of hearing loss, i.e. conductive, mixed or single sided deafness (SSD). Aims/Objective: To analyse the various factors in play when considering an auditory rehabilitation with a bone-conductive device (BCI). MATERIALS AND METHODS: The clinical charts of subjects who underwent BCI application at the same Implanting Center from 2005 to 2018 were retrieved analysing also the reason for eventual explantation and the alternative option (transition) for hearing rehabilitation. RESULTS: Nine BAHA Compact, 4 BAHA Intenso, 21 BAHA Divino, 3 BAHA BP100, 4 Ponto, 2 Sophono, 5 Bonebridge, 5 BAHA5 Attract; 11 BAHA5 Connect were used in 12 unilateral COM; 16 bilateral COM; 3 unilateral cholesteatoma; 6 bilateral cholesteatoma; 2 unilateral otosclerosis; 5 bilateral otosclerosis; 9 congenital malformations; 6 major otoneurosurgical procedures; 5 sudden deafness. Explantation was necessary for five subjects. CONCLUSIONS: Middle ear pathology and sequels from surgery represent the most common reason for BCI implantation, both in unilateral and in bilateral cases. Transition from one implantable device to another one can be predictable, mostly when explantation is necessary. SIGNIFICANCE: The role of BCI for rehabilitation in middle ear pathology may be extremely important.