Including Health Systems Research Articles

Rates and ratios of fatal and nonfatal drowning attended by ambulance in New South Wales, Australia between 2010 and 2021

Introduction: Drowning is a preventable cause of mortality, with 279 unintentional drowning deaths per year in Australia. Despite larger estimated numbers, less is known about nonfatal drowning compared to fatalities. This study aimed to examine the burden of fatal and nonfatal drowning in the Australian state of New South Wales using pre-hospital case capture. Methods: A cross-sectional analysis of individuals attended by an ambulance in NSW for drowning between 2010 and 2021 was conducted. Ambulance data (paper-based and electronic medical records) were linked to emergency department and death registry. Ratios of fatal to nonfatal drowning were constructed overall, by sex, age, and remoteness of incident and residential locations. Results: 3,973 ambulance-attended drowning patients were identified (an annual rate of 4.16/100,000 persons). Six percent (6.1%; n = 243) died within 30 days, 82.7% (n = 201) of which died on the day of incident, including at the scene. Mean survival time for those who died between 2 and 30 days was 4.6 days. The overall ratio of fatal to nonfatal incidents was 1:15. Ratios were highest for 10–19 year-olds (1:77), females (1:22), and in metropolitan incident (1:20) and residential (1:23) locations. Across the study drowning declined by 14 incidents and 0.18 fatalities per year. Discussion: Temporal trends indicate declining drowning incidents and fatalities. However, this study highlights significant numbers of nonfatal incidents among those traditionally seen as lower risk, such as adolescents and females, necessitating a widened focus on improving water safety among these groups. Conclusions: Nonfatal drowning results in significant, yet preventable health system burden in New South Wales. Practical Applications: This study highlights the importance of documenting the full burden of drowning, including health system impacts of a preventable cause of injury and death. Such data may be used to encourage further investment in primary prevention efforts.

Post-COVID pandemic: The new normal and aftermath

ABSTRACT Background: The COVID-19 pandemic has brought about unparalleled worldwide transformations, impacting all facets of human existence, including health systems, economies, societal norms, and individual behaviors. Aim: The goal is to comprehend the enduring alterations in public health strategies, economic recuperation processes, changes in work and education paradigms, and the psychological consequences for populations globally. Methods and Materials: This analysis uses a multidisciplinary approach by incorporating data from healthcare studies, economic reports, educational research, and psychological assessments. It aims to offer a comprehensive perspective on the world after the pandemic. Results: The findings suggest that the “New Normal” encompasses a wide range of changes, such as a greater dependence on digital technology, a transition toward remote work and learning, substantial modifications in global supply chains, and a revised outlook on health and wellness. The potential long-term consequences of these changes indicate that some may provide opportunities for innovation and expansion, whereas others present challenges that necessitate strategic planning and policy interventions. Conclusion: The aftermath of the COVID-19 pandemic presents a critical moment for global leaders, policymakers, and individuals to navigate the complexities of a transformed world, emphasizing the need for resilience, adaptability, and a renewed commitment to collective well-being.

Infectious diseases and global security: Analysis of global control and vaccination strategies

Introduction: Given the recent experience with the COVID-19 vaccine campaign, an optimal global policy to control future pandemics and ensure infectious security globally is highly relevant. Objective: The study aims to determine the optimal vaccination strategy to reduce COVID-19 morbidity and mortality during a pandemic.Methods: A systematic search of studies on infectious disease control and vaccination strategies for the period 2000-2023 in PubMed, Scopus, Web of Science and Google Scholar databases using keywords was conducted for the review. Relevant publications, data extraction and systematisation were selected.Results: The findings of the analysis highlight the importance of integrated interventions in global vaccination strategies, including health systems strengthening, innovative technologies for outbreak detection and international collaboration. Vaccination, as an effective preventive measure, significantly reduces the spread of infectious diseases. Vaccination with different types of vaccines has been shown to improve immune response compared to the use of the same type of vaccine. This approach, where the first and second vaccine doses are different, may increase the effectiveness of the immune response.Conclusions: Studies confirm that vaccination reduces the number of cases and deaths, reducing the economic burden. A variety of vaccines, including mRNA, vector, and inactivated vaccines, provide high efficacy in preventing COVID-19 infection and mortality, especially when a heterologous vaccination regimen is used. This review identifies the most effective infectious disease control strategies for the development of global health recommendations

Self-reported follow-up care needs can be met in both facility and self-managed abortion: Evidence from low- and middle-income countries

ObjectivesTo understand in-facility follow-up care-seeking behavior among both people who self-managed medication abortions and those who obtained facility-managed care in low-and-middle-income countries. We explore factors that contribute to meeting individual self-reported follow-up care needs, core to person-centered care. Study designWe conducted a qualitative, codebook thematic analysis of 67 in-depth interviews conducted with people who self-managed medication abortions or obtained facility-managed medication abortion care. We first classified individuals as having their follow-up care needs met (not seeking care when the participant felt confident that additional care was not warranted or desired or receiving care if it was desired) or not. Our a priori analytic domains came from the Anderson model of health services utilization - predisposing, enabling, or need factors (perceived and evaluated need for health services) that contributed to having follow-up care needs met or not. We also describe emergent themes within each domain. ResultsMost participants (n=59, 88%) had their follow-up care needs met; half (n=33, 49%) sought follow-up care in a facility. Prior birth or abortion experiences emerged as predisposing factors for having follow-up care needs met. Having accompaniment support (from activists or hotlines who provide abortion guidance outside of clinical settings), knowing what to expect, and information sources were key enabling factors for having follow-up care needs met. Need factors included flexible follow-up care guidelines. Those who did not have their follow-up care needs met described predisposing negative health system experiences; enabling factors including health system challenges, stigma from providers, and legal risk; and need factors of required follow-up care guidelines. ConclusionsMedication abortion follow-up care experiences are diverse, and individual needs can be met both in and outside of health facilities. Understanding prior experiences, enabling accompaniment support, and considering flexible follow-up care guidelines can support meeting individual follow-up care needs, which is essential to person-centered abortion care. ImplicationsFollow-up care needs, essential to ensuring access to high-quality abortion services, can be met in both self-managed and in-facility medication abortion models. Policies that require follow-up care when it is not needed or desired by the person can reinforce ideas that self-managed abortion is not safe or effective, despite existing evidence.

Evaluation of the integration of palliative care in a fragile setting amongst host and refugee communities: Using consecutive rapid participatory appraisals

Background: Palliative care is seldom integrated in healthcare in fragile, conflict affected and vulnerable settings with significant refugee populations. Aim: This study aimed to evaluate the integration of palliative care into a fragile, conflict affected and vulnerable community in Northern Uganda. Design: Consecutive Rapid Participatory Appraisals were conducted to evaluate the integration of palliative care in Adjumani District. The first established a baseline and the second, 4 years later, evaluated progress. Data collection included documentary review, key informant interviews and direct observation. Setting/participants: A rural district in Uganda with equal numbers of refugees and host populations living side-by-side. 104 key informants were interviewed, and practice observed in 11 health facilities. Results: At baseline, palliative care was not routinely integrated in the health system. Barriers included health system challenges, cultural beliefs, understanding and trust, mental health issues, gaps in palliative care provision, the role of the community and beliefs about illness impacted care with the village health teams being a trusted part of the health system. Following integration activities including training, mentorship and community sensitisation, the repeat rapid appraisal after 4 years showed a significant increase in palliative care delivery. New themes identified included increased provision of palliative care, the impact of training and community engagement and ownership of palliative care. Conclusion: Community engagement and participation, training interventions and referral pathways enabled the integration of palliative care. Rapid Participatory Appraisal provides a useful framework to evaluate activities aimed at integration of palliative care in a community.

Navigating the Landscape of Cancer From Ancient Times to Modern Challenges: A Narrative Review.

Cancer, a pervasive and multifaceted disease, has afflicted humanity since ancient times, as evidenced by early references in the Edwin Smith Papyrus and the Ebers Papyrus. Over centuries, our understanding and treatment of cancer have evolved significantly, transitioning from rudimentary remedies to advanced modalities like chemotherapy, radiation therapy, and precision medicine. Despite these advancements, cancer remains a major global health challenge. As of 2022, nearly 20 million new cancer cases and 10 million cancer-related deaths were reported worldwide. In India, the situation is particularly dire, with over 1.41 million new cases and more than 916,827 deaths in 2022, exacerbated by socioeconomic disparities, cultural stigmas, and healthcare barriers. This review traces the historical evolution of cancer treatment from ancient civilizations to modern times, highlighting key medical milestones and breakthroughs. It examines the global and Indian cancer burden, emphasizing the critical barriers to early diagnosis and effective treatment. These barriers include health system deficiencies, socioeconomic challenges, delayed diagnosis, low health literacy, and inadequate screening programs. The review was conducted through a comprehensive literature search using databases such as PubMed, Google Scholar, Journal Storage (JSTOR), and various other sources focusing on historical texts, epidemiological studies, and current medical research. The search aimed to gather a broad spectrum of perspectives and evidence to provide a well-rounded understanding of cancer's historical journey and current landscape.

Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study.

The Global Fund partnered with the Zimbabwean government to provide end-to-end support to strengthen the procurement and supply chain within the health system. This was accomplished through a series of strategic investments that included infrastructure and fleet improvement, training of personnel, modern equipment acquisition and warehouse optimisation. This assessment sought to determine the effects of the project on the health system. This study employed a mixed methods design combining quantitative and qualitative research methods. The quantitative part entailed a descriptive analysis of procurement and supply chain data from the Zimbabwe healthcare system covering 2018 - 2021. The qualitative part comprised key informant interviews using a structured interview guide. Informants included health system stakeholders privy to the Global Fund-supported initiatives in Zimbabwe. The data collected through the interviews were transcribed in full and subjected to thematic content analysis. Approximately 90% of public health facilities were covered by the procurement and distribution system. Timeliness of order fulfillment (within 90 days) at the facility level improved from an average of 42% to over 90% within the 4-year implementation period. Stockout rates for HIV drugs and test kits declined by 14% and 49% respectively. Population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence of people living with HIV. The value of expired commodities was reduced by 93% over the 4-year period. Majority of the system stakeholders interviewed agreed that support from Global Fund was instrumental in improving the country's procurement and supply chain capacity. Key areas include improved infrastructure and equipment, data and information systems, health workforce and financing. Many of the participants also cited the Global Fund-supported warehouse optimization as critical to improving inventory management practices. It is imperative for governments and donors keen to strengthen health systems to pay close attention to the procurement and distribution of medicines and health commodities. There is need to collaborate through joint planning and implementation to optimize the available resources. Organizational autonomy and sharing of best practices in management while strengthening accountability systems are fundamentally important in the efforts to build institutional capacity.

Six in ten female youths in low-income East African countries had problems in accessing health care: a multilevel analysis of recent demographic and health surveys from 2016–2021

BackgroundAccess to health care services is a basic human right, and an individual’s health and overall quality of life may suffer as a result of barriers to accessing health services. Access to comprehensive and quality health care is fundamental for promoting and maintaining health, preventing and treating diseases, and reducing premature deaths. However, only half of the African population has access to modern health services. Therefore, this study aimed to assess the health care access and associated factors among female youths in low-income East African countries.MethodsThis study used secondary data from 2016 to 2021 demographic and health surveys of 7 low-income East African countries. A total weighted sample of 51,064 youths was included. A multilevel binary logistic regression was employed to identify the associated factors of access to health care since the data has a hierarchical structure. Adjusted Odds Ratio (AOR) with a 95% confidence interval (CI) at a p-value less than 0.05 was used to measure the association of variables whereas Intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), and proportional change in variance (PCV) were used to measure random effects.ResultThe overall magnitude of access to healthcare among female youths in low-income East African countries was 38.84% (95% CI: 38.41, 39.26). Youth’s educational level, rich wealth status, media exposure, and community level education were the positive while higher youth’s age and rural residence were the negative predictors of access to healthcare among female youths. Besides, living in different countries compared to Burundi was also an associated factor for accessing healthcare in low-income East African countries.ConclusionAbout six in ten female youths were not accessing health care in low-income East African countries. Therefore, to increase healthcare access, health managers and policymakers needed to develop strategies to improve the poor household wealth index, and redistribution of health services for rural residents. The decision-makers and program planners should also work on increasing access to education and media exposure for youths. Further research including health system and quality of service-related factors for accessing healthcare should also be considered by researchers.

Resuscitation for out-of-hospital cardiac arrest in Ireland 2012–2020: Modelling national temporal developments and survival predictors

AimTo explore potential predictors of national out-of-hospital cardiac arrest (OHCA) survival, including health system developments and the COVID pandemic in Ireland. MethodsNational level OHCA registry data from 2012 through to 2020, relating to unwitnessed, and bystander witnessed OHCA were interrogated. Logistic regression models were built by including predictors through stepwise variable selection and enhancing the models by adding pairwise interactions that improved fit. Missing data sensitivity analyses were conducted using multiple imputation. ResultsThe data included 18,177 cases. The final model included seventeen variables. Of these nine variables were involved in pairwise interactions. The COVID-19 period was associated with reduced survival (OR 0.61, 95%CI 0.43, 0.87), as were increasing age in years (OR 0.96, 95% CI 0.96, 0.97) and call response interval in minutes (OR 0.97, 95% CI 0.96, 0.99). Amiodarone administration (OR 3.91, 95% CI 2.80, 5.48), urban location (OR 1.40, 95% CI 1.12, 1.77), and chronological year over time (OR 1.14, 95% CI 1.08, 1.20) were associated with increased survival. ConclusionsNational survival from OHCA has significantly increased incrementally over time in Ireland. The COVID-19 pandemic was associated with decreased survival even after accounting for potential disruption to key elements of bystander and EMS care. Further research is needed to understand and address the discrepancy between urban and rural OHCA survival. Information concerning pre-event patient health status and inpatient care process may yield important additional insights in future.

From education to practice—2024 update: An opinion paper of the Drug Information Practice and Research Network of the American College of Clinical Pharmacy

AbstractDrug information specialists (DIS) bring unique, specialized expertise and provide services in diverse settings including health systems, academia, pharmaceutical industry, compendia, medical writing, and other areas. With widespread access to drug information (DI) resources through user‐friendly, online platforms, the role of DIS has shifted. Core skill sets once confined to DIS are now distributed across various non‐DIS clinical specialties. DIS have transformed the application of their specialized skill set and adapted it to a variety of traditional and nontraditional areas, providing and applying advanced expertise to solve a variety of contemporary challenges. The training of students and residents has evolved to include evidence‐based practical contemporary methods that promote critical thinking and reasoning. Effective DI evaluation and communication necessitates customizing content for stakeholders to ensure understanding and contribute to optimal patient care, all while addressing misinformation and disinformation. The future of DI as a specialty is bright, with ever‐increasing recognition of the importance of DI skills in non‐DIS practitioners. DIS will likely continue to guide best practices in the education/training of new practitioners and continue to provide advanced services and formulary analytics. This update to our 2009 DI PRN Opinion paper will focus on: (1) DI education and training needed for all students, residents, and pharmacists; (2) career opportunities, roles, and responsibilities specifically tailored for DIS in health systems, managed care organizations, academia, pharmaceutical/biotechnology industry, and medical writing services; and (3) the future direction of DI, including the potential impact of artificial intelligence.

Power imbalances and equity in the day-to-day functioning of a north plus multi-south higher education institutions partnership: a case study

BackgroundPartnerships between Higher Education Institutions (HEIs) in the global north and south have commonly been used as a vehicle to drive global health research and initiatives. Among these initiatives, include health system strengthening, research capacity building, and human resource training in developing countries. However, the partnership functioning of many global north-south partnerships still carry legacies of colonialism through unrecognized behavior patterns, attitudes, and belief systems in how they function. Even with research literature calling for a shift from equality to equity in the functioning of these partnerships, many still struggle with issues of complex and unspoken power dynamics. To understand the successes and challenges of north-south partnerships, this paper explored partnership development and functioning of a northern and multi-southern HEIs partnership focused on nutrition education and research.MethodsA qualitative research approach was used; data were collected through in-depth interviews (IDIs) with questions developed from the Bergen Model of Collective Functioning (BMCF). Thirteen IDIs were conducted with partners from all institutions including stakeholders.FindingsThe partnership was built on the foundation of experiences and lessons of a previous partnership. Partners used these experiences and lessons to devise strategies to improve partnership inputs, communication, leadership, roles and structures, and maintenance and communication tasks. However, these strategies had an impact on partnership functioning giving rise to issues of inequitable power dynamics. The northern partner had two roles: one as an equal partner and another as distributor of project funds; this caused a conflict in roles for this partner. The partners distinguished themselves according to partner resources – two partners were named implementing partners and two named supportive partners. Roles and partner resources were the greatest contributors to power imbalances and caused delays in project activities.ConclusionUsing the BMCF to examine partnership dynamics illuminated that power imbalances caused a hierarchical stance in the partnership with northern partners having overall control and power of decision-making in the partnership. This could impact the effectiveness and sustainability of project in the southern institutions going forward.

Lived experiences of refugee women with vaginal fistula in Nakivale and Oruchinga refugee settlements, Isingiro District, Uganda

BackgroundVaginal fistula (VF) affects 2–3 million women globally, with the majority in Africa. In Uganda, it’s 2%, with western Uganda having the highest prevalence. Major predisposing factors for refugee women include health system breakdowns and sexual violence during conflict. VF has severe consequences for women, relatives, and communities. There’s limited information on lived experiences among refugee women with VF, and there’s a need for quality prevention, treatment, and social reintegration strategies. This study aimed to understand the physical, psychosocial, and economic impacts of VF on refugee women in Nakivale and Oruchinga settlements and their coping mechanisms.MethodsTen refugee women with VF were interviewed using qualitative study design, utilizing Social-Ecological and Transactional Models for data collection, analysis, and discussion.ResultsTen refugee women aged 24–50 years with or who had experienced VF participated in the study. They lived with VF for at least 2–15 years and had multiple stillbirths. Obstetric Fistula (OF) was the leading cause, followed by rape and cancer. Post-fistula, they faced social discrimination, emotional disturbances, survival difficulties, poverty, and lack of support. They struggled with stigma, social isolation, and marital sexual challenges.ConclusionRefugee women experience physical, emotional, financial, social, and sexual trauma due to VF. Discrimination and stigmatization from loved ones and society lead to isolation, depression, and suicidal thoughts. Despite successful repair, their social and emotional healing remains a burden for their lives. There is a need to provide a supportive environment for VF survivors.

Exploring older people’s understanding of the QOL-ACC, a new preference-based quality-of-life measure, for quality assessment and economic evaluation in aged care: the impact of cognitive impairment and dementia

BackgroundQuality-of-life is an essential outcome for quality assessment and economic evaluation in health and social care. The-Quality-of-Life – Aged Care Consumers (QOL-ACC) is a new preference-based quality-of-life measure, psychometrically validated with older people in aged care. More evidence is needed to inform the self-report reliability of the QOL-ACC in older people with varying levels of cognitive impairment and dementia.MethodsA think-aloud protocol was developed and applied with older residents. The Mini Mental State Examination (MMSE) was applied to assign participants to no cognitive impairment (NCI - MMSE score ≥ 27) and cognitive impairment (MMCI - MMSE score < 27) subgroups. Three independent raters utilised a Tourangeau survey response model-based framework to identify response issues. Data were compared across cognition subgroups and synthesized using a ‘traffic light’ grading to classify frequency and type of response issues. Gradings were utilised to assess self-report reliability according to different levels of cognitive impairment.ResultsQualitative data from 44 participants (NCI = 20, MMCI = 24) were included for analysis. Response issues were more evident in the cognitive impairment subgroup than the no cognitive impairment subgroup. All participants who received a ‘red’ grade had an MMSE score of < 20 and 66% of ‘amber’ grades occurred in the cognitive impairment subgroup.ConclusionsThe QOL-ACC is able to be completed reliably by older residents with an MMSE score > 17. Future research is needed to assess the generalisability of these findings to other preference-based quality of life instruments and for older people in other care settings including health systems.

Maternal near miss hospitalizations in the Borana Zone, Ethiopia: A facility-based longitudinal cross-sectional study.

Maternal near miss refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of pregnancy termination. While there has been considerable progress in reducing maternal mortality rates, maternal near miss cases can provide valuable insights into the quality of maternal healthcare and help identify areas for improvement. However, there is limited evidence on the factors contributing to maternal near miss cases, including health system failures, delays in care, and provider-related factors. Therefore, this study aimed to assess the incidence, causes, and factors associated with maternal near misses in public Hospitals of Borena Zone. A facility-based longitudinal cross-sectional study design was employed at four Public Hospitals in Borena Zone from August 15, 2022, to November 15, 2022, using the WHO criteria for maternal near miss event. In total, 117 participants were included in the study. Eligibility was determined using key clinical, organ dysfunction, laboratory, and management criteria, as per the WHO guidelines for near-miss events. Underlying and contributing causes of maternal near misses were documented from each participant's records. There were 1421 deliveries during the study period and 117 eligible women developed potentially life-threatening conditions. Only 61 women experienced severe maternal outcomes (55 near misses and six maternal deaths). The maternal near miss incidence ratio was 38.7 per 1000 live births, with a mortality index of 9.8%. Hypertensive disorders and obstetric hemorrhage are the leading underlying causes of maternal near misses. The incidence of maternal near miss was remarkably high when compared to previous studies. Giving special emphasis to life-saving interventions, critical care, reducing delays and improving the referral system are critical to improve quality of care.

Opportunities and challenges on hospital preparedness to handle motorcycle accidents in Busia County, Kenya: an exploratory qualitative study.

motorcycles continue to be a popular mode of transport in Kenya. However, the related injuries cause significant morbidity and mortality and remain to be a major and neglected public health issue. This raised the crucial need for hospital preparedness in managing morbidities and in reducing mortalities. This formed the basis of this paper which aims to document the challenges and opportunities in the healthcare system in handling motorcycle accidents in a Kenyan border town in Busia County. we drew data from an exploratory qualitative study that was carried out in 2021. All six referral hospitals purposively included in the study. The study targeted a total of 25 top level facility managers as key informants on the facility level opportunities and challenges in handling motorcycle accidents. Descriptive data were analyzed using SPSS version 20. the hospitals were not well prepared to handle motorcycle accidents. The major challenges were understaffing in critical care services; inadequate/lack of equipment to handle motorcycle injuries; inadequate/lack of infrastructure i.e. surgical wards, emergency rooms, inadequate space, functional theatre; lack/inadequate supplies; overstretched referral services arising from the hinge burden of motorcycle accidents in the area; inadequate specialized personnel to provide trauma/care services; mishandling of cases at the site of accident; inability of victims to pay related bills; inappropriate identification of victims at the facility; lack/inadequate on-job training. Some opportunities that currently exist include health system interventions which are not limited to employment of more professionals, improvement of infrastructure, provision of equipment and increase of budgetary allocation. the study reveals vast challenges that are faced by hospitals in managing patients. This calls for the government to step in and capitalize on the proposed opportunities by the health managers to be able to manage morbidities and bring down mortalities due to motorcycle accidents.

Power of narrative: a case study about documenting private insightful experiences while dealing with pain and associated disability.

People adjusting to living with a chronic disability, such as chronic pain, seek support and resources from societal systems, including health systems, to help them cope with this reality. This case study describes the use of a digital health platform designed to help in that quest. MyHealthMyRecord (MHMR), is being developed to record, register and curate personal private experiences of a chronic condition. MHMR allows users to record and log short (30-90s) personal and private audio-videos of their accommodation-seeking journey in a way that can be encrypted, registered, curated and shared privately. This case study describes the use of a prototype version of the platform by a participant co-designer who experienced a sudden onset of a chronic pain condition, of undetermined origin. System use began three months after the onset of the condition and just after being discharged from several months of hospitalization without any definitive diagnosis. During a three-month period, 65 short unstructured contributions were authored and logged. This paper presents a qualitative analysis of that content. The clips used various communication styles that documented experiences, concerns, issues, positive and negative interactions and pain episodes. Using thematic analysis with open coding, three domains (person-facing, accessibility and system-facing) and eight themes (pain, joy, therapy, environmental, recommendations, technical, culture and communication) were identified. Comments about pain, stress, etc., were the most common and occurred in 75% of all videos while technical and therapy/physio related comments were the fewest and occurred in 3 and 9% of the videos, respectively. We conclude that it is possible to create recordings of events, thoughts, reflections and issues on different aspects affecting an individual's health and well-being impact, including effects of the chronic condition as well as tangential outcomes such as accessibility (or lack of it), using MHMR over a longer period of time. The next steps will be to develop functionality to annotate the recordings, automatically analyze and summarize collections of recordings to make them consumable, useful and understandable to the individual and others, and then to share those analyses and summaries with others. In addition, evaluate this functionality longitudinally with more users.

Understanding The Reasons for High Rates of Caesarean Section Deliveries in Telangana, South India: An Explorative Study

Background: Telangana continues to top the list of the highest number of caesarean section (C-section) deliveries in the country for the financial year 2019-2020. As per NFHS-5 it is about 60.7% deliveries out of the total number of all institutionalized childbirths. This study aims to address the crucial research gap by qualitatively exploring the reasons for the high rates of unnecessary C-section rates in the state of Telangana. Methodology: A purposive sampling was done across the health care facilities and geographies in the State &amp; the districts were selected based on high, medium and low CS rates. A 360-degree stakeholder engagement approach was taken for a qualitative exploration to find out the reasons. Results: Medical, behavioural, cultural, and infrastructure including health system related factors have contributed to the rise of C-sections, particularly unnecessary elective C-sections. Limited trained personnel for doing normal deliveries in the public sector, infrastructure and safety issues for mother and child, and a preference for painless deliveries, and prior CS delivery stood out. Conclusions: As per the study's findings, it can be said that non-medical reasons account for a high percentage of C-sections in Telangana.

Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study

ObjectiveTo characterize racial differences in receipt of low value care (services that provide little to no benefit yet have potential for harm) among older Medicare beneficiaries overall and within health...

Integrating STEADI for Falls Prevention in Outpatient Rehabilitation Clinics: An Outcomes Evaluation Using the RE-AIM Framework.

The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to describe the implementation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Initiative (2018-2021) for screening and assessing all older adults ≥65 years for falls risk across 34 outpatient rehabilitation clinics within a large health system. We described the Implementation process and strategies. Using Electronic Health Records (EHRs), we identified Reach, Adoption, and Maintenance of screenings and physical assessments to identify fall risk among older adults. STEADI Implementation strategies included health system mandates, EHR revisions, email instructions, educational sessions and resources, clinical leads and champions, and chart audits. Reach: 76.4% (50,023) had a completed screening, and 44.1% screened at risk for falls. Adoption: Clinic-level adoption varied, with most performing screenings. Profession-level adoption was highest for physical therapists (PTs; 94.2% initiated, 80.6% completed) and lowest for speech-language pathologists (SLPs; 79.8% initiated, 55.9% completed). Reach and Adoption of functional outcomes measures (FOM): PTs completed an FOM on 59.5% of at-risk patients, occupational therapists on 11.6%, and SLPs on 7.9%. Maintenance: All measures declined 1%-10% annually between 2018 and 2021. STEADI screening and FOMs were implemented systemwide in 34 outpatient rehabilitation clinics, reaching over 50,000 older adults. Screening adoption rates varied by clinic. PTs had the highest adoption rate. All adoption rates declined over time. Future research should consider an implementation science approach with input from key partners before implementation to identify barriers and develop strategies to support STEADI in outpatient rehabilitation.

Suboptimal self-care trajectories of patients with coronary heart disease call for multiple levels of interventions: results from a longitudinal survey study

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): University of Akureyri Research Fund Landspitali University Hospital Science Fund. Background Self-care is an important part of secondary prevention for patients with coronary heart disease (CHD). But, we have limited knowledge about how self-care of CHD changes over time. The purpose of this prospective, longitudinal survey study was to determine if distinct trajectories of change in self-care behaviors could be identified following a hospitalization for CHD, and identify which characteristics are helpful in predicting trajectory membership. Methods Patients hospitalized acutely or electively for CHD were included in the study and completed questionnaires at hospital discharge and 6 months later. Self-care was measured with the Self-Care of Coronary Heart Disease Inventory, version 2.2 which consisted of 2 behavioral subscales (i.e., maintenance and management) that were standardized to range from 0-100 with higher scores indicating better self-care. Symptoms of anxiety and depression were assessed with the Hospital Anxiety and Depression Scale and health literacy with the Health Literacy Survey Questionnaire. Latent growth mixture modeling was used to identify distinct trajectories of CHD self-care behaviors over time. Results A total of 430 patients with CHD completed the study (mean age 64.3 ±8.9, 79% male). Overall, self-care was poor at enrollment (maintenance 61.6±15.4, management 53.5±18.5). Two trajectories of self-care behaviours were identified. The first "worse CHD self-care" trajectory (57.2% of the sample) had comparatively worse self-care maintenance and management at both enrollment and 6-month follow-up; self-care maintenance improved slightly (4.0±14.5-point improvement, p&amp;lt;0.001) but self-care management got worse (6.3±24.4-point worsening, p = 0.005) over time in this trajectory. The second "better CHD self-care" trajectory (42.8% of the sample) had comparatively better self-care maintenance and management at both enrollment and 6-month follow-up; self-care maintenance improved slightly (5.0±16.2-point improvement, p&amp;lt;0.001), and self-care management remained unchanged (0.8±21.9-point worsening, p = 0.713) in this trajectory (Figure 1). Predictors of fitting in the "worse CHD self-care" trajectory were older age, lower education, not having prior CHD hospitalizations, worse depression and anxiety symptoms, lower health literacy, and not participating in rehabilitation after hospitalization. Conclusion The determinants of change in CHD self-care overtime are complex and include multiple levels of potential intervention including health systems (e.g. rehabilitation) and individual care (e.g. red flags of poor literacy and affective symptoms). As such, care models which provide sufficient patient education, address mental health and focus on self-care management might help patients improve their self-care behaviour.Trajectories of self-care