A Journey from Science to Art: Valuing the voices of women in the exploration of traumatic childbirth and perinatal mental health.

Informed by a feminist perspective, this thesis critically explores the multiple conceptual metanarratives of in childbirth. The research focuses on the lived experiences of traumatic childbirth and perinatal mental health problems from the perspective of Health Visitors and mothers to journey from the dominant, broad medical perspective to the unique, personal emotional understanding. This highlights the knowledge to be gained through listening and learning from the voices of women who are experts by experience in traumatic childbirth and perinatal mental health care. The research was structured in three phases, a thematic analysis of focus groups with ten Health Visitors; a narrative analysis of mothers with self-defined traumatic birth stories; and a holistic representation of the stories and research experience. Using focus groups with Health Visitors, a thematic analysis constructed an over-arching theme of ‘Protecting an uncertain professional identity’, encompassing two sub-themes constituted of ‘the knowledge narrative’ exploring differing types of professional wisdom, and ‘Health Visitors role in perinatal mental health care.’ In the thematic analysis Health Visitors demonstrate some technical knowledge of PSTD following childbirth, but are under-confident in this knowledge. They outline a juxtaposition between not wanting to take on a role and responsibility in perinatal mental health care, but doing so in practice, creating anxiety. The importance of experiential and relational knowledge underpinning professional artistry is also highlighted. A narrative analysis of twelve mothers’ traumatic childbirth stories utilizes van Gennep’s (1960) Rites of Passage theoretical framework to propose a period of acute liminality following traumatic childbirth experiences, with specific strategies and rituals enabling mothers to reintegrate and incorporate these experiences into their maternal self-identity. Secondly, narrative analysis explores the dilemmatic qualities of the traumatic childbirth narratives through the use of contextually-bound ‘cervix’ repertoires, discursive resources used to negotiate unique and personal experiences within the medical discourses which contextualise contemporary childbirth. Illuminating and integrating the multiple people and positions invested in this project; the researched, the researcher, and the audience, this thesis concludes with an arts-based, novel representation/presentation of mothers’ traumatic childbirth narratives. This provides an alternative, holistic understanding through an emotional capture of the individual traumatic childbirth narratives, creating ‘empathetic engagement’ and reactive reflections. This demonstrates the unique value of aesthetic, visceral knowledge created through potent, evocative and essentially human connection

Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach

© 2023 The Author(s). Published by BMJ. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Introduction: Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. Methods and analysis: The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. Ethics and dissemination: MINDS stage 1 has received ethical approval from Yorkshire & The Humber—Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. Trial registration number: MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO registration number: CRD42021293255.Peer reviewe

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

The associations between antenatal representations (AN) and psychological health in pregnancy:Poster 13

Objective: To explore the associations between Antenatal Representations (AR) (alternatively referred to in the literature as ‘maternal-foetal attachment’ (Cranley, 1981; Condon, 1993)), and depression, anxiety, and stress. AR was measured using the Maternal Antenatal Attachment Scale (MAAS, Condon, 1993) to examine both levels and ‘styles’ of AR. Background: AR refers to the mother’s emotional bond/tie and psychological representations of her unborn baby. AR may be compromised by depression (Misri & Kendrick, 2008) and anxiety (Condon & Corkindale,1997); however stress is yet to be examined. Although most studies show relatively robust results, there are contradicting studies indicating a need for further research. Current research utilises global scores of AR (Muller, 1993), and considers subscales independently (Condon & Corkindale, 1997). Although the concept of recombining the sub-scales to create four categories/’styles’ of AR has been suggested (Condon, 1993), only one study has implemented the method using an at-risk population (Pollock & Percy, 1999). Method: A cross-sectional design was implemented using a paper or on-line self-report questionnaire pack. This pack included the MAAS and the DASS, Lovibond & Lovibond, 1995) as well as other measures, which were part of a larger study. 72 women in their second or third trimester of pregnancy were recruited on-line or at baby/toddler groups. Results: Higher levels of anxiety and stress were associated with the Quality sub-scale of the MAAS, but not the Intensity sub-scale. Results for depression showed a trend in the same direction, but were not significant. Only anxiety was significantly associated with the Global AR score. There were no significant differences between ‘styles’ of AR on psychological health variables. Conclusion: AR should be determined by independently examining the sub-scales of the MAAS, and Quality seems more influential in the associations with psychological health than Intensity. Using ‘styles’ of AR in a normative population does not seem to offer more information than scales, however previous research suggests that it may become influential in a clinical, at-risk population (Pollock & Percy, 1999), and these claims require further validation

The ever gap: The relationship between self-rated health and socio-economic inequalities in Sweden between 1999 and 2021

Health inequality linked to socioeconomic status (SES) has increased in many parts of the world. Since economic inequality also has been reported to be on the rise, it is pivotal to investigate how socioeconomic inequality affects health disparities annually. The present study is based on a yearly repeated cross-sectional probability sample of Swedish citizens (N = 141 619) collected between 1999 and 2021. We show that the relative level of SES has increased significantly in Sweden. In addition, the level of economic inequality has also increased. Based on self-rated health (SRH), we report a clear disparity between low and high SES and subjective social class (SSS), where higher SES and SSS are associated with better SRH. We observe a stronger association between SRH and reported present SSS (i.e., subjective social class aimed at capturing current situation) than between SRH and reported childhood SSS (i.e., subjective social class focusing on the situation when growing up). We show that the annual marginal effect of SES is not increasing but instead contributes with a stable annual contribution on SRH. Interestingly, the annual effect of education on SRH was substantially attenuated when adjusting for income, whereas the effect of income on SRH was only moderately different when adjusting for education. Potential mechanisms and remedies are discussed

Polisens nya tjänsteammunition : SPEER Gold Dot

Syftet med denna rapport är att undersöka hur stor skadeverkan och stoppeffekt den nya ammunitionen, SPEER Gold Dot, har i jämförelse med den gamla, Norma SÄK. Vi vill även belysa hur viktigt valet av ammunition är för tredje person och polisen sett ur ett säkerhetsperspektiv. Eftersom detta ämne är så pass nytt har det mesta av materialet, som vi tagit del av, kommit från utlåtande, rapporter media etc. Vi har utifrån materialet valt att begränsa oss till endast tre frågeställningar, vilken effekt/skadeverkan har den nya ammunitionen mot den gamla ammunitionen, vad talar för och emot den nya ammunitionen, varför har man bytt till den nya ammunitionen och inte behållit den gamla? att argumentera mot en del av medias rubriker och den viktigaste av dem alla är om den nya ammunitionen strider mot Haagkonventionens eller inte. Med allt detta bakgrundsmaterial så har vi kommit fram till att huvudskälet till varför RPS ville byta ammunition var för att öka säkerheten för tredje person, men även för polisens ska ha en effektiv beväpning och kunna räkna med att man får en stoppeffekt när man skjuter en angripare. Testresultat visar att SPEER Gold Dot har en större uppbromsning vid träff än Norma SÄK, vilket alltså ger betydligt bättre stoppeffekt på en angripande gärningsman än den gamla ammunitionen

Tumor Burden and Health-Related Quality of Life in Patients with Melanoma In-Transit Metastases

Background: Few studies have investigated the health-related quality of life (HRQOL) in patients with melanoma in-transit metastases (ITM). The aim was to investigate the association between tumor burden and HRQOL, including disparities pertaining to sex and age, in treatment-naïve patients with ITM. Methods: Functional Assessment of Cancer Therapy-Melanoma (FACT-M) questionnaire was used to assess HRQOL Pairwise comparisons using t-tests between clinical cutoffs are presented and multiple linear regression analysis showing the unique associations of gender, age, number of tumors, tumor size, presence of lymph node metastases, and tumor localization. Results: A total of 95 patients, 47% females and 53% males (median age 72 years) were included between 2012 and 2021. Women scored significantly lower on emotional well-being (p = 0.038) and lower on FACT-M (p = 0.058). Patients who had ≥10 tumors scored significantly lower on FACT-M (p = 0.015), emotional- and functional well-being (p = 0.04, p = 0.004, respectively), melanoma scale (p = 0.005), and FACT-G (p = 0.027). There was no significant difference in HRQOL depending on age, size of tumors, localization, or presence of lymph node metastases. Conclusion: For patients with melanoma ITMs, the female sex and higher tumor burden (i.e., number of tumors) were significantly correlated with lower HRQOL. However, these findings do not fully explain HRQOL for this patient population, and future research should consider the possibility that there are specific questions for patients with ITM where current instruments might fail to measure their discomfort to the full extent

Is obsessive–compulsive personality disorder related to stress‐related exhaustion?

Abstract Objective Recovery from stress‐related diagnoses can, in some cases, be long‐lasting, and several different factors could be related to such a lengthy recovery. One plausible aspect is obsessive–compulsive personality disorder (OCPD), which has previously been seen to be related to stress‐related mental health. Thus, the aim of this study was to investigate whether recovery from exhaustion disorder (ED) is associated with OCPD. Methods This study includes data from 147 patients (78% women, mean age 52.4 ± 9.8 years) who have been treated for ED. Clinical assessment was performed 7–10 years after first seeking care identifying patients with residual exhaustion. Symptoms of OCPD were concomitantly measured and several aspects of work‐ and private‐related stress exposure. Results The main result of this study is that patients with residual clinical ED report OCPD to a greater extent, compared with patients who no longer fulfill the clinical criteria for ED, 7–10 years after seeking care. Patients with OCPD that have not recovered report “excessive devotion to work” to a higher degree than patients with OCPD that have recovered. Conclusion The results indicate that factors related to OCPD may be of clinical importance for the patient's recovery from ED. However, prospective studies should be conducted and studies elucidating whether symptoms of exhaustion among patients with OCPD can be affected by therapeutic interventions

Maternal-fetal relationships and psychological health: Emerging research directions

Maternal representations of, and relationships with, the unborn baby appear to be associated with psychological health in pregnancy and beyond, and might play an important role in identifying women who need additional support, as well as providing an arena to develop positive pregnancy experiences. The mechanisms and pathways linking maternal–fetal relationships, psychological health and important outcomes are complex. This article provides an overview of some of the key findings in this area and identifies some important emerging directions for future research: the nature and form of maternal–fetal relationships and how best to measure them, the mediating and moderating factors linking maternal–fetal relationships with psychological health and other outcomes in pregnancy and beyond, and the importance and acceptability of the concept of maternal–fetal relationships to women