Coping Strategies Associated with Emotional Adjustment during the Dyadic Experience of Infertility and Its Treatment: A Systematic Review.

BACKGROUND: The aim of this systematic review was to reveal which of the coping strategies used by one partner are protective of and which pose a risk to the other partner's psychological adjustment during the treatment of infertility. MATERIAL AND METHODS: A systematic search of four electronic databases (PubMed, APA PsycINFO, SCOPUS, ScienceDirect), as well as the references of the retrieved articles, was performed between May and September 2023 for studies published from 1990 until 2023, using appropriate MeSH terms and associated text words. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Using an a priori developed pilot data extraction form, authors performed an independent extraction of articles. Information on participants, coping mechanisms, and psychological adjustment was extracted from each study. Relevant articles were critically appraised, and a narrative synthesis was conducted based on the different designs and outcome measures among the included studies. RESULTS: A total of 194 articles were retrieved, and 187 were excluded for not meeting the inclusion criteria. After duplicates had been removed, five studies were included in the review. The results revealed that the psychological adaptation of infertile couples at an interpersonal level may be correlated with both the type of coping and the stage of the stressor (infertility treatment or in vitro fertilisation - IVF). CONCLUSION: This systematic review suggests that health professionals could design and apply interventions based on modifying the coping mechanisms of infertile spouses to increase levels of well-being and decrease levels of distress.

The Associations of Perceived Self-Efficacy with Emotional Intelligence, Personality, Resilience, and Attitudes Towards Death among Midwives.

Midwives' self-efficacy can significantly affect the provided care and, therefore, maternal and neonatal outcomes. The aim of the present study was to investigate associations of perceived self-efficacy with emotional intelligence, personality, resilience, and attitudes towards death among midwives in Greece. From 2020 to 2022, a total of 348 midwives were recruited in this descriptive cross-sectional study. The participants were employed as independent professionals, in public hospitals or regional health authorities. Data collection involved five research instruments: the General Self-Efficacy Scale (GSES), the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), the Eysenck Personality Questionnaire (EPQ), the Connor-Davidson Resilience scale (CD-RISC), and the Death Attitude Profile-Revised (DAP-R) scale. The mean score for the GSES was 29.1 (SD = 4.2), suggesting a moderately elevated level of self-efficacy among midwives. The results revealed that higher scores on the GSES were significantly associated with higher scores on the Extraversion subscale (p < 0.001) and lower scores on the Neuroticism (p < 0.001) and Lie (p = 0.002) subscales of the EPQ. Additionally, high self-efficacy was significantly correlated with high emotional intelligence (p < 0.001), high neutral acceptance of death (p = 0.009), and high resilience (p < 0.001). These findings highlight the relationship between the self-efficacy of Greek midwives and various psychological factors, as well as the multifaceted nature of self-efficacy and its importance for midwives' psychological well-being and professional functioning.

Validation of the Greek version of Mother's Autonomy in Decision Making (MADM) scale.

INTRODUCTION: Ensuring expectant mothers have the capacity to make well-informed decisions regarding their prenatal care, encompassing medical interventions, and birthing preferences are crucial for fostering favorable health outcomes for both mother and newborn. The Mother's Autonomy in Decision Making (MADM) scale serves as a commonly utilized tool for evaluating the autonomy of pregnant women in the decision-making processes related to prenatal care and childbirth. The aim of this study is to validate the MADM scale in women who had at least one home childbirth experience in Greece. METHODS: A retrospective online survey collected data from Greek women with home childbirth experience (January 2010 - December 2023). We utilized a self-administered questionnaire and the Greek version of the MADM scale. RESULTS: The study included 162 women, predominantly of Greek nationality (94.4%) and residing in Attica (54%). The MADM scale showed a median score of 38. The confirmatory factor analysis indicated acceptable fit and reliability (comparative fit index, CFI=0.92; Tucker-Lewis index, TLI=0.91; root mean square error of approximation, RMSEA=0.07; Cronbach's α=0.92). Age correlated weakly negatively with the MADM scale score (Spearman's rho= -0.166, p=0.035). Additionally, women attending antenatal preparation courses with a midwife before their first home birth had higher MADM scores (median 39 vs 35, p=0.037). CONCLUSIONS: The study underscores the importance of the MADM scale, demonstrating its reliability and validity for women living in Greece. Younger age and attending antenatal preparation courses with a midwife were associated with higher MADM scores, highlighting education's role in maternal autonomy.

The Relationship between Attitudes toward Death and Emotional Intelligence, Personality, Resilience, and Justice Beliefs: A Cross-Sectional Study of Midwives in Greece.

Midwifery practice inevitably includes miscarriages, stillbirths, and neonatal deaths. The aim of the present study was to investigate the relationship between attitudes toward death and emotional intelligence, personality, resilience, and justice beliefs among midwives in Greece. A descriptive cross-sectional study was conducted from 2020 to 2022 among 348 midwives employed in public hospitals, in regional health authorities, or as independent professionals. Research instruments included the Death Attitude Profile-Revised, the Connor-Davidson Resilience Scale, the Trait Emotional Intelligence Questionnaire-Short Form, the Eysenck Personality Questionnaire, and the Belief in a Just World scale. The results revealed that greater emotional intelligence was significantly associated with higher scores in the escape acceptance subscale. Midwives scored low on the neutral acceptance subscale (2.9 ± 0.8), with the highest score being recorded in the escape acceptance subscale (4.6 ± 1.0), which was significantly associated with greater emotional intelligence. Neuroticism was significantly associated with the death avoidance, approach acceptance, fear of death, and escape acceptance subscales. Finally, the subscale of distributive justice beliefs for self and others was significantly associated with the subscales of death avoidance and approach acceptance. These findings highlight the nuanced perspectives within the healthcare community. As we delve deeper into the complexities of end-of-life care, understanding these diverse attitudes is crucial for providing comprehensive and empathetic support to both patients and healthcare professionals.

Breastfeeding Practices for COVID-19-Infected Mothers: A Systematic Review and Meta-Analysis.

(1) Background: The ongoing COVID-19 pandemic has led to an increasing number of women giving birth while also grappling with SARS-CoV-2. The objective of this review is to examine the possibility of transmission of the virus from mother to infant through breastfeeding, skin-to-skin contact, and rooming-in and to explore methods for managing COVID-19-positive mother-infant dyads. (2) Methods: A comprehensive search strategy was employed that covered pertinent studies from the Cochrane Library, PubMed Central, and Scopus databases. The Matrix Method and PRISMA guidelines were utilized by the researchers, with the search being updated until 20 December 2021, one year after the initial vaccine delivery. The inclusion criteria for the study involved articles published in English, those employing broad search terms, and those comprising full-text reviews. Additionally, the researchers required that the articles be published from December 2019 onwards. To further analyze the data, a meta-analysis was performed to estimate the rate of infant infection from mothers who engaged in breastfeeding, skin-to-skin contact, and rooming-in practices. (3) Results: Eighteen studies were analyzed in this review, with an infected infant rate of 2.8%. The maternal practices used in these studies ranged from direct separation of the infant to direct skin-to-skin contact, rooming-in, and exclusive breastfeeding. One study investigated the factors associated with positive test results in newborns and found that only the maternal social vulnerability index >90 was a significant predictor. The type of delivery, rooming-in, and the mother's symptom status were not associated with positive neonatal outcomes. (4) Conclusions: According to current data, the incidence of perinatal infection with SARS-CoV-2 is relatively low. It is advised that mothers adhere to several supportive care measures, including engaging in breastfeeding, skin-to-skin contact, and rooming-in. These measures ought to be complemented by diligent hand hygiene, the wearing of masks, and the cleansing of breasts solely when necessary.

Evaluating Sexual Health in Women with Multiple Sclerosis: A Study on the Interplay of Disability and Quality of Life.

In the context of evolving perceptions of sexuality, particularly within the realm of health and disability, this study investigates the impact of multiple sclerosis (MS) on female sexual function and quality of life. A quantitative study involving 130 female MS patients aged 35 to 50 was conducted, employing measures such as The Female Sexual Function Index (FSFI), The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), and The Fatigue Severity Scale (FSS). Results indicate a significant association between greater sexual dysfunction and poorer quality of sex life, alongside the correlation of increased fatigue with diminished sexual satisfaction. Specifically, the mean FSFI score was 20.8 (SD = 9.36), with 83.8% of participants experiencing severe fatigue (FSS score ≥ 36). Sexual dysfunction demonstrated a strong, negative correlation with all FSFI subscales (p < 0.01). Factors such as education level (p = 0.016), time of diagnosis (p = 0.035), and treatment regimen (p = 0.041) also significantly influenced outcomes. Findings underscore the importance of supportive interventions, including counseling, to enhance the quality of sex life for women with disabilities, particularly those with MS.

Serum Neuron-Specific Enolase as a Biomarker of Neonatal Brain Injury-New Perspectives for the Identification of Preterm Neonates at High Risk for Severe Intraventricular Hemorrhage.

Neonatal brain injury (NBI) is a critical condition for preterm neonates with potential long-term adverse neurodevelopmental outcomes. This prospective longitudinal case-control study aimed at investigating the levels and prognostic value of serum neuron-specific enolase (NSE) during the first 3 days of life in preterm neonates (<34 weeks) that later developed brain injury in the form of either periventricular leukomalacia (PVL) or intraventricular hemorrhage (IVH) during their hospitalization. Participants were recruited from one neonatal intensive care unit, and on the basis of birth weight and gestational age, we matched each case (n = 29) with a neonate who had a normal head ultrasound scan (n = 29). We report that serum NSE levels during the first three days of life do not differ significantly between control and preterm neonates with NBI. Nevertheless, subgroup analysis revealed that neonates with IVH had significantly higher concentrations of serum NSE in comparison to controls and neonates with PVL on the third day of life (p = 0.014 and p = 0.033, respectively). The same pattern on the levels of NSE on the third day of life was also observed between (a) neonates with IVH and all other neonates (PVL and control; p = 0.003), (b) neonates with II-IV degree IVH and all other neonates (p = 0.003), and (c) between control and the five (n = 5) neonates that died from the case group (p = 0.023). We conclude that NSE could be an effective and useful biomarker on the third day of life for the identification of preterm neonates at high risk of developing severe forms of IVH.

Conventional Cardiotocography versus Computerized CTG Analysis and Perinatal Outcomes: a Systematic Review.

Introduction: Cardiotocography (CTG) constitutes a major and generally used tool for the assessment of fetal well-being. Subjectivity is the main difficulty in the interpretation of CTG. Inter- and intra-observer variability are substantival features of the interpretation of CTGs. An auspicious answer for reduction of inter- and intra-observer variability is the computerized analysis of fetal heart rate (FHR). Moreover, computerized analysis contributes to the reduction of adverse maternal and fetal outcomes. Objective: The aim of the present review was to compare the visual and computerized analysis of CTG for establishing whether computerized CTG was related to better perinatal outcomes. Materials and methods: Three electronic medical related databases (PubMed, Scopus and Cochrane) were searched from May to June 2023 in order to find randomized controlled trials (RCTs) in English. Studies were evaluated for their methodological quality with the CONSORT checklist. The target population comprised pregnant or intrapartum women into cardiotocographic monitoring. The intervention was represented by the visual analysis of CTG, and the comparison intervention by the computerized analysis of CTG. Primary outcomes included adverse perinatal outcomes. Results: A total of 47 studies relevant with the topic were examined. However, only five articles met all inclusion and methodological criteria; four of those demonstrated that computerized analysis had no significant reduction in the rate of metabolic acidosis or obstetric interventions, and one study found a lower incidence of adverse perinatal outcome with conventional CTG (with fetal blood sampling). However, all reviews propose further development of decision-support software and more large-scale RCTs in the future. Conclusion: The computerized analysis of FHR is a promising solution for the reduction of adverse perinatal outcomes and elimination of inter- and intra-observer variability.

Fathers' Educational Needs Assessment in Relation to Their Participation in Perinatal Care: A Systematic Review.

Even though they are crucial for a positive pregnancy experience, many fathers may not be aware of the significance of their role in perinatal care. As it is important to identify the needs of the target population in the initial phases of a health plan in order to ensure success, the current systematic review is the first one to address the reported needs for men's antenatal education. METHODS: All studies written in English and published between 1997 and 2021 relevant to the theme were included in the review. The electronic databases of various mainstream journals were used to evaluate 87 studies. RESULTS: In total, the validity of 17 studies was determined based on their compliance with the inclusion criteria. According to the review, men's participation in antenatal education can significantly influence pregnancy, childbirth, parenting, couple's relationship, and overall family functioning. CONCLUSION: Providing face-to-face antenatal education to men by doctors or midwives is emphasized as an important component of perinatal care preparation because it leads to positive outcomes.

Quality of Life among Couples with a Fertility Related Diagnosis.

Fertility-related stress can negatively impact infertile couples' quality of life (QoL). Most previous studies have concentrated on the effects of stress and infertility on individual persons, especially women, though infertility affects the QoL of both spouses. Our research aimed to investigate the roles of infertility and stress in couples' quality of life as a single unit. The research sample consisted of 202 spouses, i.e., 101 couples, with a mean age of 39.5 years (SD = 4.9 years) undergoing fertility treatment at Athens Naval Hospital-Assisted Reproduction Unit. Data collection was completed via self-administered questionnaires: the FertiQoL International Questionnaire for measuring the quality of life in infertility and The Demographic Information and Medical History Questionnaire. Data collection was conducted between January and November 2022. Quantitative variables are expressed as mean values (standard deviation) and as median interquartile range, and qualitative variables are expressed as absolute and relative frequencies. Pearson's (r) and Spearman's (rho) correlations coefficients were used to explore the association of two continuous variables. Multiple linear regression analysis was used with dependence on the Ferti-QoL's subscales. The regression equation included terms for participants' demographics and information from their medical history. Adjusted regression coefficients (ß) with standard errors (SE) were computed from the results of the linear regression analyses. All reported p values are two-tailed. Statistical significance was set to p < 0.05, and analyses were conducted using SPSS statistical software (version 22.0). We found that greater anxiety and depression were significantly associated with worse quality of life. Additionally, quality of life, according to Ferti-QoL, was significantly worse in women, participants with a high level of education, those with greater depressive symptoms, and those with greater state scores. Findings of this study highlight the need for implementing interventions of supportive care methods, counseling, stress reduction methods, and improving the fertility-related quality of life of infertile couples.

Pregnancy during the pandemic: The psychological impact of COVID-19 on pregnant women in Greece.

INTRODUCTION: The COVID-19 outbreak has affected the overall health of people worldwide. Historically, pandemics pose a challenge to psychological resilience, causing heightened stress levels. This study aimed to investigate the impact of the COVID-19 pandemic on the psychological state of pregnant women in Greece. METHODS: A survey study was conducted on a sample of 149 pregnant women in late 2020, including the 'fear of COVID-19' scale, a self-report instrument that assess fear of COVID-19 among the general population and the State-Trait Anxiety Inventory (STAI) scale which measures state and trait anxiety. RESULTS: Pregnant women with a mental health history tended to score higher on the 'fear of COVID-19' scale (mean ± SD: 19.48 ± 4.35) compared to pregnant women who had never had mental health problems before (17.12 ± 5.27). Moreover, pregnant women with anxiety as part of their personality tended to also score higher on the 'fear of COVID-19' scale. In all, 48.3% of pregnant women reported that their psychological state had been severely affected by the COVID-19 outbreak. CONCLUSIONS: Pregnant women were highly affected by the COVID-19 pandemic. A significantly increased 'fear of COVID-19' scale score was associated with self-reported pre-existence mental health conditions. Pregnant women with higher levels of 'trait anxiety' tended to report higher scores on the 'fear of COVID-19' scale.

Abuse of Girls During Childhood and Its Impacts on the Health of Their Adult Lives: A Systematic Review.

Child abuse is a global problem for public health as it negatively affects people and society. The US Centers for Disease Control and Prevention (CDC) associates the adverse experience during childhood with a series of long-term impacts on health. The aim of this study is to explore the impact of child abuse on females' health, including physical, mental, and social health. The methodology used in this specific review is to carry out a systematic search in electronic databases (Google Scholar, Scopus, PubMed, and Crossref) in published articles between 2004 and 2021. The exclusion criteria were all review papers, such as literature reviews, systematic reviews, and meta-analyses. We also excluded papers that were not written in the English language. Consequently, the inclusion criteria were written in English, original articles, and prospective, case-control, cross-sectional studies that investigated childhood abuse of girls and the health effects in adulthood. Initially, from a total of 796 papers returned by the search, 415 were rejected due to duplicate articles, systematic reviews, and meta-analyses. In addition, 316 articles were rejected due to nonrelevance to the study's subject. However, from the first 796 papers, 18 met the conditions to be included in the review. We found that females exposed to childhood abuse were more likely to suffer from eating disorders, depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, anxiety, phobias, paranoid ideation and psychoticism, early menarche, sleep disorders, metabolism disorders, cardiovascular diseases, asthma, chronic pain, and early mortality, which are physical and mental conditions in females' adulthood related to child abuse. The conclusions of this work show that it is a primary need to give emphasis on combating child abuse and timely management when this is a fact.

Neonatal Palliative Care as an Integral Component of the Greek National Healthcare System: Time to Act.

Neonatal palliative care aims to provide multidisciplinary support to families and neonates suffering from life-threatening or life-limiting diseases. Many countries worldwide have recognized the importance of enhancing the quality of life in critically ill neonates and thus have created and systematically implemented palliative care protocols in neonatal intensive care units (NICUs). Europe has a very low neonatal mortality rate, which has been steadily decreasing over the last 30 years. Greece in particular, a country located in Southeast Europe, reported a neonatal mortality rate of 2.29/1,000 live births in 2020. Nevertheless, neonatal palliative care facilities are scarce on a national level. In this paper, several reasons are presented to support the integration of neonatal palliative care in the Greek national healthcare system with the vision to ensure that all neonates and their families will receive in the near future the care, support, and dignity they deserve when facing life-threatening or life-limiting illnesses.

Knowledge and Attitudes of Healthcare Professionals Regarding Perinatal Influenza Vaccination during the COVID-19 Pandemic.

Immunizations during pregnancy are an important aspect of perinatal care. Although the influenza vaccine during pregnancy is safe, vaccination rates are low. According to research data, one of the reasons for the low vaccination rates among pregnant women is that they do not receive a clear recommendation from healthcare providers. This study aims to record the knowledge and attitudes about influenza vaccination and investigate healthcare professionals' recommendations during the perinatal period. A cross-sectional study was conducted with convenience sampling in Athens, Greece. Our purposive sample included 240 midwives, Ob/Gs, and pediatricians. Data were collected using an appropriate standardized questionnaire with information about demographics, attitudes towards influenza vaccination, and knowledge about the influenza virus and peripartum vaccination. Statistical analysis was conducted using IBM SPSS-Statistics version 26.0. This study identifies the reasons for the lack of vaccine uptake including a wide range of misconceptions or lack of knowledge about influenza infection, lack of convenient access to get vaccinated, etc. Misconceptions about influenza and influenza vaccines could be improved by better education of healthcare workers. Continuing professional education for health professionals is necessary to improve the level of knowledge, prevent negative beliefs, and promote preventive and therapeutic practices.

The Effect of Antenatal Education on Expectant Fathers' Attitudes toward Breastfeeding and Attachment to the Fetus.

BACKGROUND: This study explores the effect of antenatal education on fathers' attitudes toward: (i) breastfeeding and (ii) attachment to the fetus. A secondary aim is to explore the relationship of fathers' demographic and the psycho-emotional characteristics that come with breastfeeding and attachment. METHODS: This is a longitudinal study involving a group of 216 Greek expectant fathers who participated with their partners in an antenatal educational program performed by midwives in Athens, Greece (September 2020-November 2021). The Iowa Infant Feeding Attitudes Scale (IIFAS) and Paternal Antenatal Attachment Scale (PAAS) were administered at two time points: (a) 24th-28th gestation week and (b) 34th-38th gestation week. The T-test and Univariate Analyses of Variance (ANOVA) were performed. RESULTS: The expectant fathers' scores show that breastfeeding intention/exclusivity and prenatal attachment to the fetus were higher after their participation in the antenatal education program, but the difference was not statistically insignificant. Expectant fathers with a cohabitation agreement (p = 0.026), who felt very much supported by their partners (p = 0.001) and had no relationship difficulties with their partners (p < 0.001), as well as those who reported being very happy during pregnancy (p < 0.001), showed greater paternal antenatal attachment to the fetus. CONCLUSIONS: Although the difference was statistically insignificant, antenatal education appears to have an impact on paternal breastfeeding attitudes and antenatal attachment to the fetus. Additionally, several paternal characteristics were associated with greater antenatal attachment. Future research should be directed toward the investigation of additional factors that impact antenatal-paternal attachment and breastfeeding attitudes so that effective education programs can be designed.

Assessing the Presence of IgG Antibodies against Influenza Viruses in Neonates after Maternal Vaccination and Factors That May Affect the Transplacental Transfer.

Special populations, particularly pregnant women, are uniquely susceptible to infectious diseases due to alterations in their immunological, respiratory, and cardiovascular systems during gestation. Influenza infections during the perinatal period have been associated with more severe maternal and perinatal outcomes, underscoring the critical importance of vaccination data for pregnant women. According to the World Health Organization (WHO), all pregnant women and those of childbearing age should receive the inactivated influenza vaccine, irrespective of their pregnancy stage. This study aimed to elucidate factors influencing neonatal antibody presence following maternal influenza vaccination. Conducted through convenience sampling in Athens, Greece, this study involved 78 pregnant women who received flu vaccinations. The participants completed questionnaires covering demographics, obstetric history, attitudes toward influenza vaccination, and knowledge about the influenza virus and pregnancy vaccination. Blood samples were collected from 83 neonates to assess IgG antibody presence. Five of the surveyed women had twin pregnancies. The statistical analysis employed IBM SPSS-Statistics version 26.0. This study revealed the presence of positive influenza A and B antibodies in neonates following maternal immunization. Furthermore, it identified factors such as the gestational week and timing of vaccination during pregnancy that influenced the transfer of antibodies from mother to fetus. These findings offer valuable insights for healthcare professionals to provide informed recommendations on influenza vaccination during pregnancy and empower expectant mothers to make informed decisions about the benefits of immunization.

Risk Assessment of COVID-19 Vaccination Among Childbearing Women.

Background:Recent studies have shown that pregnant women were more likely to experience COVID-19 complications than non-pregnant women, especially during the third trimester. Thus, the objective of the present systematic review is to investigate the literature so as to estimate the safety of COVID-19 vaccination during gestation, regardless of the trimester of pregnancy. Methods:This systematic review was performed based on PRISMA statement and our search included four databases: Medline, PubMed, EMBASE and Google Scholar. Original studies were included. The following search terms were used: coronavirus disease, coronavirus, COVID-19, SARS-CoV-2, vaccine, vaccination, immunity, immunization, pregnancy, gestation, pregnant women, adverse outcomes, impact, safety, risk assessment and all possible combinations between them. Results:The search strategy identified 153 unique items. After the initial screening process, 12 studies underwent full text review and five studies, which met all inclusion criteria, were ultimately included in our systematic review. All four studies claim that COVID-19 vaccination does not have a negative influence on pregnancy and can be beneficial for both the women and their newborns. Conclusion:More clinical trials assessing pregnancy outcome and the value of COVID-19 vaccines in pregnant women are urgently needed. It is vital to determine the most appropriate timing of vaccination across the three trimesters of pregnancy in order to optimize the balance between vaccine efficacy and maternal and foetal safety. Future studies should evaluate the maternal.neonatal transfer of SARS-CoV-2 antibodies as well as long-term infant outcome after administration of the COVID-19 vaccine prenatally.

Construction and validation of a preterm birth risk assessment model using fuzzy analytic hierarchy process.

Preterm births account for almost 1 million deaths globally. The objective of this study is to develop and evaluate a model that assists clinicians in assessing the risk of preterm birth, using fuzzy multicriteria analysis. The model allows experts to incorporate their intuition and judgment into the decision-making process and takes into consideration six (6) risk dimensions reflecting the socio-economic, behavioural and medical profile of pregnant women, thus adopting a holistic approach to risk assessment. Each risk dimension is further analysed and measured in terms of risk factors associated with it. Data was collected from a selected group of 35 experts, each one with more than 20 years of obstetric experience. The model criteria were selected after a thorough literature analysis, so as to ensure a holistic approach to risk assessment. The criteria were reviewed by the experts and the model structure was finalised. The fuzzy analytic hierarchy method was applied to calculate the relative importance of each criterion and subsequent use of the model in assessing and ranking pregnant women by their preterm risk. The proposed model utilises fuzzy logic and multicriteria analysis. It addresses the multifactorial nature of decision making when assessing the preterm birth risk. It also incorporates the obstetricians' intuitive judgement during risk assessment and it can be used to classify cases based upon their risk level. Additionally, it can be applied to evaluate the risk of individual cases in a personalised manner. The proposed model is compared and validated for its predictive value against judgments made by experts.

Validity and reliability of the Greek version of Pregnancy Outcome Questionnaire (POQ).

BACKGROUND: During the last decades a considerable increase in biological and psychosocial approaches have occurred so as to enhance the study of prenatal period. This study aimed to investigate the validity and reliability of the Greek version of Pregnancy Outcome Questionnaire (POQ) in assessing pregnancy-related stress. MATERIAL AND METHODS: The study group consisted of 135 first-time expectant women with good knowledge of the Greek language, low-risk pregnancies and a gestational age of ≥24 weeks. Questionnaires containing the POQ scale questions in addition to other questions and scaleswere distributed in printed and digital format at private gynecological clinics. The collected data were analysed using the SPSS software. RESULTS: The POQ scale score showed satisfactory reliability (Cronbach's alpha = 0.8), while the factor analysis showed a major factor with an eigenvalue of 4.17 and an overall interpreted factor variance of 41%. The sample showed moderate intensity values on the scale. We observed that pregnancy-related characteristics affected the scale, while no significant correlations with demographic variables were recorded. CONCLUSION: The results of the reliability and factor analyses evaluating the scale structure indicated that the tool performed well in Greek, had a compact structure with satisfying reliability, and is suitable for use in the Greek pregnant population. However, additional research is warranted to investigate the effect of various additional factors on the scale.

Identifying factors associated with adolescents' Intention for childbirth.

BACKGROUND: Around the world, caesarean section rates have steadily increased over the past few decades. The World Health Organization (WHO) guidelines on nonclinical interventions to reduce caesarean section rates emphasize educational interventions and support programs. MATERIAL AND METHODS: In this study, we have determined factors associated with adolescents' intention regarding childbirth options using the Theory of Planned Behavior (TPB). The sample was comprised of 480 high school students in Greece who were invited to complete a questionnaire consisting of three sections: a section on sociodemographic data; a section featuring the Adolescents' Intentions towards Birth Options (AIBO) scale, a recently developed instrument that accesses attitudes and intentions regarding vaginal birth and caesarean section; and a section detailing participants' awareness regarding reproduction and birth. RESULTS: Multiple logistic regression found that participants' impressions of vaginal birth and the TPB constructs were significantly associated with intention towards caesarean section. In particular, participants with a negative impression of vaginal birth had a 2.20-fold higher probability of reporting their preference for caesarean section, compared to participants with neither a negative nor a positive impression. Furthermore, participants with higher scores on the "Attitudes towards vaginal birth," "Subjective norms," and "Perceived behavior control over vaginal birth" subscales had a significantly lower probability of reporting preference for caesarean section. CONCLUSION: Our study demonstrates the effectiveness of the TPB to identify factors that influence adolescents' preference for childbirth. We highlight the necessity to implement nonclinical interventions to reduce the preference for caesarean section, providing evidence for developing school-based educational programs for a timely and consistency implementation.