Experiences of central child health services teams regarding a special governmental investment in child health services.

BACKGROUND: Historically marked by a high infant mortality rate, Sweden's healthcare reforms have successively led to a robust, decentralized universal child health system covering over 97% of the population 0-5 years. However, inequities in health have become an increasing problem and the public health law explicitly states that health inequities should be reduced, resulting in various government initiatives. This study examines the experiences of Central Child Health Services (CCHS) teams during the implementation of the Child Health Services Accessibility Agreement between the State and the regions starting in 2017. The agreement aimed to enhance child health service accessibility, especially in socio-economically disadvantaged areas, but broadly stated guidelines and the short-term nature of funding have raised questions about its effectiveness. The aim of this study was to understand the experiences of CCHC teams in implementing the Child Health Services Accessibility Agreement, focusing on investment decisions, implementation efforts, as well as facilitators and barriers to using the funds effectively. METHODS: CCHC teams were purposefully sampled and invited via email for interviews, with follow-ups for non-respondents. Conducted from January to October 2023, the interviews were held digitally and recorded with individuals familiar with the agreement's implementation within these teams. Both authors analyzed the transcripts thematically, applying Braun and Clarke's framework. Participants represented a cross-section of Sweden's varied healthcare regions. RESULTS: Three main themes emerged from the thematic analysis: "Easy come, easy go," highlighting funding uncertainties; "What are we supposed to do?" expressing dilemmas over project prioritization and partner collaboration; and "Building castles on sand," focusing on the challenges of staff retention and foundational program stability. Respective subthemes addressed issues like fund allocation timing, strategic decision-making, and the practical difficulties of implementing extended home visiting programs, particularly in collaboration with social services. CONCLUSIONS: This study uncovered the challenges faced in implementing the Child Health Services Accessibility Agreement across different regions in Sweden. These obstacles underline the need for precise guidelines regarding the use of funds, stable financing for long-term project sustainability, and strong foundational support to ensure effective interprofessional collaboration and infrastructure development for equitable service delivery in child health services.

Tecnologias eHealth nos cuidados parentais aos bebês nascidos prematuros: revisão integrativa / EHealth technologies in parental care for preterm infants: an integrative review

Resumo As tecnologias eHealth contribuem na promoção das práticas parentais de cuidado para bebês pré-termo. Não obstante, é notável a abundância de informações e aplicativos disponíveis, a disparidade na qualidade, facilidade de uso e confiabilidade desses recursos. Este artigo objetiva examinar as tecnologias eHealth direcionadas aos pais para o cuidado de bebês pré-termo. Realizou-se uma revisão integrativa nas principais bases de dados da área da saúde (Capes, EBSCO, BVS, PubMed, Scholar e SciELO), com a seleção de publicações de 2011 a 2022, em português e inglês, sobre a utilização de tecnologias eHealth voltadas aos cuidados de bebês pré-termo. Identificaram-se 13 artigos com temáticas sobre: as tecnologias da informação e comunicação nas estratégias de educação e a promoção da saúde de bebês pré-termo e seus pais; e importância da avaliação e validação das tecnologias eHealth na promoção da saúde materno-infantil. Tecnologias eHealth validadas adequadamente podem desempenhar um papel fundamental em apoiar os pais na promoção da saúde e na prestação de cuidados ao bebê pré-termo após a alta hospitalar. Isso, por sua vez, tem o potencial de impulsionar a evolução dos sistemas de saúde e a melhoria das práticas clínicas.

Abstract The eHealth technologies promote parental care practices for preterm infants. Nonetheless, we should underscore the abundant information and available apps and disparities in these resources' quality, usability, and reliability. This article examines eHealth technologies directed at parents to care for preterm infants. An integrative review was conducted across the principal health databases (Capes, EBSCO, BVS, PubMed, Scholar, and SciELO), selecting works published from 2011 to 2022 in Portuguese and English, focusing on the use of eHealth technologies for the care of preterm infants. We identified 13 articles related to information and communication technologies in strategies for educating and promoting the health of preterm infants and their parents and the importance of evaluating and validating eHealth technologies in maternal and child health promotion. Properly validated eHealth technologies can be crucial in supporting parents in promoting health and providing care for preterm infants after hospital discharge, which, in turn, can drive the evolution of healthcare systems and improve clinical practices.

Spatiotemporal trends and geographic disparities in spatial accessibility to maternal and child health services in Nanning, China: impact of two-child policies.

BACKGROUND: China's family planning policies have experienced stages of one-child policy, partial two-child policy, and universal two-child policy. However, the impact of these policy shifts on the spatial accessibility to maternal and child health (MCH) services for women and children remains uncertain. This study aimed to evaluate the spatiotemporal trends and geographic disparities in spatial accessibility to MCH services in the context of two-child polices. METHODS: This study was conducted in Nanning prefecture, China, from 2013 to 2019. Data on the transportation networks, MCH institutes, the annual number of newborns, and the annual number of pregnant women in Nanning prefecture were collected. Gaussian two-step floating catchment area (Ga2SFCA) method was employed to measure the spatial accessibility to MCH services at county, township, and village levels. Temporal trends in spatial accessibility were analyzed using Joinpoint regression analysis. Geographic disparities in spatial accessibility were identified using geographic information system (GIS) mapping techniques. RESULTS: Overall, the spatial accessibility to MCH services showed an upward trend from 2013 to 2019 at county, town, and village levels, with the average annual percent change (AAPC) being 5.04, 4.73, and 5.39, respectively. Specifically, the spatial accessibility experienced a slight downward trend during the period of partial two-child policy for both parents only children (i.e., 2013-2014), a slight upward trend during the period of partial two-child policy for either parent only child (i.e., 2014-2016) and the early stages of universal two-child policy (i.e., 2016-2018), and a large upward trend in the later stages of universal two-child policy (i.e., 2018-2019). Spatial accessibility to MCH services gradually decreased from central urban areas to surrounding rural areas. Regions with low spatial accessibility were predominantly located in remote rural areas. CONCLUSION: With the gradual opening of the two-child policies, the spatial accessibility to MCH services for women and children has generally improved. However, significant geographic disparities have persisted throughout the stages of the two-child policies. Comprehensive measures should be considered to improve equity in MCH services for women and children.

Participant and caregiver perspectives on health feedback from a healthy lifestyle check.

INTRODUCTION: The usual output following health consultations from paediatric services is a clinical letter to the referring professional or primary care provider, with a copy sent to the patient's caregiver. There is little research on how patients and caregivers perceive the letter content. We aimed to: first understand child, young people and caregiver experiences of and preferences for receiving a health feedback letter about the child/young person's health measures within a healthy lifestyle programme; and second to provide a set of recommendations for designing letters to children, young people and their families within a healthy lifestyle programme. METHODS: This qualitative study, informed by Kaupapa Maori principles, included focus groups of children aged 5-11 years and young people aged 12-18 years who were participants in a healthy lifestyle programme in Taranaki, Aotearoa New Zealand and of their respective caregivers (total n = 47). Discussions were audio-recorded, transcribed and analysed using thematic analysis. FINDINGS: Key themes were identified: letters sometimes acted as 'discourses of disempowerment'-some participants experienced a lack of safety, depersonalisation with medical jargon and 'feeling like a number'. Participants described the need for acknowledgement and affirmation in written communication-health feedback should include validation, choice regarding content, respectful tone and a strengths-based approach to health messages. INTERPRETATION: Letters to referrers, copied to families, can be perceived as disempowering, and participant and caregiver perspectives of content should be considered. This study challenges conventional practice in communicating health feedback with broader implications for written communication in healthcare. We propose separate letters aimed at the child/young person and their caregiver that offer choice in the information they receive. The administrative burden of multiple letters can be mitigated by advances in digital health. PATIENT CONTRIBUTION: This study originated in response to feedback from service users that current health feedback was not meeting their needs or expectations. Patient perspectives, especially from children, are rarely considered in the generation of clinic letters from health professionals. Participants were child participants in the community-based clinical service and their caregivers, and care was taken to represent the demographic backgrounds of service users. Collection and interpretation of Maori data were led by researchers who were local community members to ensure prioritisation and preservation of participant voice. Where possible, results are illustrated in the text by direct quotes from participants, whose identities are protected with a pseudonym.

Qualineo Strategy Indicators Associated with Neonatal Death: A Cross-Sectional Study.

CONTEXT: The Qualineo Strategy is an effective measure for reducing neonatal mortality in regions with the highest death rates. In addition, it is a relevant Brazilian tool for strengthening teamwork and neonatal assistance. This study aims to analyze the predictors of neonatal death in the indicators of care provided by the Qualineo Strategy at a reference maternity hospital in Piauí, in the years 2021 to 2022. METHODS: This is a retrospective study of 1856 newborn records. Pearson's chi-squared test was used to assess the association between the variables; a predictive regression model was used to identify the variables that predict neonatal mortality. RESULTS: There was a significant association between all neonatal variables and the outcome of death (p < 0.05). The predictor variables for death in term newborns were the use of drugs by the mother and admission to the Neonatal Intensive Care Unit. For premature newborns, the predictor variables were, as follows: the use of cannula ventilation, an Apgar score in the 1st minute <7; and admission to the Neonatal Intensive Care Unit. CONCLUSIONS: The results will make it possible to visualize better strategies for the reality analyzed and reinforce the importance of prenatal care.

Linking Maternal and Child Health Data to Enhance Public Health Surveillance and Implement Sustainable Interventions.

Our initiative aims to enhance the public health informatics infrastructure for surveillance of maternal and child health (MCH) using data captured from electronic health records (EHRs), public health information systems, and administrative health data. Our work includes development, validation, and application of linkage algorithms across records for mothers and children; integration of data across myriad sources; design of routine surveillance reports; and design of longitudinal studies to examine determinants and outcomes in MCH populations. Our work is conducted in partnership with governmental public health agencies, health care providers, academic institutions, and community-based organizations. Future work will build on the enhanced informatics infrastructure to draw from additional public health data sources and/or expand surveillance efforts to include prioritized MCH outcomes. We will further translate knowledge gained from surveillance into action, working with our partners to improve and sustain better MCH equitably in our population.

Integrated care for children and young people with special health and care needs: a systematic review.

CONTEXT: There is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN). OBJECTIVE: To assess the effectiveness of integrated/coordinated care models for CSHCN. DATA SOURCES: Embase, Ovid Medline(R), HMIC Health Management Information Consortium, Maternity & Infant Care Database (MIDIRS), PsycARTICLES, PsycINFO, Social Policy and Practice, Cochrane Central Register of Controlled Trials (CENTRAL), Global Health and PubMed. STUDY SELECTION: Inclusion criteria comprised (1) randomised trials, including cluster randomised trials; (2) an integrated/coordinated care intervention; (3) for children and young people under 25 with special healthcare needs including medical complexity; (4) assessing child-centred outcomes, health-related quality of life among parents and carers, and health or social care use, processes of care and satisfaction with care. DATA EXTRACTION: Data were extracted and assessed by two researchers, and descriptive data were synthesised according to outcome and intervention. RESULTS: 14 randomised controlled studies were included. Seven out of the 14 studies had a dedicated key worker/care coordinator as a vital part of the integrated/coordinated care intervention; however, the certainty of evidence for all outcomes was either 'low' or 'very low'. LIMITATIONS: Included studies were mostly from high-income countries. Variable study outcomes and quality of evidence precluded meta-analysis. CONCLUSIONS: Limited evidence favours integrated care for CSHCN using a dedicated key worker/care coordinator; however, heterogeneity in study outcomes and definitions of CSHCN limit the strength and utility of evidence obtained. Recommendations are made for improving integrated care practice, research and evaluation which are important for evidence-based health services for CSHCN. PROSPERO REGISTRATION NUMBER: CRD42020209320.

One-to-one counselling and school attendance in the UK: a single group pre-post study.

OBJECTIVE: Absence rates remain high in UK schools, with negative implications for attainment, life chances and inequality. Reasons for non-attendance are complex but include psychosocial factors. Few UK-based studies have evaluated psychosocial interventions for school attendance outcomes or its moderators. This pre-post evaluation examined the potential influence of school-based one-to-one counselling on school attendance and possible moderators. DESIGN AND SETTING: Secondary analysis of routine data, collected by a national mental health provider in primary and secondary schools. PARTICIPANTS: 7405 pupils aged 4-19 years, with complete school attendance records at Time1 (pre-counselling term) and Time2 (the term when counselling ended). INTERVENTION: All participants received school-based one-to-one counselling with a trained counsellor between August 2016 and December 2019. OUTCOMES: Percentage of school sessions attended (continuous) and persistent absence (binary; attending ≤90% of sessions) in a term. Potential moderators included sociodemographics, mental health and school engagement/enjoyment. RESULTS: Median Time1 attendance was 96%. 23.6% of participants were persistently absent. The intervention was not associated with improved percentage attendance (0.028%, 95% CI -0.160-0.216%) but was associated with 18.5% reduced odds of persistent absence (OR=0.815, 95% CI 0.729-0.911). We identified five moderators of change in attendance (interaction terms p<0.05): age group (improvements for 4-9 s; worsening for 15-19 s), improvement for some ethnicities and lower parent/carer education. Mental health and school engagement/enjoyment co-varied with attendance in expected directions. CONCLUSIONS: One-to-one counselling may improve school attendance among persistently absent pupils, particularly at younger ages. Improving mental health and pupil engagement/enjoyment are potential intervention targets. Our hypotheses require confirmation with controlled designs.

Factors associated with early initiation of breastfeeding / Fatores associados ao aleitamento materno na primeira hora de vida

INTRODUCTION: Early initiation of breastfeeding (EIBF) is still little stimulated in several hospitals in Brazil. Objective: To estimate the prevalence and factors associated with Early initiation of breastfeeding (EIBF). METHODS: Cross-sectional, quantitative study with retrospective secondary data collection in hospital records of 250 full-term newborns, regardless of the type of delivery, with no history of maternal gestational risk, seen in the last six months. Data collection period in a public maternity hospital in Greater São Paulo. Data collection was performed between November 2018 and January 2019, with approval from the hospital and the FMABC Research Ethics Committee under register n. 2,924,393. RESULTS: The prevalence of EIBF was 66%. BFH is associated with anesthesia at childbirth (p<0,001), APGAR less than or equal to 8 in the 1st and 5th minutes (p<0,001), and with c-section (p<0,001), which represented 29.2% of deliveries in the sample. Respiratory distress (38.82%), hypotonia (24.70%), followed by unfavorable maternal conditions (18.82%), were shown to be impeding factors for EIBF, although 90% of newborns received Apgar 9 /10 in the 5th minute. CONCLUSION: The prevalence of early breastfeeding is lower than recommended, but compatible with the most recent national frequency proportions.

INTRODUÇÃO: O aleitamento materno na primeira hora de vida ainda é pouco estimulado em vários hospitais do Brasil. OBJETIVO: Analisar a prevalência e os fatores associados ao aleitamento materno na primeira hora de vida (AMP) entre recém-nascidos a termo. MÉTODOS: Estudo transversal, de natureza quantitativa, com coleta de dados secundários retrospectivos em prontuários hospitalares de 250 recém-nascidos a termo, independentemente do tipo de parto, com histórico de gestacional de risco habitual, atendidos nos últimos seis meses anteriores ao período de coleta de dados, em uma maternidade pública da Grande São Paulo. Os dados foram coletados entre novembro de 2018 e janeiro de 2019, por meio de roteiro estruturado, mediante aprovação do hospital e do Comitê de Ética em Pesquisa da FMABC (Parecer n.º 2.924.393). O banco de dados e o tratamento estatístico foram realizados através do programa STATA®. Para a análise, utilizou-se proporções e teste qui-quadrado, adotando-se um nível de significância de 5% e 95% o intervalo de confiança. RESULTADOS: A prevalência de AMP foi de 66%. O AMP está associado a anestesia no parto (p<0,001), APGAR menor ou igual a 8 no 1º e 5º minutos (p<0,001) e ao parto cesárea (p<0,001), cuja proporção na amostra foi de 29,2%. Desconforto respiratório (38,82%), hipotonia (24,70%), seguido de condições maternas desfavoráveis (18,82%), mostraram-se como fatores impeditivos para o AMP, embora 90% dos recém-nascidos tenham recebido Apgar 9/10 no 5º minuto. CONCLUSÃO: A prevalência do aleitamento materno precoce é inferior ao recomendado, porém compatível com as proporções de frequência nacional mais recentes.

The S20 Brazilian Mental Health Report for Building a Just World and a Sustainable Planet: Part I.

This is the first part of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment, among others. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of mental disorders emerging in life. Utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote health and safety of their student population, thereby paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

Parents' perceptions of care quality at child health centres: A cross-sectional study from Sweden.

AIM: To examine parents' perceptions of care quality at child health centres. Specific objectives were to examine parents' perceptions of the care received and the subjective importance of such care. Furthermore, to examine the relationship between parents' sociodemographic characteristics and the perceptions of care quality. DESIGN: A cross-sectional study. METHODS: A random sample of parents of children born in Sweden in 2021 participated. Data were collected by the QPP-CHC questionnaire and analysed using descriptive and analytical statistics. RESULTS: The response rate was 19.4%. The targeted sample size of 210 participants was reached as 584 parents responded to the questionnaire. Parents' overall ratings of care quality at child health centres indicated optimal quality with mean values >3. However, various potential improvements areas were identified as needing additional information. These included dental care (m = 2.82), allergy prevention (m = 2.25), breastfeeding (m = 2.97), sleep (m = 2.83), the child's behaviour (m = 2.47) and the child's crying (m = 2.47). Also, parents rated suboptimal quality regarding that the care was based on healthcare routines rather than parental preferences and needs (m = 2.86). Parents born outside of the Nordic countries rated higher care quality than those born in the Nordic countries, as well as parents with a non-academic education. CONCLUSION: Parents want information based on their preferences and needs. Parent's perceptions of areas for improvement are new and important knowledge for registered nurses at child health centres. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings indicate that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres is an important component of quality work and might lead to improvements in the care quality at child health centres. REPORTING METHOD: The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross-sectional studies was used to guide reporting. IMPLICATIONS FOR POLICY AND PRACTICE: The findings of this study suggests that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres provides important knowledge which can guide further development of care quality at child health centres. The findings indicate that a family-centred approach that integrates relational and routine-oriented nursing can be a way to ensure that the care is based on parents' preferences and needs. No patient or public contribution.

Family Medicine Implementation to Maternal and Child Health in Rural Japan: A Narrative Review.

This research provides a critical narrative review of maternal and child health (MCH) in rural Japan, reflecting broader challenges faced by aging societies globally. The study explores the intertwined roles of professional and lay care in sustaining rural communities, emphasizing the unique position of family medicine and primary care in enhancing MCH services. The scarcity of healthcare resources, particularly the shortage of obstetricians and the weakening of traditional community support systems, underscores the challenges in these areas. Our review method involved a comprehensive search of PubMed for articles published from April 2000 to August 2024, focusing on MCH issues in rural Japan. This study highlights several critical gaps in rural MCH provision: the migration of medical professionals to urban centers, the transformation of social structures affecting traditional caregiving, and the lack of specialized MCH training among primary care physicians. We discuss potential solutions such as incentivizing obstetric care in rural areas, integrating MCH education within family medicine curricula, and revitalizing community-based support systems. By addressing these issues, the research aims to formulate actionable strategies to bolster MCH services, thus ensuring better health outcomes and sustainability of rural communities in Japan and similar settings worldwide.

Service design for children and young people with common mental health problems: literature review, service mapping and collective case study.

Background: The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm. Aim: To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services. Design: Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services. Setting: Global (systematic reviews); England and Wales (service map; case study). Data sources: Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites. Methods: A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'. Results: A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems. Limitations: Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn. Conclusions: There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research. Future work: Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility. Study registration: This study is registered as PROSPERO CRD42018106219. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

In this research study, we explored services for children and young people with 'common' mental health problems like depression, anxiety and self-harm. We aimed to find out what services exist, how children/young people and families find out about and access these services, what the services actually do, whether they are helpful and whether they offer value for money. We looked at the international literature (reports and research papers) to identify different approaches to providing support, and to find out whether certain approaches worked better than others and whether children/young people and families preferred some approaches over others. The literature provided very little information about the value for money of services. We also carried out a survey and used the internet to identify 154 relevant services in England and Wales. To explore services in more detail, and hear directly from those using them, we planned to visit 9 of the 154 services to interview children/young people, parents and staff. Unfortunately, coronavirus disease 2019 stopped us directly visiting the nine services and so we conducted phone and video interviews instead. We still managed to speak to, and hear the experiences of, more than 100 people (including children/young people and parents). We combined information from the literature with information from the interviews to create an evidence-based 'model' of what services should look like. This model considers some basic things like how quickly children/young people could access a service, what information was available, the importance of confidentiality and whether staff make the service fit with the child/young person's needs and interests. It also considers whether the service helps children/young people learn skills to manage their mental health and whether staff at a service work well together. We hope our model will help existing and new services improve what they offer to children/young people and families.

Children accessing accident and emergency department for non-urgent consultations: A cross-sectional study about parents' use of primary care services.

INTRODUCTION: Parents often take their children to the Paediatric Accident and Emergency Department (A&E) for non-urgent consultations rather than using community-based primary care services. This study describes the use of primary care services in parents taking their children to the A&E for non-urgent consultations. METHODS: A cross-sectional study was conducted from July 2018 to June 2019, in a second-level Italian paediatric A&E of a tertiary-level children's academic research and hub hospital. Parents of children aged between 3 months and 6 years assigned with a white code at the triage were asked to complete a paper-and-pencil 40-item questionnaire after accessing the A&E for a non-urgent consultation. RESULTS: The questionnaire was completed by the parents of 237 children (males 58 %; median age = 2.3 years). Overall, 48.1 % (n = 114) of the parents reported consulting 'often/always' the primary care paediatrician, mainly when their child was sick and for check-ups (n = 182, 76.8 %). However, only 7.2 % (n = 17) of the parents 'often/always' used any other health service in the community. Most of them (n = 191, 82 %) did not even know where the community health centre was located. CONCLUSION: Parents accessing the A&E for non-urgent consultations should be better informed/educated on how to use community health services.

FACTORS ASSOCIATED WITH EXTREME MATERNAL MORBIDITY IN A COHORT OF PREGNANT WOMEN IN A CALI EAPB 2019-2020 / FACTORES ASOCIADOS A LA MORBILIDAD MATERNA EXTREMA EN UNA COHORTE DE GESTANTES DE UNA EAPB CALI 2019-2020

Introduction: Extreme maternal morbidity (EMM) is an event of interest in public health that has an important impact when evaluating health services, since timely and quality care in a woman with a severe obstetric complication can prevent a fatal outcome. In an EAPB in the city of Cali during the 2019-2020 period, a need was evidenced to determine the behavior of the factors mostly associated with extreme maternal morbidity, this being a relevant study to support decision-making. Methodology: it is a type of observational analytical retrospective cohort study, we worked with a census of pregnant women registered in the insurer's nominal follow-up matrix, which is fed from various sources such as the single database of affiliates, SIVIGILA, RIPS among others, a characterization of the sociodemographic, clinical and health care factors was carried out by means of absolute and relative frequencies, later they were crossed in contingency tables to determine association by means of the chi square test and a regression model was carried out. binomial log to establish the factors that best explain EMM. Results: most of the pregnant women were between 18 and 35 years old, from the subsidized regime, from the urban area, with informal work, educational level of basic secondary, with a stable partner (married or in a free union), non-ethnic, (No perceived as indigenous, ROM or Afro-Colombian, were in their second or third pregnancy period, covered by IVE counseling and the psychoprophylactic course and began their prenatal care in the first trimester, and an incidence of 3,2% of EMM was estimated. Conclusions: the risk of EMM was higher in pregnant women without IVE advice, psychoprophylactic course, ultrasound, nutrition consultation, gynecology, iron sulfate, calcium or folic acid; also in adolescents, in those over 36 years of age, from rural areas, without a stable partner, ethnic, vulnerable population, primiparous, with a history of abortion, with weight/height alterations, with high obstetric risk, with Dx of HIV or gestational syphilis and with late start of prenatal care.

Introducción: La morbilidad materna extrema es un evento de interés en salud pública que tiene un impacto importante al evaluar los servicios de salud ya que una atención oportuna y de calidad en una mujer con una complicación obstétrica severa puede prevenir un desenlace fatal. En una EAPB en la ciudad de Cali durante el periodo 2019-2020 se evidencio una necesidad referente a determinar cuál es el comportamiento de los factores mayormente asociados a la morbilidad materna extrema, siendo este un estudio relevante para apoyar la toma de decisiones. Metodología: es un tipo de estudio observacional analítico de cohorte retrospectiva, se trabajó con un censo de las gestantes registradas en la matriz de seguimiento nominal de la aseguradora, que se alimenta de diversas fuentes como la base de datos única de afiliados, SIVIGILA, RIPS entre otras, se realizó una caracterización de los factores sociodemográficos, clínicos y de atención en salud  por medio de frecuencias absolutas y relativas, posteriormente se cruzaron en tablas de contingencias para determinar asociación por medio de la prueba chi cuadrado y se realizó un modelo de regresión log binomial para establecer los factores que mejor explican la Morbilidad Materna Extrema (MME). Resultados: en su mayoría las gestantes tenían entre 18 y 35 años, del régimen subsidiado, de la zona urbana, con trabajo informal, nivel educativo de básica secundaria, con pareja estable (casadas o en unión libre), no étnica, (No se perciben como indígena, ROM o afrocolombiana, cursaban su segundo o tercer periodo de gestación, con cobertura de asesoría de IVE y del curso psicoprofiláctico y iniciaron su control prenatal en el primer trimestre y se estimó una incidencia de 3,2% de MME. Conclusiones:  el riesgo de MME fue superior gestantes sin asesoría de IVE, curso psicoprofiláctico, ecografía, consulta de nutrición, ginecología, sulfato ferros, calcio o ácido fólico; además en adolescentes, en mayores de 36 años, de la zona rural, sin pareja estable, con pertenencia étnica, de población vulnerable, primigestantes, con antecedente de aborto, con alteraciones peso/talla, con alto riesgo obstétrico, con Dx de VIH o sífilis gestacional y con inicio tardío del control prenatal.

The Effect of Using a Client-Accessible Health Record on Perceived Quality of Care: Interview Study Among Parents and Adolescents.

BACKGROUND: Patient-accessible electronic health records (PAEHRs) are assumed to enhance the quality of care, expressed in terms of safety, effectiveness, timeliness, person centeredness, efficiency, and equity. However, research on the impact of PAEHRs on the perceived quality of care among parents, children, and adolescents is largely lacking. In the Netherlands, a PAEHR (Iuvenelis) was developed for preventive child health care and youth care. Parents and adolescents had access to its full content, could manage appointments, ask questions, and comment on written reports. OBJECTIVE: This study aims to assess whether and how using this PAEHR contributes to perceived quality of care from a client's perspective. METHODS: We chose a qualitative design with a phenomenological approach to explore how parents and adolescents perceived the impact of using a PAEHR on quality of care. In-depth interviews that simultaneously included 1 to 3 people were conducted in 2021. In total, 20 participants were included in the study, representing parents and adolescents, both sexes, different educational levels, different native countries, and all participating municipalities. Within this group, 7 of 13 (54%) parents had not previously been informed about the existence of a client portal. Their expectations of using the client portal, in relation to quality of care, were discussed after a demonstration of the portal. RESULTS: Parents and adolescents perceived that using Iuvenelis contributed to the quality of care because they felt better informed and more involved in the care process than before the introduction of Iuvenelis. Moreover, they experienced more control over their health data, faster and simpler access to their health information, and found it easier to manage appointments or ask questions at their convenience. Parents from a migratory background, among whom 6 of 7 (86%) had not previously been informed about the portal, expected that portal access would enhance their understanding of and control over their care processes. The parents expressed concerns about equity because parents from a migratory background might have less access to the service. Nevertheless, portal usability was regarded as high. Furthermore, both parents and adolescents saw room for improvement in the broader interdisciplinary use of Iuvenelis and the quality of reporting. CONCLUSIONS: Using Iuvenelis can contribute to the client-experienced quality of care, more specifically to perceived person centeredness, timeliness, safety, efficiency, and integration of care. However, some quality aspects, such as equity, still need addressing. In general, client information about the portal needs to be improved, specifically focusing on people in vulnerable circumstances, such as those from migratory backgrounds. In addition, to maximize the potential benefit of using Iuvenelis, stimulating a person-centered attitude among professionals is important. Considering the small number of adolescent participants (n=7), adding quantitative data from a structured survey could strengthen the available evidence.