Conceptualizing reproductive loss: a social sciences perspective

This paper defines and explores reproductive loss and, drawing on a social sciences perspective, reflects on the lack of attention that has been given to the subject within the study of human fertility. The authors argue that whilst reproductive loss (broadly defined) is exceptionally common, scholars have – with some exceptions – focused on the study of reproductive ‘success’, and continue to do so. The paper examines the implications of this for policy, practice and the role of healthcare professionals and focuses on the significance of appreciating difference and diversity in the study of reproductive loss and the importance of placing such experiences within the social structure

Epidemiology of depression in diabetes: international and cross-cultural issues

This paper reviews the most up-to-date epidemiological evidence of the relationship between depression and diabetes, and considers the risk factors for the development of depression and the consequences of depression in diabetes with an emphasis on international and cross-cultural data. The difficulties that researchers face when epidemiological studies require assessment of psychological phenomena, such as depression, across different cultural settings are explored. Methods: Relevant papers were sought on the epidemiology of diabetes and depression in people with diabetes by undertaking a literature search of electronic databases including MEDLINE, Psych-INFO, CINAHL and EMBASE. These papers were assessed by the authors and a narrative review of the relevant literature was composed. Results: Systematic reviews of the prevalence of depression in people with diabetes have focused on studies conducted in English speaking countries and emerging data suggest that there may be international variations in prevalence and also in how symptoms of depression are reported. There appears to be a bi-directional relationship between depression and diabetes, with one influencing the other; however, research in this area is further complicated by the fact that potential risk factors for depression in people with diabetes often interact with each other and with other factors. Further research is needed to elucidate the causal mechanisms underlying these associations. Limitations: Data from non-English speaking countries remain scarce and so it is difficult to come to any firm conclusions as to the international variation in prevalence rates of co-morbid diabetes and depression in these countries until further research has been conducted. Conclusion: It is important to take a culture-centered approach to our understanding of mental health and illness and has outlined some of the key issues related to the development of culturally sensitive depression screening tools. In order to come to any firm conclusions about the international variation in prevalence of co-morbid diabetes and depression, issues of culture and diversity must be taken into account prior to conducting international epidemiological studies

Does the availability of a South Asian language in practices improve reports of doctor-patient communication from South Asian patients? Cross sectional analysis of a national patient survey in English general practices.

BACKGROUND: Ethnic minorities report poorer evaluations of primary health care compared to White British patients. Emerging evidence suggests that when a doctor and patient share ethnicity and/or language this is associated with more positive reports of patient experience. Whether this is true for adults in English general practices remains to be explored. METHODS: We analysed data from the 2010/2011 English General Practice Patient Survey, which were linked to data from the NHS Choices website to identify languages which were available at the practice. Our analysis was restricted to single-handed practices and included 190,582 patients across 1,068 practices. Including only single-handed practices enabled us to attribute, more accurately, reported patient experience to the languages that were listed as being available. We also carried out sensitivity analyses in multi-doctor practices. We created a composite score on a 0-100 scale from seven survey items assessing doctor-patient communication. Mixed-effect linear regression models were used to examine how differences in reported experience of doctor communication between patients of different self-reported ethnicities varied according to whether a South Asian language concordant with their ethnicity was available in their practice. Models were adjusted for patient characteristics and a random effect for practice. RESULTS: Availability of a concordant language had the largest effect on communication ratings for Bangladeshis and the least for Indian respondents (p < 0.01). Bangladeshi, Pakistani and Indian respondents on average reported poorer communication than White British respondents [-2.9 (95%CI -4.2, -1.6), -1.9 (95%CI -2.6, -1.2) and -1.9 (95%CI -2.5, -1.4), respectively]. However, in practices where a concordant language was offered, the experience reported by Pakistani patients was not substantially worse than that reported by White British patients (-0.2, 95%CI -1.5,+1.0), and in the case of Bangladeshi patients was potentially much better (+4.5, 95%CI -1.0,+10.1). This contrasts with a worse experience reported among Bangladeshi (-3.3, 95%CI -4.6, -2.0) and Pakistani (-2.7, 95%CI -3.6, -1.9) respondents when a concordant language was not offered. CONCLUSIONS: Substantial differences in reported patient experience exist between ethnic groups. Our results suggest that patient experience among Bangladeshis and Pakistanis is improved where the practice offers a language that is concordant with the patient's ethnicity

Families Experiencing Multiple Disadvantage: their use of and views on childcare provision

This research aims to fill a gap in the evidence base by exploring the relationship between families experience of multiple disadvantage and childcare. We know that disadvantaged families are less likely to use formal childcare; however, less research has been conducted on childcare use by multiply disadvantaged families. The research is based on further analysis of the 2008 Childcare and Early Years Survey of Parents, which was published by the Department for Children Schools and Families in July 2009. The study uses a specially devised index of multiple disadvantage to explore childcare use, parents views on local childcare provision, and how childcare and other issues influence maternal employment decisions, from the point of view of families experiencing multiple disadvantage

Prevalence of co-morbid depression in out-patients with type 2 diabetes in Bangladesh

Background Little is known about the prevalence of depression in people with diabetes in Bangladesh. This study examined the prevalence and factors associated with depression in out-patients with Type 2 diabetes in Bangladesh. Methods In this cross-sectional study a random sample of 483 diabetes out-patients from three diabetes clinics in Bangladesh was invited to participate. Of them 417 patients took part. Depressive symptoms were measured using previously developed and culturally standardized Bengali and Sylheti versions of the World HealthOrganization-5 Well Being Index (WHO-5) and the Patient Health Questionairre-9 (PHQ-9) with predefined cut-off scores. Data was collected using two different modes; e.g. standard assisted collection and audio questionnaire methods. Associations between depression and patient characteristics were explored using regression analysis. Results The prevalence depressive symptoms was 34% (PHQ-9 score ≥ 5) and 36% (WHO-5 score < 52) with audio questionnaire delivery method. The prevalence rates were similar regardless of the type (PHQ-9 vs. WHO-5) and language (Sylheti vs. Bengali) of the questionnaires, and methods of delivery (standard assisted vs. audio methods). The significant predictors of depressive symptoms using either the PHQ-9 or WHO-5 questionnaires were; age, income, gender, treatment intensity, and co-morbid cardiovascular disease. Further, depression was strongly associated with poor glycaemic control and number of co-morbid conditions. Conclusions This study demonstrated that depression prevalence is common in out-patients with type 2 diabetes in Bangladesh. In a setting where recognition, screening and treatment levels remain low, health care providers need to focus their efforts on diagnosing, referring and effectively treating this important disease in order to improve service delivery

The impact of multiple sclerosis on the identity of mothers in Italy

Purpose: This paper reports on one of the themes that emerged from the analysis of the study, regarding the perceived influence of multiple sclerosis (MS) on the identity of mothers in the socio-cultural context of Italy. Method: In-depth interviews were conducted with 16 women at various stages of MS, with follow up interviews with seven of the women. Phenomenology guided the methodology and the analysis was conducted using interpretative phenomenological analysis. Results: Through the research the value of motherhood to the women who participated emerged. The findings illustrated how many strove to maintain controlof their MS, which led to some making comparisons of themselves and other mothers and feeling different. Some women described how they adjusted their roles and found strength in being mothers but others spoke of their feelings of loss. Most women described living in the moment, appreciating the present and living each day as it came. Another significant experience was fear of stigma, both realized in the form of “pity” from others, and the perceived and actual associated stigma for their families. This contributed to why some women were reluctant to disclose their condition. The mothers who took part in this study differed in how they perceived their disabled identity. Conclusion: Although this study was conducted in the socio-cultural setting of Italy, the findings have implications for professionals working with disabled mothers and women with MS in Italy and beyond; including recognizing the value associated with fully identifying oneself as a mother, rather than solely focusing on doingmothering tasks. • Implications for Rehabilitation • Professionals need to be mindful of the value of motherhood for women with multiple sclerosis. • Professionals should support women who feel like they are battling with maintaining control of their multiple sclerosis, who may be adjusting their identity as mothers; recognizing that they may be influenced by the stage of their multiple sclerosis and whether they were diagnosed before or after having their children. • Women can have feelings of loss related to their ability to fully participate in their children’s lives and professionals should work with women to help them identify the value of their mothering role not only in physically participating in activities but also in being emotionally and physically present as a mother

Body self-esteem is related to subjective well-being, severity of depressive symptoms, BMI, glycated hemoglobin levels, and diabetes-related distress in type 2 diabetes

Background There are limited data on the role of body image in patients with type 2 diabetes. The purpose of this study was to compare body self-esteem in this group with norms for the general Polish population and to investigate the relationship between body self-esteem and the psychological and clinical characteristics of the course of diabetes. Methods A group of 100 consecutive adult patients with type 2 diabetes (49 women and 51 men) aged 35 to 66 years were assessed using the Body Esteem Scale (BES), World Health Organization-Five Well-Being Index (WHO-5), Problem Areas in Diabetes Scale (PAID), and Hamilton Rating Scale for Depression (HAM-D). ResultsIn comparison to norms for the general population, women with type 2 diabetes had lower body self-esteem only in the dimension of Physical Condition (M = 30.71; SD = 7.11 versus M = 32.96; SD = 5.69; P = 0.003), whereas men in the dimensions of Physical Condition (M = 42.43; SD = 9.43 versus M = 48.30; SD = 8.42; P ConclusionsPersons with diabetes seem to have lower body self-esteem than the general population, which is significantly associated with clinical and psychological characteristics of the diabetes course. The observed differences and relationships are gender-specific

Comment on Young-Hyman et al. Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016;39:2126–2140

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