Young mothers’ experiences of relationship abuse: Personal stories and public narratives

Domestic abuse has historically been defined and constructed as an adult issue. However, in recent years there has been increasing awareness that young people also experience abuse within their relationships that can have serious and long-term effects on their health and wellbeing. Research has revealed higher rates of abuse reported by younger women than by adult women (Barter et al, 2009) and young mothers in particular appear to be at significant risk of experiencing relationship abuse (Wood et al, 2011). However, there is a lack of empirical research that has explored young mothers’ experiences of abuse and, therefore, little is known about the ways in which they understand and make sense of relationship abuse and negotiate their mothering within an abusive relationship. By focusing exclusively on mothers who became pregnant before they were 18, this research addresses this gap in knowledge and offers an original contribution to the evidence base. The primary aim of the research was to offer young mothers who experienced relationship abuse an opportunity to tell their stories. Underpinned by a feminist, social constructionist epistemology, the research adopted a narrative methodology and used semi-structured interviews to generate data. Participants were six young women who became pregnant before their eighteenth birthday and who had experienced relationship abuse in the last year; two were pregnant with their first child and four were already mothers. Narrative analysis of the data using The Listening Guide explored how participants constructed themselves and made sense of their relationships, paying particular attention to the ways in which personal stories reflected or contested available narratives about relationships, abuse, motherhood and teenage pregnancy. The emerging stories offer an insight into how these young mothers negotiated limited and sometimes contradictory narratives in order to make sense of their experiences and tell their own story. Participants told stories about their relationships and stories about becoming and being a mother that were inextricably linked. Stories of relationships and abuse overwhelmingly reflected narratives of romantic love; narratives that place responsibility for relationships with women, perpetuate gender inequalities and normalise male control and abuse. Their stories of motherhood reflected currently available narratives of ‘good’ mothering and rejected dominant narratives about teenage motherhood that were inconsistent with being a good mother. The findings highlight the limited repertoire of narratives available to young mothers who have experienced relationship abuse and reveal the potentially constraining nature of dominant narratives. Recommendations are made for policy, practice and future research

Prevenção seletiva da ansiedade e promoção da resiliência: resultados de um programa de resiliência e prevenção da ansiedade com meninas em risco

Introduction: Research has shown that the number of children and adolescents experiencing emotional difficulties such as anxiety is escalating, especially for those groups at risk. Living in an orphanage has been considered a risk factor for delays in an individuals’ social, emotional and behavioral development. Objective: The aim of this study was to evaluate the effectiveness of the Spanish version of the FRIENDS program, a CBT-based resilience program, with 57 girls from low socioeconomic status (SES) background that were living in an orphanage. Method: Participants received the program for 10 consecutive weeks, and pre- and post-test measures were collected.  Measures evaluated participants’ anxiety symptoms, level of self-concept, hope, coping skills, and psychosocial difficulties. Social validity was also assessed. Results: Results showed positive changes, including a decrease in anxiety symptoms and psychosocial difficulties, as well as an increase in their proactive coping skills. Several subscales and items of the self-concept and hope outcome measures also reported statistically significant improvements. Conclusions: Participants and parents/caregivers reported that the program was both enjoyable and useful. Implications of the findings and directions for further research are discussed.Introducción: Las investigaciones han demostrado que el número de niños y adolescentes que experimentan dificultades emocionales como la ansiedad va en aumento, sobre todo para los grupos en situación de riesgo. Vivir en un orfanato se ha considerado un factor de riesgo de retraso en el desarrollo social, emocional y conductual de un individuo.   Objetivo: El objetivo de este estudio era evaluar la eficacia de la versión en español del programa friends, un programa de resiliencia basado en la tcc, con 57 niñas de bajo nivel socioeconómico (nse) que estaban viviendo en un orfanato.   Método: Las participantes recibieron el programa durante diez semanas consecutivas y se recogieron las medidas previas y posteriores a la prueba. Las medidas evaluaban los síntomas de ansiedad, el nivel de autoconcepto, la esperanza, la capacidad de afrontamiento y las dificultades psicosociales de las participantes. También se evaluó la validez social.   Resultados: Los resultados mostraron cambios positivos, incluyendo una disminución en los síntomas de ansiedad y las dificultades psicosociales, así como un aumento en su capacidad proactiva de afrontamiento. Varias subescalas y elementos de las medidas de resultado para autoconcepto y esperanza también reportaron mejorías estadísticamente significativas.   Conclusiones: Las participantes y los padres/cuidadores informaron que el programa era agradable y útil. Se discuten las implicaciones de los hallazgos y las direcciones para futuras investigaciones.Introdução: as pesquisas têm demonstrado que o número de crianças adolescentes que experimentam dificuldades emocionais como a ansiedade vem aumentando, principalmente para os grupos em situação de risco. Viver num orfanato é considerado um fator de risco de atraso no desenvolvimento social, emocional e comportamental de um indivíduo. Objetivos: o objetivo deste estudo para avaliar a eficácia da versão em espanhol do programa friends, um programa de resiliência baseado na Terapia Cognitivo-comportamental, com 57 meninas de baixo nível socioeconômico que estavam morando num orfanato. Método: as participantes receberam o programa durante dez semanas consecutivas e foram coletadas medidas prévias e posteriores à prova. As medidas avaliavam os sintomas de ansiedade, o nível de autoconceito, a esperança, a capacidade de enfrentamento e as dificuldades psicossociais das participantes. Também foi avaliada a validade social. Resultados: os resultados mostraram mudanças positivas, o que inclui uma diminuição nos sintomas de ansiedade e das dificuldades psicossociais, bem como um aumento em sua capacidade proativa de enfrentamento. Várias subescalas e elementos das medidas de resultado para autoconceito e esperança também relataram melhoras estatisticamente significativas. Conclusões: as participantes e os pais/cuidadores informaram que o programa era agradável e útil. Discutem-se as implicações dos achados e as direções para futuras pesquisas

The Power of the Platform: Place and Employee Responses to Organizational Change

This inductive study explores how place influences collective sensemaking and employee responses during organizational change. The empirical setting of our study is an offshore oil platform undergoing changes that involve standardizing operational practices and relocating personnel as two organizations merge. We analyze the narratives of two employee groups and show how employees located onshore construct progressive change narratives, enabling them to adapt to change, while employees located on the offshore oil platform construct regressive narratives leaving them romanticizing the past and struggling to accept change. Our findings illustrate how the manipulation, reconfiguration, and exploitation of place has implications for employees’ capacities to accept and adapt to change. </jats:p

Permutable entire functions and multiply connected wandering domains

Let f and g be permutable transcendental entire functions. We use a recent analysis of the dynamical behaviour in multiply connected wandering domains to make progress on the long standing conjecture that the Julia sets of f and g are equal; in particular, we show that J(f)=J(g) provided that neither f nor g has a simply connected wandering domain in the fast escaping set

An evaluation of a price transparency intervention for two commonly prescribed medications on total institutional expenditure: a prospective study

Importance: Providing cost feedback has been demonstrated to decrease demand from clinicians. Objective: We tested the hypothesis that providing the cost of drugs to clinicians would modify total expenditure. Design: A prospective study design with a step-wise intervention. Setting/Participants: Individuals who were admitted to the XXX from November 2013 to November 2015 under the physicians. Intervention: The cost of all antibiotics and inhaled corticosteroids was added to the electronic prescribing system. Main outcomes: The weekly cost for antibiotics and inhaled corticosteroids in the intervention period compared to baseline. Results: Mean weekly expenditure on antibiotics per patient decreased by £3.75 (95% confidence intervals CI: -6.52 to -0.98) after the intervention from a pre-intervention mean of £26.44, and then slowly increased subsequently by £0.10/week (95%CI: +0.02 to +0.18). Mean weekly expenditure on inhaled corticosteroids per patient did not substantially change after the intervention (-£0.03, 95%CI: -0.06 to -0.01 after the intervention from a pre-intervention mean of £5.29 per person). New clinical guidelines for inhaled corticosteroids were associated with a decrease in weekly expenditure. Conclusions and relevance: Provision of cost feedback resulted in no sustained change in institutional expenditure. However, clinical guidelines have potential for modifying clinical prescribing behaviour

‘Function First’: how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods

Objectives To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory. Design Realist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation. Results A taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions. Abridged realist programme theory Routinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy. Co-design The programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change. Conclusions Previous physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study

Promoting physical activity and physical function in people with long-term conditions by primary care:the Function First realist synthesis with co-design

Background As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain. Objectives To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention. Data sources Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews. Design Realist evidence synthesis and co-design for primary care service innovation. Setting Primary care in Wales and England. Participants Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers. Methods The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation. Results Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change. Limitations Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts. Conclusions We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention. Future work A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial. Study registration This study is registered as PROSPERO CRD42018103027. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information. </jats:sec

'Function First - Be Active, Stay Independent' - Promoting physical activity and physical function in people with long-term conditions by primary care: A protocol for a realist synthesis with embedded co-production and co-design.

Introduction: People with long-term conditions typically have reduced physical functioning, are less physically active and therefore become less able to live independently and do the things they enjoy. Long-term conditions are managed routinely in primary care, however support rarely emphasises physical function and physical activity. This project aims to develop evidence-based recommendations about how primary care can optimally help people to become more physically active in order to maintain and improve their physical function, thus promoting independence. Methods and analysis: This study takes a realist synthesis approach, following RAMESES guidance, with embedded co-production and co-design. Stage 1 will develop initial programme theories about physical activity and physical function for people with long-term conditions, based on a review of the scientific and grey literature, and two multisector stakeholder workshops using LEGO® SERIOUS PLAY®. Stage 2 will involve focused literature searching, data extraction and synthesis to provide evidence to support or refute the initial programme theories. Searches for evidence will focus on physical activity interventions involving the assessment of physical function that are relevant to primary care. We will describe ‘what works’, ‘for whom’ and ‘in what circumstances’ and develop conjectured programme theories using (C)ontext, (M)echanism and (O)utcome (CMO) configurations. Stage 3 will test and refine these theories through individual stakeholder interviews. The resulting theory-driven recommendations will feed into Stage 4 which will involve three sequential co-design stakeholder workshops where practical ideas for service innovation in primary care will be developed. Ethics and dissemination: Healthcare and Medical Sciences Academic Ethics Committee (Reference 2018-16308) and NHS Wales Research Ethics Committee 5 approval (References 256729 and 262726) have been obtained. A knowledge mobilisation event will address issues relevant to wider implementation of the intervention and study findings. Findings will be disseminated through peer-reviewed journal publications, conference presentations, and formal and informal reports

Role of the gp85/Trans-Sialidases in Trypanosoma cruzi Tissue Tropism: Preferential Binding of a Conserved Peptide Motif to the Vasculature in Vivo

Background: Transmitted by blood-sucking insects, the unicellular parasite Trypanosoma cruzi is the causative agent of Chagas' disease, a malady manifested in a variety of symptoms from heart disease to digestive and urinary tract dysfunctions. the reasons for such organ preference have been a matter of great interest in the field, particularly because the parasite can invade nearly every cell line and it can be found in most tissues following an infection. Among the molecular factors that contribute to virulence is a large multigene family of proteins known as gp85/trans-sialidase, which participates in cell attachment and invasion. But whether these proteins also contribute to tissue homing had not yet been investigated. Here, a combination of endothelial cell immortalization and phage display techniques has been used to investigate the role of gp85/trans-sialidase in binding to the vasculature.Methods: Bacteriophage expressing an important peptide motif (denominated FLY) common to all gp85/trans-sialidase proteins was used as a surrogate to investigate the interaction of this motif with the endothelium compartment. for that purpose phage particles were incubated with endothelial cells obtained from different organs or injected into mice intravenously and the number of phage particles bound to cells or tissues was determined. Binding of phages to intermediate filament proteins has also been studied.Findings and Conclusions: Our data indicate that FLY interacts with the endothelium in an organ-dependent manner with significantly higher avidity for the heart vasculature. Phage display results also show that FLY interaction with intermediate filament proteins is not limited to cytokeratin 18 (CK18), which may explain the wide variety of cells infected by the parasite. This is the first time that members of the intermediate filaments in general, constituted by a large group of ubiquitously expressed proteins, have been implicated in T. cruzi cell invasion and tissue homing.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Microbiol Imunol & Parasitol, São Paulo, BrazilUniv São Paulo, Inst Quim, Dept Bioquim, BR-01498 São Paulo, BrazilUniv Texas MD Anderson Canc Ctr, David H Koch Ctr, Houston, TX 77030 USAUniv Texas MD Anderson Canc Ctr, Dept Canc Biol, Houston, TX 77030 USAUniversidade Federal de São Paulo, Dept Microbiol Imunol & Parasitol, São Paulo, BrazilFAPESP: 2004/03303-5FAPESP: 2008/54.806-8Web of Scienc