Search Results (422)

Stunting remains a major public health challenge in Indonesia, with a national prevalence of 21.6% in 2022. Rural regions such as Madura face heightened vulnerability due to cultural dietary taboos, gendered caregiving structures, intergenerational authority, and digital disparities that shape household nutrition decision-making. This formative qualitative study explores stakeholders’ perceptions to inform the conceptual development of gender-sensitive serious games for nutrition communication in rural Indonesia. Using an exploratory design, 42 informants, including mothers of children under five, brides-to-be, health cadres, midwives, religious and community leaders, and local digital actors, were recruited across rural Madura. Thematic analysis examined trust-based communication patterns, gender dynamics, perceptions of artificial intelligence (AI), and contextual conditions influencing digital health acceptance. Findings indicate that acceptance of gender-sensitive serious games depends on cultural alignment, institutional endorsement, perceived credibility, and usability in low-resource settings. Participants consistently positioned serious games and AI-supported features as complementary communication layers rather than replacements for health workers. Game-based tools were considered potentially relevant when designed to support intergenerational co-play, integrate local narratives and religious values, and function in low-connectivity environments. Rather than evaluating an implemented intervention, this study proposes a conceptual design framework grounded in feminist communication perspectives, serious games scholarship, and technology acceptance theory. The findings provide context-sensitive insights to guide future prototype development and pilot testing within hybrid, community-based nutrition communication systems. Full article

Indigenous Kichwa women in the Ecuadorian Amazon experience disproportionately high levels of obstetric violence, yet their experiences remain largely absent from national demographic data. This study aims to measure the prevalence and forms of obstetric violence among Kichwa women while demonstrating the utility of community-designed demographic tools for documenting marginalized reproductive health experiences. We developed a participatory survey in collaboration with Kichwa midwives and women, several of whom are co-authors, and administered 139 structured surveys and 69 ethnographic interviews across 43 Indigenous communities in the Napo province to women who had given birth in a public hospital within the past five years. Quantitative data were analyzed using descriptive statistics to estimate prevalence across domains of obstetric violence, and interviews were thematically analyzed to contextualize these patterns. Findings indicate pervasive obstetric violence, including non-consensual procedures, verbal and psychological abuse, structural barriers to care, and suppression of traditional practices such as midwifery and plant medicine. Over 80% of participants reported at least one non-consensual procedure and at least one form of cultural or epistemic suppression, with most experiencing violence across multiple domains. These results position obstetric violence in the Amazon as a compounded, population-level exposure shaped by structural, environmental, and cultural determinants, underscoring the need for intercultural health reforms and Indigenous-led models of health governance. Full article

Background: The mother’s bond with her newborn is important for the child’s development and their relationship. Midwives are well placed to witness first-hand the beginning of this relationship. Objectives: This study examined, based on mothers’ perceptions, the contribution of midwives to the development of the bond with their baby from pregnancy to the first postnatal months. Methods: We conducted a descriptive qualitative interpretative study in Quebec, Canada (from 2022 to 2025), with 10 primiparous mothers who were cared for by midwives in a model of continuity of care, and gave birth in a birth center, at home, or in a hospital. Semi-structured retrospective interviews were conducted between two and four months after childbirth, and were complemented by interviews with two midwives. Results: Most participants developed a bond with their baby during pregnancy. They discussed their midwifery care and what they felt were significant elements in the development of their bond with the baby. Midwives encouraged them to develop this bond through their approach and various means: letting them feel the fetus during palpation, talking to it, encouraging mothers to do the same, and reinforcing the bond throughout pregnancy. The birth and first moments after birth were also key moments for promoting contact between mother and baby. Midwives were also creative in promoting bonding in more difficult situations, such as when a transfer to the hospital for delivery was needed. Conclusions: Midwives play an important role in initiating and developing the mother–child bond during pregnancy, especially if they practice within a model of relational continuity. Full article

The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on public health. In the present study, we aimed to analyze the association of certain inflammatory biomarkers with severe COVID-19 and to explore the role of diabetes mellitus (DM) and vaccination status in relation to COVID-19 severity, intensive care need and mortality. Associated comorbidities (DM, obesity, cardiovascular, neurological, endocrine, hepatic, renal, pulmonary, rheumatological, psychiatric, hematological diseases, cancer and HIV), as well as inflammatory biomarkers, like ferritin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were analyzed in 866 subjects, according to vaccination status. In unvaccinated subjects, the highest AUROC curve for severe COVID-19 was recorded for CRP (0.668), and in the vaccinated group, the highest was recorded for SII (0.694). In age- and comorbidity-adjusted analyses, diabetes mellitus was associated with higher odds of severe COVID-19, ICU admission, and mortality among unvaccinated patients. This analysis was not feasible in the vaccinated group because of the very low number of unfavorable outcomes. These findings emphasize the potential role of vaccination in attenuating the excess risk linked to comorbidities—particularly diabetes mellitus—and support the use of accessible inflammatory biomarkers for early risk stratification. The results should be interpreted within the specific epidemiological phases of the pandemic and in the context of the observational study design. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as one of the greatest challenges for the modern public health system and serves as the foundation for the development of advanced stages, such as metabolic dysfunction-associated steatohepatitis (MASH), which may progress to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). MASLD and type 2 diabetes mellitus (T2DM) mutually exacerbate one another. MASLD increases the incidence of T2DM and the risk of complications in patients already affected. T2DM accelerates progression to MASH, which has become the second leading cause of liver transplantation and end-stage liver disease, and is associated with hepatic decompensation, cirrhosis, HCC, chronic kidney disease, and cardiovascular disease. MASLD and MASH are strongly linked to T2DM and obesity, pathogenesis including genetic polymorphisms, environmental factors, and multiple metabolic disturbances: insulin resistance (IR), gut dysbiosis, altered adipokine signaling, such as reduced adiponectin alongside increased pro-inflammatory cytokines. Inflammation plays a central role in the development of HCC in MASH, even in the absence of significant fibrosis. The Fibrosis-4 index (FIB-4) should be used as a first-line noninvasive tool to assess fibrosis risk. Additionally, ultrasound-based transient elastography (FibroScan) supports clinicians in assessing steatosis and fibrosis severity. Histologically, MASH is characterized by steatosis, lobular inflammatory changes, and ballooning degeneration of hepatocytes, with or without associated fibrosis. Accurately diagnosing and stratifying MASLD based on fibrosis risk is crucial to identify patients who may benefit from pharmacological treatment or can be managed only with lifestyle interventions. Patients should attain above 10% weight loss through lifestyle modifications. Resmetirom is recommended in F2/F3 fibrosis stages. For treating T2DM, glucagon-like peptide-1 receptor agonists and coagonists, sodium–glucose cotransporter-2 inhibitors, metformin (if glomerular filtration rate exceeds 30 mL/min), and insulin (in decompensated cirrhosis) are preferred. Clinical insights derived from trials are expected to optimize quality of life and long-term outcomes in patients with MASH. Full article

Background: Nutrition during the perinatal period, including pregnancy, childbirth, postpartum, and lactation, is a critical determinant of maternal and neonatal health. While the importance of balanced nutrition is well established, the integration of nutritional counseling into midwifery care remains inconsistent across settings. Evidence suggests that midwives are uniquely positioned to deliver nutrition-related support, yet gaps persist in their formal training and in the availability of structured guidance. These gaps are particularly evident in certain regions, such as Greece, where dedicated national guidelines for perinatal nutrition are lacking. Methods: This systematized narrative review synthesises evidence from studies published between 2010 and 2025, retrieved through PubMed, CINAHL, Scopus, and relevant national guidelines. Although the synthesis draws on diverse study designs to provide contextual depth, randomized controlled trials (RCTs) were prioritized and synthesized separately to evaluate the effectiveness of midwife-led interventions. In total, ten randomized controlled trials were included in the evidence synthesis, alongside additional observational and qualitative studies that informed the narrative analysis. Both international and Greek literature were examined to capture current practices, challenges, and knowledge gaps in the nutritional dimension of midwifery care. Results: Findings indicate that adequate intake of macronutrients and micronutrients, including iron, folic acid, vitamin D, iodine, calcium, and omega-3 fatty acids, is essential for optimal maternal and neonatal outcomes. Despite this, studies consistently report insufficient nutritional knowledge among midwives, limited confidence in providing counseling, and variability in clinical practice. Socio-cultural factors, such as dietary traditions and migration-related challenges, further influence nutritional behaviors and access to guidance. Emerging approaches, including e-health tools, group counseling models, and continuity-of-care frameworks, show promise in enhancing midwives’ capacity to integrate nutrition into perinatal care. Conclusion: Nutrition is a cornerstone of perinatal health, and midwives are strategically placed to address it. However, gaps in training, inconsistent guidelines, and cultural barriers limit the effectiveness of current practices. Strengthening midwifery education in nutrition, developing context-specific tools, and fostering interdisciplinary collaboration are essential steps toward more comprehensive and culturally sensitive perinatal care. Future research should focus on longitudinal and intervention studies that assess the impact of midwife-led nutritional counseling on maternal and neonatal outcomes. Full article

The closure of rural maternity units in hospitals across the United States contributes to health inequities; however, little is known about the effects of reopening maternity services in this context. We conducted a mixed-methods study to characterize labor and delivery outcomes and patient experiences associated with the reopening of a rural Level 1 Maternity Care Center (MCC) at a critical access hospital. We compared clinical outcomes and distance to care for patients who gave birth at the rural MCC in the three years after its opening with outcomes from a similar low-risk and geographically located sample who gave birth at a large suburban academic medical center in the same hospital system in the three years before the MCC reopened. We also conducted in-depth interviews with patients who gave birth at the MCC. Labor and delivery outcomes were similar across both groups, with significantly more care provided by family physicians and midwives and lower neonatal intensive care unit use at the MCC. The opening of the MCC halved the distance patients traveled to give birth, and patients reported high rates of satisfaction. Rural maternity care centers can improve access to quality care closer to home using a resource-appropriate model. Full article

Background: Midwives, despite their health-promoting role, face factors that may disrupt eating behaviours and weight regulation. Little is known about their body weight perception or disordered eating attitudes (DEAs). This study assessed body weight perception and eating attitudes across BMI categories among Polish midwives. Methods: A cross-sectional survey of 568 midwives was conducted. BMI was calculated from self-reported measures and classified according to WHO criteria. Body weight perception was assessed using discrepancies between actual and ideal body weight and between self-perceived ideal body weight and ideal body weight. Long-term weight variability was additionally evaluated using the difference between maximum and minimum adult body weight. Eating attitudes were examined using the Polish version of the EAT-26. Group differences were analysed with the Kruskal–Wallis and χ² tests. Results: Among the participants, 62.9% had normal weight, 23.4% were overweight, and 13.7% were obese. Perceived ideal body weight increased with BMI (p < 0.001). Midwives with overweight and obesity demonstrated higher EAT-26 scores than those with normal BMI, with EAT-26 > 20 observed in 8.3% of overweight and 14.1% of obese participants (p = 0.010). Overweight and obese midwives also showed larger discrepancies between actual and ideal body weight and greater lifetime weight variability, and these groups simultaneously presented higher levels of disturbed eating attitudes. Emotional eating, binge-type episodes, and dieting behaviours were more common among overweight and obese participants, while calorie awareness remained consistently high across groups. Conclusions: Midwives with excess body weight often misperceive their body size and show an elevated risk of DEA. Weight perception appears more strongly related to maladaptive eating patterns than BMI alone. These findings highlight the need for targeted, non-stigmatising interventions addressing weight perception, eating attitudes, and occupational stressors, which may support both midwives’ well-being and their professional effectiveness in delivering nutrition and lifestyle counselling. Full article

Enhancing sexual literacy through sex education from an early age is vital for preventing unintended pregnancies and sexually transmitted infections. The “Beginning of Life” section of sex education presents a crucial opportunity to educate students on fertilization and fetal development. This study aimed to determine the feasibility and usability of the Beans Education Project Card (BEPC), a novel teaching tool for this section, in a real-world educational setting. Five midwives with sex education experience were provided with the BEPC for use with elementary, middle, and high school students over an approximate 3-month period (October 2024 to January 2025). Subsequently, group interviews were conducted with the midwives to gather feedback on the design, feasibility, and usability of the tool. The interview transcripts were analyzed using qualitative analysis, with large language model-assisted thematic exploration employed as a supplementary method to identify key themes. The analysis showed that the BEPC was highly regarded for its visual appeal, ease of use, and potential to engage families. The hierarchical design and visual representations, such as the use of small holes and beans to represent different stages of fetal development, were particularly effective in facilitating student understanding. The findings suggest that the BEPC has the potential to be a visually engaging tool for interactively teaching the process of fertilization and fetal development in the “Beginning of Life” part of sex education. Future research should focus on collaborations with parents and the development of strategies for reaching out to absent or home-schooled students. Full article

Diabetes mellitus (DM) is a chronic non-communicable disease associated with macroangiopathy and microangiopathy, with disabling or even life-threatening complications. In the present study, we aimed to analyze the association between insulin resistance (IR) and inflammation biomarkers and peripheral arterial disease (PAD) and diabetic peripheral neuropathy (DPN), respectively. The study had a cross-sectional design and evaluated a panel of IR related indices and inflammatory biomarkers commonly used in clinical and epidemiological research, including the triglyceride-glucose (TyG) index and its obesity related derivates, cholesterol, HDL, glucose (CHG) index, lipid-derived ratios, and composite inflammatory indices, together with interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP) in 110 subjects, according to the presence or absence of PAD and DPN, respectively. In the PAD (+) group, TyG-waist-to-height-ratio (TyG−WHtR) and CHG recorded significantly increased values (p = 0.042, respectively p < 0.001), compared to PAD (−). CHG recorded significantly increased values in DPN (+) subjects (p = 0.007). In addition, in the PAD (+) subjects, IL-6 and systemic immune inflammation index (SII) recorded significantly increased values (p = 0.026, respectively, p = 0.015) and TNFα, monocyte to lymphocyte ratio (MLR) and C-reactive protein to albumin ratio (CAR) recorded significantly increased values in DPN (+) subjects (p = 0.028, respectively, p = 0.008, and p = 0.038). We developed a score with a good discriminatory performance for PAD and DPN, including DM duration, TyG−WHtR, SII, MLR and CAR (AUROC 0.822 in PAD, respectively 0.848 in DPN, p < 0.001). A composite score combining IR and inflammatory biomarkers showed strong discriminatory performance for lower limb complications in type 2 diabetes, suggesting a valuable tool for early detection and prevention. Full article

Use of assisted reproductive technology (ART) to bear children has in recent years become widespread in Japan. While midwives are required to understand the experiences of individual women and provide ongoing support for them, implementing respectful care that meets the needs of women using ART remains challenging. This study therefore aimed to explore the specific care components expected of midwives for women with twin pregnancies after ART. A cross-sectional questionnaire survey was conducted through Google Forms on 273 women with twin pregnancies, of whom 85 had conceived twins through ART. Women were recruited through national multiple birth support groups and midwifery centers providing postnatal care. Data were collected from July 2021 to December 2022, and care expectations were rated on a 5-point Likert scale. Factor analysis was performed to identify care components, and reliability was evaluated using Cronbach’s alpha. Among the participants, 41.2% were between 36 and 40 years of age. Seven primary care factors were identified: comprehensive parenting support for twins, addressing concerns regarding the sudden death of twins, interdisciplinary medical collaboration, connecting women with twin pregnancies, understanding post-delivery physical pain, providing continuity before and after delivery, and supporting the development and well-being of the twins. The findings emphasize the importance of understanding individual ART histories and providing tailored care to respond appropriately to women’s needs during pregnancy, childbirth, and the postpartum period. The identified components provide an empirical foundation for integrating these perspectives into routine midwifery care and educational programs for women with ART-conceived twin pregnancies. Full article

Midwives and nurses are integral to the quality and safety of patient care. However, there is a limited amount of critical discussion and debate about the use of interviews to recruit people to study for these professions. There are some reports of people who are marginalised, minoritised, or racialised, being denied the opportunity to study for a degree in these professions, despite meeting the requisite entry requirements. Therefore, this commentary analyses the contemporary narrative and discussion relating to the role of interviews in recruiting student midwives and nurses. This critical analysis uses the UK as a case study and promulgates an alternative approach that could result in a more diverse workforce and enhance patient safety. It is hoped that the critical analytical approach taken in this paper will inspire those involved in recruitment to midwifery and nursing to consider the efficacy, utility, and equity of recruitment interviews and their impact on who is or is not afforded the opportunity to pursue a career in these professions. Full article

The use of health monitoring software applications (apps) and devices is gaining popularity in obstetrics. The attitude and acceptance of different healthcare professionals regarding telemonitoring during pregnancy and the early phase of labor have not been sufficiently investigated. This study aims to assess healthcare professionals’ views on telemonitoring during pregnancy and childbirth, as well as data processing in the telemonitoring process. The study is part of an international project called `Newlife`, funded by the European Council and nationally funded by the Swiss State Secretariat for Education, Research and Innovation and Innosuisse. Eleven physicians from the fields of obstetrics and neonatology and five prenatal care nurses and five midwives were interviewed. First, participants were asked to fill out a written questionnaire with open and closed-ended answers, containing questions with a 5-point Likert scale. In a second step, a personal oral interview was conducted with all respondents. The study had an exploratory, qualitative focus. Questionnaire responses were summarized using descriptive statistics, while interview recordings were transcribed verbatim and systematically coded to identify recurring themes. Of the respondents (n = 20), five (25.0%) reported previous experience with telemonitoring in their professional practice, and all of them considered it useful. Regarding attitudes and acceptance, 57.1% (n = 12) of respondents would welcome telemonitoring during pregnancy and 52.4% (n = 11) during the early phase of labor, while 33.3% expressed no clear opinion. Rejection of telemonitoring was indicated by 9.6% (n = 2) during pregnancy, and 19.0% (n = 4) during early labor. In terms of perceived benefits, respondents highlighted early detection of problems (n = 13, 61.9%), improved prenatal care (n = 11, 52.4%), and better opportunities for data analysis and research (n = 12, 47.1%). Perceived risks included technical challenges and susceptibility to errors (n = 14, 66.7%), the lack of human contact and personal support (n = 14, 66.7%), and potentially inaccurate measurements (n = 12, 57.1%). This study offers insights into healthcare professionals’ attitudes and acceptance of telemonitoring in healthcare during pregnancy and the early stages of labor. There is a generally positive outlook but concerns and preferences exist. Addressing these considerations is essential for developing effective and user-friendly telemonitoring systems that benefit both healthcare professionals and pregnant women. Full article