Health Visitors Research Articles

Inequalities and Differences in Health Status of Pre- and Perinatal Periods in Hungarian Long-Term Series Analysis (1997–2019)

Objectives: The main goal of this study is to publish findings on the lifestyle factors of pregnant women in Hungary and their impact on early childhood health status by examining changes over time and regional/geographical disparities. Methods: The source of the data is the raw indicators reported by health visitors as per mandatory annual report data for the period of 1997–2019. To examine the association, we used indicators of pregnant women’s states as explanatory variables (for example, pregnant women in very late care, prenatal smoking habits, and pregnant women without care), and the outcome indicators were prematurity, intrauterine malnutrition, and newborn babies with developmental disorders. A univariate Poisson regression was used to examine the correlations. Results: Our results show a decreasing trend in the proportion of pregnant women who smoke and of pregnant women who apply late for care (after 28 weeks of pregnancy), with an increasing indicator of regional differences. The research results of the prenatal and perinatal indicators show that the counties Borsod-Abaúj-Zemplén and Szabolcs-Szatmár-Bereg are the most critical areas in terms of health status in Hungary. The number of pregnancies attended very late (after 28 weeks) and the number of women who gave birth without health visitor care are associated with the number of preterm births (R2 = 0.7313; p < 0.001; R2 = 0.5519; p < 0.001) and intrauterine growth restrictions (R2 = 0.3306; p < 0.001; R2 = 0.2632; p < 0.001). Conclusion: Interventions to improve early childhood health in some counties of Hungary are urgently needed to reduce regional disparities. Such counties include Borsod-Abaúj-Zemplén, Szabolcs-Szatmár-Bereg, Heves, Somogy, Bács-Kiskun, and Nógrád. Health education for pregnant women and activities to strengthen the compliance of pregnant women are key to improving early childhood health outcomes.

Higher Percentage of Virtual Primary Care Associated With Minimal Differences in Achievement of Quality Metrics.

To test the impact of virtual care usage on quality metrics used for performance measurement. Virtual care improves access to primary care; however, the quality of care must not be adversely impacted by its use. This is a mixed-design etiologic study using data from patients receiving primary care in a large, regional health system from January 2020 through December 2021. Eligible patients had at least one primary care contact. Eligible physicians had 10 or more patient contacts. The quartile of virtual visits per physician per month is calculated as the percentage of total visits conducted by phone or video (Q1 is the lowest). Six metrics used for value-based reimbursement were chosen for modeling with generalized linear mixed models. The data included 200,090 patients of 683 physicians in 42 clinics over 24 months. Virtual care usage peaked in April 2020 at 78% and then stabilized at 18%. The blood pressure metric was met in 66% (95% CI: 63%-69%) of physician months in Q1 and 65% (95% CI: 63%-68%) in Q4 (P = 0.003). The hemoglobin A1c metric was met in 73% (95% CI: 70%-76%) of physician months in Q1 and 72% (95% CI: 69%-75%) in Q4, not a significant difference. Breast cancer screening completion and colon cancer screening completion did not differ across virtual care quartiles. Medicare annual wellness visits were completed in 55% (95% CI: 50%-60%) of Q1 physician months and 54% in each of Q2, Q3, and Q4 (P < 0.0001). Some quality metrics were modestly impacted by high virtual primary care usage; the absolute differences in rates were small. This may provide reassurance to physicians and their health systems that telemedicine use may not adversely impact quality metrics.

Changes in Mental Health Services Use Under the ACA in One State: Role of Mental Health Provider Shortages.

This study aimed to examine whether changes in mental health services use under the Patient Protection and Affordable Care Act (ACA) differed in Mental Health Professional Shortage Areas (MHPSAs) versus non-MHPSAs. Multiple waves of data from the California Health Interview Survey (2011-2018) were analyzed. The sample (N=10,497) was restricted to adults (ages 18-64) who reported experiencing serious psychological distress (SPD) during the past 12 months. MHPSAs were identified by using scores from the Health Resources and Services Administration and were matched to respondents' zip codes. Weighted logistic regression and generalized linear models were used to identify adjusted changes in the rates of four measures of mental health services use (any primary care visit for mental health reasons, any specialty mental health care visit, any prescription psychiatric medication, and total number of outpatient visits for mental health) before and after implementation of the ACA. Rates of uninsured nonelderly adults with SPD in MHPSAs and non-MHPSAs decreased under the ACA. Changes in rates of specialty mental health services use under the ACA were statistically significant only in non-MHPSAs. Changes in mental health services use did not differ significantly between MHPSAs and non-MHPSAs for any of the four measures. Changes in the four measures of mental health use under the ACA did not differ in MHPSAs versus non-MHPSAs. Future research into the ACA's long-term effects should examine systemic and structural barriers to mental health care and to having sufficient numbers of mental health professionals.

Virtual Mental Health Care and Suicide-Related Events

The rising suicide rates in the US emphasize the need for effective prevention. While telehealth has transformed access to mental health care, the impact of telehealth on suicide outcomes is unknown. To evaluate the association of virtual mental health services with individual-level suicide-related events (SREs). This retrospective cohort study using broadband access as an instrumental variable assessed a national sample of Veterans Health Administration patients who received mental health care between March 1, 2020, and December 31, 2021. Participants were recently separated (ie, discharged or released from active duty) veterans who completed their active duty service between March 1, 2019, and December 31, 2020, and who received at least 2 outpatient or inpatient diagnoses related to major depressive disorder, substance use disorder, or posttraumatic stress disorder within the year before their most recent separation date. Data were analyzed May 1 to October 31, 2023. Percentage of a patient's total mental health visits that were conducted virtually by psychiatrists, psychologists, or social workers within a calendar month. Binary measure indicating whether the patient had experienced an SRE (defined as a nonfatal suicide attempt, intentional self-harm, or suicide death) in a specific month and year as evaluated an instrumental variable probit model. The sample included 66 387 data points from 16 236 unique recently separated veterans. Among these entries, 44 766 were for male veterans (67.4%), the mean (SD) age across the sample was 32.9 (8.9) years, and the sample was representative of the US veteran population. There were 929 SREs (1.4%). Virtual mental health visits comprised a mean (SD) of 44.6% (46.1%) of all mental health visits. In instrumental variable probit analyses accounting for factors simultaneously associated with use of virtual mental health care and SRE risk, a 1% increase in the probability of virtual mental health visits was associated with a 2.5% decrease in SREs. Findings from this cohort study using a retrospective quasi-experimental design found that an increase in virtual mental health visits relative to total visits was associated with a statistically significant decrease in SREs, suggesting that providing virtual mental health services may reduce suicide-related outcomes.

Exploring and enhancing the accessibility of children's oral health resources (called HABIT) for high risk communities

BackgroundWithin the city of Bradford in West Yorkshire, South Asian and Eastern European communities have an increased risk of childhood tooth decay, especially among families with Limited English Proficiency. Tooth decay is preventable, with national guidelines advocating home-based behaviours (toothbrushing with fluoride toothpaste and reducing sugar intake). In England, Health Visitors have opportunities to undertake oral health conversations during universal visits for children aged 0–24 months. The HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) intervention provides structured oral health conversations, underpinned by complex intervention methodology. A feasibility study found HABIT acceptable to parents, feasible to deliver and led to improvements in home-based behaviours. However, the reach of this original study was limited to those proficient in English. This new study focused on exploring and enhancing the accessibility of the HABIT intervention to parents with Limited English Proficiency.MethodTwenty-four parents participated in interviews and focus groups, with 21 requesting support from interpreters. Community centres and WhatsApp were used to maximise inclusivity. Interviews and focus groups, followed a topic guide and the “Think Aloud” technique, were professionally transcribed, managed in NVivo, and thematically analysed. Team discussions facilitated analytical rigour. Recruitment continued until data saturation.ResultsThree themes were developed: (1) Navigating linguistic barriers; (2) Engagement through visuals; and (3) Addressing oral health challenges. Parents employed diverse strategies to interpret resources, including Google Translate, as well as family and wider community members. Consequently, the HABIT resources were modified to include simple text, subtitles, and translation tools. Parents highlighted the benefits of shorter oral health messages with clear visuals to help understanding, and this strategy was applied across all resources. Challenges surrounding children's resistance to toothbrushing, high sugar intake within their wider families and communities, and limited dental access were all raised. The HABIT resources were updated to address these challenges.ConclusionCollaborative community engagement has enhanced the HABIT resources, enabling access for high-risk communities to preventive oral-health programmes thereby promoting health equity.

Aging population in urban India: Challenges and insights from Kolkata

In Kolkata, the elderly people represent 11.76% of the total population. Here we present new data on the aging population of Kolkata, and address its causes, and consequences. We interviewed 110 elderly male and female who are living with their family members and in old age homes in Kolkata. The data was collected from low, medium, and high-income groups from three urban housing societies as well as five old age homes. It has been observed that the elderly male and female of the low-income group have no medical and life insurance, and many of them are suffering from health issues. Although females up to 60 years are part of Self-Help Group, males are suffering from Loneliness. The elderly male and female of the medium, and high-income group do not have financial issues, but most of them do not visit doctors and health care centers for regular health check-ups. Digital literacy has to be improved. Elderly people staying in old age homes are mentally and physically much better than their counterparts who live with family members. Analysis of existing government policies reveal scope for improvement of the elderly people. We propose social innovation for the elderly population in Kolkata.

Evaluation of Pharmacist-led Telehealth Medicare Annual Wellness Visits to Satisfy Quality Metrics and USPSTF Recommendations After Implementation of a Post-Visit Follow-Up Protocol.

Background: A Medicare Annual Wellness Visit (MAWV) serves Medicare patients by identifying and addressing gaps in preventive services and health screenings, often aligning with outpatient practice quality metrics. Objective: Evaluate an existing pharmacist-led MAWV telehealth service, determine the baseline quality metric satisfaction rate of telehealth MAWVs, and assess for improvement after implementing a post-MAWV follow-up protocol at a suburban, lower-income primary care clinic. Methods: This IRB-exempt, single-center retrospective chart review utilized the electronic health record at Christ Health Center, Birmingham, AL. From August 2020 through May 2022, 288 charts were assessed between 2 retrospective chart reviews that included patients 18 years or older with Medicare insurance and the ability to conduct a telehealth MAWV. The first chart review assessed metric and recommendation satisfaction within 12months of the visit. The second chart review was performed after follow-up protocol implementation to assess for additional improvement within 3 months of the visit. Results: The percentage of MAWV recommendations completed groups after implementing a follow-up protocol. For the first chart review, 57.1% of the assessed Health Resources and Services Administration (HRSA), Uniform Data System (UDS) quality metrics, and Centers for Medicare and Medicaid Services (CMS)-required MAWV components were satisfied from the first chart review compared to 53.3% of satisfied quality metrics post-protocol implementation in spite of a substantially shorter follow-up timeframe. Conclusion: Telehealth MAWVs improve preventive care and quality metric satisfaction for Medicare patients. Post-visit follow-up protocols enhance satisfaction rates. Pharmacist-led MAWVs foster interprofessional collaboration and comprehensive patient care.

“Cough was Extremely Excruciating”: A Qualitative Study of Pre-Diagnosis Experience among Individuals with Tuberculosis in Samarinda, Indonesia

Tuberculosis (TB) is a global public health challenge. It's critical to comprehend how an infected person lives with the disease for TB control initiatives to be successful. Identifying the experiences before being diagnosed with tuberculosis needs to be done. This study aimed to explore the pre-experiences among individual that survive from TB. The qualitative method of descriptive phenomenology was utilized in this study. Purposive sampling was used in the sample process, and 16 tuberculosis survivors were included. This study found two themes that were pre-diagnosis symptoms (cough symptom, nutrition problem, hyperthermia and breathing problem) and health seeking behavior prior to being diagnosed with tuberculosis (visit health services, treatment behavior and ignore the symptoms felt). This study revealed that some individuals were still unable to identify the signs of tuberculosis and seek inappropriate treatment before receiving a diagnosis. Particularly for those who are at high risk, interventions aimed at enhancing the community's capacity to identify tuberculosis symptoms and adopt appropriate treatment-seeking behavior must be refined and implemented.

Burnout and perceived stress among health visitors in Hungary

Abstract Background In Hungary, the health visitors are responsible for the health promotion of families and communities. However, as a consequence of the structural reorganization of the health visitors service and the emotionally situations (e.g. the war in a neighboring country, the economic crisis) that have arisen, there has been an increased prevalence of chronic stress, burnout and career abandonment among health visitors. The objective of the cross-sectional study was to ascertain the prevalence of burnout among health visitors and to examine the relationship between burnout and job stress. Methods The data was collected via an online questionnaire tool. In addition to questions pertaining to sociodemographic data, the questionnaire employed the Maslach Burnout Inventory (MBI Human Services Survey) and the Perceived Stress Scale (PSS). Hypotheses were tested using analysis of variance (ANOVA), Kruskal-Wallis test, Dunett test. The source population of the study was health visitors. A total of 178 health visitors constituted the target population. Results The average age of the study participants was 45.2 years. It can be observed that health visitors who perceive less appreciation from their colleagues, employers and caregivers are more likely to experience higher levels of burnout and stress (p &amp;lt; 0.05). The lowest levels of stress were observed in school health visitors, while the highest levels were seen in health visitors covering villages (p &amp;lt; 0.05). Those who remained in the field due to a passion for working with families and children, a sense of vocation, and a desire to help others exhibited lower levels of burnout (p &amp;lt; 0.05). The high number of clients served by health visitors was found to increase burnout and stress levels (p &amp;lt; 0.05). Conclusions The findings of this research will assist in the comprehension of the phenomenon of burnout among health visitors, thereby enabling the development of more efficacious methods for the treatment and prevention. Key messages • Preventing burnout among health visitors is a priority, as it affects their work and their relationship with the families they care for in the short and long term. • Health visitors frequently encounter families in crisis during the course of their work, necessitating regular supervision to maintain their mental health.

It must not be dangerous to talk about it! Parents views of communication with schoolnurses on weight

Abstract Background The study aimed to describe parents’ experiences of communication with school nurses concerning the growth data and weight development of their children aged 8 and 10 years old in Sweden. Methods The design was descriptive and qualitative. 15 women and 3 men in south Sweden were included, with children who had performed health visits in the School Health Service (SHS). Data were collected through in - person semi structured interviews. Qualitative content analysis was used. Results The results illustrated the health visit’s purpose as unclear with need for improved dialogue and lacking feedback from the SHS. “To be able to get guidelines of what is the normal growth and what is a normal deviation and maybe a bit more about diet and lifestyle and movement.” The need for an improved channel for receiving information from SHS, and access to their child’s growth data. “Couldn’t they have a school nurse site or information page, where you get information about your child from the day they enroll in school until they leave.” Parents experienced a lack of a child-centered perspective, described the child’s context as not in focus, and desired collaboration. “I think that it is very important that children feel good in their bodies, and that is a really important task for health care.” Conclusions (a) Initiating a discussion regarding the preventive health work of school nurses and the main assignment of SHS. (b) Development of a child-centered perspective towards parents and children with focus on the child’s entire social context. (c) Implementation of evidence-based methods for communicating growth data and weight development between SHS and parents. Key messages • An increased dialogue between parents and SHS was requested, with a reachable way of communication via a digital platform. • A holistic view of the child, with positive professional attitudes seem essential to meet the needs of the child.

Barriers and Facilitators in Implementation of Nutritional Benefit Transfer to Tuberculosis Patients

Abstract Background Malnutrition &amp; Tuberculosis (TB) form a vicious cycle. Nikshay Poshan Yojana (NPY) is a key strategy for a TB free India, that seeks to provide financial assistance for nutritional support to TB patients. The study is a qualitative study to identify operational challenges and facilitators in implementation of NPY Methods In Depth Interview (IDI) of 18 Senior Treatment Supervisor (STS) at Tuberculosis Unit (TU) and 19 Tuberculosis Health Visitor (TB HV) at Designated Microscopy Centre’s (DMC) was done. For further insights, the STS, at District Tuberculosis Centre, Lucknow was also interviewed. Informal discussion was done with about 50 Tuberculosis patients. We explored providers perspective on impact of NPY on other duties/services, case load, hours dedicated to NPY, practice protocols, record keeping and data management, compliances, capacity building needs, quality protocols, key enablers, motivating factors, challenges, best practices and beneficiary’s perspectives on quality of life, facilitators and challenges in availing services. Results Motivating leadership, supportive staff, good working relationship and seamless communication, teamwork, use of technology, supportive supervision &amp; collaboration and support of NGO for private sector were the key facilitators. Barriers comprised system level barriers (Budget constraints, issues with NIKSHAY software and bank account), provider level barriers (shortage of human resource, nonfunctional tablets) and patient level barriers (stigma and bank account related challenges). The encouraging finding was majority of recipients, responding that they used the incentive to purchase ration, vitamin supplements etc. Conclusions NPY is having its intended benefit but there are barriers that need to be resolved for successful roll out. The study yield suggestions for removing barriers and found a set of innovations that can be replicated across other settings with high Tuberculosis burden Key messages • Malnutrition and Tuberculosis form a vicious cycle. Nutritional support to TB patients improves treatment outcome and can save lives. • Operational research on implementation of NPY offers insights for successful roll out of this key initiative across other resource limited settings in developing countries.

Associations between maternal origin, breastfeeding and health service use: a mediation analysis

Abstract Background The influence of maternal health utilization on breastfeeding practices is well established. However, research shows that immigrant women tend to face challenges in accessing maternal health services. Our aim was to examine any variation in maternal and child health service utilization between immigrant and native-born mothers as well as to examine potential mediation roles of service utilization on the association between maternal origin and breastfeeding practices. Methods We used a nationwide FinChildren (2020) survey on parents with infants focusing on Somali (n = 29), Arabic (n = 81) and Russian speaking (n = 181) parents and their infants. We compared them with native Finnish speakers (n = 7508). We used Process Macro to conduct mediation analysis. Results Almost 25%/ of Somali-/Arabic-speaking mothers reported not taking their infants to routine child health clinic visits. The proportion was 0.4% for native-born mothers and 1.6% for Russian-speaking mothers (p &amp;lt; 0.001). Around 18% of Somali-/Arabic-speaking mothers and only 0.6% of the native-born mothers reported not utilizing child health clinic services in the past year (p &amp;lt; 0.001). Somali-/Arabic speaking mothers were more likely to receive breastfeeding support from maternity clinics and native-born mothers from maternity hospital or peer support groups. Russian-speaking mothers were most satisfied with the received child healthcare services while Somali/Arabic-speaking mothers were least satisfied with these services (p &amp;lt; 0.001). Only participating in breastfeeding peer support groups had mediation effects on association between maternal origin and breastfeeding practices. Conclusions This study shows that immigrants mothers, particularly Somali/Arabic speaking mothers use less the maternal health services particularly routine health visits. It is essential to encourage them to use the services to be able to monitor the health of both mother and the child. Key messages • Somali-/Arabic-speaking mothers are in a vulnerable position when it comes to utilizing healthcare services. • This study call for more research exploring factors contributing to this.

Kajian Manfaat Taman Bagi Kesehatan Mental Masyarakat di Kota Sukabumi Selama Pandemi COVID-19

The COVID-19 pandemic has increased mental health problems in Sukabumi City. Urban parks can integrate environment, society, and health in urban environments by promoting an ecological approach based on contact with nature. This study aims to analyze the effect of performing activities for at least 20 minutes in Taman Alun-alun and Taman Lapang Merdeka on mental health visitors with a sample of 30 people in each park selected through purposive sampling. The data collection method used was experimental, with the One Group Pretest-Posttest research design through The Mental Health Inventory (MHI-38) questionnaire, which had been tested for validity and reliability. The data analysis method used is the Paired Samples T-test with SPSS 22. The results show that performing activities in a city park for at least 20 minutes can improve the mental health of visitors aged 18-25 years during the COVID-19 pandemic, with the highest increase in the average mental health score in Taman Lapang Merdeka because it provides facilities for physical and non-physical activities.

Differences in Utilization of Preventive Services for Primary Care Clinicians Participating in MIPS and ACOs.

Value-based payment programs link payments to the performance of providers on cost and quality of care to incentivize high-value care. To improve quality and lower costs, the Centers for Medicare and Medicaid Services (CMS) implemented the Quality Payment Program (QPP) for clinicians in 2017. Under the Medicare QPP, most eligible clinicians participate in one of the payment models: (a) Advanced Alternative Payment Models (A-APMs) through eligible APMs like Accountable Care Organizations (ACOs) or (b) the Merit-based Incentive Payment System (MIPS). ACO and MIPS clinicians participating in QPP differ in quality reporting requirements, and these differences are likely to affect the utilization of different quality measures, including preventive services. This study evaluated the differences in the utilization of preventive services by primary care clinicians participating in MIPS and ACOs. We use difference-in-difference regressions to compare preventive services in MIPS versus ACOs. Since preventive services like immunization and certain cancer screening are mandatory reporting measures for ACOs and voluntary measures for MIPS, the treatment group for this study is ACO clinicians and the comparison group is non-ACO MIPS clinicians. We obtained the rates of influenza immunization, pneumonia vaccination, tobacco use cessation intervention, depression screening, colorectal cancer screening, breast cancer screening, and wellness visits per 10000 Medicare beneficiaries from Medicare Provider Utilization and Payment Public Use File (2012-2018). We had 508144 total observations (ACO=25.78% and MIPS=74.22%) from 72592 unique primary care clinicians. Compared to MIPS clinicians, ACO clinicians had significantly higher rates of pneumonia vaccination (incidence rate ratio [IRR] 1.25; 95% confidence interval [CI], 1.10-1.43) but lower rates of colorectal cancer screening (IRR 0.69; 95% CI, 0.50-0.96). Similarly, clinicians in ACO shared savings-only models had significantly higher rates of pneumonia vaccination (IRR 1.28; 95% CI, 1.11-1.48), depression screening (IRR 1.72; 95% CI, 1.09-2.71), and wellness visits (IRR 1.27; 95% CI, 1.09-1.47) compared to MIPS clinicians. There were no differences between ACO and MIPS clinicians on the utilization of breast cancer screening procedures and tobacco use cessation interventions. ACO clinicians may have prioritized relatively low-cost services such as pneumonia vaccination, depression screening, and wellness visits to improve their performance under QPP. Policymakers may need to alter incentives in performance-based payment programs to ensure that clinicians are improving all types of quality measures, including cancer screening.

Assessing tuberculosis knowledge, attitudes, practices, and health-seeking behaviours of students at a selected university in South Africa

Tuberculosis (TB) remains a public health concern in South Africa, particularly among young adults. This study aimed to assess and investigate the attitudes, practices, and health-seeking behaviours of students at the University of KwaZulu-Natal (UKZN) regarding TB. The research provides valuable insights into the awareness of TB among students, their preventive practices, and their healthcare-seeking behaviours related to the disease. A cross-sectional design was employed, utilising a structured questionnaire to collect data from a representative sample of UKZN students on the Howard College campus. Data analysis involved descriptive statistics, such as frequencies and percentages, to summarise responses. Inferential statistics, including chi-square tests, were used to explore associations between variables and assess the knowledge, attitudes, and health-seeking behaviours of respondents. The study, which included 221 postgraduate and undergraduate students, revealed that participants were well aware of the symptoms, causes, and modes of TB transmission. The descriptive analysis indicated that 97.7% of respondents exhibited good knowledge about TB, with a total mean score of 0.977 and a standard deviation of 0.149. However, regarding health-seeking behaviours and practices, 53.4% of respondents demonstrated poor health-seeking behaviours, in contrast to 46.6% who exhibited good practices, with a mean score of 0.466 and a standard deviation of 0.499. Although all respondents indicated they would visit health facilities if they suspected they had TB, there was evidence of low screening practices and suboptimal health-seeking behaviours. Based on these findings, the study suggests leveraging social media to disseminate knowledge about TB to promote its prevention and treatment.

'I never knew it was so prevalent': Experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings.

Health visitors have a key role in supporting and protecting adults and children affected by domestic abuse. The study aimed to examine the experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings. Semi-structured interviews were conducted with five student health visitors in the United Kingdom. Interviews were transcribed and analysed using interpretive phenomenological analysis. Four superordinate themes were identified: 'part and parcel of health visiting practice'; 'challenges in identifying domestic abuse'; 'uncertainty and apprehension'; 'strengthening knowledge and confidence'. All participants had engaged in practice activities related to domestic abuse within SCPHN placements, commonly expressing a sense of disbelief at the scale of the issue in practice. Difficulties and unease regarding identification and management of domestic abuse were reported. Access to support and opportunities to reflect and 'talk things through' were found to be important for students regarding this sphere of practice. The findings contribute to the body of knowledge about domestic abuse-related practice within nursing. Recommendations made may contribute to practice development and help inform future teaching and educational strategies within SCPHN programmes.

Commentary: 'I never knew it was so prevalent': experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings.

Commentary: 'I never knew it was so prevalent': experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings.

Integrating Universal Hepatitis C Screening into Adolescent Well Visits is a "Win-Win" Scenario: Rationale and Demonstration of Real-World Feasibility and Implementation.

Hepatitis C virus (HCV) testing is recommended for all adults 18 years and older to increase identification of those with infection and facilitate prompt referral for curative antiviral therapy. While critical to promote elimination, this strategy excludes a key demographic group who are clearly at risk of undetected HCV infection and who could benefit from early treatment: adolescents. In this paper, we review the available data on the burden of HCV and the close association with injection drug use, discuss the rationale of universal testing in adolescents and, finally, present data from a quality improvement project implementing HCV testing into routine adolescent health visits.

The who, when, and why of pacifier use.

Social and familial consequences of pacifier use remain poorly understood. The present study attempts to shed more light on the characteristics of parents using pacifiers with their infants and to explore how pacifier use affects perceptions of infant emotionality, maternal stress, and parental efficacy. The study sample consisted of 428 mothers (range: 17-49 years) of infants (0-36 months) who completed a comprehensive questionnaire assessing infant and parent characteristics as well as parenting practices and pacifier use. We compared attitudes toward pacifiers, parenting stress, children's levels of reactivity and self-regulation, and maternal efficacy among Pacifier Users, Never-Users, and families that Tried-Pacifiers. The reported results reveal benefits of pacifier use for the family relationships, namely reduced parenting stress (p = 0.018), better parent-child dynamics (p < 0.001), and more positive perceptions of child's affectivity (p = 0.006), which are all important aspects of infant development. Our findings highlight developmental benefits of pacifier use, a practice that is known to have both positive and negative long-term consequences for healthy child development. It is, therefore, important for health professionals to have discussions about the pros and cons of pacifier use with parents. The study provides novel insights into how and why mothers use pacifiers and into the psychological consequences of this practice. We found pacifier use is associated with less maternal stress, better mother-child dynamics, and more positive perceptions of child's affectivity. Our findings document developmental benefits of pacifier use adding a new perspective to the debate on pacifiers. Doctors, health visitors, pediatric nurses, and midwives may consider this evidence when advising parents on pacifier use.

Neonatal Survival and Outcomes following Periviable Rupture of Membranes.

To clarify survival for infants affected by periviable prolonged preterm premature rupture of membranes (PPROM) in the military health system (MHS). To add to current literature on outcomes following expectant management, including long-term neurodevelopment outcomes. Retrospective matched cohort review of six level 3 military neonatal intensive care units (NICUs; 2010-2020). Cases were matched 1:1 with control infants, matched by location, gender, gestational age (within 1 week), birth weight (within 300 g), and rupture of membranes (ROM) within 24 hours of delivery. Follow-up data were obtained for each infant through 48 months' corrected age or age of last documented health visit in a military treatment facility. Forty-nine infants met inclusion criteria. Mean ROM for cohort infants was 20.7 weeks, with mean latency period of 34.6 days and mean gestational age at delivery of 25.7 weeks. Cohort infants had a mean birth weight of 919 g. Cohort survival to NICU discharge was 75.5 versus 77.6% of controls (p = 0.81). Statistically significant short-term outcomes: oligohydramnios or anhydramnios at delivery (p < 0.0001), pulmonary hypertension (p = 0.0003), and high-frequency ventilation (p = 0.004) were higher in cohort infants. No differences were found regarding rates of early sepsis, intraventricular hemorrhage, surgical necrotizing enterocolitis, oxygen at 36 weeks or at discharge. No statistical difference in long-term outcomes at 18 to 48 months of age or incidence of autism, cerebral palsy, attention deficit hyperactivity disorder, or asthma. Cohort survival to discharge in the MHS was 75.5%, higher than previously reported and not different from matched controls. Infants born after periviable PPROM should deliver at centers with access to high-frequency ventilation and ability to manage pulmonary hypertension. There was no difference in long-term neurodevelopment between the groups. · Survival to NICU discharge is similar between infants exposed to periviable PPROM and controls.. · Cohort survival to discharge was 75.5%, higher than previously reported in recent literature.. · Infant with periviable PPROM should delivery at centers capable of managing pulmonary complications..