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‘I just had to park up at the hospital and leave her’: retrospective interview study of pregnancy, birth and parenting during the Covid-19 pandemic restrictions
Get PDFIntroduction
Lockdown restrictions during the Covid-19 pandemic had a negative impact on many aspects of our lives. In the UK some groups were disproportionately affected. Evidence indicated higher rates of stress and depression among parents during restrictions. Disruption to early years education interrupted preschoolers’ language and cognitive development. Associations between parental health and child behaviour are also apparent, where parents experiencing mental distress report their child has more difficulties with self-regulation. The longer-term impacts on infants born during restrictions, who are now approaching school age, are not yet known. It is important to get parents’ retrospective reflections and explore the longer-term impacts of lockdown restrictions on families.
Materials and Methods
The study followed a retrospective qualitative interview design. Recruitment sampling ensured views were gathered from people of different genders, sexual orientations, birth/adoptive status and geographic areas. Those residing outside England were excluded; participants needed to speak sufficient English to be interviewed. Interviews were conducted using Zoom software and analysed using Framework Analysis.
Results
Seventeen participants were interviewed. Three overarching themes emerged: navigating antenatal and postnatal care alone; difficult decisions when caring for an infant and the long shadow on the family. Major issues which emerged included attending antenatal appointments - and in some cases giving birth - alone; limited postnatal care; disrupted parental leave; changes in employment and strained relationships. Residual effects continued for some participants, including psychological impacts.
Discussion
Although parents were able to report some positive consequences of the pandemic restrictions, the prevailing experience was one of restricted access to services and missed opportunities for support. In the event of a future pandemic, restrictions should accommodate couples from the same household more pragmatically, and children’s developmental checks should not be deprioritised. Finally, as part of post-pandemic provision, in-person antenatal and post-natal care and consistent early years provision remain vital services which must be acknowledged by policy makers.
Acknowledgements
We would like to thank all the parents for the insights they gave to the BICYCLE team.
If the issues raised in this article affect you personally, please consider speaking with your GP, health visitor, school nurse or your child’s teacher, as appropriate. If you are a healthcare worker you can also get support from NHS England, by visiting: NHS England » Support available for our NHS people Games to support children’s language and communication can be found at: BBC Tiny Happy Peopl
Look-alike modelling in violence-related research: A missing data approach
Get PDFViolence has been analysed in silo due to difficulties in accessing data and concerns for the safety of those exposed. While there is some literature on violence and its associations using individual datasets, analyses using combined sources of data are very limited. Ideally data from the same individuals would enable linkage and a longitudinal understanding of experiences of violence and their (health) impacts and consequences. This paper aims to provide proof of concept to create a synthetic dataset by combining data from the Crime Survey for England and Wales (CSEW) and administrative data from Rape Crisis England and Wales (RCEW), pertaining to victim-survivors of sexual violence in adulthood. Intuitively, the idea was to impute missing information from one dataset by borrowing the distribution from the other. In our analyses, we borrowed information from CSEW to impute missing data in the RCEW administrative dataset, creating a combined synthetic RCEW-CSEW dataset. Using look-alike modelling principles, we provide an innovative and cost-effective approach to exploring patterns and associations in violence-related research in a multi-sectorial setting. Methodologically, we approached data integration as a missing data problem to create a synthetic combined dataset. Multiple imputation with chained equations were employed to collate/impute data from the two different sources. To test whether this procedure was effective, we compared regressions analyses for the individual and combined synthetic datasets on binary, continuous and categorical variables. We extended our testing to an outcome measure and, finally, applied the technique to a variable fully missing in one data source. Our results show that the effect sizes for the combined dataset reflect those from the dataset used for imputation. The variance is higher, resulting in fewer statistically significant estimates. Our approach reinforces the possibility of combining administrative with survey datasets using look-alike methods to overcome existing barriers to data linkage
Protest as a relational field: An analysis of brokerage positions within and across contentious episodes and the individuals occupying them
Get PDFThis paper analyses participation in multiple protest episodes to explore the potential for people to broker relations between same-issue and different-issue episodes. Through an analysis of original survey data from six European countries, we map two-mode networks of individuals and protest episodes in each country to identify protesters in two brokerage positions: coordinators that can broker relations via same-issue contentious episodes and boundary spanners, that can broker relations via different-issue episodes. Combining network and regression analysis, we identify the individuals occupying such positions and characterize their protest participation. We find that embeddedness in different types of activist networks is the most important predictor of brokerage positions. However, the two brokerage positions are associated with different types of embeddedness. By fleshing out the importance of individuals in shaping contentious fields, we offer a unique insight into protest networks, thus advancing the sociological understanding of collective action with an innovative mixed-methods design
Service user experiences of mental health assessments: a systematic review and thematic synthesis of qualitative literature
Get PDFBackground
Successive governments have placed service users’ experiences at the heart of mental health services delivery and development. However, little is known about service users’ experiences of assessments and there is some evidence that assessments can cause harm.
Aims
To synthesise the qualitative literature on service users’ experiences of undergoing mental health service assessments.
Methods
Literature was systematically searched, screened and extracted, following PRISMA guidelines. Several search strategies were employed, including electronic database searches, handsearching, and forward and backward citation tracking, to identify literature which contained data on service users’ experiences of mental health assessments. Thematic synthesis was used to derive a set of themes underpinning these experiences.
Results
Of the 10,137 references screened, 47 were identified as relevant to the review. Two main themes were identified: the importance of humanising assessment processes and experiences of service user agency, with each theme containing four sub-themes.
Conclusions
Findings highlight key factors determining service user experience. We identify key practice implications, contextualised within the literature on trauma-informed approaches and conclude that trauma-informed approaches may aid understanding and improvement of people’s assessment experiences. Further research into the experiences of people from Black and minority ethnic communities is indicated
Differential quantile-based sensitivity in discontinuous models
Get PDFDifferential sensitivity measures provide valuable tools for interpreting complex computational models, as used in applications ranging from simulation to algorithmic prediction. Taking the derivative of the model output in direction of a model parameter can reveal input–output relations and the relative importance of model parameters and input variables. Nonetheless, it is unclear how such derivatives should be taken when the model function has discontinuities and/or input variables are discrete. We present a general framework for addressing such problems, considering derivatives of quantile-based output risk measures, with respect to distortions to random input variables (risk factors), which impact the model output through step-functions. We prove that, subject to weak technical conditions, the derivatives are well-defined and we derive the corresponding formulas. We apply our results to the sensitivity analysis of compound risk models and to a numerical study of reinsurance credit risk in a multi-line insurance portfolio
Multi-material 3D printed composites inspired by nacre: a hard/soft mechanical interplay
Get PDFStructural materials are used extensively in nature where mechanical function is required. These structures are composites consisting of soft and, in some cases, hard phases precisely distributed over different length scales. Bio-inspiration aims at producing materials with structure, design and/or mechanical properties adopted from biological tissues. To reproduce complex structures found in nature, additive manufacturing (AM) using three-dimensional printing (3DP) is an attractive method to assemble complex topologies with resolutions approaching the micro and nano-composition. Specifically, high-resolution MultiJetPrinting (MJP) 3D printing allows the simultaneous deposition of soft and hard photo curable plastic resins. Nacre is a prevalent example of a complex biological composite material organization that can test the ability of MJP to manufacture a bio-inspired engineering structure, where the organization of materials in nacre is optimized to avoid catastrophic failure. The ability to generate complex 3D organizations required to mimic the structure of nacre by controlled organization of soft and hard materials is achieved here using a generative design approach. Such a generative design is further enhanced by incorporating two differing MJP directions that provide relatively strong and weak interfaces between the soft and hard material phases. Consideration of classical stress transfer theory between at a hard material reinforcement interface was shown to correlate with experimental observations of mechanical performance and failure in 3D printed nacre inspired composites. Thus, the ability to distribute materials with a range of mechanical properties and incorporate further interfacial design is demonstrated. The approach presented is flexible and allows complex bio-inspired composites to be 3D printed that incorporate different interfacial quality through changing printing direction
The future of free flap monitoring by laser continuous doppler flowmetry: A prospective assessment in consecutive 71 patients
Get PDFObjective: This study evaluated the effectiveness of laser Doppler flowmetry (LDF) in detecting perfusion disturbances during microvascular free tissue transfer.
Methods: Conducted at a single centre from December 2020 to September 2022, this prospective study involved 71 patients mainly undergoing head and neck free flap reconstructions, using the Pocket LDF™ for continuous perfusion monitoring.
Results: Out of the 71 cases, data from 69 cases were analysed after excluding those with significant noise or sensor detachment. Blood flow disturbances were observed in 9 cases (13.0 %), with 5 of these cases with a history of surgery or radiation in the same area. There were 5 cases of ischaemia, 4 of which occurred during monitoring. There were 4 cases of venous congestion, with 1 occurring during monitoring. Re-operation was necessary in 8 cases (11.6 %), involving flap replacements, vascular re-anastomoses and hematoma evacuation. Complete flap necrosis occurred in 5 cases (7.2 %) and partial necrosis occurred in 3 cases (4.3 %). The LDF device demonstrated the ability to identify perfusion issues hours before the clinical symptoms manifested, suggesting its potential for early intervention. However, challenges included maintaining continuous monitoring immediately post-surgery and during patient transfers.
Conclusion: LDF is a valuable, non-invasive tool for early detection of perfusion disturbances in free flap procedures. It provides continuous, real-time feedback on microcirculation, facilitating timely interventions. Despite its benefits, enhancements in sensor adhesion and wireless technology are needed to improve monitoring reliability. Further studies are recommended to refine LDF usage and validate its efficacy in various clinical settings
Predicting OCT retinal ganglion cell volume from pattern ERGs and VEPs in children with suspected optic neuropathy in a tertiary referral setting
Get PDFPurpose
To determine the relationship between retinal ganglion cell (RGC) structure, measured by optical coherence tomography (OCT), and function measured by electrodiagnostic tests in children with suspected optic neuropathy.
Methods
Children presenting consecutively with suspected optic neuropathy were investigated by visual electrophysiology. ISCEV Standard monocular pattern reversal visual evoked potential (PVEP) P100 and pattern electroretinogram (PERG) P50 and N95, amplitudes and peak times were collected, along with the N95 slope 30 ms after the P50 peak. OCT retinal nerve fibre layer (RNFL) thickness from each peripapillary sector and the average macular RGC volume in a 3.45 mm diameter circle were collated. The sensitivity (SENS) and specificity (SPEC) of abnormal visual electrophysiology measures in predicting OCT structural measures were estimated by receiver operating characteristic (ROC) area under the ROC curve (AUC).
Results
Monocular PVEPs and PERGs from 30-degree stimulus fields and OCT RNFL and RGC volume were available from 42 children (84 eyes) aged 5.5–16.3 years (median 12.4 years). PVEP AUC was highest for predicting both RGC macular volume and temporal RNFL thinning (SENS 88%, SPEC 88%), followed by the PERG N95 slope (SENS 79%, SPEC 78%). PERG N95:P50 had the lowest SENS of 62% and SPEC of 61%, which were similar for all RNFL sectors.
Conclusion
Abnormal PERG N95 slopes and PVEPs predicted severe loss of macular RGC volume and temporal sector RNFL with high diagnostic accuracy. These measures are important additions to the less specific PERG N95:P50, which was broadly sensitive to all RNFL sectors. The N95 slope and PVEPs are valuable objective functional markers of RGC health in children
Nascer nas Casas de Parto do Brasil: protocolo de pesquisa
Get PDFOs Centros de Parto Normal (CPN) no Brasil são definidos como unidades de saúde vinculadas a um estabelecimento hospitalar, podendo estar localizados em suas dependências internas (CPN intra-hospitalares) ou imediações (CPN peri-hospitalares ou Casa de Parto). As estruturas física e assistencial das Casas de Parto são definidas pelo Ministério da Saúde. Fazem parte do seu modelo de cuidado as práticas adequadas, bons desfechos maternos e infantis e a promoção da experiência positiva da mulher no parto. O Nascer nas Casas de Parto do Brasil é um estudo transversal, em âmbito nacional, com os objetivos principais de avaliar a estrutura das Casas de Parto para atendimento a partos de risco habitual; avaliar a assistência ao parto e nascimento nas Casas de Parto; comparar os resultados desta pesquisa com os de nascimentos de risco habitual ocorridos nos hospitais amostrados na pesquisa Nascer no Brasil II. Este artigo tem como objetivo informar o delineamento e as etapas metodológicas propostas para o Nascer nas Casas de Parto do Brasil. Foram selecionadas oito Casas de Parto e fazem parte da amostra as gestoras dos serviços e 1.560 mulheres usuárias. A coleta de dados compreende o período de agosto de 2022 a outubro de 2024. Apresentam-se as variáveis do estudo e instrumentos, as etapas de coleta de dados desde a admissão até 120 dias após o parto, as atividades da equipe de pesquisa, o plano de análise dos dados e os aspectos éticos. Discute-se a relevância da divulgação deste protocolo de pesquisa e as especificidades de pesquisa em Casas de Parto
That’s not Fair! Navigating the Duality of Fairness in Insurance
Get PDFInsurance serves as a social good, providing financial protection against disasters whilst operating within a profit-driven market. This dual role highlights the complex intersection of social and commercial interests, raising a fairness puzzle often portrayed as a trade-off between solidarity and actuarial fairness. Insurance organisations adhere to actuarial fairness by setting insurance premiums proportional to the risk each individual’s risk. As extreme weather drives greater losses in high-risk areas, actuarial fairness often results in unaffordable premiums for many. To address this, societies may adopt principles of solidarity fairness to subsidise their premiums. However, this approach risks diminishing personal responsibility to contain risk, as individuals may rely on subsidised protection rather than taking proactive measures. This study draws on a longitudinal qualitative study of a government-legislated insurance organisation to develop a process framework that reconceptualises fairness in insurance as a duality of solidarity and actuarial fairness. It offers insights into designing insurance systems that are socially equitable and financially sustainable
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