'All for the well-being of the infant': nurses' perceptions of preterm infants' eye examinations: a phenomenographic study.

BACKGROUND: Preterm infants are at risk of complications due to their prematurity and Retinopathy of Prematurity (ROP) is one of them. To discover and treat ROP the preterm infants regularly undergo eye examinations. Nurses are responsible for the infants' care during this painful and stressful procedure. AIM: The aim of this study was to explore nurses' perceptions of preterm infants' eye examinations. METHODS: Data were collected through semi-structured interviews with 10 nurses experienced in participating in preterm infants' eye examinations. Data were analysed using a phenomenographic approach. RESULTS: The results showed several perceptions of the eye examinations, and the analysis resulted in four descriptive categories: Infants are affected by the eye examination; Nurses have comprehensive overall responsibility for the infants; Parents are important to their infants, but they need support to fulfil their parental role, and Collaboration is important for the examination's favourable outcome. The category Nurses have comprehensive overall responsibility for the infants was regarded as the most comprehensive, covering all the other categories. CONCLUSIONS: Nurses felt a great responsibility during a painful and stressful procedure for preterm infants. Infants' well-being could be better protected by interprofessional collaboration, improved nursing care and involved parents.

Maternal Mental Health in Latinx/Hispanic Women after COVID-19 Pandemic.

The recent COVID-19 global emergency may have ripple effects on mental health of many people worldwide. This is especially true for populations like birthing and postpartum women where many changes to daily routines, access to medical care, work-related routines and socialization were experienced. This brief report presents data from an ongoing cohort study aiming to describe maternal mental health during the pandemic T12 (March 2020 to April 2021) with post-pandemic T2 (May 2022 to May 2023) of mothers followed in Puerto Rico. 47 out of 100 mothers have been recalled and assessed with psychosocial interviews (COPE-IUS) and assessments of anxiety (GAD-7) and depression (PHQ-9). Paired t-test revealed mean scores of depressions (PHQ-9) were significantly higher for T2 with a mean of 6.35 and a range of 4.4+/- than for T1 where mean was 5.15 (+/- 2.9), t=-1.954, df=45, p < .05. Similarly, anxiety scores (GAD-7) were significantly higher in T2 6.67 (4.2) than for T1 5.35 (3.7), t=-1.8, df=45, p < .05. Also, COPE-IUS Post-pandemic psychosocial interview results evidence that 80% of mothers do not feel the COVID-19 pandemic is a significant stressor at T2 and are able to maintain routine activities with no social distancing measures. However, reports of loneliness, sadness, worry, and fear continue to be present. Our findings point to the need to further identify other contributing factors to the deterioration of maternal mental health during the perinatal/peripartum period (pregnancy, birth, and postpartum) in Puerto Rico. Possibly the effects of repeated adversity that has been present in the island (multiple environmental stressors, history of traumatic experiences, and constant hardships) may all have cumulative impact over maternal mental health during the perinatal/peripartum period.

Support Needs, Barriers, and Facilitators for Fathers With Fear of Childbirth in Sweden: A Mixed-Method Study.

The aim of this mixed-method study was to identify support needs, as well as barriers and facilitators to seeking support in a sample of Swedish fathers with a fear of childbirth (FOC). Participants completed an anonymous quantitative online survey (N = 131), with three free-text items for those self-identifying as having an FOC (N = 71) and five individual in-depth interviews. Data analysis included descriptive and chi-square analyses for quantitative data, and manifest content analysis for qualitative data. Those with a severe FOC were more likely to report having on-going mental health difficulties (p = .039) and one fifth (21%) of the participants with severe FOC wanted to receive professional treatment, but only 8.1% received treatment. Most participants either preferred individual support or to receive support together with their partner. Fathers with severe FOC were more likely to report one or more barriers than those without FOC (p = .005), where unwanted social stigma was the single largest barrier. Qualitative findings identified one main category: Expectant fathers missing and wishing for support for FOC composed four generic categories: (1) support in developing an understanding of their fear, (2) coping by being aware of feelings, (3) professional support through trust and respect, and (4) needing individualized support. To encourage healthy fathers, clinical professionals should find ways to support fathers, such as by providing them with their own perinatal appointments, asking them about their feelings, as well as screening, diagnosing, and treating fathers with severe FOC.

Mothers and Babies Virtual Group (MBVG) for perinatal Latina women: study protocol for a hybrid type-1 effectiveness-implementation randomized controlled trial.

BACKGROUND: Immigrant Latinas (who are foreign-born but now reside in the USA) are at greater risk for developing postpartum depression than the general perinatal population, but many face barriers to treatment. To address these barriers, we adapted the Mothers and Babies Course-an evidence-based intervention for postpartum depression prevention-to a virtual group format. Additional adaptations are inclusion of tailored supplemental child health content and nutrition benefit assistance. We are partnering with Early Learning Centers (ELC) across the state of Maryland to deliver and test the adapted intervention. METHODS: The design is a Hybrid Type I Effectiveness-Implementation Trial. A total of 300 participants will be individually randomized to immediate (N = 150) versus delayed (N = 150) receipt of the intervention, Mothers and Babies Virtual Group (MB-VG). The intervention will be delivered by trained Early Learning Center staff. The primary outcomes are depressive symptoms (measured via the Center for Epidemiologic Studies-Depression Scale), parenting self-efficacy (measured via the Parental Cognition and Conduct Towards the Infant Scale (PACOTIS) Parenting Self-Efficacy subscale), and parenting responsiveness (measured via the Maternal Infant Responsiveness Instrument) at 1-week, 3-month, and 6-month post-intervention. Depressive episodes (Structured Clinical Interview for DSM-V- Disorders Research Version) at 3-month and 6-month post-intervention will also be assessed. Secondary outcomes include social support, mood management, anxiety symptoms, perceived stress, food insecurity, and mental health stigma at 1-week, 3-month, and 6-month post-intervention. Exploratory child outcomes are dysregulation and school readiness at 6-month post-intervention. Intervention fidelity, feasibility, acceptability, and appropriateness will also be assessed guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. DISCUSSION: This study will be one of the first to test the efficacy of a group-based virtual perinatal depression intervention with Latina immigrants, for whom stark disparities exist in access to health services. The hybrid effectiveness-implementation design will allow rigorous examination of barriers and facilitators to delivery of the intervention package (including supplemental components) which will provide important information on factors influencing intervention effectiveness and the scalability of intervention components in Early Learning Centers and other child-serving settings. REGISTRATION: ClinicalTrials.gov NCT05873569.

A qualitative study exploring the perinatal experiences of social stress among first- and second-generation immigrant parents in Quebec, Canada.

BACKGROUND: Perinatal psychological distress adversely impacts the well-being and social adjustment of parents and their children. Expectant parents who have migrated may be at higher risk for perinatal psychological distress due to various migration-specific stressors and healthcare service barriers. Limited studies have examined the perceived determinants of perinatal distress in immigrant parents, particularly men. This study explored first and second-generation immigrant parents' lived experiences of social stressors and facilitators of perinatal psychological well-being. METHODS: Participants were recruited by convenience and purposive sampling as part of a larger study. Semi-structured interviews were conducted virtually with first and second-generation immigrant women and men in Quebec, Canada. An inductive thematic analysis was performed. RESULTS: Sixteen women (age = 34.8 ± 3.7 years) and ten men (age = 35.1 ± 4.9 years) from various ethnic backgrounds participated in the study at 7.4 ± 0.73 and 7.5 ± 0.72 months postpartum, respectively. Three themes were identified: (1) cultural pressures (cultural differences in parenting, gender-related cultural pressures, health and baby-related practices), (2) health and social service access (social benefits and resources, and systemic barriers in health care), and (3) discrimination (physical appearance or parental-related discrimination, gender-related discrimination, ethnic-related discrimination). First-generation immigrant parents reported greater acculturative stress (i.e. mental health stigma, health care access) and ethnic discrimination concerns related to their distress. Among men, barriers include feeling as though the paternal role was devalued by society and not receiving consideration by health care. CONCLUSIONS: Our results highlight different social factors of perinatal well-being perceived by men and women from various ethnic and immigration backgrounds during the perinatal period. Perceived factors include macro-level factors, such as a country's social climate, health and social policies and services, and social aspects of acculturative stress. Our findings suggest the need for continued efforts to challenge and eliminate discriminatory practices. Interventions and resources directed at first-generation immigrant parents should be bolstered. Understanding what parents perceive to facilitate or hinder their psychological well-being can help inform the development of tailored evidence-based programs and policies to better meet the mental health needs of Canadians and reduce gender disparities in the treatment of perinatal distress.

Predictors of Mothers Living with HIV Uptake of HIV Early Infant Diagnosis Services in Iringa District, Tanzania.

BACKGROUND: Uptake of HIV early infant diagnosis (HEID) among HIV-exposed infants is the key to timely initiation of Antiretroviral Treatment (ART). However, despite the availability of HEID services in Tanzania, its uptake is low. We aimed to determine predictors of mothers living with HIV' with HIV-exposed infants' uptake of HEID services in Iringa District, Tanzania. METHODS: A health facility-based cross-sectional study was conducted in Iringa District from May to June 2023. Mothers with HIV-exposed infants were recruited in the study through a multistage sampling technique and interviewed using pre-tested structured questions. Logistic regression analysis was employed to determine potential predictors of HEID uptake. RESULTS: A total of 309 mothers with HIV-exposed infants participated in the study. About 78.3% of the HIV-exposed infants had initial DNA PCR for HEID within 6 weeks of age and 86.1% within 8 weeks. Most mothers had high perceived benefits on uptake of HEID with a mean score of 4.3, high perceived self-efficacy with a mean score of 3.8 and 2.7 perceived risk of HIV infection on their HIV-exposed infants on the 5 scale Likert scale with 5 showing the highest perceived benefit, self-efficacy and risk. High perceived self-efficacy and being a businesswoman were the predictors of uptake of HEID. The odds of self-efficacy on the uptake of HEID by 2.4 times (aOR 2.4 95% CI 1.6-3.2) within 6 weeks of age and 1.9 (aOR 1.9 95% CI 1.3-2.7) within 8 weeks. The odds of being a businesswoman were 0.4 for 6 weeks and 0.3 for 8 weeks (aOR 0.4 95% CI 0.2-0.8) and (aOR 0.3 95% CI 0.1-0.8) respectively. CONCLUSION: Over three-quarters of the HIV-exposed infants had initial DNA PCR for HEID testing as recommended. Perceived self-efficacy was the main factor influencing HEID uptake. These findings highlight the need for strengthening HIV-positive mother's self-efficacy for improved uptake of HEID services.

Predictors of mothers living with HIV' uptake of HIV early infant diagnosis services in Iringa District, TanzaniaThis study aimed to find out the factors associated with the uptake of HIV early infant diagnosis (HEID) services among mothers living with HIV in Iringa District, Tanzania. The uptake of HEID in Tanzania is still below the 95% national and global target of ending AIDS as a public health by 2030 We employed a cross-sectional study design and collected data from May to June 2023 to determine predictors of mothers with HIV-exposed infants' uptake of HEID in Iringa District, Tanzania. The analysis was done by descriptive statistics and logistic regression analysis. A total of 309 mothers with HIV-exposed infants participated in the study. About 78.3% of the HIV-exposed infants had initial DNA PCR for HEID within 6 weeks of age and 86.1% within 8 weeks. Most mothers had high perceived benefits on uptake of HEID with a mean score of 4.3, high perceived self-efficacy with a mean score of 3.8 and 2.7 perceived risk of HIV infection on their HIV-exposed infants. High perceived self-efficacy was positively associated These findings highlight the need for strengthening HIV-positive mother's self-efficacy for improved uptake of HEID services.

Early detection of perinatal depression in couples: a single-center prospective study.

OBJECTIVE: This prospective study aimed to assess couples' psychological status during the perinatal period to identify those at risk for postpartum depression. METHODS: Conducted at Lyon University Hospital from March to July 2022, the study enrolled pregnant women without progressive psychiatric disorders or obstetric risk factors, and their partners. Participants completed the Edinburgh Postnatal Depression Scale (EPDS) at three points: during the 9th month of pregnancy, immediate postpartum, and 6-8 weeks after delivery. A score ≥10 on the EPDS indicated depression risk. A score ≥10 on the EPDS indicate depression risk. The primary endpoint was EPDS scores throughout the perinatal period. RESULTS: Ninety-five couples participated; 96% of patients and 68% of partners completed pre-delivery questionnaires, 81% and 71% during maternity stay, and 64% and 46% postpartum, respectively. Overall, 15% of patients and 1% of partners had EPDS scores >10 in the postpartum period. Psychiatric history and emergency cesarean sections were associated with higher immediate postpartum EPDS scores in patients [Beta 3.7 points, 95% CI 0.91; 6.4 and Beta 5.2 points, 2.2; 8.1, respectively]. Episiotomy was associated with higher EPDS scores in partners. No significant association between the different factors studied and the EPDS score was found at 6-8 weeks postpartum in patients nor their partners. CONCLUSIONS: While specific risk factors for persistent perinatal depression in couples were not identified, a notable proportion of patients exhibited high EPDS scores. Screening all couples during prepartum and postpartum periods is crucial, regardless of identified risk factors.

Reconsidering Breastfeeding Recommendations in the Context of Cannabis Use to Support Health Equity.

The authors offer guidance to perinatal nurses and clinicians on how to assist patients who use cannabis and wish to breastfeed.

Implementation and evaluation of a proactive consultation-liaison model on an inpatient obstetric unit.

OBJECTIVE: Perinatal mental and anxiety disorders (PMADs) contribute to adverse health outcomes, though they are underrecognized and undertreated. Inpatient obstetric settings represent a unique opportunity for behavioral health engagement, including screening, brief treatment, and referrals for outpatient care. The proactive consultation-liaison (CL) model has proven effective in general hospital settings but is not well-studied in obstetric settings. This article describes the implementation and evaluation of a proactive CL model in an inpatient obstetric unit within a tertiary medical center. METHODS: We implemented a multidisciplinary, proactive CL model in an inpatient obstetric unit with the purpose of identifying patients at risk for or experiencing PMADs and providing intervention and/or referral to treatment. Systematic screening of 7322 admitted patients was performed over a 17-month period to identify eligible patients for behavioral health consultation. Consultation data was retrospectively extracted from the electronic medical record. Key implementation outcomes were assessed using a RE-AIM measures (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. RESULTS: 1589 initial consults were conducted by the multidisciplinary team, yielding a consult rate of 21.7 %. The majority of consults (94 %) were completed by a social worker or psychologist, with most patients identified for consultation at multidisciplinary rounds (60.7 %). The most common indications for consultation with a psychiatrist included medication management, history of bipolar disorder, and history of anxiety. All invited staff and providers participated in the model. Alternative funding sources agreed to cover the salaries of the multidisciplinary team following conclusion of pilot grant funding. CONCLUSIONS: A proactive CL model implemented in an inpatient obstetric unit led to a higher consult rate (21.7 %) than is observed with traditional CL services. A multidisciplinary proactive CL model shows promise in identifying people at-risk for PMADs and providing targeted interventions to prevent PMADs and treat those with active symptoms.

Psychological needs fulfillment and perinatal well-being among low-SES individuals: a mixed methods investigation.

Poor perinatal mental health is associated with deleterious effects and individuals with low socioeconomic status (SES) are at elevated risk. Fortifying multi-level resources of low-SES pregnant individuals to boost their well-being is a crucial step toward achieving equity in perinatal health. The purpose of this project was to explore what patterns of resources supported well-being among low-SES pregnant individuals in Colorado. In a prospective mixed methods cohort study, 23 low-SES pregnant individuals completed surveys and interviews. Participants were separated into 3 subgroups based on their overall Warwick-Edinburgh Mental Well-being Scale (WEMWBS) score and interviewed to identify multi-level resources that supported their well-being. Our analysis was framed by Self-Determination Theory which contends that three universal basic psychological needs are required for individuals to function in a healthy manner: autonomy, competence, and relatedness. We extrapolated resources that promoted perinatal competence, autonomy, and relatedness from the high well-being group. Perinatal-related knowledge (construct related to competence); mindfulness and intended pregnancy (constructs related to autonomy); and emotional, informational, and friend support, social capital, and connection to nature (constructs related to relatedness) were identified as the resources more frequently endorsed in the high well-being group. Targeting interventions to fortify specific multi-level resources that support the autonomy, competence, and relatedness of pregnant individuals facing socioeconomic disadvantage is a crucial step toward achieving equity in perinatal health.

Perinatal substance use treatment and criminal legal system referral trends.

INTRODUCTION: To guide improvements in treatment for pregnant persons with substance use disorders within the criminal legal system, treatment programs must first determine the primary substances of concern for this population. The objective of this study is to compare trends in specific substance use upon admission to treatment in pregnancy, based upon whether referrals originated from the criminal legal system or from another referral source. METHODS: This research accessed data on perinatal substance use (1995-2021) and referral sources from the Treatment Episode Data Set-Admissions (TEDS-A). Analyses use multiple logistic regressions to evaluate trends in primary substance use leading to treatment admission during pregnancy. RESULTS: Approximately 1 % (N = 536,948) of all substance use treatment admissions in TEDS-A were for pregnant people. Between 1995 and 2021, the percentage of treatment admissions increased for primary methamphetamine use (10 % to 27 %), primary opioid use (21 % to 38 %), and primary cannabis use (9 % to 18 %), and decreased for primary cocaine use (32 % to 6 %) and primary alcohol use (26 % to 11 %). By 2021, treatment admissions referred from criminal legal agencies were more likely to primarily be for primary methamphetamine use (33 % vs 25 %) and less likely to be for primary opioid use (22 % vs 42 %) compared to other referral sources. CONCLUSIONS: Trends in substance use treatment during pregnancy have changed substantially over the past few decades and emphasize the unique needs of patients referred to treatment by the criminal legal system. Treatment programs must therefore adapt to fluctuating trends in perinatal substance use. In particular, it is important to expand programs that prioritize treatment of methamphetamine use disorder for pregnant people referred through criminal legal agencies.

Effectiveness and cost-effectiveness of models of maternity care for women from migrant and refugee backgrounds in high-income countries: A systematic review.

BACKGROUND: Different models of care may be appropriate for various groups of women during their perinatal period, depending on their risk level, location, and accessibility of healthcare practitioners and facilities. Evaluating these models' effectiveness and cost-effectiveness is critical to allocating resources and offering sustained care to women from refugee backgrounds. This systematic review aimed to synthesize evidence on the effectiveness and cost-effectiveness of maternity care models among women from migrant and refugee backgrounds living in high-income countries. METHODS: A comprehensive search of major databases for studies published in English between 2000 and 2023 was developed to identify literature using defined keywords and inclusion criteria. Two authors independently screened the search findings and the full texts of eligible studies. The quality of the included studies was appraised, and qualitative and quantitative results were synthesised narratively and presented in tabular form. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Forty-seven research papers from six countries were included in the review. The review highlighted the positive impact of community and stakeholders' involvement in the implementation of models of maternity care for women from migrant and refugee backgrounds. The review summarised the models of care in terms of their effectiveness in improving perinatal health outcomes and minimising medical interventions, continuum of care in maternity services, enhancing health literacy, maternity service use and navigating the healthcare system, social support, and sense of belongingness, and addressing cultural and linguistic barriers. Notably, only one study conducted a partial economic evaluation to determine the cost-effectiveness of the model. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH: While the reviewed models demonstrated effectiveness in improving perinatal health outcomes, there was considerable variation in outcome measures and assessment tools across the models. Thus, reaching a consensus on prioritised perinatal outcomes and measurement tools is crucial. Researchers and policymakers should collaborate to enhance the quality and quantity of economic evaluations to support evidence-based decision-making. This includes thoroughly comparing costs and outcomes across various health models to determine the most efficient interventions. By emphasizing the importance of comprehensive economic evaluations, healthcare systems can better allocate resources, ultimately leading to more effective and efficient healthcare delivery.

Study protocol: perinatal mood treatment study.

Perinatal depression (PND) affects up to 20% of women and is associated with significant impairment and disability in affected women. In addition, perinatal depression is associated with broader public health and multigenerational consequences. Innovative approaches are needed to reduce the burden of perinatal depression through identification, tracking, and treatment of depressive symptoms during the perinatal period. This study is a randomized clinical trial comparing the relative efficacy of a multi-tiered system of care, Screening and Treatment of Anxiety and Depression (STAND) to perinatal care delivered by a reproductive psychiatrist in reducing symptoms of depression and anxiety. A sample of 167 individuals was randomized between week 28 of pregnancy and 6 months postpartum. A secondary aim compares the original online therapy intervention used in the first half of the study to a newer online therapy program used in the second half of the study for individuals assigned to the STAND treatment. The study measures, intervention groups, and analysis methods are described, as well as expected implications. The findings from this study may improve the methods for tracking symptom changes over time, monitoring treatment response, and providing personalized care for individuals with PND. As such, this study may improve the lives of patients with PND and their families and lower the related health care costs to society.Trial registration NCT: 9/24/2021NCT direct link: https://www.clinicaltrials.gov/study/NCT05056454?term=NCT05056454&rank=1&a=1 .

Who is (not) vaccinated? A proposal for a comprehensive immunization information system.

The role of immunization in public health is crucial, offering widespread protection against infectious diseases and underpinning societal well-being. However, achieving optimal vaccination coverage is impeded by vaccine hesitancy, a significant challenge that necessitates comprehensive strategies to understand and mitigate its effects. We propose the integration of Population Health Management principles with Immunization Information Systems (IISs) to address vaccine hesitancy more effectively. Our approach leverages systematic health determinants analysis to identify at-risk populations and tailor interventions, thereby promoting vaccination coverage and public health responses. We call for the development of an enhanced version of the Italian National Vaccination Registry, which aims to facilitate real-time tracking of individuals' vaccination status while improving data accuracy and interoperability among healthcare systems. This registry is designed to overcome current barriers by ensuring robust data protection, addressing cultural and organizational challenges, and integrating behavioral insights to foster informed public health campaigns. Our proposal aligns with the Italian National Vaccination Prevention Plan 2023-2025 and emphasizes proactive, evidence-based strategies to increase vaccination uptake and contrast the spread of vaccine-preventable diseases. The ultimate goal is to establish a data-driven, ethically sound framework that enhances public health outcomes and addresses the complexities of vaccine hesitancy within the Italian context and beyond.

Psychosocial and mental health challenges facing perinatally HIV-infected adolescents along the Kenyan coast: a qualitative inquiry using the socioecological model.

Background: The advent of antiretroviral therapy has led perinatally HIV-infected (PHI) adolescents to live long, fulfilling lives through lifelong treatment. However, there is limited knowledge about the lived experiences and psychosocial and mental health challenges faced by PHI adolescents in sub-Saharan Africa, where 80% of PHI adolescents reside. To address this gap, we adapted the socioecological model to investigate the challenges and lived experiences of PHI adolescents in rural coastal Kenya. Methods: Between October and November 2018, a sample of 40 participants (20 PHI adolescents and their 20 primary caregivers) participated in a qualitative study using an H-assessment data collection approach for adolescents and focus group discussions with caregivers. Data analysis was conducted using a framework approach on NVIVO 11 software. Results: PHI adolescents from this setting experience many challenges across various levels of the ecosystem. At the individual level, challenges include living in denial, HIV status disclosure, antiretroviral adherence, internalized stigma, and mental health issues. Within the family, challenges such as parental loss, insufficient care from parents, and unacceptance lead to threats of harm. In the broader community, key challenges such as gossip, unsupportive community members, long waiting times at the health facility, isolation, rejection, and an unresponsive school system fail to address the needs of PHI adolescents. Finally, HIV-related stigma and discrimination manifested across different levels of the socioecological framework. To cope with these challenges, PHI adolescents often rely on privacy and social support from their families. Conclusion: The findings underscore the need to develop and implement multi-level adolescent-friendly interventions to address PHI adolescent challenges and guide future investment in adolescent's health. Furthermore, there is a need to address internalized and interpersonal stigmas through individual-level interventions that promote resilience and the active involvement of adolescents, their caregivers, peers, and teachers who are their social support system.

Maternal Fiber Intake and Perinatal Depression and Anxiety.

(1) Background: Dietary fiber can significantly alter gut microbiota composition. The role of the gut microbiome in the Gut-Brain Axis and modulation of neuropsychiatric disease is increasingly recognized. The role of antenatal diet, particularly fiber intake, in mitigating maternal mental health disorders remains unexplored. The objective of this review is to investigate the association between maternal fiber intake and perinatal depression and anxiety (PDA). (2) Methods: A literature review of PubMed and Google Scholar was conducted using appropriate keyword/MeSH terms for pregnancy, diet, fiber, and mental health. Observational and clinical trials published between 2015 and 2021 were included and data pertaining to dietary patterns (DP), food intake, mental health, and demographic data were extracted. The top three fiber-containing food groups (FG) per study were identified using a sum rank scoring system of fiber per 100 g and fiber per serving size. The consumption of these top three fiber FGs was then ranked for each dietary pattern/group. Mental health outcomes for each study were simplified into three categories of improved, no change, and worsened. The relationship between top three fiber FGs consumed within each DP and mental health outcomes was analyzed using Spearman's correlation. (3) Results: Thirteen of fifty-two studies met the inclusion criteria. Ten (76.9%) studies assessed DPs (seven examined depression only, two examined depression and anxiety, and one examined anxiety only). Seven (53.9%) studies reported at least one significant positive relationship between mental health outcomes and DPs while three reported at least one negative outcome. Three (23.1%) studies compared intake of different food groups between depressed and non-depressed groups. In studies of DPs, the average consumption ranking of the top three fiber FGs bore a significant inverse association with mental health outcomes [r = -0.419 (95%CI: -0.672--0.078)] p = 0.015. In studies comparing the intake of different FGs between depressed and non-depressed groups, the consumption of top-ranking fiber foods was higher in the non-depressed groups, but significantly higher in four of the ten high fiber FGs. (4) Conclusions: This study reframes findings from previously published studies of maternal diet and mental health outcomes to focus on fiber intake specifically, using a fiber ranking system. A significant correlation between lower intake of fiber and poorer mental health outcomes warrants further investigation in future studies.

Sexual and reproductive health outcomes of women who experienced violence in Germany: Analysis of the German health interview and examination survey for adults (DEGS1).

OBJECTIVES: Violence against women is a widespread public health concern with severe effects to women's sexual and reproductive health, including higher risks for miscarriage or stillbirth, unintended pregnancy and induced abortion. This study examined the association between women exposure to physical violence, psychological violence and sexual and reproductive health outcomes (contraceptive use, miscarriage or stillbirth and abortion) in Germany. METHODS: This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18-64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions). RESULTS: Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02-1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17-3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30-2.70). CONCLUSIONS: The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers.

Trajectories of adolescents living with vertical transmission-HIV virus. / Trajetórias de adolescentes que vivem com o vírus HIV por transmissão vertical.

This study analyzes the life stories of eight young people living with vertically transmitted HIV in order to understand their perceptions marked by secrecy and silence regarding their experiences with the virus. Conducted at a specialized outpatient clinic in Rio de Janeiro, the study adopted circle dance, a Complementary and Integrative Health Practice, as a care tool. Using a qualitative approach and Life History as a data collection method, the focus was to understand the youth's experiences related to the disease and the crucial aspects of their lives. Three girls and five boys participated in the study, all aware of their diagnosis. The principal emerging themes included family dynamics, school environment connection, challenges in treatment adherence, age at the time of diagnosis disclosure, and time elapsed since then. Analyzing these young people's narratives allowed us to explore individual and social aspects of their experiences, revealing their similarities and differences. The circle dance workshops provided a playful space for expressing emotions and feelings through body movements, expanding young people's perspectives on the future.

Este estudo analisa as histórias de vida de oito jovens vivendo com HIV por transmissão vertical, visando compreender suas percepções marcadas pelo segredo e silêncio sobre suas vivências com o vírus. Realizado em ambulatório especializado no Rio de Janeiro, o estudo adotou como ferramenta de cuidado a dança circular, considerada uma Prática Integrativa e Complementar em Saúde. Utilizando abordagem qualitativa e a História de Vida como método de coleta, o foco foi compreender as experiências dos jovens, não apenas relacionadas à doença, mas também a aspectos cruciais de suas vidas. Participaram do estudo três meninas e cinco meninos, todos cientes de seu diagnóstico. Os principais temas emergentes incluíram dinâmica familiar, conexão com o ambiente escolar, desafios na adesão ao tratamento, idade no momento da revelação do diagnóstico e tempo decorrido desde então. A análise das narrativas desses jovens, permitiu explorar aspectos individuais e sociais da experiência, revelando similaridades e diferenças entre eles. As oficinas de dança circular ofereceram um espaço lúdico para a expressão de emoções e sentimentos por meio dos movimentos corporais, ampliando as perspectivas dos jovens em relação ao futuro.

Assessment of Navy Provider Knowledge of Women's Mental Health Services, Treatment Practices, and Training.

INTRODUCTION: As female active duty populations increase in all military environments, it is critical that women's health be addressed in a comprehensive manner. The study's results will be utilized to assist Navy health care leaders in addressing female force readiness policies, treatment gaps, and training specific to women's mental health. MATERIALS AND METHODS: In total, 212 active duty participants were recruited from the Navy's mental health specialties. The survey was hosted on the U.S. Government's MAX.gov survey website and received Institutional Review Board and Survey Review Board approval per Navy and Defense Health Agency requirements. Participants recorded their experiences with various patient presentations using Likert scale assessments, indicated their comfort in prescribing medication to patients with 11 distinct presenting concerns, and responded to six questions regarding their training and clinical experience in the field of women's mental health. RESULTS: Differences were noted for provider gender, treatment setting, patient sex, provider rank, and years of independent practice. Female providers were more likely than males to report that their female patients presented with 15 of the 21 measured issues. Providers located at MTFs were significantly more likely than providers in operational billets to report female patients presenting with certain conditions and reported being more comfortable prescribing medication. Eighty percent of respondents authorized to prescribe medicine rated themselves as very or extremely comfortable prescribing medications to their patients for all specified conditions except two: women who are breastfeeding and women who are pregnant. Senior officers reported the most comfort prescribing medication to women who are planning to become pregnant and women who have experienced perinatal loss. Only a minority of providers (20%, female; 33%, males) reported receiving women's mental health education during their training. Of those who did receive training, it was limited to post-partum and pregnancy. Most participants (93%) agreed that women's mental health should be incorporated into training programs for military providers. CONCLUSIONS: This exploratory study highlights that provider variables impact assessment and treatment of and for patients. The study highlights the interplay of gender, treatment setting, experiences, and level of comfort are associated with provider assessment of presenting concerns. The authors hope this study will help in prioritizing women's mental health practices, mental health training, and research, and in informing policy and decision-making.

Perspectives of parents with lived experience of cytomegalovirus infection, on universal newborn screening for congenital cytomegalovirus (cCMV) in Canada: a patient-led qualitative study.

OBJECTIVE: To understand parental perspectives regarding universal newborn screening (UNS) for congenital cytomegalovirus (cCMV) in Canada. DESIGN: A qualitative, patient-led study using the Patient and Community Engagement Research approach consisting of online focus groups and in-depth individual interviews to understand parental preferences regarding UNS for cCMV. Data were analysed iteratively using inductive thematic analysis and narrative story analysis. SETTING: Canada-wide study conducted via video conference from October to December 2023. PATIENTS: 12 participants from five Canadian provinces who self-identified as 18 years of age or older and as having parental lived experience with cytomegalovirus (CMV) or cCMV participated in the study. RESULTS: We identified three themes: (1) attitudes about UNS for cCMV, including participants' unanimous support for UNS and confirmation that parental anxiety is not a deterrent for screening, (2) cCMV diagnosis, including the importance of coupling cCMV diagnosis with access to treatment and medical support and (3) awareness of cCMV, where participants shared their frustration about the lack of public and pregnant people's awareness of cCMV. CONCLUSIONS: Parental anxiety is not a deterrent for UNS for cCMV. Children with cCMV and their families deserve every opportunity to attain their best possible outcomes. UNS offers children with cCMV access to early intervention if they need it, and also helps to raise awareness and education to prevent future CMV infections.