The combined effect of family environment and parents' characteristics on the use of food to soothe children.

Parental feeding practices, such as the use of food to soothe, can be shaped by various factors, including the family environment and parents' psychological characteristics and capacities. To our knowledge, the combined effect of these factors has not been studied. Furthermore, parental feeding practices have mainly been studied in women, resulting in a gender gap in the research. This study aims to investigate the combined effect of family environment and parental characteristics on the likelihood of using food to soothe children, taking the gender of both parents into account. This cross-sectional study included a sample of 846 parents (36.3% men) of 1-year-old children from different regions of Spain. Participants completed an online survey that included questionnaires to measure whether parents used food to soothe children, the family environment, parents' characteristics, and their psychological capacities. Binary logistic regression analyses were performed to identify associations between the variables. The final model showed that, within the family environment, higher levels of dyadic adjustment between couples (OR = 0.965; p = .026) were associated with a reduced likelihood of using food to soothe children, whereas the psychological characteristic of parental fatigue (OR = 1.053; p = .007) appeared to be associated with an increased likelihood. Also associated with an increased likelihood of this practice were higher parental sense of competence (OR = 1.028; p = .029) and the attention dimension of emotional intelligence (OR = 1.043; p = .007). Our study suggests that using food to soothe children may be influenced by factors at different levels, from the quality and adjustment of the couple's relationship to parental fatigue, self-competence, and emotional intelligence. For future research, it may be worthwhile contextualizing parental practices to gain a better understanding of children's behavior.

Spanish adaptation of the perinatal grief intensity scale.

AIMS/BACKGROUND: Assessing the intensity of perinatal grief is very important for identifying the more complex cases in mothers and fathers. Despite this, there are few assessment tools available. The aim of this study was to analyse the psychometric properties (factorial structure, reliability, and validity) of the Spanish version of the Perinatal Grief Intensity Scale (PGIS). DESIGN/METHODS: An online survey was completed by 291 mothers and fathers who had suffered perinatal loss in the previous six years. RESULTS: The results showed adequate fit indexes for the three-factor model of the PGIS: reality, confront others, and congruence. Reliability values for the overall scale and subscales were adequate. Finally, with regard to validity, significant (p < .05) and positive relationships were found with levels of complicated grief, event centrality, guilt, anxiety, and depression. There were also differences depending on whether participants exhibited high or low levels of complicated grief, and on the number of weeks of pregnancy at the time of the loss. CONCLUSION: In conclusion, the Spanish adaptation of the PGIS has adequate reliability and validity scores and a factorial structure consistent with the original version.

Psychometric properties of parental stress scales used in paediatric health care settings: A systematic review1.

AIM: To identify scales that assess parental stress in the paediatric clinical population and to analyse their psychometric properties. METHODS: Four electronic databases (PubMed, Web of Science, PsycINFO, and Scopus) and metasearch engines (Google Scholar and Open Grey) were searched with no time period limitations. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach modified by COSMIN. Finally, recommendations were made for the instruments with the highest quality of evidence. RESULTS: A total of 38 studies reporting on 11 different instruments for assessing parental stress in the paediatric clinical setting were included. Six instruments were 'A' rated (recommended) in the final phase in line with COSMIN guidelines. The Paediatric Inventory for Parents was the instrument that evaluated the highest number of psychometric properties and obtained the highest methodological quality, global assessment, and quality of evidence for the different psychometric properties. CONCLUSIONS: This systematic review provides an overview of the measurement properties of the parental stress instruments used in the paediatric clinical setting. The Paediatric Inventory for Parents stands out as being one of the most robust instruments for measuring stress in parents with a hospitalised or sick child. Evidence needs to be generated for all the parental stress scales used in the clinical setting. IMPACT: Given that the psychometric properties of the existing parental stress scales used in paediatric health care settings have not been systematically assessed, the present review utilised comprehensive methods according to COSMIN. NO PATIENT OR PUBLIC CONTRIBUTION: REPORTING METHOD: PRISMA statement and COSMIN reporting guidelines for studies on measurement properties of patient-reported outcome measures.

Factor structure and validity of the Parental Competence Questionnaire in the Paediatric Hospital Emergency Setting (ECP-U).

OBJECTIVE: To confirm the structure and examine the psychometric properties of the Parental Competence Questionnaire in the Paediatric Hospital Emergency Setting (ECP-U). METHODS: An instrumental validation study of the ECP-U questionnaire and an examination of its psychometric properties were carried out. RESULTS: The participants were 260 mothers and fathers seeking care in the paediatric emergency department of a hospital in Valencia (Spain) with children aged 0 to 14 years old. The five-factor structure of the ECP-U was confirmed with excellent statistical fits. Second-order models and a more parsimonious four-factor structure with adequate but marginal fits are proposed. With the exception of the "parental agency" factor (in both models examined) and the "active social support" factor (in the original five-factor structure), the internal consistency of the different factors was modest (≥ 0.70). A negative correlation was found between the Parental Stress Scale and the ECP-U for most factors. CONCLUSIONS: Validity and reliability analyses indicate that the ECP-U is an instrument with modest psychometric properties. IMPLICATIONS FOR PRACTICE: The ECP-U is an instrument that can be used by future researchers to identify different levels of parental competence in paediatric hospital emergency departments. This will enable help to be given to families with parenting issues and problems. The underlying concern is to reduce the number of frequent users and "Non-Urgent Presentations" to paediatric emergency departments due to low parental competence.

Development and validation of a parental competence questionnaire in the paediatric hospital emergency setting (ECP-U).

OBJECTIVE: To develop and validate a parental competence questionnaire for parents of children seeking care in hospital emergency departments. METHODS: An instrumental study of the development of an assessment questionnaire was carried out in three phases: 1) review of relevant measures and item generation, 2) content validity evaluation, 3) psychometric evaluation. Exploratory factor analysis was performed to examine the factorial structure. Internal consistency was evaluated using ordinal alpha. Hypothesis testing was determined between the resulting factors, the Parental Stress Scale and the State-Trait Anxiety Inventory. RESULTS: The participants were 270 parents of children aged 0-14 years old from a referral hospital in Valencia (Spain). An 18-item questionnaire was developed, comprising five factors that explain 53.0% of the variance: 1) "emotional management and expression", 2) "passive social support", 3) "parental agency", 4) "basic needs and care" and 5) "active social support". The internal consistency for the different factors was modest (>0.70). A negative correlation between the Parental Stress Scale and the parental competence questionnaire was found for most of the factors. CONCLUSIONS: This questionnaire on parental competence in the hospital emergency department (ECP-U) is a useful and simple self-report instrument for assessing the parental competence of parents with children in the emergency department. PRACTICAL IMPLICATIONS: The resulting questionnaire is of practical value to both healthcare professionals and researchers in this field. It can be administered quickly in clinical practice and used to identify parents' levels of parental competence and refer those with difficulties to appropriate support services.

Paternal feeding practices and styles: a systematic review.

CONTEXT: Studies on parenting, including feeding styles and practices in general, have focused mainly on mothers. Consequently, there is a gap with respect to fathers in the scientific literature. OBJECTIVE: This study's main objective is to determine paternal feeding styles toward children aged 0 to 18 years and to identify those most commonly used by men. DATA SOURCES: The PubMed, Scopus, Web of Science, Cochrane, and PsycINFO databases were consulted. DATA EXTRACTION: Articles that were not published in English, Spanish, or Italian were excluded, as well as those that referred to other subjects, those whose sample did not include men, or those studying children with pathologies that could influence their diet. All the articles ultimately included were assessed using the STROBE checklist. DATA ANALYSIS: A total of 183 articles were found. Of these, 13 were included in the review. No trend was found for paternal parenting style, and disparities existed among the authoritative, authoritarian, and permissive styles. In terms of feeding practices, men were more likely to use coercion. The most reported feeding styles were authoritarian and permissive. CONCLUSIONS: The findings of systematic review suggest cultural and gender differences exist with respect to parenting styles and feeding styles and practices. In terms of paternal parenting styles, there is some disparity. However, when it comes to feeding, men showed a tendency toward an authoritarian feeding style and coercive feeding practices.

Psychometric Properties of the Spanish Version of the Iowa Infant Feeding Attitude Scale in Fathers.

BACKGROUND: Research gaps exist with regard to paternal attitudes towards breastfeeding and the association between fathers' attitudes and the type of breastfeeding. RESEARCH AIMS: (1): To analyze the psychometric properties of the Spanish version of the Iowa Infant Feeding Attitude Scale in fathers, and (2) to examine the association between fathers' attitudes and type of breastfeeding. METHOD: We used a cross-sectional study design to analyze the scale's psychometric properties and performance. RESULTS: A total of 639 fathers participated in the study. The mean age was 35.83 years (SD = 4.65) and 67.3% (n = 430) were married or in a civil partnership. We observed an adequate fit in the confirmatory factor analysis: TLI = 0.96, CFI = 0.97 and RMSEA = 0.05. The overall internal consistency was 0.76. Between 1-6 months, 48% (n = 307) of participants' babies were exclusively breastfed, 35.2% (n = 225) were partially breastfed, and 16.7% (n = 107) were exclusively formula fed. Statistically significant differences were shown in attitudes towards breastfeeding, depending on the type of breastfeeding, between 1 and 6 months (F = 54.67; p < .001). Fathers who reported that their baby had been exclusively breastfed scored higher on attitudes towards breastfeeding. Statistically significant differences were also found between partial breastfeeding and formula feeding. CONCLUSIONS: The Spanish version of the Iowa Infant Feeding Attitude Scale is a valid and reliable instrument for measuring paternal attitudes towards breastfeeding.

Relación del retraso de la lactogénesis II con la percepción materna de leche insuficiente: un estudio longitudinal / Relationship of Delayed Lactogenesis II to Maternal Perception of Insufficient Milk: a longitudinal study

Objetivo: Analizar la relación del retraso de la lactogénesisII con la percepción materna de leche insuficiente. Método: Se realizó un estudio observacional longitudinal prospectivo, multicéntrico. Se obtuvieron datos al alta y entre 1 y 5meses posparto sobre la percepción de leche insuficiente y las variables relacionadas mediante un cuestionario autoadministrado y el posterior seguimiento postal y online. Para el desarrollo del modelo explicativo, se realizó un análisis de regresión logística. Resultados: Participaron un total de 260 puérperas. El 31,9% de ellas percibieron leche insuficiente y el 23,6% presentaron retraso de la lactogénesisII. Durante el ingreso posparto, se relacionó con la percepción materna de leche insuficiente el retraso de la lactogénesisII (OR=2,26; IC95%=1,07-4,79), la dificultad para amamantar (OR=1,02; IC95%=1,00-1,03) y la ayuda de los profesionales en la lactancia (OR=0,70; IC95%=0,50-0,97). Conclusiones: La aparición de dificultades en la lactancia durante el ingreso posparto y al alta, especialmente cuando existe un retraso de la lactogénesisII, deben considerarse indicadores de riesgo, que sugieren la necesidad de un apoyo adicional a los cuidados estandarizados. La percepción de leche insuficiente es un indicador adecuado para evaluar la calidad del apoyo profesional a la lactancia en intervenciones de mejora.(AU)

Aim: To analyze the relationship of delayed lactogenesisII with maternal perception of insufficient milk. Methods: A prospective, multicenter, longitudinal observational study was conducted. Data were obtained at discharge and between 1 and 5months postpartum on the perception of insufficient milk and related variables, by means of a self-administered questionnaire, and subsequent postal and online follow-up. Logistic regression analysis was used to develop the explanatory model. Results: A total of 260 puerperal mothers participated. Of these, 31.9% had insufficient milk and 23.6% had delayed lactogenesisII. During postpartum admission, delayed lactogenesis II (OR=2.26; 95%CI=1.07-4.79), difficulty in breastfeeding (OR=1.02; 95%CI=1.00-1.03), and professional help in breastfeeding (OR=0.70; 95%CI=0.50-0.97) were associated with maternal perception of insufficient milk.Conclusions: The occurrence of breastfeeding difficulties during postpartum admission and at discharge, especially when there is delayed lactogenesisII, should be considered risk indicators, suggesting the need for additional support to standardized care. The perception of insufficient milk is a suitable indicator to assess the quality of professional breastfeeding support in improvement interventions.(AU)

Relationship of delayed lactogenesis II to maternal perception of insufficient milk: A longitudinal study.

AIM: To analyze the relationship of delayed lactogenesis II with maternal perception of insufficient milk. METHODS: A prospective, multicenter, longitudinal observational study was conducted. Data were obtained at discharge and between 1 and 5 months postpartum on the perception of insufficient milk and related variables, by means of a self-administered questionnaire, and subsequent postal and online follow-up. Logistic regression analysis was used to develop the explanatory model. RESULTS: A total of 260 puerperal mothers participated. Of these, 31.9% had insufficient milk and 23.6% had delayed lactogenesis II. During postpartum admission, delayed lactogenesis II (OR = 2.26; 95%CI = 1.07-4.79), difficulty in breastfeeding (OR = 1.02; 95%CI = 1.00-1.03), and professional help in breastfeeding (OR = 0.70; 95%CI = 0.50-0.97) were associated with maternal perception of insufficient milk. CONCLUSIONS: The occurrence of breastfeeding difficulties during postpartum admission and at discharge, especially when there is delayed lactogenesis II, should be considered risk indicators, suggesting the need for additional support to standardized care. The PIM is a suitable indicator to assess the quality of professional breastfeeding support in improvement interventions.

Relationships between parent-infant bonding, dyadic adjustment and quality of life, in an intra-partner sample.

The transition to parenthood represents a moment of change and adaptation in which the dyadic marital relationship becomes a triadic relationship. Facilitating a positive transition requires a thorough understanding of the explanatory model of the relationship between parental-infant bonding, dyadic adjustment and quality of life (QoL) from an integrative perspective of the family unit. The aim of this work was to analyse the relationships between parent-infant bonding, dyadic adjustment and QoL from an intra-partner perspective, 6-12 months after the birth of a child. A cross-sectional observational study was performed in a convenience sample of 222 couples 6-12 months postpartum, enrolled from October 2013 to March 2016. The mean age of the mothers was 34.07 years (SD = 3.67), and for the fathers, it was 35.75 years (SD = 4.02). Mothers perceived better QoL and greater mother-infant bonding compared to fathers. The perception of an adequate dyadic adjustment, together with positive parent-infant bonding, had positively influenced the individual QoL of both members of the couple 6-12 months after birth. From an intra-partner perspective, the positive transition was influenced by the relationship between parent-infant bonding, dyadic adjustment and QoL. Positive parent-infant bonding in mothers and fathers, as well as promotion of the quality of the relationships between couples, can help promote a better QoL. Positive health results can be achieved in terms of individual and family well-being by designing healthcare interventions that encourage the presence and participation of the family unit.

Predicting exclusive breastfeeding in maternity wards using machine learning techniques.

BACKGROUND AND OBJECTIVE: Adequate support in maternity wards is decisive for breastfeeding outcomes during the first year of life. Quality improvement interventions require the identification of the factors influencing hospital benchmark indicators. Machine Learning (ML) models and post-hoc Explainable Artificial Intelligence (XAI) techniques allow accurate predictions and explaining them. This study aimed to predict exclusive breastfeeding during the in-hospital postpartum stay by ML algorithms and explain the ML model's behaviour to support decision making. METHODS: The dataset included 2042 mothers giving birth in 18 hospitals in Eastern Spain. We obtained information on demographics, mothers' breastfeeding experiences, clinical variables, and participating hospitals' support conditions. The outcome variable was exclusive breastfeeding during the in-hospital postpartum stay. We tested algorithms from different ML families. To evaluate the ML models, we applied 10-fold stratified cross-validation. We used the following metrics: Area under curve receiver operating characteristic (ROC AUC), area under curve precision-recall (PR AUC), accuracy, and Brier score. After selecting the best fitting model, we calculated Shapley's additive values to assign weights to each predictor depending on its additive contribution to the outcome and to explain the predictions. RESULTS: The XGBoost algorithms showed the best metrics (ROC AUC = 0.78, PR AUC = 0.86, accuracy = 0.75, Brier = 0.17). The main predictors of the model included, in order of importance, the pacifier use, the degree of breastfeeding self-efficacy, the previous breastfeeding experience, the birth weight, the admission of the baby to a neonatal care unit after birth, the moment of the first skin-to-skin contact between mother and baby, and the Baby-Friendly Hospital Initiative accreditation of the hospital. Specific examples for linear and nonlinear relations between main predictors and the outcome and heterogeneity of effects are presented. Also, we describe diverse individual cases showing the variation of the prediction depending on individual characteristics. CONCLUSION: The ML model adequately predicted exclusive breastfeeding during the in-hospital stay. Our results pointed to opportunities for improving care related to support for specific mother's groups, defined by current and previous infant feeding experiences and clinical conditions of the newborns, and the participating hospitals' support conditions. Also, XAI techniques allowed identifying non-linearity relations and effect's heterogeneity, explaining specific cases' risk variations.

Does the global activity limitation indicator measure participation restriction? Data from the European Health and Social Integration Survey in Spain.

PURPOSE: The global activity limitation indicator (GALI) is the only internationally agreed and harmonised participation restriction measure. We examine if GALI, as intended, is a reflective measure of the domains of participation; furthermore, we determine the relative importance of these domains. Also, we investigated the consistency of response to GALI by age and gender and compared the performance of GALI with that of self-rated health (SRH). METHODS: We used Spanish data from the European Health and Social Integration Survey and selected adults aged 18 and over (N = 13,568). Data analysis, based on logistic regression models and Shapley value decomposition, were also stratified by age. The predictors of the models were demographic variables and restrictions in participation domains: studies, work, mobility, leisure and social activities, domestic life, and self-care. The GALI and SRH were the response variables. RESULTS: GALI was strongly associated with all participation domains (e.g. for domestic life, adjusted OR 24.34 (95% CI 18.53-31.97) in adult under 65) and performed differentially with age (e.g. for domestic life, adjusted OR 13.33 (95% CI 10.42-17.03) in adults over 64), but not with gender. The relative importance of domains varied with age (e.g. work was the most important domain for younger and domestic life for older adults). The results with SRH were parallel to those of GALI, but the association of SRH with participation domains was lowest. CONCLUSIONS: GALI reflects well restrictions in multiple participation domains and performs differently with age, probably because older people lower their standard of good functioning.

Reliability and validity of the reduced Spanish version of the Prenatal Breastfeeding Self-Efficacy Scale.

Breastfeeding self-efficacy is a relevant predictor of exclusive breastfeeding during the first six months of life. The Prenatal Breastfeeding Self-Efficacy Scale (PBSES) is a 20-item tool developed to determine breastfeeding self-efficacy during pregnancy. Our study aimed to assess the structural validity and psychometric characteristics of the PBSES and to explore item reduction according to the statistical criteria for parsimony and incremental validity. In this study, conducted in six hospitals in eastern Spain, we recruited 1183 women with healthy, full-term, single-birth newborns. Data on sociodemographic, breastfeeding-related variables, and the PBSES, were obtained from self-administered questionnaires during the third trimester of pregnancy, at postpartum discharge, and 5 months postpartum, and from a phone survey 12 months postpartum. Item reduction was conducted after revising the PBSES item floor and ceiling effects, interitem correlations, and item-score relationships with breastfeeding-status variables during follow-up. The factorial structure of the short form of the PBSES (PBSES-SF) was tested using both exploratory and confirmatory approaches. After item reduction, the confirmatory factor analysis of the 12 remaining items of the PBSES-SF revealed adequate fit statistics for a three-factor structure and a second-order factor. Internal consistency was measured using the Cronbach's α coefficient of the PBSES-SF (0.86). We provided evidence on the discriminant validity of the PBSES-SF by comparing its scores between known groups, convergent validity by examining its correlations with other variables, and predictive validity by assessing the association of PBSES-SF scores with breastfeeding behavior at critical points in time during the first postpartum year.

Robust estimation of infant feeding indicators by data quality assessment of longitudinal electronic health records from birth up to 18 months of life.

BACKGROUND AND OBJECTIVE: The Baby-Friendly Hospital Initiative (BFHI) is an international strategy aimed at improving breastfeeding practices in health care services. Regular monitoring of indicators is key for BFHI implementation and maintenance. Currently, routine data collected from electronic health records (EHR) is an excellent source for infant feeding monitoring, however data quality (DQ) assessment should be undertaken. The aim of this research is to enable robust estimations of infant feeding indicators through DQ assessment of routine EHR data. MATERIALS AND METHODS: We use the longitudinal series of healthcare contacts belonging to 6427 children born from 2009 to 2018 in the Health Area V of Murcia (Spain). Longitudinal data came from EHR at hospital discharge and community infant health reviews up to 18 months. The data of each healthcare contact contained a 24-h recall of infant feeding. We perform a DQ process in three phases: (1) an assessment of each-single-contact and the definition of their infant feeding status; (2) a longitudinal DQ assessment of completeness and consistency of the series of contacts to obtain meta-information that guides the duration calculus, for each case, of the different types of breastfeeding: exclusive breastfeeding (EBF), full breastfeeding (FBF) and any breastfeeding (ABF); and finally (3) a robust estimation of indicators and description of DQ of each indicator. RESULTS: We found deficiencies of DQ in 30.42% of single contacts for EBF, 19.02% for FBF and 22.50% for ABF that were used to establish the infant feeding status. However, after longitudinal DQ assessment, we obtained valid and reliable data rates for most indicators such as "median duration of breastfeeding" nearly 90%, both for FBF and ABF, not so for EBF. CONCLUSIONS: Despite the DQ deficiencies found in raw data, the DQ assurance approach by indicators proposed in this work, allowed us to obtain a robust estimation of indicators with a significant percentage of subjects with valid information for ABF and FBF monitoring. The estimations were consistent with results previously published. The methodology provided with this study allows a continuous and reliable population monitoring of infant feeding indicators of BFHI from routine EHR data.

Longitudinal Study of Dyadic Adjustment in a Sample of Spanish Fathers.

The objectives of this study were to examine the evolution of fathers' long-term dyadic adjustment after the birth of a child and to analyze their evolution considering related factors. A total of 113 Spanish fathers with a mean age of 35.72 years (SD = 3.84 years) participated. In general, there was a decline in the dyadic adjustment of the fathers until 6-12 months after childbirth, after which their level of adjustment remained stable until 13-24 months. We observed different patterns when analyzing the evolution by subgroups formed based on these different variables, previous experience of paternity, and anxiety. The intrinsic differences between fathers should also be considered because these differences can influence the way in which men face the parental process as well as the evolution of the quality of their relationship with their partner.

The Spanish version of the Mothers' Postnatal Sense of Security Scale: Psychometric properties and predictive utility.

Postnatal sense of security is a relevant construct related to several variables of motherhood. However, it has not yet been studied in the Spanish context. The aims were: (a) To analyze the psychometric properties of a Spanish version of the Mothers' Postnatal Sense of Security Scale (PPSS-S); (b) analyze the factors related to mothers' sense of security during the first 2 weeks following childbirth (sociodemographic variables and factors related to maternity); and (c) examine the predictive utility that mothers' sense of security has on symptoms of postpartum depression 6-11 months after childbirth. This was a prospective longitudinal study performed in the first 6-11 months post-partum in four regions of Spain. A total of 928 mothers whose mean age was 33.67 years (standard deviation = 4.54) participated. The confirmatory factor analysis showed adequate adjustment to the original structure (χ2 = 17,272.79, df = 153, p < .001; Tucker-Lewis index = 0.98; comparative fit index = 0.98; root mean square error of approximation = 0.058 [0.053-0.063])and the overall internal consistency was 0.89. Direct relationships were shown between women' sense of security and already having had a child, the absence of postpartum health complications (either in the mother or the newborn) and receiving consistent information from healthcare professionals. Our results showed adequate evidence for the reliability and validity of the Spanish version of the PPSS-S. Understanding mothers' sense of security during the early months of motherhood, as well as related factors in the postpartum period, will allow health professionals to implement preventive measures to promote mental health and could help reduce symptoms of postpartum depression.

Effectiveness of interventions aimed at improving the sexuality of women with multiple sclerosis: a systematic review.

OBJECTIVE: To evaluate the effectiveness of interventions aimed at improving the sexuality of women with multiple sclerosis. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Embase and the Cochrane Library, as well as doctoral thesis databases Teseo and ProQuest Dissertations & Theses Global and the grey literature database Opengrey were searched, last on 15 October 2019. Journals related to the topic were also consulted. The bibliographic references of the articles included were reviewed. METHOD: Studies were selected if they included women with multiple sclerosis in whom interventions aimed at reducing sexual dysfunction were applied. Data extraction was carried out by two independent reviewers. The Jadad scale was used to evaluate the methodological quality of the studies included. RESULTS: In total, 12 clinical trials were selected, and 611 patients were examined. Studies were classified into six interventions: sexual therapy (4), pharmaceutical drugs (3), pelvic floor exercises (2), yoga (1), mindfulness (1) and vaginal devices (1). Most of them improved some primary outcomes of sexual dysfunction such as lubrication, arousal, desire or orgasm. Pain was the most common secondary outcome evaluated and it became better in two studies including sexual therapy and in one intervention with pelvic floor exercises. Tertiary outcomes such as anxiety or depression were rarely examined, and they improved with sexual therapy and with OnabotulinumtoxinA. CONCLUSION: Sexual therapy, administration of OnabotulinumtoxinA, pelvic floor muscles exercises alone or combined with electrostimulation and the use of clitoral devices could be the most recommended interventions to improve the sexuality in women with multiple sclerosis.

Factors Related to the Intra-Partner Postnatal Sense of Security in a Spanish Sample.

BACKGROUND: The fathers' sense of security and their related factors during the process of parenthood remains largely unexplored. The objectives were to analyse: the psychometric properties of the Spanish version of the Parent's Postnatal Sense of Security scale used for fathers, and the factors related to fathers' sense of security during the postpartum period. METHODS: A total of 583 fathers participated. The fathers' version of the questionnaire was adapted for Spanish speakers. The psychometric properties of the instrument and its relationship with the mother's sense of security were considered. FINDINGS: The results showed that the data fit well with the original model (TLI = 0.98, CFI = 0.98, and RMSEA = 0.05). The fathers' sense of security was associated with previously having become a father (t = -2.39, p = .02), the level of state anxiety (r = -0.34; p < .01) and trait anxiety (r = -0.24; p < .01), as well as the sense of security of their partners (r = 0.55, p < .001). In the regression analysis, the mothers' sense of security construct provided the greatest explanation of the model. DISCUSSION: The results of this study highlight the importance of considering the family unit in pre-, intra-, and postnatal education in order to increase the sense of security of both parents and reduce their anxiety levels. APPLICATION TO PRACTICE: This study provides Spanish healthcare professionals with access to a scale for assessing fathers' sense of security in the immediate postpartum period and allows them to identify needs in the process of becoming parents, emphasising the inclusion of both parents in any intervention.

Maternal and Neonatal Hair Cortisol Levels and Psychological Stress Are Associated With Onset of Secretory Activation of Human Milk Production.

BACKGROUND: Several factors can influence the production of mothers' own milk. PURPOSE: To assess the influence of maternal psychological stress, maternal cortisol levels, and neonatal hair cortisol levels on timing of secretory activation. METHODS: A prospective study was conducted at 2 public health centers in Andalusia, Spain. Participants were 60 pregnant women and their 60 neonates. Hair cortisol levels and psychological stress (pregnancy-specific stress [Prenatal Distress Questionnaire, PDQ] and perceived stress [Perceived Stress Scale, PSS]) were evaluated during the third trimester and the postpartum period. This study was part of the GESTASTRESS cohort study on the effects of stress during pregnancy. RESULTS: Higher PDQ and PSS scores (P < .05) in the third trimester were associated with later onset of secretory activation. Higher postpartum maternal hair cortisol levels were associated with a delayed secretory activation of mother's own milk (P < .05). IMPLICATIONS FOR RESEARCH: Future studies should look at the influence of psychological stress and cortisol levels on hormones involved in mother's own milk production. IMPLICATIONS FOR PRACTICE: Neonatal nurses and other healthcare providers should be familiar with levels of neonates' exposure to maternal prenatal stress prior to birth.

Validity and Reliability of the Spanish Version of the Pregnancy-Related Thoughts Scale.

OBJECTIVE: To adapt the Pregnancy-Related Thoughts Scale into Spanish (Spanish PRTS) and evaluate its psychometric properties. DESIGN: Instrument translation (Phase 1), validation, and psychometric testing (Phase 2). SETTING: Phase 2 was conducted in three general hospitals in eastern Spain. PARTICIPANTS: A convenience sample of 180 women during the third trimester of pregnancy participated in Phase 2. METHODS: After a standard process of linguistic validation in Phase 1, we used the Spanish PRTS with other instruments to evaluate its psychometric properties in Phase 2. The participants completed a battery of questionnaires during prenatal visits in the third trimester (28-42 weeks gestation) at health care centers. Responses to the postnatal depression questionnaire were obtained through an online questionnaire between the first and third months after childbirth. We evaluated the factor structure; reliability; and convergent, discriminant, and predictive validity of the Spanish PRTS. RESULTS: The Spanish PRTS had a Cronbach's alpha coefficient of .81 and McDonald's omega coefficient of .82. The confirmatory factor analysis showed that the best adjustment of the scale was one factor with two pairs of correlated residuals. The Spanish PRTS scores were positively correlated to scores on pregnancy worries, state and trait anxiety, fatigue, symptoms of postnatal depression, and poor quality of life and inversely correlated to scores on self-efficacy for coping with stress. CONCLUSION: The findings support the validity and reliability of the Spanish PRTS to evaluate pregnancy-related anxiety; this tool can be used to measure outcomes of interventions for the prevention or treatment of women's anxiety during pregnancy.