Development of a Blueprint for Integrated Care for Vulnerable Pregnant Women

Purpose There has been increasing awareness of perinatal health and organisation of maternal and child health care in the Netherlands as a result of poor perinatal outcomes. Vulnerable women have a higher risk of these poor perinatal outcomes and also have a higher chance of receiving less adequate care. Therefore, within a consortium, embracing 100 organisations among professionals, educators, researchers, and policymakers, a joint aim was defined to support maternal and child health care professionals and social care professionals in providing adequate, integrated care for vulnerable pregnant women. Description Within the consortium, vulnerability is defined as the presence of psychopathology, psychosocial problems, and/or substance use, combined with a lack of individual and/or social resources. Three studies focussing on population characteristics, organisation of care and knowledge, skills, and attitudes of professionals regarding vulnerable pregnant women, were carried out. Outcomes were discussed in three field consultations. Assessment The outcomes of the studies, followed by the field consultations, resulted in a blueprint that was subsequently adapted to local operational care pathways in seven obstetric collaborations (organisational structures that consist of obstetricians of a single hospital and collaborating midwifery practices) and their collaborative partners. We conducted 12 interviews to evaluate the adaptation of the blueprint to local operational care pathways and its’ embedding into the obstetric collaborations. Conclusion Practice-based research resulted in a blueprint tailored to the needs of maternal and child health care professionals and social care professionals and providing structure and uniformity to integrated care provision for vulnerable pregnant women.

Construction and validation of the prognostic model for patients with neuroendocrine cervical carcinoma: a competing risk nomogram analysis

Purpose Neuroendocrine cervical carcinoma (NECC) is an uncommon malignancy of the female reproductive system. This study aimed to evaluate cancer-specific mortality and to construct prognostic nomograms for predicting the survival of patients with NECC. Methods we assembled the patients with NECC diagnosed between 2004 to 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Meanwhile, we identified other patients with NECC from the Wenling Maternal and Child Health Care Hospital between 2002 to 2017. Fine and Gray’s test and Kaplan–Meier methods were used to evaluate cancer-specific mortality and overall survival (OS) rates, respectively. Nomograms were constructed for predicting cancer-specific survival (CSS) and OS for patients with NECC. The developed nomograms were validated both internally and externally. Results a total of 894 patients with NECC were extracted from the SEER database, then classified into the training cohort (n = 628) and the internal validation cohort (n = 266). Besides, 106 patients from the Wenling Maternal and Child Health Care Hospital served as an external validation cohort. Nomograms for predicting CSS and OS were constructed on clinical predictors. The validation of nomograms was calculated by calibration curves and concordance indexes (C-indexes). Furthermore, the developed nomograms presented higher areas under the receiver operating characteristic (ROC) curves when compared to the FIGO staging system. Conclusions we established the first competing risk nomograms to predict the survival of patients with NECC. Such a model with high predictive accuracy could be a practical tool for clinicians.

Barriers and facilitators to discussing parent mental health within child health care: Perspectives of parents raising a child with congenital heart disease

This study aimed to identify barriers and facilitators to discussing parent mental health within child health care for parents of children with congenital heart disease (CHD). Seventy-nine parents of young children with CHD who received care across 40 hospitals in the United States responded to questions about barriers and facilitators to discussing their mental health with their child’s health care providers. Responses were analyzed using qualitative research methods. Parents described multiple barriers: (1) belief that parent mental health support was outside the care team’s scope of practice, (2) perceived expectation to “stay strong,” (3) fear of negative judgment or repercussion, (4) individual preferences for communication/support, (5) desire to maintain care resources on their child, (6) perceived need to compartmentalize emotions, and (7) negative reactions to past emotional disclosure. Parents also described several facilitators: (1) confidence in the care team’s ability to provide support, (2) intentional efforts by the care team to provide support, (3) naturally extroverted tendencies, and (4) developing personal connections with health care providers. It is important that health care providers normalize the impact of child illness on the family and create an environment in which parents feel comfortable discussing mental health challenges.

Peluang Pelaksanaan dan Tantangan Pengembangan Hospital without Walls pada Pelayanan Kebidanan dan Kandungan di RSUD Noongan

Hospitals as the health referral facilities play an important role in decreasing the maternal mortality rate (MMR) since they also belong to the personal health service as a whole including mother child health care. This study was aimed to analyze the implementation opportunities and challenges of developing ‘hospital without walls’ program in obstetrics and gynaecology services at RSUD (Rumah Sakit Umum Daerah) Noongan. This was a qualitative study. Informants in this study were taken from three places, as follows: the hospital, namely the Director of the Hospital and obstetrician-gynaecologist doctors; puskesmas (primary health center), namely the heads of puskesmas; and the community. Data were collected through in-depth interviews and direct observation. The results indicated that ‘hospital without walls’ in obstetrics and gynaecology services at RSUD Noongan had the opportunity to be implemented because this program had been partly applied by the hospital and it had a good impact on the hospital, health center, and the community as well as PONED-PONEK collaboration. The challenges of imple-menting this program at RSUD Noongan were the existence of cold cases caused by gatekeeper failure, lack of health facilities and human resources at the puskesmas, and insubstantial collaboration between PONED-PONEK. In conclusion, ‘hospital without walls’ program in obste-trics and gynaecology services can be implemented at RSUD Noongan with awareness to the possible challenges in its development.Keywords: opportunity and challenge; hospital without walls; obstetrics and gynecology services Abstrak: Rumah sakit sebagai fasilitas kesehatan rujukan paripurna berperan penting dalam menurunkan angka kematian ibu (AKI) termasuk pelayanan kesehatan ibu dan anak (KIA). Penelitian ini bertujuan untuk menganalisis peluang pelaksanaan dan tantangan pengembangan program hospital without walls pada pelayanan kebidanan dan kandungan di RSUD Noongan. Jenis penelitian ialah kualitatif. Informan penelitian diambil dari tiga tempat yaitu: RSUD Noongan (Direktur Rumah Sakit dan dokter spesialis obstetri dan ginekologi); puskesmas (kepala puskesmas); dan masyarakat. Data dikumpulkan melalui wawancara mendalam dan observasi langsung. Hasil penelitian memperlihatkan bahwa hospital without walls pada pelayanan kebi-danan dan kandungan di RSUD Noongan berpeluang untuk dilaksanakan karena sebagian pro-gram ini telah diterapkan oleh rumah sakit dan juga berdampak baik bagi rumah sakit, puskesmas dan masyarakat, serta kolaborasi PONED-PONEK. Tantangan pelaksanaan program ini di RSUD Noongan yaitu adanya cold case yang merupakan kegagalan gatekeeper, fasilitas kesehatan dan sumber daya manusia (SDM) yang masih kurang di puskesmas, serta kolaborasi PONED-PONEK belum optimal. Simpulan penelitian ini ialah program hospital without walls pada pelayanan kebidanan dan kandungan berpeluang untuk dilaksanakan di RSUD Noongan dengan memperhatikan tantangan pengembangan.Kata kunci: peluang dan tantangan; hospital without walls; pelayanan kebidanan dan kandungan

Mathematical analysis of China's birth rate and research on the urgency of deepening the reform of art education

Aims To understand the reasons for the decline in the birth rate of our country, the effects of the decline in the birth rate and the countermeasures needed to reduce the birth rate, as well as the urgency of the reform of education, especially art education. Methods Using a mathematical statistical analysis method, the decline of the birth rate in our country was statistically analysed, and the influence of education, especially art education, was discussed. Results The results show that the birth rate of China's population decreased significantly, that is, from 36% in 1949 to 23.3% in 1987 and from 12.95% in 2016 to 10.8% at present. This has a significant impact on the manpower of all walks of life. Students at all levels and all kinds of schools have brought about a greater impact. Higher education, especially art education, has a greater impact. Conclusions In the face of the decline in the birth rate, corresponding countermeasures must be taken to strengthen the development of maternal and child health care and medical resources. In-depth reform or correction of the current compulsory education must be assessed in order to relieve the worries of women who have given birth so that the birth rate increases within the framework of a reasonable, normal span of time and demonstrates smooth development. In order to ensure that China has sufficient human resources and enough students at all levels and all kinds of schools, the reform of art education is deepened, thus facilitating training of the talents of world-class masters.

Prevalence and factors associated with fertility desire among HIV-positive women in Rwanda in the context of improved life expectancy

Background The knowledge of the key factors associated with fertility desire among people living with HIV/AIDS is crucial for the efficient planning of maternal and child health care programs. Fertility desire has generally increased among women of reproductive age in Rwanda. However, its level and determinants among women living with HIV/AIDS (WLHA) are currently not well known in the context of Rwanda. The present study aimed to fill in this knowledge gap. Methods Data were extracted from the 2015 Rwanda demographic and health survey (RDHS) for 243 HIV-positive women of reproductive age. Univariate and multivariable logistic regression analyses were conducted in order to identify the most influential factors. Results The prevalence of desire to have another child in HIV-positive women was found to be as high as 40.7%. Multivariable logistic regression analyses showed that the woman’s age of 35–49 years (AOR = 0.051, 95% CI: 0.013–0.204), woman’s parity of 3 children or above (AOR = 0.177, 95% CI: 0.037–0.837), being employed (AOR = 0.298, 95% CI: 0.113–0.782) and currently using contraceptives (AOR = 0.146; 95% CI: 0.057–0.375) were significantly associated with low odds of fertility desire among HIV- positive women in Rwanda. Women younger than 25 years, with no living child, or who were unemployed or who were not using any contraceptive were significantly associated with greater odds of desire to have another child than did other HIV- positive women. A woman whose partner's desire for children is different from hers was associated with about four times higher odds (AOR = 3.752; 95% CI: 1.203–11.702) of desire for more children than women who desire the same as their partners. Conclusion Fertility desire in WLHA is currently high in Rwanda. It is significantly influenced by demographic and socioeconomic factors. The Rwanda’s health care system should be prepared to intensify the required services for the prevention of the vertical transmission of HIV, the delivery of maternal and child health care services, and the support to WLHA in planning their fertility. Interventions should target low-parity young women, with a particular focus on meeting their contraceptive needs.

Barriers to Maternal and Child Health Care Service Uptake in Assosa Zone, Benishangul Gumuz Region, Ethiopia: A Qualitative Study

Background. Ethiopia has reduced maternal mortality from 871 to 412 per 100,000 live births between 2000 and 2016. In 2019, under-5 mortality rates in Ethiopia were 55 deaths per 1,000 live births. Benishangul Gumuz was the second-largest region in the under-5 mortality rate (98/1,000 live births) in the country. Maternal and child health care service uptake is an important indicator of health outcomes. This study is aimed at exploring major barriers to maternal and child health care uptake in Assosa Zone. Methods. This study was conducted in the Bambasi, Menge, and Sherkole districts of the Assosa Zone from July 17 to August 31/2019. The study explored the life experience of study participants about MCH services. The sampling technique was purposive, and data collection methods were focus group discussions, key informant interviews, and in-depth interviews. Data were analyzed thematically. Result. The main barriers to child health care services were financial problems, lack of knowledge, preference of traditional medicines for a sick child, women having no time to care for their sick child, poor roads. poor health facility readiness, the poor economy of families, lack of ambulance, cultural and traditional beliefs, providers being male, and unprofessional behaviors which were the major barriers hindering the uptake of maternal health service utilization. Conclusion. Poor health facility readiness, indirect costs, inaccessibility to health facilities, and cultural and traditional practices were among the major barriers to service uptake identified by this research in the study area.