https://www.um.edu.mt/library/oar/handle/123456789/342 Thu, 04 Jun 2026 20:43:04 GMT 2026-06-04T20:43:04Z https://www.um.edu.mt/library/oar/handle/123456789/146886 Title: Position statement : integrating planetary health into infection prevention and control in healthcare settings ― towards a balanced and evidence-based approach Authors: Tartari, Ermira; Meşe, Emine Alp; Bulabula, Andre N.H.; Dancer, Stephanie J.; Giacobbe, Daniele Roberto; Krone, Manuel; Kilpatrick, Claire; Marek, Aleksandra; Petrosillo, Nicola; Presterl, Elisabeth; Ranjan, Manish; Severin, Juliëtte; Stroffolini, Giacomo; Tostmann, Alma; Vos, Margreet C.; Widmer, Andreas F.; Zingg, Walter; ESCMID Study Group for Nosocomial Infections (ESGNI) Abstract: Background Infection prevention and control (IPC) is fundamental for patient safety. Effective IPC generates direct ecological benefits by preventing healthcare-associated infections, thereby reducing prolonged hospitalization, antibiotic use, and resource consumption. Paradoxically, IPC measures single-use materials, chemical disinfectants, and resource-intensive waste streams, which contribute to healthcare’s greenhouse gas emissions and environmental burden. As climate change and environmental degradation threaten human and ecosystem health, there is growing urgency to evaluate IPC measures through a planetary health lens, ensuring sustainability considerations complement rather than compromise infection prevention outcomes. Aims This position paper by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Nosocomial Infections examines intersections between IPC practice and planetary health. Drawing on a synthesis of current evidence and expert consensus, it identifies opportunities to reduce the environmental footprint of IPC where evidence supports equivalent or superior IPC outcomes, and outlines research and policy priorities where evidence remains insufficient. Content The paper analyses five key domains at the IPC-planetary health interface: (1) single-use vs. reusable, (2) biocides and environmental contamination, (3) healthcare waste, (4) antimicrobial resistance—IPC priorities within a One Health framework, and (5) IPC and planetary health in low- and middle-income countries. Cross-cutting themes, including circular economy principles, life-cycle assessment, regulatory barriers, and climate-related risks, are explored, with implications for regulation, procurement, infrastructure, and workforce competencies. Implications Sustainability considerations in IPC must function as a complement to, not a substitute for, infection prevention outcomes. Where evidence supports equivalent safety with a reduced environmental footprint, change is justified and should be pursued through evidence-based, risk-stratified, and context-specific approaches. Achieving this requires regulatory reform, interdisciplinary collaboration, and targeted investment in research, education, and capacity building. Positioning IPC as a partner in sustainable healthcare offers a pathway to reduce avoidable environmental harm while strengthening resilience against infectious threats—with patient safety as the primary and non-negotiable objective. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/146886 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146630 Title: Beyond 42 days : a national cohort study of maternal and late maternal deaths in Brazil from 2010 to 2023 Abstract: Background/Objectives: Maternal mortality is a serious public health problem and reflects social, ethnic, racial, and regional inequalities in access to and quality of obstetric care. Despite advances in the surveillance and investigation of maternal deaths in Brazil, late maternal deaths (occurring between 43 days and 1 year after birth) are still underestimated and underexplored. Therefore, the objective of this study was to analyze the distribution and factors associated with maternal deaths and late maternal deaths in Brazil between 2010 and 2023. Methods: This was a population-based, retrospective cohort study with a quantitative approach, using secondary data from the Mortality Information System. All maternal deaths (Chapter XV of ICD-10) and late deaths recorded during the period were included. Sociodemographic, clinical, and administrative variables were analyzed. Statistical tests of association (chi-square, test of proportions, and 95% CI) were used, with a significance level of 5%. Results: A total of 26,953 deaths were identified, of which 24,387 were maternal and 2,566 were late deaths. Most deaths occurred among single, mixed-race women with 8 to 11 years of schooling, and residing in the Southeast region. Late deaths were more frequent in the South and among women aged 40 to 49. The main causes were direct obstetric conditions. A statistically significant association was observed between the type of death and sociodemographic variables. Conclusions: The results highlight structural inequalities in maternal mortality in Brazil and reinforce the importance of expanding postpartum surveillance beyond 42 days, with a focus on equity and continuity of care. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/146630 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145398 Title: Midwives’ attitudes towards the development and implementation of birth plans Abstract: Birth plans are written documents that outline women’s preferences for labour, birth, and the postpartum period. Despite their recognised benefits in supporting woman-centred care, birth plans are not currently implemented in Malta, and local research on midwives’ attitudes is lacking, with limited quantitative evidence in international literature. This highlights the need for this study to inform practice and policy development. This study aimed to assess Maltese midwives’ attitudes towards developing and implementing birth plans, addressing the research question: What are midwives’ attitudes towards the development and implementation of birth plans in Malta? Its objectives were to explore their views and attitudes, perceived challenges, and strategies to support readiness for its implementation into practice. A primarily quantitative, non-experimental, cross-sectional, descriptive design was adopted, using a self-administered, self-designed online questionnaire supplemented by qualitative open-ended questions. Content validity was established via expert review, with indices indicating excellent item- and scale-level content validity, and inter-rater agreement. Reliability and feasibility were confirmed through a pilot study. Convenience sampling was employed, where 281 midwives practising at Mater Dei Hospital and Gozo General Hospital were invited to participate. 128 completed questionnaires were received, yielding a 45.55% response rate. Quantitative data were analysed using descriptive and inferential statistics, and qualitative data were analysed using reflexive thematic analysis (Braun & Clarke, 2022). The findings revealed generally positive views and attitudes towards birth plans, with midwives recognising their value for woman-centred care, informed decision-making, and communication. Midwives also identified practical challenges that may affect birth plan development and implementation and suggested strategies to facilitate adoption. The Theory of Planned Behaviour helped shed light on these findings, suggesting that midwives’ positive attitudes may strengthen intentions to implement birth plans, while perceived challenges can influence perceived behavioural control and subjective norms. This study indicates that overall, Maltese midwives view birth plans positively but require organisational support, education, and structured processes for effective implementation. These findings can inform policy development, enhance woman-centred care, and help align Maltese maternity services with international standards of respectful, evidence-based maternity care. Description: M.Sc.(Melit.) Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/145398 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145397 Title: The influence of the birth environment on childbirth experiences : a quantitative study of midwives’ perspectives Abstract: Purpose: In recent decades, the institutionalisation of childbirth has led to increasingly medicalised maternity settings, with growing recognition of the impact this has on childbirth experiences. However, research has largely explored women’s perspectives and the physical aspects of the birth environment using qualitative methods. This study addresses these gaps by quantitatively investigating midwives’ perspectives on how various dimensions of the hospital birth environment shape the childbirth experience. Aim: To examine midwives’ views on the impact of the birth environment on the woman’s childbirth experience. Objectives: To identify midwives’ perceptions of physical factors in the birth environment that influence the woman’s childbirth experience; to assess midwives’ perceptions of psychological and emotional factors in the birth environment that influence the woman’s childbirth experience and to evaluate midwives’ reported practices in utilising the birth environment to enhance the woman’s childbirth experience. Methodology: A quantitative, non-experimental, cross-sectional design was employed using a self-designed online questionnaire distributed to midwives working in selected maternity settings within the main public hospital. Purposive sampling recruited 141 participants from a total population of 213 midwives, representing a 66.2% response rate. Quantitative findings were evaluated through descriptive and inferential statistical methods, whereas qualitative responses were examined using content analysis. The study was guided by the Birth Territory Theory (Fahy et al., 2008) and the Theory of Supportive Birth Settings (Maxwell et al., 2024), which provided the theoretical lens for interpreting findings. Results: Midwives highlighted key physical factors of the birth environment, including privacy, lighting and availability of birthing aids, while a calm and supportive atmosphere was recognised as crucial for psychological and emotional wellbeing. Novel findings included concerns about the delivery bed quality and functionality, the impact of swinging doors on privacy and soundproofing, and the anxiety-inducing presence of large wall clocks opposite delivery beds. Midwives identified various practices used to enhance the birth environment, however, institutional barriers were often reported to limit these efforts. Conclusion: This study contributes to the existing body of knowledge by providing quantitative evidence of midwives’ perspectives, a group previously underrepresented, and by extending focus beyond the physical to the psychological and emotional factors of the birth environment. Findings underscore the need for a balanced approach integrating environmental design, professional empowerment and institutional support to enhance childbirth experiences. The study provides a foundation for future research on broader dimensions of the birth environment and the factors that facilitate or hinder improvements in maternity care settings. Description: M.Sc.(Melit.) Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/145397 2026-01-01T00:00:00Z