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Preliminary findings on the experiences of care for women who suffered early pregnancy losses during the COVID-19 pandemic: A qualitative study
Get PDFBackground: Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic’s impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported. Methods: In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women’s access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic. Results: All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal. Conclusions: These findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss
Suppression of Bcl3 disrupts viability of breast cancer cells through both p53-dependent and p53-independent mechanisms via loss of NF-κB signalling
Get PDFThe NF-κB co-factor Bcl3 is a proto-oncogene that promotes breast cancer proliferation, metastasis and therapeutic resistance, yet its role in breast cancer cell survival is unclear. Here, we sought to determine the effect of Bcl3 suppression alone on breast cancer cell viability, with a view to informing future studies that aim to target Bcl3 therapeutically. Bcl3 was suppressed by siRNA in breast cancer cell lines before changes in viability, proliferation, apoptosis and senescence were examined. Bcl3 suppression significantly reduced viability and was shown to induce apoptosis in all cell lines tested, while an additional p53-dependent senescence and senescence-associated secretory phenotype was also observed in those cells with functional p53. The role of the Bcl3/NF-κB axis in this senescence response was confirmed via siRNA of the non-canonical NF-κB subunit NFKB2/p52, which resulted in increased cellular senescence and the canonical subunit NFKB1/p50, which induced the senescence-associated secretory phenotype. An analysis of clinical data showed a correlation between reduced relapse-free survival in patients that expressed high levels of Bcl3 and carried a p53 mutation. Together, these data demonstrate a dual role for Bcl3/NF-κB in the maintenance of breast cancer cell viability and suggests that targeting Bcl3 may be more beneficial to patients with tumours that lack functional p53
The economic and social costs of body dissatisfaction and appearance-based discrimination in the United States
Get PDFThis study estimated the social and economic costs of body dissatisfaction and appearance-based discrimination (specifically, weight and skin-shade discrimination) in the United States (USA) in the 2019 calendar year. We used a prevalence-based approach and a cost-of-illness method to estimate the annual cost of harmful appearance ideals for cases of body dissatisfaction and discrimination based on weight and skin shade. Impacts on conditions/illnesses such as eating disorders that are attributable to body dissatisfaction, weight discrimination and skin-shade discrimination were identified through a quasi-systematic literature review, which captured financial, economic, and non-financial costs. For each impact attributable to body dissatisfaction or appearance-based discrimination, annual health system and productivity costs (or labor market costs) were primarily estimated by using a population attributable fraction methodology. Only direct costs that resulted from body dissatisfaction and appearance-based discrimination were included (for example, costs associated with conditions such as depression attributable to body dissatisfaction or appearance-based discrimination). In contrast, indirect costs (e.g. costs associated with a health condition developed following skin bleaching, which was undertaken as a result of body dissatisfaction) were not included. In 2019 body dissatisfaction incurred 221 billion through reduced well-being. Financial costs of weight discrimination and skin-shade discrimination were estimated to be 63 billion, respectively, and reduced well-being was estimated to be 8.4 billion due to skin-shade discrimination. Sensitivity testing revealed the costs likely range between 507 billion for body dissatisfaction, between 537 billion for skin-shade discrimination, and between 265 billion for weight discrimination. This study demonstrates that the prevalence and economic costs of body dissatisfaction and weight and skin-shade discrimination are substantial, which underscores the urgency of identifying policy actions designed to promote prevention
Case method teaching, strategic storytelling, and social change: A pilot evaluation of an online course to address colourism in Malaysia
Get PDFColourism is the discriminatory practice of favoring lighter skin over darker skin. It perpetuates social disparities and drives skin-lightening products (SLP) use globally, including in Malaysia. This study presents the results of an innovative 3 week online training course designed to equip health professionals and educators who work with youth in Malaysia with the knowledge and skills to combat colourism and the use of dangerous SLPs through strategic storytelling. We recruited a diverse group of learners ( N = 19) and assessed their knowledge and attitudes of colourism and use of SLP before and after the course. We also assessed student engagement and collected qualitative acceptability data. The course incorporated case method teaching, interactive case delivery, strategic storytelling methods, and team collaboration elements through digital platforms to facilitate course engagement and learning. Our findings indicate significant improvements in learners’ knowledge and concern regarding skin-shade discrimination and SLP usage pre- to post-course. Learners reported their intention to use strategic storytelling techniques for public health advocacy around colourism and use of SLPs. Qualitative learner feedback highlighted the positive aspects of the course, including its realism and the importance of collaborative learning with professionals from diverse fields to combat prevailing sociocultural issues. While this study offers valuable insights into the effectiveness of this innovative training approach, it also identifies areas of future improvements as suggested by learners, such as the need to increase content diversity, enhance communication channels, and extend time for discussion. This course provides a promising model for addressing colourism-related issues in Malaysia
Interleukins in urine and blood as markers of infection and as risk factors for systemic conditions
Get PDFInterleukins are a diverse group of cytokines that play a crucial role in controlling immune responses and have potential as biomarkers. This mini review evaluates 12 recent papers linking urinary interleukins to both urinary infection and systemic diseases. While measurement of serum interleukins can indicate systemic inflammation, urinary interleukins provide more specific insights into renal or urinary tract inflammation. Urinary interleukins such as IL-8, IL-18, and IL-1β show promise for diagnosing urinary tract infections and other conditions. However, their diagnostic utility is complicated by their wide distribution in the body and patient-related factors. Advances in analytical techniques have enhanced the sensitivity and speed of interleukin measurement, improving their clinical utility. PATIENT SUMMARY: This review highlights research showing that measurement of molecules associated with the immune system in urine samples can help in diagnosing and monitoring disease affecting the urinary tract and kidneys. These urine tests can provide more specific information about infections than blood tests can. [Abstract copyright: Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.
Evaluation of the thyroid and hypothyroid function after postoperative radiation therapy among breast cancer patients
Get PDFThe current advances in radiotherapy (RT) have improved the outcome of breast cancer (BC) patients. Despite its therapeutic benefits, the iatrogenic toxicities of RT and its impact on BC survivors are still debated, and further evaluations should be considered. This study aims to assess the rate of subclinical hypothyroidism and hypoparathyroidism among BC patients who were exposed to therapeutic radiation. Seventy females undergoing RT for BC were enrolled in this cross-sectional study. Laboratory assessment of thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels was obtained to evaluate thyroid function. The parathyroid function was evaluated by measuring serum levels of Calcium (Ca), Phosphorus (P), and parathyroid hormone (PTH) at baseline, six and 12 months after RT. The mean age of patients was 54.3±6.4 years. We found no cases of hypothyroidism before radiotherapy. However, nine patients developed hypothyroidism in the six months after radiotherapy (one clinical and eight subclinical, 13% in total), and six patients were identified with hypothyroidism in the 12 months after radiotherapy (one clinical and five subclinical, 8.7% in total). Significant relationships were observed in the hypothyroidism rate at both six months (p = 0.003) and 12 months (p = 0.028) after RT compared with the baseline. There was no case of hypoparathyroidism before and after RT. In summary, we found that thyroid and parathyroid dysfunction after RT are relatively common findings among women with BC. It is a treatable source of morbidity in patients undergoing RT. Therefore, routine thyroid function monitoring should be recommended to improve the quality of life in BC survivors. [Abstract copyright: © 2024 Canadian Association of Nurses in Oncology (CANO).
Research delivery secondments: A scoping review
Get PDFAim: To explore and summarise published literature with regards to secondments to clinical research and to identify the gaps in research to inform further work. Design: Systematic scoping review. Method: A scoping review was undertaken in accordance with the Patterns, Advances, Gaps, Evidence and Research framework. Databases searched included CINAHL, PubMed, Medline and Embase. Inclusion/exclusion criteria were applied by two independent reviewers. Two reviewers independently retrieved full‐text studies for inclusion and applied the framework as a tool for synthesising Patterns, Advances, Gaps, Evidence and Research recommendations. Results: Six papers and one abstract published between 2003 and 2018 were included. All secondees (n = 34) were released from NHS posts, with secondments (where specified) ranging in duration from 0.25 to 2 years and for 40%–100% of their working hours. All seven papers reported benefits for personal and professional development, predominantly in the form of personal reflections. Few described involvement with research delivery teams. Conclusion: Published initiatives vary in nature and lack standardised reporting and measurement of impact. Further research is required to identify benefits at a departmental or organisational level, the facilitators for setting up secondments and the application of knowledge gained from secondment opportunities. Implications for the Profession: Undertaking a research secondment is reported to offer professional and personal benefit for clinical staff. Research secondments are one way in which a research culture can practically be embedded within clinical settings. Impact: This scoping review identified a lack of published empirical research seeking to understand research secondments as a tool to enhance research and evidence engagement. Although there is a suggestion that secondments could positively impact staff retention, there is limited evidence about the benefit for the organisation or for patient care. These findings have implications for staff, managers and their organisations. Reporting Method: The PRISMA‐ScR guidelines were used to guide reporting. No Patient or Public Contribution: This was not relevant to the research design
Mothers’ experiences of their sons’ appearance-altering combat injuries: Distressed and unsupported
Get PDFEmerging evidence indicates that combat injuries that change appearance, such as limb loss and physical scarring, can impact psychosocial wellbeing of injured military veterans. Parents of young children with a visibly different appearance may experience emotional distress and consequently have their own support needs, but less is known about the experiences of the parents of veterans with appearance-altering combat injuries. Using a qualitative individual interview design, this study aimed to understand the experiences and support needs of parents of military veterans who sustained appearance-altering combat injuries. Reflexive Thematic Analysis of interviews with six mothers identified two main themes “The distress of my son’s appearance-altering injury” and “I can’t express my distress”. The themes represent the emotional distress, guilt, and social difficulties experienced by the mothers following their sons’ appearance-altering injury, their experience of feeling they should supress their feelings of distress, the limited available support, and barriers to accessing support. This study highlights how the mothers of combat-injured veterans are often overlooked and provides emerging evidence that adjusting to a son’s changed appearance following combat-injury can create additional challenges for mothers, who could benefit from specific support
Personalised care packages for people with rheumatoid arthritis: a mixed-methods study.
Get PDFDisease management in rheumatoid arthritis (RA) requires holistic assessment. We aimed to design personalised care packages suitable for people with RA. This study was conducted using a mixed-methods approach and exploratory sequential design. Consensus workshops were held, involving people with RA and healthcare professionals (HCPs) treating them. Subsequently, an online survey sought views on future care packages for people with RA at relevant disease progression/stages, based on (1) results from previous quantitative data analyses (eg, socioeconomic/clinical factors), and (2) themes identified during workshops. Two conceptual care pathways were identified: (1) around the time of RA diagnosis, an early opportunity to influence the disease course; (2) for individuals with established RA, emphasising the importance of 'the right MDT member at the right time'.Three care packages were suggested: (1) early care package (around RA diagnosis): introduction to MDT; (2) continuity of care package (established RA): primary/secondary providers; and (3) personalised holistic care package: integral to packages 1 and 2, implemented alongside allied health professionals.The survey received 41 responses; 82.9% agreed that people with RA need a consistent 'early care package' at diagnosis. 85.4% approved of additional care packages tailored to individuals' clinical, psychological and social needs when moving to different stages of their long-term disease. Fleiss' Kappa calculations demonstrated fair level of agreement among respondents. Two care pathways, with three tailored care packages, were identified, with potential to improve management of people with RA. Future research will help to determine if such care packages can impact clinical (including patient-reported) outcomes. [Abstract copyright: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Ontological insecurity of inattentiveness: Conceptualizing how risk management practices impact on patient recovery when admitted to an acute psychiatric hospital
Get PDFRisk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient's perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patient risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as “ontological insecurity of inattentiveness”. This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients' experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views. It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital