Factors shaping the timing of later entry into parenthood: narratives of choice and constraint

Objective: This study explores the choices and constraints affecting timing of parenthood among those who became parents in their mid-thirties and early forties and how their fertility decisions were both affected by and negotiated within the interplay of different temporal frameworks. Background: Recent decades have seen a trend towards postponement of parenthood in many countries. Explanations for this delay include structural factors, changing social norms and the influence of the social meanings of age. The study assesses the influence of these factors on perceptions of the ‘right’ time to become parents. Method: The study draws on qualitative interviews with 23 women and men who participated in the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) survey and had a first child when they were aged between 33 and 46. Results: Prerequisites for parenthood were seen as financial security, a suitable home and a steady relationship. Educational attainment and the achievement of personal and lifestyle goals affected the age at which parenthood was considered as were individual circumstances. Age was less influential than life stage as a criterion for readiness although, for women, chronological age was a decisive factor. Conclusions: Choice in shaping personal biographies was greater among participants than it would have been for previous generations but its consequences acted to constrain options regarding the timing of parenthood. Time taken to fulfil personal and professional ambitions, changing social norms regarding the appropriate age for parenthood as well as individual and structural factors resulted in less predictable life trajectories.</p

Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007-2019

PURPOSE: Mental health problems and substance misuse are common among the mothers of children who experience court-mandated placement into care in England, yet there is limited research characterising these health needs to inform evidence-based policy. In this descriptive study, we aimed to generate evidence about the type, severity, and timing of mental health and substance misuse needs among women involved in public family law proceedings concerning child placement into care ('care proceedings'). METHODS: This is a retrospective, matched cohort study using linked family court and mental health service records for 2137 (66%) of the 3226 women involved in care proceedings between 2007 and 2019 in the South London and Maudsley NHS Mental Health Trust (SLaM) catchment area. We compared mental health service use and risk of dying with 17,096 female-matched controls who accessed SLaM between 2007 and 2019, aged 16-55 years, and were not involved in care proceedings. RESULTS: Most women (79%) were known to SLaM before care proceedings began. Women had higher rates of schizophrenia spectrum disorders (19% vs 11% matched controls), personality disorders (21% vs 11%), and substance misuse (33% vs 12%). They were more likely to have a SLaM inpatient admission (27% vs 14%) or to be sectioned (19% vs 8%). Women had a 2.15 (95% CI 1.68-2.74) times greater hazard of dying, compared to matched controls, adjusted for age. CONCLUSION: Women involved in care proceedings experience a particularly high burden of severe and complex mental health and substance misuse need. Women's increased risk of mortality following proceedings highlights that interventions responding to maternal mental health and substance misuse within family courts should offer continued, long-term support

An Estimate of the Prevalence of Dementia in Idiopathic Parkinson's Disease

A review of the records for evidence of dementia using criteria adapted from the third edition of the Diagnostic and Statistical Manual of Mental Disorders in every patient (hospitalized and outpatient) with parkinsonism at a major medical center during an 18-month period revealed an overall prevalence of 10.9% in 339 patients with idiopathic Parkinson's disease. Demented patients were older, had a later age at onset of motor manifestations, and a more rapid progression of physical disability than nondemented patients. Duration of illness and levodopa use and the presence of tremor or depression were similar in demented and nondemented patients. Demented patients more often responded poorly or developed adverse effects to levodopa than nondemented patients. When Parkinson's disease began after age 70 years, dementia was noted over three times more frequently than when the disease began at an earlier age. The age-specific prevalence rate of dementia for patients older than 70 years was more than twice that for younger patients. Moreover, the number of records with evidence for dementia with idiopathic Parkinson's disease was 3.75 times greater than expected in comparison with data from a study of the prevalence of dementia in the elderly

Rapid evidence review: pathways focused on the dying phase in end of life care and their key components

This report presents a rapid review of published peer reviewed research about end of life care pathways focused on the dying phase. In particular it examines evidence in relation to use of such pathways in hospitals. Our intention is to provide clear information for stakeholders charged with considering whether any change in current policy and practice is required

Genetic Susceptibility and Head Injury as Risk Factors for Alzheimer's Disease among Community-Dwelling Elderly Persons and Their First-Degree Relatives

We performed a community-based study to investigate the relationship of genetic susceptibility and head injury to Alzheimer's disease(AD) in 138 patients with AD and 193 healthy elderly control subjects. Data concerning presence or absence of dementia and certain exposures were also obtained from 799 first-degree relatives of the patients and 1,238 first-degree relatives of the control subjects. Adjusting for age, gender, and other risk factors, the odds ratio for AD associated with head injury was 3.7 (95% confidence interval [CI], 1.4–9.7). The association was highest for head injuries that occurred after age 70. The risk of AD was higher in first-degree relatives of patients with onset prior to age 70 than in relatives of control subjects (risk ratio [RR] = 2.5; 95% CI, 1.1–5.6). The risk was not increased for relatives of patients with onset of AD at age 70 or older. Compared with relatives without head injury, the risk of AD was increased among both head-injured relatives of patients (RR = 5.9; 95% CI, 2.3–14.8) and head-injured relatives of control subjects (RR = 6.9; 95% CI, 2.5–18.9). Our results are consistent with the hypothesis that severe head injury and genetic susceptibility are associated with AD. Both associations concur with current concepts regarding the role of amyloid in AD. Although we regard head injury, like genetic susceptibility, to be a putative risk factor for AD, the temporal relationship between head injury and AD warrants further investigation

Health professionals' lack of knowledge of central venous access devices: the impact on patients

Background The literature on patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept CVADs as should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to the hope. Aim The aim of this study was to uncover the global, cross-disease experience of patients with CVADs.MethodsAn online survey was sent to an international sample of people living with CVADs.FindingsSeventy-four people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion due to lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice.ConclusionClinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience

Transformation in a changing climate: a research agenda

The concept of transformation in relation to climate and other global change is increasingly receiving attention. The concept provides important opportunities to help examine how rapid and fundamental change to address contemporary global challenges can be facilitated. This paper contributes to discussions about transformation by providing a social science, arts and humanities perspective to open up discussion and set out a research agenda about what it means to transform and the dimensions, limitations and possibilities for transformation. Key focal areas include: (1) change theories, (2) knowing whether transformation has occurred or is occurring; (3) knowledge production and use; (4), governance; (5) how dimensions of social justice inform transformation; (6) the limits of human nature; (7) the role of the utopian impulse; (8) working with the present to create new futures; and (9) human consciousness. In addition to presenting a set of research questions around these themes the paper highlights that much deeper engagement with complex social processes is required; that there are vast opportunities for social science, humanities and the arts to engage more directly with the climate challenge; that there is a need for a massive upscaling of efforts to understand and shape desired forms of change; and that, in addition to helping answer important questions about how to facilitate change, a key role of the social sciences, humanities and the arts in addressing climate change is to critique current societal patterns and to open up new thinking. Through such critique and by being more explicit about what is meant by transformation, greater opportunities will be provided for opening up a dialogue about change, possible futures and about what it means to re-shape the way in which people live

Spatiotemporal regulation of liver development by the Wnt/β- catenin pathway

While the Wnt/β-catenin pathway plays a critical role in the maintenance of the zonation of ammonia metabolizing enzymes in the adult liver, the mechanisms responsible for inducing zonation in the embryo are not well understood. Herein we address the spatiotemporal role of the Wnt/β-catenin pathway in the development of zonation in embryonic mouse liver by conditional deletion of Apc and β-catenin at different stages of mouse liver development. In normal development, the ammonia metabolising enzymes carbamoylphosphate synthetase I (CPSI) and Glutamine synthetase (GS) begin to be expressed in separate hepatoblasts from E13.5 and E15.5 respectively and gradually increase in number thereafter. Restriction of GS expression occurs at E18 and becomes increasingly limited to the terminal perivenous hepatocytes postnatally. Expression of nuclear β-catenin coincides with the restriction of GS expression to the terminal perivenous hepatocytes. Conditional loss of Apc resulted in the expression of nuclear β-catenin throughout the developing liver and increased number of cells expressing GS. Conversely, conditional loss of β-catenin resulted in loss of GS expression. These data suggest that the Wnt pathway is critical to the development of zonation as well as maintaining the zonation in the adult liver