Young pregnancy and motherhood: A discourse analysis of context and expertise

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Progressing into the 21st century young pregnancy and parenthood in the United Kingdom is a focus of political, media and public attention. The country is described as experiencing an epidemic, with the highest rates of young pregnancy and parenthood recorded in Western Europe. Statistics demonstrate that in 2000 38,690 under 18 year-olds in England became pregnant, of which 44.8% ended in legal termination. In light of this data, and within their remit to address the issue of Social Exclusion, New Labour commissioned a report into young pregnancy resulting in the development and implementation of the Teenage Pregnancy Strategy. The Strategy has two main aims; namely reducing the rates of young conceptions and providing better support and education for young parents. This thesis argues from a conceptual framework that questions the contested assumption that young pregnancy and parenthood is a problem. A literature review demonstrates a lack of representation of the voices and experiences of young mothers. This directs the research question to ask what is the experience of young mothers in their own words and placed within context? Critical Discourse Analysis is used to examine three examples of context shaping data that includes government policy, a newspaper article and a radio talk show programme. The analysis reveals discourses that suggest there is a right time and framework for motherhood. These discourses form a dialectical relationship with voices and experiences of young mothers that are analysed using Discourse Analysis. This analysis elicits two key central discourses permeating the experiences of young mothers that are the Good- Bad mother binary that informs and exacerbates experiences of maternal ambivalence. Moreover, these discourses inform the practice of discrimination against young mothers. The thesis concludes with a call to listen to the experiences of young mothers in order that their needs might be more fully understood. It suggests that discrimination against young mothers be incorporated into Equal Opportunity and Anti- Discrimination policy

Young pregnancy and motherhood : a discourse analysis of context and expertise

Progressing into the 21st century young pregnancy and parenthood in the United Kingdom is a focus of political, media and public attention. The country is described as experiencing an epidemic, with the highest rates of young pregnancy and parenthood recorded in Western Europe. Statistics demonstrate that in 2000 38,690 under 18 year-olds in England became pregnant, of which 44.8% ended in legal termination. In light of this data, and within their remit to address the issue of Social Exclusion, New Labour commissioned a report into young pregnancy resulting in the development and implementation of the Teenage Pregnancy Strategy. The Strategy has two main aims; namely reducing the rates of young conceptions and providing better support and education for young parents. This thesis argues from a conceptual framework that questions the contested assumption that young pregnancy and parenthood is a problem. A literature review demonstrates a lack of representation of the voices and experiences of young mothers. This directs the research question to ask what is the experience of young mothers in their own words and placed within context? Critical Discourse Analysis is used to examine three examples of context shaping data that includes government policy, a newspaper article and a radio talk show programme. The analysis reveals discourses that suggest there is a right time and framework for motherhood. These discourses form a dialectical relationship with voices and experiences of young mothers that are analysed using Discourse Analysis. This analysis elicits two key central discourses permeating the experiences of young mothers that are the Good- Bad mother binary that informs and exacerbates experiences of maternal ambivalence. Moreover, these discourses inform the practice of discrimination against young mothers. The thesis concludes with a call to listen to the experiences of young mothers in order that their needs might be more fully understood. It suggests that discrimination against young mothers be incorporated into Equal Opportunity and Anti- Discrimination policy.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

The effect of inhaled IFN-β on worsening of asthma symptoms caused by viral infections. A randomized trial

Rationale: Ex vivo, bronchial epithelial cells from people with asthma are more susceptible to rhinovirus infection caused by deficient induction of the antiviral protein, IFN-β. Exogenous IFN-β restores antiviral activity. Objectives: To compare the efficacy and safety of inhaled IFN-β with placebo administered to people with asthma after onset of cold symptoms to prevent or attenuate asthma symptoms caused by respiratory viruses. Methods: A total of 147 people with asthma on inhaled corticosteroids (British Thoracic Society Steps 2-5), with a history of virus-associated exacerbations, were randomized to 14-day treatment with inhaled IFN-β (n = 72) or placebo (n = 75) within 24 hours of developing cold symptoms and were assessed clinically, with relevant samples collected to assess virus infection and antiviral responses. Measurements and Main Results: A total of 91% of randomized patients developed a defined cold. In this modified intention-to-treat population, asthma symptoms did not get clinically significantly worse (mean change in six-item Asthma Control Questionnaire &lt;0.5) and IFN-β treatment had no significant effect on this primary endpoint, although it enhanced morning peak expiratory flow recovery (P = 0.033), reduced the need for additional treatment, and boosted innate immunity as assessed by blood and sputum biomarkers. In an exploratory analysis of the subset of more difficult-to-treat, Step 4-5 people with asthma (n = 27 IFN-β; n = 31 placebo), Asthma Control Questionnaire-6 increased significantly on placebo; this was prevented by IFN-β (P = 0.004). Conclusions: Although the trial did not meet its primary endpoint, it suggests that inhaled IFN-β is a potential treatment for virus-induced deteriorations of asthma in difficult-to-treat people with asthma and supports the need for further, adequately powered, trials in this population. Clinical trial registered with www.clinicaltrials.gov (NCT 01126177)