First-time fathers’ experiences of parenting during the first year

Objective: The objective of this study was to explore the experiences of fathers during their first year as parents to fully capture their experiences and transition to parenthood. Background: Becoming a parent for the first time has a life-changing impact for both the mother and the father, yet the factors implicated in the transition to fatherhood have been under-researched. Methods: In this qualitative study using an interpretative phenomenological approach (IPA), 10 first-time fathers were interviewed 7–12 months after the birth of their baby. Results: Two super-ordinate themes were uncovered: experiences during pregnancy and fatherhood – the early days, which are supported by six sub-ordinate themes. Fathers’ narratives can be understood within the theoretical framework of Draper’s Transition Theory; early fatherhood represents the continuation of a man’s transitory journey, which starts during pregnancy. Conclusion: Despite increasing public awareness and socio-political changes affecting paternal parenting culture, fathers still seem to feel undervalued and unsupported when it comes to antenatal support. The antenatal period is a critical time in which to engage with and support motivated expectant fathers; antenatal psycho-education classes can be adapted to accommodate the needs of men. The mental health of the man has an impact on the woman in the antenatal and post-natal periods; addressing the needs of men during pregnancy can function as an early intervention for his family system and could reduce the financial cost to health services in the long term.     

Family planning in Serbia – The perspective of female students from the University of Belgrade

ABSTRACT

Objectives To assess whether current knowledge and attitudes of future female doctors, pharmacists, politicians, journalists and social workers indicate that positive changes may take place in family planning in Serbia.

Methods A total of 504 female students from the University of Belgrade completed a questionnaire related to the physiology of reproduction, contraception, childbearing, and extended cycles of combined oral contraceptive (COC) use.

Results Eighty percent of the study population knew the fertile period in the menstrual cycle. The students had positive opinions about COCs in 52% of the cases, and negative opinions in 48%. More than 80% of respondents were aware of the possibility of suppressing uterine bleeding by COC use, but only 22% would utilise COCs in that manner. Seventy-nine percent considered 25–29 years as the optimal age span for starting childbearing. Nearly all expressed the desire to have children later, with 2.56 being the average number of children wanted.

Conclusion Our findings indicate that professionals who, in the future, will provide education and counselling in the field of contraception, or will be involved in developing a national family planning framework in Serbia, are not likely to go about much differently from those presently active.     

Risk factors of the vertical transmission of human papilloma virus in newborns from singleton pregnancy – preliminary report

Objectives.?Hypoxic-ischemic cerebral injury due to perinatal asphyxia is an important cause of neonatal mortality and morbidity. To predict who will survive or die due to this disorder still remains obscure. The aim of this study is to evaluate the predictive value of myocardial involvement in the assessment of mortality for the neonates with hypoxic-ischemic encephalopathy (HIE).

Patients and methods.?The study included 34 term newborns fulfilling the diagnostic criteria for HIE and staged according to Sarnat and Sarnat classification. To assess the myocardial involvement, electrocardiogram (ECG) and echocardiogram (Echo) were performed in the first 24–48 h of life. In addition, serum Troponin I and creatine kinase-myocardial band (CK-MB) were measured at delivery and postnatal day 3.

Results.?Of the 34 cases, 19 (55.9%) were stage in 1, 9 were in (26.4%) stage 2 and 6 (17.6%) were in stage 3 HIE. Nine (26.4%) patients died of the disease. Thirteen patients (38.2%) showed ECG findings related to perinatal asphyxia. Only one patient had mild Echo changes. Higher Troponin I level was a significant predictor of mortality, whereas CK-MB did not show any significant predicting value. Troponin I test showed 33% sensitivity and 80% specificity in predicting mortality. In addition, the sensitivity and specificity of ECG as a predictor of mortality were 77 and 76%, respectively.

Conclusion.?This study highlights the significance of monitoring cardiac functions in newborns with HIE. ECG changes and serum Troponin I level at 72 h after birth are likely to have significant predictive value in the assessment of mortality in HIE. Further studies will provide additional data for the long-term prognostic value of cardiac functions in this disorder.     

Implementation of the NICE guideline – Recommendations from the British Fertility Society for national criteria for NHS funding of assisted conception

It has been demonstrated that embryo transfer during IVF treatment can be performed competently and successfully by nurses (Barber et al., 1996). The present study has examined the success of nurses in training using the standardized protocol of this Unit. Initially, three nurses (two experienced (training completed) and one inexperienced (training ongoing)) each performed 80 transfers, which were standardized to three embryos replaced per transfer. The study aimed to establish whether a standardized procedure was undertaken by the nurses and to assess the influence of one inexperienced nurse performing the procedure. A further study (study 2) was performed to assess the influence of three inexperienced nurses against three experienced nurses undertaking the same procedures. In study 1, the pregnancy rates were 27.5%, 38.8% and 40.0% and there was no significant difference in the clinical pregnancy rates. In study 2, the pregnancy rates were 18.7%, 20.0% and 20.0% for the inexperienced nurses, and 26.3%, 30.0% and 32.5% for the experienced nurses. There was no significant difference in the clinical pregnancy rates within the inexperienced group or the experienced group. When the results of the three inexperienced nurses were grouped and were compared with those of the three experienced nurses, the pregnancy rates were 19.5% and 29.5%, respectively (P < 0.02). It has been shown that good clinical pregnancy rates can be achieved when nurses perform embryo transfer. There is no significant effect on clinical results when one nurse is in training; however, because of the expected learning curve, when three nurses train together a more significant effect is observed.     

Bureaucratic overheating is a parasite hampering modern clinical research – a viewpoint from the ‘belly of the beast’

Clinical researchers in Europe are experiencing an increasing amount of bureaucracy, which in our eyes has now reached surrealistic heights, hampering the future of research, and thus, the development of new treatment regimens and advances in clinical research. In the long term, the current approval and control processes will negatively impact patient care, education, academia and the health economy of our countries. Thus, a debate is necessary including not only healthcare workers, but also politicians and patients.     

Characteristics of yoga and meditation users among older Australian women – results from the 45 and up study

Background and purposeYoga and meditation are predominantly utilised by healthy well-educated young women, but little is known about utilisation by older chronically ill women. Therefore, the purpose of this study was to investigate the characteristics of yoga and meditation use among middle-to-higher aged Australian women with chronic conditions.Materials and methodsThis is a sub-study of the 45 and Up Study including 1925 Australian women aged 53–95 years diagnosed with chronic conditions (asthma, depression, diabetes, osteoarthritis, and osteoporosis). Information on yoga and meditation use frequencies (categories: ‘no yoga’, ‘at least once daily’, ‘at least once weekly’, and ‘at least once monthly’), self-perceived effectiveness and communication with health care providers were assessed via self-report. Logistic regression analyses were conducted to identify independent predictors of yoga and meditation use, using SPSS 24.0.ResultsOverall 6.8% and 10.7% of women reported the use of yoga and meditation respectively. Meditation was rarely practiced supervised (11.7%), compared to significant higher rates in yoga (53.2%). Predictors for yoga and meditation use were marital status (married/in relationship > not married/in relationship), higher health related hardiness, and higher education, whereas obesity, and diabetes decreased likelihood of use. While the majority found yoga and meditation helpful for their condition, the use was rarely monitored by or discussed with health care practitioners.ConclusionThis study finds that yoga and meditation are used by middle-to-higher aged Australian women with chronic illnesses. The lack of communication with health care providers is concerning and might hinder coordinated and effective health care around chronic illness. Further research is necessary to help understand possible concurrent health care use and thereby help inform safe, effective and coordinate health seeking amongst those with chronic illness.     

The impact of chorionicity and the type of twin growth on the early neonatal outcome in twin pregnancies – 20 years of experience from one tertiary perinatal center

ObjectiveTwin pregnancies are associated with higher neonatal mortality and morbidity. Growth discordance and monochorionicity are among the factors that worsen the course of pregnancy. The study aimed to assess neonatal conditions and mortality in relation to growth type and chorionicity.Materials and methodsData from 820 pregnant women with twin pregnancies and their 1640 newborns were analyzed. The Apgar score and umbilical artery blood pH, as well as the rate of complications, were compared between dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twins with symmetric and discordant growth. The Student's t-test and the Pearson chi-square test were used for comparisons.ResultsThere were 576 (70.2%) DCDA pregnancies, including 421 (73.1%) with symmetric growth and 155 (26.9%) with discordant growth, and 244 (29.8%) MCDA pregnancies, including 110 (45.1%) with symmetric growth and 134 (54.9%) with discordant growth. A significantly greater percentage of twins with discordant growth occurred in women older than 34 years than in those that were younger. An Apgar score of ≤7 was significantly more common among MCDA discordant twins, while an arterial umbilical blood pH of <7.2 was more common among MCDA twins with symmetric growth. Early neonatal deaths (n = 29; 1.8%), respiratory disorders, and a birth weight of <1500 g were significantly more common in MCDA twins than in DCDA twins.ConclusionMCDA twins with growth discordance are burdened with a higher risk of neonatal morbidity and mortality than symmetric DCDA twins. Chorionicity and growth discordancy are important determinants of the outcome of twin pregnancy.     

Approaches to the prevention of postnatal depression and anxiety – a review of the literature

Introduction: Poor maternal mental health during the perinatal period has been shown to have potentially long-lasting effects for mother and child. In recognition of this, maternal mental health is receiving increased attention from political and healthcare organizations, with a growing focus on preventing the onset of common mental health disorders.

Objective: The objective for this review is to provide an update of randomized controlled trials examining the use of interventions targeted to prevent the onset of postnatal depression and anxiety in nondiagnostic populations with universal or selected samples.

Methods: A total of four databases, EBSCO Host, Science Direct, Scopus, and Web of Science, incorporating PsychINFO were searched and papers selected according to clearly specified inclusion criteria. A large Health Technology review was published in 2016, for which the final search was conducted in December 2012. Therefore inclusion criteria were studies published from January 2013 onwards, available in English language, had a focus on prevention of postnatal maternal depression and anxiety, and used psychological interventions. Drug intervention trials were excluded.

Findings: 12 studies were identified as examining antenatal or postnatal intervention trials with an aim of preventing maternal postnatal depression and/or anxiety. There continues to be limited evidence to recommend specific prevention strategies for universal samples without further testing. There is evidence to suggest the use of rational-emotive behavioral therapy in an antenatal sample may have some utility, and the use of psychotherapy-based interventions in a postnatal setting is also supported although both require further investigation. Additionally, there is a need to gather information on acceptability, as many trials were hindered by poor adherence to interventions and high attrition that were otherwise unexplained.     

Early adenocarcinoma of the cervix: is radical vaginal trachelectomy safe?

Objective

Radical vaginal trachelectomy (RVT) is a revolutionary option for fertility preservation in young women with early cervical tumors. Several series have demonstrated outcomes comparable to radical hysterectomy (RH), but none has addressed the influence of histology. We evaluated the safety of RVT in adenocarcinomas.

Methods

Data on surgically treated adenocarcinoma (AC) and squamous cell carcinoma (SCC) cases was taken from a centralized Toronto Cervical Cancer Database. Prognostically important tumor features, lymph node status, and the use of adjuvant therapies were compared. Adenocarcinoma cases treated with RVT were compared to AC cases treated with RH, and to SCC cases that had RVT. Recurrence-free survival was calculated from the date of surgery. Medians, proportions, and survival curves were compared with the Mann Whitney test, the Chi-square test, and the Log Rank test, respectively.

Results

74 patients with AC and 66 patients with SCC undergoing RVT, and 187 cases of AC undergoing RH were analyzed.Patients undergoing RVT were younger than patients having RH (31 vs. 40, p < 0.001). Tumor characteristics were similar, but depth of invasion and the frequency of high grade lesions were higher in the RH group (5 mm vs. 3 mm, p < 0.001; and 36% vs. 22%, p = 0.04). Adjuvant treatment was given more frequently after RH (12% vs. 3%, p < 0.05). There was no significant difference in recurrence-free survival between RH and RVT for AC, or between AC and SCC patients treated by RVT.

Conclusions

RVT is a safe alternative for early stage cervical adenocarcinoma in appropriately selected patients wishing to preserve fertility.     

Is fertility associated with the number of siblings of the couple? Evidence from India

The influence of family on an individual’s fertility has long been an important topic of interest in fertility research. Although studies conducted mostly in developed countries found a significant bearing of fertility of the parents on the fertility of the children, there is a lack of formal research around this topic in India. The present study analyses the effect of sibling size of husband and wife on the completed family size of women using information of 5506 ever-married women aged 45–49 years incorporated in the India Human Development Survey-II (2011–2012). Inferential statistics, bivariate, Chi-square and Poisson regression were used as the methods of analysis. The unadjusted estimates of Poisson regression reveal sibling size of women (IRR: 1.02; p?p?相似文献   

Epidemiology of ROP update – Africa is the new frontier

Several epidemics of blindness due to retinopathy of prematurity (ROP) have been described, with the most recent (the third) occurring in middle income countries in Latin America and Eastern Europe initially, and more recently in the more advanced economies in Asia. In these settings, which are characterized by variation in the quality of neonatal care and inadequate coverage of ROP screening and treatment, larger, more mature infants are affected as well as extremely preterm infants. In 2010 the annual incidence of blindness and visual impairment from ROP globally was estimated to be 32,300, with the lowest incidence in sub-Saharan countries. However, ROP is likely to become an increasingly important cause of blindness in children in sub-Saharan Africa as neonatal care expands unless policies and programmes for control are included at the outset.     

Illegal births and legal abortions – the case of China

Background  

To investigate whether low birth weight increases the risk of myocardial infarction later in life in women.     

Neonatal outcome of the pregnancies associated with placental villous thrombosis – thrombophilic status of the mothers and the infants

Objective: To analyze the relationship of obstetric complications and neonatal outcomes with the thrombophilic status of the mother–infant couples in case of demonstrated placental villous thrombosis in histopathological evaluation after delivery. Methods: Placentas of high-risk pregnancies, unexplained fetal loss or infants who needed neonatal intensive care unit (NICU) admission were collected at the time of delivery. Results: In a 6 months period, placental villous thrombosis was detected in 30 among 800 placentas. Half of the mothers had a bad obstetric outcome previously, such as at least one abortus or stillbirth. Eighteen neonates (60%) were premature. Seventy-five percent of the neonates (n = 24) needed NICU admission and the mortality rate was 9.3 %. Five of the patients had congenital anomalies. Thrombophilic mutations could be evaluated in seven mothers-infant couples, all of whom had at least one positive mutation for thrombosis. Conclusions: Severe fetal vasculopathy appears to be a predisposing factor for adverse neonatal outcomes. Analyzing placentas will yield advantages as the same pathological process may repeat in subsequent pregnancies. Thrombophilic mutations should be evaluated to provide the etiology of the adverse outcome and to give prophylaxis for the future pregnancies.     

Illegal births and legal abortions – the case of China

Background  

China has a national policy regulating the number of children that a woman is allowed to have. The central concept at the individual level application is "illegal pregnancy". The purpose of this article is to describe and problematicize the concept of illegal pregnancy and its use in practice.