Exploring Stakeholder Service Navigation Needs for Children with Developmental and Mental Health Diagnoses.

OBJECTIVE: Service navigation programs are necessary for children with neurodevelopmental and/or mental health diagnoses to facilitate access to specialized therapies, social services, and community programs, especially those who are socially and economically marginalized. Few studies have included diverse stakeholders in the development and implementation of such programs in resource-limited settings. In this qualitative formative study, we aimed to explore stakeholder experiences after the implementation of a pilot service navigation program in resource-limited settings and identify the perceived elements of an effective service navigator, to develop a revised service navigation program for this patient population. METHODS: A novel navigation pilot program was implemented in an urban inner-city setting. Using phenomenology as a methodology, we conducted qualitative in-depth interviews with patient caregivers, pediatricians, allied health staff, clinic administrators, and the patient navigator. Data were analyzed within and across stakeholder groups using thematic analysis and supported by group discussion. RESULTS: Twenty-five stakeholders participated. All stakeholders reported challenges with accessing services before the implementation of the navigation program. Caregivers expressed frustration navigating a fragmented health care system, while providers felt limited by time and knowledge. The navigator's role was described as multifaceted: finding and completing applications for funding and programs, offering emotional support, liaising between physicians and patients, and advocating with schools and agencies. Based on stakeholder input, a revised service navigation model of care is proposed. CONCLUSION: Caregivers and providers face immense barriers trying to help children with mental health and developmental diagnoses access necessary services and funding. Service navigation programs can be effectively embedded within pediatric clinical teams to improve access to required services for this patient population.

Low-intensity physical activity may protect pregnant women against spontaneous preterm labour: a prospective case-control study.

The innate immune system plays a significant role in onset of parturition. Maternal antenatal physical activity can influence immune function and timing of labour. We examined physical activity patterns and concentration of 19 cytokines at 16 and 27 weeks gestational age (GA), in peripheral plasma of 28 asymptomatic women who later had spontaneous preterm labour (SPTL, <37 weeks GA) and 52 women who later delivered at term (TL; ≥37 weeks GA). This nested case-control study used data from the Ontario Birth Study cohort. Exercise was assessed using the International Physical Activity Questionnaire, and cytokines were analyzed using Luminex assays. There was no significant difference in exercise patterns between SPTL and TL subjects. Plasma concentration of interleukin (IL)-10 was significantly higher in SPTL women at 16 and 27 weeks, while tumour necrosis factor alpha (TNF-α), IL-8, and monocyte chemoattractant protein (MCP)-1 concentrations were increased at 27 weeks GA (p < 0.05). Concentration of IL-10 was negatively correlated with the amount of reported walking (ρ = -0.264, p = 0.03). Women should be encouraged to partake in low-intensity exercise throughout pregnancy, as it may confer a protective effect against SPTL through IL-10-mediated pathways. Additionally, plasma cytokine analysis at 27 weeks GA may be useful for predicting SPTL in asymptomatic women. Novelty: In women that delivered preterm, plasma levels of anti-inflammatory cytokine IL-10 were significantly elevated at 16 and 27 weeks of gestation. Plasma levels of IL-10 were negatively correlated with the amount of reported walking. Concentration of IL-8, MCP-1 and TNF-α were increased in plasma of asymptomatic women that subsequently deliver preterm.

Cytokine Changes in Maternal Peripheral Blood Correlate With Time-to-Delivery in Pregnancies Complicated by Premature Prelabor Rupture of the Membranes.

Premature prelabor rupture of the membranes (PPROM) causes one-third of preterm births worldwide and is most likely caused by subclinical intrauterine infection and/or inflammation. We proposed that women with systemic inflammation at the time of PPROM would have shorter latency. Peripheral blood samples were collected from 20 singleton pregnant women with PPROM between 23 ± 1 and 33 ± 6 weeks. The first sample was drawn within 48 hours of admission, followed by weekly blood draws until delivery. Pregnancies complicated with acute chorioamnionitis, preeclampsia, intrauterine growth restriction, obesity, substance abuse, and chronic maternal disease were excluded. Twenty uncomplicated, gestational age-matched pregnancies served as controls. Plasma concentration of 39 cytokines was measured longitudinally using Luminex assays to investigate their value as predictive biomarkers of latency. Women with PPROM exhibited significantly lower plasma concentration of interferon-γ-inducible protein 10-Chemokine (c-x-c motif; IP10/CXCL10), Chemokine (c-x-c motif) Ligand 9 (MIG/CXCL9), Platelet-derived growth factor BB (PDGFbb), and cutaneous T cell-attracting chemokine, also known as CCL27/CCL27 than controls at admission but significantly elevated interleukin (IL)1RA, tumor necrosis factor α, monocyte chemotactic protein-1/CCL2 at delivery compared to admission. Women with PPROM who delivered within 7 days had significantly lower plasma concentration of anti-inflammatory cytokine IL1RA than those with latency periods >7 days. The IL1RA and endotoxin activity in conjunction with clinical parameters results in excellent prediction of latency to delivery (area under the receiver-operating characteristic curve = 0.91). We concluded that higher levels of anti-inflammatory cytokines in women with PPROM were associated with increased latency until delivery, likely due to counterbalancing of proinflammatory load. When used in conjunction with other predictive characteristics of time until delivery, cytokines may further assist clinical decision-making and optimize pregnancy outcomes in women with PPROM.