La Maison Bleue: Strengthening resilience among migrant mothers living in Montreal, Canada.

INTRODUCTION: La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families. METHODS: We conducted a focused ethnography. Immigrants, refugees, asylum seekers and undocumented migrants were invited to participate. We collected data from November to December 2017 via semi-structured interviews and participant observation during group activities at La Maison Bleue. Data were thematically analysed. RESULTS: Twenty-four mothers participated (9 interviewed, 17 observed). Challenges to well-being included family separation, isolation, loss of support, the immigration process, an unfamiliar culture and environment, and language barriers. Key protective factors were women's intrinsic drive to overcome difficulties, their positive outlook and ability to find meaning in their adversity, their faith, culture and traditions, and supportive relationships, both locally and transnationally. La Maison Bleue strengthened resilience by providing a safe space, offering holistic care that responded to both medical and psychosocial needs, and empowering women to achieve their full potential towards better health for themselves and their families. CONCLUSION: Migrant mothers have many strengths and centres like La Maison Bleue can offer a safe space and be an empowering community resource to assist mothers in overcoming the multiple challenges that they face while resettling and raising their young children in a new country.

Putting Implementation Science into Practice: Lessons from the Creation of the National Maternal and Child Health Workforce Development Center.

Purpose This article describes how implementation science informed the design of a national training and technical assistance (TA) center, and how implementation best practices have been used to improve the quality of training and technical assistance services offered to states/jurisdictions. Description An existing tool, based on the Implementation Drivers Framework (in: Fixsen et al., Implementation research: a synthesis of the literature, University of South Florida, The National Implementation Research Network, Tampa, 2005), was adapted to assess efforts of the National MCH Workforce Development Center (the Center) against known implementation best practices. Staff identified specific examples of effective practice and gaps for inclusion in this article. Assessment Using implementation science to establish, assess and improve Center practice was both feasible and practical, requiring intentionality, dedicated time, and staff committed to deepening their understanding of implementation science. The Implementation Drivers framework proved useful for creating a shared approach to analysis and identification of opportunities for improvement of Center practice. Conclusion Policymakers and funding agencies should consider how training and technical assistance programs demonstrate knowledge and use of implementation science best practices among other evidence based practices in their work. Increasing attention to the use of implementation science can contribute to a higher quality of service among technical assistance centers, with the long term goal of improving outcomes for training and assistance recipients and the communities they serve. Establishing the link between customer satisfaction and quality of technical assistance, on the one hand, and long term outcomes, on the other, remains a challenge and an area of focus and learning for the Center.

La Sección de Hospitalaización de Pediatría del Hospital Materno Infantil Gregorio Marañón en 2016 / Pediatric Hospitalization Section of the Hospital Materno Infantil Gregorio Marañón in 2016

Entre los objetivos principales de la hospitalización pediátrica en un hospital terciario se incluyen el cuidado integral de los pacientes pediátricos ingresados incluyendo aspectos diagnósticos, curativos, preventivos y de rehabilitación. La Academia Americana de Pediatría reconoció hace más de 20 años la importancia y el papel crucial de los programas de hospitalización pediátrica. Así, la Pediatría General en un hospital terciario juega un papel muy importante en el cuidado agudo de pacientes pediátricos con patologías prevalentes, pero también como coordinador e integrador del cuidado de pacientes crónicos y de alta complejidad. También creemos que la Pediatría General en un hospital terciario tiene la responsabilidad de desarrollar los programas de calidad, implantar una cultura de seguridad en Pediatría, promover protocolos y guías clínicas en patologías prevalentes, ser referentes en la educación de los familiares de nuestros pacientes así como desarrollar los programas de e-health y cooperación internacional (AU)

The main objectives of the Pediatric Hospitalist Programs within a Tertiary Hospital include comprehensive care to hospitalized pediatric patients in diagnostic, curative, preventive, and rehabilitation aspects. The American Academy of Pediatrics recognized about 20 years ago, the importance and the key role of Pediatrics Hospitalist programs. General Pediatrics plays an important role not only for the care in acute prevalent pathologies, but also as a coordinator and integrator in chronic and highly complex patients. We also believe that General Pediatrics at a Third level hospital, has the responsibility to develop quality programs, implement safety culture in hospitalized patients, promote protocols and clinical guidelines in prevalent pathologies, health education in our population, and developing e-health and international cooperation programs (AU)

Reaching out: caring for women prisoners in Western Australia.

Incarcerated women are a vulnerable group with complex needs in pregnancy, birth and early parenting; and this is further complicated with a drug and/or alcohol addiction. Prior to the establishment of an antenatal outreach clinic in a Western Australian prison for women, pregnant inmates received fragmented antenatal care. Some of the women did not disclose drug and alcohol issues for fear of involvement of child protection services, and some refused to be transported for care to maternity hospitals for antenatal appointments. This is the first antenatal care clinic for pregnant women to be established within a prison population in Western Australia.

Towards comprehensive women's healthcare in sub-Saharan Africa: addressing intersections between HIV, reproductive and maternal health.

This themed supplement to JAIDS: Journal of Acquired Immune Deficiency Syndromes focuses on the critical intersections between HIV, reproductive, and maternal health services in the health systems of sub-Saharan Africa. The epidemiology of HIV among women of reproductive age on the sub-continent demands a holistic conceptualization and comprehensive approaches to ensure that HIV, reproductive, and maternal health are optimally addressed. Yet, in many instances, the national and global responses to these health issues remain siloed. Women's health needs and new global and national guidelines for HIV treatment raise important policy, programmatic, and operational questions regarding service integration, scale-up, and health systems functioning. In June 2013, the Maternal Health Task Force at the Harvard School of Public Health, the United States Agency for International Development, and the United States Centers for Disease Control and Prevention convened an international technical meeting of researchers, policymakers, and practitioners to discuss the existing evidence base about the interconnections between HIV, reproductive, and maternal health and identify the most important knowledge gaps and research priorities. The articles in this special issue deepen and expand on those discussions by (1) providing empirical evidence about challenges, (2) identifying how improving clinical care and models of service delivery, strengthening health systems, and addressing social dynamics can contribute to better outcomes, and (3) mapping future research directions. Together, these articles underscore that new policy frameworks and integrated approaches are necessary but not sufficient to address health system challenges. Addressing the multiple needs of women of reproductive age who are living with HIV or are at risk of acquiring HIV is a complex undertaking that requires improved access to, utilization and quality of comprehensive women's healthcare. Continued evaluation and knowledge generation are needed to ensure that potential health gains are actualized.

Perinatal mental health: midwives and health visitors working together.

The Healthy Child Programme (HCP) focuses on the care offered to pregnant women and children in the first five years of life. It is delivered by a range of professionals, with the health visitor as lead. Effective delivery of the HCP depends on services for children and families being fully integrated, and partnership working between different agencies on a local level seems to be the key to success. This article focuses on how effective implementation of the HCP facilitates the recognition and care of women with anxiety, mild to moderate depression and other perinatal mental disorders during both the antenatal period and after the birth.

Integrated maternal and child health services in Mozambique: structural health system limitations overshadow its effect on follow-up of HIV-exposed infants.

BACKGROUND: The follow-up of HIV-exposed infants remains a public health challenge in many Sub-Saharan countries. Just as integrated antenatal and maternity services have contributed to improved care for HIV-positive pregnant women, so too could integrated care for mother and infant after birth improve follow-up of HIV-exposed infants. We present results of a study testing the viability of such integrated care, and its effects on follow-up of HIV-exposed infants, in Tete Province, Mozambique. METHODS: Between April 2009 and September 2010, we conducted a mixed-method, intervention-control study in six rural public primary healthcare facilities, selected purposively for size and accessibility, with random allocation of three facilities each for intervention and control groups. The intervention consisted of a reorganization of services to provide one-stop, integrated care for mothers and their children under five years of age. We collected monthly routine facility statistics on prevention of mother-to-child HIV transmission (PMTCT), follow-up of HIV-exposed infants, and other mother and child health (MCH) activities for the six months before (January-June 2009) and 13 months after starting the intervention (July 2009-July 2010). Staff were interviewed at the start, after six months, and at the end of the study. Quantitative data were analysed using quasi-Poisson models for significant differences between the periods before and after intervention, between healthcare facilities in intervention and control groups, and for time trends. The coefficients for the effect of the period and the interaction effect of the intervention were calculated with their p-values. Thematic analysis of qualitative data was done manually. RESULTS: One-stop, integrated care for mother and child was feasible in all participating healthcare facilities, and staff evaluated this service organisation positively. We observed in both study groups an improvement in follow-up of HIV-exposed infants (registration, follow-up visits, serological testing), but frequent absenteeism of staff and irregular supply of consumables interfered with healthcare facility performance for both intervention and control groups. CONCLUSIONS: Despite improvement in various aspects of the follow-up of HIV-exposed infants, we observed no improvement attributable to one-stop, integrated MCH care. Structural healthcare system limitations, such as staff absences and irregular supply of essential commodities, appear to overshadow its potential effects. Regular technical support and adequate basic working conditions are essential for improved performance in the follow-up of HIV-exposed infants in peripheral public healthcare facilities in Mozambique.

The double task of preventing malnutrition and overweight: a quasi-experimental community-based trial.

BACKGROUND: The Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age. METHODS: A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models. RESULTS: 196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI -0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (-0.31, 95%CI -0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding. CONCLUSIONS: Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

Bringing it all together: effective maternal and child health practice as a means to improve public health.

Effective maternal and child health (MCH) practice requires skillfully combining a number of theoretical models and frameworks to support systems addressing the health needs of women, children, and families. This paper describes three perspectives relevant to current MCH practice: the federal Maternal & Child Health Bureau's Pyramid of MCH Health Services [1], Frieden's Health Impact Pyramid [Frieden in Am J Public Health 100(4):590-595, (2010)], and life course theory [Halfon in Milbank Quart, 80:433-79, (2002); Kotelchuck in Matern Child Health J, 7:5-11, (2003); Pies (2009)], an emerging conceptual framework that addresses a number of pressing maternal and child health issues including health disparities and the social determinants of health. While developed independently, a synthesis of these three frameworks provides an important analytical perspective to assess the adequacy and comprehensiveness of current public health programs and systems supporting maternal and child health improvement. Synthesizing these frameworks from the specific vantage point of MCH practice provides public health practitioners with important and dynamic opportunities to promote improvements in health, especially for state and local governmental health agencies with the statutory authority and public accountability for improving the health of women, children, and families in their jurisdictions. A crucial finding of this synthesis is that significant improvements in MCH outcomes at the state and local levels are the result of collaborative, integrated, and synergistic implementation of many different interventions, programs and policies that are carried out by a number of stakeholders, and administered in many different settings. MCH programs have a long history of coordinating disparate sectors of the health care and public health enterprise to create systems of services that improve maternal and child health. Future improvements in MCH build on this legacy but will come from a "paradigm shift" in MCH practice that blends (1) evidence-based interventions and best practices that improve the health of individuals, communities, and populations, and crosscuts health service settings with (2) public policies that promote and improve maternal and child health needs at the local, state, and national levels, and (3) supports MCH leadership to implement such changes in MCH systems nationwide. As such, the challenge presented by this synthesis is not merely technical, i.e. having the scientific and organizational capacity to address identified MCH needs. Instead, a more pressing challenge is providing effective leadership in the coordination and integration of these frameworks and using them in practice to develop a vision that guides programs and policies to improve maternal and child health nationwide.

Externalities of prevention of mother-to-child transmission programs: a systematic review.

There has been considerable debate about the effects of targeted global health assistance in low- and middle-income countries on health systems, specifically HIV/AIDS funding. Recently, a handful of studies have emerged that describe the implementation of PMTCT programs, which have many theoretical links to maternal and child health. Through a systematic review of research published between January 2000 and March 2011, this paper synthesizes evidence evaluating the impact of these programs. We assessed 5,855 papers, reviewed 154, and included 21 articles. They offer evidence of beneficial synergies between PMTCT programs and both STI prevention and early childhood immunization. Other data, including information about antenatal and delivery care, family planning, and nutrition supplementation varied considerably across studies demonstrating both positive and negative effects of PMTCT. More research is needed to allow countries and funders to make informed decisions regarding allocation of limited funds to targeted versus broad categories of health care.

[The functioning of feldsher-midwife stations].

The article presents the materials based on the statistical data and results of sociological survey. They characterize the condition of feldsher-midwife stations, their field of services, personnel issues and certain issues of everyday life of feldshers of Perm kray. The proposals concerning the development of feldsher-midwife stations functioning are analyzed. The comparative analysis with the data of similar survey of 1982 is done. The study results support the necessity to maintain and develop feldsher-midwife stations in the system of primary medical sanitary care of rural population, especially on the territories with low population density.

Midwives and obstetrician-gynecologists collaborating for Native American women's health.

Certified Nurse-Midwives (CNMs) and Obstetrician-Gynecologists (OBGs) have a long history of successful collaborative practice serving Native American women from the 1960s. CNMs provide holistic, patient-centered care focusing on normal pregnancy and childbirth. OBGs support CNMs with consultation services focusing on complications during pregnancy and specialty gynecology care. Collaborative care in Indian Health Service and Tribal sites optimizes maternity care in a supportive environment, achieving excellent outcomes including low rates of cesarean deliveries and high rates of successful vaginal birth after cesarean.