Breast cancer disproportionately affects young women raising minor children. Unresolved parenting concerns can impair patients mental health, reduce treatment adherence, and compromise long-term oncological outcomes. However, previous studies have paid limited attention to the heterogeneity of parenting concerns in this population and lack a theory-grounded classification framework for stratified supportive care. This descriptive qualitative study, framed by social role theory, recruited 17 Chinese breast cancer patients through maximum variation sampling and conducted semi-structured in-depth interviews. From four dimensions-role expectation, role load, role resources, and role adaptation-the study extracted four distinct parenting concern personas: role overload, role strain, role resilience, and role disablement. The four subgroups differed significantly in maternal role expectations, treatment-related physical burden, family support resources, and coping strategies. These findings can assist clinicians in identifying the specific types of distress faced by different patient subgroups, thereby providing a basis for developing stratified and individualized precision support strategies.
Humming is a ubiquitous yet understudied form of human vocalisation that may play a role in regulating internal bodily states during early development. Unlike speech or singing with lyrics, humming consists of continuous, semantically unstructured vocal sounds produced with a closed mouth. It generates sustained sonic, vibratory and respiratory patterns that engage interoceptive and autonomic processes. This paper explores the hypothesis that humming critically contributes to homeostatic regulation in caregiver-infant interaction. Drawing on research in developmental psychology, perinatal care and vocal practice, we propose that humming provides a simple mechanism through which caregivers may scaffold the infant's developing interoceptive awareness, paving the way to subsequent social cognition abilities. Through slow rhythmic breathing, chest and cranial vibration, and temporally structured vocal phrasing, humming may influence cardio-respiratory rhythms and support autonomic balance while also organising moments of social engagement. Evidence is gathered from studies of maternal humming during kangaroo care with preterm infants, showing that these vocalisations can stabilise physiological parameters and invite infant vocal participation. We argue that humming may function as an embodied, interoceptive form of co-regulation for both infants and caregivers, linking physiological homeostasis with early communicative exchange.
Background Marginalised populations face significant health risks in pregnancy with reduced access to preventive and life-saving services due to conflict and migration. Infectious disease risk is high and the double burden of malnutrition increases risk from non-communicable disease although only weak epidemiological data supports this in refugees and migrant communities. This manuscript describes the SMRU Refugee and Migrant Pregnancy Cohort commencing nearly 40 years ago, established in response to the very high rate of Plasmodium falciparum maternal mortality in refugee camps on the Thailand Myanmar border Methods Pregnant women who registered to antenatal care clinics of the Shoklo Malaria Research Unit from 1986 to 2024 living in marginalised communities of refugee and migrants were the eligible population. Pregnancies were prospectively followed from enrolment through to childbirth. Types of data include: 1) medical and obstetric records including patient characteristics, pregnancy progress and birth outcomes and 2) investigations (such as HIV). Results Among 94,645 pregnancies maternal mortality was 176 per 100,000 livebirths (120/68,024). Embedded cohorts included observational and clinical trials, providing evidence on the optimisation of treatment of malaria in pregnancy and on the rapid changes towards non-communicable diseases in refugees and migrants. Low mean height (151.4 cm), well below European and American populations from which the majority of guidelines have been created, questions appropriateness, such as gestational weight gain in pregnancy. A broad scope of research findings including tropical infections impacting pregnancy outcomes, mental health and suicide, a shared platform of "-omics" of Karen and Burmese women from first trimester, and practice of care in low-income settings have emerged and been shared. Conclusions The SMRU Refugee and Migrant Pregnancy Cohort findings have had significant local and international impact including changing the World Health Organisation Malaria Treatment Guidelines in pregnancy; and establishing a range of guidelines and tools improving maternal-child health practices.
Research in Context Evidence before this study We searched PubMed for studies published between Jan 1, 2015, and Dec 31, 2025, using combinations of the terms “ Klebsiella pneumoniae ”, “neonate”, “young infant”, “bloodstream infection”, “sepsis”, “risk factors”, and “sub-Saharan Africa”. Only seven studies were identified. These studies were identified in South Africa, Tanzania, and Ethiopia. They have identified Gram-negative bacteria, including Klebsiella pneumoniae , as important causes of neonatal bloodstream infections and mortality. Previous work has described the epidemiology, antimicrobial resistance profiles, and outcomes of neonatal bloodstream infections, highlighting the increasing burden of multidrug-resistant and extended-spectrum β-lactamase-producing organisms. Studies have also identified risk factors for neonatal sepsis, including prematurity, low birthweight, healthcare exposure, and invasive procedures. However, no studies in Sub-Saharan Africa have specifically examined risk factors for Klebsiella pneumoniae infection among infants younger than 3 months of age. Furthermore, most available studies have focused on clinical outcomes, antimicrobial resistance, or transmission pathways rather than determinants of Klebsiella pneumoniae infection. Data from sub-Saharan Africa remain limited, particularly for young infants in high-burden settings. To our knowledge, no validated risk prediction tools are available to identify infants at increased risk of Klebsiella pneumoniae infection, and there is limited evidence linking risk stratification approaches to targeted treatment or management strategies. No such data have been reported from Malawi. Added value of this study This study investigated risk factors associated with Klebsiella pneumoniae infection among infants younger than 3 months of age in Malawi. We identified factors independently associated with Klebsiella pneumoniae infection in early infancy, and we quantified the risk of neonates getting these Klebsiella pneumoniae infections, and this was done in a setting where rapid microbiological diagnosis is often unavailable. We also linked risk prediction to potential clinical management by evaluating antibiotic susceptibility patterns and identifying antibiotic regimens that may be appropriate for infants classified as being at high risk of Klebsiella pneumoniae infection. Our findings provide evidence from a high-burden African setting where data on pathogen-specific risk prediction and treatment guidance remain scarce. Implications of all the available evidence Together with existing evidence, our findings provide further evidence that neonatal sepsis in African settings is commonly healthcare associated and antimicrobial resistant. Antimicrobial stewardship is not simply about restriction to unnecessary therapy, but also enabling access where it has the potential to be life-saving. Neonates do not have the physiological reserve to wait for antimicrobial therapy to be tailored to a blood culture result. Early identification of infants with clinical suspicion of sepsis that are at increased risk of Klebsiella pneumoniae infection could support more targeted clinical management and reduce mortality due to Klebsiella pneumoniae and improve antimicrobial stewardship in high-burden settings. Background Klebsiella pneumoniae ( Kpn ) is a major cause of neonatal sepsis in Africa. 3 rd -generation cephalosporin and gentamicin resistant Kpn is the norm in many sites, rendering WHO-recommended first- and second-line antimicrobials ineffective. An understanding of which neonates and infants are most at risk of sepsis caused by Kpn would support the case for improved access to WHO watch and reserve antimicrobials (i.e. carbapenems) for patients most likely to benefit from them. Methods A prospective case-control study was conducted at Queen Elizabeth Central Hospital, Malawi. Cases were infants <3 months of age with blood or CSF culture-confirmed Kpn infection. Controls were healthy infants from the same wards and were matched 2:1. Univariate and multivariate logistic regression were performed on mean-centred data to determine risk factors for infection with Kpn. Results We analysed data from 38 cases and 76 controls between [insert dates]. Mortality at 3 months of age was 21/38 (29%) for cases, with 14/38 (37%) identified postmortem and 6/76 (7.9%) for controls (OR 14.0 (95% CI 4.59, 49.2, p>0.001). Cases were more likely to be born out of QECH than controls (42% vs. 24%, p = 0.043), and cases had lower birthweights (median 2200g vs. 2850g, p = 0.005). Multivariate logistic regression analysis revealed that increasing birthweight was protective against Kpn infection (OR: 0.858 [95% CI: 0.745–0.987] per 100g increase), while longer hospital stay was associated with increased odds of infection (OR: 1.148 [95% CI: 1.012–1.1.303] per additional day). Most infecting isolates (34/38 [89%]) were resistant to first- and second-line antimicrobial agents, but all were sensitive to meropenem and 33/36 [92%] to amikacin. Conclusion Low birthweight infants with prolonged hospital stay were at greatest risk of Kpn infections that were typically resistant to WHO first- and second-line antimicrobial therapy. These infants should be prioritised for antibiotics that have the potential to be life-saving. The overlapping and evolving nature of these risk factors makes it difficult to design a simple tool to support empiric initiation of meropenem. Neonates critically ill with Kpn sepsis cannot, however, afford to wait for blood culture-confirmation before receiving effective treatment. This highlights the need for empiric decision-making frameworks that allow rapid initiation of effective therapy in high-risk neonates.
Objective Female Genital Mutilation/Cutting (FGM/C) is one of the most widespread traditional practices harmful to the health of women and girls in the world. Its spread to the West highlights the need to establish preventive actions in European countries taking into account the affected population. That is why this study is aimed at finding out the elements that support the continuation of FGM/C and those that promote the change of attitudes and fight against FGM / C from the perspective of the sub-Saharan women themselves who reside in Spain. Design Qualitative exploratory research that uses the method of life stories through an open interview. Participants and setting The participants were 24 women living in the Region of Murcia (Spain) who come from sub-Saharan countries where FGM/C is commonly practised. Findings Arguments supporting FGM/C, the lack of knowledge and family pressure are identified as factors that perpetuate the practice, whereas the motivating factors for the change in attitudes that make most of the interviewees oppose FGM/C are the awareness of the consequences on health and close negative experiences, growing awareness of their rights, supportive legislation and breaking the taboo related to this practice to question justifications for FGM / C and share experiences. Key conclusion and implications for practice Being aware of the arguments of both sides, women who defend FGM/C and those who oppose it, is a valuable source of information that obstetrics, midwifery and nursing professionals can use. The study provides the core elements that any healthcare education program should incorporate to prevent female genital mutilation/circumcision.
Pastor-Bravo MDM, Almansa-Martínez P, Jiménez-Ruiz I
Many adolescents face barriers to accessing reproductive health care even though quality reproductive health care is a fundamental human right. The objective of this study is to understand the requests of quality reproductive health among high school girls in Kenya. We conducted a secondary analysis of qualitative data from a sub-sample of adolescent girls in Kenya who participated in the What Women Want global campaign and analyzed interview data from key informants involved in the survey. We used pre-existing codes and current literature to design the coding framework and thematic analysis to describe emerging themes. Atlas. ti 8 was used to organize and analyze codes. Over 4,500 high school girls, ages 12 and 19 years, were included in the analysis, with 61.6% from all-girls boarding schools and 13.8% from mixed-day schools. Data from nine key informants complemented findings from the survey. Emerging themes included: 1) The need for improved menstrual health and hygiene: Sanitary towels and cleaner toilets; 2) Prevention of adolescent pregnancy: Access to contraception; 3) Respect and dignity: Participants want privacy and confidentiality; and 4) The need to address social determinants of health: Economic stability and a safe physical environment. This study indicated that adolescent high school girls have varied requests for reproductive health care and services. While menstrual health and hygiene are key issues, reproductive needs are beyond just sanitary products. The results suggest a need for targeted reproductive health interventions using a multi-sectoral approach.
Background Migrant women face an increased risk of poor obstetric and neonatal outcomes. Norway implemented a multicultural doula (MCD) program in 2018, which was designed to improve pregnancy care for this group in vulnerable circumstances. This study aimed to assess the impact of MCD support, provided in addition to standard care, on obstetric and neonatal outcomes for selected newly arrived migrants. Methods This was a multi-centre case-control study involving all nine hospitals actively running the MCD program, which covers four of Norway's five regions. Women who received MCD support at the time of childbirth (n = 339), from 2018-2023, were compared to similar newly arrived immigrant women who did not receive MCD support (n = 339) and gave birth within the same timeframe. Hospital records were reviewed, and outcomes were analysed using binary logistic regression. The results are expressed as crude and adjusted associations with 95% confidence intervals (CIs). Results Women receiving MCD support exhibited a 41% lower likelihood of undergoing emergency caesarean sections (adjusted odds ratio [aOR] 0.59, 95% Cl 0.34-0.98) and those giving birth vaginally had a 75% lower risk of estimated blood loss ≥1000 ml (aOR 0.25, 95% Cl 0.12-0.52) compared with women without MCD support. Additionally, MCD support was associated with more use of pain-relief (aOR 2.88, 95% Cl 1.93-4.30) in labour and increased rates of exclusive breastfeeding at discharge (aOR 2.26, 95% Cl 1.53-3.36). Conclusions Our study suggests that MCD support may contribute to improved outcomes for migrants in vulnerable circumstances, potentially impacting their future reproductive health and children's well-being.
BACKGROUND: The armed conflict that erupted on April 15, 2023, in Khartoum, Sudan, between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), has resulted in catastrophic humanitarian consequences. Over 61,000 people have been killed in Khartoum State alone, and more than 8.2 million have been displaced, making it one of the worst displacement crises in the world. The violence in Khartoum, Darfur, Jazeera, and Kordofan, as well as in other states, has made women and girls more vulnerable to exploitation and abuse. Furthermore, children and teenagers have experienced major disruptions to their education, health, and future prospects. METHODS: A cross-sectional survey was conducted in Sudan, targeting women and children, from 1 December 2023 to 31 October 2024. The survey included 243 women and 122 children, and data were collected using a structured online submission form. RESULTS: Among the surveyed population, 48.8% of women were aged 36 and older, and 11.6% were between 18 and 23 years old. Approximately 90% of them were in Khartoum on April 15, 2023, and reported significant psychological and physical impacts. Symptoms of depression among the surveyed included 47.8% experiencing loss of energy and 48% reporting loss of interest. 93.5% of participants reported sleep-related difficulties such as insomnia or excessive tiredness. Educational disruption was profound, with 74% of women still seeking solutions to resume their studies. Health challenges were also significant, with 27.4% of women suffering from chronic diseases and facing irregularities in medication intake due to the conflict. The impact of war on children was equally severe. The depression symptoms reported by their mothers included sadness or a low mood (19.7%) and irritability or anger (16.4%). There was a clear, significant difference (p-value = 0.000639) between children who witnessed armed conflict (87.6%) and those who were unable to continue their education (37.2%), as they were trapped within the country and unable to resume their education. Self-reported signs of malnutrition were a significant concern, with 44.4% of mothers reporting reduced food intake and 19.4% experiencing limited access to nutritious food for their children. CONCLUSION: The ongoing conflict in Sudan has sparked a severe crisis that is primarily affecting women and children, with expected repercussions at both the family and community levels. The violence has caused significant damage to health services, education, and mental well-being. Urgent intervention from civil society organisations and policymakers is essential to stop this devastating war and address the critical needs of those impacted by the conflict.
BACKGROUND: Women born in Somalia who have migrated to Sweden have increased risks of complications related to pregnancy and childbirth. Swedish-Somali women are, compared to women born in Sweden, less likely to contact healthcare for decreased fetal movements, which can be a sign of fetal distress. This study aimed to evaluate the effect of a Mindfetalness-based intervention in increasing awareness of fetal movements and its impact on birth outcomes among Swedish-Somali migrant women. METHODS: An intervention study with a non-randomised control group, encompassing Swedish-Somali migrant women, with a singleton pregnancy, giving birth from gestational week 32 + 0 between June 2022 and June 2024. Data was collected from the Swedish Pregnancy Register and the Swedish Neonatal Quality Register. The intervention group consisted of 1,251 women who, in addition to routine information about fetal movements, also received information about Mindfetalness, a concept supporting women to become familiar with the baby’s movement pattern. The control group consisted of 1,555 women who only received routine information about fetal movement. Outcome measures included Apgar score at five minutes after birth, birth weight, neonatal intensive care unit admission, fetal death, onset of labour, mode of birth, and gestational age at birth. Log-binomial regression analyses were applied to assess associations between the intervention and selected outcomes. RESULTS: There was a statistically significant increase in spontaneous vaginal births in the intervention group (RR 1.06, CI 1.01–1.11). No statistically significant differences between the intervention and control groups were observed for any other outcomes. Nearly one-third of women in both groups experienced a prolonged or post-term birth, while two-thirds were overweight or obese. The overall stillbirth rate ranged between 0.3% and 0.4%. CONCLUSIONS: The Mindfetalness intervention was associated with an increased incidence of spontaneous vaginal births, but no effect on other birth outcomes was observed. Implementing health interventions in a high-quality healthcare setting present challenges. When designing interventions to improve birth outcomes, it is essential to consider demographic data and the prevalence of risk factors within the target population. Further research involving stakeholders representing Swedish-Somali women is needed to understand the implications of this intervention. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov: NCT05540639, 30/06/2022.
Female Genital mutilation/cutting (FGM/C) is associated with enduring psychiatric complications. In this study, we investigate the rates of co-morbid abuses and polyvictimization experienced by survivors of FGM/C. This is a sub-analysis of a cohort study examining the patient population at the EMPOWER Center for Survivors of Sex Trafficking and Sexual Violence in New York City. A retrospective chart-review of electronic medical records was conducted for all consenting adult patients who had FGM/C and had an intake visit between January 16, 2014 and March 6, 2020. Of the 80 participants, ages ranged from 20 to 62 years with a mean of 37.4 (SD = 9.1) years. In addition to FGM/C, participants were victims of physical abuse (43; 53.8%), emotional abuse (35; 43.8%), sexual abuse (35; 43.8%), forced marriage (20; 25%), child marriage (13; 16.3%), and sex trafficking (1; 1.4%). There was a high degree of polyvictimization, with 41 (51.2%) experiencing 3 or more of the aforementioned abuses. Having FGM/C on or after age 13 or having a higher total abuse score was also found to be strong predictors of depression and PTSD. The high rates of polyvictimization among survivors of FGM/C are associated with development of depression and PTSD. Despite co-morbid abuses, patients still attribute substantial psychiatric symptoms to their FGM/C. Health care providers should understand the high risk of polyvictimization when caring for this patient population.
