Impact of prenatal care provider on the use of ancillary health services during pregnancy

BACKGROUND: Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy. METHODS: Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women’s experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy. RESULTS: During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR = 0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR = 0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR = 4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR = 1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician. CONCLUSIONS: Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience

Single Room Maternity Care Model: Unit Culture and Healthcare Team Practices

The evidence regarding the effects of a Single Room Maternity Care (SRMC) model on women’s childbirth experiences, healthcare providers’ workplace satisfaction, and cost outcomes remains equivocal. The research questions for this focused ethnographic study are: how is culture experienced by nurses and other healthcare providers on the SRMC unit, and how do the values, beliefs, and norms of nurses and other healthcare providers on the SRMC unit influence their day-to-day practices of caring for women and their families. The aim of this qualitative focused ethnography was to explore the culture and practices of the healthcare team in a SRMC unit. Twelve healthcare providers were recruited from a Single Room Maternity Care unit located in a Western Canadian hospital. Semi-structured interviews, participant observations, and examination of unit-related documents were conducted between October 2014 and January 2015. Data were analyzed using an approach by Roper and Shapira (2000). Two main themes emerged from the data: creating and maintaining culture and the work family. The participants considered themselves a family, and made collective and conscious efforts to create a unit culture where everyone could feel supported and valued. Unit culture determined the ways members of the healthcare team functioned in their day-to-day practice. Further research is required to explore the relationship between the maternity unit and quality of patient care, as well as the impact of collaborative practices on both providers and recipients of maternal care

Trajectory of service use among young Albertans with complex needs

Introduction Youth with complex-needs are vulnerable as a consequence of exposure to social adversity and/or chronic health conditions, and are at a high risk of school failure and justice involvement. Information about the patterns of service use across government sectors that influence the life outcomes of complex-needs youth is unknown. Objectives and Approach Youth with complex needs often engage with multiple services across multiple government sectors for extended periods of time. Understanding the patterns and trajectory of their service use may inform programs, decision makers and government in the optimal allocation of resources to increase their life outcomes. It may reveal where and when interventions would be most effective to improve the life course for vulnerable youth. In this study, through a unique approach to link over 20 administrative longitudinal datasets and a novel trajectory clustering technique, the patterns of service use among complex-needs young Albertans is revealed and visualized. Results A trajectory clustering technique was applied to reveal patterns of service use among complex-needs individuals. Compared to the general population, higher proportions of youth with complex needs lived in low socio-economic neighborhoods, suffered from mental health issues, were high cost health service users, and had lower rates of high school completion. Furthermore, youth having complex needs for a longer period of time and who required multiple complex services in a given year had the poorest outcomes, in terms of high school completion, mental health issues, and other health problems. The majority of complex-needs youth came in contact with services via the education system, followed by child services/welfare. Conclusion/Implications The trajectories of service use among complex-needs youth reveals that these individuals are primarily identified through education. Consequently, educational supports would best address the development of effective programs including mental health supports and other needs

The relationship between Prenatal Stress, Depression, Cortisol and Preterm Birth: A review

Preterm birth is one of the most common adverse pregnancy outcomes. Maternal risk factors such as stress and depression have been associated with preterm birth. Preterm infants are at a higher risk of poor growth and neuro developmental outcomes. The objective of this paper is to examine the relationship between maternal stress, depression, cortisol level, and preterm birth. Preterm birth is one of the most common adverse pregnancy outcomes with a global prevalence of 9.6% and one of the major contributors to infant mortality and morbidity. The association between psychosocial stress and preterm birth, although examined for more than 25 years, has not yet been fully established. A systemic review was conducted in which research studies and review articles from 1970 to 2012, published in English, focusing on human subjects, and addressing the relationship between stress, depression, cortisol and preterm birth were included in this review. The studies examining the relationship between stress, cortisol levels and preterm birth have shown inconsistent findings that may be explained by varied study designs, differences in defining and measuring stress, timing of stress measurement, sample characteristics, and study designs. The relationship between stress, cortisol levels and preterm birth may be multifactorial and complex with premature birth being the final common pathway. A longitudinal cohort study, with a large sample size and multiple measures of stress, depression, and cortisol level, as well as a measure of anxiety and other stress hormone biomarkers may add new knowledge and enhance our understanding about the contribution of psychosocial stress to preterm birth

Maternal well-being and its association to risk of developmental problems in children at school entry

<p>Abstract</p> <p>Background</p> <p>Children at highest risk of developmental problems benefit from early identification and intervention. Investigating factors affecting child development at the time of transition to school may reveal opportunities to tailor early intervention programs for the greatest effectiveness, social benefit and economic gain. The primary objective of this study was to identify child and maternal factors associated with children who screened at risk of developmental problems at school entry.</p> <p>Methods</p> <p>An existing cohort of 791 mothers who had been followed since early pregnancy was mailed a questionnaire when the children were aged four to six years. The questionnaire included a screening tool for developmental problems, an assessment of the child's social competence, health care utilization and referrals, and maternal factors, including physical health, mental health, social support, parenting morale and sense of competence, and parenting support/resources.</p> <p>Results</p> <p>Of the 491 mothers (62%) who responded, 15% had children who were screened at high risk of developmental problems. Based on a logistic regression model, independent predictors of screening at high risk for developmental problems at age 5 were male gender (OR: 2.3; 95% CI: 1.3, 4.1), maternal history of abuse at pregnancy (OR: 2.4; 95% CI: 1.3, 4.4), and poor parenting morale when the child was 3 years old (OR: 3.9; 95% CI: 2.1, 7.3). A child with all of these risk factors had a 35% predicted probability of screening at high risk of developmental problems, which was reduced to 13% if maternal factors were favourable.</p> <p>Conclusions</p> <p>Risk factors for developmental problems at school entry are related to maternal well being and history of abuse, which can be identified in the prenatal period or when children are preschool age.</p

Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill's epidemiologic criteria for causality

<p>Abstract</p> <p>Background</p> <p>Modern diets have been suggested to increase systemic acid load and net acid excretion. In response, alkaline diets and products are marketed to avoid or counteract this acid, help the body regulate its pH to prevent and cure disease. The objective of this systematic review was to evaluate causal relationships between dietary acid load and osteoporosis using Hill's criteria.</p> <p>Methods</p> <p>Systematic review and meta-analysis. We systematically searched published literature for randomized intervention trials, prospective cohort studies, and meta-analyses of the acid-ash or acid-base diet hypothesis with bone-related outcomes, in which the diet acid load was altered, or an alkaline diet or alkaline salts were provided, to healthy human adults. Cellular mechanism studies were also systematically examined.</p> <p>Results</p> <p>Fifty-five of 238 studies met the inclusion criteria: 22 randomized interventions, 2 meta-analyses, and 11 prospective observational studies of bone health outcomes including: urine calcium excretion, calcium balance or retention, changes of bone mineral density, or fractures, among healthy adults in which acid and/or alkaline intakes were manipulated or observed through foods or supplements; and 19 <it>in vitro </it>cell studies which examined the hypothesized mechanism. Urine calcium excretion rates were consistent with osteoporosis development; however calcium balance studies did not demonstrate loss of whole body calcium with higher net acid excretion. Several weaknesses regarding the acid-ash hypothesis were uncovered: No intervention studies provided direct evidence of osteoporosis progression (fragility fractures, or bone strength as measured using biopsy). The supporting prospective cohort studies were not controlled regarding important osteoporosis risk factors including: weight loss during follow-up, family history of osteoporosis, baseline bone mineral density, and estrogen status. No study revealed a biologic mechanism functioning at physiological pH. Finally, randomized studies did not provide evidence for an adverse role of phosphate, milk, and grain foods in osteoporosis.</p> <p>Conclusions</p> <p>A causal association between dietary acid load and osteoporotic bone disease is not supported by evidence and there is no evidence that an alkaline diet is protective of bone health.</p

The Experience of Establishing Data Sharing & Linkage Platforms for Administrative, Research and Community-Service Data

Introduction Innovative data platforms (e.g. biobanks, repositories) continually emerge to facilitate data sharing. Extant and emerging data platforms must navigate myriad tensions for successful data sharing and re-use. Two Alberta data platforms navigated such processes and factors regarding administrative, research and nonprofit data: the Child & Youth Data Laboratory (CYDL) and Secondary Analysis to Generate Evidence (SAGE). Objectives To clarify the social and policy factors that influenced CYDL and SAGE establishment and implementation, and the relationships, if any, between these factors and data type. Methods This paper involves a qualitative secondary analysis of two developmental evaluations on CYDL and SAGE establishment. Six-years post-implementation, the CYDL evaluation entailed document review; website user analysis; informant interviews (n=30); online stakeholder survey (n=260); and an environmental scan. One-year post implementation, the SAGE evaluation included 15 interviews and document review. We used thematic analysis and comparisons with the literature to identify key factors. Results Three (not mutually exclusive) categories of social and policy factors influenced the navigation towards CYDL and SAGE realization: trusting relationships; sustainability amidst readiness; and privacy within social context. For these platforms to be able to manage, link or share data, trust had to be fostered and maintained across multiple, dynamic and intersecting relationships between primary data producers, data subjects, secondary users and institutions. Platform sustainability and readiness required capacity building and innovation. Privacy and information sharing evolved culturally and correspondingly for these data platforms, which required constant flexibility and awareness. Conclusions This commentary calls for more empirical research on the value of data re-use or the detriment in not re-using data. While the culture of information sharing is progressing towards greater openness and capacity for data sharing and re-use, successful data platforms must advocate, facilitate and mobilize analysis and innovation using data re-use while being cognizant of social and policy influences

Health care service for families with children at early risk of developmental delay : an All Our Families cohort study

AIM: This study examined children's health care service use, mothers' workforce participation, and mothers' community engagement based on children's risk of developmental delay. METHOD: We used data from the All Our Families study, a prospective pregnancy cohort. Ages and Stages Questionnaire (ASQ) scores at year 2 indicated risk of developmental delay. To investigate the impact of risk of developmental delay when children were not diagnosed, a sensitivity analysis excluded reports of neurodevelopmental disorder (NDD) diagnosis at year 3. Outcomes were maternal reports of children's health and allied health visits (and estimated costs), and maternal workforce participation and community engagement from year 2 to 3. RESULTS: Among 1314 mother-child dyads, 209 (16%) children were classified as being at risk of developmental delay by the ASQ, and 42 (3%) had a reported diagnosis of NDD. Risk of developmental delay was related to increased use of allied health care services (incidence risk ratio 5.04 [year 3]; 95% confidence interval 2.49-10.2) and health visits (incidence risk ratio 1.33 [year 3]; 95% confidence interval 1.14-1.54). The average expected allied health costs were greater for children at risk versus not at risk of developmental delay. However, when excluding children with reported diagnoses of an NDD from this analysis, increased service use and costs in the remaining at-risk population were not observed. Community engagement and workplace participation among families did not differ on the basis of risk of developmental delay. INTERPRETATION: These results suggest increased health care service use by families of children at risk of developmental delay is driven by those receiving a diagnosis of an NDD in the subsequent year. WHAT THIS PAPER ADDS: Early developmental delay risk was related to health care service use and costs. Diagnosis of neurodevelopmental disorder drove increased health care service use and costs. Early developmental delay risk did not relate to parental workforce participation. Early developmental delay risk did not relate to community engagement participation