Search Results (154)

Introduction: Tuberculosis [TB] and diabetes mellitus (DM) remain major public health concerns worldwide. TB negatively affects an individual’s glucose tolerance, increasing the risk of developing DM. Similarly, DM reduces the host’s ability to fight TB infection and increases the likelihood of developing TB and poor response to TB medication. This study analysed stigma and health-seeking behaviour in a sub-district of Accra Metropolis. Methods: We used a mixed-methods research approach involving a cross-sectional survey and in-depth interviews to explore community knowledge, stigma, and health-seeking behaviour related to TB and DM. A total of 437 individuals were selected for a survey using a simple random sampling technique, while 22 participants, including three TB patients, four nurses, one medical doctor, four students from a nursing and midwifery school, five students from a school of hygiene, and five community members, were involved in the study. Healthcare providers and patients were purposively selected, while students and community members were recruited through convenience sampling. Descriptive and logistic regression analyses were performed on the quantitative data using STATA, while the qualitative data were thematically analysed using the MAXQDA software. Results: Participants’ age, sex, and educational levels were significantly associated with their knowledge of TB and DM. Males were 0.600 times as likely as females to be knowledgeable about DM (95% CI: 0.386–0.934, p = 0.024). Social determinants of health, such as poverty, local beliefs, stigma, and negative attitudes from healthcare workers, may influence TB patients’ preference for traditional remedies over biomedical treatment. Conclusion: Therefore, we observed that addressing cultural barriers, stigma, and financial costs related to TB and diabetes care will help increase patients’ willingness for biomedical treatment. Full article

Gout is a crystal-induced inflammatory arthritis driven by hyperuricemia and monosodium urate (MSU) crystal deposition, yet urate burden alone does not explain why only a subset of hyperuricemic individuals develops clinical disease, why acute flares are usually self-limited, or why gout clusters with renal and cardiometabolic comorbidity. This structured narrative review uses a gout-specific redox-switch framework, defined as a context-dependent shift in uric acid biology according to concentration, compartment, crystallization state, xanthine oxidoreductase (XOR) activity, inflammatory priming, and disease stage rather than as a binary molecular event. We integrate evidence on XOR-derived reactive oxygen species (ROS), mitochondrial stress, NLRP3 inflammasome signaling, neutrophil oxidative responses, neutrophil extracellular traps (NETs), lipid peroxidation, and potential ferroptosis-related mechanisms. Evidence is classified into five categories: established, mechanistically supported, human-associative, conceptual, and emerging/unvalidated. The available human data support lipid-peroxidation and ferroptosis-associated molecular signatures, but do not yet establish ferroptotic cell death as a driver of gout. Therapeutic implications are therefore framed conservatively: urate-lowering therapy remains foundational, whereas redox-directed approaches require pathway specificity, disease-stage definition, and biomarker validation. The redox-switch concept is proposed as an organizing framework for mechanistic and translational research, not as a validated clinical algorithm. Full article

Background: Pregnancy and childbirth expose the pelvic floor and perineal tissues to substantial biomechanical stress, increasing the risk of obstetric perineal trauma and subsequent maternal morbidity. Objectives: This prospective observational pilot study aimed to explore the association between antenatal perineal massage and perineal outcomes at birth, as well as postpartum pelvic floor findings, in primiparous women. Methods: Women attending an antenatal education programme at the Family Counselling Centre of Francavilla al Mare (Italy) between May and November 2024 were recruited and followed through childbirth and the postpartum period. Results: Twenty-seven primiparous women who experienced spontaneous vaginal birth underwent a comprehensive perineal assessment 6–10 weeks after delivery. Fifteen women (55.6%) self-reported regular antenatal perineal massage during the final weeks of pregnancy, whereas 12 (44.4%) did not perform massage or practiced it only sporadically. Women self-reporting regular perineal massage showed a different distribution of perineal outcomes compared with those in the no/sporadic massage group, with a higher proportion of intact perineum or first-degree tears. Antenatal perineal massage was also associated with a higher frequency of upright birth positions and warm compress use during labour, as well as differences in postpartum vulvar gaping, genital trophism, perineal tone, and pelvic floor muscle performance assessed by the PC-Test. Urinary incontinence and postpartum perineal pain were observed only among women who did not report massage practice. Conclusions: These findings represent exploratory associations and cannot establish causal relationships or demonstrate the independent effect of antenatal perineal massage. Because massage practice clustered with other perineal protection strategies, larger studies with adequate adjustment for potential confounding factors are required to clarify the contribution of individual interventions to perineal and postpartum outcomes. Full article

Background: Thai obstetric nurses follow WHO gestational weight gain (GWG) guidelines to prevent gestational diabetes mellitus (GDM). However, these Western-derived guidelines misclassify approximately 16% of Thai pregnant women, who carry excess metabolic risk at lower BMI values than Western populations. Objectives: To derive and validate Thai-specific GWG targets using Thai BMI cut-points across five BMI subgroups and assess implications for nursing practice in GDM prevention. Methods: Retrospective cohort study of 1396 Thai singleton pregnancies at a maternal and child hospital (2023–2025). GWG targets were derived as interquartile ranges (P25–P75) from a healthy-outcomes subgroup (n = 706), with validity confirmed by multivariable logistic regression and a 70:30 derivation/validation split. Results: GDM prevalence was 15.8%, with a rising crude trend that was attenuated after accounting for a mid-study change in screening protocol. Provisional Thai-specific GWG targets were underweight/normal weight 11.5–18.0 kg, overweight 9.7–18.0 kg, obesity class I 9.1–16.0 kg, and obesity class II+ 5.8–12.1 kg. Inadequate GWG in obesity class I was associated with a 3.92-fold GDM risk increase (aOR 3.92, 95% CI 2.12–7.24, p < 0.001). Adherence improved from 34.7% (IOM 2009) to 50.2% with Thai-specific targets. Conclusions: These Thai-specific GWG targets are provisional, single-centre pilot estimates. They appear clinically safe and are substantially more achievable than IOM 2009 criteria and are offered to inform BMI-appropriate antenatal counselling and to justify a multi-centre validation study, rather than as ranges that are ready for immediate national adoption. Full article

Background: Preparing midwifery graduates to be confident, competent, and resilient is essential for workforce sustainability, yet students report a disconnect between academic preparation and clinical realities. Increasing care complexity, workforce shortages, and variable clinical learning environments globally highlight the need to examine how educational strategies support effective transition to practice. Objective: To map and synthesise the evidence regarding educational approaches, learning experiences, and transition-to-practice factors that influence preparedness for professional practice among midwifery students, and to identify gaps in the existing literature to inform a coherent and future-ready educational framework. Methods: A PRISMA-ScR-guided scoping review was conducted across seven databases. Data were extracted through a standardised template and analysed using narrative synthesis. Qualitative, quantitative, and mixed-method studies were examined for learning approaches, practice conditions, and transition experiences. Results: Three overarching domains and seven sub-domains were identified. Reflective practice, blended learning, simulation, and collaborative approaches were widely valued but inconsistently implemented. Students frequently experienced transition shock, limited scaffolding of higher-order thinking, variable supervision, with misalignment between curricula, competency frameworks, and clinical expectations, leading to uneven confidence and skill development. Educator capacity constraints particularly in feedback, reflection, and simulation pedagogy were recurrent barriers. Positive clinical environments and structured reflective opportunities consistently strengthened competence, identity formation, and readiness. Conclusion: Midwifery education is evolving towards contemporary, competency-based pedagogies, yet persistent inconsistencies undermine the reliability of graduate preparation. Strengthening curriculum coherence, standardising key learning experiences, investing in educator capability, and embedding structured reflection and simulation are essential. A unified educational framework that integrates these components is required to enable confident, adaptable, and practice-ready midwives. Full article

Background: In Saudi Arabia, nurses have long lacked a formally defined scope of practice, contributing to role ambiguity and role overlap. In 2023, the Saudi Commission for Health Specialties (SCFHS) released the first national Scope of Nursing and Midwifery Practice document. This study explored how nurse managers and supervisors perceived the scope of practice following this update in Makkah Cluster Hospitals. Methods: As the second, explanatory phase of a larger sequential explanatory mixed-methods study, a qualitative descriptive study was conducted between May and August 2025 with 20 nurses in managerial roles (Nursing Directors, Nursing Supervisors, and Head Nurses) at two hospitals within the Makkah Health Cluster. Participants were selected through purposive sampling, restricted to managerial and supervisory positions to capture a cross-departmental, organizational perspective on scope enactment. Interviews were conducted via Zoom in Arabic, translated into English, and analyzed using inductive thematic analysis consistent with the approach of Braun and Clarke. Trustworthiness was addressed through credibility, transferability, dependability, and confirmability, with reporting guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Four themes emerged from the accounts of the 20 participants (10 men and 10 women from both hospitals): (1) expanding the scope of nursing practice, (2) bridging the gap between training and practice, (3) overcoming barriers to full professional practice, and (4) promoting nurse empowerment and accountability. Participants described a tension between a formally defined scope and inconsistent enactment across departments and shifts. Unclear job descriptions, administrative constraints, staffing shortages, and resource deficits were the primary barriers, whereas autonomy and continuous development were identified as essential enablers. Conclusions: The nurse managers and supervisors in this study perceived the scope of nursing practice as variably enacted and frequently constrained following the 2023 SCFHS update. These findings suggest that regulatory publication alone may be insufficient, highlighting the need to operationalize the framework through revised job descriptions, simulation-based professional development, adequate staffing, and leadership-supported autonomy aligned with Saudi Vision 2030. Because these findings reflect the perspectives of nursing leaders rather than bedside clinical nurses, their application to direct patient care contexts should be interpreted with appropriate caution. Full article

Background/Objectives: While the traditional partograph remains widely used in labor monitoring, concerns about its clinical effectiveness have led to the introduction of the World Health Organization’s Labour Care Guide (LCG) in 2020, raising questions about its acceptance in practice. This study aimed to determine midwives’ perceptions of these two tools, their usage preferences, and the influencing factors. Methods: This multicenter cross-sectional study was conducted with 153 midwives working in public and university hospitals in Mardin, Batman, and Hakkari between 7 April and 30 June 2025. Data were collected using a socio-demographic form and analyzed with descriptive statistics, Chi-square tests, and logistic regression. Results: Findings showed that 89.5% of midwives considered the partograph more appropriate, and 85.6% found it more practical. In contrast, 62.1% rated the LCG as poor, and 77.8% reported that not all its parameters were necessary. Midwives with high job satisfaction used the partograph significantly more actively. Those working in public hospitals were 2.83 times more likely to find the LCG useful than those in university hospitals, while midwives with higher perceived professional competence were 2.29 times more likely to favor the LCG. Conclusions: Midwives perceive the traditional partograph as more efficient, whereas the LCG is viewed as overly detailed and increasing workload. The findings suggest that beyond theoretical training, successful LCG implementation requires workload regulation, adequate staffing, and practice-oriented in-service training. Full article

Background/Objectives: Fear of childbirth may begin before pregnancy and may be shaped by earlier traumatic and relational experiences. This study examined the association between intimate partner violence (IPV) and prior-to-pregnancy fear of childbirth among non-pregnant women and considered its implications for preconception and obstetric care. Methods: This descriptive, correlational, cross-sectional study was conducted online in Türkiye between 1 January and 31 May 2025 after approval from the Non-Interventional Scientific Research Ethics Committee of Istanbul Atlas University (23 December 2024; No. 10/07). The sample comprised 125 nulligravid women, defined as women who had never previously been pregnant, who were aged 18 years or older, were not currently pregnant, were living with an intimate partner, were literate in Turkish, and reported no psychiatric disorder. Data were collected using a Personal Information Form, the Husband Violence Against Women Scale (HVWAS), and the Fear of Childbirth Prior to Pregnancy Scale (FCPPS). Descriptive statistics, Spearman correlation analysis, Mann–Whitney U tests, and Kruskal–Wallis tests were performed. Results: The mean age of participants was 28.84 ± 5.47 years. The mean HVWAS score was 46.11 ± 12.51, and the mean FCPPS score was 36.05 ± 13.56. HVWAS scores were weakly positively correlated with prior-to-pregnancy fear of childbirth (rho = 0.207, p = 0.020). An exploratory association was observed between educational level and HVWAS scores (p = 0.019); however, the educational subgroups were highly unequal in size. No significant association was found between educational level and FCPPS scores (p = 0.219). Conclusions: Higher HVWAS scores were weakly associated with greater prior-to-pregnancy fear of childbirth. Because of the cross-sectional design, the direction and causality of this association cannot be determined. Confidential assessment of IPV and childbirth-related fear during preconception counseling and women’s health encounters may assist in identifying women who could benefit from further psychosocial evaluation and support. Full article

Background: The transition to motherhood represents a critical life phase marked by profound biological, psychological and social changes. During this period, women’s nutritional practices are shaped not only by physiological needs but also by shifting identities, caregiving responsibilities and social expectations. Although nutrition during pregnancy and the postpartum period has been widely studied from a biomedical perspective, less attention has been paid to how women experience, negotiate and attribute meaning to food during the transition to motherhood. Objective: This systematic qualitative review aimed to synthesise existing qualitative evidence on women’s experiences of nutritional practices during the transition to motherhood, with particular attention to food as self-care, control, autonomy, identity formation and mental well-being. Methods: A systematic search of electronic databases was conducted to identify qualitative studies exploring women’s experiences of nutrition during pregnancy and early motherhood. Eligible studies employed qualitative methodologies such as interviews, focus groups or ethnographic approaches. Study selection followed PRISMA guidelines. Methodological quality was appraised using established qualitative appraisal tools. A thematic synthesis approach was used to integrate findings across studies. Results: The synthesis identified several interrelated themes: nutrition as a form of self-care and emotional regulation; loss of autonomy and heightened moral surveillance around food choices; food practices as a means of performing and negotiating “good motherhood”; and the emotional burden of dietary expectations in relation to mental health and identity. Women described navigating competing demands between their own nutritional needs and those of their infants, often within contexts of social judgement and limited support. Conclusions: Nutritional practices during the transition to motherhood extend beyond health behaviours and are deeply embedded in issues of identity, autonomy and care. Recognising the social and emotional dimensions of maternal nutrition may inform more holistic, woman-centred approaches to nutritional guidance and maternal health support. Full article

Background: The early or latent phase of labour (early labour) is a time when women feel unsupported and have limited access to quality midwifery support, often being advised to stay at home. As a result, women seek online information and often turn to hospital websites as a trusted source of this information. Women from underserved and marginalised groups may be particularly reliant on online information. The aim of this study was to systematically evaluate the availability, accessibility, content, and evidence base of online early labour information provided by UK hospitals, with a focus on inclusivity, and equity in information provision. Methods: A systematic search of NHS and HSC maternity websites across the UK (England, Scotland, Wales, and Northern Ireland) was undertaken to identify publicly available guidance on early labour. Eligible materials included webpages, downloadable leaflets, and multimedia resources. The identified guidance was evaluated in terms of availability, accessibility, content, and transparency of evidence. Data were synthesised descriptively and presented using narrative summaries and tables. Results: A total of 146 hospital websites were reviewed, of which 72 (49%) provided guidance specific to early labour or included a dedicated section on the latent phase. There was marked variation in availability, accessibility, and content. Accessibility was often limited, with few multilingual resources, alternative formats, or inclusive visual materials. Most guidance was text-heavy, with minimal use of multimodal or user-friendly formats and limited representation of diverse populations. Clinical content also varied, particularly in definitions of early labour and recommendations for pain management. Only a minority of resources referenced supporting evidence. Conclusions: Online early labour information provided by UK maternity services varies in availability, accessibility, and inclusivity, raising important equity concerns. Limitations in accessibility, consistency, and transparency of evidence may contribute to disparities in understanding and decision-making, particularly among women from disadvantaged or marginalised groups. There is a clear need for standardised, evidence-based, and inclusive information that is accessible to diverse populations to support equitable maternity care during early labour. Full article

Background/Objectives: Labor pain is a multidimensional experience associated with physiological, cultural, psychological, and contextual factors. This study aimed to examine the association of personality-related characteristics, cultural beliefs, obstetric characteristics, and proxy indicators of post-disaster context with labor pain perception among women giving birth in Hatay after the 2023 Türkiye earthquakes. Methods: This prospective observational study was conducted with 314 women admitted to Hatay Training and Research Hospital between February and June 2025. Participants were between 38 and 42 gestational weeks, had a singleton healthy fetus, were admitted in active labor, and were expected to give birth vaginally. Data were collected using a researcher-developed questionnaire, the Ten-Item Personality Inventory, and the Visual Analog Scale. Labor pain was assessed at 6 cm, 8 cm, and full cervical dilatation (10 cm). Results: VAS scores increased significantly across cervical dilatation points, from 5.04 ± 0.81 at 6 cm to 7.01 ± 0.82 at 8 cm and 8.06 ± 0.93 at full cervical dilatation (10 cm). Repeated-measures ANOVA showed a significant within-person increase in pain intensity across the three assessment points, F(2, 626) = 996.444, p < 0.001, partial η² = 0.761. Age was not significantly correlated with VAS pain score at full cervical dilatation. In exploratory unadjusted comparisons, VAS scores at full cervical dilatation differed according to education level, official marriage status, previous birth history and mode, attendance at antenatal education, and praying to relieve labor pain. In the multivariable regression model, higher Extraversion and higher education level were associated with lower VAS scores, whereas attendance at antenatal education, greater importance given to traditional rules, previous assisted vaginal/cesarean birth, and current place of residence were independently associated with VAS scores. Conscientiousness was not significantly associated with VAS scores in the adjusted model. Earthquake experience was not significantly associated with VAS scores. Conclusions: Labor pain perception was associated with selected sociodemographic, obstetric, and cultural characteristics. The findings support the importance of individualized, culturally sensitive, and trauma-informed midwifery care in disaster-affected regions. Personality-related findings should be interpreted cautiously because the corrected reliability analysis showed low internal consistency for Agreeableness, Emotional Stability, and Openness to Experience, although Extraversion showed high internal consistency and Conscientiousness showed relatively better but still limited internal consistency. Disaster-related findings should also be interpreted cautiously because post-disaster context was assessed using only limited proxy indicators; current place of residence was independently associated with VAS scores in the adjusted model, whereas earthquake experience was not. Because of the observational design, causal interpretations cannot be made. Full article

Background/Objectives: Early postpartum milk expression is common, but its relationship with later breastfeeding outcomes depends on the clinical context in which expression is used. This systematic review examined distinct exposure domains, including expression method, timing and intensity of expression, expressed-milk feeding modality, composite in-hospital feeding patterns, and clinically indicated expression in pump-dependent populations. Methods: Following PRISMA 2020 guidance, primary studies of postpartum milk expression, breast pump use, or expressed breast-milk feeding were identified and synthesized using a PECO framework. Because included studies differed substantially in population, exposure definition, comparator structure, and outcome measurement, meta-analysis was not undertaken. Instead, studies were grouped a priori into exposure families, and conclusions were derived within each domain while explicitly considering risk of bias was assessed using RoB 2, version of 22 August 2019, for randomized trials and the original 2016 version of ROBINS-I for non-randomized studies. Results: Seventeen studies met the eligibility criteria. In healthy term dyads, routine early pumping or exclusive/predominant expressed-milk feeding was generally associated with less favorable breastfeeding continuation than direct feeding at the breast, although these associations were mainly derived from observational studies at serious risk of confounding by indication. In preterm, separated, or otherwise pump-dependent dyads, earlier and more frequent milk expression was associated with improved early lactation outcomes, including lactogenesis, milk yield, or achievement of full lactation; evidence for longer-term breastfeeding continuation was more limited. Broad population-level definitions of any pump use produced less consistent findings and were not directly comparable with studies of exclusive expressed-milk feeding. Conclusions: Early postpartum milk expression should be interpreted as a context-dependent practice rather than as a uniform exposure. The strongest clinical inference is that direct breastfeeding should be supported when feasible in healthy term dyads, whereas early and frequent expression remains necessary and potentially beneficial when direct breastfeeding is not immediately possible. Full article

Background: Group Care (GC) is an antenatal/postnatal care model comprised of a stable group of pregnant people or parent–child dyads receiving care in two-hour group sessions that combine clinical care with interactive discussion and learning. Integrating GC into healthcare systems organised for individual care poses challenges at both site and system levels. This study identified scheduling-related modifications across contexts to understand modification processes. Methods: We used an explanatory sequential design with mixed qualitative methods across seven GC implementation sites in Belgium, Kosovo, and the United Kingdom. A qualitative survey based on the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) was completed at each site by multiple stakeholders. Subsequently, in-depth interviews were conducted to further explore modification processes and examine whether changes were sustained or discontinued up to three years post-implementation initiation. Results: Two modifications were identified across countries: (1) combining GC sessions with individual consultations, and (2) integrating GC into digital booking and medical record systems. Guided by FRAME, we identified similarities and differences in the goals, drivers, and impact of these modifications. The dominant one-to-one antenatal care model strongly influenced modifications, making it more difficult to implement GC as a stand-alone model in obstetrician-led systems (Belgium and Kosovo) compared to a midwifery-led system (UK). In both contexts, the dominant model negatively influenced the perceived value of GC, with GC sessions viewed only as education and individual consultations seen as the actual care. Integration in the booking system appeared essential for payment and scheduling arrangements. Conclusions: Integrating GC scheduling into existing care pathways is challenging in systems where one-to-one care is the predominant model. Sustainable integration of GC requires early coordination and shared ownership across areas, including clinical, administrative, and IT. Full article

Background/Objectives: Clinical childbirth in high-income countries is increasingly shaped by standardised routines that do not always accommodate individual preferences. In Germany, approximately one in eight pregnant persons experiences clinically significant childbirth-related post-traumatic stress disorder symptoms, with pregnant persons facing language or health-literacy barriers being at particular risk of inadequate preference integration. Methods: This paper presents the conceptual foundation and proposed study design for FAIR-Birth, an interdisciplinary initiative to develop and feasibility-test a mobile application supporting Advance Birth Planning (ABP) embedded within midwifery-led antenatal care. The intervention combines four elements: transfer of the Advance Care Planning concept to antenatal care, a domain-restricted Large Language Model (LLM) supporting multilingual preference articulation, integration of the resulting ABP document into midwifery-led continuity of care, and iterative adaptation. Following the updated MRC framework, this study will employ a sequential mixed-methods design encompassing systematic review, participatory instrument development, Delphi consensus on the knowledge base, iterative technical development with usability testing, and a feasibility study across two perinatal centres in Bavaria. Results/Conclusions: FAIR-Birth is expected to generate a content-validated ABP instrument, a domain-restricted multilingual LLM dialogue system, and an evaluated application prototype. The work corresponds to the development and feasibility phases of the MRC framework; effectiveness questions are reserved for a planned subsequent randomised controlled trial. Full article

Background: Autonomy in decision making is a critical component of respectful, person-centered maternity care. The Mother’s Autonomy in Decision Making (MADM) scale has been widely used internationally to evaluate women’s perceptions of autonomy during perinatal period. Objectives: To assess the reliability and validity of the Greek translation of the MADM questionnaire among postpartum women who have given birth in hospitals and clinics in Greece. Methods: A cross-sectional study was conducted with 450 postpartum women who gave birth in public and private maternity facilities in Greece. Participants completed the Greek MADM scale, and statistical analyses included exploratory and confirmatory factor analysis (EFA/CFA), internal consistency (Cronbach’s alpha), test–retest reliability (intraclass correlation coefficient, ICC), criterion validity (correlation with the Birth Satisfaction Scale (G-BSS), and Rasch analysis. Results: EFA revealed a one-factor structure explaining 77.6% of the variance (KMO = 0.913; Bartlett’s p < 0.001). CFA supported good model fit (CFI = 0.924, RMSEA = 0.085). The Greek MADM showed excellent internal consistency (Cronbach’s α = 0.951) and test–retest reliability (ICC = 0.995). Criterion validity was supported by moderate correlations with G-BSS subscales (r = 0.338–0.389, p < 0.005). Rasch analysis confirmed unidimensionality, high item reliability, and acceptable item fit. A cut-off score of 27.5 on the MADM scale was identified to distinguish between high and low–moderate birth satisfaction. Conclusions: The Greek version of the MADM scale demonstrates excellent psychometric properties and is a valid, reliable tool for assessing autonomy in maternity decision making. Its use can enhance quality assessment and promote respectful, autonomy-supportive perinatal care in Greek healthcare settings. Full article