Objective: Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries (LMICs). Mobile health technologies may improve noncommunicable disease outcomes, but LMICs lack resources to provide these services. We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure (BP) monitoring as a strategy for improving systolic BPs (SBPs) and other outcomes of hypertensive patients in two LMICs. Subjects and Methods: This was a randomized trial with a 6-week follow-up. Participants with high SBPs ( ‡140 mm Hg if nondiabetic and ‡130 mm Hg if diabetic) were enrolled from clinics in Honduras and Mexico. Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States, plus a home BP monitor. At baseline, control patients received BP results, hypertension information, and usual healthcare. The primary outcome, SBP, was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs. Secondary outcomes included perceived health status and medicationrelated problems. Results: Of the 200 patients recruited, 181 (90%) completed follow-up, and 117 of 181 had low literacy or high hypertension information needs. The median annual income was $2,900 USD, and average educational attainment was 6.5 years. At follow-up intervention patients' SBPs decreased 4.2 mm Hg relative to controls (95% confidence interval -9.1, 0.7; p = 0.09). In the subgroup with high information needs, intervention patients' average SBPs decreased 8.8 mm Hg ( -14.2, -3.4, p = 0.002). Compared with controls, intervention patients at follow-up reported fewer depressive symptoms (p = 0.004), fewer medication problems (p < 0.0001), better general health (p < 0.0001), and greater satisfaction with care (p £ 0.004). Conclusions: Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs. A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support.

Background: In October 2012, the Advisory Committee on Immunization Practices (ACIP) recommended a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) during each pregnancy, irrespective of the patient’s prior history of receiving Tdap. A retrospective cohort study to assess the safety of Tdap vaccination in pregnant women in two Vaccine Safety Datalink (VSD) sites during 2010-2012 found a small but statistically significant increased risk of chorioamnionitis. Objective: We conducted a review of the VAERS database to describe reports of chorioamnionitis following receipt of any vaccines. Methods: We searched the VAERS database for reports of chorioamnionitis after any vaccine in the United States during the period from July 1, 1990 through February 2, 2014. Results: VAERS received 31 reports of chorioamnionitis out of 3,389 pregnancy reports. The three most common vaccines administered were 2009 H1N1 inactivated influenza, quadrivalent human papillomavirus (HPV4), and Tdap vaccines in 32%, 29% and 26% of reports, respectively. Fifty-eight percent of reports had at least one risk factor for chorioamnionitis. Chorioamnionitis was identified in 3 reports of spontaneous abortions and 6 stillbirths, 6 reports of preterm birth (two of whom died) and 16 reports of term birth; maternal outcomes included two reports of postpartum hemorrhage and one report of maternal admission to the intensive care unit. No maternal deaths were reported. Conclusion: Chorioamnionitis was found to be uncommonly reported, representing 1% of pregnancy reports to VAERS. A majority of reports had at least one risk factor for chorioamnionitis.

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INTRODUCTION: Hospital guidelines and standards recommend the routine use of professional interpreters for patients with Limited English Proficiency (LEP). There is no preexisting data on LEP obstetrics patients and their communications with physicians and nurses. Our objective was to review English LEP patients’ communication with physicians and nurses during their delivery hospitalization, including the use of interpreters and language proficient providers, as well as its association with patient satisfaction. METHODS: Cross-sectional study with in-person survey methodology and retrospective chart review of patients admitted to our postpartum service after delivery at our institution. IRB exempt. RESULTS: 148 postpartum patients were screened. After applying inclusion and exclusion criteria, 20 patients participated in the survey. 70% of these patients were admitted by non-language proficient provider. Of these, only 36% documented use of interpreter during admission. 2 of the 3 patients who underwent cesarean section reported that the reason for cesarean was explained to them in English without the use of interpreter. Despite this, there was reported 100% satisfaction with overall physician care, physician communication with respect to medical condition, and physician respect for culture and language. CONCLUSION: We hypothesized that the rate of use of interpreters and language-proficient providers would be poor, and this proved to be correct in our internal review. The high reported rates of patient satisfaction with both physician and nursing care, communication, and perception of respect for culture and language was a seemingly discordant finding that warrants further exploration. Patient satisfaction drivers may be somewhat different for obstetric populations. This warrants further investigation.

INTRODUCTION: The benefits of breastfeeding for both a newborn and mother are well established. Parents often co-sleep with their children for ease of breastfeeding. However, co-sleeping is associated with sleep-related deaths. To alleviate this burden, Temple University Hospital (TUH) provided all newly delivered mothers with a Baby Box, a box with a firm mattress, for a safe sleeping environment. The purpose of this project was to study the impact of a safe sleeping environment on breastfeeding rates. METHODS: This is a retrospective study of patients between May 2016 and May 2018 who delivered at TUH and were provided a Baby Box prior to hospital discharge. A phone survey was performed after discharge. Categorical variables were analyzed using Pearson chi-squared test. This study on review by the TUH IRB was given exempt status. RESULTS: Of 4,394 eligible women, 26% reported exclusive breastfeeding of their infant. Approximately 26% of those exclusively breastfeeding reported using the Baby Box for infant sleep, and 54% reported that breastfeeding was easier while using the Baby Box. Approximately 32% of those who exclusively breastfed reported co-sleeping with their infant. There was no statistically significant difference between feeding method and use of the Baby Box. CONCLUSION: With the use of the baby box, the number of participants exclusively breastfeeding was low. Of those who exclusively breastfeed, there was a high rate of co-sleeping, despite being provided with a safe sleeping environment. This study demonstrates the need for continued efforts to promote breastfeeding and safe sleeping in this patient population.