Maternal and Child Health Journal最新文献

{"title":"Impact of COVID-19 Pandemic-Related Workflow Changes on a Clinically-Integrated Breastfeeding Peer Counselor Program.","authors":"Fatima Sattar, Ann E B Borders, Lauren S Keenan-Devlin","doi":"10.1007/s10995-024-04035-w","DOIUrl":"10.1007/s10995-024-04035-w","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether Covid-19 related workflow changes to a clinically-integrated breastfeeding peer counseling (ci-BPC) program were associated with poorer breastfeeding outcomes for Medicaid-enrolled patients.</p><p><strong>Methods: </strong>This retrospective chart review included patients who received ci-BPC care during January 2017-March 2020 (\"Pre-Pandemic,\" N = 318); March 2020-September 2020 (\"During-Peak,\" N = 53); and September 2020-May 2021 (\"Post-Peak,\" N = 97). ANOVA evaluated differences in encounter type frequencies for each time point, as well as differences in breastfeeding initiation, exclusivity during inpatient admission, and continuation of breastfeeding at least 6 weeks post-delivery.</p><p><strong>Results: </strong>In-person prenatal counseling significantly decreased from Pre-Pandemic to During-Peak (43.9-8.2%, p < 0.05). Breastfeeding at 6 weeks postpartum significantly increased from the Pre-Pandemic cohort to the During-Peak cohort (67-85%, p < 0.05), and returned to baseline for the Post-Peak cohort (74%).</p><p><strong>Conclusions for practice: </strong>Covid-19 related workflow changes for the peer counselor did not decrease breastfeeding outcomes as anticipated.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"148-155"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referrals to Peer Support for Families in Pediatric Subspecialty Practices: A Qualitative Study.","authors":"Alex Kobrin, Olivia Chan, Emily Crabtree, Joe Zickafoose, Amy Wodarek O'Reilly, Edward Schor, Holly Henry, Allison Gray","doi":"10.1007/s10995-025-04062-1","DOIUrl":"10.1007/s10995-025-04062-1","url":null,"abstract":"<p><strong>Introduction: </strong>Referrals to peer support (PS) can help families of children with special health care needs in providing emotional support, reducing feelings of stress and anxiety, and improving the care experience. This study aimed to gain providers' perspectives about PS referrals for families of children with special health care needs, including their perspectives on logistics of, barriers to, and facilitators of making referrals as well as the perceived impacts of PS referrals.</p><p><strong>Methods: </strong>This study builds on a 2022 survey of California pediatric subspecialists about the value and challenges of PS. The study team conducted 20 semistructured interviews with people from pediatric subspecialty practices in California and used a priori themes derived from the interview protocol to develop a codebook, code interview transcripts, conduct a thematic analysis, and summarize findings.</p><p><strong>Results: </strong>Respondents offered a variety of PS referrals inside and outside their institutions, tailoring referrals to each family's needs and preferences. Social workers and family liaisons were most commonly responsible for making PS referrals. Respondents found that care team collaboration and ease of sharing information about PS resources among colleagues facilitated the referral process. Respondents noted a need for more PS resources, including funding, education, and the need for a network where providers can identify PS resources.</p><p><strong>Discussion: </strong>Encouraging PS program information-sharing within and across organizations could help connect more families to PS services. Future research should assess families' experiences with PS referrals and services to understand approaches that can best meet their needs for information, instrumental, and emotional supports.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"280-286"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in Hospital Breastfeeding Care in the US.","authors":"Jane Lazar Tucker, Kimberly Arcoleo, Diane DiTomasso, Brietta M Oaks, Howard Cabral, Thaís São-João","doi":"10.1007/s10995-025-04065-y","DOIUrl":"10.1007/s10995-025-04065-y","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines the associations between race and ethnicity and receipt of Baby Friendly Hospital Initiative (BFHI) key clinical practices that support breastfeeding in US hospitals.</p><p><strong>Methods: </strong>National data from 2016 to 2019 CDC PRAMS were analyzed. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We conducted adjusted regression analyses to compare the odds of receiving individual key clinical practices that support breastfeeding, as well as the percent of key clinical practices received.</p><p><strong>Results: </strong>While some key clinical practices were received at high rates, less than 25% of mothers received 100% of recommended key clinical practices. Compared to White non-Hispanic mothers, mothers from various racial and ethnic groups were at lower odds of receiving 100% of key clinical practices: Black non-Hispanic [adjusted odds ratio (AOR) 0.59, 95% confidence interval (CI) (0.47-0.65)], English-Speaking Hispanic [AOR 0.79, 95% CI (0.71-0.88)], Spanish-speaking Hispanic [AOR 0.63, 95% CI (0.53-0.73)], and Asian/Pacific Islander non-Hispanic [AOR 0.54, 95% CI (0.47-0.63)].</p><p><strong>Conclusions for practice: </strong>Despite a steady increase in the number of BFHI hospitals in the US, there are racial and ethnic disparities in the receipt of BFHI key clinical practices. More US hospitals must adopt BFHI key clinical practices and consistently implement those practices for every racial and ethnic group.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"173-182"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Evaluation of the New Translated and Culturally Adapted Postpartum Bonding Questionnaire in German-Speaking Women.","authors":"Pia-Cecilia Steinbrueck, Gabriele Meyer, Gertrud Ayerle","doi":"10.1007/s10995-024-04029-8","DOIUrl":"10.1007/s10995-024-04029-8","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the construct validity and reliability of the newly adapted German version of the Parental Bonding Questionnaire (PBQ) in a group of mothers drawn from the general population, with children aged 12-24 weeks. This assessment followed a thorough linguistic validation, which was conducted through a systematic, multi-step translation process.</p><p><strong>Methods: </strong>363 women completed the PBQ online 12-24 weeks after delivery. Cronbach's alpha and exploratory factor analysis (EFA) were used to assess internal consistency reliability and construct validity.</p><p><strong>Results: </strong>The original 4-factor model could not be confirmed. The new PBQ provides a single factor solution. Ten items were removed from the original 25-item PBQ to produce the abbreviated German PBQ-15, which showed strong internal consistency. The Cronbach's alpha for this version was 0.86.</p><p><strong>Conclusion: </strong>While further research is needed to establish diagnostic thresholds and strengthen the construct validity of the shortened version, the German-language 15-item version of the PBQ holds promise as an accessible tool for recognizing bonding issues in a general population of German-speaking women 3-6 months postpartum.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"240-248"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting the Advancement of a National Agenda for Pediatric Healthcare Reform: A multi-year Evaluation of a Leadership Education in Neurodevelopmental and Related Disabilities Program.","authors":"Caitlin Koob, Sarah F Griffin, Mackenzie Stuenkel, Kathleen B Cartmell, Kerry Sease","doi":"10.1007/s10995-025-04040-7","DOIUrl":"10.1007/s10995-025-04040-7","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the implementation and sustainability of the effect of a 1-year Leadership in Education for Neurodevelopmental and related Disabilities (LEND) program in a southeastern state, and to examine its impact on advancing the Maternal Child Health Bureau's (MCHB) Blueprint for Change-a national agenda for pediatric healthcare reform.</p><p><strong>Methods: </strong>This study applies the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to rigorously evaluate LEND implementation and impact between 2018 and 2022. In-depth interviews (N = 24) were conducted among long-term (1-year) LEND trainees, via Zoom, in a southeastern state. A hybrid approach of deductive and inductive thematic analysis was conducted to identify emergent patterns and themes from trainees' experiences, related to the EPIS constructs and national priorities.</p><p><strong>Results: </strong>Exploration and Preparation. Trainees identified insights from multidisciplinary discussions and family panels as key facilitators to their development.</p><p><strong>Implementation: </strong>Trainees reported growth in confidence and communication and improving their service delivery, including implementation of a collaborative approach to patient care, family-centered care, and occasionally facilitating their obtainment of leadership positions. Trainees also reported systemic barriers to implementation, including time and financial constraints. Sustainability. Trainees identify their experienced shift in mindset and statewide connections as drivers for sustained change, with suggestions for follow-up events and networking opportunities to enhance the effect of LEND training.</p><p><strong>Conclusions for practice: </strong>These results may inform LEND objectives to enhance the statewide network and to advance a national framework for prioritizing family well-being and quality of life and access to services.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"205-216"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Investigation of Adolescent Mental Health In a New York City Cohort Before and During the COVID-19 Pandemic in the Primary Care Setting.","authors":"Deanna Hano, Anjile An, Jodie Nghiem, Elizabeth Koh, Vidushi Tripathi, Rachel Wirtshafter, Cori Green","doi":"10.1007/s10995-024-04037-8","DOIUrl":"10.1007/s10995-024-04037-8","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate differences in the prevalence of positive depression screens before and during the COVID-19 pandemic within primary care and assess patient characteristics based on depression screen results in both time periods.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients ages 12-21 years-old from two urban primary care clinics seen for well-child visits and who had completed depression screens before and during the pandemic. Additional variables evaluated included demographics, substance use, and mental health (MH) conditions such as anxiety, depression, and suicidal ideation (SI). Paired analyses using McNemar's Chi-squared test and paired t-test evaluated differences in variables between time periods. Patients were also categorized into four groups determined by their depression screen result in each period and characteristics between the four groups were compared using the Fisher's exact test.</p><p><strong>Results: </strong>Of 1621 patient charts reviewed with documented depression screens, there were 232 patients who had screens completed during both time periods. Twenty three (9.9%) patients screened positive for depressive symptoms before the pandemic and 38 (16.4%) screened positive during the pandemic. More patients had SI, depression, anxiety, and substance use during the pandemic. Patients who had at least one positive depression screen had more MH conditions than patients who had negative depression screens during both time periods.</p><p><strong>Conclusions: </strong>Among a cohort of adolescents seen in primary care before and during the pandemic, more patients screened positive for depression and there were more MH conditions during the pandemic, demonstrating a need to prioritize MH resources for adolescents in the primary care setting.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"156-163"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Influences Postpartum Depressive Symptoms? The role of Social Determinants of Health, Race-Based Discrimination and Stressful Life Experiences.","authors":"Haley L Ringenary, Jessilyn M Froelich, Wanjikũ F M Njoroge, Emily D Gerstein","doi":"10.1007/s10995-025-04055-0","DOIUrl":"10.1007/s10995-025-04055-0","url":null,"abstract":"<p><strong>Objective: </strong>Development of postpartum depressive symptoms (PDS) is influenced by many social determinants of health, including income, discrimination, and other stressful life experiences. Early recognition of PDS is essential to reduce its long-term impact on mothers and their children, but postpartum checkups are highly underutilized. This study examined how stressful life experiences and race-based discrimination influence PDS development and whether or not a women has a postpartum checkup.</p><p><strong>Methods: </strong>Pregnancy Risk Assessment Monitoring System (2016-2022) was used for secondary data analysis of mothers from 9 sites (n = 8,851). Stressful life experiences prior to birth, race-based discrimination, PDS, and postpartum checkup data were collected using the PRAMS questionnaire. Covariates were collected using primarily birth certificate data.</p><p><strong>Results: </strong>Women of multiple races and ethnicities were significantly more likely to experience PDS if they reported a greater number of stressful life experiences. Women of multiple races and ethnicities were more likely to experience PDS if they reported experiencing race-based discrimination, with Asian women having nearly 8 times greater odds. Black and Hispanic women were less likely to have a postpartum checkup if they reported a greater number of stressors. Black women were less likely to have a postpartum checkup if they had previously experienced race-based discrimination.</p><p><strong>Conclusion: </strong>The influence of race-based discrimination was seen across a diverse group of races and ethnicities. Findings highlight the need to expand questionnaires focused on social determinants of health, specifically discrimination, in PRAMS to all 50 states to better assess their significant consequences for maternal wellbeing.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"183-193"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Medicaid Policies on Pre-pregnancy Preventive Dental Care.","authors":"Nazeeba Siddika, Katlyn Hettinger, Claire E Margerison","doi":"10.1007/s10995-025-04041-6","DOIUrl":"10.1007/s10995-025-04041-6","url":null,"abstract":"<p><strong>Background: </strong>Dental care before pregnancy is critical for preventing poor oral health, which is associated with adverse pregnancy outcomes. People with low incomes, however, may face insurance-related barriers to obtaining dental care. Medicaid expansion under the Affordable Care Act increased access to dental care utilization among adults with low incomes. However, little is known about the impact of Medicaid policies on pre-pregnancy dental care utilization.</p><p><strong>Objective: </strong>To evaluate the impacts on pre-pregnancy dental care utilization of two aspects of Medicaid policy: (1) state level of Medicaid dental coverage and (2) Medicaid expansion overall and by state level of dental coverage.</p><p><strong>Methods: </strong>We used data from Pregnancy Risk Assessment Monitoring System (PRAMS) data phases 7 (2012-15) and 8 (2016-18). To examine the association between state level of dental coverage beyond emergency services (i.e., extensive vs. limited) and pre-pregnancy dental care utilization, we conducted an adjusted logistic regression analysis. To evaluate the impact of Medicaid expansion on pre-pregnancy dental care utilization, we conducted a quasi-experimental event study design, which estimates the percentage point difference in the outcome between expansion and non-expansion states at each time period compared to the period just prior to Medicaid expansion.</p><p><strong>Results: </strong>We found a significant 13% (adjusted odds ratio (OR) = 1.13; 95% CI: 1.05, 1.22) higher odds of pre-pregnancy dental care utilization among the birthing people residing in states that provided extensive dental coverage compared to those in states that provided limited dental coverage. However, Medicaid expansion under the ACA was not associated with pre-pregnancy dental care utilization overall or among either states with extensive or limited Medicaid dental coverage.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"217-224"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Maternal Resilience among Predominantly Low-Income and Minoritized Women.","authors":"Fathima Wakeel, Yalitza Corcino-Davis, Samara Everman, Patricia H Manz, Gabriella Ledis","doi":"10.1007/s10995-025-04044-3","DOIUrl":"10.1007/s10995-025-04044-3","url":null,"abstract":"<p><strong>Background: </strong>Research has increasingly explored maternal resilience or protective factors that enable women to achieve healthier maternal and child outcomes. However, it has not adequately examined maternal resilience using a culturally-relevant, socio-ecological lens or how it may be influenced by early-life stressors and resources. The current study contributes to the literature on maternal resilience by qualitatively exploring the salient multi-level stressors and resources experienced over the lifecourse by predominantly low-income and minoritized women.</p><p><strong>Procedures: </strong>Data are from 19 women who were either adult mothers with children under 18 years of age living at home or reproductive-aged. Respondents completed semi-structured interviews, and grounded theory analyses identified themes related to stressors experienced and resilience resources utilized over the lifespan.</p><p><strong>Results: </strong>Four domains relating to maternal stress and resilience, including stressors (caregiving stress, family conflict, and deaths in the family), traumas (abandonment, domestic violence, child abuse, and substance misuse), coping mechanisms (positive mindset, faith, activities, and movement, healthy eating, self-regulation, and self-love/care), and supports (family, friends, spouses/partners, community members, and religious institutions), emerged from the data. Familial relationships were perceived as the most significant support as well as the biggest source of stress and trauma.</p><p><strong>Conclusions: </strong>As proposed by the socio-ecological framework, our findings suggest that components of maternal resilience exist at the individual (i.e., positive mindset, faith, self-regulation, self-love, and positive health behaviors), interpersonal (i.e., support from family, friends, and partner), and community (i.e., support from community members and religious organizations) levels.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"194-204"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity Analysis of a Reproductive Health Association: a Case Study.","authors":"Ndidiamaka Amutah-Onukagha, Adriana Black, Emily W Harville, Jacqueline Gifuni-Koutsouris, Ayesha Shah, Brenda Hernandez, Isha Datta, Sophie Howard","doi":"10.1007/s10995-024-04034-x","DOIUrl":"10.1007/s10995-024-04034-x","url":null,"abstract":"<p><strong>Purpose: </strong>To demonstrate the process and results of an equity analysis of a reproductive health association.</p><p><strong>Description: </strong>A series of quantitative surveys and qualitative interviews were conducted with employees of Planned Parenthood League of Massachusetts (PPLM), assessing different aspects of equity. Amaka Consulting and Evaluation Services, LLC, an external consulting agency, analyzed the results and provided recommendations for improvements.</p><p><strong>Assessment: </strong>Between 25% and 33% of the employees identified as Black, Indigenous, and people of color (BIPOC). Staff expressed a high degree of satisfaction with the organization's alignment to its mission and commitment to equity. Turnover was higher among BIPOC employees, and employees of color were less likely to say they had confidence in senior management. Themes that arose frequently in surveys included the need for increased communication around equity action steps, greater accountability, and work environment issues. Qualitative interviews indicated acknowledgment of diversity, equity, and inclusion (DEI) efforts but feeling that they were not as legitimate as they could be and vocalized a need for more equitable hiring. Recommendations for improvements included tracking feedback around social movements; conducting equity impact assessments; supporting staff through salary, opportunities for advancement, and better supervision; requiring management to attend equity initiatives, and creating equity resources for staff.</p><p><strong>Conclusion: </strong>This study provides a template for other evaluations of equity. Similar to other organizations in the field, this equity analysis suggests that PPLM had a stronger commitment to certain aspects of DEI than others, and that there was a need for improvement in several areas, particularly hiring and management.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"164-172"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}