Recognising anxiety and post-traumatic stress disorder in cardiac patients

Research has established that anxiety and post-traumatic stress disorder (PTSD) are risk factors for the development of heart disease in healthy populations. In addition, anxiety and PTSD are associated with further morbidity in people with existing heart disease. This article considers whether anxiety and PTSD influence onset and recovery from heart disease. Clinical implications for cardiac nursing are considered, including screening, treatment, and referral on to specialist services

Density functional scheme for calculating the pair density

The density functional scheme for calculating the pair density is presented by means of the constrained-search technique. The resultant single-particle equation takes the form of the modified Hartree-Fock equation which contains the kinetic contribution of the exchange-correlation energy functional as the correlation potential. The practical form of the kinetic contribution is also proposed with the aid of the scaling relations of the kinetic energy functionals.Comment: 5 page

Robust methods for predicting the transition states of chemical reactions: new approaches that focus on key coordinates

A new method for optimizing transition state and minima structures using redundant internal coordinates is presented. The new method is innovative because it allows the user to select a few key reduced coordinates, whose Hessian components will be accurately computed by finite differencing; the remaining elements of the Hessian are approximated with a quasi-Newton method. Usually the reduced coordinates are the coordinates that are involved in bond breaking/forming. In order to develop this method, several other innovations were made, including ways to (a) select the key reduced coordinates automatically, (b) guess the transition state quickly and efficiently, (c) choose dihedrals so that the “linear angle problem” is avoided, (d) robustly convert redundant internal coordinates to Cartesian coordinates. These, and other technical developments (e.g., new quasi-Newton Hessians, new trust-radius updates), were validated using a database of 7000 initial transition-state guesses for a diverse set of 140 chemical reactions

What are we measuring and why? Using theory to guide perinatal research and measurement

Background: A theory is a set of ideas that attempt to explain phenomena and can provide guiding principles on which to base practice. Many theories from biological and social sciences are relevant to women’s health and wellbeing during pregnancy and after birth, yet theory is not commonly explicitly reported in perinatal research. Method: This paper outlines the importance of theory to perinatal research and provides a pragmatic overview of when and how to use theory in research. In particular, we consider (i) deciding when it is appropriate to use theory, (ii) choosing which theory to use and (iii) how to operationalise theory in research. We give examples that illustrate how four different theories have been used in perinatal research to increase understanding and inform the development of interventions. Conclusion: Even when it is not appropriate to use theory in our research, careful consideration of pertinent theories contributes to greater clarity of concepts and understanding of different explanations or perspectives on what we are studying. It also prompts us to consider where our research fits in terms of contribution to knowledge or the development and evaluation of treatments. However, it is important that a critical approach is taken so that theories continue to be developed. In this way we will systematically advance our understanding of general factors or processes that are relevant to perinatal health, as well as those factors that are unique to perinatal health

The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework

There is evidence that 3.17% of women report posttraumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its etiology. Systematic searches were carried out on PsychInfo, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least one month after birth. 50 studies (N=21,429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (.51), fear of childbirth (.41), poor health or complications in pregnancy (r = .38), and a history of PTSD (.39) and counselling (.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (.59), having an operative birth (assisted vaginal or caesarean, .48), lack of support (-.38), and dissociation (.32). After birth, PTSD was associated with poor coping and stress (.30), and was highly comorbid with depression (.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the etiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care

Subsystem constraints in variational second order density matrix optimization: curing the dissociative behavior

A previous study of diatomic molecules revealed that variational second-order density matrix theory has serious problems in the dissociation limit when the N-representability is imposed at the level of the usual two-index (P, Q, G) or even three-index (T1, T2) conditions [H. van Aggelen et al., Phys. Chem. Chem. Phys. 11, 5558 (2009)]. Heteronuclear molecules tend to dissociate into fractionally charged atoms. In this paper we introduce a general class of N-representability conditions, called subsystem constraints, and show that they cure the dissociation problem at little additional computational cost. As a numerical example the singlet potential energy surface of BeB+ is studied. The extension to polyatomic molecules, where more subsystem choices can be identified, is also discussed.Comment: published version;added reference

Supporting women with postpartum anxiety: exploring views and experiences of specialist community public health nurses in the UK

Anxiety is common among postpartum women and can have adverse effects on mother's and child's somatic and psychological health if left untreated. In the UK, nurses or midwifes with a specialisation in community public health nursing, also called health visitors (HVs), work with families who have children younger than 5 years of age and are therefore in a key position to identify and support women with postpartum mental health issues. Until recently, postpartum mental health support provided by HVs mainly focused on identifying and managing depression, but the updated clinical guidance by the National Institute for Health and Care Excellence also includes guidance regarding screening and psychological interventions for perinatal anxiety. This study therefore aimed to explore HVs' experiences of supporting women with postpartum anxiety and their views on currently available care. Using a qualitative approach, in-depth semi-structured interviews were conducted with 13 HVs from the UK between May and October 2015. Participants were interviewed in person at their workplace or on the phone/Skype. Using thematic analysis, four main themes emerged: identification and screening issues; importance of training; service usage; and status of current service provision. Women with postpartum anxiety were commonly encountered by HVs in their clinical practice and described as often heavily using their or other related healthcare services, which puts additional strain on HVs' already heavy workload. Issues with identifying and screening for postpartum anxiety were raised and the current lack of perinatal mental health training for HVs was highlighted. In addition, HVs described a current lack of good perinatal mental health services in general and specifically for anxiety. The study highlights the need for HV perinatal mental health training in general and postpartum anxiety specifically, as well as better coverage of specialist mental health services and the need for development of interventions targeted at postpartum anxiety

Interest in web-based treatments for postpartum anxiety: an exploratory survey

Objective: This study aimed to explore women’s interest in web-based treatments for postpartum anxiety and determine the feasibility of reaching women with postpartum anxiety online. Background: Anxiety in the postpartum period is common and often untreated. One innovative approach of offering treatment during this period is through web-based self-help. Assessing women’s interest in new treatments, such as a web-based self-help, is an important step prior to development efforts. Methods: A cross-sectional online survey was created and promoted for 4 months via unpaid social media posts (Facebook and Twitter). To be eligible, women had to be over the age of 18, live in England, fluent in English, be within 12 months postpartum and self-report at least mild levels of anxiety. Results: A sample of 114 eligible women were recruited. The majority were Caucasian, well-educated, middle-class women. Seventy percent reported moderate or severe anxiety. Sixty-one percent of women expressed interest in web-based postpartum anxiety treatments. Women preferred treatment in a smartphone/tablet application format, presented in brief modules and supported by a therapist via email or chat/instant messaging. Conclusions: Based on the stated preferences of participating women it is recommended that postpartum anxiety web-based treatments include different forms of therapist support and use a flexibly accessible smartphone/tablet application format with content split into short sections. The findings also suggest that unpaid social media can be feasible in reaching women with postpartum anxiety, but additional efforts are needed to reach a more diverse population

Think Pink! a Pink Sticker Alert System for Women with Psychological Distress or Vulnerability During Pregnancy

The importance of good clinical communication to women during pregnancy and birth is clear. Poor communication in labour is associated with general dissatisfaction, more complaints and a range of perinatal mental health problems including posttraumatic stress disorder (PTSD) and postnatal depression. To communicate effectively, maternity staff needs information about which women are vulnerable and require extra support. To address this, we implemented and evaluated a pink sticker communication system to alert midwifery and obstetric staff to potential psychological difficulties experienced by some women. Evaluation showed this system was viewed positively by women and midwifery staff. Audit of referrals to the perinatal psychology service during this period suggests no woman with a pink sticker developed birth trauma as a direct result of perceived poor care. In addition, the proportion of referrals to perinatal psychology for birth trauma significantly reduced during this period