Maternal Home Research Articles

Perinatal Consequences in Pregnant Women Suffering from Metabolic Syndrome

The aim of the study was to evaluate perinatal outcomes in pregnant women suffering from metabolic syndrome
 Material and methods. The study was carried out on the basis of Maternity House No. 7" (Odesa) in 2014-2021. 57 women with metabolic syndrome were examined. Anthropometric parameters, basic metabolism, leptin content and lipid profile, frequency of complications of pregnancy and childbirth were evaluated. Statistical processing was carried out by methods of dispersion and correlation analysis using Statistica 13.0 software (TIBCO, USA).
 Research results.
 The average age of the examined women was 27.4±1.1 years. Of them, 16 (28.1%) pregnant women were primiparous, and 41 (71.9%) pregnant women gave birth again. BMI in all women was above 25 kg/m2 (on average 29.2±0.6 kg/m2) with a fat content of 47.3±2.4%. During pregnancy, leptin level was on average 39.3±1.6 ng/ml, LDL content was 1.8±0.1 mmol/l. The presence of metabolic syndrome significantly increased the frequency of obstetric and perinatal complications. The possible relationship between the identified disorders and qualitative changes in the intestinal microbiome is discussed.
 Conclusions:
 
 In women with manifested metabolic syndrome, the course of pregnancy was complicated by preeclampsia in 24.6% of cases, placental dysfunction in 29.8% of cases. The threat of premature birth occurred in 40.4%, gestational diabetes – in 31.6% of women.
 With metabolic syndrome, the frequency of operative delivery increases to 35.1%. The main indications for a cesarean section were a clinically narrow pelvis, a severe form of preeclampsia, and weakness of labor that cannot be corrected with medication.
 During childbirth, women in labor with metabolic syndrome often experience such complications as weakness of labor (19.3%), premature discharge of amniotic fluid (24.6%). The main complication of the postpartum period was subinvolution of the uterus (15.8%).
 Most of the children born had signs of macrosomia, which closely depended on leptin concentration (r=-0.31).
 The proven existence of a strong correlation between the level of leptin production and LDL (rs=0.76).

A Social Network Analysis of a Multi-sector Service System for Intimate Partner Violence in a Large US City

About one in four women in the US report having experienced some form of intimate partner violence (IPV) during their lifetime and an estimated 15.5 million children live in families in which IPV occurred in the past year. Families of young children with IPV experiences often face complex needs and require well-coordinated efforts among service providers across social and health sectors. One promising partnership aims to support pregnant and parenting IPV survivors through coordination between IPV agencies and community-based maternal and early childhood home visiting programs. This study used social network analysis (SNA) to understand the interconnectedness of the system of IPV prevention and intervention for families with young children in a large US city. The SNA included 43 agencies serving this population across various service domains spanning IPV, legal, maternal and child health, and public benefit programs. An SNA survey collected data on four forms of collaboration between agencies, including formal administrative relationship, referral reciprocity, case consultation, and shared activities in community committees/organizing bodies. Density and centrality were the primary outcomes of interest. A community detection analysis was performed as a secondary analysis. The overall level of interconnectedness between the 43 responding agencies was low. Making referrals to each other was the most common form of collaboration, with a network density of 30%. IPV agencies had the highest average number of connections in the networks. There was a high level of variation in external collaborations among home visiting agencies, with several home visiting agencies having very few connections in the community but one home visiting program endorsing collaborative relationships with upwards of 38 partner agencies in the network. In serving families at risk for IPV, home visiting agencies were most likely to have referral relationships with mental health provider agencies and substance use disorder service agencies. A community detection analysis identified distinct communities within the network and demonstrated that certain agency types were more connected to one another while others were typically siloed within the network. Notably, the IPV and home visiting communities infrequently overlapped. Sensitivity analyses showed that survey participants’ knowledge of their agencies’ external collaborations varied by their work roles and agencies overall had low levels of consensus about their connectedness to one another. We identified a heterogeneous service system available to families of young children at-risk for or experiencing IPV. Overall inter-agency connectedness was low, with many siloed agencies and a lack of shared knowledge of community resources. Understanding current collaborations, silos, and centrality of agencies is an effective public health tool for allocating scarce resources across diverse service sectors to efficiently improve the system serving families experiencing IPV.

Missed opportunities in postpartum contraception: Bridging the gaps for patients who deliver at Catholic hospitals in Illinois

AbstractIntroductionCatholic hospitals' religious restrictions limit postpartum contraceptive care and reproductive counselling. This qualitative study explores opportunities for patients and providers to ensure access to desired postpartum contraception care.MethodsWe interviewed people who had obstetric experiences in Illinois Catholic hospitals: 21 patients and 23 providers, including clinicians, doulas, nurses, and maternal health home visitors. We transcribed interviews and coded transcripts then used a thematic content approach for analysis. To guide future interventions, we sought interviewees' perspectives on opportunities to improve postpartum contraceptive care for patients affected by these restrictions.ResultsPatients delivered in Catholic hospitals for varied reasons unrelated to religious affiliation and were generally unaware of limits on access to contraception. Some providers offered referrals or workarounds for some contraceptive methods. The majority of providers described the importance of initiating contraceptive counselling during the prenatal period, but few patients reported receiving comprehensive contraceptive counselling during this time. Patients who received contraceptive counselling often had these experiences with doulas and maternal health home visitors who were not affiliated with religious health centres.ConclusionContraceptive counselling in the prenatal period can be a particularly helpful tool for patients delivering in hospitals that limit access to postpartum contraception, particularly in Catholic hospitals. Prenatal counselling can support advance planning if a patient needs to transfer or seek care outside their preferred health system. Where counselling and referrals are prohibited by religious restrictions, doulas and other maternal health home visitors can bridge gaps and support patient decision‐making and navigation to receive postpartum contraceptive care.

Analysis of Needs and Weaknesses of The Maternal and Child Health Surveillance System

The maternal and child health program in Sukoharjo district includes several reports on childbirth, postpartum, immunization reports, nutritional counseling, midwife courses, home visit reports, and family planning services, both in hospitals, health centers, maternity homes, and midwives. The maternal and child health surveillance that has been carried out so far has only been carried out to fill in data reports to health agencies at the central level. It has not been presented and analyzed properly, let alone disseminated the information to those who need it. Therefore, efforts are needed to improve the quality of epidemiological data and information so that planning and evaluation are well coordinated to improve the quality of the analysis results of surveillance data studies in terms of timeliness and sensitivity of reports. This research aims to determine the weaknesses in the need for a maternal-child health surveillance system and a maternal-child health surveillance system. The intervention method used is through on-the-job training. Meanwhile, district officers who have been trained previously (tiered training) train maternal and child health workers at community health centers. From the results of the analysis, it can be concluded that the maternal and child health program surveillance system is generally running well.

Perinatal Birth Asphyxia Among Newborns at Jiblah Public Health Hospital in Ibb City, Yemen, During Six Years of Conflict and Its Predictive Factors: A Retrospective Cross-Sectional Study.

Birth asphyxia is a major cause of infant death across the world, especially in developing countries, where the issue is significantly underreported and underestimated, particularly in fragile and conflict-affected states. The purpose of this study was to determine the prevalence and risk factors for birth asphyxia in women at Jiblah University Hospital in Ibb, Yemen, and its predictive factors throughout six years of conflict. We conducted a retrospective cross-sectional chart review and analysis of the birth database spanning from June 2013 to September 2019 at Jiblah University Hospital in Ibb, Yemen. We used APGAR (appearance, pulse, grimace, activity, and respiration) scores <7 at both the first- and fifth-minute post-delivery with umbilical cord arterial blood pH <7 (metabolic acidosis) and/or neurologic manifestations (seizures or an altered tone) within the first 24 hours of life to define birth asphyxia cases. Factors associated with birth asphyxia were analyzed using univariate and multivariate regression analysis with an odds ratio (OR) and 95% confidence interval (CI). A total of 5,193 neonates were delivered during the study period. The prevalence of birth asphyxia in 309 (6%) neonates. In a multivariate analysis, illiteracy (OR: 2.90; 95% CI: 0.98-8.41), referred mothers (OR: 3.04; 95% CI: 1.42-6.40), advanced maternal age (OR: 1.05; 95% CI: 1.02-1.07), home delivery (OR: 6.50; 95% CI: 3.09-12.57), prematurity (OR: 1.43; 95% CI: 1.05-1.93), and low birth weight (OR: 3.09; 95% CI: 1.93-4.93) were predictors for birth asphyxia and were statistically significant (p<0.05). In this study, the prevalence of birth asphyxia was equivalent to that of other underdeveloped nations. However, continual attention and treatments are required to lower the risk of birth asphyxia. Illiteracy, referred mothers, advanced maternal age, home delivery, prematurity, and low birth weight were all predictors of birth asphyxia in this research. Most birth asphyxia factors mentioned in this study can be managed through effective prenatal, intrapartum, and postpartum care, as well as a strict following of national obstetrics and neonatal guidelines.

The carbon footprint of different modes of birth in the UK and the Netherlands: An exploratory study using life cycle assessment.

To compare the carbon footprint of caesarean and vaginal birth. Life cycle assessment (LCA). Tertiary maternity units and home births in the UK and the Netherlands. Birthing women. A cradle-to-grave LCA using openLCA software to model the carbon footprint of different modes of delivery in the UK and the Netherlands. 'Carbon footprint' (in kgCO2 equivalents [kgCO2 e]). Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21 kgCO2 e, compared with 12.47 kgCO2 e for vaginal birth in hospital and 7.63 kgCO2 e at home. In the Netherlands the carbon footprint of a caesarean was higher (32.96 kgCO2 e), but lower for vaginal birth in hospital and home (10.74 and 6.27 kgCO2 e, respectively). Emissions associated with analgesia for vaginal birth ranged from 0.08 kgCO2 e (with opioid analgesia) to 237.33 kgCO2 e (nitrous oxide with oxygen). Differences in analgesia use resulted in a lower average carbon footprint for vaginal birth in the Netherlands than the UK (11.64 versus 193.26 kgCO2 e). The carbon footprint of a caesarean is higher than for a vaginal birth if analgesia is excluded, but this is very sensitive to the analgesia used; use of nitrous oxide with oxygen multiplies the carbon footprint of vaginal birth 25-fold. Alternative methods of pain relief or nitrous oxide destruction systems would lead to a substantial improvement in carbon footprint. Although clinical need and maternal choice are paramount, protocols should consider the environmental impact of different choices.

Blood lead levels and math learning in first year of school: An association for concern

Lead is a well-known neurotoxicant that continues to affect children's cognition and behavior. With the aim to examine the associations of lead exposure with math performance in children at the beginning of formal schooling, we conducted a cross-sectional study of first-grade students from 11 schools in Montevideo, Uruguay. Math abilities were assessed with tests from the Batería III Woodcock-Muñoz (Calculation, Math Facts Fluency, Applied Problems, Math Calculation Skills and Broad Maths). Separate generalized linear models (GLM) tested the association of blood lead level (BLL) and each math ability, adjusting for key covariates including age and sex, maternal education, household assets and Home Observation for Measurement of the Environment Inventory score. In a complete-case of 252 first-grade students (age 67–105 months, 45% girls), mean ± SD blood lead level was 4.0 ± 2.2 μg/dL. Covariate-adjusted logistic models were used to examine the association between childhood BLLs and the odds of low math performance. BLL was negatively associated with scores on the Calculation test (β (95% CI): −0.18 (−0.33, −0.03)), Math Calculation Skills (−1.26 (−2.26, −0.25)), and Broad Maths cluster scores (−0.88 (−1.55, −0.21)). Similarly, performance on the Calculation test, as well as cluster scores for Broad Maths and Math Calculation Skills differed between children with BLLs <5 and ≥ 5 μg/dL (p < 0.01), being lower in children with higher BLLs. Finally, considering the likelihood of low test performance, each 1 μg/dL higher B–Pb was related to 27% higher likelihood for Maths Facts Fluency, 30% for Broad Math and Math Calculation Skills, and 31% for Calculation (p < 0.05). These results suggest that lead exposure is negatively associated with several basic skills that are key to math learning. These findings further suggest that the cognitive deficits related to lead exposure impact student achievement at very early stages of formal education.

Maternity homes survey in Prefecture A: Seeking the continuation and development of Japanese maternity homes

Maternity homes survey in Prefecture A: Seeking the continuation and development of Japanese maternity homes

APPLICATION OF AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY IN PATIENTS OF NEONATAL INTENSIVE CARE UNITS

Intriduction. Amplitude-integrated electroencephalography is a technique for monitoring continuous cerebral function, when electroencephalographic signal is filtered, scaled and compressed in time.&#x0D; Objective of the study is to elucidate peculiarities of interpreting findings of the amplitude-integrated electroencephalography in patients of neonatal intensive care units, and represent a clinical case of establishing diagnosis by using the amplitude-integrated electroencephalography for a critically sick neonate.&#x0D; Materials and methods. A comprehensive literature review was conducted across international and national databases, including Elsevier, PubMed, Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar, covering the period from 2019 to 2023. The search focused on the keywords "amplitude-integrated electroencephalography" and/or "aEEG" and "neonates" and/or "term infants" and/or "preterm infants." The clinical case presented took place at the neonatal intensive care unit of the Maternity Home "Central Municipal Clinical Hospital", Chernivtsi, Ukraine. Permission for publication was obtained from both parents of the child.&#x0D; Results. The main indications for conducting the amplitude-integrated electroencephalography in neonates include the assessment of the cerebral function and the degree of cerebral damage with hypoxic-ischemic encephalopathy or asphyxia at birth (often combined with therapeutic hypothermia); assessment of sleep-wake cycle; identification of seizures; assessment of cerebral function maturity in preterm neonates.&#x0D; The underlying cerebral activity is estimated according to the amplitude-integrated electroencephalography findings by means of a simple recognition of visual images corresponding to the five main patterns: Continuous Normal Voltage, Discontinuous Normal Voltage, Burst Suppression, Low Voltage, and Flat Trace. A typical neonatal single seizure fit on the amplitude-integrated electroencephalography looks like a “hump” or lower edge elevation interrupting the background recording. Repeated fits (epileptic status) look like a “saw” of repeated “humps”, one of each represents one attack. The article presents a clinical case of the diagnostic search in the neonate with congenital pneumonia and development of multiple organ failure syndrome including seizure syndrome. Clinical tonic-clonic seizures of the infant were associated with electroencephalographic criteria of status epilepticus both on the amplitude-integrated electroencephalography (repeated symmetrical elevations of the lower edge in the left and right) and on the standard electroencephalography (different variations of seizure graphic elements in the right and left). Considering the results of the clinical and instrumental examination, an adequate anticonvulsant therapy was administered.&#x0D; Conclusions. Continuous recording of the video-amplitude-integrated electroencephalography and standard electroencephalography in infants from the risk group is a good strategy of the neurological status effective monitoring. It enables to assess the underlying cerebral electric activity and it maturity, diagnose seizures and manage anticonvulsant therapy correctly. An adequate training of the staff who are at the patient’s bedside 24/7 is an important part of the interdisciplinary collaboration which is essential for a safe and effective management of patients in the neonatal intensive care units, prevention of early complications and disability in the future.

Dietary diversity practice and its associated factors among pregnant women in Eastern Ethiopia: A community-based cross-sectional study.

Micronutrient insufficiencies during pregnancy have a marked impact on the health of the woman and her offspring. Evidence about the dietary practice of pregnant women is limited in Ethiopia, particularly in drought-prone areas where food insecurity is widely seen. Therefore, this research aimed to assess the dietary diversity practice and associated factors among pregnant women in Chiro district, Eastern Ethiopia. We employed a community-based cross-sectional survey in Chiro district, Eastern Ethiopia. The data were collected from 417 randomly selected pregnant women using an interview-administered structured questionnaire. EpiData-3.1 and STATA-14 were used for data entry and analysis, respectively. The binary logistic regression analysis was deployed to assess the association between dietary diversity practice and predictor variables. Out of 420 calculated sample size, 417 pregnant women completed the survey giving a response rate of 99.3%. The overall prevalence of optimal dietary diversity was 38.4% (95% CI: 33.7%, 43.2%). Educational status (adjusted odds ratio [AOR]: 2.71, 95% CI: 1.08, 6.81), meal frequency (AOR: 1.91, 95% CI: 1.11, 3.28), home gardening (AOR: 4.21, 95% CI: 2.48, 7.16), and household food security (AOR: 0.23, 95% CI: 0.13, 0.40) were independent predictors of dietary diversity practice.This study found that a substantial proportion of pregnant women had suboptimal dietary diversity, indicating a fundamental micronutrient inadequacy. Educational status, meal frequency, home gardening practice, and household food security were independent determinants of dietary diversity practice. The findings suggest that promoting maternal education and home gardening practice, and controlling food insecurity might enhance optimal dietary diversity.

Characterization of the comprehensive care of pregnant women admitted to the maternity home

Characterization of the comprehensive care of pregnant women admitted to the maternity home

Internship in obstetrics and gynecology by interns of the 2nd year of education on the base of maternity home № 1, Odessa

Annotation. Internship in obstetrics and gynecology is carried out in accordance with the Internship Regulations. Internship in obstetrics and gynecology consists of educational and practical parts, conducted according to individual curricula. The purpose of the work is to analyze the organization and peculiarities of internship training by intern doctors of the 2nd year of training in the specialty of obstetrics and gynecology. 12 second-year interns are undergoing an internship in obstetrics and gynecology on the basis of maternity hospital No. 1 in Odesa. The educational part of the internship program of the second year of study in obstetrics and gynecology is three months (15.6 ECTS credits / 468 hours and is conducted under the supervision of employees of the Department of Obstetrics and Gynecology of ONMedU who work on the basis of the maternity hospital. The educational part includes: Course 4 About benign diseases in gynecology (7 credits / 210 hours); Course 5 is devoted to the problems of reproductive medicine (4 credits / 120 hours); Course 6 - study of urogynecological problems (2 credits / 60 hours); Course 7 - study of precancerous pathology of the female sphere (1 credit / 30 hours); the additional program is dedicated to emergency medicine - in the amount of 1.6 credits / 48 hours. Practice of practical skills also takes place in the equipped simulation classes of the Department of Obstetrics and Gynecology, the clinical base of maternity hospital No. 1, the Department of Simulation Medicine. the practical part of the internship is 8 months (1248 hours). The level of mastery for each competence, practical skill is determined in the range from A to D. The mandatory number of manipulations, operations is controlled by the curator in accordance with the recording in the operational log, the manipulation log and is approved by the supervising department in the Diary of an intern. An urgent issue is the need to ensure professional development of personal qualities of specialists, acquisition of new knowledge and skills. The interaction between the teacher and the internal obstetrician-gynecologist consists in the use of modern technologies, increasing the quality of success and evaluation.

Promoting Coordination and Collaboration in Tribal Home Visiting Programs in the United States.

A joint statement from two federal agencies in the United States calls for coordination and collaboration between programs serving families of infants and toddlers who are at risk or developmentally delayed or disabled U.S. Department of Education and U.S. Department of Health and Human Services. Policy guidance: Joint statement on collaboration and coordination of the MIECHV and IDEA Part C programs. (2017). Individuals with Disabilities Education Act. ED/HHS Joint Guidance Document: Collaboration and Coordination of the Maternal, Infant, and Early Childhood Home Visiting Program and the Individuals with Disabilities Education Act Part C Programs. Young Native American children living on tribal lands in this country are currently eligible for two federal programs associated with these agencies which overlap in mission and implementation. This paper outlines potential strategies for creating a more seamless system of services for tribal families involving more centralized intake processes and procedures, cross training of staff to work across programs, and adopting more unifying approaches to program implementation. A streamlined system of services will result in interventions that better support family and child outcomes while reducing duplication of services, consolidating the limited number of qualified professionals available to provide services, and increasing convenience and cultural attunement of services to Native American families currently participating in both programs.

Promotion of school readiness in home visiting: creating a key driver diagram for continuous quality improvement

ABSTRACT School readiness is a topic of great interest to early childhood and maternal child health initiatives, such as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. However, there is a lack of information about best practices or strategies in home visiting and their relative effectiveness in improving school readiness, making this topic appropriate for improvement through Continuous Quality Improvement (CQI) methods. In 2022, Alabama developed a Key Driver Diagram (KDD) for improving school readiness efforts within the home visiting programme using synchronous online focus groups as a method of qualitative data collection with early childhood and home visiting experts. Findings from this study include development of a KDD that includes aims, key drivers, and secondary drivers. The KDD represents the first of many steps toward a unified theory of change. Future efforts will include development of a CQI change package and testing change ideas in the field.

The Experience of Maternity Group Homes: A Qualitative Study of Mothers and Providers

Foster teens are particularly vulnerable to the negative consequences of pregnancy. Maternity group homes (MGHs) aim to mitigate risks and promote stability among pregnant and parenting teens. This study applied the stage-environment fit and emerging adulthood frameworks to explore MGH experiences and exit outcomes from the perspectives of residents and providers. Mothers were 18 to 25 years old. Most participants were non-Hispanic, Black (64%) with the remaining mothers identifying as Hispanic (20%) or non-Hispanic white (16%). Mothers averaged 5 years in foster care, and 75% experienced 5+ placements. Qualitative interview data were collected from mothers aging out of care with MGH experience ( N = 25) and MGH providers ( N = 16) throughout one state. Using thematic and narrative analytic techniques, emerging themes were mapped onto dominant narratives explaining circumstances entering, living in, and leaving MGHs. Mothers’ experiences were shaped by their situations leading to placement; perceptions of individualized care; and level of openness to change. These conditions shaped how they navigated the MGH environment, their exit outcomes, and subsequent residential stability. Dominant narratives indicate the importance of individualizing care and connecting house responsibilities with independence when developing relationships and delivering services.

Ochrona zdrowia społeczności żydowskiej na Górnym Śląsku w latach 1945–1950

Health care of the Jewish community in Upper Silesia 1945–1950 The post-war activities of the Jewish health care in Upper Silesia, were part of a centuries-old tradition of activity by Jewish aid organisations. Its task was not only to spread medical aid, but also to provide, under adverse conditions and at short notice, the basis of existence and a sense of security for several thousand people. In the first half of 1945, issues of health care for the Jewish population settled in Upper Silesia after the Second World War remained the responsibility of the health departments at the field committees of the Central Committee of Jews in Poland. Starting from August 1945, the health policy and the protection of the health of Jews in Poland rested on the shoulders of the Society for the Protection of the Health of the Jewish People (TOZ) reactivated within the structures of the CKŻP. The organisation’s functioning was based on provincial branches, with interventions including: primary and specialist medical care, preventive measures including spa stays or maternal and child health. The Katowice branch was established in April 1946. At its busiest, it was the second largest branch of TOZ in Poland and covered five cities in Upper Silesia: Bytom, Chorzów, Zabrze, Gliwice and Opole. Among other things, there were nine outpatient clinics, mother and baby clinics, a maternity home and a dental surgery. Their activities came to an end in 1950, when all social organisations, including Jewish ones, were nationalised in Poland.

“Taking it day by day”: Maternity group homes in the lives of mothers aging out of foster care

BackgroundPregnant and parenting teens aging out of foster care, and their children are high-risk groups that require access to comprehensive services. Using a resilience framework, this study examined one mechanism to serve the population: maternity group homes. Despite interest in meeting the needs of these young families, little is known about maternity group home services and the impact for mothers and their children. ObjectiveThis study aimed to understand maternity home characteristics, strengths, and challenges from mothers’ and providers’ perspectives. MethodData were collected from qualitative interviews with maternity group home providers (N = 16) and young mothers aging out of foster care (N = 25) and analyzed using thematic analysis. ResultsFindings reflected four themes: (1) adversity, crisis, and rejection, (2) tension between useful programs and structured delivery, (3) unfulfilled aspirations for connections, and (4) slow progress towards independence. Mothers desired independent living skills, supportive relationships, and successful transitions to adulthood. Providers shared these goals for mothers. Past trauma, chronic adversity, and instability interfered with mothers’ ability to fully capitalize on maternity home programs. ConclusionMaternity homes are important resources for pregnant and parenting teens aging out of foster care. Yet, residency did not universally support mothers. Specifically, mothers living in maternity homes face high levels of adversity and instability which may interfere with their ability to harness protective factors. To improve outcomes, mothers may benefit from opportunities to gradually build trust and increase responsibility with extended stay eligibility to prepare for independent living.

Seasonal Trends and Interactions of Viral Pathogens in Children Presenting with Acute Respiratory Tract Infections in the Advancing Periods of SARS-CoV-2 Pandemic

Although various bacteria and viruses have been identified in the etiology of acute respiratory tract infections (ARI), 90% of acute ARIs that develop in children are of viral origin. The aim of this study was to investigate the seasonal trends and interactions between infectious agents and to determine the risk factors associated with ARI in children aged 1-15 years admitted to the Pediatric Emergency Department of Manisa Celal Bayar University Hospital in the advancing periods of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. To determine the bacterial and viral agents, samples were taken from 314 patients attending to the hospital with symptoms suggestive for ARI, between 06/01/2021 and 05/31/2022. Viral and bacterial agents were identified by multiplex polymerase chain reaction (PCR) and automated identification system, respectively. Demographic data of the participants and possible risk factors for ARI were recorded in the questionnaires. In the study, viral agents were detected in 77.3% of the children, and the most common infectious agent was rhinovirus/enterovirus (RV/EV) (36.3%), followed by influenza viruses (11.2%), and SARS-CoV-2 (10.5%). While RV/EV positivity was found to be higher in children with moderate and below average (p< 0.001) hand hygiene, influenza positivity was found higher in those attending school/preschool institution (p< 0.001) and whose mothers working full-time (p< 0.001). Respiratory syncytial virus positivity was associated with maternal smoking (p= 0.013) and home overcrowding (p= 0.014). Bacterial colonization was detected in 33 (11.6%) of 284 children whose swabs were taken for both bacterial and viral agents and the most frequently detected agents were Staphylococcus aureus (60.6%) and Pseudomonas aeruginosa (15.2%). Having siblings (p= 0.008) and maternal smoking (p= 0.012) were found to be associated with the detection of bacterial agents. In this study, in the advanced period of the pandemic, the most detected agents and seasonal characteristics were found to be similar to the pre-pandemic period. It is thought that knowing the regional etiology and risk factors will contribute to taking the necessary local control and protective measures.

EP02.42: Maternity home in Matagalpa: successful results for our women and children

EP02.42: Maternity home in Matagalpa: successful results for our women and children

Co-designing a conceptual framework of home visiting implementation quality

Early childhood home visiting is a two-generation approach to promote positive health and well-being outcomes among people who are pregnant and families with infants and young children. A popular family support strategy for the past several decades, home visiting expanded exponentially in the United States when the federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) was authorized in 2010 through a provision within the Affordable Care Act. MIECHV currently funds evidence-based home visiting services in underserved and historically marginalized communities in all 50 states, 22 tribes, the District of Columbia, and five U.S. territories. It is widely accepted that achieving intended child and family outcomes through home visiting services requires “high-quality” program implementation, but the field lacks a standard definition or empirical evidence for what “quality” means in the context of home visiting. With the rapid expansion of home visiting that has accompanied MIECHV, there is increased interest from the field in having a shared understanding of home visiting implementation quality that is applicable across models and accounts for dimensions of quality across the entirety of the home visiting implementation system. This paper describes the process used to develop a conceptual framework to understand home visiting quality. We engaged MIECHV awardees and other experts from the fields of home visiting, early childhood, implementation science, and health equity in a co-design process that involved initial brainstorming, a series of iterative framework drafts, and finalization of the model. The resulting framework captures the multiple levels (i.e., the contexts, agencies, entities, and individuals) that are part of the home visiting system and the theorized key aspects of quality that are applicable across the levels of the systems. We discuss potential uses of the conceptual framework, as well as lessons learned from the co-design process.