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To assess health service use between days 43 and 365 postdelivery, comparing individuals with and without severe maternal morbidity (SMM).
Population-based cohort study.
Linked datasets from Population Data BC in British Columbia, Canada, April 2013–March 2021.
Postpartum individuals aged >18 years with a hospital or home delivery, with/without SMM occurring from 20 weeks’ gestation through 42 days post partum. Ectopic pregnancies, missing identifiers and maternal deaths at delivery or within 42 days post partum were excluded.
The primary outcome was high health service use, defined as being in the 95th percentile for use of one or more of the following non-obstetric visits: emergency department, hospitalisations and outpatient visits to a primary care physician or specialist—each occurring between 43 and 365 days after delivery hospitalisation discharge. Secondary outcomes included being in the 95th percentile for each visit type. Log binomial regression assessed the rate and risk of high health service use in SMM compared with non-SMM pregnancies, adjusting for confounders.
The cohort included 261 287 deliveries (5575 (2.1%) with SMM). Those with >15 visits within 43–365 days postdelivery were classified as having high health service use. SMM-affected individuals were twice as likely to have high health service use (9.2% vs 4.3%; adjusted relative risk (aRR)=1.96, 95% CI 1.78 to 2.17). Individuals with non-hypertensive cardiovascular SMM had markedly higher health service use (21.4% vs 4.3%; aRR=5.18, 95% CI 3.28 to 8.16). There was heterogeneity in the association between SMM and high health service use among those without versus with previous comorbidities, without versus with high service use in the 2 years prior to delivery, and without vs with preterm birth.
Our study revealed high health service use after SMM. These findings can help guide the development of standardised postpartum care pathways.
by Dwi Sisca Kumala Putri, Kencana Sari, Nur Handayani Utami, Nazarina Nazarina, Tiara Amelia, Nadira Yuthie Salwa, Ning Sulistiyowati, Adindra Vickar Ega, Muhammad Azzumar, Rika Rachmawati, Salimar, Mieska Despitasari, Donny Kristanto Mulyantoro
BackgroundMobile Health (mHealth) Applications offer a promising approach to promote the adoption of healthy nutrition and behavior among adolescent girls. A tailored mobile app, Teen ‘n Fit, was developed to support adolescent girls in Indonesia to assess their nutritional status, physical activity, and eating behavior; as a nutrition education media; and as a reminder of iron folic acid consumption. However, it is essential to measure the app’s usability prior to the release.
ObjectiveThis study aimed to measure the usability of a mobile application designed to promote nutrition and healthy behavior of adolescent girls by modifying the mHealth App Usability Questionnaire (MAUQ).
MethodsA cross-sectional usability study was conducted on 64 adolescent girls aged 15–18 from a public high school in Depok, Indonesia. Participants completed app-based tasks and filled out a post-task usability questionnaire. The usability questionnaire was adapted from a validated MAUQ for a standalone mHealth app. The exploratory factor analysis was conducted to determine the items constituting each component in the modified MAUQ. Mann-Whitney analysis was employed to analyze the difference in usability score means based on participants’ characteristics.
ResultsThe modified MAUQ demonstrated strong reliability (Cronbach’s alpha = 0.945). The app achieves a strong usability score, 6.0 ± 0.8 out of 7, with 79.7 percent of participants reporting no prior mHealth experience. The score among participants who occasionally used mHealth applications was higher (p = 0.046) than those who had never made prior use.
ConclusionThe findings indicate strong usability potential of Teen ‘n Fit as a digital health promotion tool for adolescent girls; however, future efforts in conducting effectiveness tests and maintaining user engagement are needed.
Children with medical complexity (CMC) are a subset of children with special healthcare needs, defined by high healthcare utilisation, severe single or multisystem organ dysfunction, and in many cases, reliance on medical technology. In the emergency care setting, known challenges for this population include poor quality of care, avoidable admissions and high caregiver and provider burden. While experts and professional societies recommend emergency care planning tools to address these concerns, evidence to support effectiveness and implementation of such tools is lacking. Through a human-centred design approach, we recently engaged key partners to create and optimise an emergency care action plan (ECAP) for infants with medical complexity. Here, we describe the protocol for a pilot type 1 hybrid effectiveness-implementation randomised controlled trial (RCT) for infants with medical complexity aimed to evaluate ECAP effectiveness and implementation.
Infants with medical complexity and their caregivers will be randomly assigned to the intervention group (ECAP) or control group (standard care) in a pilot type 1 hybrid effectiveness-implementation RCT. The primary outcome is number of inpatient hospital days for infant participants. Additional effectiveness outcomes include perceived avoidance of emergency department (ED) visits, healthcare costs, caregiver stress and self-efficacy. Preliminary implementation outcomes include acceptability, feasibility, appropriateness and usability, as well as contextual barriers and facilitators to reach, adoption and implementation. Key partners, including caregivers of CMC and healthcare providers, will be engaged throughout the implementation of the ECAP and execution of the trial.
This study was approved by the University of Vermont Institutional Review Board (STUDY00002937). Findings will be disseminated through peer-reviewed publications, conference presentations, and focus groups and interviews with key stakeholders.
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