Perinatal mental health care from the user and provider perspective: protocol for a qualitative study in Switzerland.

BACKGROUND: Mental disorders in the perinatal period (PMD) can severely harm women and their children if not detected early and treated appropriately. Even though mental health care is covered by health insurance and is used widely by women in the perinatal period in Switzerland, it is not known if the care provided is meeting the needs of the patients and is efficient in the view of health care professionals. The aim of this study is to identify strengths, gaps and requirements for adequate mental health care in the perinatal period from the perspectives of patients and care providers for a wide range of relevant mental disorders. METHODS: In the qualitative study we conduct (1) semi-structured single interviews with former PMD patients to obtain narratives about their experiences and needs for health care for their condition. Women are included who have been treated for PMD but are mentally stable at the time of the interview (n = 24). We will stratify the sample by 4 clusters of relevant ICD-10 F-diagnoses, covering the most frequent and the most severe mental disorders. We will further stratify the sample based on whether the women already had experience with psychiatric or psychological health care or not before their last episode of PMD. We will also conduct (2) three interprofessional focus groups with health and social care professionals involved in perinatal care, and a health insurance representative. The focus groups will consist of 5-8 professionals. Data collection and thematic analysis will consider Levesque's et al. (2013) conceptual model on access to health care. DISCUSSION: The study will provide fundamental data on the experiences and perspectives about perinatal mental health care from user and provider perspectives. The study will generate the evidence base needed to develop models of integrated, coordinated, patient- and family-centred care that is accessed by women with various types of PMD. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov in November 2019 under the identifier NCT04185896.

Sexual and reproductive healthcare for women asylum seekers in Switzerland: a multi-method evaluation.

BACKGROUND: Forced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers' health. Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study's objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers. METHODS: The study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis. RESULTS: The accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise. CONCLUSIONS: The standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.

If I tweet will you cite later? Follow-up on the effect of social media exposure on article downloads and citations.

OBJECTIVES: We previously reported that random assignment of scientific articles to a social media exposure intervention did not have an effect on article downloads and citations. In this paper, we investigate whether longer observation time after exposure to a social media intervention has altered the previously reported results. METHODS: For articles published in the International Journal of Public Health between December 2012 and December 2014, we updated article download and citation data for a minimum of 24-month follow-up. We re-analysed the effect of social media exposure on article downloads and citations. RESULTS: There was no difference between intervention and control group in terms of downloads (p = 0.72) and citations (p= 0.30) for all papers and when we stratified by open access status. CONCLUSIONS: Longer observation time did not increase the relative differences in the numbers of downloads and citations between papers in the social media intervention group and papers in the control group. Traditional impact metrics based on citations, such as impact factor, may not capture the added value of social media for scientific publications.

Perinatal mental disorders in Switzerland: prevalence estimates and use of mental-health services.

BACKGROUND: Perinatal mental disorders (PMDs) are the most common complication of pregnancy and the first postpartum year. Since PMD prevalence and use of mental-health services by perinatal women in Switzerland are unknown, we analysed existing health statistics. METHODS: We used statistics from a large health insurance company, hospitals and freelance midwives. We assessed the annual rates of mental-healthcare use in perinatal women (n = 13 969). We ascertained the annual rates of PMD treatment in obstetric inpatients (n = 89 699), and annual rates of PMD records by freelance midwives (n = 57 951). In 15 104 women who gave birth in 2012 or 2013, we assessed use of mental healthcare before and during pregnancy, and in the postpartum year. For the same sample, we determined proportions of medication and consultation treatments. We used multiple regression analysis to estimate the influence of PMD on overall healthcare costs of mandatory health insurance. RESULTS: The annual rate of mental-healthcare use by perinatal women was 16.7%. The annual rate of PMD treatment in obstetric inpatients was 1.1%. The annual rate of PMD records in the midwifery care setting was 2.9%. Women with PMD use mental health services mainly in non-obstetric outpatient settings. Medication was the most frequent treatment. Primary care providers and mental health specialists contributed almost equally to consultation treatments. PMD during pregnancy raised overall costs of healthcare in the postpartum year by 1214 Swiss francs. CONCLUSIONS: Health-system research and perinatal healthcare should take into consideration the high prevalence of PMD. Real PMD prevalence may be even higher than our data suggest and could be assessed with a survey using our model of PMD prevalence.

If I tweet will you cite? The effect of social media exposure of articles on downloads and citations.

OBJECTIVES: We sought to investigate whether exposing scientific papers to social media (SM) has an effect on article downloads and citations. METHODS: We randomized all International Journal of Public Health (IJPH) original articles published between December 2012 and December 2014 to SM exposure (blog post, Twitter and Facebook) or no exposure at three different time points after first online publication. RESULTS: 130 papers (SM exposure = 65, control = 65) were randomized. The number of downloads did not differ significantly between groups (p = 0.60) nor did the number of citations (p = 0.88). Adjusting for length of observation and paper's geographical origin did not change these results. There was no difference in the number of downloads and citations between the SM exposure and control group when we stratified for open access status. The number of downloads and number of citations were significantly correlated in both groups. CONCLUSIONS: SM exposure did not have a significant effect on traditional impact metrics, such as downloads and citations. However, other metrics may measure the added value that social media might offer to a scientific journal, such as wider dissemination.

An isochore transition zone in the NF1 gene region is a conserved landmark of chromosome structure and function.

The mammalian genome is organized as a mosaic of isochores, stretches of DNA with a distinct sequence composition. Isochores form the basis of the chromosomal banding pattern, which is tightly correlated with a number of structural and functional features. We have recently demonstrated that the transition from a GC-poor isochore to a GC-rich one in the NF1 gene region occurs within 5 kb and demarcates genomic regions with high and low recombination frequency. We now report that the same transition zone separates early replicating from late replicating chromatin on the molecular level. At the isochore transition the replication fork is stalled in mid-S phase and can be visualized by fiber-FISH techniques as a Y-shaped structure. The switch in GC content and in replication timing is conserved between human and mouse, emphasizing the importance of the transition zones as landmarks of chromosome organization and function.