The impact of depression on satisfaction with prenatal care in Kazakhstan during COVID-19 pandemic

Abstract Background Depression and anxiety are common during perinatal periods, representing a considerable public health concern during global pandemic. Only few studies have examined the influence of emotional disturbances on satisfaction with maternity care. This study aimed to assess the prevalence of satisfaction with prenatal care and to examine its association with depression and anxiety among pregnant women in Kazakhstan. Methods Participants were recruited to this online cross-sectional survey in the outpatient clinic in Novoshamalgan, Almaty region (n = 174) in December-January, 2022. A single-item measure of satisfaction was used by asking a question “How satisfied are you with health services?”, scored on a 5-point Likert scale. A simplified 2-item Edinburgh Postpartum Depression Scale and 2-item Generalized Anxiety Disorder scale were used to measure depressive and anxiety symptoms. Results Majority of women were very satisfied or satisfied (n = 128; 74%), while less than a third of the sample (n = 46; 26%) were dissatisfied with the received care. The prevalence of depression in the total sample was higher, compared to the prevalence of anxiety (34% versus 18%). Multivariable logistic regression showed that dissatisfaction with prenatal care was associated with older age, not attending check-ups regularly, and being employee of private company or student. Depression increased the odds of being dissatisfied by 2.6 times (95% CI 1.19∼5.79); while obstetric issues and anxiety were not associated with satisfaction. Perception of women about inadequate solution of the problem of antenatal depression was a significant predictor of dissatisfaction (AOR 6.87; 95% CI 1.81∼26.12). Conclusions Depressed women in our study were less satisfied with prenatal care. Further investigation of the perception of women about specific aspects of perinatal health services is suggested. Providing a quality, patient-centered care is needed to support pregnant women during the current pandemic. Key messages To improve the quality of prenatal care, health providers should address not only physical concerns, but also psychosocial issues and symptoms of depression of pregnant women during current pandemic. Although prenatal care is accessible to all pregnant women in Kazakhstan, development of patient-centered perinatal care is needed, focusing on communication skills and quality of interaction.


Introduction:
Professionals caring for persons with dementia (PwD) have to meet demands from various sides. Considering today's high standards put on institutional care with respect to ''person centred care'' and the skills related to specific needs of PwD, caring for care staff is one of the major challenges.

Objectives:
The aim of this study was to investigate the caregiver burden in professional dementia care and its work related differences.

Methods:
The study was carried out from September 2021 to February 2022 among 105 professionals working in different settings for PwD in Slovakia including home care and day care centres. The Professional Care Team Burden scale (PCTB) and the Zarit Burden Interview (ZBI-12) were chosen to measure caregiver burden. Length of work in the organisation (< 3, 3 to 6, > 6 years), job position (domiciliary and other care worker), and current dementia care intensity ( 8, 9 to 39, > 40 hours/ week) were also measured. Independent samples T-tests and ANOVA were used to analyse the differences (IBM SPSS 27). Results: 87.6% of professionals were women (mean age 48.6AE9.8 years). 52.5% worked more than 6 years in the organisation, 53.3% were in the job position of domiciliary care workers, and for 52.1% the current dementia care intensity was 9 to 39 hours/week. Caregiver burden mean scores achieved were 26.7AE4.0 (PCTB) and 9.7AE6.2 (ZBI-12). The significant difference was found in the PCTB by job position with the higher burden in domiciliary care workers (mean score 26.0 + 4.2, p < 0.05). No significant differences were observed in the PCTB and the ZBI-12 by the length of work in the organisation and current dementia care intensity.

Conclusions:
Specific scales for assessing professionals' caregiver burden are useful to uncover areas for intervention. Structuring the interventions by taking the care staff subjective feelings of burden into account is important for future improvements in institutional care. (Grant support: VEGA no. 1/0372/20).

Key messages:
Caring for professionals is one of the major challenges to improve health and social services for persons with dementia.
Structuring the tailored interventions should take the caregiver burden into account.

Background:
Depression and anxiety are common during perinatal periods, representing a considerable public health concern during global pandemic. Only few studies have examined the influence of emotional disturbances on satisfaction with maternity care. This study aimed to assess the prevalence of satisfaction with prenatal care and to examine its association with depression and anxiety among pregnant women in Kazakhstan.

Methods:
Participants were recruited to this online cross-sectional survey in the outpatient clinic in Novoshamalgan, Almaty region (n = 174) in December-January, 2022. A single-item measure of satisfaction was used by asking a question ''How satisfied are you with health services?'', scored on a 5-point Likert scale. A simplified 2-item Edinburgh Postpartum Depression Scale and 2-item Generalized Anxiety Disorder scale were used to measure depressive and anxiety symptoms.

Results:
Majority of women were very satisfied or satisfied (n = 128; 74%), while less than a third of the sample (n = 46; 26%) were dissatisfied with the received care. The prevalence of depression in the total sample was higher, compared to the prevalence of anxiety (34% versus 18%). Multivariable logistic regression showed that dissatisfaction with prenatal care was associated with older age, not attending check-ups regularly, and being employee of private company or student. Depression increased the odds of being dissatisfied by 2.6 times (95% CI 1.19$5.79); while obstetric issues and anxiety were not associated with satisfaction. Perception of women about inadequate solution of the problem of antenatal depression was a significant predictor of dissatisfaction (AOR 6.87; 95% CI 1.81$26.12).

Conclusions:
Depressed women in our study were less satisfied with prenatal care. Further investigation of the perception of women about specific aspects of perinatal health services is suggested. Providing a quality, patient-centered care is needed to support pregnant women during the current pandemic.

Background:
In national health systems based on primary care, cross-level clinical coordination (CC) is a priority, as it may improve quality of care. Evidence on the impact of information and communication technology (ICT)-based coordination mechanisms on CC is inconclusive. The implementation of those mechanisms increased during the pandemic. The aim is to adapt the validated COORDENA-CAT questionnaire, for measuring CC, to analyse the implementation of ICT-based coordination mechanisms and its impact on CC in three regions of Spain.

Methods:
The COORDENA-CAT questionnaire underwent a two-stage adaptation process:1) contents revision based on literature review, expert discussions, and pretest to adapt the contents and language and produce a version for each region; and 2) piloting the adapted version by self-administration of the questionnaire to primary and secondary care doctors in the health systems of two of the participating regions.

Results:
The adapted version (COORDENA-TICs) kept most of the original contents. Main changes were on coordination mechanisms section. Pretest showed an adequate level of comprehensiveness, comprehension, sequence of themes and questions, and length. A low non-response rate was observed, with little variability or unexpected responses. The question on any difficulties encountered in answering the questionnaire revealed no relevant difficulties. The Shared Electronic Medical Record of each region was the most frequently used ICT-based coordination mechanism. Limited access to information and technical issues related to its use were the most common difficulties encountered. Suggestions for improving its use were receiving specific training on its use.

Conclusions:
COORDENA-TICs questionnaire is a useful tool to assess utilization of ICT-based coordination mechanisms and its impact on CC from the perspective of primary and secondary care doctors. It will allow comparisons across areas, regions and to evaluate changes over time

Introduction:
The importance of timely care is well documented for numerous emergency conditions, including STEMI and ischemic stroke, where low symptom-to-balloon/symptomto-needle times are crucial for mortality and disability. The study of all potential delays helps us understand the constraints we have to work under. Here, we use Google Maps services to map the travel times from central Athens areas to on-duty hospitals Methods: We built our code in the Python programming language, using the Google Maps Distance Matrix API to perform real-time trip duration calculations based on real-life data. As reference points, we used a set of Athens neighbourhoods provided by the Municipality as open data; we considered only public secondary and tertiary health facilities as valid destinations, and based our calculations based on the available daily duty schedules.

Results:
Our algorithm collected 43,200 data points in total over two weeks, using 144 starting points. The average trip durations to reach an on-duty department formed a right-skewed distribution (-0.424), with a mean of 19.55 minutes and a median of 19.95 minutes. The maximum average time was 26.78 minutes, and the overall maximum was 44 minutes. Average travel times to cardiology, general surgery, neurology and internal medicine ERs, which experience a heavy patient load, were higher than the total mean (20.60/22.06/21.31/20.51 mins respectively). We found no correlation between the average travel time and average distance from a hospital or the geographical location, but we were able to create a map with hotspots of high/low travel times.

Conclusions:
Our approach to collecting accurate trip data has shown the impact of time-of-day and location on trips to hospitals, even for patients within the same larger area. As acute care can be time-sensitive, similar wide-scale modelling could be used to create systemic solutions, e.g. data-guided spatial distribution of facilities or transportation. Key messages: Public APIs can be used to gather useful data about the context around our health systems. In Athens, a difference in position can mean up to 100% longer travel times to a hospital.