Rural Nebraska Women\u27s Explanatory Models Of Postpartum Depressive Symptomatology

The purpose of this study was to construct the explanatory models of postpartum depressive symptomatology (PPDS) from the perspective of rural Nebraska women and to compare these models with the medical model of PPDS. A sample of 20 rural Nebraska women were interviewed in a one-on-one qualitative descriptive telephone interview using questions based on Kleinman’s (1980) explanatory model of illness. This study used feminist pragmatism as a guiding philosophical paradigm. Qualitative data were analyzed using content analysis, and results were compared and contrasted with the medical model of PPDS, which included the onset, symptoms, and duration listed in the DSM-5 for major depressive disorder with a peripartum onset specifier; a primarily physiological etiology; and pharmacological antidepressants as the treatment of choice. Rural women were more likely to attribute their PPDS to nonphysiological causes than physiological causes. Rural women reported the onset, duration, and symptomatology of PPDS were similar to what is outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Women considered the effects of PPDS on their lives far-reaching and serious. Rural women in this study preferred nonpharmacological treatment options and care from informal networks to that available from health care providers. Although the rural women in this study did not believe PPDS could be prevented, they believed women could better prepare themselves for PPDS by having a support system in place and by planning for practical life concerns. Health care providers and researchers should consider rural women\u27s explanatory models of PPDS when considering interventions and program development for women in rural communities

Cultural Bereavement and Resilience in Refugee Resettlement: A Photovoice Study With Yazidi Women in the Midwest United States

This study explored how ethnic Yazidi refugee women overcome adversity to promote psychosocial health and well-being within the context of U.S. resettlement. Nine Yazidi women participated in two small photovoice groups, each group lasting eight sessions (16 sessions total). Women discussed premigration and resettlement challenges, cultural strengths and resources, and strategies to overcome adversity. Yazidi women identified trauma and perceived loss of culture as primary stressors. Participants’ resilience processes included using naan (as sustenance and symbol) to survive and thrive as well as by preserving an ethnoreligious identity. Findings suggest that women’s health priorities and resilience-promoting strategies center on fostering a collective cultural, religious, and ethnic identity postmigration. Importantly, women used naan (bread) as a metaphor to index cultural values, experiences of distress, and coping strategies. We discuss implications for this in promoting refugees’ mental and psychosocial health in U.S. resettlement

Spatial Localisation of Actin Filaments across Developmental Stages of the Malaria Parasite

Actin dynamics have been implicated in a variety of developmental processes during the malaria parasite lifecycle. Parasite motility, in particular, is thought to critically depend on an actomyosin motor located in the outer pellicle of the parasite cell. Efforts to understand the diverse roles actin plays have, however, been hampered by an inability to detect microfilaments under native conditions. To visualise the spatial dynamics of actin we generated a parasite-specific actin antibody that shows preferential recognition of filamentous actin and applied this tool to different lifecycle stages (merozoites, sporozoites and ookinetes) of the human and mouse malaria parasite species Plasmodium falciparum and P. berghei along with tachyzoites from the related apicomplexan parasite Toxoplasma gondii. Actin filament distribution was found associated with three core compartments: the nuclear periphery, pellicular membranes of motile or invasive parasite forms and in a ring-like distribution at the tight junction during merozoite invasion of erythrocytes in both human and mouse malaria parasites. Localisation at the nuclear periphery is consistent with an emerging role of actin in facilitating parasite gene regulation. During invasion, we show that the actin ring at the parasite-host cell tight junction is dependent on dynamic filament turnover. Super-resolution imaging places this ring posterior to, and not concentric with, the junction marker rhoptry neck protein 4. This implies motor force relies on the engagement of dynamic microfilaments at zones of traction, though not necessarily directly through receptor-ligand interactions at sites of adhesion during invasion. Combined, these observations extend current understanding of the diverse roles actin plays in malaria parasite development and apicomplexan cell motility, in particular refining understanding on the linkage of the internal parasite gliding motor with the extra-cellular milieu

Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Background Phenytoin is the recommended second-line intravenous anticonvulsant for treatment of paediatric convulsive status epilepticus in the UK; however, some evidence suggests that levetiracetam could be an effective and safer alternative. This trial compared the efficacy and safety of phenytoin and levetiracetam for second-line management of paediatric convulsive status epilepticus.Methods This open-label, randomised clinical trial was undertaken at 30 UK emergency departments at secondary and tertiary care centres. Participants aged 6 months to under 18 years, with convulsive status epilepticus requiring second-line treatment, were randomly assigned (1:1) using a computer-generated randomisation schedule to receive levetiracetam (40 mg/kg over 5 min) or phenytoin (20 mg/kg over at least 20 min), stratified by centre. The primary outcome was time from randomisation to cessation of convulsive status epilepticus, analysed in the modified intention-to-treat population (excluding those who did not require second-line treatment after randomisation and those who did not provide consent). This trial is registered with ISRCTN, number ISRCTN22567894.Findings Between July 17, 2015, and April 7, 2018, 1432 patients were assessed for eligibility. After exclusion of ineligible patients, 404 patients were randomly assigned. After exclusion of those who did not require second-line treatment and those who did not consent, 286 randomised participants were treated and had available data: 152 allocated to levetiracetam, and 134 to phenytoin. Convulsive status epilepticus was terminated in 106 (70%) children in the levetiracetam group and in 86 (64%) in the phenytoin group. Median time from randomisation to cessation of convulsive status epilepticus was 35 min (IQR 20 to not assessable) in the levetiracetam group and 45 min (24 to not assessable) in the phenytoin group (hazard ratio 1·20, 95% CI 0·91–1·60; p=0·20). One participant who received levetiracetam followed by phenytoin died as a result of catastrophic cerebral oedema unrelated to either treatment. One participant who received phenytoin had serious adverse reactions related to study treatment (hypotension considered to be immediately life-threatening [a serious adverse reaction] and increased focal seizures and decreased consciousness considered to be medically significant [a suspected unexpected serious adverse reaction]). Interpretation Although levetiracetam was not significantly superior to phenytoin, the results, together with previously reported safety profiles and comparative ease of administration of levetiracetam, suggest it could be an appropriate alternative to phenytoin as the first-choice, second-line anticonvulsant in the treatment of paediatric convulsive status epilepticus

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Finding Strength in Vulnerability: Ethical Approaches when Conducting Research with Vulnerable Populations

Researchers who desire to make positive changes for vulnerable populations often conduct problem-focused studies. Although problem focused research is important, when such studies are not carefully designed, their results can contribute to a deficit discourse. A deficit discourse is a narrative that describes the person through a myopic lens of negativity characterized only by illness, death, depression, failure, or the like. Deficit discourse negatively affects how health care providers and society interact with vulnerable people. This article discusses deficit discourse in health care and strengths-based research: an ethical approach to working with vulnerable individuals in research settings and a strategy to overcome deficit discourse. Strengths-based research approaches balance risks with countermeasures that include areas that are positive and amenable to growth or intervention. Strengths-based research can be conducted using qualitative, quantitative, or mixed-methods methodology. Strengths-based research should be culturally relevant and population-specific, often including the individuals of study throughout the process. By modifying the research approach, critical problems can be identified and addressed while also emphasizing positive ways to empower individuals and improve their lives. Additionally, these changes better the way researchers and health care providers view and care for people while also challenging deficit discourses in society at large

Breastfeeding initiation and duration in depressed and non-depressed women who gave birth during COVID-19

Breastfeeding is crucial to the development of a strong maternal-infant bond and for maternal and infant health. Previous studies have determined that maternal depression may have an impact on breastfeeding initiation and duration. The purpose of this study was to explore the relationship between depression and breastfeeding initiation and duration in women who have given birth during the Coronavirus Disease 2019 (COVID-19) pandemic. This study is a secondary analysis of a retrospective mixed methods study on women who gave birth during the COVID-19 pandemic. Women were recruited for the parent study if they spoke English and gave birth in the United States on or after March 1st, 2020. The measures of this study were taken from the parent study. The evaluation tools are the 10 item Birth Satisfaction Scale Revised (BSS-R), the 2 item Connor Davidson Resilience Scale (CD-RISC2), the 10 item Perceived Stress Scale (PSS10), the 7 item Pearlin Mastery (PM) scale, demographic questions, birth and pregnancy related questions, and a narrative text box where the participant can describe in their own words their birth and postpartum experience. This study will focus on depression and breastfeeding initiation and duration. This study will offer insight into the possible relationship of depression and breastfeeding initiation and duration in women who gave birth during the COVID-19 pandemic. Results and data analysis are pending. The relationship between depression and breastfeeding initiation and duration in women who gave birth during COVID-19 remains uncertain. The results from this study may be used to develop future research or to advance healthcare practices.https://digitalcommons.unmc.edu/surp2020/1003/thumbnail.jp

Finding Strength in Vulnerability: Ethical Approaches when Conducting Research with Vulnerable Populations

Researchers who desire to make positive changes for vulnerable populations often conduct problem-focused studies. Although problem focused research is important, when such studies are not carefully designed, their results can contribute to a deficit discourse. A deficit discourse is a narrative that describes the person through a myopic lens of negativity characterized only by illness, death, depression, failure, or the like. Deficit discourse negatively affects how health care providers and society interact with vulnerable people. This article discusses deficit discourse in health care and strengths-based research: an ethical approach to working with vulnerable individuals in research settings and a strategy to overcome deficit discourse. Strengths-based research approaches balance risks with countermeasures that include areas that are positive and amenable to growth or intervention. Strengths-based research can be conducted using qualitative, quantitative, or mixed-methods methodology. Strengths-based research should be culturally relevant and population-specific, often including the individuals of study throughout the process. By modifying the research approach, critical problems can be identified and addressed while also emphasizing positive ways to empower individuals and improve their lives. Additionally, these changes better the way researchers and health care providers view and care for people while also challenging deficit discourses in society at large