State transition modeling of complex monitored health data

This article considers the analysis of complex monitored health data, where often one or several signals are reflecting the current health status that can be represented by a finite number of states, in addition to a set of covariates. In particular, we consider a novel application of a non-parametric state intensity regression method in order to study time-dependent effects of covariates on the state transition intensities. The method can handle baseline, time varying as well as dynamic covariates. Because of the non-parametric nature, the method can handle different data types and challenges under minimal assumptions. If the signal that is reflecting the current health status is of continuous nature, we propose the application of a weighted median and a hysteresis filter as data pre-processing steps in order to facilitate robust analysis. In intensity regression, covariates can be aggregated by a suitable functional form over a time history window. We propose to study the estimated cumulative regression parameters for different choices of the time history window in order to investigate short- and long-term effects of the given covariates. The proposed framework is discussed and applied to resuscitation data of newborns collected in Tanzania.     

Delaying factors for maternal health service utilization in eastern Ethiopia: A qualitative exploratory study

BackgroundIn Ethiopia, maternal health service utilization is still unacceptably low. The societal and cultural factors that constrain women from attending these services have not yet been sufficiently explored. Using qualitative methods, we aimed to explore the factors that delay maternal health service utilization in eastern Ethiopia.MethodA total of 13 audio-recorded focus group discussions were conducted comprising 88 participants. We conducted separate group discussions with reproductive aged women, mothers-in-law, traditional birth attendants, husbands, and Health Extension Workers to capture their knowledge, practices, feelings, thoughts and attitudes towards maternal health service utilization. The recorded sessions were transcribed into the local language and then translated into English for analysis.ResultThe study identified a number of factors that may delay maternal health service utilization. Factors were grouped using the Three Delays model as a framework. Low level of awareness regarding need, poor involvement of husband, perceived absence of health problems, social power, community misperceptions and cultural restrictions, negative attitudes towards male midwives, acceptance of traditional birth attendants and poor social networking were Delay One factors. Lack of physical accessibility and high transportation costs were categorised as Delay Two factors for skilled birth care attendance. Perceived or experienced poor quality of care were categorised as Delay Three factors for both skilled birth and postnatal care utilization.ConclusionDespite the ongoing government measures to improve maternal health service utilization in Ethiopia, numerous factors continue to contribute to delays in service use, which in turn contribute to high maternal mortality.     

Breastfeeding experiences and perspectives among women with postnatal depression: A qualitative evidence synthesis

BackgroundStudies show that postnatal depression affects around 10–16% of women globally. It is associated with earlier cessation of breast feeding, which can negatively impact infants’ long-term development. Mechanisms underpinning associations between mental health and women’s decision to commence and continue to breastfeed are complex and poorly understood.AimThe aim of this review was to investigate breastfeeding experiences, perspectives, and support needs of women with postnatal depression. No previous reviews were identified which had addressed this aim.MethodA systematic search was conducted of six databases to identify relevant qualitative studies. Six included studies were critically appraised and synthesised using thematic synthesis.FindingsFive themes were identified: (1) desire to breastfeed and be a ‘good mother’, (2) struggles with breastfeeding, (3) mixed experiences of support from healthcare professionals, (4) importance of practical and social support, (5) support for mental health and breastfeeding. Most women with postnatal depression expressed strong intentions to breastfeed, although some perceived ‘failure’ to breastfeed triggered their mental health problems. Practical and non-judgemental support for their mental health needs and for successful breastfeeding from healthcare professionals, family and friends are needed.ConclusionMost women with postnatal depression desired to breastfeed but experienced breastfeeding difficulties that could impact on their mental health. By offering women with postnatal depression tailored and timely support, healthcare professionals could help women minimize breastfeeding problems which could consequently impact on their mental well-being and ensure they and their infants have opportunity to benefit from the advantages that breastfeeding offers.     

Reinvigorating the social contract and strengthening social cohesion: Social protection responses to COVID-19

The COVID-19 pandemic has exposed the vulnerability of those who are inadequately covered by social protection in more and less developed countries alike, and has exacerbated the fragility of a social contract that was already under strain in many countries. A weak social contract in the context of an exceptional crisis poses a very real risk to social cohesion. Nevertheless, many States have reasserted themselves as the guarantor of rights by protecting public health and incomes. By sustaining these measures, economic recovery will be supported which will help minimize risks that may weaken social cohesion. However, this is a fast-moving, inherently unstable and protracted crisis. Social protection stands at a critical juncture. Decisive policy action will be required to strengthen social protection systems, including floors, as one of the cornerstones of a reinvigorated social contract.     

Building home on a fault line: Aging out of child welfare with a serious mental health diagnosis

Youth aging out of foster care are at high risk for homelessness. This research explains how and why homelessness occurs among youth with serious mental health struggles after aging out of residential and transitional living programmes. Using a longitudinal constructivist grounded theory design, we analyse 20 in‐depth interviews exploring youth's transition experiences and perceptions of transition success within 4 months of emancipation and at 6 and 12 months postemancipation. Monthly 15‐min check‐ins prevented attrition. A three‐phase transition process was observed driven by participant desires and actions to cultivate psychological home through establishing physical home alone away from social networks. Pre‐emancipation, the promise of home was privacy and opportunity for self‐redefinition. Shortly after emancipation, home became a physical and social space to be, a valuable resource to share and a demonstration of personal transition success. However, later in the year postemancipation, maintaining physical home proves nearly impossible given the risk context. Findings speak to how and why youth aging out appear overly self‐reliant upon emancipation. Cultivating a psychological sense of home has practice implications for child welfare providers who aim to prepare youth to live independently postemancipation.     

Parenthood and Well-Being: A Decade in Review

Understanding social aspects of parental well-being is vital because parents' welfare has implications not only for the parents themselves but also for child development, fertility, and the overall health of a society. This article provides a critical review of scholarship on parenthood and well-being in advanced economies published from 2010 to 2019. It focuses on the role of social, economic, cultural, and institutional contexts of parenting in influencing adult well-being. The authors identify major themes, achievements, and challenges and organize the review around the demands-rewards perspective and two other theoretical frameworks: the stress process model and the life course perspective. The analysis shows that rising economic insecurities and inequalities and a diffusion of intensive parenting ideology were major social contexts of parenting in the 2010s. Scholarship linking parenting contexts and parental well-being illuminated how stressors related to providing and caring for children could unjustly burden some parents, especially mothers, those with fewer socioeconomic resources, and those with marginalized statuses. In that vein, researchers continued to emphasize how stressors diverged by parents' socioeconomic status, gender, and partnership status, with new attention to strains experienced by racial/ethnic minority, immigrant, and sexual minority parents. Scholars' comparisons of parents' positions in various countries expanded, enhancing knowledge regarding specific policy supports that allow parents to thrive. Articulating future research within a stress process model framework, the authors show vibrant theoretical pathways, including conceptualizing potential parental social supports at multiple levels, attending to the intersection of multiple social locations of parents, and renewing attention to local contextual factors and parenting life stages.     

Potentials of care: The uncertain politics of social and emotional ability and difference in American childhood

This article examines middle class children's and parents' complex engagements with contemporary practices of cultivation, care and surveillance focused on children's social and emotional capacities and differences. Emblematic of a sociality and emotion-focused biopolitics of childhood, such care provokes moments of spontaneous connection and self-expression for children even as they engage dynamics of disciplining control and normalisation, an outcome that may work against and towards the objectives of care. Moreover, parental investments in social–emotional care reveal adults' conflicted implication in dynamics of child normalisation, and the potential of this form of caretaking to generate politically valuable empathic insight.     

Analyzing free-text survey responses: An accessible strategy for developing patient-centered programs and program evaluation

Despite widespread availability of yoga in the Veterans Health Administration (VA), it remains unclear how to best evaluate yoga programs. This is particularly problematic for programs aimed at veterans with mental health concerns, as evaluation typically focuses narrowly upon mental health symptom severity, even though program participants may have other health-related priorities. We analyzed responses to free-text questions on 237 surveys completed by veterans with mental health concerns enrolled in a yoga program at six VA clinics in Louisiana to characterize veteran participants’ experiences with yoga. Qualitative analysis resulted in 15 domains reflecting veterans’ individual health-related values and priorities. We use results to illustrate the potential for analysis of free-text responses to reveal valuable insights into patient experiences, demonstrating how these data can inform patient-centered program evaluation. The approach we present is more accessible to those responsible for decision-making about local programs than conventional methods of analyzing qualitive evaluation data.     

Responding to Adolescent Violence in the Home – A Community Mental Health Approach

Family violence perpetrated by adults is increasingly understood as a health issue, and we argue that this pertains even more strongly to violence by adolescents. The co-dependence of the parent–child bond, lack of maturity in the adolescent, and often related issues of disability or mental illness make these young people both complex and also vulnerable. This research paper reviews the current literature relating to adolescent violence in the home, identifies known best practice, and evaluates the importance of taking a family-focused, therapeutic approach to adolescent family violence, in place of a punitive one. It describes the use of a co-design workshop to unpack gaps in service provision and develop a potential family focused model of care to address the needs both of young people who use violence, and their families. The findings indicate that an inclusive family approach is a key element in addressing adolescent violence in the home across a spectrum of behaviours and mental health care needs. The use of a coordinated, family-inclusive response through mental health care services is recommended to address the complexity of this issue, as well as to provide support both to adolescents and to their families and carers.