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Background: Most countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries' (LMICs') midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration. Methods: Using the most recent available data from publicly available global databases for the period 2000–2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality. Results: In LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country. Conclusions: A complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes. [ABSTRACT FROM AUTHOR]

Background: Economic evaluations are being conducted with increasing frequency in the maternity care setting, with more randomized controlled trials containing a health economic component. Key emerging criticisms of economic evaluation in maternity care are lack of robust data collection and measurement, inconsistencies in methodology, and lack of adherence to reporting guidelines. Methods: This article provides a guide to the design of economic evaluations alongside clinical trials in maternal health. We include economic concepts and considerations for the maternity setting and provide examples from the UK and Australia. Results: There are many important considerations for the design of economic evaluations alongside clinical trials. To be effective, researchers must select types of economic evaluation, which align with their study objectives; choose an appropriate evaluation perspective, time horizon, and discount rate; and identify accurate ways to measure and evaluate health outcomes and costs. Discussion: This guide is written for noneconomists and can be used for designing economic evaluations to be conducted as a part of clinical trials. We seek to improve the quality, consistency, and transparency of economic evaluations in maternal health. [ABSTRACT FROM AUTHOR]

Value based healthcare beyond the clinical domain is the focus of this case study. We share NSW Health's experiences in achieving value through a focus on outcomes in non-clinical and clinical support services using examples that demonstrate key aspects across the commissioning cycle. These include: the importance of stakeholder engagement in the planning phase to later success; the critical role of non-clinical services in patient experience; the opportunity to facilitate value by introducing new approaches in business areas such as procurement; and the role of clinical supports such as digital enablement to facilitate outcome-focussed clinical models. Applying a value lens to non-clinical services can increase the potential benefits to patients, clinicians and the system. What is known about the topic? Value based healthcare is a way of making transparent and equitable decisions about resource allocation to deliver better outcomes for individuals, health services and the system. What does this paper add? This paper reflects on the opportunity to deliver value based healthcare beyond clinical models of care, including in non-clinical and clinical support services, using a commissioning approach. What are the implications for practitioners? The learnings shared through the case studies presented can be applied by practitioners to their own projects to support value based approaches across all aspects of health care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Purpose: Sexual health is an important contributing factor for health-related quality of life, but research in this domain is scarce. Moreover, normative data are needed to interpret patient-reported outcome measures on sexual health. The aim of this study was to collect and describe normative scores of the Female Sexual Distress Scale (FSDS) and the Body Image Scale (BIS) from the Dutch population and assess the effect of important demographic and clinical variables on the outcome. As the FSDS is also validated in men, we refer to it as SDS. Method: Dutch respondents completed the SDS and BIS between May and August 2022. Sexual distress was defined as a SDS score > 15. Descriptive statistics were calculated to present normative data per age group per gender after post-stratification weighting was applied. Multiple logistic and linear regression analyses were conducted to assess the effect of age, gender, education, relationship status, history of cancer and (psychological) comorbidities on SDS and BIS. Results: For the SDS 768 respondents were included with a weighted mean score of 14.41 (SD 10.98). Being female (OR 1.77, 95% CI [1.32; 2.39]), having a low educational level (OR 2.02, CI [1.37; 2.39]) and psychological comorbidities (OR: 4.86, 95% CI [2.17; 10.88]) were associated with sexual distress. For the BIS, 696 respondents were included. Female gender (β: 2.63, 95% CI [2.13; 3.13]), psychological comorbidities (β: 2.45, 95% CI [1.43; 3.47]), higher age (β: −0.07, 95% CI [−0.09; −0.05]), and a high educational level (β:−1.21, CI: −1.79 to −0.64) were associated with the non-disease related questions of the Body Image Scale. Conclusion: This study provides age- and gender-dependent normative values for the SDS and the non-disease related questions of the BIS. Sexual distress and body image are influenced by gender, education level, relationship status and psychological comorbidities. Moreover, age is positively associated with Body Image. [ABSTRACT FROM AUTHOR]

Measuring quality of care with Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) is becoming increasingly important. With this study we evaluated ESWL and URS treatments with PROMs/PREMs and gained experience with the execution and implementation of PROMs/PREMs in daily practice. A longitudinal survey study was performed with ESWL and URS urolithiasis patients, using a questionnaire directly (T0-response 69.8%, n = 51) and 10 days after treatment (T1-response 56%, n = 42). Problems on performing daily activities were experienced by 54.2% of ESWL and 61.1% of URS-patients. In the two weeks after treatment 45.8% of the ESWL group and 70.6% of the URS-patients uses pain medication. URS-patients miss more workdays (5.61 versus 1.26 p = 0.025). Patient satisfaction is similar in both groups. With this study we have made a start with PROMs and PREMs for urolithiasis patients. It shows that urolithiasis treatment has influence on patient's life. More knowledge in this area will improve shared decision making. [ABSTRACT FROM AUTHOR]