Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project.

BACKGROUND: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM-a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam-was implemented from 2013-2016 with promising results. Despite mMOM's findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. OBJECTIVE: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19-related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. METHODS: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women's unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam's Ministry of Health for adoption and further scaling up. RESULTS: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. CONCLUSIONS: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44720.

A framework of freshwater services flow model into assessment on water security and quantification of transboundary flow: A case study in northeast China.

Ecosystem service flow dynamics which establish the linkage between human and nature is essential in an ecosystem service assessment. This study constructed an ecosystem service flow model of freshwater flow then utilized it to assess the water-related ecosystem services in northeast China. We included the provision, consumption, and spatial flow of freshwater services in an index to assess the water security condition and quantified the services trans-boundary flow from the northeast forest belt (NFB) in northeast China. Our results showed that large areas (50.54%, 55.10% and 52.90%, respectively) of northeast China received upstream freshwater service in three years. The water security condition of northeast China deteriorated from 2005 to 2015 with the change of water security index considering water flow (WSIflow), mainly influenced by precipitation and agriculture water consumption. Approximately 4.16 billion m3 of freshwater service were delivered from NFB to surrounding regions demonstrating the importance of NFB in terms of ecosystem service provision. In addition, 73 key watersheds (4.71% of total area) within NFB that significantly affect the trans-boundary flow were further identified. We suggested that local government should advocate develop water-saving agriculture and livestock water quotas. Moreover, priorities should be given to protect the key watersheds within NFB in order to maintain the supply of freshwater service. This study provided a framework for exploring suitable strategies for managing water resources and laid a foundation for promoting the ecological compensation in the future.

Environmental integrated assessment via Monte Carlo simulation with a case study of the Mid-Atlantic region, USA.

Environmental integrated assessments are often carried out via the aggregation of a set of environmental indicators. Aggregated indices derived from the same data set can differ substantially depending upon how the indicators are weighted and aggregated, which is often a subjective matter. This article presents a method of generating aggregated environmental indices in an objective manner via Monte Carlo simulation. Rankings derived from the aggregated indices within and between three Monte Carlo simulations were used to evaluate the overall environmental condition of the study area. Other insights, such as the distribution of good or bad values of indicators at a watershed and/or a subregion, were observed in the study.

Sensitivity analysis of aggregated indices for integrated assessment with a case study of the Mid-Atlantic region.

Environmental indicators are often aggregated into a single index for various purposes in environmental studies. Aggregated indices derived from the same data set can differ, usually because the aggregated indices' sensitivities are not thoroughly analyzed. Furthermore, if a sensitivity analysis is carried out, it is not presented in a transparent fashion to policy decision-makers. This paper presents a method of generating various aggregated environmental indices and analyzing their sensitivities via the use of the fuzzy set concept. Results show that several insights into the environmental conditions of the study area (e.g., the distribution of good or bad values of indicators at a watershed and or across the region) can be revealed in the sensitivity analysis of aggregated indices.

Imaging popliteal artery disease in young adults with claudication: self-assessment module.

The educational objectives of this self-assessment module on imaging popliteal artery disease in young adults with intermittent claudication are for the participant to exercise, self-assess, and improve his or her knowledge of the imaging and clinical features of popliteal artery entrapment syndrome, cystic adventitial disease,and masses associated with popliteal artery obstruction.

An overview of data integration methods for regional assessment.

The U.S. Environmental Protections Agency's (U.S. EPA) Regional Vulnerability Assessment(ReVA) program has focused much of its research over the last five years on developing and evaluating integration methods for spatial data. An initial strategic priority was to use existing data from monitoring programs, model results, and other spatial data. Because most of these data were not collected with an intention of integrating into a regional assessment of conditions and vulnerabilities, issues exist that may preclude the use of some methods or require some sort of data preparation. Additionally, to support multi-criteria decision-making, methods need to be able to address a series of assessment questions that provide insights into where environmental risks are a priority. This paper provides an overview of twelve spatial integration methods that can be applied towards regional assessment, along with preliminary results as to how sensitive each method is to data issues that will likely be encountered with the use of existing data.

Integrated environmental assessment of the Mid-Atlantic region with analytical network process.

A decision analysis method for integrating environmental indicators was developed. This was a combination of Principal Component Analysis (PCA) and the Analytic Network Process (ANP). Being able to take into account the interdependency among variables, the method was capable of ranking ecosystems in terms of environmental conditions and suggesting cumulative impacts across a large region. Using data on land cover, population, roads, streams, air pollution, and topography of the Mid-Atlantic Region of the United States, we were able to point out areas which were in relatively poor condition and/or vulnerable to future deterioration regarding various environmental aspects. The method offered an easy and comprehensive way to combine the strengths of conventional multivariate statistics (PCA) and decision-making science tool (ANP) for integrated environmental assessment.

Self-organizing maps for integrated environmental assessment of the Mid-Atlantic region.

A new method has been developed to perform environmental assessment at regional scale. This involves a combination of a self-organizing map (SOM) neural network and principal component analysis (PCA). The method is capable of clustering ecosystems in terms of environmental conditions and suggesting relative cumulative environmental impacts of multiple factors across a large region. Using data on land-cover, population, roads, streams, air pollution, and topography of the Mid-Atlantic region, the method was able to indicate areas that are in relatively poor environmental condition or vulnerable to future deterioration. Combining the strengths of SOM with those of PCA, the method offers an easy and useful way to perform a regional environmental assessment. Compared with traditional clustering and ranking approaches, the described method has considerable advantages, such as providing a valuable means for visualizing complex multidimensional environmental data at multiple scales and offering a single assessment or ranking needed for a regional environmental assessment while still facilitating the opportunity for more detailed analyses.

Fuzzy decision analysis for integrated environmental vulnerability assessment of the mid-Atlantic Region.

A fuzzy decision analysis method for integrating ecological indicators was developed. This was a combination of a fuzzy ranking method and the analytic hierarchy process (AHP). The method was capable of ranking ecosystems in terms of environmental conditions and suggesting cumulative impacts across a large region. Using data on land cover, population, roads, streams, air pollution, and topography of the Mid-Atlantic region, we were able to point out areas that were in relatively poor condition and/or vulnerable to future deterioration. The method offered an easy and comprehensive way to combine the strengths of fuzzy set theory and the AHP for ecological assessment. Furthermore, the suggested method can serve as a building block for the evaluation of environmental policies.

Diagnosis and treatment of respiratory symptoms of initially unsuspected gastroesophageal reflux in infants.

Gastroesophageal reflux (GER) in infants is most commonly thought of as repeated excessive vomiting and failure to thrive, with most infants responding favorably to medical therapy. However, GER may also manifest exclusively with a variety of respiratory symptoms that, if not detected and treated early, may lead to life-threatening complications. During the period of 1987 to 1992, 39 neonates and infants underwent Nissen fundoplication for the treatment of respiratory symptoms attributed to GER. Symptoms included apnea and bradycardia (64%), pneumonia (31%), cyanosis (28%), cough (18%), and stridor (15%). Most patients were ascribed at least one incorrect diagnosis to explain respiratory symptoms. These include apnea of prematurity (38%), bronchopulmonary dysplasia (31%), asthma (8%), and subglottic stenosis (8%). All patients underwent a variety of investigations and medical treatments without noticeable clinical improvement. These included bronchoscopy, esophagoscopy, and polysomnograms. Treatment such as antibiotics, theophylline, bronchodilators, steroids, and oxygen were directed at presumed primary respiratory disease. On the other hand, H2 blockers, metoclopramide, positioning, and thickened feeds were prescribed to treat GER without objective evidence of disease. Ultimately, GER was demonstrated by upper gastrointestinal series in 64%, pH probe in 61%, and both studies in 38%. All patients underwent Nissen fundoplication after failed attempts at medical therapy. A total of 95% of patients had resolution or substantial improvement of respiratory symptoms postoperatively. Preoperative hospitalization averaged 37.0 days, and postoperative stay averaged only 14.2 days. We present a series of patients with GER, all of whom presented with respiratory symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)