The (un)controlled body:A grounded theory analysis to conceptualise stigma for women with gestational diabetes mellitus

Health-related stigma is associated with adverse outcomes including depression, stress and reduced engagement in health behaviours which are particularly harmful in pregnancy and the postpartum. Women with gestational diabetes mellitus (GDM) report negative psychosocial experiences and may be at risk of stigma related to the condition. We aimed to understand women’s experiences of GDM-specific stigma. Individual interviews were conducted with n = 53 women living in the UK with a current or past (within 4 years) GDM. Grounded theory methodology was used to analyse the data. Four themes were identified: (1) Preconceptions and misconceptions; (2) Locating, regaining, and negotiating agency; (3) Tension about and resisting the dominant discourse of stigma; and (4) Reclaiming control over the body. GDM-specific stigma was diverse and far reaching and may have broader implications for perinatal mental health and postnatal wellbeing. It is pertinent to investigate possible prospective associations between GDM-specific stigma, and biomedical and mental health outcomes.</p

In situ detection of boron by ChemCam on Mars

We report the first in situ detection of boron on Mars. Boron has been detected in Gale crater at levels Curiosity rover ChemCam instrument in calcium-sulfate-filled fractures, which formed in a late-stage groundwater circulating mainly in phyllosilicate-rich bedrock interpreted as lacustrine in origin. We consider two main groundwater-driven hypotheses to explain the presence of boron in the veins: leaching of borates out of bedrock or the redistribution of borate by dissolution of borate-bearing evaporite deposits. Our results suggest that an evaporation mechanism is most likely, implying that Gale groundwaters were mildly alkaline. On Earth, boron may be a necessary component for the origin of life; on Mars, its presence suggests that subsurface groundwater conditions could have supported prebiotic chemical reactions if organics were also present and provides additional support for the past habitability of Gale crater

A mobile phone app for the prevention of type 2 diabetes in Malaysian women with gestational diabetes mellitus: Protocol for a feasibility randomized controlled trial

Background: Over 50% of women with a history of gestational diabetes mellitus (GDM) will develop type 2 diabetes (T2D) in later life. Asian women experience a disproportionate risk of both GDM and T2D compared to women from other ethnic backgrounds. Lifestyle interventions and behavior change can delay or even prevent the onset of T2D. We have developed a digitalized diabetes prevention intervention for the prevention of T2D in Malaysian women with GDM. Objective: The protocol describes a randomized controlled trial (RCT) to test the feasibility of undertaking a definitive trial of a diabetes prevention intervention, including a smartphone app and group support. Secondary aims are to summarize anthropometric, biomedical, psychological, and lifestyle outcomes overall and by allocation group, and to undertake a process evaluation. Methods: This is a two-arm parallel feasibility RCT. A total of 60 Malaysian women with GDM will be randomized in the antenatal period to receive the intervention or standard care until 12 months post partum. The intervention is a diabetes prevention intervention delivered via a smartphone app developed based on the Information-Motivation-Behavioral Skills model of behavior change and group support using motivational interviewing. The intervention provides women with tailored information and support to encourage weight loss through adapted dietary intake and physical activity. Women in the control arm will receive standard care. The Malaysian Ministry of Health’s Medical Research and Ethics Committee has approved the trial (NMRR-21-1667-60212). Results: Recruitment and enrollment began in February 2022. Future outcomes will be published in peer-reviewed health-related research journals and presented at national, regional, or state professional meetings and conferences. This publication is based on protocol version 2, January 19, 2022. Conclusions: To our knowledge, this will be the first study in Malaysia that aims to determine the feasibility of a digital intervention in T2D prevention among women with GDM. Findings from this feasibility study will inform the design of a full-scale RCT in the future

Predictors of Women’s Psychosocial Outcomes of Outpatient Priming for Induction of Labour

This item is only available electronically.Induction of labour (IOL) is one of the most commonly performed obstetric procedures. Many women undergoing IOL require cervical priming. Most Australian hospitals have an inpatient procedure for cervical priming, which involves pre-labour overnight hospital admission and separation from family and support companions. An alternative is for women to undergo the overnight ripening process in their own homes (outpatient setting). The outpatient setting for IOL has been associated with lower health care costs, reduced length of hospital stays, improved psychological outcomes for women, and overall improvement in women’s experience of the procedure. The aim of the current study was to examine predictors of women’s psychosocial outcomes of outpatient priming for IOL. The current investigation utilised data collected as part of a randomised controlled trial at two South Australian hospitals. Three-hundred and seven women completed a questionnaire seven weeks after giving birth to measure postnatal depression, infant feeding practices, psychosocial experiences of IOL in the outpatient setting, and demographic information. Several consistent findings emerged during data analysis. Women’s reported experiences of safety regarding priming for IOL in the outpatient setting was a significant psychosocial predictor of both postnatal depression and infant feeding practices. Further, women’s linguistic background emerged as a consistent finding, demonstrating a statistically significant relationship with numerous psychosocial experiences, including social support, self-efficacy, readiness, control, information, and safety. The current study offers psychological insight into the outpatient experience of IOL and has clear implications for the advancement of outpatient obstetric care.Thesis (B.Sc.(Hons)) -- University of Adelaide, School of Psychology, 201

Women’s Psychosocial Outcomes Following Cardiotocography (CTG) and ST-Analysis (STan) Fetal Surveillance during Labour: An Australian Randomised Controlled Trial

The STan Australian Randomised Controlled Trial (START) has been designed to compare two techniques of intrapartum fetal surveillance: cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram (STan+CTG) versus CTG alone. The aim of START, the first trial of its kind in Australia, is to determine if STan+CTG reduces Emergency Caesarean Section (EmCS) rates. It is also the first comprehensive intrapartum fetal surveillance trial worldwide to include the examination of clinical, economic, and psychosocial outcomes. This thesis encompasses four studies (presented as self-contained papers, two of which are published), undertaken alongside the randomised controlled trial (RCT), to integrate the perspectives of women who participated in the study and add important contextual value to the clinical results. The aim of Study One was to identify, collate and examine the evidence surrounding women’s psychosocial outcomes of EmCS worldwide. The systematic review included a large number of studies (n=66) from 22 different countries. Key psychosocial outcomes found to be negatively impacted by EmCS included post-traumatic stress, health-related quality of life, overall experiences, infant-feeding, satisfaction, and self-esteem. Post-traumatic stress was one of the most examined psychosocial outcomes, with a strong consensus that EmCS contributes to both symptoms and diagnosis. The aim of Study Two was to examine women's experiences with the type of monitoring they received in the RCT. Using a qualitative research design, a sample of thirty-two women were interviewed about their experiences with the fetal monitoring. Six themes emerged from analysis: reassurance, mobility, discomfort, perception of the fetal Scalp Electrode (FSE), and overall positive experiences. The primary difference between the two techniques was whether or not women had an FSE (an FSE is always used with STan+CTG and when necessary with CTG alone). In general, it was found that women were very accepting of STan+CTG as it was perceived as a more accurate form of monitoring than CTG alone. Study Three examined women’s psychosocial outcomes alongside the RCT. A cohort of consecutively recruited women who had participated in the RCT from its initiation were invited to complete a mixed-method psychosocial questionnaire approximately eight weeks after giving birth to explore numerous outcomes including; postnatal depression, quality of life, psychological distress, infant feeding practices, and satisfaction. Of the 527 women invited to participate, 207 women completed the questionnaire (n=113/263, STan+CTG; n=94/264, CTG alone). Analysis was by intention to treat. This questionnaire provided necessary data for two subsequent papers. The first paper presents the findings in relation to women’s satisfaction with birth and monitoring and the second presents findings on women’s psychological and health outcomes. In terms of birth satisfaction, while there were no clear statistically significant differences between the two groups in satisfaction with the overall birth, responses about experiences with fetal monitoring tended to favour women randomised to the STan+CTG arm. Women in the STan+CTG arm reported higher average satisfaction with staff competency associated with the monitoring and were more likely to disagree with the statement that they would prefer a different type of monitoring in future labours compared to CTG alone. The qualitative component of this study provides further insight into the key positive and negative aspects of both forms of fetal surveillance and interestingly shows that women in the CTG arm who had an FSE, reported very similar experiences to women in the STan arm, findings that are in line with Study Two. In terms of psychological and health outcomes, both monitoring types appeared to produce comparable results in terms of postnatal depression, quality of life, distress, and infant feeding. Results of this research firstly highlight the diverse and significant impact EmCS can have on women’s psychosocial outcomes, particularly in relation to traumatic stress. These findings underscore the requirement for evidence-based strategies to provide appropriate psychosocial support and information about EmCS in the context of routine antenatal and postnatal care. Furthermore, against a backdrop of several RCTs worldwide examining the clinical outcomes of STan, this is the first comprehensive trial to include women’s perspectives. Overall, policy makers can be assured that STan results in, at the very least, comparable psychosocial outcomes relative to CTG alone. Findings from this trial should be incorporated when developing consumer-based information about intrapartum fetal surveillance, regarding common misconceptions by women and care providers about the potential use of an FSE.Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 202

Indigenous students’ experience and engagement with support at university: a mixed-method study

Abstract There remains significant under representation of Aboriginal and Torres Strait Islander peoples in Australian higher education systems. A number of strategies have been implemented by governments and universities to best support Indigenous students within higher education that have produced varying levels of success in increasing participation, retention and completions. One key strategy is the inclusion of Aboriginal Education Units within universities. The current study aimed to examine students experience and engagement with a range of support services across university, in particular with an Aboriginal Education Unit. Utilising a mixed-method approach, data were collected from 103 students who identified as Aboriginal and/or Torres Strait Islander at The University of Adelaide. Overall, students were most satisfied with support provided by family (70%) and the Aboriginal Education Unit (61%), followed by support provided by university faculties (49%), and the wider university (43%). The main reasons students were accessing the Unit was for academic and tutoring purposes, also rating tutoring as the most beneficial service provided by the Unit. This study highlights the importance of examining and evaluating enablers such as support mechanisms from the student perspective and has demonstrated the significant role Aboriginal Education Units play in the student experience, laying a crucial foundation for targeted support initiatives