Frequency and Determinants of Breastfeeding in Greece: A Prospective Cohort Study during the COVID-19 Pandemic

Breastfeeding is considered to be the cornerstone of child health. In Europe however, overall breastfeeding rates remain low. The present study aimed at estimating the frequency of breastfeeding in Greece during the COVID-19 pandemic period and comparing findings with the latest national study in order to identify a potential impact of the pandemic. Additionally, possible correlations of socio-cultural and demographic characteristics with breastfeeding indicators were investigated. This prospective cohort study included 847 women from five tertiary maternity hospitals, between January and December 2020. Data were collected by a structured questionnaire via interview during hospitalization and via telephone in the first, third and sixth month postpartum. Results showed that all breastfeeding indicators improved over the last three years. Full breastfeeding reached 7.2%, contrary to 0.78% of the latest national study at six months postpartum. Employment, marital status, educational level, mode of delivery, type of maternity hospital, body mass index before pregnancy, previous breastfeeding experience of the mother and infant’s birth weight correlated significantly with breastfeeding indicators at different time periods. The COVID-19 pandemic seems to have favorably influenced breastfeeding initiation and duration in Greece due to lockdowns, home confinement and teleworking.

Determinants of Under-Five Child Mortality in Iran: A Systematic Review

Background: The under-five child mortality is considered as one of the indicators of development and health of a population. The death of many children during this period is preventable. This study reviewed the determinants of child death in Iran.Methods: A systematic search in seven electronic databases and two search engines of all the studies that identified determinants of child mortality in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies, a combination of hand searching, gray literatures and bibliographies was also conducted. These sources and citations yielded a total of 512 articles; nevertheless, finally 32 articles fulfilled the inclusion criteria, then were reviewed and analyzed.Results: Amongst the 32 studies published between 2000 and 2019 in Iran, 22 studies were cross-sectional and 14 published in Farsi language. The associations between several factors (n=57) and the child mortality were examined. Factors such as ‘birth weight’, ‘mother’s literacy’, ‘socioeconomic status’, ‘delivery type’, ‘gestational age’, ‘pregnancy interval’, ‘place of residence’, ‘Immaturity’, ‘type of nutrition’, ‘father’s literacy’ and ‘child gender’ were the most important determinants of child mortality.Conclusions: Effective efforts with emphasis on identifying and managing the determinants of child mortality are essential to improve their health indicators.

Effects of Breastfeeding on Endometriosis-Related Pain: A Prospective Observational Study

Endometriosis is a gynecological estrogen-dependent disease whose commonest pain symptoms are dysmenorrhea, dyspareunia, and acyclic chronic pelvic pain (CPP). Hormonal changes occurring during breastfeeding seem to reduce pain and disease recurrence. The aim of this observational prospective study was to assess the effect of breastfeeding on pain and endometriotic lesions in patients with endometriosis and to evaluate a possible correlation between the duration of breastfeeding, postpartum amenorrhea, and pain. Out of 156 pregnant women with endometriosis enrolled, 123 who breastfed were included in the study and were monitored for 2 years after delivery; 96/123 exclusively breastfed for at least 1 month. Mode of delivery, type and duration of breastfeeding, intensity of pain symptoms, and lesion size before pregnancy and during the 24-month follow-up were analyzed. All patients experienced a significant reduction in dysmenorrhea proportional to the duration of breastfeeding. CPP was significantly reduced only in women who exclusively breastfed. No significant improvement in dyspareunia was observed. Ovarian endometriomas were significantly reduced. Therefore, breastfeeding, particularly if exclusive, may cause improvement in dysmenorrhea and CPP proportional to the duration of breastfeeding, as well as a reduction in the size of ovarian endometriomas.

Students’ Preference Analysis on Online Learning Attributes in Industrial Engineering Education during the COVID-19 Pandemic: A Conjoint Analysis Approach for Sustainable Industrial Engineers

The decline of enrollees for industrial engineering during the COVID-19 pandemic and the increasing demand for professional industrial engineers should be explored. The purpose of this study was to determine the preference of industrial engineering students of different educational levels on online learning during the COVID-19 pandemic. Specifically, this study utilized conjoint analysis with orthogonal design considering seven attributes: delivery type, layout, term style, final requirements, Coursera requirements, seatwork and practice sets, and platforms. Among the attributes, 20 stimuli were created through SPSS and were answered voluntarily by 126 respondents utilizing a 7-point Likert Scale. The respondents were comprised of 79 undergraduate, 30 fully online master’s degree, and 17 master’s and doctorate degree students collected through purposive sampling. One university from the two available universities that offer all educational levels of IE in the Philippines was considered. The results showed that undergraduate students considered the final requirements with multiple-choice as the highest preference, followed by non-modular term style, and no seatwork and practice sets. In addition, fully online master’s degree students considered delivery type with the mix as the highest preference, followed by layout, and no seatwork and practice sets. Finally, master’s and doctorate degree students considered final requirements with publication as the highest preference, followed by no seatwork and practice sets, and mix delivery type. The students are technologically inclined, want to learn at their own pace, know where and how to get additional online learning materials, but still need the guidance of teachers/professors. The results would help contribute to the theoretical foundation for further students’ preference segmentation, specifically on online learning during the COVID-19 pandemic worldwide. Moreover, the design created could be utilized for other courses in measuring students’ preference for online learning even after the COVID-19 pandemic.

Comparison of the Effect of Preoperative Anxiety on the Oxidative Stress Biomarkers in Umbilical Cord Blood After Vaginal and Cesarean Delivery

Objective This study examined the independent effect of delivery type and preoperative anxiety on placenta oxidative stress response. Materials and methods A total of 126 patients who gave birth were divided into two groups according to delivery type: vaginal delivery group (VD) (n=56) and elective cesarean section delivery group (CS) (n=70). The preoperative anxiety levels of pregnant women who came to the delivery room were evaluated with the State Anxiety Inventory (SAI) scale. Malonyldialdehyde (MDA), superoxide dismutase (SOD), total antioxidative status (TAS), total oxidative state (TOS), and oxidative stress index (OSI) levels in umbilical cord blood were compared according to preoperative anxiety level and type of delivery. Results The CS group had significantly higher MDA (0.88±0.15 versus 0.79±0.09, p=0.001) and TOS (8.37±1.81 versus 7.53±0.77, p=0.019) values compared to the VD group. TAS levels did not differ significantly between the groups. SOD levels were higher in VD group compared to CS group (p=0.049). When the factors affecting oxidative stress biomarkers are analyzed by regression analysis, factors affecting MDA were found to be SAI score (Beta=0.358), CS (Beta=0.212), the factor affecting SOD was found to be VD (Beta=0.318), the factors affecting TOS were found to be SAI score (Beta=0.317) and CS (Beta=0.183). Conclusıon Oxidative stress biomarker levels in umbilical cord blood and preoperative anxiety levels were higher in patients who underwent elective caesarean section than those who delivered vaginally. Preoperative anxiety was the factor that increased oxidative stress biomarkers of umbilical cord blood the most.

Telehealth Interventions to Support Self-Management in Stroke Survivors: A Systematic Review

Telehealth (TH) intervention is a method to optimize self-management (SM) support in stroke survivors. Objectives of this study included identifying the TH-SM intervention’s focus and SM support components, the TH delivery type, and the TH-SM support effects on stroke survivors. Five databases were searched for the years 2005–2020 to identify TH-SM support interventions for stroke survivors. Randomized controlled trials and quasi-experimental, one-group re-post study designs were included. Ten studies were reviewed. TH-SM support focused on post-stroke depression, obesity management, participation, functional mobility, and activities of daily living. The TH delivery type most used in selected studies was messaging. Regarding the SM support components, the education component was used in all studies, and psychological support and lifestyle advice and support were used in 8 out of 10 studies. TH-SM intervention had positive effects in terms of goal achievement for SM behavior, emotional state, and mobility of clinical outcomes, and TH acceptance in stroke survivors. Although the TH-SM-supported intervention effects were not found consistently in all outcomes, this review discovered a positive effect on various SM-related outcomes. In addition, TH delivery types and SM support components showed the possibility of various options to be considered for intervention. Therefore, we suggest that TH-SM supported intervention is a positive alternative for SM support in stroke survivors.

In-birth CPR in neonates; Predictable or Unpredictable?

Background: Anticipating on in-birth Cardiopulmonary Resuscitation(CPR) in neonates is very important and complex. Timely identification and rapid CPR in neonates in the delivery room significantly affect reducing the mortality and other neurological disabilities. The aim of this study is to create a prediction system for identifying the need to in-birth CPR in neonates based on Machine Learning(ML) algorithms.Methods: In this study, 3882 neonatal medical records were retrospectively reviewed. Records were extracted from the maternal, fetal, and neonatal registry of Valiasr hospital in Tehran. A total of 60 risk factors were extracted, and five ML algorithms including J48, Naïve Bayesian, Multilayer Perceptron (MLP)، Support Vector Machine (SVM) and Random Forest were compared to predict the need to in-birth CPR in neonates. Also, using 10 feature selection algorithms, the features were ranked based on the importance, and using the ML algorithms, the important risk factors were identified. Results: In order to predict the need to in-birth CPR in neonates, SVM using all risk factors reached the accuracy of 88.43% and F-measure of 88.4%, while MLP using the 15 first important features reached the accuracy of 90.86% and the F-measure of 90.8%. The most important risk factors included gestational age, delivery type, presentation, steroid administration, macrosomia, prenatal care, infant number and rank, mother addiction, maternal chronic disease history, fetal hydrops, amniotic fluid, gestational hypertension, infertility and placental abruption. Conclusions: The proposed system can be useful in predicting the need to CPR in neonates in the delivery room.

Elaboration and Validation of Two Predictive Models of Postpartum Traumatic Stress Disorder Risk Formed by Variables Related to the Birth Process: A Retrospective Cohort Study

This study aimed to develop and validate two predictive models of postpartum post-traumatic stress disorder (PTSD) risk using a retrospective cohort study of women who gave birth between 2018 and 2019 in Spain. The predictive models were developed using a referral cohort of 1752 women (2/3) and were validated on a cohort of 875 women (1/3). The predictive factors in model A were delivery type, skin-to-skin contact, admission of newborn to care unit, presence of a severe tear, type of infant feeding at discharge, postpartum hospital readmission. The area under curve (AUC) of the receiver operating characteristic (ROC) in the referral cohort was 0.70 (95% CI: 0.67–0.74), while in the validation cohort, it was 0.69 (95% CI: 0.63–0.75). The predictive factors in model B were delivery type, admission of newborn to care unit, type of infant feeding at discharge, postpartum hospital readmission, partner support, and the perception of adequate respect from health professionals. The predictive capacity of model B in both the referral cohort and the validation cohort was superior to model A with an AUC-ROC of 0.82 (95% CI: 0.79–0.85) and 0.83 (95% CI: 0.78–0.87), respectively. A predictive model (model B) formed by clinical variables and the perception of partner support and appropriate treatment by health professionals had a good predictive capacity in both the referral and validation cohorts. This model is preferred over the model (model A) that was formed exclusively by clinical variables.