Health Care Research Articles

Forming of modern Russian youth’s social representations about maintaining health: condition and problems

The article deals with the study of health maintaining among Russian youth. Based on data from all-Russian surveys and presented in relevant studies, the contradictions between the value perception of health and destructive health practices among young people were found. In this regard, based on the understanding of health conservation as a purposeful activity, in the structure of which the cognitive component plays a significant role, the author underlines to study young people’s ideas about health and health caring in order to realise the reasons of differences between the state of health and the attitude of Russian youth. In this regard, the author conducted a study of the structure of social ideas of young Russians. The theoretical basis of the study was the key provisions of the concept of social representations by S. Moscovici. The empirical basis was the data of the author’s empirical study “Health Saving of Modern Russian Youth: Ideas and Practices”. Based on the results of the study, it was established that the core of modern youth’s social ideas about health conservation are traditional images and ideas that reflect the most characteristic of Russian society and its health conservation culture, but in a limited format. The peripheral zone includes components such as breaking bad habits, well-being, and maintaining emotional stability. The least characteristic of young Russians is the connection between ideas about health and health preservation with institutional practices of clinical examination and preventive examinations, which suggests a decrease in the role of the medical institute as an agent of social control in relation to health in the ideas of the younger generation. Thus, the social ideas of young Russians about health and the practices of its preservation, along with traditional ideas, are distinguished by features, the formation of which, according to the author, is due to the influence of new agents of healthy lifestyle socialization and the online-sources

Cross-Sector Support for a Policy Framework to Tackle Social Determinants of Health.

This JAMA Forum discusses 4 focus areas developed by a collaborative of more than 40 organizations and experts in health care, social services, and other sectors designed to find ways to support and address social determinants of health with better program coordination and partnerships and novel financing approaches.

Functionalization of Emulsion Interfaces: Surface Chemistry made Liquid.

Disperse systems, and emulsions in particular, are currently massively used in fields as varied as food industry, cosmetics, health care and environmentally-friendly materials. To meet increasingly precise needs or targeted applications, these systems need to be endowed with new functionalities at their interfaces, in addition to their composition and structural properties. However, due to the fragility of drops and the low reactivity of their surface, conventional solid surface chemistry cannot be used for such a purpose. Several specific emulsion interface functionalization techniques have thus been developed for targeted systems and applications, but a general framework has yet to be drawn. In this review, we attempt to present these methods in a unified way through the prism of what we may call "liquid surface chemistry". We propose to categorize existing methods into drop-coating strategies, including layer-by-layer techniques and polymer coating, and emulsifier-carrier approaches involving particles and/or amphiphilic molecules. They are discussed in a transversal way, highlighting the underlying physico-chemical principles and providing a comparative analysis of their advantages, current limitations and potential for improvement. We also propose future directions and opportunities, involving for instance DNA-based programmability or artificial intelligence, which could make liquid surface chemistry more versatile and controlled.

Racial and Ethnic Disparities in Perceived Health Status Among Patients With Cardiovascular Disease.

Understanding health outcomes among people with cardiovascular disease (CVD) is crucial for improving treatment strategies and patient quality of life. This study investigated racial and ethnic disparities in perceived health status among non-Hispanic Black, Hispanic, and non-Hispanic White adults with CVD. The study had a retrospective cross-sectional design and used data from the Medical Expenditure Panel Survey spanning 8 calendar years (2014-2021). The study population consisted of adults diagnosed with various CVDs. We used ordinal logistic regression models adjusted for demographic and socioeconomic characteristics, CVD severity, comorbidities, and health care expenditures to assess racial and ethnic differences in perceived health status. Among the 11,715 (weighted frequency, 15,431,283) adults with CVD, we observed significant differences in perceived health status across racial and ethnic cohorts. The unadjusted analysis showed that non-Hispanic Black adults had significantly higher odds than non-Hispanic White adults of perceiving their health as poorer (odds ratio [OR]= 1.89; 95% CI, 1.74-2.07; P < .001), with a similar observation among Hispanic adults (OR = 2.05; 95% CI, 1.85-2.26; P < .001). Although female sex, higher education, and better income had protective effects on perceived health status independent of race, we found significant racial and ethnic differences in the effect of older age, physical and cognitive limitations, and health insurance status on perceived health status. This study revealed substantial racial disparities in perceived health status among adults with CVD, with notable differences in the effects of predictive factors. Addressing these disparities requires targeted interventions to improve health care access and enhance socioeconomic conditions tailored to the needs and experiences of racial and ethnic populations.

Implementation of peer specialists in Veterans Health Administration primary care: Improving program fidelity through enhanced preimplementation support.

Peer specialists (PS) in the Veterans Health Administration are veteran employees with lived mental health experience supporting others in recovery. While PS worked in traditional mental health settings for many years and demonstrated benefits to veteran engagement and satisfaction with health care, little is known about the best strategies to support implementation in novel, complex settings like primary care (PC). Implementation facilitation, which combined external facilitation plus national resources, was chosen to promote uptake when the VA MISSION Act of 2018 required the Veterans Health Administration to implement PS into PC. Using a mixed-methods, formative program evaluation approach, we examined the effects of implementation facilitation across two cohorts of 15 sites. Due to startup timing, Cohort 1 received minimal implementation facilitation during preimplementation compared with Cohort 2. Outcome measures included qualitative evaluation of facilitator notes, time to attain implementation milestones, and PS productivity and program fidelity (percent of total PS encounters in PC). Results suggested that overall productivity was similar across cohorts, but Cohort 2 demonstrated high program fidelity in Month 1 of implementation, while Cohort 1 required 12 months to attain similar fidelity. Qualitative findings indicated implementation facilitation that fostered team cohesion, clarified roles, supported supervisor training, and encouraged sites to guard against competing demands smoothed transitions for PS into PC. During preimplementation, implementation facilitation that focused on these findings resulted in the rapid attainment of program fidelity. Policymakers should consider the value of investing in preimplementation support for speeding the attainment of high-fidelity implementation of novel and complex practices such as PS in PC. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating the implementation of the National Primary Health Care Development Agency (NPHCDA) gateway for the Basic Healthcare Provision Fund (BHCPF) across six Northern states in Nigeria.

This evaluation research utilized both qualitative and quantitative methods to assess the implementation of the National Primary Health Care Development Agency (NPHCDA) gateway of the Basic Health Care Provision Fund (BHCPF) across six states in Northern Nigeria: Bauchi, Borno, Kaduna, Kano, Sokoto, and Yobe. This was a mixed-method research that utilized longitudinal surveys and Key informant interviews to gather information about the implementation status of the BHCPF-NPHCDA gateway. Checklists were developed based on the BHCPF's national guidelines to gather quantitative data, while simple open-ended questionnaires were used to collect qualitative data from the state BHCPF Program Implementation Unit (PIU) focal persons as key informants. The result revealed that the NPHCDA had accredited these six states to use one Primary Health Care (PHC) facility in each political ward to implement the BHCPF. Factors that contributed to the success achieved in some states included the early completion of contingent start-up activities, well-established coordination structures, strong support from partners, and the availability of established financial management systems. However, the delays in the submission of quarterly business plans by the BHCPF facilities affected timely approval and fund disbursement. Other challenges included staff capacity gaps, inadequate human resources, and poor management and supervision from the state health agency teams. There was suboptimal implementation of the BHCPF in at least one thematic area across all states. Therefore, actions such as government commitment for improved coordination, continuous capacity building, effective monitoring and evaluation, and targeted supportive supervision using innovative approaches should be undertaken to improve the program's implementation. In a broader setting, the insights from BHCPF implementation are valuable for LMICs, offering guidance on overcoming implementation challenges associated with PHC financing. This research provides a resource for enhancing healthcare financing strategies in similar contexts.

From perpetual pilots to sustainable transformation: Scaling up geriatric care.

With an ageing population, there is an increasing need to focus on the care of older adults, particularly those who are more medically complex. Frail older adults are more likely to require care from multiple providers across multiple settings. It is well recognized that the current Canadian healthcare system is not well-designed for this complex population. To address the health system challenges, healthcare leaders are rapidly developing and implementing programs to better support the ageing population. Unfortunately, this often means that organizations are implementing and scaling health and social care programs with limited evidence or understanding of the specific context in which it was implemented. Drawing on regional experiences, this article will explore challenges and offer solutions related to the implementation, spread, and scale of healthcare programs for older adults.

Evaluation of an Educator Mental Health Literacy Online Training Package

ABSTRACTEducators and school staff are critical to recognizing and supporting students' mental health, but frequently do not have the training to confidently bring mental health literacy into the classroom or assist students who experience distress. Moreover, few free, easily accessible trainings are available for this audience. Classroom Well‐being Information and Strategies for Educators (Classroom WISE) is a free, K‐12 mental health literacy training package that includes a self‐paced online course, video library, and resource collection. Using pre‐ and postcourse anonymous surveys from over 2000 educators, school mental health professionals, and school staff who completed Classroom WISE, this study found high levels of satisfaction, significant increases in mental health literacy knowledge, high perceived importance of mastering skills to promote student well‐being, and increased preparedness to implement mental health‐related strategies. Participants reported intentions to bring mental health literacy into the classroom, and identified barriers and facilitators to using Classroom WISE that leaders can respond to or employ when moving to implement Classroom WISE across a school or district. School district or school‐wide use of Classroom WISE can assist in building a safe and supportive school environment and help students in need to access mental health services.

From Silos to Synergy: A Scoping Review of Team Approaches to Outpatient Eating Disorder Treatment.

This scoping review synthesizes the available evidence on team outpatient eating disorder treatment, focusing on team composition, reported health and service outcomes, and reported principles of Interprofessional Collaborative Practice (IPCP), a synergistic healthcare approach characterized by shared values and ethics, clear roles, communication, and teamwork. A comprehensive search was conducted across five databases, targeting studies published between January 2004 and August 2024 that discussed team-based outpatient eating disorder treatment. Peer-reviewed and gray literature were included if they detailed team composition, characteristics, dynamics, experiences, processes, or outcomes. Forty-five studies met the inclusion criteria; nearly half were case reports or lacked primary data. Treatment teams commonly comprised mental health professionals, dietitians, and medical practitioners. Clinical outcomes, such as body mass index and psychopathology, were the most frequently reported, while satisfaction and organizational outcomes were underrepresented. IPCP principles were inconsistently reported, with "Roles/Responsibilities" and "Communication" most frequently mentioned but often superficially addressed. The evidence base for team outpatient eating disorder treatment lacks rigor and depth. Future research should focus on refining the integration of roles across disciplines, developing comprehensive outcome measures for benchmarking, and applying IPCP principles more systematically.

Cultural Spanish adaptation, factor structure, and reliability of implementation science instruments for suicide prevention.

Research on the implementation of community gatekeeper training interventions for suicide prevention in Spanish-speaking countries is limited. Gatekeepers identify warning signs of suicidal behavior in at-risk population and refer them to specialized mental health care. To identify factors that influence the implementation of evidence-based practices, standardized measures are needed in Spanish. We culturally adapted and evaluated the factor structure and reliability of two measures for use in the Mexican population: the final version of Acceptability, Appropriateness, and Feasibility of the Intervention (Weiner et al., 2017), and the Organizational Readiness for Implementing Change (ORIC; Shea et al., 2014). Our study consisted of two consecutive phases. The first addressed the cross-cultural adaptation. In the second phase, we administered an online survey to a nonrandom sample of 453 middle school personnel and performed a confirmatory factor analysis (CFA). Participants were 73.95% female, 25.17% male, and 0.88% nonbinary/other and came from the 32 Mexican states. CFA indices for the Mexican Spanish version of the acceptability, appropriateness, and feasibility measure yielded values of comparative fit index (CFI) = 0.96, Tucker-Lewis fit index (TLI) = 0.94, root-mean-square error of approximation (RMSEA) = 0.05, and standardized root-mean-square residual (SRMR) = 0.03. Internal consistency was Ω = 0.95. CFA indices of the Mexican Spanish version of the ORIC were CFI = 0.95, TLI = 0.93, RMSEA = 0.08, and SRMR = 0.03, and internal consistency was Ω = 0.94. We conclude that both instruments show preliminary psychometric properties that support their validity and reliability in the Mexican Spanish-speaking context. These findings promise to drive research on the implementation of gatekeeper interventions and other evidence-based practices in Spanish-speaking school settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Early Detection of Psychosis in Eating Disorders: Unnecessary or a Useful Addition?

The absence of consensus regarding the presence and interpretation of certain symptoms as indicative of either a psychosis spectrum disorder or an eating disorder (ED) can hinder cooperation amongst treatment programmes for the early detection of psychosis and an ED. This study trans-diagnostically assessed the prevalence and co-occurrence of at-risk mental states for a psychosis (ARMS) or the risk of having an ED (EDr), and it explored the characteristics of ARMS profiles of individuals with an EDr. This cross-sectional and observational-prevalence study used assessment outcomes from an ED screening instrument (SCOFF), a psychosis prodromal screening questionnaire (PQ16) and a CAARMS interview (to evaluate the possibility of ARMS) with newly admitted outpatients aged 16-35 who were referred for various kinds of non-psychotic disorders from a secondary Mental Health Care Centre in the Netherlands. Data analysis consisted of calculating prevalences, associations amongst variables and conditional probabilities. Of the 736 individuals who were screened, an EDr was identified in 51.2% and 49.0% of the participants who scored high on the PQ16, half of whom also completed the CAARMS interview. The results indicated that 53.0% of the participants were classified as not having ARMS, 28.3% as having ARMS and 18.7% as having a psychosis. EDr patients presented with symptoms of a psychotic spectrum disorder, which included both ED-consistent and ED-inconsistent symptoms. There were relatively frequent endorsements of the two subscale items guilt/punishment and ideas of reference. From a trans-diagnostical perspective, the results indicate that collaboration amongst ED programmes and psychosis prevention interventions should be strongly encouraged. Future researchers are encouraged to conduct studies that assess associations amongst and features of psychotic spectrum symptoms in EDs. The unexpectedly high proportion of EDr suggests that a co-morbid ED in other kinds of psychopathology is being overlooked.

“Honoring their stories”: care providers’ understanding of psychosocial concerns among Bhutanese American older adults with refugee life experience

Purpose This paper aims to explore the barriers and facilitators to psychosocial well-being among ethnic Nepali Bhutanese American older adults from the perspective of health care and service providers working with this population. Specifically, the authors aimed to understand health-care and service providers’ perceptions of the psychosocial well-being in this community and appropriate interventions. Design/methodology/approach Qualitative research methods were used to collect and analyze data in collaboration with a community-based organization. A total of ten participants were interviewed. Interviews were conducted in either English or Nepali, based on participant preference. An inductive thematic analysis approach was used to analyze the data. Findings Three major themes were generated from the analysis. The first two were in reference to perceived barriers to mental well-being among Bhutanese American older adults: isolation that older adults faced in the USA and shifting responsibilities and lifestyles that arose from the cultural and structural barriers in the USA. Throughout these themes, there was an understanding that acculturation threatened families’ connections to each other and impacted older adults’ connections with younger generations. The third theme, a perceived facilitator of well-being, was the power of storytelling to counteract feelings of isolation and disempowerment caused by shifting lifestyles felt by older adults, especially amid community events. Originality/value Bhutanese American older adults, many of whom have limited English proficiency, face numerous challenges, psychosocial stressors and factors contributing to well-being. Care for this population should prioritize dignity, empowerment and the incorporation of strengths within their narratives. Interventions and services tailored for older Bhutanese American adults need to be adapted to integrate multiple care systems.

Teachers' knowledge about the principles of dealing with a student with type 1 diabetes mellitus.

A proper self-management and therapy process, and the involvement of patients and their carers in this process, influences the effectiveness of T1DM therapy. The responsibility for the self-management process lies with children and adolescents with T1DM, as well as their parents and other carers. The aim of this study was to assess the level of teachers' knowledge of the principles of the treatment and self-management of T1DM in children and to demonstrate the influence of various factors influencing teachers' knowledge. A cross-sectional survey was conducted among the teachers in the Pomeranian Voivodeship. The first part of the survey contained questions on sociodemographic data, the second part contained questions on personal attitudes towards a student with T1DM, and the third part contained twenty-nine questions assessing the basic knowledge of the self-management and treatment principles of T1DM. Tests were conducted with 698 (86.4%) female teachers and 110 (13.6%) male teachers. The median (25thQ ÷ 75thQ) score of the test on the teachers' knowledge was 20 (18 ÷ 21) points, with a maximum of 29 and a minimum of 0 points. Male teachers, aged between 26-40years, with 6-10years of seniority, working in rural areas, having a person with T1DM in their immediate environment or having a student with T1DM in their class had a higher knowledge level. Teachers who worked in schools where no nurse was employed and those who had not completed specific training on the principles of caring for a child with T1DM at school had a lower level of knowledge. 1. Knowledge of teachers is insufficient to ensure safe stay at school for a child with T1DM. 2. The ongoing training of teachers on the principles of the self-management and treatment of T1DM is necessary to improve and increase the safety of children and adolescents with T1DM in school units. 3. There is a need to improve the quality of health care for children with T1DM in the learning environment by increasing the number of school nurses and improving their knowledge, and by the ongoing training of teachers and other staff in school units. 4. Detailed care plans should be developed for children with T1DM, adapted to the school conditions.

The California collaborative network to promote data driven care and improve outcomes in early psychosis (EPI-CAL) project: rationale, background, design and methodology.

A prolonged first episode of psychosis (FEP) without adequate treatment is a predictor of poor clinical, functional, and health outcomes and significant economic burden. Team-based "coordinated specialty care" (CSC) for early psychosis (EP) has established effectiveness in promoting clinical and functional recovery. However, California's CSC program implementation has been unsystematic and could benefit from standardizing its processes and data collection infrastructure. To address this, we established a consortium of EP clinics across the state via a Learning Health Care Network (LHCN) framework to develop the Early Psychosis Intervention Network of California (EPI-CAL). EPI-CAL's LHCN developed a core battery of evidence-based measures for service users and family members and linked them together using a unique data collection and visualization application, Beehive. EPI-CAL's LHCN collects, visualizes, and aggregates data at the individual and clinic level for EP programs across California via Beehive. Beehive was designed to: (1) collect outcomes data from service users receiving care at EP programs and their support persons, (2) provide the data to providers on a secure web-based dashboard to support measurement-based care, and (3) allow data to be used for program or research analysis. We will (1) determine the feasibility of implementing an LHCN across a diverse, decentralized network of early psychosis programs, (2) determine if the implementation of an LHCN increases the delivery of measurement-based care, and (3) determine if the implementation of measurement-based care is associated with significant improvements in key service user outcomes. EPI-CAL's network will contribute data to the Early Psychosis Intervention Network (EPINET) program. The current study aims to establish an LHCN of EP clinics in California that implements harmonized data collection using Beehive and assesses the feasibility of establishing such a network. Our goal is for this harmonized data collection approach to be used to inform decisions and develop learning opportunities for service users, staff, and administrators, and to improve outcomes for service users and their supporters in CSC care. Further, the data will enable programs and research teams to examine what elements of care lead to program success and improved treatment outcomes for service users. www. gov , identifier NCT04007510; registered 07/05/2019.

Considering patient-centred care and patient empowerment as essential to quality health care delivery in Ghana

Background: Rising cases of non-communicable diseases (NCDs), poor health choices, mistrust of the health system, self-medication, resistance of diseases to medication and dissatisfaction with the service experience serve as red flags on the path to Universal Health Coverage (UHC).Aim: This study explored the importance of patient-centred care (PCC) and patient empowerment (PE) within the context of healthcare service delivery in Ghana.Setting: The study considered PCC and PE from the perspective of three public healthcare facilities within the Greater Accra region.Methods: The researcher adopted a qualitative exploratory research approach. The study employed purposive sampling for the selection of healthcare facilities and healthcare providers. Convenience sampling was applied to select patient participants. A total of 33 in-depth interviews and 4 focus group discussions (FGDs) were conducted across the three sampled facilities as part of the data collection process.Results: Healthcare providers and patients unanimously view quality as essential for effective healthcare delivery. The application of the capacitating role of PE and PCC is inexact and largely left to subjective interpretation.Conclusion: The Ministry of Health (MOH) has recognised that patient experiences, a key indicator of care quality, have often been suboptimal and is actively working to address these weaknesses.Contribution: This study supports the call for health systems to remain committed to efforts to achieve UHC, with a focus on PCC and PE.

Health care workers hospitalized for COVID-19 in Liberia: who were they, and what were their outcomes?

Background Sustaining a ‘fit-for-purpose’ health workforce requires a better understanding of the health care worker cadres that are affected during pandemics and their outcomes. In hospitalized health care workers with confirmed COVID-19 between March 2020 and May 2023 in Liberia, we determined the hospitalization and case fatality rates, type of health care worker cadres affected, their demographic and clinical characteristics and hospital exit outcomes. Methods This was a cohort study using routine data extracted from hospitalization forms for health care workers in 24 designated COVID-19 treatment facilities. Results Of the 424 health care workers with COVID-19, hospitalization rates progressively declined between 2020 and 2023, (P&lt;0.001) with the highest rates in 2020 (24/1,000 health care workers) and 2021 (14/1,000 health care workers). Case fatality was 2% in both 2020 and 2021 with no deaths thereafter. Among those hospitalized, the highest proportions were nursing cadres with 191(45%), physicians with 63 (15%) and laboratory technicians with 42 (10%). The most frequent reported site for COVID-19 infection was the health facility (326, 89%). COVID-19 vaccination coverage in health care workers was 20%. The majority (91%) of hospitalizations were for mild symptomatic infections. Even in referral centres (n-52), 18 (35%) were for mild infections. Of the 424 who were hospitalized, 412 (97%) recovered, 9 (2%) died and 3 (1%) either left against medical advice or absconded. Of the nine deaths, none were vaccinated, seven had moderate-to-severe disease but were not referred to specialized COVID-19 treatment centers. Conclusions The hospitalized health care workers for COVID-19 were predominantly clinical and laboratory personnel who were mostly unvaccinated, and health facilities were hot-spots for contracting infections. The triage and referral system was weak with unnecessary hospitalization of mild infections. This study provides useful insights for outbreak preparedness including priority vaccination and improving health care worker safety in Liberia.

Bibliometric Analysis Examining Triage and Digital Triage Results in Emergency Departments

New technologies developed for triage systems can have positive effects on health care professionals. The research was conducted to identify and visualize the studies conducted between 2001 and 2024 on triage and digital triage systems in emergency departments and reveals global trends on this subject. The data were obtained from the "Web of Science Core Collection" database on February 8th, 2024. Performance analysis, scientific mapping, and bibliometric analyses were performed using the VOSviewer (1.6.15) software program. Data from 236 publications were analyzed in the study. The most publications were by Alcock J (n= 3), the most publications by country were published in the USA (n= 114), Harvard University (n= 19) was the institution that published the most, the United States Department of Health Human Services (n= 25) supported publications among the funding institutions, and the most publications were published in the Emergency Medicinal Journal (n=8). The results obtained from the study reveal the triage and digital triage systems used in emergency services, provide a general perspective on the subject, and guide future research on this subject.

Midpregnancy Placental Growth Factor Screening and Early Preterm Birth.

Early preterm birth (ie, at less than 34 weeks' gestation) confers a high risk for adverse health outcomes, yet no universal screening strategy exists, preventing targeted delivery of effective interventions. To evaluate the ability of midpregnancy placental growth factor (PlGF) screening to identify pregnancies at highest risk for early preterm birth. This prospective cohort study was conducted at an urban, tertiary care center from 2020 to 2023. Participants were unselected, pregnant people with singleton pregnancies, receiving universal-access prenatal care from obstetricians, family physicians, or midwives, who underwent a PlGF test at the time of routine gestational diabetes screening, typically at 24 to 28 weeks' gestation. Data were analyzed from January to May 2024. PlGF level less than 100 pg/mL at the time of gestational diabetes screen. The primary outcome was all early preterm birth, defined as less than 34 weeks' gestation. Secondary outcomes included iatrogenic preterm birth, spontaneous preterm birth, preeclampsia, stillbirth, and small-for-gestational-age birth weight. Among 9037 unique pregnant individuals, 156 (1.7%) experienced early preterm birth (52 spontaneous births; 104 iatrogenic births). The area under the curve (AUC) for PlGF and early preterm birth was 0.80 (95% CI, 0.75-0.85). Low PlGF level was associated with early preterm birth (positive likelihood ratio [LR], 79.400 [95% CI, 53.434-115.137]; negative LR, 0.606 [95% CI, 0.494-0.742]; specificity, 99.5% [95% CI, 99.3%-99.6%]; negative predictive value, 98.9% [95% CI, 98.8%-99.1%]). Time to birth from PlGF test was significantly reduced among patients with a PlGF level less than 100 pg/mL, among whom more than 50% delivered within 50 days of testing. Individuals with a low PlGF level made up more than 30% of subsequent stillbirths (aRR, 36.78 [95% CI, 18.63-72.60]) and more than half of patients requiring iatrogenic early preterm birth (aRR, 92.11 [95% CI, 64.83-130.87]). The AUC for iatrogenic early preterm birth was 0.90 (95% CI, 0.85-0.94). These findings suggest that low PlGF level (<100 pg/mL), identified at the time of routine gestational diabetes screening, may be a powerful clinical tool to identify pregnant people at risk of early preterm birth, especially in iatrogenic births. Strategic redirection of tertiary health care resources to this high-risk group could improve maternal and perinatal outcomes.

Engaging Low-Wage Workers in Health and Well-Being Survey Research: Strategies From 5 Occupational Studies.

Without perspectives of low-wage workers in studies of worker health and well-being, researchers cannot comprehensively assess occupational health and health equity impacts of workplace exposures and interventions. Researchers and practitioners have noted particular challenges in engaging low-wage workers in worksite-based health survey research, yet little scholarship has described strategies for improving their engagement and response rates. To fill this gap, we present case examples from 5 occupational studies conducted between 2020 and 2024 in industries including health care, food service, and fulfillment centers. For each case, we describe how we identified barriers to worker engagement in surveys, explain specific strategies we used to address those barriers, and assess the effectiveness of these actions. Then, summarizing across case examples, we offer practical recommendations to researchers surveying low-wage populations, highlighting that high-touch recruitment, building trust with workers and managers, and obtaining manager support to take surveys during work time (for worksite-based studies) are critical for obtaining reliable, representative data. Our work contributes to broader discussions on improving survey response rates in vulnerable worker populations and aims to support future researchers undertaking similar efforts. (Am J Public Health. Published online ahead of print November 14, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307875).

Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study.

The 42 days after delivery ("fourth trimester") are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. To fill a gap in the critical "fourth trimester," we developed 2 ruled-based chatbots-one for birthing individuals and one for newborn caregivers-that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Overall, 2748 (63%) individuals opened the newborn chatbot messaging, and 2244 (64%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40% (n=40) identified as Black, 27% (n=27) identified as Hispanic/Latina, and 18% (n=18) completed the survey in Spanish. Payer distribution was 55% (n=55) for individuals with public insurance, 39% (n=39) for those with commercial insurance, and 2% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80%) and found the reminders to schedule the newborn visit (n=59, 59%) and postpartum visit (n=66, 66%) useful. Across 23 interviews (n=14, 61% Black; n=4, 17% Hispanic/Latina; n=2, 9% in Spanish; n=11, 48% public insurance), 78% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot's impact on health outcomes and reduce disparities.