31 research outputs found
Health services research into postnatal depression : results from a preliminary cross-cultural study
Background: Little is known about the
availability and uptake of health and
welfare services by women with postnatal
depression in different countries.
Aims: Within the context of a cross-
cultural research study, to develop and
test methods for undertaking quantitative
health services research in postnatal
depression.
Method: Interviews with service
planners and the collation of key health
indicators were used to obtain a profile of
service availability and provision. A service
use questionnaire was developed and
administered to a pilot sample in a number
of European study centres.
Results: Marked differences in service
access and use were observed between
the centres, including postnatal nursing
care and contacts with primary care
services.Rates of use of specialist services
were generally low.Common barriers to
access to care included perceived service
quality and responsiveness. On the basis of
the pilot work, a postnatal depression
version of the Service Receipt Inventory
was revised and finalised.
Conclusions: This preliminary study
demonstrated the methodological
feasibility of describing and quantifying
service use, highlighted the varied and
often limited use of care in this population,
and indicated the need for an improved
understanding of the resource needs and
implications of postnatal depression
Postnatal depression across countries and cultures : a qualitative study
Background: Postnatal depression seems to be a universal condition with
similar rates in different countries. However, anthropologists question the
cross-cultural equivalence of depression,
particularly at a life stage so influenced by
cultural factors.
Aims: To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and
described and to enquire into people’s
perceptions of remedies and services for
morbid states of unhappiness within the
context of local services.
Method: The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interviews with fathers and
grandmothers, and interviews with health
professionals.Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres.
Results: All centres described morbid unhappiness after childbirth comparable
to postnatal depression but not all saw this
as an illness remediable by health interventions.
Conclusions: Although the findings of
this study support the universality of a
morbid state of unhappiness following childbirth, they also support concerns
about the cross-cultural equivalence of postnatal depression as an illness requiring the intervention of health professionals;
this has implications for future research
Mothers’ accounts of the impact on emotional wellbeing of organised peer support in pregnancy and early parenthood: a qualitative study
Perceptions of postnatal depression across countries and cultures: from a TransCultural Study of PostNatal Depression (TCS-PND)
Objectives
The qualitative study was conducted within the international
“Transcultural study of postnatal depression (PND)” in 17 centres
located in 13 different countries. The aim was to explore
perceptions of PND by lay and professional key informants,
specifically regarding description of symptoms, awareness of this
pathology and of possible care.
Methods
Broad areas of inquiry and open-ended probes were developed by
the TCS-PND research group during international workshops to
obtain data comparable between countries on perceptions of
PND. A non-random convenience sampling method was used to
recruit postpartum mothers for focus groups, and fathers and
grandmothers for interviews. Influential healthcare planners and
clinicians were interviewed as professional key informants in each
centre. Within sites, transcripts of focus groups and interviews
underwent a process of text analysis in the original language until
exhaustive theme extraction was achieved. Themes (in English)
from all the centres were combined into broader categories and
after consensus discussions these categories were revalidated.
Results and discussion
Qualitative data were supplemented in each centre with sociodemographic
data to address the issues of: (i) whether perceptions
of PND are related to some specific cultural perception of mental
heath and/or of status of parenthood and (ii) how high or low
levels of general care and specificity of health policy relate to
differences in perception of needs for care. Data collected using
the same probes and methodology in different countries and
cultures has enabled a comparative analysis of perceptions of
PND. In addition it has shown that, although not described with
the same words, PND is a well-recognised condition by recent
mothers in all countries in this study. Data on focus groups and
interviews from selected countries are given in the following
abstracts to illustrate some similarities and differences in
perceptions between countries
The effectiveness of mindfulness-based interventions on maternal perinatal mental health outcomes:A systematic review
Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study
International audienceObjectiveThe aim of this study was to evaluate the effect of hydroxychloroquine (HCQ) on fetal preterm delivery and intrauterine growth restriction (IUGR) in a cohort of pregnant women with systemic lupus erythematosus (SLE).MethodsOver an 11-year period (January 1, 2001 to December 31, 2011), all women with SLE and admitted to deliver after 22 weeks of gestation to Bordeaux University Hospital (France), were retrospectively enrolled in the present study. The population was then split into two groups based on the treatment they received: HCQ exposed (HCQ+) versus HCQ non-exposed (HCQ?) group.Results118 pregnancies were included, 41 in the HCQ+ group and 77 in the HCQ? group. The rate of adverse fetal outcome was significantly lower in the HCQ+ group (p?=?0.001), particularly in terms of preterm delivery, 15.8 % versus 44.2 % (p?=?0.006), and IUGR, 10.5 % versus 28.6 % (p?=?0.03). No adverse outcomes were reported in the HCQ+ group.ConclusionHCQ reduces neonatal morbidity in women with SLE by significantly decreasing the rate of prematurity and intrauterine growth restriction
Contextual assessment of the maternity experience (CAME): development of an instrument for cross-cultural research
Background: There is evidence that
stressors may trigger the onset of a
depressive episode in vulnerable women.
A new UK interview measure, the
Contextual Assessment of the Maternity
Experience (CAME), was designed to
assess major risk factors for emotional
disturbances, especially depression,
during pregnancy and post-partum.
Aims: Within the context of a cross-
cultural study, to establish the usefulness of
the CAME, and to test expected
associations of the measure with
characteristics of the social context and
with major or minor depression.
Method: The CAME was administered
antenatally and postnatally in ten study
sites, respectively to 296 and 249 women.
Affective disorder throughout pregnancy
and up to 6 months postnatally was
assessed by means of the Structured
Clinical Interview for DSM IV Axis I
Disorders.
Results: Adversity, poor relationship
with either a partner or a confidant, and
negative feelings about the pregnancy all
predicted onset of depression during the
perinatal period.
Conclusions: The CAME was able to
assess major domains relevant to the
psychosocial context of the maternity
experience in different cultures.Overall,
the instrument showed acceptable
psychometric properties in its first use in
different cultural settings.Fernand Seguin Research Centre (Montreal,
Canada)
Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery.
Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery
<p>BACKGROUND: Gynaecological laparoscopic surgery outcomes can be compromised by the formation of de novo adhesions. This randomized, double-blind study was designed to assess the efficacy and safety of 4% icodextrin solution (Adept®) in the reduction of de novo adhesion incidence compared to lactated Ringer's solution (LRS).</p>
<p>METHODS: Patients undergoing laparoscopic surgery for removal of myomas or endometriotic cysts were treated with randomized solution as an intra-operative irrigant and 1l post-operative instillate. De novo adhesion incidence (number of sites with adhesions), severity and extent were independently scored at a second-look procedure and the efficacy of the two solutions compared. The effect of surgical covariates on adhesion formation was also investigated. Initial exploratory analysis of individual anatomical sites of clinical importance was progressed.</p>
<p>RESULTS: Of 498 patients randomized, 330 were evaluable (160 LRS – 75% myomectomy/25% endometriotic cysts; 170 Adept – 79% myomectomy/21% endometriotic cysts). At study completion, 76.2% LRS and 77.6% Adept had ≥1 de novo adhesion. The mean (SD) number of de novo adhesions was 2.58 (2.11) for Adept and 2.58 (2.38) for LRS. The treatment effect difference was not significant (P = 0.909). Assessment of surgical covariates identified significant influences on the mean number of de novo adhesions regardless of treatment, including surgery duration (P = 0.048), blood loss in myomectomy patients (P = 0.019), length of uterine incision in myomectomy patients (P < 0.001) and number of suture knots (P < 0.001). There were 15 adverse events considered treatment-related in the LRS patients (7.2%) and 18 in the Adept group (8.3%). Of 17 reported serious adverse events (9 LRS; 8 Adept) none were considered treatment-related.</p>
<p>CONCLUSIONS: The study confirmed the safety of Adept in laparoscopic surgery. The proportion of patients with de novo adhesion formation was considerably higher than previous literature suggested. Overall there was no evidence of a clinical effect but various surgical covariates including surgery duration, blood loss, number and size of incisions, suturing and number of knots were found to influence de novo adhesion formation. The study provides direction for future research into adhesion reduction strategies in site specific surgery.</p>