1,400 research outputs found

    The efficacy of ‘debriefing’ after childbirth: Is there a case for targeted intervention?

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    To review the efficacy of debriefing interventions for reducing posttraumatic stress (PTS) and/ or depressive symptoms in postnatal women. Background: Techniques referred to as debriefing have been adapted for use within maternity care settings to prevent the development of PTS symptoms or depression. There is a requirement to disaggregate methods and approaches used by existing studies, rather than review the research as a whole, to identify elements that may contribute to an efficacious intervention and to clarify what is currently a confused position. Methods: Papers assessing the utility of providing a brief psychological intervention involving discussion of a birth with the mother and a professional, to reduce symptoms of PTS or depression, were reviewed. Discussions could be structured or unstructured, and involve any aspect of discussing the birth, responses and coping strategies. Results: Nine papers (eight studies) were reviewed. While the majority of studies reported findings indicating that debriefing was ineffective for reducing PTS or depressive symptoms, there was evidence indicating that targeted interventions (for women who experienced a traumatic birth) were efficacious. Conclusion: There may be potential utility in providing a debriefing intervention for women who perceive their childbirth experience to have been traumatic. A diversity of approaches termed ‘debriefing’ highlight a requirement to consider alternative terminology; the term ‘childbirth review’ is suggested as a useful alternative. Further research evaluating the efficacy of debriefing using a targeted approach for trauma perception is recommended

    Merger relics of cluster galaxies

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    Context. Sheen and collaborators recently found that a surprisingly large portion (38%) of massive early-type galaxies in heavy clusters show strong merger-related disturbed features. This contradicts the general understanding that massive clusters are hostile environments for galaxy mergers. Considering the significance of mergers in galaxy evolution, it is important to understand this. Aims. We aim to present a theoretical foundation that explains galaxy mergers in massive clusters. Methods. We used the N-body simulation technique to perform a cosmological-volume simulation and derive dark-halo merger trees. Then, we used the semi-analytic modeling technique to populate each halo with galaxies. We ran hydrodynamic simulations of galaxy mergers to estimate the lifetime of merger features for the imaging condition used by Sheen and collaborators. We applied this merger feature lifetime to our semi-analytic models. Finally, we counted the massive early-type galaxies in heavy model clusters that would show strong merger features. Results. While there still are substantial uncertainties, our preliminary results are remarkably close to the observed fraction of galaxies with merger features. Key ingredients for the success are twofold: firstly, the subhalo motion in dark haloes has been accurately traced, and, second, the lifetime of merger features has been properly estimated. As a result, merger features are expected to last very long in cluster environments. Many massive early-type galaxies in heavy clusters therefore show merger features not because they experience mergers in the current clusters in situ, but because they still carry their merger features from their previous halo environments. Conclusions. Investigating the merger relics of cluster galaxies is potentially important, because it uniquely allows us to backtrack the halo merger history.Comment: 4 pages, 3 figures, accepted for publication in A&A Research Not

    The experience and impact of traumatic perinatal event experiences in midwives: A qualitative investigation

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    Background: Through their work midwives may experience distressing events that fulfil criteria for trauma. However, there is a paucity of research examining the impact of these events, or what is perceived to be helpful/unhelpful by midwives afterwards. Objective: To investigate midwives’ experiences of traumatic perinatal events and to provide insights into experiences and responses reported by midwives with and without subsequent posttraumatic stress symptoms. Design: Semi-structured telephone interviews were conducted with a purposive sample of midwives following participation in a previous postal survey. Methods: 35 midwives who had all experienced a traumatic perinatal event defined using the Diagnostic and Statistical Manual of Mental Disorders (version IV) Criterion A for posttraumatic stress disorder were interviewed. Two groups of midwives with high or low distress (as reported during the postal survey) were purposefully recruited. High distress was defined as the presence of clinical levels of PTSD symptomatology and high perceived impairment in terms of impacts on daily life. Low distress was defined as any symptoms of PTSD present were below clinical threshold and low perceived life impairment. Interviews were analysed using template analysis, an iterative process of organising and coding qualitative data chosen for this study for its flexibility. An initial template of four a priori codes was used to structure the analysis: event characteristics, perceived responses and impacts, supportive and helpful strategies and reflection of change over time codes were amended, integrated and collapsed as appropriate through the process of analysis. A final template of themes from each group is presented together with differences outlined where applicable. Results: Event characteristics were similar between groups, and involved severe, unexpected episodes contributing to feeling ‘out of a comfort zone.’ Emotional upset, self-blame and feelings of vulnerability to investigative procedures were reported. High distress midwives were more likely to report being personally upset by events and to perceive all aspects of personal and professional lives to be affected. Both groups valued talking about the event with peers, but perceived support from senior colleagues and supervisors to be either absent or inappropriate following their experience; however, those with high distress were more likely to endorse this view and report a perceived need to seek external input. Conclusion: Findings indicate a need to consider effective ways of promoting and facilitating access to support, at both a personal and organisational level, for midwives following the experience of a traumatic perinatal event

    What are the characteristics of perinatal events perceived to be traumatic by midwives?

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    Objective: there is potential for midwives to indirectly experience events whilst providing clinical care that fulfil criteria for trauma. This research aimed to investigate the characteristics of events perceived as traumatic by UK midwives. Methods: as part of a postal questionnaire survey conducted between December 2011 and April 2012, midwives (n=421) who had witnessed and/or listened to an account of an event and perceived this as traumatic for themselves provided a written description of their experience. A traumatic perinatal event was defined as occurring during labour or shortly after birth where the midwife perceived the mother or her infant to be at risk, and they (the midwife) had experienced fear, helplessness or horror in response. Descriptions of events were analysed using thematic analysis. Witnessed (W; n=299) and listened to (H; n=383) events were analysed separately and collated to identify common and distinct themes across both types of exposure. Findings: six themes were identified, each with subthemes. Five themes were identified in both witnessed and listened to accounts and one was salient to witnessed accounts only. Themes indicated that events were characterised as severe, unexpected and complex. They involved aspects relating to the organisational context; typically limited or delayed access to resources or personnel. There were aspects relating to parents, such as having an existing relationship with the parents, and negative perceptions of the conduct of colleagues. Traumatic events had a common theme of generating feelings of responsibility and blame Finally for witnessed events those that were perceived as traumatic sometimes held personal salience, so resonated in some way with the midwife's own life experience Key conclusions: midwives are exposed to events as part of their work that they may find traumatic. Understanding the characteristics of the events that may trigger this perception may facilitate prevention of any associated distress and inform the development of supportive interventions

    Identifying fear of childbirth in a UK population: qualitative examination of the clarity and acceptability of existing measurement tools in a small UK sample

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    Background: Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research. Methods: Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale – fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item. Results: All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC. Conclusions: Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population

    A programme for the prevention of post-traumatic stress disorder in midwifery (POPPY): indications of effectiveness from a feasibility study

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    Background: Midwives can experience events they perceive as traumatic when providingcare. As a result, some will develop post-traumatic stress disorder (PTSD), with adverse implications for their mental health, the quality of care provided for women and the employing organizations. POPPY (Programme for the prevention of PTSD in midwifery) is a package of educational and supportive resources comprising an educational workshop, information leaflet, peer support and access to trauma-focused clinical psychology intervention. A feasibility study of POPPY implementation was completed. Objective: This study aimed to identify potential impacts of POPPY on midwives’ understandingof trauma, their psychological well-being and job satisfaction. Method: POPPY was implemented in one hospital site. Before taking part in the POPPY workshop (T1) midwives (N = 153) completed self-report questionnaires, which measured exposure to work-related trauma, knowledge and confidence of managing trauma responses, professional impacts, symptoms of PTSD, burnout and job satisfaction. Measures were repeated (T2) approximately 6 months after training (n = 91, 62%). Results: Midwives’ confidence in recognizing (p = .001) and managing early traumaresponses in themselves and their colleagues significantly improved (both p < .001). There was a trend towards reduced levels of PTSD symptomatology, and fewer midwives reported sub clinical levels of PTSD (from 10% at T1 to 7% at T2). The proportion of midwives reporting high and moderate levels of depersonalization towards care was reduced (33% to 20%) and midwives reported significantly higher levels of job satisfaction at T2 (p < .001). Reductions in self-reported stress-related absenteeism (12% to 5%), long-term changes to clinical allocation (10% to 5%) and considerations about leaving midwifery (34% to 27%) were identified. Conclusions: In conclusion, POPPY shows very positive potential to improve midwives’ mental health and the sensitivity of care they provide, and reduce service disruption and costs for trusts. Large-scale longitudinal evaluation is required

    Activism Among College Students with Disabilities and the Move Beyond Compliance to Full Inclusion

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    This article discusses two case studies of activism by college students with disabilities that have successfully moved disability issues beyond regulatory compliance to a conversation of equity. The two case studies are compared to identify strategies that promoted the success of the campaigns. The article concludes with a discussion of the usage of student activism to ensure equality of opportunity

    The development of the Slade–Pais Expectations of Childbirth Scale (SPECS) *

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    Objective: To develop a valid and reliable English language-based scale to measure pregnant women’s expectations of childbirth. Background: During pregnancy, most women think about their forthcoming childbirth, and develop expectations of how they think this experience will be. Women with adverse expectations of childbirth have been found to have more negative actual experiences. Measuring expectations is therefore important. Existing measures are limited in their established psychometric properties. Methods: Items were generated from semi-structured interviews with 18 pregnant women to explore their expectations of their forthcoming childbirth. Content analysis was used to analyse interview data and scale items were developed using the constructs extracted. A population sample of 148 pregnant women completed the initial 85-item version of the Slade–Pais Expectations of Childbirth Scale (SPECS) and the State Trait Anxiety Inventory. Results: Principal components analysis of the SPECS identified six underlying components labelled ‘coping and robustness to pain’, ‘staff and service responsive to needs’, ‘fear’, ‘out of control and embarrassed’, ‘perceptions of partner’s coping’ and ‘positive anticipation of birth’. Items with poor psychometric properties were excluded. A final 50-item version of the SPECS showed acceptable internal reliability and good content and construct validity. Conclusion: The SPECS shows promising psychometric robustness for use both as a research and clinical tool. It can be used as a total score, as a shortened scale focussed only on expectations of self, or as a series of subscales covering all domains
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