Childbirth Narratives of Women With Posttraumatic Stress Symptoms in the Postpartum Period.

OBJECTIVE: To examine cognitive, emotional, and perceptual differences in the childbirth narratives of women with high levels of posttraumatic stress symptoms (PTSS) compared with women with low levels of PTSS in the postpartum period. DESIGN: A cross-sectional design. Participants were retrospectively assigned to the high or low PTSS group on the basis of their scores on the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) administered at 1 week and 3 months after childbirth. SETTING: Participants' homes and Internet survey. PARTICIPANTS: Twenty-five women were included in the high PTSS group (PPQ score ≥ 12), and 25 were included in the low PTSS group (PPQ score ≤ 1). METHODS: Participants completed the PPQ and a writing task about the birth experience 1 week after birth and completed an online version of the PPQ 3 months after birth. Characteristics of the narratives were analyzed and compared between the two groups using the Linguistic Inquiry Word Count. RESULTS: Compared with participants with low levels of PTSS, participants with high levels of PTSS reported more negative emotions, including horrific images connected to labor and birth and fewer positive emotions. Participants with high levels of PTSS used more sensory and perceptual terms (tactile, visual, and auditory). In contrast, women with low levels of PTSS described more active participation during birth and used more future tense verbs. CONCLUSION: Our findings suggest the aspects that are involved in the development and maintenance of PTSS after birth and may be considered for use in clinical practice to improve quality of care and women's health during the postpartum period.

Health workers' perceptions of Italian female adolescents: a qualitative study about sexuality, contraception, and caring practices in family health centers.

Our aim was to explore health workers' perceptions of providing sexuality and contraception care for female adolescents within family health centers. We interviewed 26 volunteer health workers and analyzed the interviews using thematic analysis. We identified three main themes: (a) "adolescents and sexuality," with the subthemes "initiation rite," "me like the others," and "just for fun"; (b) "adolescents and contraception," with the subthemes "omnipotent adolescents," "aware adolescents," and "women's responsibility"; and

The lived experience of fathers of preterm infants in the Neonatal Intensive Care Unit: a systematic review of qualitative studies.

AIMS AND OBJECTIVES: To systematically review the experience of fathers of preterm infants hospitalised in the Neonatal Intensive Care Unit. BACKGROUND: Family-centred care is more and more acknowledged in Neonatal Intensive Care Units, advocating for active engagement of both parents in the care journey. Nonetheless, fathers' Neonatal Intensive Care Unit experience has received limited research attention. DESIGN: Systematic review of qualitative studies. METHODS: Four electronic databases (CINHAL, ISI Web of Science, PubMed, Scopus) were explored and studies published between 2000-2014 were included. Preferred Reporting Item for Systematic Reviews and Meta-analysis (PRISMA) and Joanna Briggs Institute (JBI) Critical Appraisal Tool for Qualitative Studies guidelines were adopted. Key themes were extracted and synthesised. RESULTS: Five main themes resuming fathers' experience of preterm birth and Neonatal Intensive Care Unit stay were identified from 14 studies. Themes were: emotional roller-coaster, paternal needs, coping strategies, self-representation and caregiving engagement. These dimensions were found to be dynamically shaped across three critical turning points: preterm birth, Neonatal Intensive Care Unit stay and at home. CONCLUSIONS: Neonatal Intensive Care Unit fathers of preterm infants experience ambivalence, a set of different needs and coping strategies. They modify their self-representations along the Neonatal Intensive Care Unit journey and needs specific nursing support and intervention to sustain caregiving engagement and transition to parenthood. RELEVANCE TO CLINICAL PRACTICE: A systematic and deepened understanding of preterms' fathers lived experience in Neonatal Intensive Care Unit would be helpful to inform nursing practice. Specific action priorities are suggested within the frame of family-centred care.

The impact of the ketogenic diet on arterial morphology and endothelial function in children and young adults with epilepsy: a case-control study.

PURPOSE: The present study aimed to assess the impact of the ketogenic diet on arterial morphology and endothelial function of the big vessels of the neck and on cardiac diastolic function, in a cohort of epileptic children and young adults treated with the ketogenic diet. METHODS: Patients were recruited based on the following inclusion criteria: (1) patients who were or had been on the ketogenic diet for a time period of at least six months. Each patient underwent measurement of carotid intima media thickness, carotid artery stiffness, echocardiography, and diastolic function assessment. Patients with drug resistant epilepsy, matched for number, age and sex and never treated with ketogenic diet, were recruited as controls. RESULTS: The population study was composed by 43 epilepsy patients (23 males), aged between 19 months and 31 years (mean 11 years). Twenty-three patients were or had been treated with ketogenic diet, and 20 had never been on it (control group). Subjects treated with the ketogenic diet had higher arterial stiffness parameters, including AIx and ß-index and higher serum levels of cholesterol or triglycerides compared to those who had never been on the diet (control group) (p<0.001). CONCLUSIONS: Arterial stiffness is increased in children and young adults treated with the ketogenic diet, before the increase of the intima media thickness. This supports that arterial stiffness is an early marker of vascular damage.

Brainstem arteriovenous malformation presenting with dyspraxic handwriting in a young girl.

We report the case of a 11-year-old girl who developed an isolated hand-writing disorder with dysgraphia at the beginning of the school year in the sixth grade. A brain magnetic resonance angiography showed a round arteriovenous malformation sited in the left side of the midbrain extending to the ipsilateral medio-basal thalamus. Child neurologists should never neglect a thorough neurological evaluation in case of isolated worsening of handwriting, to rule out possible underlying organic causes.

Rufinamide for refractory focal seizures: an open-label, multicenter European study.

PURPOSE: The present study aimed to assess the efficacy and tolerability of rufinamide as adjunctive drug for the treatment of a large series of children, adolescents and adults with refractory cryptogenic or symptomatic focal epilepsy. METHODS: Patients were recruited in a prospective, add-on, open-label treatment study from six Italian and one German centers for pediatric and adolescent epilepsy care. Inclusion criteria were: (1) age 3 years or more; (2) diagnosis of cryptogenic or symptomatic focal epilepsy refractory to at least three previous antiepileptic drugs (AEDs), alone or in combination; (3) more than one seizure per month in the last 6 months; (4) use of at least one other AED, but no more than three, at baseline; (5) informed consent from parents and/or caregivers. RESULTS: Sixty-eight patients (40 males, 28 females), aged between 3 and 63 years (mean 19.9 years, median 16.0)±SD 12.58, with cryptogenic (28 pts, 41.2%) or symptomatic focal epilepsy (40 pts, 58.8%), were recruited in the study. After a mean follow-up period of 10.4±10.29 months, twenty-two patients (32.3%) had a 50-99% seizure reduction, and none became seizure-free. Twelve patients (17.6%) had a 25-49% seizure decrease, while in 30 (44.1%) seizure frequency was unchanged. A seizure worsening was reported in 5 patients (7.3%). A better response to rufinamide occurred in frontal lobe seizures (51.6%) and secondary generalized tonic-clonic seizures (50%). CONCLUSION: Rufinamide was effective against focal-onset seizures, particularly in the treatment of secondary generalized frontal lobe seizures.