Improving care for immigrant women before, during, and after childbirth - what can we learn from regional interventions within a national program in Sweden?

Background Migration has increased the number of immigrant women in western countries, which has led to a need to adapt sexual and reproductive health (SRH) care to a larger variety of experiences. Examples of problems are poor access/utilization of SRH services among migrants and a comparatively higher rate of mortality and morbidity in relation to pregnancy, especially among those from low- and middle-income settings. Attempts to improve SHR care must consider the complexity of both the problem and the system. A national program to improve women's health in Sweden provided opportunities to study interventions aimed at immigrant women, using a complexity theory lens. The purpose was to explore the characteristics and complexity of regional interventions aiming to improve care and health of immigrant women before, during and after childbirth, and provide knowledge on how regional healthcare actors perceive and address problems in these areas. Methods This archival research study is based on qualitative data from detailed yearly reports of all regional program interventions (n = 21 regions) performed between January 2017 and January 2019. The archival data consists of the regional actors' answers to an extensive questionnaire-like template, where the same questions were to be filled in for each reported intervention. Data analyses were performed in several steps, combining classic and directive content analysis. Results Six problem categories were addressed by 54 regional interventions, 26 directed at immigrant women and their families, 11 at healthcare staff, and 17 at the organizational system. The simple level interventions (n = 23) were more unilateral and contained information campaigns, information material and translation, education, mapping e.g., of genital mutilation, and providing staff and/or financial resources. The complicated interventions (n = 10) concerned increasing communication diversity e.g., by adding iPads and out-reach visits. The complex interventions (n = 21), e.g., health schools, integration of care, contained development, adaptions, and flexibility with regards to the immigrant women's situation, and more interaction among a diversity of actors, also from the wider welfare system. Conclusions It is important that complex problems, such as ensuring equal care and health among a diverse population, are addressed with a mix of simple, complicated, and complex interventions. To enhance intended change, we suggest that pre-requisites e.g., communication channels and knowledge on behalf of immigrant women and staff, are ensured before the launch of complex interventions. Alternatively, that simple level interventions are embedded in complex interventions

Recent Korean isolates of duck hepatitis virus reveal the presence of a new geno- and serotype when compared to duck hepatitis virus type 1 type strains

Duck hepatitis was first reported in 1985 in Korea. The complete nucleotide sequence of two past Korean isolates, DHV-HS and DHV-HSS, isolated in 1994 and 1995, and four recent Korean isolates, AP-03337, AP-04009, AP-04114 and AP-04203 isolated in 2003 and 2004, were determined. Phylogenetic analysis using the 3D protein sequence confirmed that the previously characterized duck hepatitis virus type 1 strains and the six Korean isolates described here constitute a monophyletic group and form two clades/genotypes in which all except the four recent Korean isolates form one group (A) and the recent Korean isolates of 2003 and 2004 constitute a second group (B). Phylogenetic analysis of the VP1 protein supported the division into two different groups. Antisera raised against viruses of group A showed significant neutralizing cross-reaction against a member of the same genotype but not to a strain of group B and vice versa. These results demonstrated that the two genotypes also could be regarded as two different serotypes.The authors would like to thank Hyuk-Man Kwon for propagation of duck hepatitis virus. This work was supported financially by the National Veterinary Research and Quarantine Service (NVRQS), Ministry of Agricultural and Forestry (MAF), Republic of Korea. AML and CT were supported by the Knowledge Foundation, Sweden, and the Research Programme in Medical Bioinformatics, Karolinska Institute, Stockholm, Swede

Evidence for Ljungan virus specific antibodies in humans and rodents, Finland.

Objectives Ljungan virus (LV) belongs to the genus Parechovirus. Human parechoviruses (HPeV) are common viruses causing diarrhea and gastroenteritis, and the first infection is commonly faced during the early childhood and 90% of humans acquire HPeV antibodies by the age of two. Ljungan virus, however, is known as a rodent-borne parechovirus first isolated (LV 87-012) near Ljungan river in Sweden from a wild bank vole (Myodes glareolus). Puumala hantavirus causes Nephropatia epidemica (NE) in humans and these cases are fairly common in Finland comprising approximately 800-3000 suspected NE cases per year depending somewhat on the size of rodent population. However, the abundance of Finnish patients diagnosed with NE, i.e., with a history of rodent contact, makes any connection between human disease and Ljungan virus infection likely to be found in the country. With this study, we sought to find evidence of Ljungan virus in Finnish humans and rodents. We aimed to develop a reliable method for serological screening of LV in humans and rodents, and to confirm the specificity of this method. Methods Initially, neutralization assays were designed and carried out followed by an immunofluorescent assay (IFA) for serology screening. The IFA and neutralization assays were set up using Vero-cells infected with Ljungan virus strain 145SLG kindly provided by Conny Tolf et al. (Uppsala University, Uppsala, Sweden). Serological assays were used for detecting Ljungan virus antibodies both in humans and rodents. Furthermore, 8 human sera used in the Ljungan virus neutralization assay were cross-checked for titres of neutralizing antibodies to six different human parechoviruses (HPeV 1-6), that are closely related to Ljungan virus. Neutralization effect of the antibodies to 42 different human picornaviruses against Ljungan virus (145SLG) was also studied. Results and Conclusion The study is ongoing, but preliminary data indicates that we have LV specific antibodies in Finland. Twenty-six sera out of 41 human serums were not able to neutralize Ljungan 145SLG virus. However, 15 human serum samples neutralized the Ljungan 145SLG virus. Wide titer range of the HPeV 1-6 antibodies were also detected in eight human serums studied in more closely. The preliminary IFA results are also supporting the neutralization results. In total, 8 out of the 50 (16%, 95% CI: 8.1–28.8%) rodent samples (Konnevesi, Finland, year 2008) were Ljungan antibody positive. Our data is first evidence of human Ljungan virus infections in Finland both in humans and rodents. This data can be used as a stepping stone for further studies of Ljungan virus: the broad seroprevalence study both in humans and rodents, and to investigate the role of Ljungan virus infection in Finland