Women’s views on anxiety in pregnancy and the use of anxiety instruments: a qualitative study

Objective: To explore women’s experience of anxiety in pregnancy and views on the use of anxiety instruments in antenatal care. Background: Anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy the optimal methods to identify anxiety in pregnancy have not been confirmed. Methods: A qualitative study using two focus group discussions was undertaken. Focus group one included women in a community setting and focus group two included women in a hospital clinic setting who had received additional support for anxiety in pregnancy. Participants were women who had given birth within the past nine months and considered themselves to have been anxious during their pregnancy. Results: Three main themes were identified using template analysis: sources of support, administration of anxiety instruments and the use of instruments to prompt discussion. Women stated anxiety instruments could help them to identify their anxious feelings and prompt a discussion around those feelings. However they expressed concerns surrounding the administration of anxiety instruments and questioned how useful they would be in helping women access help and support. Conclusions: The introduction of anxiety instruments in antenatal care may present an opportunity to discuss women’s emotional health and anxieties. Providing women with sufficient time to discuss their anxious feelings, identified by such instruments, could facilitate access to additional support

Processes underlying the nutritional programming of embryonic development by iron deficiency in the rat

Peer reviewedPublisher PD

Infrared and millimetre-wave scintillometry in the suburban environment – Part 2: Large-area sensible and latent heat fluxes

A millimetre-wave scintillometer was paired with an infrared scintillometer, enabling estimation of large-area evapotranspiration across northern Swindon, a suburban area in the UK. Both sensible and latent heat fluxes can be obtained using this "two-wavelength" technique, as it is able to provide both temperature and humidity structure parameters, offering a major advantage over conventional single-wavelength scintillometry. The first paper of this two-part series presented the measurement theory and structure parameters. In this second paper, heat fluxes are obtained and analysed. These fluxes, estimated using two-wavelength scintillometry over an urban area, are the first of their kind. Source area modelling suggests the scintillometric fluxes are representative of 5–10 km2. For comparison, local-scale (0.05–0.5 km2) fluxes were measured by an eddy covariance station. Similar responses to seasonal changes are evident at the different scales but the energy partitioning varies between source areas. The response to moisture availability is explored using data from 2 consecutive years with contrasting rainfall patterns (2011–2012). This extensive data set offers insight into urban surface-atmosphere interactions and demonstrates the potential for two-wavelength scintillometry to deliver fluxes over mixed land cover, typically representative of an area 1–2 orders of magnitude greater than for eddy covariance measurements. Fluxes at this scale are extremely valuable for hydro-meteorological model evaluation and assessment of satellite data product

Infrared and millimetre-wave scintillometry in the suburban environment – Part 1: Structure parameters

Scintillometry, a form of ground-based remote sensing, provides the capability to estimate surface heat fluxes over scales of a few hundred metres to kilometres. Measurements are spatial averages, making this technique particularly valuable over areas with moderate heterogeneity such as mixed agricultural or urban environments. In this study, we present the structure parameters of temperature and humidity, which can be related to the sensible and latent heat fluxes through similarity theory, for a suburban area in the UK. The fluxes are provided in the second paper of this two-part series. A millimetre-wave scintillometer was combined with an infrared scintillometer along a 5.5 km path over northern Swindon. The pairing of these two wavelengths offers sensitivity to both temperature and humidity fluctuations, and the correlation between wavelengths is also used to retrieve the path-averaged temperature–humidity correlation. Comparison is made with structure parameters calculated from an eddy covariance station located close to the centre of the scintillometer path. The performance of the measurement techniques under different conditions is discussed. Similar behaviour is seen between the two data sets at sub-daily timescales. For the two summer-to-winter periods presented here, similar evolution is displayed across the seasons. A higher vegetation fraction within the scintillometer source area is consistent with the lower Bowen ratio observed (midday Bowen ratio < 1) compared with more built-up areas around the eddy covariance station. The energy partitioning is further explored in the companion paper

THYMUS-DERIVED LYMPHOCYTES PRODUCE AN IMMUNOLOGICALLY SPECIFIC MACROPHAGEARMING FACTOR

Spleen cells from mice immunized with an allogeneic tumor when cultured with the specific tumor cells release into the supernatant a specific macrophage-arming factor(s) (SMAF) which binds nonspecifically to macrophages from both mice and rats and renders these cytotoxic to the specific tumor cells. SMAF also binds in an immunologically specific way to the target cells. SMAF-treated target cells grow normally in the absence of macrophages but are killed in the presence of normal macrophages. Thymus-derived cells are necessary for the production of SMAF since (a) after treatment with anti-θ serum immune spleen cells fail to release SMAF; (b) spleen cells from immunized T cell-deprived mice (thymectomized as adults followed by whole body irradiation and restored with bone marrow) fail to produce SMAF on stimulation with the specific target cells. While SMAF has the properties of a cytophilic antibody, it does not belong to one of the established classes of immunoglobulin since high activity is found after column separation in a fraction having a molecular weight between 50,000–60,000 daltons

Understanding the social inclusion needs of people living in mental health supported accommodation

Objectives: To identify the social inclusion needs that were (i) most commonly identified and (ii) most and least commonly prioritised as support planning goals for mental health service users living in supported accommodation, using the online Social Inclusion Questionnaire User Experience (SInQUE). We qualitatively examined mental health supported accommodation staff and servicer users’ views on barriers to offering support with two less commonly prioritised areas: help finding a partner and feeling less lonely. // Methods: Anonymous SInQUE data were collected during a completed study in which we developed and tested the online SInQUE. Four focus groups were conducted with mental health supported accommodation staff (N = 2) and service users (N = 2). // Results: The most common social inclusion needs identified by service users (N = 31) were leisure activities, finding transport options, and feeling less lonely. Of the needs identified, those that service users and staff least frequently prioritised as support planning goals were having company at mealtimes, getting one’s own furniture, feeling less lonely, help with finances, and help finding a partner. In the focus groups, staff and service users identified barriers to helping with loneliness and finding a partner which related to staff and service users themselves, supported accommodation services, and wider societal factors

Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women: a systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions

To assess women’s views on the acceptability of and satisfaction with non-pharmacological interventions to reduce the symptoms of anxiety in pregnant women. A systematic review and narrative synthesis (Prospero protocol number CRD42015017841). Fourteen included studies were conducted in Australia, Canada, Germany, New Zealand, UK and USA. Interventions were cognitive behavioural therapy, mindfulness, yoga, psychological assessment, supportive and educational based interventions. Studies included women from general antenatal populations and women with anxiety or depression symptoms or risk factors for anxiety or depression. The findings were limited due to the small number of studies evaluating different types of interventions using various study methods. Some studies had too little procedural reporting to allow a full quality assessment. Women’s views on the acceptability of and satisfaction with interventions were overwhelmingly positive. The review highlights women’s motivations for and barriers to participation as well as the benefit women perceived from peer support and individual discussions of their situation. Interventions need to be further evaluated in randomised controlled trials. The inclusion of women’s views and experiences illuminates how and why intervention components contribute to outcomes. Women’s initial concerns about psychological screening and the benefit derived from peer support and individual discussion should be noted by providers of maternity care

Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the Medical Research Council framework

Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. Results: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care. Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems

Women’s views on anxiety in pregnancy and the use of anxiety instruments: a qualitative study

Objective: To explore women’s experience of anxiety in pregnancy and views on the use of anxiety instruments in antenatal care. Background: Anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy the optimal methods to identify anxiety in pregnancy have not been confirmed. Methods: A qualitative study using two focus group discussions was undertaken. Focus group one included women in a community setting and focus group two included women in a hospital clinic setting who had received additional support for anxiety in pregnancy. Participants were women who had given birth within the past nine months and considered themselves to have been anxious during their pregnancy. Results: Three main themes were identified using template analysis: sources of support, administration of anxiety instruments and the use of instruments to prompt discussion. Women stated anxiety instruments could help them to identify their anxious feelings and prompt a discussion around those feelings. However they expressed concerns surrounding the administration of anxiety instruments and questioned how useful they would be in helping women access help and support. Conclusions: The introduction of anxiety instruments in antenatal care may present an opportunity to discuss women’s emotional health and anxieties. Providing women with sufficient time to discuss their anxious feelings, identified by such instruments, could facilitate access to additional support