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Aims/Background: Assessing the intensity of perinatal grief is very important for identifying the more complex cases in mothers and fathers. Despite this, there are few assessment tools available. The aim of this study was to analyse the psychometric properties (factorial structure, reliability, and validity) of the Spanish version of the Perinatal Grief Intensity Scale (PGIS). Design/Methods: An online survey was completed by 291 mothers and fathers who had suffered perinatal loss in the previous six years. Results: The results showed adequate fit indexes for the three-factor model of the PGIS: reality, confront others, and congruence. Reliability values for the overall scale and subscales were adequate. Finally, with regard to validity, significant (p < .05) and positive relationships were found with levels of complicated grief, event centrality, guilt, anxiety, and depression. There were also differences depending on whether participants exhibited high or low levels of complicated grief, and on the number of weeks of pregnancy at the time of the loss. Conclusion: In conclusion, the Spanish adaptation of the PGIS has adequate reliability and validity scores and a factorial structure consistent with the original version.

Parental feeding practices, such as the use of food to soothe, can be shaped by various factors, including the family environment and parents' psychological characteristics and capacities. To our knowledge, the combined effect of these factors has not been studied. Furthermore, parental feeding practices have mainly been studied in women, resulting in a gender gap in the research. This study aims to investigate the combined effect of family environment and parental characteristics on the likelihood of using food to soothe children, taking the gender of both parents into account. This cross-sectional study included a sample of 846 parents (36.3% men) of 1-year-old children from different regions of Spain. Participants completed an online survey that included questionnaires to measure whether parents used food to soothe children, the family environment, parents' characteristics, and their psychological capacities. Binary logistic regression analyses were performed to identify associations between the variables. The final model showed that, within the family environment, higher levels of dyadic adjustment between couples (OR = 0.965; p = .026) were associated with a reduced likelihood of using food to soothe children, whereas the psychological characteristic of parental fatigue (OR = 1.053; p = .007) appeared to be associated with an increased likelihood. Also associated with an increased likelihood of this practice were higher parental sense of competence (OR = 1.028; p = .029) and the attention dimension of emotional intelligence (OR = 1.043; p = .007). Our study suggests that using food to soothe children may be influenced by factors at different levels, from the quality and adjustment of the couple's relationship to parental fatigue, self-competence, and emotional intelligence. For future research, it may be worthwhile contextualizing parental practices to gain a better understanding of children's behavior.

Seminario de Febrero de 2024 perteneciente al Ciclo de seminarios Concepción Arenal - Grupo de investigación Salud Pública / Person-centred Care and Health Outcomes Innovation

Satisfaction with life is considered an essential indicator of quality of life and has implications not only for parents but also for the general health of society. It is relevant to know the factors that could explain differences in parents’ satisfaction with life. The objectives of this study were to analyse the degree of satisfaction with life of a cohort of fathers 13–24 months after the birth of their child and to analyse the predictive capacity of sociodemographic, physical, psychological, and social factors on their long-term life satisfaction. This was a longitudinal study with follow-up at 6–12 months and at 13–24 months (n = 152 fathers). The Fatigue Assessment Scale, Athens Insomnia Scale, Parental Stress Scale and short version of the Dyadic Adjustment Scale were completed online at 6–12 months. Finally, Satisfaction with Life Scale was assessed between 13 and 24 months after birth. The mean score of life satisfaction of the participants 13–24 months after the birth of their child was 18.72 (SD = 3.71) and was negatively correlated with fatigue, insomnia, and stress (p < 0.01), and positively correlated with dyadic adjustment (p < 0.01). The final hierarchical regression model showed that educational levels and insomnia were the main predictive variables for life satisfaction during the second-year postpartum. This work has important implications for clinical practice because it allows health professionals to understand the factors influencing satisfaction with life and health among fathers and to plan more effective antenatal and postnatal care.

Antecedentes: La transición a la parentalidad implica cambios complejos para los padres, los cuales se reflejan en modificaciones cognitivas, emocionales y conductuales. También afectan los niveles de estrés y felicidad experimentados durante esta etapa. Los determinantes de la parentalidad son influenciados por factores internos y externos, los cuales se dividen en características de los padres (como el sexo, la edad, el nivel educativo y la paridad), los hijos (como el sexo y la edad) y el contexto en el que se desenvuelven. Entre todos estos factores, las características de los padres tienen una influencia más significativa, ya que son los principales agentes de socialización en la crianza de los hijos. Un aspecto importante de la parentalidad es la competencia parental percibida, que se refiere a la autopercepción de los padres sobre su capacidad para cuidar y educar a sus hijos. Esta competencia tiene un impacto en la competencia objetiva de los padres y en su bienestar psicológico. Además, desempeña un papel crucial durante la transición a la parentalidad, afectando el desarrollo y la salud de los niños. Para medir la competencia parental percibida, se utiliza la escala Parental Sense of Competence (PSOC). Esta escala evalúa la capacidad de los padres para asumir su rol parental (autocompetencia) y su satisfacción con su propia competencia (satisfacción). Ha sido estudiada en relación a la salud mental de los padres, el comportamiento de los hijos, las relaciones de pareja y el funcionamiento familiar. Aunque la versión original del PSOC ha sido ampliamente utilizada en diferentes países e idiomas, no existe una adaptación cultural al contexto español con propiedades psicométricas sólidas. Objetivos: El objetivo principal de la tesis es validar lingüísticamente la versión original en inglés de la escala PSOC al español en una muestra de madres y padres. Para lograr este objetivo, se plantearon los siguientes objetivos específicos: (i) realizar la traducción y

Introducció. La lactància materna és beneficiosa per als nadons, les mares i la societat. Malgrat això, al nostre àmbit no s'assoleixen les taxes de lactància recomanades per l’Organització Mundial de la Salut. Segons el model ecològichumà, hi ha diversos factors que actuen als nivells individual, de relacions i comunitaris, i social i cultural que influeixen en l’abandó prematur de la lactància, abans del que les mares desitgen. L’adequada instauració de la lactància durant els primers dies de vida del nadó, que pot avaluar-se amb mesures de l’eficàcia de la lactància, és un factor determinant per a l’abandó de la lactància. La lactància materna eficaç requerix una agafada correcta del nadó al pit, una succió-deglució adequada i la transferència de llet efectiva. A més, el suport professional a la mare en els primers dies és fonamental. L’avaluació de l'alletament abans de sortir de l'hospital és un aspecte comunament referit en les guies de pràctica clínica, en l’àmbit nacional i internacional. Les escales LATCH i Infant Breastfeeding Assessment Tool (IBFAT) són utilitzades per avaluar l'alletament, però requereixen una adequada adaptació cultural i validació en espanyol. L'objectiu de la tesi és adaptar culturalment aquestes escale avaluar-ne les propietats psicomètriques i la utilitat predictiva. Material i mètode. Es va dur a terme un estudi instrumental de seguiment per validar dues escales d'avaluació de la lactància materna: l'escala LATCH-e i l'escala IBFAT-e. Aquest estudi constava de dues fases: adaptació cultural i validació psicomètrica. Per a l'escala LATCH-e, es va utilitzar una mostra de conveniència de 495 mares, i per a l'escala IBFAT-e, la mostra va ser de 481 mares. El període de recopilació de dades i els criteris d'inclusió/exclusió va ser d’octubre de 2013 a juny de 2014. Addicionalment, es va portar a terme un estudi pilot amb professionals de la salut per a avaluar la fiabilitat entre observadors de l’escala LATCH. Fase 1: adaptació cultural

Background: Research gaps exist with regard to paternal attitudes towards breastfeeding and the association between fathers’ attitudes and the type of breastfeeding. Research Aims: (1) To analyze the psychometric properties of the Spanish version of the Iowa Infant Feeding Attitude Scale in fathers, and (2) to examine the association between fathers’ attitudes and type of breastfeeding. Method: We used a cross-sectional study design to analyze the scale’s psychometric properties and performance. Results: A total of 639 fathers participated in the study. The mean age was 35.83 years (SD = 4.65) and 67.3% (n = 430) were married or in a civil partnership. We observed an adequate fit in the confirmatory factor analysis: TLI = 0.96, CFI = 0.97 and RMSEA = 0.05. The overall internal consistency was 0.76. Between 1–6 months, 48% (n = 307) of participants’ babies were exclusively breastfed, 35.2% (n = 225) were partially breastfed, and 16.7% (n = 107) were exclusively formula fed. Statistically significant differences were shown in attitudes towards breastfeeding, depending on the type of breastfeeding, between 1 and 6 months (F = 54.67; p < .001). Fathers who reported that their baby had been exclusively breastfed scored higher on attitudes towards breastfeeding. Statistically significant differences were also found between partial breastfeeding and formula feeding. Conclusions: The Spanish version of the Iowa Infant Feeding Attitude Scale is a valid and reliable instrument for measuring paternal attitudes towards breastfeeding., Antecedentes: Existen otras lagunas de investigación en relación con la promoción de la lactancia materna, específicamente en las actitudes de los padres. Objetivos: Los objetivos del presente trabajo fueron: 1) analizar las propiedades psicométricas de la versión española de Iowa Infant Feeding Attitude Scale en padres, y 2) examinar la asociación entre las actitudes paternas y el tipo de lactancia materna. Método: nosotros llevamos a cabo un diseño transversal para analizar las propiedades psicométricas y el funcionamiento de la escala. Resultados: participaron 639 padres con una edad media de 35.83 (DE = 4.65) y el 67.3% estaban casadas o eran pareja de hecho. Observamos un ajuste adecuado en el análisis factorial confirmatorio: TLI = 0.96, CFI = 0.97, y RMSEA = 0.05. La consistencia interna total fue de 0.76. Entre el mes y los seis meses, el 48% de sus bebés se alimentaba exclusivamente con lactancia materna, el 35.2% lactancia mixta y el 16.7% solo utilizaba lactancia con fórmula. Se mostraron diferencias estadísticamente significativas en la actitud hacia la lactancia materna en función de la lactancia realizada entre el mes y los 6 meses (F = 54.67; p < .001). Los padres que notificaron que su bebe amamantaba de manera exclusiva tenían una puntuación más elevada en la actitud hacia la lactancia materna. También se encontraron diferencias estadísticamente significativas entre la lactancia mixta y la lactancia artificial. Conclusiones: La versión en español de Iowa Infant Feeding attitude Scale es un instrumento válido y fiable para evaluar las actitudes hacia la lactancia materna en padres.

Background. In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience. Methods. This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure. Result. The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence. Conclusion. Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.

Aim: To identify scales that assess parental stress in the paediatric clinical population and to analyse their psychometric properties. Methods: Four electronic databases (PubMed, Web of Science, PsycINFO, and Scopus) and metasearch engines (Google Scholar and Open Grey) were searched with no time period limitations. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach modified by COSMIN. Finally, recommendations were made for the instruments with the highest quality of evidence. Results: A total of 38 studies reporting on 11 different instruments for assessing parental stress in the paediatric clinical setting were included. Six instruments were ‘A’ rated (recommended) in the final phase in line with COSMIN guidelines. The Paediatric Inventory for Parents was the instrument that evaluated the highest number of psychometric properties and obtained the highest methodological quality, global assessment, and quality of evidence for the different psychometric properties. Conclusions: This systematic review provides an overview of the measurement properties of the parental stress instruments used in the paediatric clinical setting. The Paediatric Inventory for Parents stands out as being one of the most robust instruments for measuring stress in parents with a hospitalised or sick child. Evidence needs to be generated for all the parental stress scales used in the clinical setting. Impact: Given that the psychometric properties of the existing parental stress scales used in paediatric health care settings have not been systematically assessed, the present review utilised comprehensive methods according to COSMIN. No Patient or Public Contribution. Reporting method: PRISMA statement and COSMIN reporting guidelines for studies on measurement properties of patient-reported outcom

Objective: To confirm the structure and examine the psychometric properties of the Parental Competence Questionnaire in the Paediatric Hospital Emergency Setting (ECP-U). Methods: An instrumental validation study of the ECP-U questionnaire and an examination of its psychometric properties were carried out. Results: The participants were 260 mothers and fathers seeking care in the paediatric emergency department of a hospital in Valencia (Spain) with children aged 0 to 14 years old. The five-factor structure of the ECP-U was confirmed with excellent statistical fits. Second-order models and a more parsimonious four-factor structure with adequate but marginal fits are proposed. With the exception of the “parental agency” factor (in both models examined) and the “active social support” factor (in the original five-factor structure), the internal consistency of the different factors was modest (≥ 0.70). A negative correlation was found between the Parental Stress Scale and the ECP-U for most factors. Conclusions: Validity and reliability analyses indicate that the ECP-U is an instrument with modest psychometric properties. Implications for practice: The ECP-U is an instrument that can be used by future researchers to identify different levels of parental competence in paediatric hospital emergency departments. This will enable help to be given to families with parenting issues and problems. The underlying concern is to reduce the number of frequent users and “Non-Urgent Presentations” to paediatric emergency departments due to low parental competence.

Context: Studies on parenting, including feeding styles and practices in general, have focused mainly on mothers. Consequently, there is a gap with respect to fathers in the scientific literature. Objective: This study's main objective is to determine paternal feeding styles toward children aged 0 to 18 years and to identify those most commonly used by men. Data Sources: The PubMed, Scopus, Web of Science, Cochrane, and PsycINFO databases were consulted. Data Extraction: Articles that were not published in English, Spanish, or Italian were excluded, as well as those that referred to other subjects, those whose sample did not include men, or those studying children with pathologies that could influence their diet. All the articles ultimately included were assessed using the STROBE checklist. Data Analysis: A total of 183 articles were found. Of these, 13 were included in the review. No trend was found for paternal parenting style, and disparities existed among the authoritative, authoritarian, and permissive styles. In terms of feeding practices, men were more likely to use coercion. The most reported feeding styles were authoritarian and permissive. Conclusions: The findings of systematic review suggest cultural and gender differences exist with respect to parenting styles and feeding styles and practices. In terms of paternal parenting styles, there is some disparity. However, when it comes to feeding, men showed a tendency toward an authoritarian feeding style and coercive feeding practices.

Objective: To develop and validate a parental competence questionnaire for parents of children seeking care in hospital emergency departments. Methods: An instrumental study of the development of an assessment questionnaire was carried out in three phases: 1) review of relevant measures and item generation, 2) content validity evaluation, 3) psychometric evaluation. Exploratory factor analysis was performed to examine the factorial structure. Internal consistency was evaluated using ordinal alpha. Hypothesis testing was determined between the resulting factors, the Parental Stress Scale and the State-Trait Anxiety Inventory. Results: The participants were 270 parents of children aged 0–14 years old from a referral hospital in Valencia (Spain). An 18-item questionnaire was developed, comprising five factors that explain 53.0% of the variance: 1) “emotional management and expression”, 2) “passive social support”, 3) “parental agency”, 4) “basic needs and care” and 5) “active social support”. The internal consistency for the different factors was modest (>0.70). A negative correlation between the Parental Stress Scale and the parental competence questionnaire was found for most of the factors. Conclusions: This questionnaire on parental competence in the hospital emergency department (ECP-U) is a useful and simple self-report instrument for assessing the parental competence of parents with children in the emergency department. Practical implications: The resulting questionnaire is of practical value to both healthcare professionals and researchers in this field. It can be administered quickly in clinical practice and used to identify parents' levels of parental competence and refer those with difficulties to appropriate support services.

Background and objective: Adequate support in maternity wards is decisive for breastfeeding outcomes during the first year of life. Quality improvement interventions require the identification of the factors influencing hospital benchmark indicators. Machine Learning (ML) models and post-hoc Explainable Artificial Intelligence (XAI) techniques allow accurate predictions and explaining them. This study aimed to predict exclusive breastfeeding during the in-hospital postpartum stay by ML algorithms and explain the ML model’s behaviour to support decision making. Methods: The dataset included 2042 mothers giving birth in 18 hospitals in Eastern Spain. We obtained information on demographics, mothers’ breastfeeding experiences, clinical variables, and participating hospitals’ support conditions. The outcome variable was exclusive breastfeeding during the in-hospital postpartum stay. We tested algorithms from different ML families. To evaluate the ML models, we applied 10-fold stratified cross-validation. We used the following metrics: Area under curve receiver operating characteristic (ROC AUC), area under curve precision-recall (PR AUC), accuracy, and Brier score. After selecting the best fitting model, we calculated Shapley’s additive values to assign weights to each predictor depending on its additive contribution to the outcome and to explain the predictions. Results: The XGBoost algorithms showed the best metrics (ROC AUC = 0.78, PR AUC = 0.86, accuracy = 0.75, Brier = 0.17). The main predictors of the model included, in order of importance, the pacifier use, the degree of breastfeeding self-efficacy, the previous breastfeeding experience, the birth weight, the admission of the baby to a neonatal care unit after birth, the moment of the first skin-to-skin contact between mother and baby, and the Baby-Friendly Hospital Initiative accreditation of the hospital. Specific examples for linear and nonlinear relations between main predictors and the outcome and heterogene

The transition to parenthood represents a moment of change and adaptation in which the dyadic marital relationship becomes a triadic relationship. Facilitating a positive transition requires a thorough understanding of the explanatory model of the relationship between parental–infant bonding, dyadic adjustment and quality of life (QoL) from an integrative perspective of the family unit. The aim of this work was to analyse the relationships between parent–infant bonding, dyadic adjustment and QoL from an intra-partner perspective, 6–12 months after the birth of a child. A cross-sectional observational study was performed in a convenience sample of 222 couples 6–12 months postpartum, enrolled from October 2013 to March 2016. The mean age of the mothers was 34.07 years (SD = 3.67), and for the fathers, it was 35.75 years (SD = 4.02). Mothers perceived better QoL and greater mother–infant bonding compared to fathers. The perception of an adequate dyadic adjustment, together with positive parent–infant bonding, had positively influenced the individual QoL of both members of the couple 6–12 months after birth. From an intra-partner perspective, the positive transition was influenced by the relationship between parent–infant bonding, dyadic adjustment and QoL. Positive parent–infant bonding in mothers and fathers, as well as promotion of the quality of the relationships between couples, can help promote a better QoL. Positive health results can be achieved in terms of individual and family well-being by designing healthcare interventions that encourage the presence and participation of the family unit.

Objetivo: Analizar la relación del retraso de la lactogénesis II con la percepción materna de leche insuficiente. Método: Se realizó un estudio observacional longitudinal prospectivo, multicéntrico. Se obtuvieron datos al alta y entre 1 y 5 meses posparto sobre la percepción de leche insuficiente y las variables relacionadas mediante un cuestionario autoadministrado y el posterior seguimiento postal y online. Para el desarrollo del modelo explicativo, se realizó un análisis de regresión logística. Resultados: Participaron un total de 260 puérperas. El 31,9% de ellas percibieron leche insuficiente y el 23,6% presentaron retraso de la lactogénesis II. Durante el ingreso posparto, se relacionó con la percepción materna de leche insuficiente el retraso de la lactogénesis II (OR = 2,26; IC 95% = 1,07-4,79), la dificultad para amamantar (OR = 1,02; IC 95% = 1,00-1,03) y la ayuda de los profesionales en la lactancia (OR = 0,70; IC 95% = 0,50-0,97). Conclusiones: La aparición de dificultades en la lactancia durante el ingreso posparto y al alta, especialmente cuando existe un retraso de la lactogénesis II, deben considerarse indicadores de riesgo, que sugieren la necesidad de un apoyo adicional a los cuidados estandarizados. La percepción de leche insuficiente es un indicador adecuado para evaluar la calidad del apoyo profesional a la lactancia en intervenciones de mejora., Aim: To analyze the relationship of delayed lactogenesis II with maternal perception of insufficient milk. Methods: A prospective, multicenter, longitudinal observational study was conducted. Data were obtained at discharge and between 1 and 5 months postpartum on the perception of insufficient milk and related variables, by means of a self-administered questionnaire, and subsequent postal and online follow-up. Logistic regression analysis was used to develop the explanatory model. Results: A total of 260 puerperal mothers participated. Of these, 31.9% had insufficient milk and 23.6% had delayed lactogenesis II. During postpartum admission, delayed lactogenesis II (OR = 2.26; 95% CI = 1.07-4.79), difficulty in breastfeeding (OR = 1.02; 95% CI = 1.00-1.03), and professional help in breastfeeding (OR = 0.70; 95% CI = 0.50-0.97) were associated with maternal perception of insufficient milk. Conclusions: The occurrence of breastfeeding difficulties during postpartum admission and at discharge, especially when there is delayed lactogenesis II, should be considered risk indicators, suggesting the need for additional support to standardized care. The perception of insufficient milk is a suitable indicator to assess the quality of professional breastfeeding support in improvement interventions.

Aim: To analyze the relationship of delayed lactogenesis II with maternal perception of insufficient milk. Methods: A prospective, multicenter, longitudinal observational study was conducted. Data were obtained at discharge and between 1 and 5 months postpartum on the perception of insufficient milk and related variables, by means of a self-administered questionnaire, and subsequent postal and online follow-up. Logistic regression analysis was used to develop the explanatory model. Results: A total of 260 puerperal mothers participated. Of these, 31.9% had insufficient milk and 23.6% had delayed lactogenesis II. During postpartum admission, delayed lactogenesis II (OR = 2.26; 95%CI = 1.07–4.79), difficulty in breastfeeding (OR = 1.02; 95%CI = 1.00–1.03), and professional help in breastfeeding (OR = 0.70; 95%CI = 0.50–0.97) were associated with maternal perception of insufficient milk. Conclusions: The occurrence of breastfeeding difficulties during postpartum admission and at discharge, especially when there is delayed lactogenesis II, should be considered risk indicators, suggesting the need for additional support to standardized care. The PIM is a suitable indicator to assess the quality of professional breastfeeding support in improvement interventions., Objetivo: Analizar la relación del retraso de la lactogénesis II con la percepción materna de leche insuficiente. Método: Se realizó un estudio observacional longitudinal prospectivo, multicéntrico. Se obtuvieron datos al alta y entre 1 y 5 meses postparto sobre la percepción de leche insuficiente y las variables relacionadas, mediante un cuestionario autoadministrado, y posterior seguimiento postal y online. Para el desarrollo del modelo explicativo, se realizó un análisis de Regresión Logística. Resultados: Participaron un total de 260 puérperas. El 31,9% de ellas percibió leche insuficiente y el 23,6% presentó retraso de la lactogénesis II. Durante el ingreso posparto, se relacionó con la percepción materna de leche insuficiente el retraso de la lactogénesis II (OR = 2,26; IC95% = 1,07–4,79), la dificultad para amamantar (OR = 1,02; IC95% = 1,00–1,03), y la ayuda de los profesionales en la lactancia (OR = 0,70; IC95% = 0,50–0,97). Conclusiones: La aparición de dificultades en la lactancia durante el ingreso posparto y al alta, especialmente cuando existe un retraso de la lactogénesis II, deben considerarse indicadores de riesgo, que sugieren la necesidad de un apoyo adicional a los cuidados estandarizados. La PIM es un indicador adecuado para evaluar la calidad del apoyo profesional a la lactancia en intervenciones de mejora.