Experiences of childbirth care in Lithuania and Romania: Insights from the European Babies Born Better survey.

BACKGROUND: Data on experience and satisfaction of users are essential for improvement of health care, especially in the field of childbirth. The aim of this study was to compare childbirth care experiences in Lithuania and Romania. METHODS: Data derived from the EU Babies Born Better online survey were analyzed. Parturients from Lithuania (N = 373) and Romania (N = 359) who had given birth within the last 5 years were included. Participants were asked to (1) describe the best things in childbirth care and (2) suggest changes in the care received at their birthplace. Qualitative data were analyzed using a previously developed deductive coding framework. RESULTS: In agreement with previous findings from Austria, positive experiences mainly addressed care experienced at an individual level (in particular healthcare practitioners' competence and personality traits) and suggested changes mainly addressed services at birthplace (issues related to infrastructure, information and counseling, and empowerment). Responses not initially included in the coding framework addressed aspects such as informal payment (in both countries), desire for home birth (particularly in Lithuania), or mistreatment of parturients (particularly in Romania). CONCLUSIONS: We conclude that similar trends in childbirth care exist in Lithuania and Romania with regard to parturients' personal experiences and psychosocial needs and that addressing the needs of parturients is important for improving service provision.

'To be Informed and Involved': Women's insights on optimising childbirth care in Lithuania.

INTRODUCTION: The user expectations and experiences of healthcare services are acknowledged as components of the quality of healthcare evaluations. The aim of the study is to analyse women's experiences and views on childbirth care in Lithuania. METHODS: The study used the Babies Born Better (B3) online survey as the data collection instrument. The B3 is an ongoing longitudinal international project, examining the experiences of intrapartum care and developed as part of EU-funded COST Actions (IS0907 and IS1405). Responses to open-ended questions about (1) the best things about the care and (2) things in childbirth care worth changing are included in the current analysis. The participants are 373 women who had given birth within 5 years in Lithuania. A deductive coding framework established by the literature review was used to analyse the qualitative data. The framework involves three main categories: (1) the service, (2) the emotional experience and (3) the individually experienced care, each further divided into subcategories. RESULTS: Reflecting the experience and views regarding the service at birthplace women wished empowerment, support for their autonomy and to be actively involved in decisions, the need for privacy, information and counselling, especially about breastfeeding. In terms of emotional experience, women highlighted the importance of comprehensibility/feeling of safety, positive manageability of various situations and possibilities for bonding with the newborn. Individually experienced care was described by feedback on specific characteristics of care providers, such as competence, personality traits, time/availability and encouragement of esteem in women in childbirth. The possibilities of homebirth were also discussed. The findings reflected salutogenic principles. KEY CONCLUSIONS: The findings suggest that the Lithuanian healthcare system is in a transition from paternalistic attitude-based practices to a shift towards patient-oriented care. Implementation of the improvements suggested for women in childbirth care in Lithuania would require some additional services, improved emotional and intrapersonal aspects of care and a more active role for women. PATIENT/PUBLIC CONTRIBUTION: Patients and the public contributed to this study by spreading information about surveys and research findings through their involvement in service user groups that have an interest in maternity care. Members of the patients' groups and the public were involved in the discussion of the results.

Effectiveness of the ELLA Training for the Promotion of Emotional and Social Competences in Lithuanian Preschool Children.

By developing the emotional and social competences of children of preschool age, one can expect the prevention of emotional and behavioral problems and a better social and academic adaptation. The aim of this study was to evaluate the effectiveness of the ELLA training for the promotion of emotional and social competences in 3-6-year-old children in preschool education institutions in Lithuania. In total, 140 children aged 3-6 years participated in the quasi-experimental study, of which 86 children were assigned to the experimental group and 54 were assigned to the control group. Children of the experimental group were given a modified program-the ELLA training for the promotion of emotional and social competences. Children's emotional and social competences were assessed before and after the program. The EMK 3-6 inventory (germ. Inventar zur Erfassung Emotionaler Kompetenzen bei Drei-bis Sechsjährigen, EMK 3-6) was used to conduct a questionnaire survey of teachers and to carry out an individual assessment performed by psychologists in order to assess the children's competences. The ELLA training significantly improved children's emotional and social competences. Based on the teachers' assessment, the children's self-regulation abilities improved, and based on the children's individual assessment conducted by psychologists, the application of the program resulted in the improvement of the children's primary emotions, secondary emotions, and prosocial behavior competences.

Social Anxiety in 15-19 Year Adolescents in Association with Their Subjective Evaluation of Mental and Physical Health.

BACKGROUND: Studies show that social anxiety in adolescence have negative impact on quality of life. The study evaluates social anxiety links with mental and physical health factors in adolescents aged 15-19 years. METHODS: The research was performed in 2018 in secondary schools in Lithuania and included 1722 participants (46.1% males and 53.9% females). The social anxiety was assessed using Social Anxiety and Avoidance Scale for Adolescents. The main results were obtained using univariate and multivariate logistic regression analysis. RESULTS: Total of 58.5% of adolescents were characterized by high social anxiety and 14.7% by high avoidance. Females more often were characterized by high anxiety compared to males. Multivariate logistic regression revealed that good mental health was a significant protective factor against high SA in adolescents. For females, high anxiety and avoidance were associated with living with both parents, for males, high anxiety was linked with mother's university education. Very common stomach and abdominal pain in females as well as severe and very common stomach or abdominal pain in males, increase the risk of major social anxiety. CONCLUSIONS: High social anxiety were more prevalent between females than males and was linked with various well-being and health aspects in adolescents.

The Behavioral Problems in 2.5-5 Years Old Children Linked with Former Neonatal/Infantile Surgical Parameters.

Studies report the link between exposure to major neonatal surgery and the risk of later neurodevelopmental disorders. The aim of this study was to find out the behavioral problem scores of 2.5-5 years old children who had undergone median/major non-cardiac surgery before the age of 90 days, and to relate these to intraoperative cerebral tissue oxygenation values (rSO2), perioperative duration of mechanical ventilation (DMV) and doses of sedative/analgesic agents. Internalizing (IP) and externalizing problems (EP) of 34 children were assessed using the CBCL for ages 1½-5. Median (range) IP and EP scores were 8.5 (2-42) and 15.5 (5-33), respectively and did not correlate with intraoperative rSO2. DMV correlated and was predictive for EP (ß (95% CI) 0.095 (0.043; 0.148)). An aggregate variable "opioid dose per days of ventilation" was predictive for EP after adjusting for patients' gestational age and age at the day of psychological assessment, after further adjustment for age at the day of surgery and for cumulative dose of benzodiazepines (ß (95% CI 0.009 (0.003; 0.014) and 0.008 (0.002; 0.014), respectively). Neonatal/infantile intraoperative cerebral oxygenation was not associated with later behavioral problems. The risk factors for externalizing problems appeared to be similar to the risk factors in preterm infant population.

PREDICTORS OF EMOTIONAL AND BEHAVIORAL PROBLEMS IN 1-YEAR-OLD CHILDREN: A LONGITUDINAL PERSPECTIVE.

Emotional and behavioral problems at an early age can reasonably be considered a high-risk factor for later mental health disorders. The aim of the article is to reveal predictive factors of 1½-year-old children's emotional and behavioral problems. The study was a part of a prospective birth-cohort study. The study sample consisted of 172 full-term infants (born during Gestational Weeks 37-42) and their mothers. Emotional and behavioral problems at the age of 1½ years were measured using the Child Behavior Checklist for Ages 1½-5 (T. Achenbach & L. Rescorla, 2000), which was completed by mothers. Emotional and behavioral problems at age of 1½ years were more prevalent in infants born via cesarean section, as compared to infants born vaginally without administration of medication. Newborns' suboptimal functioning after birth, complicated emotional acceptance of pregnancy, a couple's nonsatisfactory relationship during pregnancy, maternal distress during pregnancy and in the first months after childbirth, and inflexible and parent-oriented attitudes toward infant-rearing also predicted children's emotional and behavioral problems independent of sociodemographic factors. Results suggest that biomedical and psychosocial factors which manifest themselves in the prenatal and perinatal periods can have associations with later infant and child mental health.

Smoking during pregnancy in association with maternal emotional well-being.

OBJECTIVE: The aim of the study was to investigate psychosocial predictors of smoking during pregnancy. MATERIALS AND METHODS: It was a cross-sectional analysis of a prospective birth-cohort study. The participants were 514 mothers of full-term infants. Women completed questionnaires during hospital stay after delivery. Questionnaire included items on sociodemographic characteristics, planning and emotional acceptance of pregnancy, reproductive history, health-related behavior, emotional well-being, and relationships with a partner. RESULTS: Smoking during pregnancy was reported by 14.8% of the participants. Prenatal smoking was associated with secondary or lower education, maternal age less than 20 years, childbirth outside of marriage, history of elective abortion, unplanned pregnancy, lack of positive emotional acceptance of pregnancy by mother and father, emotional distress and alcohol consumption during pregnancy. Smoking during pregnancy remained significantly associated with prenatal alcohol consumption, previous elective abortion, and lack of positive emotional acceptance of pregnancy by mother even after adjustment for maternal age, education, and family structure. CONCLUSIONS: Results support an idea of complexity of the relationships among smoking, alcohol use, and emotional well-being. Lack of positive emotional acceptance of pregnancy by mother and history of elective abortions can be considered as possible associates of smoking during pregnancy and suggest that strengthening of positive attitudes toward motherhood could add to lower smoking rates among pregnant women.

Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment.

BACKGROUND: Problems experienced within the first year of an infant's life can be precursors of later mental health conditions. The purpose of this study was to examine the frequency and continuity of difficult behaviors in infants at 3 and 6 months of age and the associations of these difficulties with biomedical and psychosocial factors. METHODS: This study was a part of an ongoing prospective birth-cohort study. Study participants were 189 uniparous mothers and their full-term newborns. The index of infant difficult behavior was constructed. This index was then associated with the following factors: delivery mode, newborn function after birth, maternal emotional well-being, risk behavior, subjective evaluation of the quality of the relationship of the couple, and attitudes toward infant-rearing. RESULTS: Common difficult behaviors, including crying, sleeping and eating problems, were characteristic for 30.2% of 3 month old and for 22.2% of 6 month old full-term infants. The expression of infant difficult behaviors at the age of 3 months increased the likelihood of the expression of these difficulties at 6 months by more than 5 times. Factors including younger maternal age, poor prenatal and postnatal emotional well-being, prenatal alcohol consumption, low satisfaction with the couple's relationship before pregnancy, and deficiency of infant-centered maternal attitudes towards infant-rearing increased the likelihood of difficult behaviors in infants at the age of 3 months. Low maternal satisfaction with the relationship of the couple before pregnancy, negative emotional reactions of both parents toward pregnancy (as reported by the mother) and the deficiency of an infant-centered maternal attitude towards infant-rearing increased the likelihood of infant difficult behaviors continuing between the ages of 3 to 6 months. Perinatal biomedical conditions were not related to the difficult behaviors in infants. CONCLUSIONS: Our study suggests that early onset of difficult behavior highly increases the risk for the continuation of difficult behavior during infancy. In general, the impact of prenatal psychosocial environment on infant behavior decreases from the ages of 3 to 6 months; however, some prenatal and preconceptional psychosocial factors have direct associations with the continuity of difficult behaviors through the first half-year of an infant's life.