Identification of Characteristics Associated with Discrepancy Between Self-Estimated and Measured Interests

Student Personnel and Guidanc

Supporting multiple birth families:Perceptions and experiences of health visitors

Objective: To explore the current practice and perceptions of health visitors in supporting multiple birth families. Design and sample: Practicing health visitors across the United Kingdom were invited to complete a cross-sectional, descriptive, online survey. The questionnaire covered multiple birth caseload, education received about multiples and the experience of working with families. Two-hundred and ninety health visitors completed the questionnaire. Descriptive and inferential statistics were used for analysis of the quantitative components and thematic analysis for the qualitative data. Results: Most health visitors had twins on their current workload. Most health visitors had not received any specific training or continuing professional development regarding the needs of multiple birth families. Supporting the families within the confines of reduced time and increased workload was challenging. Daily tasks of caring for multiples were the main areas that health visitors and parents wanted more information about. Conclusions: In the United Kingdom, health visitors are uniquely positioned to support multiple birth families, in particular during the more challenging early years. However, the findings of this study suggest that many health visitors are aware that the care and support that they are able to provide multiple birth families falls short of meeting their needs

Creating multiple connections - Exploring experiences of families with twins, triplets or more

Adjusting to family life and caring for two, three or more new babies, with possible health problems mainly due to prematurity, provides psychosocial and practical challenges for the multiple birth family. Specialist in formation, advice and support from professionals due to the demands of parenting multiples is needed. There is limited research into the lived experiences of multiple birth families during the early years and their perceptions of family life with young children who are multiples. The aim of the study was to explore the parenting journey of parents of multiples from pregnancy to starting school through the medium of family photographs

RCN multiple births midwife standard: review of distribution and implementation

Reports of an ‘excellent and comprehensive document’, pride, and success stories have shown that the Multiple Births Midwife Standard (MBMS) can be an effective tool for providing multiple birth mothers with personalised and professional care. When staffing, funding, and resources allow, Multiple Births Midwives have affirmed how valuable the role is for co-ordinating care and improving experiences for multiple pregnancy families. Accompanying these success stories are reports from other services around implementation challenges, a lack of strategic plans for improvement, and incomplete multidisciplinary teams

The construction of masculinities and femininities in the Church of England:the case of the male clergy spouse

The ordination of women to the priesthood in the Church of England in 1994 signified great change. The impact of the new priests was well documented, and their integration became the focus of much research in the following years. One important area of change was the altered dynamics of gender identity. New roles had opened up for women, but new identities had also emerged for men. While women priests were a new historical emergence, so too were clergy husbands. This paper will consider the historical construction of masculinities and femininities within the church and will go on to look at this in the context of clergy spouses, specifically focusing on men occupying this role. Some provisional findings, acting as work in progress, will be considered

Evaluation of the Arabin cervical pessary for prevention of preterm birth in women with a twin pregnancy and short cervix (STOPPIT-2):An open-label randomised trial and updated meta-analysis

BackgroundPreterm-labour-associated preterm birth is a common cause of perinatal mortality and morbidity in twin pregnancy. We aimed to test the hypothesis that the Arabin pessary would reduce preterm-labour-associated preterm birth by 40% or greater in women with a twin pregnancy and a short cervix.Methods and findingsWe conducted an open-label randomised controlled trial in 57 hospital antenatal clinics in the UK and Europe. From 1 April 2015 to 14 February 2019, 2,228 women with a twin pregnancy underwent cervical length screening between 18 weeks 0 days and 20 weeks 6 days of gestation. In total, 503 women with cervical length ≤ 35 mm were randomly assigned to pessary in addition to standard care (n = 250, mean age 32.4 years, mean cervical length 29 mm, with pessary inserted in 230 women [92.0%]) or standard care alone (n = 253, mean age 32.7 years, mean cervical length 30 mm). The pessary was inserted before 21 completed weeks of gestation and removed at between 35 and 36 weeks or before birth if earlier. The primary obstetric outcome, spontaneous onset of labour and birth before 34 weeks 0 days of gestation, was present in 46/250 (18.4%) in the pessary group compared to 52/253 (20.6%) following standard care alone (adjusted odds ratio [aOR] 0.87 [95% CI 0.55-1.38], p = 0.54). The primary neonatal outcome-a composite of any of stillbirth, neonatal death, periventricular leukomalacia, early respiratory morbidity, intraventricular haemorrhage, necrotising enterocolitis, or proven sepsis, from birth to 28 days after the expected date of delivery-was present in 67/500 infants (13.4%) in the pessary group compared to 76/506 (15.0%) following standard care alone (aOR 0.86 [95% CI 0.54-1.36], p = 0.50). The positive and negative likelihood ratios of a short cervix (≤35 mm) to predict preterm birth before 34 weeks were 2.14 and 0.83, respectively. A meta-analysis of data from existing publications (4 studies, 313 women) and from STOPPIT-2 indicated that a cervical pessary does not reduce preterm birth before 34 weeks in women with a short cervix (risk ratio 0.74 [95% CI 0.50-1.11], p = 0.15). No women died in either arm of the study; 4.4% of babies in the Arabin pessary group and 5.5% of babies in the standard treatment group died in utero or in the neonatal period (p = 0.53). Study limitations include lack of power to exclude a smaller than 40% reduction in preterm labour associated preterm birth, and to be conclusive about subgroup analyses.ConclusionsThese results led us to reject our hypothesis that the Arabin pessary would reduce the risk of the primary outcome by 40%. Smaller treatment effects cannot be ruled out.Trial registrationISRCTN Registry ISRCTN 02235181. ClinicalTrials.gov NCT02235181

The Arabin pessary to prevent preterm birth in women with a twin pregnancy and a short cervix:the STOPPIT 2 RCT

Background: Preterm birth is common in twins and accounts for significant mortality and morbidity. There are no effective preventative treatments. Some studies have suggested that, in twin pregnancy complicated by a short cervix, the Arabin pessary, which fits around the cervix and can be inserted as an outpatient procedure, reduces preterm birth and prevents neonatal morbidity. Objective: STOPPIT 2 aimed to evaluate the clinical utility of the Arabin cervical pessary in preventing preterm birth in women with a twin pregnancy and a short cervix. Design: STOPPIT 2 was a pragmatic, open label, multicentre randomised controlled trial with two treatment group – the Arabin pessary plus standard care (intervention) and standard care alone (control). Participants were initially recruited into the screening phase of the study, when cervical length was measured. Women with a measured cervical length of ≤ 35 mm were then recruited into the treatment phase of the study. An economic evaluation considered cost-effectiveness and a qualitative substudy explored the experiences of participants and clinicians. Setting: Antenatal clinics in the UK and elsewhere in Europe. Participants: Women with twin pregnancy at < 21 weeks’ gestation with known chorionicity and gestation established by scan at ≤ 16 weeks’ gestation. Interventions: Ultrasound scan to establish cervical length. Women with a cervical length of ≤ 35 mm at 18+ 0–20+ 6 weeks’ gestation were randomised to standard care or Arabin pessary plus standard care. Randomisation was performed by computer and accessed through a web-based browser. Main outcome measures: Obstetric – all births before 34+ 0 weeks’ gestation following the spontaneous onset of labour; and neonatal – composite of adverse outcomes, including stillbirth or neonatal death, periventricular leukomalacia, early respiratory morbidity, intraventricular haemorrhage, necrotising enterocolitis or proven sepsis, all measured up to 28 days after the expected date of delivery. Results: A total of 2228 participants were recruited to the screening phase, of whom 2170 received a scan and 503 were randomised: 250 to Arabin pessary and 253 to standard care alone. The rate of the primary obstetric outcome was 18.4% (46/250) in the intervention group and 20.6% (52/253) in the control group (adjusted odds ratio 0.87, 95% confidence interval 0.55 to 1.38; p = 0.54). The rate of the primary neonatal outcome was 13.4% (67/500) and 15.0% (76/506) in the intervention group and control group, respectively (adjusted odds ratio 0.86, 95% confidence interval 0.54 to 1.36; p = 0.52). The pessary was largely well tolerated and clinicians found insertion and removal ‘easy’ or ‘fairly easy’ in the majority of instances. The simple costs analysis showed that pessary treatment is no more costly than standard care. Limitations: There was the possibility of a type II error around smaller than anticipated benefit. Conclusions: In this study, the Arabin pessary did not reduce preterm birth or adverse neonatal outcomes in women with a twin pregnancy and a short cervix. The pessary either is ineffective at reducing preterm birth or has an effect size of < 0.4. Future work: Women with twin pregnancy remain at risk of preterm birth; work is required to find treatments for this. Trial registration: Current Controlled Trials ISRCTN98835694 and ClinicalTrials.gov NCT02235181. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 44. See the NIHR Journals Library website for further project information

The effect of intra-uterine growth on Verbal IQ scores in childhood: a monozygotic twin study

Objective. Given the adverse neurobiological effects of suboptimal nutrition on the developing brain, it is of social and medical importance to determine whether the global prevalence of poor intra-uterine growth causes lasting cognitive deficits. We examined whether sub-optimal intra-uterine growth relates to impaired cognitive outcome by comparing birthweight and cognition in monozygotic (MZ) twins. Our study considered whether children who do not reach their potential birthweight, as indexed by the weight of their heavier twin, also do not attain their potential IQ. Methods. 71 MZ twin pairs participated (7 years 11 months to 17 years 3 months). The Wechsler Intelligence Scale for Children Third Edition (WISC-III) was administered and Verbal IQ (VIQ) and Performance IQ (PIQ) scores calculated. Regression was used to relate within pair differences in birthweight to within pair differences in IQ scores. Results. VIQ but not PIQ score was affected by pre-natal growth restriction. The results suggest that the mean advantage for heavier twins relative to their lighter co-twins can be as much as half a SD in VIQ points. In pairs with minimal birthweight discordance, heavier twins had lower VIQ scores than their lighter co-twins Conclusions. Our study suggests that lower birthweight can negatively impact on cognition in the long term, not only in infants born small, but across the birthweight spectrum. Restricting analyses to MZ twins enables the effect of reduced intra-uterine growth on cognition to be examined independently of confounding factors including parental IQ and education, gender, age, genes, and gestation

Inspection time and cognitive abilities in twins aged 7 to 17 years: age-related changes, heritability and genetic covariance

We studied the age-related differences in inspection time and multiple cognitive domains in a group of monozygotic (MZ) and dizygotic (DZ) twins aged 7 to 17 years. Data from 111 twin pairs and 19 singleton siblings were included. We found clear age-related trends towards more efficient visual information processing in older participants. There were substantial correlations between inspection time and cognitive abilities. The heritability of inspection time was 45%, and ranged from 73% to 85% for cognitive abilities. There were significant non-shared environmental effects on inspection time and Wechsler IQ scores, but no shared environmental effects. The genetic correlation between inspection time and Performance IQ was 0.55 and with Verbal IQ it was 0.28. There was a significant non-shared environmental correlation of 0.24 between inspection time and Verbal IQ