LETTER TO THE EDITOR Knowledge about umbilical cord blood donation: a survey-based study performed in Tuscany Emanuele Ginori¹, Sara Savelli², Mariacarla Iorio², Francesca Nocchi², Barbara Luchetti², Francesca Ceccarelli², Patrizia Urciuoli², Simone Lapi², Laura Rasero3, Fabrizio Scatena² ¹Coordination Area of Organ, Tissue and Cell Donation, Health Authority 11, Empoli; ²Division of Transfusion Medicine and Transplant Biology, Pisana University Hospital, Pisa; 3Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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misleading information that exists in Greece about public banks in contrast to private banks. The reason given for choosing private banks was that the UCB would be stored better. Moreover, private storage was encouraged by doctors, friends or relatives and by the belief that it guarantees the baby's future4. A survey-based study was conducted from the 1st September 2013 to the 31st of January 2014, in the whole region of Tuscany. The aim of the survey was to explore the knowledge that pregnant women have about UCB stem cell donation and the quality of education from health care professionals. For this purpose anonymous, standardised printed or on-line questionnaires were provided. Printed questionnaires were given to 2,999 women (average age=31.91) who delivered in birth centres in 14 Hospitals, while on-line questionnaires were sent to gynaecologists and 706 midwives who are involved in raising awareness about donation and cord blood collection. The surveyed population was divided based on the birth centre of origin (Table I). Since only eight gynaecologists filled in the questionnaire, our attention focused on pregnant women and midwives. Among 2,999 mothers who were asked to fill in the questionnaire, 1,568 (52%) returned the completed form; 60% of the respondents had not had previous pregnancies. The women were asked whether they had received general information about UCB donation during pregnancy. A considerable portion of pregnant women (82%) were aware of the possibility of donating UCB, while 18% had not received any information. The most common sources of information came from midwives (41.90%), gynaecologists (17.16%), family doctors (1.4%) and other sources, such as friends (14.60%) and media (7.53%). Several women received information from more than one of these sources. The 706 midwives involved in this study were divided in different groups depending on how long they had worked. While 70.49% of them had not received specific training on cord blood donation during their degree course, 69.4% of the midwives had attended a post-degree course about cord blood donation.
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Dear Sir, It is well known that umbilical cord blood (UCB) is an alternative source of stem cells for haematopoietic transplantation, which can cure children and adults of malignant and non-malignant diseases, such as leukaemias, lymphomas, metabolic disorders, immunodeficiency states, haemoglobinopathies and bone marrow failure syndromes1-2. Cord blood processing and cryopreservation are very costly procedures. In order to reduce these costs several pre-birth parameters were suggested to be useful for identifying and selecting the potential best collections3 . A survey-based study was recently performed in Greece on a sample of Greek citizens, with high reproductive capacity. The results indicated that the majority of them (74%) were in favour of UCB storage and that the main source of information (45.5%) was the media, with an additional source provided by medical health care professionals (36.6%)4. However, most of the Greek population do not have adequate information about this precious resource and the authors believed that different campaigns regarding UCB storage and uses should be developed through the cooperation of the Ministry of Health and Social Solidarity, the National Blood Donation Centre and the National Transplant Organisation4. In accordance with the findings of the Greek study, a survey conducted by Screnci et al. at the "Sapienza" University of Rome on blood donors and pregnant women showed that a considerable proportion of the individuals analysed had some general, but minimal knowledge about UCB. Moreover, the level of knowledge regarding the proper and real usefulness was generally low: 31% of informed pregnant women gave a wrong answer. A very small proportion of them consulted the specific website section of the Ministry of Health concerning the appropriate use of stem cells from UCB5. Despite the theoretically positive intention of Greek respondents towards UCB storage, most did not proceed to do so. Among the parents who chose to store UCB, most preferred private storage, perhaps because of the
Blood Transfus 2015; 13: 696-7 DOI 10.2450/2015.0308-14 © SIMTI Servizi Srl
696 All rights reserved - For personal use only No other uses without permission
Cord blood donation Table I - Distribution of the sample.
However, all midwives declared that specific training courses would be important to update their knowledge on UCB donation and to make colleagues aware of this topic. Moreover, the time spent by midwives to inform pregnant women is thought to be insufficient. Finally, we consider that divulgation of information by means of leaflets should be combined with verbal communication, which is known to be the best way of raising people's awareness. We believe that in our regional reality Hospitals should invest more money and time in promoting UCB donation, mostly because our data show that 58% of midwives don't usually provide with information about this topic. Finally, we believe that professionals and institutions should make an effort to provide updates, education and evidence-based information about UCB donation, focusing on both the usefulness and limitations of UCB stem cells.
Samples
Responders N (%)
ASL 1 Massa Carrara (one birth centre)
N. of mothers: 251 N. of obstetricians: 37
136 (54%) 11 (30%)
ASL2 Lucca (two birth centres)
N. of mothers: 236 N. of obstetricians: 28
148 (63%) 10 (36%)
ASL3 Pistoia (two birth centres)
N. of mothers: 198 N. of obstetricians: 71
131 (66%) 5 (7%)
ASL 5 Pisa (one birth centre)
N. of mothers: 231 N. of obstetricians: 37
161 (70%) 17 (46%)
ASL 6 Livorno (three birth centres)
N. of mothers: 319 N. of obstetricians: 73
289 (91%) 28 (38%)
ASL 7 Siena (two birth centres)
N. of mothers: 168 N. of obstetricians: 35
38 (23%) 13 (37%)
ASL 8 Arezzo (three birth centres)
N. of mothers: 178 N. of obstetricians: 58
70 (39%) 18 (31%)
ASL9 Grosseto (one birth centre)
N. of mothers: 156 N. of obstetricians: 40
56 (36%) 11 (27%)
ASL 10 Firenze (three birth centres)
N. of mothers: 294 N. of obstetricians: 121
136 (46%) 6 (5%)
ASL 11 Empoli (one birth centre)
N. of mothers: 248 N. of obstetricians: 53
171 (67%) 28 (53%)
The Authors declare no conflict of interest.
ASL 12 Viareggio (one birth centre)
N. of mothers: 136 N. of obstetricians: 24
80 (59%) 9 (38%)
References
AOU Careggi (two birth centres)
N. of mothers: 256 N. of obstetricians: 54
0 14 (26%)
AOU Pisana (one birth centre)
N. of mothers: 189 N. of obstetricians: 46
102 (54%) 7 (15%)
AOU Senese (one birth centre)
N. of mothers: 139 N. of obstetricians: 29
Total
N. of mothers: 2,999 N. of obstetricians: 706
Solh M. Haploidentical vs cord blood transplantation for adults with acute myelogenous leukemia. World J Stem Cells 2014; 6: 371-9. Park M, Lee YH, Kang H-R, et al. Unrelated donor cord blood transplantation for non-malignant disorders in children and adolescents. Pediatr Transplant 2014; 18: 221-9. Urciuoli P, Passeri S, Ceccarelli F, et al. Pre-birth selection of umbilical cord blood donors. Blood Transfus 2010; 8: 36-43. Karagiorgou LZ, Pantazopoulou M-NP, Mainas NC, et al. Knowledge about umbilical cord blood banking among Greek citizens. Blood Transfus 2014; 12 (Suppl 1): 353-60. Screnci M, Murgi E, Pirrè G, et al. Donating umbilical cord blood to a public bank or storing it in a private bank: knowledge and preference of blood donors and of pregnant woman. Blood Transfus 2012; 10: 331-7.
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Hospitals
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3)
1,562 (52%) 183 (23%)
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44 (32%) 6 (21%)
5)
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Overall, 68.31% of midwives claimed to promote cord blood donation; however, although they claimed to be competent enough (mean=6.4) about their own skill and knowledge, 95.63% of them believed that further specific cord blood training would be necessary. About three-quarters (72.60%) of midwives use printed leaflets to give information, while only 1.37% of them use verbal communication. The majority of midwives spend an average of 13 minutes to give information. The critical aspects that arose from the survey highlight some solutions that could be adopted in order to improve the quality of information provided to pregnant women. The lack of interest shown by gynaecologists is one aspect which limits the choice of donating UCB. For this reason further involvement of these professionals will be necessary in the future. Midwives who had been employed for longer did not receive specific training on UCB collection during their degree course, even if they showed greater participation in training courses, in comparison with their colleagues who had started work more recently.
Arrived: 5 December 2014 - Revision accepted: 22 December 2014 Correspondence: Sara Savelli Division of Transfusion Medicine and Transplant Biology Azienda Ospedaliero-Universitaria Pisana Via Paradisa 2 56124 Pisa, Italy e-mail: [email protected]
Blood Transfus 2015; 13: 696-7 DOI 10.2450/2015.0308-14 697 All rights reserved - For personal use only No other uses without permission
iz i
Sr l
misleading information that exists in Greece about public banks in contrast to private banks. The reason given for choosing private banks was that the UCB would be stored better. Moreover, private storage was encouraged by doctors, friends or relatives and by the belief that it guarantees the baby's future4. A survey-based study was conducted from the 1st September 2013 to the 31st of January 2014, in the whole region of Tuscany. The aim of the survey was to explore the knowledge that pregnant women have about UCB stem cell donation and the quality of education from health care professionals. For this purpose anonymous, standardised printed or on-line questionnaires were provided. Printed questionnaires were given to 2,999 women (average age=31.91) who delivered in birth centres in 14 Hospitals, while on-line questionnaires were sent to gynaecologists and 706 midwives who are involved in raising awareness about donation and cord blood collection. The surveyed population was divided based on the birth centre of origin (Table I). Since only eight gynaecologists filled in the questionnaire, our attention focused on pregnant women and midwives. Among 2,999 mothers who were asked to fill in the questionnaire, 1,568 (52%) returned the completed form; 60% of the respondents had not had previous pregnancies. The women were asked whether they had received general information about UCB donation during pregnancy. A considerable portion of pregnant women (82%) were aware of the possibility of donating UCB, while 18% had not received any information. The most common sources of information came from midwives (41.90%), gynaecologists (17.16%), family doctors (1.4%) and other sources, such as friends (14.60%) and media (7.53%). Several women received information from more than one of these sources. The 706 midwives involved in this study were divided in different groups depending on how long they had worked. While 70.49% of them had not received specific training on cord blood donation during their degree course, 69.4% of the midwives had attended a post-degree course about cord blood donation.
©
SI
M
TI S
er v
Dear Sir, It is well known that umbilical cord blood (UCB) is an alternative source of stem cells for haematopoietic transplantation, which can cure children and adults of malignant and non-malignant diseases, such as leukaemias, lymphomas, metabolic disorders, immunodeficiency states, haemoglobinopathies and bone marrow failure syndromes1-2. Cord blood processing and cryopreservation are very costly procedures. In order to reduce these costs several pre-birth parameters were suggested to be useful for identifying and selecting the potential best collections3 . A survey-based study was recently performed in Greece on a sample of Greek citizens, with high reproductive capacity. The results indicated that the majority of them (74%) were in favour of UCB storage and that the main source of information (45.5%) was the media, with an additional source provided by medical health care professionals (36.6%)4. However, most of the Greek population do not have adequate information about this precious resource and the authors believed that different campaigns regarding UCB storage and uses should be developed through the cooperation of the Ministry of Health and Social Solidarity, the National Blood Donation Centre and the National Transplant Organisation4. In accordance with the findings of the Greek study, a survey conducted by Screnci et al. at the "Sapienza" University of Rome on blood donors and pregnant women showed that a considerable proportion of the individuals analysed had some general, but minimal knowledge about UCB. Moreover, the level of knowledge regarding the proper and real usefulness was generally low: 31% of informed pregnant women gave a wrong answer. A very small proportion of them consulted the specific website section of the Ministry of Health concerning the appropriate use of stem cells from UCB5. Despite the theoretically positive intention of Greek respondents towards UCB storage, most did not proceed to do so. Among the parents who chose to store UCB, most preferred private storage, perhaps because of the
Blood Transfus 2015; 13: 696-7 DOI 10.2450/2015.0308-14 © SIMTI Servizi Srl
696 All rights reserved - For personal use only No other uses without permission
Cord blood donation Table I - Distribution of the sample.
However, all midwives declared that specific training courses would be important to update their knowledge on UCB donation and to make colleagues aware of this topic. Moreover, the time spent by midwives to inform pregnant women is thought to be insufficient. Finally, we consider that divulgation of information by means of leaflets should be combined with verbal communication, which is known to be the best way of raising people's awareness. We believe that in our regional reality Hospitals should invest more money and time in promoting UCB donation, mostly because our data show that 58% of midwives don't usually provide with information about this topic. Finally, we believe that professionals and institutions should make an effort to provide updates, education and evidence-based information about UCB donation, focusing on both the usefulness and limitations of UCB stem cells.
Samples
Responders N (%)
ASL 1 Massa Carrara (one birth centre)
N. of mothers: 251 N. of obstetricians: 37
136 (54%) 11 (30%)
ASL2 Lucca (two birth centres)
N. of mothers: 236 N. of obstetricians: 28
148 (63%) 10 (36%)
ASL3 Pistoia (two birth centres)
N. of mothers: 198 N. of obstetricians: 71
131 (66%) 5 (7%)
ASL 5 Pisa (one birth centre)
N. of mothers: 231 N. of obstetricians: 37
161 (70%) 17 (46%)
ASL 6 Livorno (three birth centres)
N. of mothers: 319 N. of obstetricians: 73
289 (91%) 28 (38%)
ASL 7 Siena (two birth centres)
N. of mothers: 168 N. of obstetricians: 35
38 (23%) 13 (37%)
ASL 8 Arezzo (three birth centres)
N. of mothers: 178 N. of obstetricians: 58
70 (39%) 18 (31%)
ASL9 Grosseto (one birth centre)
N. of mothers: 156 N. of obstetricians: 40
56 (36%) 11 (27%)
ASL 10 Firenze (three birth centres)
N. of mothers: 294 N. of obstetricians: 121
136 (46%) 6 (5%)
ASL 11 Empoli (one birth centre)
N. of mothers: 248 N. of obstetricians: 53
171 (67%) 28 (53%)
The Authors declare no conflict of interest.
ASL 12 Viareggio (one birth centre)
N. of mothers: 136 N. of obstetricians: 24
80 (59%) 9 (38%)
References
AOU Careggi (two birth centres)
N. of mothers: 256 N. of obstetricians: 54
0 14 (26%)
AOU Pisana (one birth centre)
N. of mothers: 189 N. of obstetricians: 46
102 (54%) 7 (15%)
AOU Senese (one birth centre)
N. of mothers: 139 N. of obstetricians: 29
Total
N. of mothers: 2,999 N. of obstetricians: 706
Solh M. Haploidentical vs cord blood transplantation for adults with acute myelogenous leukemia. World J Stem Cells 2014; 6: 371-9. Park M, Lee YH, Kang H-R, et al. Unrelated donor cord blood transplantation for non-malignant disorders in children and adolescents. Pediatr Transplant 2014; 18: 221-9. Urciuoli P, Passeri S, Ceccarelli F, et al. Pre-birth selection of umbilical cord blood donors. Blood Transfus 2010; 8: 36-43. Karagiorgou LZ, Pantazopoulou M-NP, Mainas NC, et al. Knowledge about umbilical cord blood banking among Greek citizens. Blood Transfus 2014; 12 (Suppl 1): 353-60. Screnci M, Murgi E, Pirrè G, et al. Donating umbilical cord blood to a public bank or storing it in a private bank: knowledge and preference of blood donors and of pregnant woman. Blood Transfus 2012; 10: 331-7.
er v
1)
iz i
Sr l
Hospitals
TI S
2)
3)
1,562 (52%) 183 (23%)
4)
M
44 (32%) 6 (21%)
5)
©
SI
Overall, 68.31% of midwives claimed to promote cord blood donation; however, although they claimed to be competent enough (mean=6.4) about their own skill and knowledge, 95.63% of them believed that further specific cord blood training would be necessary. About three-quarters (72.60%) of midwives use printed leaflets to give information, while only 1.37% of them use verbal communication. The majority of midwives spend an average of 13 minutes to give information. The critical aspects that arose from the survey highlight some solutions that could be adopted in order to improve the quality of information provided to pregnant women. The lack of interest shown by gynaecologists is one aspect which limits the choice of donating UCB. For this reason further involvement of these professionals will be necessary in the future. Midwives who had been employed for longer did not receive specific training on UCB collection during their degree course, even if they showed greater participation in training courses, in comparison with their colleagues who had started work more recently.
Arrived: 5 December 2014 - Revision accepted: 22 December 2014 Correspondence: Sara Savelli Division of Transfusion Medicine and Transplant Biology Azienda Ospedaliero-Universitaria Pisana Via Paradisa 2 56124 Pisa, Italy e-mail: [email protected]
Blood Transfus 2015; 13: 696-7 DOI 10.2450/2015.0308-14 697 All rights reserved - For personal use only No other uses without permission
