Azahara Reyes-Lacalle

Background: Exclusive breastfeeding is recommended as healthier and more sustainable than formula feeding. It produces less waste, requires fewer resources, and has a smaller environmental impact. Breastfeeding has some environmental impact related to increased maternal dietary needs and the use of feeding accessories. In light of the global climate emergency and suboptimal breastfeeding rates, targeted interventions are urgently needed to promote sustainable infant feeding practices. There are few studies that evaluate sustainability interventions in the postpartum period. Objective: The objective of this study is to evaluate the effectiveness of an educational and counseling intervention on breastfeeding and healthy maternal nutrition from an environmental perspective. Methods: A multicenter prospective intervention study is being conducted in 2 cohorts in primary care centers and hospitals in the north metropolitan area of Barcelona. The control group received standard obstetric care. The experimental group additionally received an educational intervention and health care support on breastfeeding and healthy and sustainable maternal nutrition. Pregnant women were monitored from 24 weeks of gestation to 6 months post partum. The rates of different types of breastfeeding, the women’s diet, and the associated environmental impacts (climate change and water footprint) will be analyzed to assess the effectiveness of the intervention. Results: The development of the educational and counseling intervention has been completed, including the creation of the Guide to Good Practices in Breastfeeding, Nutrition, and Sustainability. Health care professionals received targeted training. Recruitment of pregnant women was conducted from December 2023 to December 2024. Prenatal education sessions and specialized care pathways were designed and implemented. Breastfeeding-friendly spaces were adapted to support the participating centers. Data collection for monitoring breastfeeding practices, maternal diet, and environmental impact indicators (carbon footprint and water footprint), with the follow-up period of 6 months post partum, was extended until September 2025, with a complementary missing data collection in October 2025. Data cleaning for final analysis is expected to conclude by January 2026. This study hypothesizes that mothers who receive higher levels of education and counseling support will (1) breastfeed for a longer duration, (2) adopt healthier and more sustainable dietary practices, and (3) reduce environmental impacts associated with both infant feeding accessories and dietary choices. Conclusions: We expect an increase in the incidence and prevalence rates of breastfeeding and a shift toward a healthy and sustainable diet with low environmental impact. Trial Registration: ClinicalTrials.gov NCT05729581; https://clinicaltrials.gov/study/NCT05729581 International Registered Report Identifier (IRRID): DERR1-10.2196/80358

Background/Objectives: Breastfeeding is the best source of food for newborns. Leading health organizations recommend exclusive breastfeeding for the first 6 months of life, followed by the gradual introduction of complementary foods. Evidence shows that breastfeeding offers numerous benefits for newborns, mothers, society as a whole, and the environment. Current breastfeeding rates fall below the established recommendations. This study aims to describe breastfeeding rates at hospital discharge and one month postpartum, analyze fluctuations in feeding types during this period, and identify any characteristics, preventive factors, and barriers to breastfeeding and mixed feeding. Methods: This is a multicenter observational study in the North Metropolitan area of Barcelona, with 411 participants surveyed by midwives. Results: In total, 79% of women were exclusively breastfeeding, 14% practiced mixed breastfeeding, and 7% used formula feeding at hospital discharge. At one month postpartum, these rates fluctuated to 64%, 23%, and 13%, respectively. Factors such as older age, having a university education, having 16 weeks of parental leave, and having a foreign-born status were positively associated with exclusive breastfeeding, while mental illness was associated with a lower prevalence. The use of breastfeeding accessories was not significantly associated with fluctuations in feeding type, but it was associated with maintaining mixed feeding. Conclusions: It is essential to implement individual and community interventions, educate healthcare professionals on factors that hinder breastfeeding, and promote workplace policies that support breastfeeding.

BACKGROUND Exclusive breastfeeding is recommended as healthier and more sustainable than formula feeding. It produces less waste, requires fewer resources, and has a smaller environmental impact. Breastfeeding has some environmental impact related to increased maternal dietary needs and the use of feeding accessories. In light of the global climate emergency and suboptimal breastfeeding rates, targeted interventions are urgently needed to promote sustainable infant feeding practices. There are few studies that evaluate sustainability interventions in the postpartum period. OBJECTIVE The objective of this study is to evaluate the effectiveness of an educational and counseling intervention on breastfeeding and healthy maternal nutrition from an environmental perspective. METHODS A multicenter prospective intervention study is being conducted in 2 cohorts in primary care centers and hospitals in the north metropolitan area of Barcelona. The control group received standard obstetric care. The experimental group additionally received an educational intervention and health care support on breastfeeding and healthy and sustainable maternal nutrition. Pregnant women were monitored from 24 weeks of gestation to 6 months post partum. The rates of different types of breastfeeding, the women’s diet, and the associated environmental impacts (climate change and water footprint) will be analyzed to assess the effectiveness of the intervention. RESULTS The development of the educational and counseling intervention has been completed, including the creation of the Guide to Good Practices in Breastfeeding, Nutrition, and Sustainability. Health care professionals received targeted training. Recruitment of pregnant women was conducted from December 2023 to December 2024. Prenatal education sessions and specialized care pathways were designed and implemented. Breastfeeding-friendly spaces were adapted to support the participating centers. Data collection for monitoring breastfeeding practices, maternal diet, and environmental impact indicators (carbon footprint and water footprint), with the follow-up period of 6 months post partum, was extended until September 2025, with a complementary missing data collection in October 2025. Data cleaning for final analysis is expected to conclude by January 2026. This study hypothesizes that mothers who receive higher levels of education and counseling support will (1) breastfeed for a longer duration, (2) adopt healthier and more sustainable dietary practices, and (3) reduce environmental impacts associated with both infant feeding accessories and dietary choices. CONCLUSIONS We expect an increase in the incidence and prevalence rates of breastfeeding and a shift toward a healthy and sustainable diet with low environmental impact. CLINICALTRIAL ClinicalTrials.gov NCT05729581; https://clinicaltrials.gov/study/NCT05729581 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/80358

Background: Breastfeeding mothers have an increased demand for nutrients, including increased intake of certain nutrients, and are recommended to consume a theoretical 500 extra kilocalories (kcal), follow a varied diet, and increase protein, carbohydrate, omega-3, iron, and vitamin D intake. Objectives: We sought to analyze mothers’ energy and nutrient intake and food habits during the postpartum period 6 weeks after delivery and to identify whether there are any differences between breastfeeding and non-breastfeeding mothers. Methods: This was a cross-sectional, multicenter observational study at seven sexual and reproductive healthcare centers in the Metropolitan North area of Barcelona (Spain). The sample comprised 393 women who responded to an infant feeding questionnaire and 24 h diet recall (24 HR). We used frequencies and medians for descriptive analysis as well as the chi-squared and Kruskal–Wallis tests for the bivariate analysis. Results: Mean energy intake was lower than the recommendations in 57% of participants. Mothers who exclusively breastfed consumed a median of 201 kcal more than non-breastfeeding mothers, although this was not significant. The intake of fatty acids and micronutrients, such as iron, calcium, magnesium, and especially vitamin D, was insufficient. Breastfeeding mothers consumed significantly more polyunsaturated fatty acids (PUFAs) (p = 0.0297): 15.4 g vs. 12.7 g per day. Conclusions: There are no significant differences between the diet of breastfeeding and non-breastfeeding women, except for PUFA intake. A general insufficient intake of the analyzed micronutrients was observed. Educational campaigns and dietary guidance from health professionals are a priority.

Background: The effectiveness of the educational intervention on breastfeeding was shown in previous studies. The main objective of this study is to evaluate the effectiveness of a multimodal educational and support intervention on exclusive breastfeeding rates from a holistic point of view. We will study the environmental impacts of three feeding types (exclusive breastfeeding, mixed and formula feeding), including accessories used, as well as the mother's diet and other relevant factors to reduce the carbon footprint. Methods: This is a prospective multicenter intervention study (Phase II of the GREEN MOTHER project) that will last from 24 weeks of pregnancy until 4-6 weeks after birth, with additional observations of feeding types at 1, 3, 4 and 6 months. The results on rates of different lactation types and duration together with environmental impacts associated to diet and feeding will be compared between 2 groups: 1) an experimental group, which will receive a multimodal educational and support intervention on healthy and sustainable nutrition and breastfeeding, and environmental impacts associated with both; and 2) a control group, which will receive standard educational courses and care. This project was approved by the Research Ethics Committee of the Jordi Gol i Gurina University Institute Foundation for Primary Health Care Research (IDIAP) under code 22/101-P dated 22/02/2023. Discussion: To increase awareness of the environmental impacts of different types of lactation and mother’s diet will be disseminated among relevant professionals and stakeholders: community health worker associations and the general public.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Today's young people have long been demanding a paradigm shift in the emotional and sexual education they receive. While for them, affective-sexual and gender diversity is already a reality, the sexual and reproductive health professionals they encounter lack sufficient training. The digital devices and affective-sexual education websites aimed at today's young people must also be thoroughly evaluated. The website Sexe Joves is a website on sexuality of the Department of Health of the Government of Catalonia (Spain). It is designed for 14- to 25-year-olds. It currently needs to undergo a process of evaluation. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. Objective: The aim of this study was to evaluate the website Sexe Joves as a source of affective-sexual health information, education and communication for young people. It takes into account sex, gender identity, sexual orientation, socioeconomic status and location within Catalonia (urban, semiurban and rural areas). Methods: Observational, descriptive and cross-sectional study that forms part of a larger mixed methods study. An ad hoc questionnaire was used to collect data. In total, 1,830 participants were included. The study was carried out simultaneously in all the territorial administrations of Catalonia. Results: Almost 30% of the sample obtained were young people who experience affective-sexual and gender diversity. Of those surveyed, only 14.2% (n=260) said they were familiar with the website and of these, 6.5% said they used it (n=114). The website content rated most indispensable was sexual abuse, harassment and violence, followed by sexually transmitted infections. And 70.5% reported that they visit pornographic websites. Conclusions: The results of this study will contribute to the design of new strategies for the website Sexe Joves, a public health resource, in order to improve affective-sexual education for young people.

BACKGROUND Today’s young people have long been demanding a paradigm shift in the emotional and sexual education they receive. While for them, affective-sexual and gender diversity is already a reality, the sexual and reproductive health professionals they encounter lack sufficient training. The digital devices and affective-sexual education websites aimed at today’s young people must also be thoroughly evaluated. The website Sexe Joves is a website on sexuality by the Department of Health of the Government of Catalonia (Spain). It is designed for people aged 14 to 25 years. It currently needs to undergo a process of evaluation. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. OBJECTIVE The aim of this study was to evaluate the website Sexe Joves as a source of affective-sexual health information, education, and communication for young people. It takes into account sex, gender identity, sexual orientation, socioeconomic status, and location within Catalonia (urban, semiurban, and rural areas). METHODS This was an observational, descriptive, and cross-sectional study that forms part of a larger mixed methods study. An ad hoc questionnaire was used to collect data. In total, 1830 participants were included. The study was carried out simultaneously in all the territorial administrations of Catalonia. RESULTS Almost 30% of the sample obtained were young people who experience affective-sexual and gender diversity. Of those surveyed, only 14.2% (n=260) said they were familiar with the website and of these, 6.5% said they used it (n=114). The website content rated most indispensable was on sexual abuse, harassment, and violence, followed by sexually transmitted infections; 70.5% (n=1200) reported that they visit pornographic websites. CONCLUSIONS The results of this study will contribute to the design of new strategies for the website Sexe Joves, a public health resource, in order to improve affective sexual education for young people. INTERNATIONAL REGISTERED REPORT RR2-10.3390/ijerph192416586

The website Sexe Joves is a website on sexuality of the Department of Health of the Government of Catalonia (Spain). This study aims to understand the experiences and opinions of people aged 14 to 25 regarding this website, taking into account sex, gender identity, sexual orientation, socioeconomic status and location within Catalonia (urban, semiurban and rural areas). With the objective of improving the website and adpating the resources allocated to it, this study evaluates whether this population is familiar with it and uses it, as well as the website’s usability and accessibility (digital equity), usefulness and the relevance of its content. A parallel convergent triangulation design is used: a qualitative study using a social constructivist perspective, and an observational, descriptive and cross-sectional quantitative study. We conduct a discourse analysis of participants and use an “ad hoc” questionnaire to collect quantitative data. A descriptive analysis of all variables is carried out. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. This analysis will contribute to the design of new strategies for the wesbite Sexe Joves, a public health resource, in order to improve affective-sexual education for young people.

BACKGROUND Increase of sexually transmitted infections (STIs) as well as increased use of new information and communication technologies (ICTs) among young people in Catalonia triggers the idea of designing a mobile phone application to promote partner notification (PN). OBJECTIVE Assess the impact of a web based tool adapted to mobile phones for partner notification of STI among youngsters 16 to 24 years old and evaluate its role in increasing the “patient referral” partner notification. METHODS This is a multicentre randomised controlled trial with a proportional stratification of the sample by centre and random allocation of participants to the three groups of the study: game intervention (GIG), direct web intervention (DWIG) and control (CG). It was conducted by midwives, gynaecologists and physicians in the sexual and reproductive areas of the primary health care centres. The study population was: 1- All youngsters 16 to 24 years old diagnosed with one of the three curable STIs, (syphilis, gonococcus and chlamydia). 2- All partners of those diagnosed with the previous STIs, independently of their state of infection. Primary outcome was the ratio of partners notified per index case. Secondary outcomes included media used to notify and progress through the web app. RESULTS There were 366 index cases. Most of them were girls (91.9%), heterosexual (91.6%) with Pre-University studies (40%) and chlamydia infection as main diagnosis (92.3%) and a median age of 20 (interquartile range, IQR 18-23). The ratio of partners notified per index case was higher among GIG (1.7) and DWIG (1.6), than CG (1.2) group although no significant differences were found between the three groups. CONCLUSIONS The “Notijoves” web app may have a positive impact in the partner notification practice among youngsters. CLINICALTRIAL ClinicalTrials.gov.Identifier:NCT03986567; https://clinicaltrials.gov/ct2/show/NCT03986567

The coverage of maternal vaccination against pertussis and, particularly, influenza is lower than expected. The lack of recommendation from healthcare providers conditions non-vaccination in pregnant women. The purpose was to determine the knowledge, perceptions, attitudes and practices of midwives regarding maternal influenza and pertussis vaccination. A qualitative descriptive study based on semi-structured, face-to-face interviews with seventeen midwives was conducted, including purposive sampling and thematic analyses. Midwives had disparate knowledge and perceptions about the severity of influenza and pertussis in pregnant women, and influenza was not considered very serious. The vaccines were generally considered safe. However, because midwives did not have enough information about the safety of the influenza vaccine, there was a tendency not to recommend it. While most midwives had a positive attitude toward vaccination, their advocation for vaccination against influenza was not as clear as it was for pertussis. Not wanting to influence the decision and assuming an informative–facilitating role also led providers to recommend the influenza vaccine less frequently. Midwives are among the main sources of professional advice for pregnant women. Addressing their understanding and professional practices regarding maternal vaccination is key to change the attitude of pregnant women and thus increase vaccine uptake among them, particularly for influenza.