Critical Need For Interventions Research Articles

Impact of Transition to Studying on Online Mode on the Mental Health of MBA Students in Mumbai

Coronavirus set off a global chain reaction of socioeconomic calamity and mental distress. Throughout the COVID-19 epidemic, a variety of psychological issues and serious mental health consequences emerged gradually. MBAstudents have been identified as a vulnerable group, with rates of anxiety, depression, drug misuse, and disordered eating that are greater than the overall population. As a result of the COVID-19 epidemic, the nature of their educational experience transformed radically from an offline to an online one. Measures such as social distancing, quarantine, the closure of educational institutions, and self-isolation have a negative impact on people's psychology because they increase loneliness, distrust, and reduce social interaction. Aweakened immune system or having close relatives who are susceptible to diseases increases stress, anxiety, and frustration in the population to a life-threatening level. This research is being conducted to learn more about the psychological effects of the covid19 pandemic on MBAstudents in Mumbai, such as social isolation, insomnia, frustration, and over thinking, as well as the effects of the same pandemic's shift from offline to online learning. In both primary and secondary research, the impact of psychological discomfort caused by social isolation/distancing, as well as dissatisfaction and sadness caused by overthinking about the future, is being investigated. Our findings underscore the critical need for intervention to address college students' mental health, as well as how the pandemic impacted more than simply traditional teaching and learning.

Financial burden in adults with chronic liver disease: A scoping review.

The economic burden of chronic liver disease is rising; however, the financial impact of chronic liver disease on patients and families has been underexplored. We performed a scoping review to identify studies examining financial burden (patient/family health care expenditures), financial distress (material, behavioral, and psychological consequences of financial burden), and financial toxicity (adverse health outcomes of financial distress) experienced by patients with chronic liver disease and their families. We searched MEDLINE, Embase, Cochrane Library, and the Web of Science online databases for articles published since the introduction of the Model for End-Stage Liver Disease score for liver transplantation allocation in February 2002 until July 2021. Final searches were conducted between June and July 2021. Studies were included if they examined the prevalence or impact of financial burden or distress among patients with chronic liver disease and/or their caregivers. A total of 19 observational studies met inclusion criteria involving 24,549 patients and 276 caregivers across 5 countries. High rates of financial burden and distress were reported within the study populations, particularly among patients with hepatic encephalopathy, hepatocellular carcinoma, and liver transplantation recipients. Financial burden and distress were associated with increased pre- and posttransplantation health care utilization and poor health-related quality of life as well as caregiver burden, depression, and anxiety. None of the included studies evaluated interventions to alleviate financial burden and distress. Observational evidence supports the finding that financial burden and distress are underrecognized but highly prevalent among patients with chronic liver disease and their caregivers and are associated with poor health outcomes. There is a critical need for interventions to mitigate financial burden and distress and reduce financial toxicity in chronic liver disease care.

COVID-19 and stress: An evaluation using Beck's depression and anxiety inventory among college students and faculty members of Jouf University.

Individuals might suffer emotional, psychological, and even bodily challenges as a result of any pandemic. The impact of the COVID-19 outbreak on Saudi Arabian University students and faculty members has received little attention. To assess stress during the COVID-19 pandemic among university college students and faculty members of Jouf University, KSA and evaluate the impact of socio- demographic factors on anxiety and depression levels. Two hundred and seventeen participants from Jouf University completed an anonymous web-based survey that includes questionnaires about anxiety and depression symptoms. Beck's anxiety inventory (BAI) was used to assess the anxiety levels, and Beck's depression inventory (BDI) was used to determine the depression levels due to COVID 19 pandemic. The research was carried out between April 1, 2020, and June 30, 2020. An ordinal logistic regression analysis was performed to explain the odds of observing anxiety and depression. For "moderate anxiety" (22-35), the most frequently observed category of age, nationality, gender, duration spent in lockdown and profession was 20-30 years (n = 15, 65%), Saudis (n = 14, 61%), female (n = 15, 65%),>3 months (n = 17, 74%), and students (n = 15, 65%) respectively. For "moderate depression" (21-30), the most frequently observed category of age, nationality, gender, duration spent in lockdown and profession was 20-30 years (n = 10, 50%), Saudi (n = 15, 65%), female (n = 26, 65%).>3 months (n = 13, 65%), and both students and faculty members, each with an observed frequency of 10 (50%) respectively. Ordinal logistic regression analysis suggested that the observed effects of nationality, gender, and duration spent in lockdown period influenced the anxiety levels among participants. The impact of the lockdown duration was more significant in students than in faculty members and females than in males. Authors recommend the critical need for intervention and prevention strategies to address college students' mental health.

Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019.

Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22-84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452-S462. https://doi.org/10.2105/AJPH.2022.306735).

Brief Report: Assessment of a Caregiver-Implemented Intervention for Improving Social Communication Skills in Toddlers and Young Children with Autism.

As early identification of autism improves, there is a critical need for interventions to support the development of social communication skills in toddlers. Caregiver coaching and parental involvement is crucial for improving outcomes and providing children with adequate hours of planned active engagement. This pilot study assessed a 4-week intervention for individual caregiver–child dyads. Eight toddlers 21- to 45-months of age participated. Standardized assessments were collected at four study visits to assess autism symptomatology, language development, and both caregiver knowledge and engagement. Results demonstrated the feasibility of the intervention. Social communication, receptive and expressive language all improved as measured by direct assessment. Caregiver knowledge and caregivers’ subjective feelings of engagement with their toddlers also improved.

The role of cultural beliefs and distress in adherence to recommended physical activity among patients with type 2 diabetes mellitus.

The aim of this research was to examine the role of negative cultural beliefs about exercise and their relation to diabetes distress as determinants of exercise treatment adherence among culturally and socio-economically diverse patients with type 2 diabetes mellitus (T2DM). Participants included 193 Latin American (Latino) and non-Latino White patients with T2DM from a region of Southern California, with high rates of T2DM. The research was guided by Betancourt's Integrative Model of Culture, Psychology, and Behavior which specifies the structure of relations among socio-structural, cultural, and psychological factors as determinants of health behavior. As hypothesized, structural equation modeling revealed that negative cultural beliefs about exercise predicted higher levels of diabetes distress (ß = 0.32, p < 0.05), which in turn predicted lower exercise treatment adherence (ß = -0.34, p < 0.05). Findings suggest a critical need for interventions that target both cultural and psychological factors in order to improve diabetes outcomes.

Navigating Disconnected Social Circles: Experiences and Personal Networks of Latino/a Adolescents in the U.S. Rural South

Informed by Bronfenbrenner’s ecological model of development, this mixed-methods study’s aims are to: (1) describe rural Latino/a adolescents’ ( N = 62) narratives and lived social experiences in the context of rurality, and (2) examine their personal networks to better understand their social interactions (subset of 30 adolescents). Rural Latino/a adolescents move in limited social circles and experience geographic, cultural, and social isolation due to immigration status problems, socioeconomic issues, racial discrimination, and family dynamics. This limitation is reflected by personal networks that tend to be homogenous in terms of ethnicity, age, and sociodemographic characteristics. School, although characterized by weak social ties often disconnected from community and family contacts, emerged as the dominant context of sociability where adolescents build their social identity outside the circle of dense family ties. Findings suggest a critical need for interventions to reduce isolation and enhance social connectedness between family, school, and rural community in this population.

Head Games: A Systematic Review and Meta-analysis Examining Concussion and Head Impact Incidence Rates, Modifiable Risk Factors, and Prevention Strategies in Youth Tackle Football.

The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth football (high school level or younger); (2) identify modifiable risk factors for concussion and head impact; and (3) evaluate the effectiveness of prevention strategies in tackle football at any level. Nine databases (CINAHL Plus with Full Text; Cochrane Central Register of Controlled Trials; EMBASE; ERIC; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; ProQuest Dissertations & Theses Global Database; PsycINFO; Scopus; and SPORTDiscus with Full Text) were searched using the search strategy focusing on four main concepts: concussion/head impact, tackle football, modifiable risk factors, and primary prevention. Two reviewers completed title, abstract, and full-text screening as well as risk of bias assessment (using the Downs and Black checklist), with a third author available to resolve any disagreements. After removing duplicates, 1911 articles were returned. Fifty-eight articles were included in the review and 20 in the meta-analysis. The overall combined rates of concussion (including game and practice-related concussion) based on the meta-analysis were 0.78 concussions/1000 athlete exposures [95% confidence interval (CI) 0.67-0.89] for high school football (ages 13-19) and 1.15 concussions/1000 athlete exposures (95% CI 0.89-1.41) for minor football players (ages 5-15). There is evidence that contact training and practice contact restrictions have reduced the rate of head impacts and concussion. Heads Up Football (an intervention focused on coach education and contact training) has been shown to reduce the rate of concussion by 32% and head impacts by 38% amongst high school football players. Limiting contact practices in high schools to 2days per week reduced practice head impacts per player-season by 42%, and limiting full contact in practice to 75min per week in the second week of the season and 60min in week 3 and beyond resulted in a 54% decrease in the practice-related concussion rate (p = 0.003). This review identified a critical need for interventions to address the high rates of concussion and head impact in youth football. To date, contact training and contact restrictions have the strongest evidence supporting their effectiveness at reducing these rates. Future research should use consistent concussion definitions and validated injury surveillance systems, and ensure complete reporting of participant characteristics and sampling details. Prospero ID CRD42020193775.

Injured patients who would benefit from expedited major trauma centre care: a consensus-based definition for the United Kingdom.

Despite the importance of treating the 'right patient in the right place at the right time', there is no gold standard for defining which patients should receive expedited major trauma centre (MTC) care. This study aimed to define a reference standard applicable to the United Kingdom (UK) National Health Service major trauma networks. A one-day facilitated roundtable expert consensus meeting was conducted at the University of Sheffield, UK, in September 2019. An expert panel of 17 clinicians was purposively sampled, representing all specialities relevant to major trauma management. A consultation process was subsequently held using focus groups with Public and Patient Involvement (PPI) representatives to review and confirm the proposed reference standard. Four reference standard domains were identified, comprising: need for critical interventions; presence of significant individual anatomical injuries; burden of multiple minor injuries; and important patient attributes. Specific criteria were defined for each domain. PPI consultation confirmed all aspects of the reference standard. A coding algorithm to allow operationalisation in Trauma Audit and Research Network data was also formulated, allowing classification of any case submitted to their database for future research. This reference standard defines which patients would benefit from expedited MTC care. It could be used as the target for future pre-hospital injury triage tools, for setting best practice tariffs for trauma care reimbursement and to evaluate trauma network performance. Future research is recommended to compare patient characteristics, management and outcomes of the proposed definition with previously established reference standards.

An exploration of the relationship between adverse events on the farm and suicidal ideation in farmers.

The risk of suicide for agricultural workers in parts of the United Kingdom (UK) is almost twice the national average. Existing literature has suggested that adverse farming events, where failure is determined by uncontrollable and unpredictable forces, may be to blame. Yet, the impact of such events on farmer suicidality has not been explicitly explored. The present paper therefore aimed to investigate the relationship between adverse farming events and suicidal ideation in farmers. A cross-sectional questionnaire battery was disseminated between July 2018 and February 2019, and completed by 170 adult farmers. Over a 12-month period, 88.8% reported that they had experienced an adverse farming event and 32.9% said that they had experienced suicidal thoughts. Correlational analysis revealed a relationship between these variables. The high prevalence of suicidal ideation within farmers demonstrates a critical need for intervention. Likewise, the prevalence of adverse farming events suggests that interventions need to be appropriately tailored, with greater understanding about the impact of such events on the mental wellbeing of farmers.

Does the Heart Want What It Wants? A Case for Self-Adapting, Mechano-Sensitive Therapies After Infarction

There is a critical need for interventions to control the development and remodeling of scar tissue after myocardial infarction. A significant hurdle to fibrosis-related therapy is presented by the complex spatial needs of the infarcted ventricle, namely that collagenous buildup is beneficial in the ischemic zone but detrimental in the border and remote zones. As a new, alternative approach, we present a case to develop self-adapting, mechano-sensitive drug targets in order to leverage local, microenvironmental mechanics to modulate a therapy's pharmacologic effect. Such approaches could provide self-tuning control to either promote fibrosis or reduce fibrosis only when and where it is beneficial to do so.

A Review of Unintended Pregnancy in Opioid-Using Women: Implications for Nursing.

Opioid use among reproductive-age women has greatly increased, resulting in high rates of opioid-exposed pregnancies, which are associated with negative outcomes, such as neonatal abstinence syndrome. Prevention of unintended pregnancy among opioid users is a critical pathway to reducing opioid-exposed pregnancies; however, little is known about pregnancy intention in this group. This article estimates the prevalence of unintended pregnancy among opioid-using women, thereby supporting efforts to develop interventions to reduce unintended pregnancy. A systematic literature search was conducted in PubMed, Web of Science, PsycINFO, and CINAHL, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework. Reference lists of articles were searched. Eligibility criteria included reported unintended pregnancy rates within a population of opioid-using women of reproductive age. The search was completed in July 2018 and updated in October 2019. We identified 115 citations, screened 64 titles/abstracts, reviewed 31 full-text articles, and included 12 articles for this review. Rates of unintended pregnancy in opioid users were estimated in two ways, across the lifetime and for a current pregnancy, depending on study samples. Rates for both groups were high, with rates among currently pregnant opioid-using women (85%) compared with 45% among the general population. Unintended pregnancy rates in opioid-using women were strikingly high, indicating a critical need for intervention. Routine inclusion of pregnancy planning in opioid treatment care is indicated. Education regarding contraception and opioid treatment services is essential for nurses in these settings. Family planning and opioid treatment efforts can be optimized by care coordination, with focus on nurse training for screening and patient education.

Diagnosis and treatment of substance use disorder among pregnant women in three state Medicaid programs from 2013 to 2016

Substance use disorder (SUD) during pregnancy increases risks of adverse outcomes for mothers and children. Because Medicaid covers about half of all births and maternal SUD is a costly problem, describing the timing of enrollment and health care that Medicaid-enrolled pregnant women with SUDs receive is critical to understanding gaps in the timeliness and specificity of SUD diagnosis and treatment for pregnant women with SUDs. We used linked maternal and infant Medicaid claims and enrollment data and infant birth records from three states (n=72,086 mother-infant dyads) to estimate the share of sample women diagnosed with a specified SUD (e.g., opioid use disorder) before or during the birth month, with a specified SUD after the birth month, and with only an unspecified SUD diagnosed (e.g., drug use disorder complicating pregnancy). We also examined the timing of first observed Medicaid enrollment, SUD diagnosis and treatment, and maternal and infant costs.In the 24 months surrounding birth, 3.6% of women had a specified SUD diagnosis first observed before or during the birth month, 1.7% had a specified SUD diagnosis first observed after the birth month, and 6.0% had an SUD diagnosis that was not specified. Most women with a specified SUD diagnosis were enrolled in Medicaid before or early in pregnancy and initiated prenatal care in the first or second trimester, yet nearly one-third of these women received their specified SUD diagnosis after the birth month. Less than two-thirds of women with a specified SUD diagnosis received any SUD treatment during the study period (59.9% among those identified before or during the birth month and 63.1% among those observed after the birth month), and women with an unspecified SUD were about half as likely to get treatment (28.6%). Among treated women, more than two-thirds had the first observed treatment in the same month as their first observed SUD diagnosis.Findings point to a critical need for interventions as well as substantial opportunities to improve the identification of substance use–related needs and provision of treatment among women who birth in Medicaid. Changes in Medicaid and other public policy to reduce disincentives for pregnant and parenting women to report substance use during medical visits and to increase providers' abilities and motivation to equitably screen for as well as treat women with SUDs before, during, and after pregnancy could improve outcomes for mothers and their children. Improvements in SUD diagnosis would also improve prevalence estimates of specific types of SUD, which could contribute to better Medicaid policies aimed at prevention and treatment.

Missed nursing care and nurses' intention to leave: An integrative review.

To identify the factors that are associated with missed nursing care and the nurses' intention to leave. Errors and mistakes are an inevitable part of work, but there is increased evidence that missed care is a concerning issue affecting nurses' ability to effectively coordinate, provide and evaluate care interventions delivered to patients globally. An integrative review of qualitative and quantitative studies examining the consequences of missed nursing care, including intention to leave. Eight papers met the inclusion criteria. Thematic analysis generated three themes: Prevalence of missed nursing care, Factors associated with missed nursing care, Factors that impact on missed care and influence the intention to leave. The outcomes of this review demonstrate the need for critical interventions to address the factors that can impact the provision of high-quality nursing care. Missed nursing care is not only a patient safety issue but may also contribute to the inadequate staffing levels. And, better understanding of the factors that affect the intention to leave by nurse managers can stimulate the development of appropriate leadership styles in combination with adjustment of workplace to prevent intention to leave.

Mobile Phone Access and Preference for Technology-Assisted Aftercare Among Low-Income Caregivers of Teens Enrolled in Outpatient Substance Use Treatment: Questionnaire Study.

BackgroundImprovements in parenting practices can positively mediate the outcomes of treatment for adolescent substance use disorder. Given the high rates of release among adolescents (ie, 60% within three months and 85% within one year), there is a critical need for interventions focused on helping parents achieve and maintain effective parenting practices posttreatment. Yet, research suggests that engaging parents in aftercare services is difficult, partly due to systemic-structural and personal barriers. One way to increase parent use of aftercare services may be to offer mobile health interventions, given the potential for wide availability and on-demand access. However, it remains unclear whether mobile phone–based aftercare support for caregivers of substance-using teens is feasible or desired. Therefore, formative work in this area is needed.ObjectiveThis study aims to determine the feasibility and acceptability of mobile phone–based aftercare support in a population of caregivers with teens in treatment for substance use.MethodsUpon enrollment in a treatment program, 103 caregivers completed a mobile phone use survey, providing information about mobile phone ownership, access, and use. Caregivers also provided a response to items assessing desire for aftercare services, in general; desire for mobile phone–based aftercare services specifically; and desire for parenting specific content as part of aftercare services. Research assistants also monitored clinic calls made to caregivers’ mobile phones to provide an objective measure of the reliability of phone service.ResultsMost participants were mothers (76.7%) and self-identified as Hispanic (73.8%). The average age was 42.60 (SD 9.28) years. A total of 94% of caregivers owned a mobile phone. Most had pay-as-you-go phone service (67%), and objective data suggest this did not impede accessibility. Older caregivers more frequently had a yearly mobile contract. Further, older caregivers and caregivers of adolescent girls had fewer disconnections. Bilingual caregivers used text messaging less often; however, caregivers of adolescent girls used text messaging more often. Although 72% of caregivers reported that aftercare was needed, 91% of caregivers endorsed a desire for mobile phone–based aftercare support in parenting areas that are targets of evidence-based treatments.ConclusionsThe results suggest that mobile phones are feasible and desired to deliver treatments that provide support to caregivers of teens discharged from substance use treatment. Consideration should be given to the age of caregivers when designing these programs. Additional research is needed to better understand mobile phone use patterns based on a child’s gender and among bilingual caregivers.

WYZ: a pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV

IntroductionYouth and young adults bear a disproportionate share of the HIV burden and there is a critical need for interventions to curb health disparities experienced among these age groups. The...

College Readiness for English Language Learners (ELLs) in California: Assessing Equity for ELLs under the Local Control Funding Formula

ABSTRACTEnglish Learners (ELs) represent critical mass of K-12 students in public schools across the nation. However, states have failed to improve EL student academic outcomes, including college readiness. In 2013, California altered its school funding policy, providing additional support for English learners. Drawing on Vertical Equity and a Critical Community Strength Framework, this study examines the impact of local funding on college readiness among EL students by analyzing accountability plans and secondary data of 13 districts and assessing reforms using markers of college readiness. Document analysis shows: 1) school districts’ prioritization, 2) resource allocation based on those priorities, and 3) different approaches to operationalizing the construct of equity. Secondary data analysis reveals EL students lagged behind peers in performance on state assessments and enrollment in college preparatory and Advanced Placement varied across districts. These data confirm the critical need for intervention and targeted investment to raise overall college readiness rates among EL students in California and have national implications for states with growing Latino and EL student populations.

Family, Health, and Poverty Factors Impacting Suicide Attempts in Cambodian Women.

Our recent report demonstrates that 5.5% of Cambodian women have previously attempted suicide. Despite these high rates and critical need for intervention, research on suicide attempts in Cambodia is lacking, and life-saving information on suicide prevention is therefore unknown. This study explores factors impacting Cambodian women suicide attempts. A total of 1,801 women participated in the large national survey during which 100 of these women (5.5%) reported at least one suicide attempt. Of the 100 participants 76 provided qualitative reasons for the suicide attempts. Only the 76 who provided the reasons for suicide attempt were included for analysis in this study. Four major themes emerged: (1) family conflict, (2) emotional distress, (3) poverty, and (4) illness. Family conflict, emotional distress, poverty, and illness were all interrelated with each other; for example, women without money were unable to pay for treatment of otherwise treatable illnesses. Owing to the nature of the data collection, member checking could not be conducted. Cumulative and intertwined personal, interpersonal, and contextual-level factors impacting suicide attempts included emotional distress, illness, family conflict, and poverty. Findings highlight points of intervention at individual, familial, and contextual levels to prevent suicide.

Family, Health, and Poverty Factors Impacting Suicide Attempts in Cambodian Women.

Our recent report demonstrates that 5.5% of Cambodian women have previously attempted suicide. Despite these high rates and critical need for intervention, research on suicide attempts in Cambodia is lacking, and life-saving information on suicide prevention is therefore unknown. This study explores factors impacting Cambodian women suicide attempts. A total of 1,801 women participated in the large national survey during which 100 of these women (5.5%) reported at least one suicide attempt. Of the 100 participants 76 provided qualitative reasons for the suicide attempts. Only the 76 who provided the reasons for suicide attempt were included for analysis in this study. Four major themes emerged: (1) family conflict, (2) emotional distress, (3) poverty, and (4) illness. Family conflict, emotional distress, poverty, and illness were all interrelated with each other; for example, women without money were unable to pay for treatment of otherwise treatable illnesses. Owing to the nature of the data collection, member checking could not be conducted. Cumulative and intertwined personal, interpersonal, and contextual-level factors impacting suicide attempts included emotional distress, illness, family conflict, and poverty. Findings highlight points of intervention at individual, familial, and contextual levels to prevent suicide.

281 Emergency Medical System Response to in Home Delivery and Midwife Utilization in the State of Michigan

We observed that out-of-hospital deliveries locally have high complication rates. Some cases involved (non-nurse) midwives for which state licensure was not required until 2016. There is scant literature that addresses out-of-hospital deliveries and none that evaluate the interaction of emergency medical services (EMS) and midwives. Our objective was to describe utilization, complications, and outcomes of EMS attended out-of-hospital deliveries in Michigan in 2015. We queried the Michigan EMS Information System (MI-EMSIS) for out-of-hospital deliveries in 2015. We identified candidate cases, using a combination of narrative, demographic and procedural search strategies. Inclusion was birth prior to hospital arrival. We abstracted demographics, birth circumstances, complications, and birth outcome. Duplicate reviews of 20% of cases were performed to assure interrater reliability. Categories of complications were constructed post hoc. Non-viability was defined as <22 weeks gestation, fetal demise as stillborn or failure to resuscitate upon delivery, and extreme prematurity (24-28 week gestational age). First trimester miscarriages were excluded. Michigan Vital Statistics reported 1,577 out-of-hospital (excluding birthing center) births in 2015, of which 1361 were attended by midwives. We identified 228 EMS attended deliveries from 1.6 million MI-EMSIS records. Mothers’ median age was 28 (range 15-41). The majority (59.2%) were white. Most were normal vaginal deliveries on scene or enroute to hospital (92, 40.0%), or delivered prior to EMS arrival (58, 25.4%). Maternal or fetal complications were identified in 71(31.1%) deliveries. Complications included non-viable fetus (13, 5.7%), fetal demise (12, 4.8%), post-partum hemorrhage (8, 3.5%), non-transient apnea (7, 3.0%), and extreme prematurity (7, 3.0%). Midwives attended 32 (14.0%) EMS cases, with complications reported in 20 (62.5%). Complications included post-partum hemorrhage (6); non-transient apnea (4); and fetal demise (3). The complication rate with and without midwife involvement was 62.5% and 26.9%, respectively. EMS deliveries were rare and most were normal vaginal deliveries, but almost a third had complications. Midwife versus non-midwife EMS deliveries had higher complication rates. Midwife attended EMS deliveries were rare, but had high rates of complications including need for critical interventions.