Training Of Care Providers Research Articles

Délais diagnostiques et parcours des patientes souffrant d’endométriose en France : une étude multicentrique

IntroductionThe diagnosis of endometriosis is often difficult to make, generating a median diagnostic delay ranging from 2 to 10.7years. A study of the care pathway of these patients seems essential in order to evaluate the diagnostic delay of endometriosis in France and the factors related to the diagnostic delay. MethodsThis is a prospective multicenter study, conducted between 2017 and 2019. A questionnaire concerning their care pathway and their feelings about the diagnosis was distributed to all patients consulting for endometriosis. Statistical analyses were performed using the Kruskal-Wallis, Chi2 and Student's t tests. ResultsFifity-seven of the 84 patients (67.8%) who completed the questionnaire were included in the evaluation of diagnostic delays. The total diagnostic delay was 12years (min 0; max 33) and was comparable between all inclusion cities (P=0.68). Regarding the care pathway according to specialties, the diagnosis of endometriosis was made by gynecologists in 81% of patients versus 19% by general practitioners. The time between the onset of symptoms and the first consultation was significantly shorter in favor of the general practitioner (2years versus 4years, P=0.012). 60% of the patients reported that their symptoms were labelled as “normal” by the physicians and 35% of them considered them normal themselves. ConclusionOur study showed that the delay in diagnosis in France was still very long and that the mechanisms of the delay in management were multifactorial. Awareness raising and training of health care providers remains one of the major areas to be optimized.

The Effects of Obstetric Emergency Team Training on Patient Outcome: A Systematic Review and Meta-Analysis

(Acta Obstet Gynecol Scand. 2022;101:25–36. doi: 10.1111/aogs.14263) Participants in simulation-based team training in obstetric emergencies often report increased confidence in their ability to manage unfolding emergencies that may present in actual practice. However, empirical data that examines the efficacy of such training on impacting clinical outcomes is incomplete. This review assesses the contribution of simulation-based training for health care providers to the outcomes of obstetric emergencies.

The impact of the COVID-19 pandemic on palliative care practice: A survey of clinical oncologists.

Palliative care is an essential intervention to improve the quality of life for patients with cancer, whereas the ongoing COVID-19 pandemic poses a challenge to supportive and palliative care providers. This survey aims to explore the current status of palliative care practice for cancer and the influence of COVID-19, from the perspective of oncologists. The semi-structure electronic questionnaire was designed. Mixed-mode surveys including electronic questionnaires, face-to-face interactions, and telephone interviews were adopted according to the willingness of respondents. Face-to-face and telephone interviews were based on same questions in the online questionnaire. Participants working in cancer-related departments with frontline palliative care experience during the COVID-19 outbreak were included. Surveys covered experiences and perspectives regarding the impact of COVID-19 on clinical work, personal lives, and palliative care practice. Suggestions on coping strategies were further proposed and qualitatively analyzed. Thirty-seven oncologists participated in this study from September 2021 to January 2022. The majority of them believed COVID-19 significantly and negatively affected their clinical work routines (75.7%), personal daily lives (67.6%), and palliative care practice (64.9%). Most specialists considered that currently the palliative care system remained underdeveloped (73.0%), and other factors besides COVID-19 were associated with this situation (78.4%). Seventeen participants further made suggestions on how to promote palliative care during COVID-19, and three themes emerged through the qualitative analysis: (1) Remote or online service (88.2%); (2) Publicity, education, or shared decision-making for patients (29.4%); (3) Guidelines, training, or programs for care providers (23.6%). Oncologists consider that COVID-19 has an adverse impact on their palliative care practice and daily routine. In addition to COVID-19, other factors affecting palliative care should not be neglected. Corresponding measures are warranted to encourage palliative care practice during COVID-19.

The role of self-regulation strategies in physical activity behavior change: results from an exercise prescription program at a Federally Qualified Health Center

ABSTRACT Physical activity (PA) improves quality of life and prevents chronic disease, yet many adults are inactive. Planning with health care providers in the form of exercise “prescriptions“ may increase PA, but the role of individual psychosocial factors within exercise prescription programs is not well understood. Therefore, the purpose of this study is to describe the role of self-regulation strategies (e.g., goal setting, self-monitoring, reinforcements) in PA behavior change within the context of an exercise prescription program. Patients at a large, Federally Qualified Health Center with an on-site exercise facility (ie, ”Wellness Center”) referral were eligible to exercise with a personal fitness advisor. Self-reported PA and use of 15 self-regulation strategies were measured via survey at two time points and merged with electronic health records and attendance data. Patients (n = 151) were, on average, 50.3 ± 13.3 years and mostly female (76.8%). Almost one-third (30.5%) were Hispanic/Latino, 48.3% were non-Hispanic Black, and 20.5% were non-Hispanic white. Participants completed 10.7 ± 12.0 in-person exercise sessions with a fitness advisor. Between baseline and follow-up, the self-regulation strategies that had the largest change in frequency over time were keeping track of PA (p < 0.001), thinking about surroundings (p < 0.001), rewarding yourself for PA (p < 0.001), making PA more enjoyable (p < 0.001), setting goals (p < 0.001), and trying different kinds of PA (p < 0.001). Among exercise prescription program participants, the total self-regulation strategies score was significantly associated with physical activity at follow-up (p = 0.04). Leveraging self-regulatory skill-building activities within the context of exercise prescription programs in clinical settings may provide a personalized and multicomponent approach to PA promotion. Self-regulation strategy training for fitness advisors and/or health care providers has great potential for supporting long-term health behaviors like PA for managing chronic disease among underserved patients.

A Point of Care Quality Improvement Initiative for Enhancing Immediate Drying of Babies and Prevention of Hypothermia in Labor Room, Nishtar Medical University, Multan Pakistan

Objective: To find out the current status of prevention of neonatal hypothermia by firstly, initialization of immediate drying and skin to skin contact of all newborns delivered by spontaneous vaginal delivery, and secondly, to initiate early breast feeding. Methodology: This was an observational study carried out in labor room of Gyne Unit 1, Nishtar Medical University (NMU) and Hospital, Multan Pakistan from April to September 2019. Based on “Point of Care Quality Improvement (POCQI)” guidelines, Initially, data were collected for 4 weeks during morning shift (phase 1) utilizing 2 indicators i-e immediate drying and number of babies who developed hypothermia within one hour of birth. Data were analyzed; results interpreted, and necessary modifications made. After implementation of changes further data was collected for 24 hours shift of gyne unit 1 for the rest of study period including additional indicators i.e., initiation of early breastfeeding and skin to skin contact. Results: A total of 744 babies delivered over a period of six months during this initiative, which was carried out in 2 phases, the phase-1 comprised of four weeks and included study of 24 babies and the phase 2 included 720 babies over five months. During phase-1, all 24 (100%) newborns were dried immediately after birth and the temperature was recorded among 20 (83.3%) of the babies with lost to follow up of 4 (16.7%) babies due to shifting to NICU for intensive care. During the second phase, among 720 babies that were delivered, 590 (81.9%) received skin-to-skin care for minimum of half hour due to rapid turnover of patients for delivery in labor room. Breastfeeding was initiated within one hour after birth in 593 babies (82.3%). Temperature was recorded among 528 (73.3%) babies with 37 (5.1%) shifted to NICU. Hypothermia was observed in 10 babies (1.4%) during this phase. Practical Implications: Hypothermia is a preventable cause of neonatal mortality which can be easily prevented by training of health care providers, midwives, and lady health visitors to incorporate components of essential newborn care in their medical practice. Conclusion: Implementation of POQCI was found to be highly applicable yielding good response. Keywords: Newborn, hypothermia, immediate drying, point of care quality improvement, neonatal intensive care unit.

Australian fertility preservation guidelines for people with cancer 2022: review and recommendations.

Australian fertility preservation guidelines for people with cancer 2022: review and recommendations.

A collaboration to improve perioperative acute pain care at the University Teaching Hospital of Butare, Rwanda

&#x0D; &#x0D; &#x0D; BACKGROUND: A perioperative acute pain care program integrating standardized assessment and treatment forms into pain care was developed and implemented at an urban hospital in Rwanda through a collaboration between Rwandan and Canadian experts. This study evaluated the perioperative acute pain care program using a quality improvement lens.&#x0D; METHODS: Using the Model for Improvement: Plan, Do, Study, Act (PDSA) cycle, a mixed methods evaluation was performed. Over one year, 519 randomized patient chart audits were conducted and analyzed through control charts. Through purposeful sampling, focus groups comprised ofsurgeons and nurses (N=34) involved in pain care in surgery, obstetrics, and anesthesiology were performed and analyzed via thematic coding.&#x0D; RESULTS: The average attempted form completion rate across all forms varied monthly between 56-93% (mean=79%; median=81%). Across all forms, both the mean and median total number of errors per form were 12.5. Enablers of form use included improved pain care for patients and feelings of professional satisfaction. Program implementation was challenged by resource constraints, form integration, and health care provider training.&#x0D; CONCLUSION: Future quality improvement collaborations should identify and address improved pain care while working with local experts to ensure PDSA cycles are continuous, and evidence based.&#x0D; &#x0D; &#x0D;

Readiness of the primary health care units and associated factors for the management of hypertension and type II diabetes mellitus in Sidama, Ethiopia.

BackgroundIn low-income nations such as Ethiopia, noncommunicable diseases (NCDs) are becoming more common. The Ethiopian Ministry of Health has prioritized NCD prevention, early diagnosis, and management. However, research on the readiness of public health facilities to address NCDs, particularly hypertension and type II diabetes mellitus, is limited.MethodsThe study used a multistage cluster sampling method and a health facility-based cross-sectional study design. A total of 83 health facilities were evaluated based on WHO’s Service Availability and Readiness Assessment (SARA) tool to investigate the availability of services and the readiness of the primary health care unit (PHCU) to manage type II diabetes and Hypertension. Trained data collectors interviewed with PHCU head or NCD focal persons. The study tried to investigate (1) the availability of basic amenities and the four domains: staff and guidelines, basic equipment, diagnostic materials, and essential medicines used to manage DM and HPN, (2) the readiness of the PHCU to manage DM and HPN. The data were processed by using SPSS version 24. Descriptive statistics, including frequency and percentage, inferential statistics like the chi-square test, and logistic regression models were used to analyze the data.ResultsOf the 82 health facilities, only 29% and 28% of the PHCU identified as ready to manage HPN and DM. Facility type, facility location, presence of guidelines, trained staff, groups of antihypertensive and antidiabetic medicines had a significant impact (P < 0.05) on the readiness of the PHCU to manage HPN and DM at a 0.05 level of significance. Facilities located in urban were 8.2 times more likely to be ready to manage HPN cases than facilities located in rural (AOR = 8.2, 95% CI [2.4–28.5]) and P < 0.05.Conclusion and recommendationThe results identified comparatively poor and deprived readiness to offer HPN and DM services at lower-level health facilities(health centers). Equipping the lower-level health facilities with screening and diagnostic materials, essential medicines, and provision of basic training for the health care providers and NCD guidelines should be available, especially in the lower health care facilities.

Interprofessional Collaboration in Fall Prevention: Insights from a Qualitative Study.

(1) Background and objective: to explore the experiences of Swiss health care providers involved in a community fall prevention pilot project on barriers and facilitations in interprofessional cooperation between 2016 and 2017 in three regions of Switzerland. (2) Methods: semi-structured interviews with health care providers assessed their perspective on the evaluation of jointly developed tools for reporting fall risk, continuous training of the health care providers, sensitizing media campaigns, and others. (3) Results: One of the project’s strengths is the interprofessional continuous trainings. These trainings allowed the health care providers to extend their network of health care providers, which contributed to an improvement of fall prevention. Challenges of the project were that the standardization of the interprofessional collaboration required additional efforts. These efforts are time consuming and, for some categories of health care providers, not remunerated by the Swiss health care system. (4) Conclusions: On a micro and meso level, the results of the present study indicate that the involved health care providers strongly support interprofessional collaboration in fall prevention. However, time and financial constraints challenge the implementation. On a macro level, potential ways to strengthen interprofessional collaboration are a core element in fall prevention.

Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study.

BackgroundThe COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population.ObjectiveThe aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic.MethodsWe conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework.ResultsWe identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that “one size does not fit all,” and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients’ abilities to access necessary health care.ConclusionsThis study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models.

Patient and Family-Centered I-PASS SCORE Program: Resident and Advanced Care Provider Training Materials.

IntroductionPatient and family-centered rounds (PFCRs) are an important element of family-centered care often used in the inpatient pediatric setting. However, techniques and best practices vary, and faculty, trainees, nurses, and advanced care providers may not receive formal education in strategies that specifically enhance communication on PFCRs.MethodsHarnessing the use of structured communication, we developed the Patient and Family-Centered I-PASS Safer Communication on Rounds Every Time (SCORE) Program. The program uses a standardized framework for rounds communication via the I-PASS mnemonic, principles of health literacy, and techniques for patient/family engagement and bidirectional communication. The resident and advanced care provider training materials, a component of the larger SCORE Program, incorporate a flipped classroom approach as well as interactive exercises, simulations, and virtual learning options to optimize learning and retention via a 90-minute workshop.ResultsTwo hundred forty-six residents completed the training and were evaluated on their knowledge and confidence regarding key elements of the curriculum. Eighty-eight percent of residents agreed/strongly agreed that after training they could activate and engage families and all members of the interprofessional team to create a shared mental model; 90% agreed/strongly agreed that they could discuss the roles/responsibilities of various team members during PFCRs.DiscussionThe Patient and Family-Centered I-PASS SCORE Program provides a structured framework for teaching advanced communication techniques that can improve provider knowledge of and confidence with engaging and communicating with patients/families and other members of the interprofessional team during PFCRs.

APA Pleased Over Recent Legislative Wins but Must Keep Pushing

APA Pleased Over Recent Legislative Wins but Must Keep Pushing

Evaluation of Clinical Communicational Skill Training Period in Isfahan Dental School 2014

Introduction: Professional ethics in any field of medical specialties lead to better communication between patient and doctor and ultimately improve the quality of health care and patient satisfaction will follow. So, we aimed to evaluate the professional communication skills in students before and after training in an attempt to improve the clinical skills in all students of medicine and dentistry.&#x0D; Materials &amp; Methods: This quasi experimental study had 100 dental students from Isfahan University of Medical Sciences enrolled in the year 2016 before and after taking the course and were rated using valid and reliable questionnaires and then the scores were compared. The data was analysed via independent-t test and co-variance. P value = 0.05 was considered statistically significant.&#x0D; Results: Based on the results of data analysis a difference between the level of students' knowledge before and after the lessons were observed. Moreover, the mean score for men and women after completing the course did not significantly differ. Based on the results of independent t test scores in men and women's clinical skills before taking the course, there was no significant difference (p value = 0.689). There was no significant relationship between other subscales and gender before and after training (p value = 0.2).&#x0D; Conclusion: According to the results of data analysis, the theoretical presentation of the course has improved students' perceptions of clinical skills. Therefore, taking into account the views of dental students is one of the necessary elements in improving the education and training of oral health care providers in the community in the future.

Exploring Enablers and Barriers to Utilize Printed Information, Education, and Communication Materials Among Healthcare Providers of North Shoa Zone, Oromia, Ethiopia

BackgroundInformation, education, and communication (IEC) materials have paramount relevance in primary health care which mainly focused on disease prevention and control. They are a cost-effective approach for achieving better health outcomes in all clinical and public health interventions. This study aimed to explore enablers and barriers to utilize printed IEC materials among healthcare providers of North Shoa Zone, Oromia, Ethiopia, 2020.MethodsA descriptive, qualitative study was conducted from December 1, 2020, to December 30, 2020, among health care providers. A judgmental sampling technique was used and 20 key informants were recruited considering their educational level, professional categories, working units, work experience, and types of health facilities. The data were collected by using a semi-structured interview guide. The transcribed data were uploaded into ATLAS. ti version 7.5.18 software. Then, the inductive process of thematic analysis was employed and the data were coded, categorized, and thematized. Direct quotations were presented with a thick description of the findings.ResultsThe findings of the study were discussed under four themes of enablers and four themes of barriers. The four themes of enablers were availability of printed IEC materials, distribution of printed IEC material, perceived usefulness of printed IEC materials, and support from the non-government organization. The four themes of barriers were printed IEC materials-related factors, patients related factors, health care provider’s related factors, and government-related factors.ConclusionIn this study, we found that the utilization of IEC materials was influenced by a number of facilitators and barriers. Thus, all concerned bodies need to give due attention to IEC materials and work towards the improvement of the quality of IEC materials, provide training for health care providers, work to increase the availability of IEC materials, and distribute them to the health facilities.

Magnitude of Depression and Associated Factors Among Patients on Tuberculosis Treatment at Public Health Facilities in Harari Regional State, Eastern Ethiopia: Multi-Center Cross-Sectional Study.

BackgroundDepression among tuberculosis patients remains a significant public health concern. Its burden and severity is increasing in low-income countries, especially in sub-Saharan Africa. Although it has negative impacts on quality of life, depression among tuberculosis patients is rarely studied in Ethiopia, particularly in the study area. Therefore, this study aimed to determine the magnitude of depression and associated factors among tuberculosis patients in Eastern Ethiopia.MethodsA facility-based cross-sectional study was conducted from April 15 to May 15, 2021, among 213 tuberculosis patients in public health facilities of the Harari Regional State, Eastern Ethiopia. Study participants were selected using a systematic sampling technique. Data were collected using interviewer-administered questionnaire. Depression was assessed using Patients Health Questionnaire-9 (PHQ-9). Epi-data and SPSS were used for data processing and analysis. Bi-variable and multivariable logistic regressions were employed to determine the effects of predictors on depression. Statistical significance was considered at a p-value <0.05.ResultsThe magnitude of depression among tuberculosis patients was 52.1% [95% CI (45.4, 58.8%)]. Patient’s age of 25–34 years [AOR = 0.31, 95% CI (0.128, 0.75)], female sex [AOR = 5.04; 95% CI (2.18, 11.62)], intensive phase of tuberculosis treatment [AOR = 2.56; 95% CI (1.118, 5.876)], HIV-positive status [AOR = 7.143; 95% CI (1.55, 32.93)], smoking history [AOR = 9.08; 95% CI (3.35, 24.61)] and having poor social support [AOR = 4.13; 95% CI (1.29, 13.22)] were factors statistically associated with depression.ConclusionIn this study, the magnitude of depression was relatively high as more than half of the participants had depression. Advanced age, female sex, intensive phase of tuberculosis treatment, HIV-positive status, smoking history, and poor social support were identified as associated factors with depression. Therefore, this result calls all stakeholders to give duly emphasis on incorporating and integrating mental health support programs as routine practice in tuberculosis follow-up clinics, as screening, early detection and treatment, and training for all health care providers are very crucial in tackling depression among tuberculosis patients.

Attitudes and Perceptions Regarding Sexual Health History Taking; A Cross-Sectional Study Among Undergraduate Medical Students of College of Medicine and Health Sciences, Oman

Background: Sexual health has been recognised as an essential dimension of health. Therefore, sexual health training of health care providers assumes a significant role. The present study was conducted to assess the attitudes and perceptions of final-year medical students regarding sexual health history taking at a medical college in Oman. Methods: The present cross-sectional survey was conducted among 81 final-year medical students. Demographic characteristics, attitudes and perceptions of the participants regarding sexual health history taking were collected using a self-administered questionnaire after obtaining informed consent. Prior approval was obtained from the institutional research and ethics committee. Statistical analysis was conducted using SPSS 20.0 Results: The mean age of the participants was 24.19 ± 1.03 years. Most of the participants (97.6%) opined that it was important for doctors to know how to elicit a sexual health history. Most of the participants were aware of their limitations in eliciting sexual health history and recognizing gender and cultural differences (67.9%) as barriers while communicating sexual health problems with the patients. About 50%of the participants responded that they had satisfactory understanding of sexual health (50.7%); a similar number had an adequate understanding of sexual health problems (53.1%). Majority (65.4 %) of the participants were interested in learning about sexual health. Conclusion: The present study revealed that medical students recognised the importance of sexual health history taking and their strengths and limitations regarding the same. The study revealed the barriers to effective communication between students and patients in matters of sexual health, which pave the way to improve teaching-learning programs and ultimately contribute to providing effective holistic health care.

Reviewing a model of public-private mix employed for tuberculosis control in Pakistan

This narrative review of the public private mix (PPM) TB plan by comprehensively evaluated the performance of this initiative in case reporting, management, treatment outcome, affordability, and accessibility from the district health system data to the TB Control Programs. Comprehensive literature review was done from the peer-reviewed journals; reports including global and national TB control programs along with technical guidelines on PPM were reviewed. This paper focusses on PPM model in the TB case notification since its establishment in Pakistan based on the data reported by national TB control mechanisms by reviewing the involvement of and TB case contribution by private health care providers, active case finding through chest camps, TB case finding through enhanced case findings in large private hospitals, and case finding through lady health workers. PPM is a promising strategy for TB care and control and scaling up of PPM should include financial support in addition to material inputs. Moreover, improving program governance and training for the health care providers with the help of integrated collaborative mechanisms is warranted. There should be a standard reporting system for private practitioners for setting up standard guidelines for the Tuberculosis treatment.

Munich Alliance Against Depression.

Background: A four-level community-based intervention aiming simultaneously to improve the care for depression and to prevent suicidal behavior has been implemented in the German city Munich. Aims: Changes in suicide rates in Munich during 2009-2014 were analyzed with respect to a 10-year baseline. The same was true for a control region (Cologne) and Germany minus Munich. Method: The interventions included training of primary care providers, a public awareness campaign, training of community facilitators, and support for patients and relatives. Analyses included repeated-measures, generalized linear models. Results: In Munich, the suicide rate significantly decreased during the intervention period compared to baseline (percentage change = -15.0%; p < .001, 198 compared to 222 suicides per year). Differences in the change for Munich and the change for the control locations (Cologne; -1.7%; p = .71) and Germany minus Munich (-6.2%; p = .09) were not significant. Limitations: Data on suicide attempts were unavailable. Conclusion: In Munich, a clinically and statistically significant decrease in suicide rate was found. This change was numerically but not significantly larger than in the control regions. The results are promising, however. Because of low suicide base rates and limited power, no strong conclusions can be drawn concerning suicide preventive effects of the intervention.

Self-rated health and quality of life among Syrian refugees in Ireland – data from a cross-sectional study

IntroductionAs a response to the humanitarian crisis in Syria, the Irish government agreed to accept up to 4000 refugees for resettlement in Ireland in 2016. Prior to their arrival in Ireland, health screening was carried out by the International Organisation for Migration. However, no population-level measurement of the health status or needs takes place in Ireland to inform policy or health services requirements.MethodsCross-sectional data from a self-completed questionnaire among 194 Syrian Refugees aged 16 years and older resident in reception centres in Ireland in 2017/2018 is reported upon. The questionnaire measured self-reported health including quality of life and all study material were available in English and Arabic. The data was examined applying descriptive statistics and regression analysis.ResultsSyrian Refugees in Ireland consist of a relatively young cohort; in this study the majority of participants were younger than 35 years (69.5%). Two-thirds of the respondents reported their overall health status to be good or very good. The most common health condition was found to be headache and the most common medications used were painkillers. Chronic pain was experienced by one quarter of respondents; 27.5% were considered as suffering from anxiety and 10.0% had symptoms compatible with post-traumatic stress disorder (PTSD). A significant relationship was observed between chronic pain and self-rated health, as well as between chronic pain and anxiety. Quality of life (QoL) scores were lowest for the QoL environment domain.ConclusionsChronic pain is relatively widespread among these young and otherwise healthy refugees. Psychological distress and trauma are important factors in respondents’ quality of life scores. Chronic pain is associated with one’s mental health. Our findings and the literature suggests that the diagnosis and treatment of pain and providing care in a culturally sensitive manner should be a priority and included in the preparation and training of the relevant care providers. Additionally, the impact of living conditions on quality of life should not be underestimated.

Impact of introduction of the growth assessment protocol in a South Indian tertiary hospital on SGA detection, stillbirth rate and neonatal outcome

India has a high rate of stillbirths, and many deaths are due to fetal growth restriction and potentially preventable. Screening and identification of the small for gestational age (SGA) fetus during the antenatal period has been shown to reduce stillbirths. We set out to evaluate the impact of implementing the Growth Assessment Protocol (GAP), a programme designed for screening for SGA. Observational study comparing two-time epochs; before (years 2011-2014) and after (years 2015-2018) introduction of GAP. The programme includes identification of risk factors, risk categorization, serial fundal height measurement, customised fetal growth charts and appropriate referral protocols. Fetal growth charts and birth centiles were generated based on the hospital database of normal outcome pregnancies, customised to women's ethnicity, parity, height, and weight. The protocol was introduced following training of obstetric and midwifery care providers. We evaluated SGA detection rates, stillbirth rates (from 28weeks) and neonatal morbidity at term. There were 26,199 and 31,498 births, with 115 and 108 stillbirths in the pre and post-GAP implementation periods, respectively. SGA detection rates increased from 51.1 to 67.1%, representing a 31% improvement (p<0.001). Overall stillbirth rates declined from 4.4 to 3.4 per 1000 births (RR 0.78 CI 95% 0.60-1.02) and at term from 1.5 to 0.6 (RR 0.37 CI 95% 0.20-0.66). Neonatal intensive care admission and neonatal encephalopathy in term neonates also decreased significantly. Introduction of the GAP programme in an Indian tertiary maternity service was associated with improved antenatal detection of SGA and reduced stillbirth rates and neonatal morbidity.