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Soc Indic Res ; 163(3): 1445-1465, 2022.
Article in English | MEDLINE | ID: covidwho-1942549


Due to the dramatic health situation caused by the COVID-19 pandemic, in Italy the emergency remote teaching lasted longer than in other countries. The mandatory teaching modalities have required digital transformation processes in a framework where digital-divide is one of the limitations to school modernization. We believe that the experience can promote a deeper formatting of organizational process. The paper shows results of a multitarget research carried out during the Italian lockdown aiming at animating the debate around school from multi-actors perspectives and at supporting policies. The paper aims at showing the potentiality of a multivariate statistical method as a tool supporting school managers in identifying those challenges they have to face to improve the setting up of internal processes. The main result is a model supporting the decision making process at orienting school managers strategies.

Preprint in English | SSRN | ID: ppcovidwho-326406


Background: Since there is no available data on the trends of caesarean section (CS) rates in pregnant women with COVID-19 through the pandemic, we aimed to analyse the trends in caesarean section rate in a large cohort of pregnant women with COVID-19 according to the Robson Ten Group Classification System of deliveries. Methods: We prospectively enrolled pregnant women with diagnosis of COVID-19 who delivered in our Center between March 2020 and November 2021. Deliveries were classified according to Robson group classification and according to three time periods: 1) deliveries from March 2020 to December 2020;2) deliveries from January 2021 to April 2021;3) deliveries from May 2021 to November 2021.We compared pregnancy characteristics and incidence of caesarean section according to the Robson category in the total population and according to the three time periods. Findings: We included in our analysis 457 patients matching the inclusion criteria . We found that overall CS rate significantly decreased over time from period 1 to period 3 (152/222, 68.5% vs 81/134, 60.4% vs 58/101, 57.4%, χ 2 =4.261, p=0.039). CS rate significantly decreased over time in Robson category 1 (48/80, 60% vs 27/47,57.4% vs 8/24, 33.3%, χ2 =4.097, p=0.043) and Robson category 3 (13/42, 31% vs 6/33, 18.2% vs 2/22, 9.1%, χ2 =4.335, p=0.037). We also found that incidence of induction of labor significantly increased over time (8/222, 3.6% vs 12/134, 9% vs 11/101, 10.9%, χ2 =7.245, p=0.027). Interpretation Our data provide an overview of the temporal changes in the management and obstetric outcome of COVID-19 pregnant women through the pandemic, confirming that working in a high-volume referral center for COVID-19 in pregnancy improved standards of obstetrical assistance over time. Funding: None to declare.

Am J Obstet Gynecol MFM ; 4(3): 100592, 2022 05.
Article in English | MEDLINE | ID: covidwho-1670131


BACKGROUND: Different factors may influence the closure of the uterine wall, including suture material. Suture materials may indeed influence tissue healing and therefore the development of scar defects. OBJECTIVE: To test whether uterine closure using synthetic absorbable monofilament sutures at the time of cesarean delivery would reduce the rate of cesarean scar defects compared with uterine closure using synthetic absorbable multifilament sutures. STUDY DESIGN: Parallel-group, nonblinded, randomized clinical trial of women with singleton pregnancies undergoing cesarean delivery at term in a single center in Italy. The inclusion criteria were singleton pregnancy, first or second cesarean delivery, scheduled and emergent or urgent cesarean deliveries, and gestational age between 37 0/7 and 42 0/7 weeks. Eligible participants were randomly allocated in a 1:1 ratio to either the monofilament group (polyglytone 6211 [Caprosyn]; Covidien, Dublin, Ireland) or the multifilament suture group (coated polyglactin 910 suture with Triclosan [Vicryl Plus]; Ethicon, Inc, Raritan, NJ). The primary outcome was the incidence of cesarean scar defect at ultrasound at the 6-month follow-up visit. The secondary outcomes were residual myometrial thickness and symptoms. RESULTS: Overall, 300 women were included in the trial. Of the randomized women, 151 were randomized to the monofilament group and 149 to the multifilament group. However, 27 women were lost to follow-up: 15 in the monofilament group and 12 in the multifilament group. Of note, 6 months after delivery, the incidence rates of cesarean scar defect were 18.4% (25 of 136 patients) in the monofilament group and 23.4% (32 of 137 patients) in the multifilament group (relative risk, 0.79; 95% confidence interval, 0.41-1.25; P=.31). The mean residual myometrial thicknesses were 7.6 mm in the monofilament group and 7.2 mm in the multifilament group (mean difference, +0.40 mm; 95% confidence interval, -0.23 to 1.03). There was no between-group substantial difference found in the incidence of symptoms, including pelvic pain, painful periods, and dyspareunia. CONCLUSION: In singleton pregnancies undergoing primary or second cesarean delivery, the use of synthetic absorbable monofilament sutures at the time of uterine wall closure was not associated with a reduction in the rate of cesarean scar defect 6 months after delivery compared with the use of synthetic absorbable multifilament sutures.

Cicatrix , Suture Techniques , Cesarean Section/adverse effects , Cicatrix/epidemiology , Cicatrix/etiology , Cicatrix/prevention & control , Female , Humans , Male , Polyglactin 910 , Pregnancy , Suture Techniques/adverse effects , Sutures