Women's experiences of pregnancy, childbirth, and the postnatal period in the Gambia: A qualitative study

Objective: In sub-Saharan African countries, there are unique cultural factors and adverse physical conditions that contribute to women's experiences of pregnancy and birth. The objective of this study was to qualitatively explore women's experiences of pregnancy, childbirth, the postnatal period, and maternal psychological distress in The Gambia. Design and methods: Semi-structured interviews were carried out with 55 women who had given birth within the previous year. Results: Thematic analysis identified five themes: (1) transition to adulthood, (2) physical difficulties, (3) value of children in relation to others, (4) children as a strain, and (5) going through it alone. The results suggest that having a child is a defining point in women's lives associated with happiness and joy. However, women also described situations which could lead to unhappiness and distress in the perinatal period. A child conceived out of wedlock or a baby girl can be sources of distress because of negative cultural perceptions. The strain of having a child, particularly the additional financial burden, and minimal support from men were also a concern for women. Finally, women recognized the danger associated with delivery and expressed recurrent worries of complications during childbirth which could result in the death of them or the baby. Conclusions: Further research is needed to identify women vulnerable to psychological distress so that health services and target interventions can be developed accordingly

Deriving the Hirshfeld partitioning using distance metrics

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Variational determination of the second-order density matrix for the isoelectronic series of beryllium, neon and silicon

The isoelectronic series of Be, Ne and Si are investigated using a variational determination of the second-order density matrix. A semidefinite program was developed that exploits all rotational and spin symmetries in the atomic system. We find that the method is capable of describing the strong static electron correlations due to the incipient degeneracy in the hydrogenic spectrum for increasing central charge. Apart from the ground-state energy various other properties are extracted from the variationally determined second-order density matrix. The ionization energy is constructed using the extended Koopmans' theorem. The natural occupations are also studied, as well as the correlated Hartree-Fock-like single particle energies. The exploitation of symmetry allows to study the basis set dependence and results are presented for correlation-consistent polarized valence double, triple and quadruple zeta basis sets.Comment: 19 pages, 7 figures, 3 tables v2: corrected typo in Eq. (52

Malignancy and all-cause mortality; incidence in adolescents and young adults living with perinatally acquired HIV.

Background: Adults living with HIV have an increased risk of malignancy yet there is a paucity of data for adolescents and young adults (AYA) with perinatally acquired HIV (PaHIV). Methods: Retrospective cohort analysis of all-cause mortality and malignancies in AYA with PaHIV aged 10-24 years attending a tertiary unit from 01 January 2004 to 31 December 2017, assessing cancer presentation, immunology and comparing mortality and malignancy incidence to age-matched UK general population rates. Results: A total of 290 AYA with PaHIV contributed 2644 person-years of follow up. Six (2.0%) died within the study period at a median age of 17 years (interquartile range [IQR]15-19), 3 of malignancy, 2 with end-stage HIV and 1 with cryptococcal meningitis. Overall mortality rate was 2.3/1000 person-years, with an age-matched general population rate of 0.2/1000 person-years. Eight (2.8%) were diagnosed with a malignancy; 6 with lymphoma (n=3 Hodgkin's, n=1 Burkitt's, n=2 B-cell) and one each with hepatocellular carcinoma and gastrointestinal adenocarcinoma. At cancer diagnosis the median age was 19 years (IQR 14-23), median CD4 T cell count was 453 cells/mm3 (IQR 231-645) and median length of HIV viremia was 15 years (IQR 12-17). The incidence rate of a malignancy was 3.0/1000 person-years in AYA with PaHIV, whilst that in the age-matched general population is 0.2/1000 person-years. Conclusion: AYA living with PaHIV had an increased risk of all-cause mortality and of malignancy compared to their uninfected peers, with the excess in malignancy driven by lymphomas. It is hoped that earlier access to antiretroviral therapy will mitigate some of the AIDS-defining and non-AIDS defining risks for future generations

Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial

BACKGROUND: Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer potential flexibility and anonymity. What Am I Worried About (WaWa) is a self-guided treatment based on cognitive-behavioral and mindfulness principles for women experiencing postpartum anxiety. WaWa was developed in Australia and consists of 9 modules with optional weekly telephone support. WaWa was adapted to a Web-based version for use in England (Internet-based What Am I Worried About, iWaWa). OBJECTIVE: This study aimed to investigate the feasibility (engagement and usability) and acceptability (usefulness, satisfaction, and helpfulness) of iWaWa among English postpartum women with anxiety. METHODS: Postpartum (<12 months) women with mild-to-severe anxiety were recruited anonymously via social media during an 8-week period. Participants were randomized to the iWaWa treatment (8 weeks) or wait-list control group. Treatment and study feasibility and acceptability were assessed after the treatment, and anxiety symptoms were assessed at baseline, 8 weeks postrandomization, and 12 weeks postrandomization (treatment group only) using Web-based questionnaires. Semistructured telephone interviews were carried out after the treatment period for a more in-depth exploration of treatment acceptability and feasibility. RESULTS: A total of 89 eligible women were recruited through social media and randomized into the treatment (n=46) or wait-list control group (n=43). Women were predominantly Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Dropout rates were high, especially in the treatment group (treatment: 82%, 38/46; wait-list control: 51%, 22/43). A total of 26 women started iWaWa with only 2 women completing all 9 modules. Quantitative and qualitative data suggest iWaWa was experienced as generally useful and helpful. Participants enjoyed iWaWa's accessibility, anonymity, and weekly reminders, as well as the introduction to the principles of cognitive-behavioral therapy (CBT) and mindfulness. However, iWaWa was also experienced as not user-friendly enough, too long, and not smartphone-friendly. Parts of the content were experienced as not always relevant and appropriate. Participants felt that iWaWa could be improved by having it in a smartphone app format and by making the content more concise and inclusive of different parenting styles. CONCLUSIONS: Despite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format. However, this first trial provides useful evidence about treatment format and content preferences that can inform iWaWa's future development, as well as research and development of Web-based postpartum anxiety treatments, in general, to optimize adherence. TRIAL REGISTRATION: ClinicalTrials.gov NCT02434406; https://clinicaltrials.gov/ct2/show/NCT02434406 (Archived by WebCite at http://www.webcitation.org/6xTq7Bwmd)

Internet-based interventions for postpartum anxiety: exploring health visitors’ views

Objective: This study aimed to explore health visitors’ (HVs) views on the acceptability and potential implementation of internet-based postpartum anxiety interventions in their practice. Background: Internet-based self-help has been shown to be effective and acceptable for postpartum depression. Recently, an internet-based intervention has been developed for postpartum anxiety. Before implementing new anxiety interventions in postpartum care, it is important to determine the acceptability and ways of implementing such interventions. This study therefore explored HVs’ views on this, as they are the some of the key healthcare professionals supporting women postpartum. Methods: Semi-structured interviews were conducted with 13 HVs across the UK. Audio-recorded interviews were transcribed verbatim and analysed using thematic analysis. Results: Five themes emerged – suitability; benefits; concerns; importance of one-to-one support; implementation. Internet-based interventions were seen as suitable as an additional option for a sub-group of postpartum women. Identified benefits included increased availability of a treatment tool for postpartum anxiety and treatment anonymity and flexibility. Reported concerns were the women’s state of mind, decreased human and professional contact, as well as IT access and literacy and language skills. HVs considered the most feasible way to implement internet-based interventions would be to have flyers for HVs to include with other information provided after birth or to hand out and discuss during their visits. The need for sufficient evidence of treatment efficacy and appropriate training was highlighted. Conclusion: This study highlights the opportunities and challenges that need to be considered before implementing internet-based interventions for postpartum anxiety in the postpartum care

Neurodevelopmental Outcomes at 2 and 3.5 Years for Very Preterm Babies Enrolled in a Randomized Trial of Milking the Umbilical Cord versus Delayed Cord Clamping

Background: Guidelines published by the International Liaison Committee for Resuscitation and by the World Health Organization recommend delaying cord clamping at birth as part of routine care for infants. Objective: To study the use of milking of the cord 4 times as an alternative to enhance the redistribution of placental blood into the baby. Methods: This is a prospective cohort study of neurodevelopmental assessment by the Bayley III method of very preterm infants who had participated in a trial of delayed cord clamping versus cord milking at birth that was conducted in a neonatal tertiary care hospital. The primary outcomes were differences in cognitive, motor and language development at 2 and 3.5 years. Two-tailed analyses were performed with the χ2 test, Fisher's exact test, t test, Mann-Whitney U test and ANCOVA. Results: Out of the 58 infants enrolled in the original study, 39 infants (67%) were assessed at 2 years and 29 (50%) at 3.5 years of age. Neurodevelopmental outcomes at 2 and 3.5 years did not significantly differ between the two groups for the three Bayley III composite scores. At 3.5 years there was a trend towards higher scores for girls in the language composite scores (girls: mean = 121.6, SD = 15.22; boys: mean = 101.07, SD = 19.84) and on the motor scale (girls: mean = 124.60, SD = 18.15; boys: mean = 97.86, SD = 17.23). Conclusions: In this small number of participants followed up at 2 and 3.5 years of age, milking of the cord 4 times did not have any long-term adverse effect on neurodevelopmental outcome, suggesting that cord milking could be used as an alternative to delayed cord clamping

Parents' experiences and satisfaction with care during the birth of their very preterm baby: a qualitative study

Objective: To assess parents' experiences and satisfaction with care during very preterm birth and to identify domains associated with positive and negative experiences of care. Design: Qualitative study using semi-structured interviews. Setting: Three neonatal units in tertiary care hospitals in South-East England. Population: Thirty-two mothers and seven fathers who had a baby born before 32 weeks of gestation and spoke English well. Methods: Semi-structured interviews were conducted. Results were analysed using thematic analysis. Main outcome measures Participants' experiences and satisfaction with care during the birth of their preterm baby. Results: Overall, 80% of participants were extremely satisfied with the care during the birth of their preterm baby, seven were generally satisfied but felt some things could be improved and one was dissatisfied. Four key determinants of experiences of care were identified: staff professionalism, which included information and explanation, being calm in a crisis, appearing confident and in control, and conversely not listening to the woman; staff empathy, which included caring and emotional support, and encouragement and reassurance; involvement of the father; and birth environment. Conclusions: Although the determinants of experiences of care are generally consistent with previous research on term births, unique factors to preterm birth were identified. These were the importance of the staff appearing calm during the birth, and the staff portraying confidence and taking control during the birth. Women valued being listened to, and both they and their partners valued staff helping fathers to feel involved during the birth

Charge Transfer in Partition Theory

The recently proposed Partition Theory (PT) [J.Phys.Chem.A 111, 2229 (2007)] is illustrated on a simple one-dimensional model of a heteronuclear diatomic molecule. It is shown that a sharp definition for the charge of molecular fragments emerges from PT, and that the ensuing population analysis can be used to study how charge redistributes during dissociation and the implications of that redistribution for the dipole moment. Interpreting small differences between the isolated parts' ionization potentials as due to environmental inhomogeneities, we gain insight into how electron localization takes place in H2+ as the molecule dissociates. Furthermore, by studying the preservation of the shapes of the parts as different parameters of the model are varied, we address the issue of transferability of the parts. We find good transferability within the chemically meaningful parameter regime, raising hopes that PT will prove useful in chemical applications.Comment: 12 pages, 16 figure