Health Care Programs Research Articles

Self-Determination to Better Health Outcomes: A Study of Diabetes in the Native American Community

Increased self-determination in health care by the Native American community may help combat preventable diseases like diabetes. The racial stereotyping of Native Americans in medical clinics has been found to directly correlate to health disparities such as poor care and poor medical outcomes (Solomon et al.). However, since 1975, the ISDEAA, or Indian Self-Determination and Education Assistance Act, provides three major avenues by which Native Americans may receive health care: directly from the federal government through the Indian Health Service, through a Title I contract to administer part of their own health care programs, or through a Title V compact to take over all of their own health care (Marley, “Ambiguous Jurisdiction” 433). Longitudinal research into the diabetes prevalence rates across time for each of the 574 federally recognized tribes should be juxtaposed against the timeline of when each individual tribe evolved from Indian Health Service dependent to Title I, and then finally to Title V. I had sought to prove that diabetes prevalence rates for Native Americans show a lagging decline as self-determination of health care increases. Further collection of specific, tribal, micro-level data is necessary to prove or disprove this point. Ultimately, this conceptual paper is a proposal for further data collection by the United States Department of Health and Human Services, which is in charge of the Indian Health Service.

Prevalence of depression and its associated factors among undergraduate admission candidates in Bangladesh: A nation-wide cross-sectional study.

The undergraduate admission test is one of the most stressful assessments in a student's life, as it is required for admission to any of Bangladesh's public universities or medical colleges. Those taking the admissions test are under a lot of pressure to perform well. This study aimed to determine the prevalence of clinical depression among Bangladeshi admission candidates and the factors that contribute to it. Patient Health Questionnaire (PHQ-9) and other socio-demographic information were collected from 5263 students from all over Bangladesh. Apart from descriptive statistics and chi-square tests, an ordinal logistic regression model was also applied to determine the factors associated with depression. The study revealed that among the undergraduate admission applicants, 74% of individuals were affected by depression, while 26% experienced moderate depression, 26% experienced moderately severe depression, and 22% experienced severe depression. The level of depression among females was 1.8 times higher than the male admission candidates. Our analyses found that gender (p <0.001), exercise (p <0.001), pre-marital relationships (p <0.001), daily study time less than 3 hours (p <0.001), practice of religion (p <0.001), victim of blackmail (p <0.001), family unrest (p <0.001), major illness (p <0.001), COVID-19 infection (p <0.001), GPA in higher secondary (p <0.001), mental problem (p <0.001), all categories of the variable confidence level for exam preparation (p <0.001) had a significant impact on increasing depression. The research found a severe rate of depression among Bangladeshi undergraduate admission candidates. Interactive mental health care programs must include family and teachers to tackle the problem. To alleviate mental stress and depression, students should learn to nurture their mental health.

Healthcare access and equity in Nigeria

This study examines government health finance, which requires patients to pay out-of-pocket even in the presence of a universal healthcare program, and how it affects Nigerians' life expectancy. Numerous investigations have indicated that socioeconomic factors impact healthcare results as well as the dispersion of medical facilities and resources throughout Nigeria. Government spending and gender life expectancy were used as indices to look at healthcare access and equity among socioeconomic determinants in Nigeria. In order to determine the impact of government health expenditure on life expectancy in relation to healthcare and equity in Nigeria, time series data was sourced from the Central Bank of Nigeria (CBN) statistical bulletin and World Population Prospects. A combination of descriptive statistics, Unit Root (ADF) test, Vector Regression (VAR), Autoregressive Distributed Lag (ARDL), Bounds test and residual diagnostics and stability test were used in the analyses. The study demonstrated a long-term, statistically significant association between the independent factors, such as male and female life expectancy, and the dependent variable, government health expenditure. Recurrent and capital health expenditures in Nigeria have been greatly impacted by the insufficient financial allocation to healthcare. It is important to remember that any health system's capital expenditures will continue to be greatly impacted by the inadequate funding. It is important to reform the healthcare finance system, ensure smart resource allocation, and shift the focus away from out-of-pocket healthcare expenses in order to improve the lives of both sexes and extend the existing life expectancy.

Collaboration from a Distance: Remote Simulation in Hybrid Healthcare Education

Introduction: Simulation is an established method to teach interprofessional collaborative practice, but little is known about best practices when using simulation for remote learning activities in allied healthcare education. This mixed-methods study seeks to provide hybrid healthcare program educators with evidence regarding the effect of a remote simulation to address the topic of interprofessional collaboration. Methods: Authors investigated student self-assessed competency, satisfaction, and self-confidence in response to a remote learning activity in which Doctor of Physical Therapy (DPT) students and licensed occupational therapists and speech language pathologists collaborated in a simulated pediatric case discussion via video-conferencing technology. The Interprofessional Collaborative Competency Attainment Survey-Revised and the Student Satisfaction and Self-Confidence in Learning scale were administered to 97 entry-level Doctor of Physical Therapy (DPT) students. One-on-one semi-structured interviews were completed to acquire student perception about the learning experience. Results: Results confirmed a significant increase in self-assessed collaborative competency attainment and students reported general levels of satisfaction and self-confidence in learning related to the interdisciplinary, remote simulated experience. Qualitative responses revealed three main themes: (1) unique interaction in a structured simulation experience, (2) ‘it was definitely a point of confirmation’, a learning experience, and (3) collaboration. Discussion: The use of remote healthcare simulation has the potential to improve interprofessional collaborative learning and practice among allied healthcare students. Faculty might consider the use of remote simulated experiences for the purpose of interprofessional learning in hybrid or online programs. Use of this teaching method within other groups of allied healthcare students should be examined. Implications for Practice Remote simulation can be an effective and satisfactory method of teaching interprofessional collaboration among allied healthcare students in hybrid programs. Quantitative and qualitative findings offer evidence that entry-level DPT students in hybrid programs value remote simulation as a learning opportunity and were engaged in the educational process. Faculty of hybrid allied health professional education programs may want to consider implementation of remote simulation for the purposes of interprofessional collaboration with the intent of readying students for practice.

Community-based care for people with chronic knee and hip pain: Preliminary clinical outcomes and healthcare utilisation for ESCAPE-pain.

Joint pain impairs physical and psychosocial wellbeing, quality of life (QoL) and has a significant socioeconomic impact. Enabling Self-management and Coping with Arthritic Pain using Exercise, ESCAPE-pain, is a rehabilitation programme that mitigates the wide impacts of joint pain. Financial, logistical and workforce constraints in health systems severely limit access to the programme. Delivering the programme by trained exercise professionals in community venues could increase access and reduce costs. Four hundred eighty-two exercise professionals were trained to deliver ESCAPE-pain at community sites to people >55years with chronic knee or hip pain. Pain, physical function, QoL, self-reported activity, mental wellbeing and healthcare utilisation (consultations, investigations, treatments, medication) were measured before, immediately after and 6months after the programme. One thousand four hundred ninety-two people (mean age 70years) were recruited. ESCAPE-pain improved pain, function, QoL, mental wellbeing and objective physical function (p<0.0001). Before the programme, only 24% of participants were classified as 'fairly active/active' (doing ≥30min activity/week); after the programme, 78% were classified as 'fairly active/active'; 6months later, 69% were still 'fairly active/active'. Participants used less healthcare after ESCAPE-pain, resulting in savings of £326.16/participant. Older people with chronic joint pain were willing to attend ESCAPE-pain when delivered by exercise professionals in community centres, and it was found to be as effective as when delivered by physiotherapists in hospitals. Delivering ESCAPE-pain in the community could facilitate access to effective care and on-going support to sustain the benefits of healthcare programmes, producing a more efficient use of health and community resources.

Do public healthcare programs make societies more equal? Cross-country evidence on subjective wellbeing

BackgroundUniversal health coverage (UHC) aims to provide quality healthcare services and safeguard the population from the financial burden of catastrophic health expenditure. Its primary objectives are to improve longevity and enhance overall quality of life. This study investigates the relationship between UHC and the inequality in subjective wellbeing (SWB) and explores whether public health programs can reduce social inequality. By employing SWB inequality as a measure, we go beyond the conventional income-centric approach to assess social inequality.MethodsThe SWB data used in this study are derived from the repeated cross-sectional survey obtained from the European Values Study (EVS) and the World Values Survey (WVS). We adopt an observational study design and employ statistical techniques, such as ordinary least squares, Oaxaca–Blinder decomposition, and the recentered influence function (RIF). The RIF, in particular, allows us to characterise the entire distribution of SWB, rather than focusing on a single point.ResultsUHC programs are negatively associated with SWB inequality (-0.070, significant at 5%). The negative association is observed at the 5th, 50th, and 75th percentiles of the SWB distribution, whilst the association becomes positive at the 95th percentile. UHC programs do not contribute to the SWB inequality gap.ConclusionsUHC programs exhibit an inequality-reduction property when the inequality is not severe or when countries are more equal. However, their effectiveness diminishes in the presence of extreme inequality. Health programs do not contribute to the existing SWB inequality gap between developed and developing countries. Strengthening the two dimensions of the UHC program (i.e., service coverage and financial protection) will ensure better health and wellbeing for all, and potentially foster a more equal and inclusive society.

Uptake of diabetes follow-up checks by minority community groups: a rapid review of the evidence for the CYMELL study

BackgroundType 2 diabetes is a public health priority for the UK. A growing body of evidence has indicated ethnic and socioeconomic disparities in rates of diabetes prevalence and complications. Attendance at diabetes follow-up checks is key to ensuring complications are identified and managed at an early stage. The aim of this rapid review was to identify and summarise evidence of ways to improve diabetes management in ethnic minority groups. MethodsIn this rapid review, we searched PubMed, PsycInfo, and CINAHL for studies published in English between Jan 1, 2000, and Jan 31, 2023. Studies were included if the population was from ethnic minority groups and if the intervention was community-based and aimed to improve diabetes self-care. The comparisons were persuasion and behaviour change, and the outcomes were improved diabetes self-management including, glycaemic control, attending eye tests, kidney, and foot screening follow-up checks. This study is registered with PROSPERO 2023, CRD42023399283. FindingsNine studies were included, from Mexico (n=1), USA (n=7), and UK (n=1). Most studies reported on community engagement (n=8), and one focussed on peer support and diabetes self-management. Peer support and diabetes self-management education were found to significantly improve diabetes control in a Mayan community (n=29) in Mexico (p<0·0001) and in the Korean American (n=105), African American (n=107), and Latino American (n=56) communities in the USA. Another study showed that women from the Pakistani community in England also benefitted from a culturally appropriate and socially supportive environment when learning about diabetes self-management. Diabetic eye screening rates could be increased through education but not through incentive payments. InterpretationCulturally competent health-care policies and programmes have been shown to increase diabetes self-management including uptake of diabetes screening for people with diabetes from ethnic minority communities to avoid potential harmful and life limiting conditions. A strength of this review is that robust, recent, and relevant papers regarding self-management of diabetes were included. The main limitations were that none of the nine studies included any cost analyses, and only one UK-based study was included, indicating that further research is required to fill the evidence gap. FundingResearch for Patient and Public Benefit (RfPPB), Health and Care Research Wales.

TB NOTIFICATION IN CHILDREN: THE EXPERIENCE OF TARGETED COMMUNITY DEMAND CREATION AMIDST INSECURITY IN IMO STATE, NIGERIA

This paper explores the challenges and successes of tuberculosis (TB) notification in children amidst a backdrop of insecurity in Imo State, Nigeria. Emphasizing targeted community demand creation strategies, the study investigates the intricate relationship between insecurity, community engagement, and pediatric TB detection. Drawing upon a comprehensive literature review, this research delves into the epidemiology, diagnosis, and treatment of TB in children, the ramifications of insecurity on healthcare access in Imo State, and effective community engagement strategies in healthcare initiatives. The literature findings underscore the substantial burden of TB among children and the distinct hurdles faced in environments characterized by insecurity. The prevailing insecurity in Imo State significantly disrupts healthcare services, leading to delays in TB diagnosis and treatment initiation. Nevertheless, the review identifies community engagement approaches as a promising avenue for bolstering TB notification rates in pediatric populations. These approaches empower local communities to actively participate in the identification and management of TB cases, ultimately contributing to the enhancement of pediatric TB notification. A conceptual framework, derived from amalgamated literature, elucidates the intricate interplay between insecurity, community engagement, and TB notification. This study highlights the pivotal role of community-driven interventions in mitigating the challenges posed by insecurity in Imo State, Nigeria, and presents actionable recommendations for the development of healthcare policies and programs tailored to the region. This research not only augments our comprehension of TB notification among children within insecure contexts but also provides valuable insights into the broader domain of community-based healthcare interventions. It underscores the exigency for customized strategies to address TB in pediatric populations in regions marked by insecurity, ultimately contributing to the amelioration of health outcomes for children in Imo State, Nigeria, and analogous settings&#x0D; Keywords: TB, Children, Community, Nigeria.

Newborn Hearing Screening in Québec, Canada.

This study discusses the history and current state of the newborn hearing screening program in Québec and aims to assess general challenges associated with establishing universal newborn hearing screening (UNHS) programs. We reviewed the statistics of the occurrence and long-term effects of congenital hearing loss and the immediate and long-term benefits of UNHS and its limitations. The resources for this study included financial reports related to establishing UNHS in different health care systems; Canadian provincial, territorial, and federal regulations and publications; local and nationwide media; and interviews health care staff and program managers. Because of its benefits and its cost-effectiveness, UNHS programs have been implemented in many health care systems around the world. Despite Canada's success in offering a wide array of health care services to its citizens, certain provinces trail behind others in developing UNHS programs. Although there have been recent improvements in the screening rate of the province of Québec, nearly half of all Québec newborns continue to not be screened for hearing loss. The reasons for the current low screening rate include delays in implementation, information-technology complications, operating costs, and lack of public awareness. For UNHS to be implemented in a timely fashion, those involved in the process should first understand what challenges may arise. Québec's experience with this process may provide useful lessons for other health care systems.

Nurse-guided mobile health care program to reduce emotional distress experienced by parents of infants prenatally diagnosed with critical congenital heart disease: A pilot study

BackgroundFollowing prenatal diagnosis of critical congenital heart disease (CCHD), parents encounter emotional distress while facing caregiving challenges. Supportive psycho-educational interventions using mobile health (mHealth) can make care more accessible. ObjectivesWe tested a novel nurse-guided mHealth care program, Preparing Heart and Mind™ (PHM™), with the objectives of examining feasibility and estimating the effect of the intervention on parents' emotional distress. MethodsThis pilot study design randomized participants using a 2:1 intervention to control ratio. Analysis involved description of retention, intervention attendance and engagement, and adjusted linear mixed models to estimate group differences in depressive (CES-D), anxiety (STAI-S), and traumatic stress (IES-r) symptoms. ResultsThe sample included 55 parents (n = 38 PHM™ group, n = 17 control). Complete retention of 37 (67 %) parents included 29 (76 %) in the PHM™ group and 8 (47 %) control. Most attrition was due to infant death (7 parents), transplant referral (2 parents), or postnatal diagnostic ineligibility (4 parents). For the PHM™ group, ≥96 % of parents attended pre- and postnatal sessions, and most (65 %) messaged with the nurse. mHealth engagement was highest prenatally, with handling uncertainty the most viewed topic (average 94 % pages viewed). In linear mixed models analyses, the PHM™ group had on average 4.84 points lower depression (95 % CI: −10.68–1.04), 6.56 points lower anxiety (−14.04–0.92), and 6.28 points lower trauma (−14.44–1.88) scores by study end. ConclusionFindings suggest that a nurse-guided mHealth approach is feasible and may contribute to a clinically important reduction in parents' emotional distress.

Development of Health Education Media About Cultural Practices of The Palu Indigenous Culture Related to Breastfeeding for Postpartum Women Who Have Been Caring at Home

The practice of providing appropriate breastfeeding for the first 6 months of life is the most important and cost-effective thing to reduce morbidity and mortality rate toward children. However, the obedience of exclusive breastfeeding in some of countries has not been satisfactory, so need the efforts to be done to increase its coverage. This study aims to develop and produces the health education media for cultural practices of the Palu indigenous culture related to breastfeeding for postpartum women who have been caring at home in Sigi Regency of Palu district in the form both of Kaili and Indonesian languages modules. This research is qualitative research with an ethnographic approach through two stages, namely: Phase I; Identification of cultural that influence the success of exclusive breastfeeding, Phase II; Development of health education media as a solution to the problem of an exclusive breastfeeding culture. The informants were taken by snowball method with a total seventeen of postpartum women, one informan key was from the community (Dukun), and one coordinator was the public health care nurse at the Biromaru Public Health Center. Data analysis in this ethnographic research is to find out the cultural themes, namely verbatim, keywords, and categories. The categories are the same and related to the sub-themes and the last step is to determine the theme itself. The research results is Phase I, Identifying both of myths and cultures that influence exclusive breastfeeding that still very well maintained, lack of womens' knowledge and womens' attitudes want to providing the exclusive breastfeeding. Phase II: development of health education media as a solution to the problem of exclusive reastfeeding culture based on the results of the phase I research. The conclusion is This study has developed a health education media related to the cultural practice of the Kaili tribe regarding exclusive breastfeeding to postpartum women who have been caring at home in Sigi Regency Palu district in the form both of Kaili and Indonesian language modules. In order to implement exclusive breastfeeding promotion media, by integrating it into the public health care program (Perkesmas), for maternal and child health programs and it need to involve community leaders by a cultural perspective.

Description and student perceptions of a medications dosing calculations course for non-healthcare majors.

To describe and assess a dosing calculations course presented to first-year college honors students who are not healthcare majors. The primary objective is, can first year undergraduate college honors students, who have not enrolled in a professional healthcare program, be successful in a calculations dosing course? The secondary objective is, what are the students' perceptions of the course? The instructor facilitated an in-person dosage calculations course, 1 h per week over 14 weeks. Small teams of students were created to facilitate learning throughout the semester. All 15 students passed the course, and overall, the student perceptions were positive. First-year college students, who were not healthcare majors, were able to be successful in a math and medications course. Overall, students had a positive perception of the course. Some students did have a concern about the relevance of the course to their future careers. This may be improved with the selection of healthcare students in the course for future offerings.

Developing an innovative pediatric integrated mental health care program: interdisciplinary team successes and challenges.

Children and adolescents often do not receive mental healthcare when they need it. By 2021, the complex impact of the COVID-19 pandemic, structural racism, inequality in access to healthcare, and a growing shortage of mental health providers led to a national emergency in child and adolescent mental health in the United States. The need for effective, accessible treatment is more pressing than ever. Interdisciplinary, team-based pediatric integrated mental healthcare has been shown to be efficacious, accessible, and cost-effective. In response to the youth mental health crisis, Rady Children's Hospital-San Diego's Transforming Mental Health Initiative aimed to increase early identification of mental illness and improve access to effective treatment for children and adolescents. A stakeholder engagement process was established with affiliated pediatric clinics, community mental health organizations, and existing pediatric integrated care programs, leading to the development of the Primary Care Mental Health Integration program and drawing from established models of integrated care: Primary Care Behavioral Health and Collaborative Care. As of 2023, the Primary Care Mental Health Integration program established integrated care teams in 10 primary care clinics across San Diego and Riverside counties in California. Measurement-based care has been implemented and preliminary results indicate that patient response to therapy has resulted in a 44% reduction in anxiety symptoms and a 62% decrease in depression symptoms. The program works toward fiscal sustainability via fee-for-service reimbursement and more comprehensive payor contracts. The impact on patients, primary care provider satisfaction, measurement-based care, funding strategies, as well as challenges faced and changes made will be discussed using the lens of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Preliminary results suggest that the Primary Care Mental Health Integration is a highly collaborative integrated care model that identifies the needs of children and adolescents and delivers brief, evidence informed treatment. The successful integration of this model into 10 primary care clinics over 3 years has laid the groundwork for future program expansion. This model of care can play a role addressing youth mental health and increasing access to care. Challenges, successes, and lessons learned will be reviewed.

Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review.

To identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems. Six academic databases were searched to identify relevant peer-reviewed journal articles published in English between July 2011 and June 2022. Studies were included if they reported on healthcare program sustainability and explicitly identified barriers to, and facilitators of, sustainability. A systematic integrative review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Study quality was appraised using Hawker's Quality Assessment Tool. A team of reviewers screened eligible studies against the inclusion criteria and extracted the data independently using a purpose-designed Excel spreadsheet. Barriers and facilitators were extracted and mapped to the Integrated Sustainability Framework (ISF). Frequency counts of reported barriers/facilitators were performed across the included studies. Of the 124 studies included in this review, almost half utilised qualitative designs (n = 52; 41.9%) and roughly one third were conducted in the USA (n = 43; 34.7%). Few studies (n = 29; 23.4%) reported on program sustainability beyond 5years of program implementation and only 16 of them (55.2%) defined sustainability. Factors related to the ISF categories of inner setting (n = 99; 79.8%), process (n = 99; 79.8%) and intervention characteristics (n = 72; 58.1%) were most frequently reported. Leadership/support (n = 61; 49.2%), training/support/supervision (n = 54; 43.5%) and staffing/turnover (n = 50; 40.3%) were commonly identified barriers or facilitators of sustainability across included studies. Forty-six (37.1%) studies reported on the outer setting category: funding (n = 26; 56.5%), external leadership by stakeholders (n = 16; 34.8%), and socio-political context (n = 14; 30.4%). Eight studies (6.5%) reported on discontinued programs, with factors including funding and resourcing, poor fit, limited planning, and intervention complexity contributing to discontinuation. This review highlights the importance of taking into consideration the inner setting, processes, intervention characteristics and outer setting factors when sustaining healthcare programs, and the need for long-term program evaluations. There is a need to apply consistent definitions and implementation frameworks across studies to strengthen evidence in this area. https://bmjopen.bmj.com/content/7/11/e018568 .

The Role of HTA for Essential Health Benefit Package Design in Low or Middle-Income Countries

ABSTRACT This Commentary explores the relationship between Health Technology Assessment (HTA) and Health Benefits Package (HBP) design to achieve Universal Health Coverage (UHC) in low- and middle-income countries. It emphasizes that while HTA evaluates individual healthcare interventions, HBP reform aims to create comprehensive service sets considering overall population health needs and available resources. Challenges in LMICs include limited local data and technical capacity, leading to reliance on cost-effectiveness estimates from other settings. We suggest a practical approach by combining HTA and HBP elements through a hybrid or compartmentalized method. This approach sets differentiated cost-effectiveness thresholds for specific healthcare platforms or programs (e.g., primary care or essential surgery), aligning priority-setting with organizational considerations, ethics, and implementation strategies. Strong institutions and academic support are vital for evidence-informed priority-setting processes. In summary, HTA can play a pivotal role in designing HBPs for UHC in LMICs, and a compartmentalized approach can enhance priority-setting while considering budget constraints and equity.

Health evaluation: the level of implantation of the tuberculosis program in primary health care

Health evaluation: the level of implantation of the tuberculosis program in primary health care

Gender transformative approaches in mHealth for maternal healthcare in sub-Saharan Africa: a systematic review.

This review focuses on studies about digital health interventions in sub-Saharan Africa. Digital health interventions in sub-Saharan Africa are increasingly adopting gender-transformative approaches to address factors that derail women's access to maternal healthcare services. However, there remains a paucity of synthesized evidence on gender-transformative digital health programs for maternal healthcare and the corresponding research, program and policy implications. Therefore, this systematic review aims to synthesize evidence of approaches to transformative gender integration in digital health programs (specifically mHealth) for maternal health in sub-Saharan Africa. The following key terms "mobile health", "gender", "maternal health", "sub-Saharan Africa" were used to conduct electronic searches in the following databases: PsycInfo, EMBASE, Medline (OVID), CINAHL, and Global Health databases. The method and results are reported as consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Data synthesis followed a convergent approach for mixed-method systematic review recommended by the JBI (Joanna Briggs Institute). Of the 394 studies retrieved from the databases, 11 were included in the review. Out of these, six studies were qualitative in nature, three were randomized control trials, and two were mixed-method studies. Findings show that gender transformative programs addressed one or more of the following categories: (1) gender norms/roles/relations, (2) women's specific needs, (3) causes of gender-based health inequities, (4) ways to transform harmful gender norms, (5) promoting gender equality, (6) progressive changes in power relationships between women and men. The most common mHealth delivery system was text messages via short message service on mobile phones. The majority of mHealth programs for maternal healthcare were focused on reducing unintended pregnancies through the promotion of contraceptive use. The most employed gender transformative approach was a focus on women's specific needs. Findings from gender transformative mHealth programs indicate positive results overall. Those reporting negative results indicated the need for a more explicit focus on gender in mHealth programs. Highlighting gender transformative approaches adds to discussions on how best to promote mHealth for maternal health through a gender transformative lens and provides evidence relevant to policy and research. PROSPERO CRD42023346631.

Antepartum Depression and Its Clinico-Social Correlates: A Cross Sectional Study in a Tertiary Hospital of North India.

Maternal depression, the second leading cause of disease burden in women worldwide is often under-diagnosed and untreated. It can have consequences for pregnancy outcomes and child health. (1) To estimate the prevalence of antepartum depression among females attending antenatal clinic of a tertiary hospital. (2) To determine its obstetric and clinico-social correlates. A cross-sectional study was conducted in antenatal clinic by consecutive sampling of 300 pregnant women. We included those in third trimester, aged 18-40years and giving informed consent and excluded those with pre-diagnosed mental disorders. Pre-tested structured questionnaire and Edinburgh postnatal depression scale used. Score ≥ 10 indicated possible antepartum depression (APD). Chi-square test and logistic regression analysis applied using IBM SPSS version 22.0. P < 0.05 was considered statistically significant. Prevalence of possible APD was 23.3%. It was higher among urban females (25.3%) than rural (17.7%) but the difference was not statistically significant. APD increased with increasing maternal age. Other socio-demographic and obstetric factors were not associated significantly with APD. History of recent stressful life event, domestic violence, marital conflict, lack of support from husband, and preference of male child were found to be the significant correlates. More than one out of five antenatal females had possible antepartum depression, but none had sought treatment for the same. Antenatal women of higher age and those afflicted with social pathologies are more at risk. Screening for APD should be included in the maternal and child health care programme to address this hidden 'iceberg' disease.

Abstract 17879: Assessing the Safety of an Early Repatriation Strategy for Uncomplicated ST-Elevation Myocardial Patients After Primary Percutaneous Intervention

Introduction: Repatriation of patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) is common in Canadian regional health care programs. However, the safety of early repatriation after PPCI in uncomplicated STEMI patients remains unknown. We aimed to compare the outcomes between uncomplicated STEMI patients repatriated early (transfer to home hospital ≤4hrs of PPCI completion) vs. those who remained at the PPCI-hospital until discharge. Methods: We performed a retrospective, cohort study examining consecutive, uncomplicated STEMI patients treated with PPCI between 2016-2018 in the Fraser Health Authority. Patients were designated as uncomplicated if there was no evidence of cardiogenic shock, prolonged cardiac arrest or congestive heart failure requiring mechanical ventilation. Outcomes of interest included discharge with guideline-based medical therapy (GBMT) and a composite of 1-year major cardiovascular events. Results: A total of 787 patients were included for analysis, with 62% (n=492) being repatriated early. Early repatriated patients were similar in age and baseline characteristics when compared with those discharged from the PPCI-based hospital. Interestingly, early repatriated patients were more likely to be discharged on GBMT (89% vs. 83%, p=0.015) In multivariate analysis, early repatriation was not associated with worsened 1-year cardiovascular outcomes (OR 1.05, 95% CI 0.6782,1.6521, p=0.80). Independent predictors of 1-year major cardiovascular outcomes included hypertension (OR 1.75, 95% CI 1.0918-2.8349, p=0.02) and discharge with GBMT (OR 0.49, 95% CI 0.2831-0.8465, p=0.01). Amongst the subset of early repatriated patients, primary treatment by cardiologist vs internist did not result in differences in 1-year outcomes (10% vs. 8%, p=0.23) or discharge with GBM (87% vs. 83%, p=0.09). Conclusions: Early repatriation of uncomplicated STEMI patients after PPCI was associated with outcomes similar to those having ongoing care at the PPCI-based hospital. Therefore, early repatriation serves as a safe treatment strategy for regional STEMI programs and may be particularly relevant for PPCI centres with limited bed capacity.

Embracing diversity: a healthcare immersion program for under-represented high school students, creating a pipeline for diversity in medicine

Embracing diversity: a healthcare immersion program for under-represented high school students, creating a pipeline for diversity in medicine