Is maternity care in Scotland equitable? Results of a national maternity care survey

Objective High-quality maternity care is key to long-term improvements in population health. However, even within developed welfare systems, some mothers and babies experience poorer care and outcomes. This study aimed to explore whether women’s experiences of maternity care in Scotland differs by their physical or sociodemographic characteristics. Design Secondary analysis of the 2015 Scottish Maternity Care Experience Survey. The questionnaire was based on the Care Quality Commission English maternity survey. Setting National Health Service maternity care in Scotland. Participants The survey was distributed to 5025 women who gave birth in Scotland during February and March 2015 with 2036 respondents (41%). Main outcome measures The questionnaire explored aspects of care processes and interpersonal care experienced from the first antenatal contact (booking) to 6 weeks following the birth. The analysis investigated whether experiences were related to age, parity, deprivation, rurality, self-reported general health or presence of a health condition that limited daily activities. Analysis used mixed effect multilevel models incorporating logistic regression. Results There were associations between parity, age and deprivation with gestation at booking indicating that younger women, women from more deprived areas and multiparous women booked later. Women reporting generally poorer health were more likely to describe poorer care experiences in almost every domain including continuity, pain relief in labour, communication with staff, support and advice, involvement in decision making, confidence and trust and overall rating of care. Conclusions We found few differences in maternity care experience for women based on their physical or socioeconomic characteristics. Our findings indicate that maternity care in Scotland is generally equitable. However, the link between poorer general health after childbirth and poorer experience of maternity care is an important finding requiring further study

Women’s Understanding of the Effects of Domestic Abuse: The Impact on Their Identity, Sense of Self and Resilience. A Grounded Theory Approach

Research on women who have experienced domestic abuse indicates that they feel marginalized; stigma, shame and fear about the response of services stop women from seeking the support they need. The current study aimed to explore the unique perspectives of women who have experienced domestic abuse in order to gain an understanding of their experiences, their perceived identity, sense of self and resilience. Interviews were conducted with eight women who had experienced domestic abuse and transcripts were analysed using grounded theory methodology. Findings indicated that domestic abuse had a significant impact on the women interviewed. In particular, the ongoing relationship the women had with their abusive partner, due to contact with the children, served to perpetuate their identity as an abused woman. The study also found, however, that the women were able to utilise resources that increased their resilience. They were striving for a normal life, prioritising their role as a mother and attempting to reconstruct their own identity through the assumption of new roles

Prenatal anxiety, maternal stroking in infancy, and symptoms of emotional and behavioral disorders at 3.5 years

Animal findings of long-term effects of maternal behaviors mediated via altered GR gene expression will, if translated into humans, have far reaching implications for our understanding of child and adolescent psychopathology. We have previously shown that mothers’ self-reported stroking of their infants modifies associations between prenatal depression and anxiety and child outcomes at 29 weeks and 2.5 years. Here, we examine whether the effect of early maternal stroking is evident at 3.5 years, and in a much larger sample than in previous publications. A general population sample of 1233 first-time mothers completed anxiety measures at 20 weeks gestation, 865 reported on infant stroking at 9 weeks, and 813 on child symptoms at 3.5 years. Maternal stroking moderated the association between pregnancy-specific anxiety and internalizing (p = 0.010) and externalizing (p = 0.004) scores, such that an effect of PSA to increase symptoms was markedly reduced for mothers who reported high levels of stroking. There was no effect of maternal stroking on general anxiety. The findings confirm the previously reported effect of maternal stroking, and in a much larger sample. They indicate that there are long-term effects of early maternal stroking, modifying associations between prenatal anxiety and child emotional and behavioral symptoms

Profiling the host response to malaria vaccination and malaria challenge.

A vaccine for malaria is urgently required. The RTS,S vaccine represents major progress, but is only partially effective. Development of the next generation of highly effective vaccines requires elucidation of the protective immune response. Immunity to malaria is known to be complex, and pattern-based approaches such as global gene expression profiling are ideal for understanding response to vaccination and protection against disease. The availability of experimental sporozoite challenge in humans to test candidate malaria vaccines offers a precious opportunity unavailable for other current targets of vaccine research such as HIV, tuberculosis and Ebola. However, a limited number of transcriptional profiling studies in the context of malaria vaccine research have been published to date. This review outlines the background, existing studies, limits and opportunities for gene expression studies to accelerate malaria vaccine research

Body image during pregnancy: an evaluation of the suitability of the body attitudes questionnaire

Background:&nbsp;Available data suggest that body dissatisfaction is common during pregnancy and may even be a&nbsp;precursor to post-natal depression. However, in order to accurately identify at-risk women, it is essential to first&nbsp;establish that body image measures function appropriately in pregnant populations. Our study examines the&nbsp;suitability of the Body Attitudes Questionnaire (BAQ) for measuring body dissatisfaction among pregnant women&nbsp;by comparing the psychometric functioning of the BAQ: (1) across key phases of pregnancy, and (2) between&nbsp;pregnant and non-pregnant women.&nbsp;Methods: A total of 176 pregnant women from Melbourne, Victoria filled out a questionnaire battery containing&nbsp;demographic questions and the Body Attitudes Questionnaire at 16, 24, and 32 weeks during pregnancy. A&nbsp;comparison group of 148 non-pregnant women also completed the questionnaire battery at Time 1. Evaluations of&nbsp;the psychometric properties of the BAQ consisted of a series of measurement invariance tests conducted within a&nbsp;structural equation modelling framework.Results: Although the internal consistency and factorial validity of the subscales of the BAQ were established across&nbsp;time and also in comparisons between pregnant and non- pregnant women, measurement invariance tests showed&nbsp;non-invariant item intercepts across pregnancy and also in comparison with the non-pregnant subgroup.&nbsp;Inspection of modification indices revealed a complex, non-uniform pattern of differences in item intercepts across&nbsp;groups.Conclusions: Collectively, our findings suggest that comparisons of body dissatisfaction between pregnant and&nbsp;non-pregnant women (at least based on the BAQ) are likely to be conflated by differential measurement biases that serve to undermine attempts to accurately assess level of body dissatisfaction. Researchers should be cautious in&nbsp;assessments of body dissatisfaction among pregnant women until a suitable measure has been established for use&nbsp;in this population. Given the fact that body dissatisfaction is often associated with maladaptive behaviours, such as&nbsp;unhealthy eating and extreme weight loss behaviours, and with ante-and post-natal depression, that have serious&nbsp;negative implications for women&rsquo;s health and well-being, and potentially also for the unborn foetus during&nbsp;pregnancy, developing a suitable body image screening tool, specific to the perinatal period is clearly warranted.</div

A Case Study Of The Student Academic Support System: State University

In 1985, the Florida Legislature mandated the development of a computer assisted academic advisement program for the State University System. This study of the Student Academic Support System (SASS) explored the administrator and advisor viewpoints, rather than traditional student perception assessments, in order to add to the understanding of computer assisted advising as it now stands in the State of Florida. The goal of this research was to determine the best practices of computer assisted advising throughout the State University System. Individuals who use or have responsibility for the advising system were identified in each institution in the State University System. An instrument was developed to identify the use of key components of the Student Academic Support System and interviews were scheduled. A review of the literature and results of this study found that there were many factors that influenced the success or failure of a computer assisted advising system. Factors such as funding, administrative sponsorship from the highest levels of the institution, institutional culture, advisor computer proficiency, and the existence of alternate computer advising technologies played significant roles in the development and implementation of the mandated state computer advising system. The qualitative interviews utilized in this case study highlighted the complexities of computer assisted advising. This research studied the perceptions and practices of administrators and advisors in the 11 State Universities in Florida. This research study documents the history of the development and implementation of computer assisted advising within the Florida State University System. As such, this research provides insight for administrators, technology professionals, and policy makers in the field of student advisement. Implications of this study, for the Florida State University System, show that strong administrative support and acceptance of the value of the system by advisors are necessary for successful implementation of a computer assisted advising system. Continued assessment, modification, and funding must be a priority for any institution that utilizes computer assisted advising systems. A properly implemented advising tool, such as the Student Academic Support System, results in a better informed student and a more effective sharing of information between students, advisors, and the university. Properly advised students will reach their educational goals in a timely and efficient fashion. The use of computer assisted advising was found to result in a satisfying academic experience for the advisor and to increase a student\u27s level of satisfaction with the advising encounter

Maternal mental health and child problem behaviours: disentangling the role of depression and borderline personality dysfunction

Background It is not known whether associations between child problem behaviours and maternal depression can be accounted for by comorbid borderline personality disorder (BPD) dysfunction. Aim To examine the contributions of maternal depression and BPD symptoms to child problem behaviours. Method Depression trajectories over the first-year postpartum were generated using repeated measurement from a general population sample of 997 mothers recruited in pregnancy. In a stratified subsample of 251, maternal depression and BPD symptoms were examined as predictors of child problem behaviours at 2.5 years. Results Child problem behaviours were predicted by a high maternal depression trajectory prior to the inclusion of BPD symptoms. This association was no longer significant after the introduction of BPD symptoms. Conclusions Risks for child problem behaviours currently attributed to maternal depression may arise from more persistent and pervasive difficulties found in borderline personality dysfunction