Strategies to improve postpartum engagement in healthcare after high-risk conditions diagnosed in pregnancy: a narrative review.

Transition from antepartum to postpartum care is important, but often fragmented, and attendance at postpartum visits can be poor. Access to care is especially important for individuals diagnosed antepartum with conditions associated with longer-term implications, including gestational diabetes (GDM) and hypertensive disorders in pregnancy (HDP). Strategies to link and strengthen this transition are essential to support people to attend recommended appointments and testing. This narrative review evaluates what is known about postpartum transition of care after higher-risk antepartum conditions, discusses barriers and facilitators to uptake of recommended testing, and outlines strategies trialled to increase both postpartum attendance and testing. Barriers to attendance frequently overlap with general barriers to accessing healthcare. Specific postpartum challenges include difficulties with transport, coordinating breastfeeding and childcare access. Systemic challenges include inadequate communication to women around implications of health conditions diagnosed in pregnancy, and the importance of postpartum follow up. Uptake of recommended testing after a diagnosis of GDM and HDP is variable but generally suboptimal. Strategies which demonstrate promise include the use of patient navigators, focused education and specialised clinics. Reminder systems have had variable impact. Telehealth and technology are under-utilised in this field but offer promising options particularly with the expansion of virtual healthcare into routine maternity care. Strategies to improve both attendance rates and uptake of testing must be designed to address disparities in healthcare access and tailored to the needs of the community. This review provides a starting point to develop such strategies from the community level to the population level.

Attitudes toward year-round influenza vaccination in pregnant women.

Influenza virus circulates year-round, yet uptake of maternal influenza vaccination decreases outside of influenza season. This prospective study of 62 pregnant women provides insight into the possible underlying reasons for this. Despite knowledge of benefits for maternal and infant outcomes, we observed a lack of understanding of rates of influenza infection outside influenza season, concerns about safety in relation to receiving multiple vaccinations during the same pregnancy, and lack of healthcare provider recommendation to be vaccinated outside influenza season. These findings can help tailor public health education targeting pregnant women and their healthcare providers to improve influenza vaccine uptake.

Viral Genomics to Inform Infection-control Response in Occupational Coronavirus Disease 2019 (COVID-19) Transmission.

Healthcare workers are at increased risk of occupational transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report 2 instances of healthcare workers contracting SARS-CoV-2 despite no known breach of personal protective equipment. Additional specific equipment cleaning was initiated. Viral genomic sequencing supported this transmission hypothesis and our subsequent response.

Ethnic disparities in community antibacterial dispensing in New Zealand, 2015.

AIMS: There are significant ethnic disparities in the incidence of various infectious diseases in New Zealand. Antimicrobial stewardship interventions which ignore these disparities may have negative effects on the health of some ethnic groups. We aimed to determine the relationship between ethnicity and community antimicrobial dispensing in New Zealand, to inform the development of antimicrobial stewardship interventions in New Zealand. METHODS: Demographic data on all patients registered with a general practice in New Zealand and on all community pharmacy antibacterial dispensings during 2015 were obtained from national healthcare databases. The rates of dispensing were measured as the number of dispensings per 1,000 population per day and as defined daily doses per 1,000 population per day. RESULTS: The rate of community antibacterial dispensing for the total population surveyed was 3.01 dispensings per 1,000 population per day, and was 3.49 for Pacific, 3.23 for Maori, 3.02 for European, 2.70 for Middle Eastern, Latin American and African, and 2.35 for Asian people. In all ethnic groups the rate of community antibacterial dispensing increased with increasing socioeconomic deprivation. Seasonal variation in antibacterial dispensing ranged between 34% in Asian people and 24% in European people. CONCLUSIONS: The ethnic disparities in the rates of antibacterial dispensing in New Zealand are consistent with, but less marked than, the ethnic disparities in the incidence of infectious diseases in New Zealand. Improved community-wide understanding of both the benefits and the harms of antibacterial medicines is necessary to support improved antibacterial use in New Zealand in the future.