Emotional resilience and event centrality mediate posttraumatic growth following adverse childhood experiences

Research has long established that adverse childhood experiences (ACEs) can lead to a range of negative psychological consequences, including post-traumatic stress (PTS) symptoms. It is also increasingly recognized that ACEs can serve as a catalyst for positive changes, such as post-traumatic growth (PTG). The mechanisms by which people report negative or positive changes are less well known. This study explored whether emotional resilience and event centrality could determine the degree of negative or positive changes reported following ACEs. Participants (N = 167; 54.5% female; aged 19-95 years) completed an online survey measuring experiences of childhood adversity, resilience, event centrality, PTS symptoms and PTG. Mediation analyses indicated that resilience and event centrality explained PTG only, exerting significant medium negative and small positive indirect effects on PTG, respectively. These findings indicate that following ACEs, the treatment and management of emotional resilience and event centrality could lead to positive effects on psychological well-being

Mental Health Prevention and Promotion for Those Who Have Had Covid-19 in Primary Care: A Case Series Study

The Covid-19 pandemic has had a negative impact upon individual’s psychological wellbeing. This case study series aimed to use a mental health prevention and promotion approach to promote positive emotional wellbeing and prevent deterioration of mental health difficulties in individuals who have had Covid-19. 573 individuals, who had recently tested positive for Covid-19, registered across two General Practices (GP), were initially screened, and 409 were contacted and offered psychological support. 9.1% accepted the offer at first but only 3.2% started the sessions. Psychometrics was used within the first and last session but also at a 6-week follow up to measure wellbeing, resiliency, low mood and anxiety. Experience of service questionnaires was also taken. Scores for wellbeing and resiliency increased at a statistically significant level. Scores for anxiety and low mood decreased at a statistically significant level, this was maintained at follow up. Qualitative feedback was positive. This service supports previous findings that mental health prevention and promotion interventions are effective. However, it is important to be mindful that given only 12 individuals finalized the sessions, the power of statistical findings are reduced. Nonetheless, this service is reasonably effective for people with a recent, positive Covid-19 test. Service scope should widen to include those who have struggled with the effects of the pandemic and not just those who received a positive diagnosis

The predictors of foot ulceration in patients with rheumatoid arthritis

This study was conducted to determine the predictors of foot ulceration occurring in patients with rheumatoid arthritis (RA) without diabetes. A multi-centre case control study was undertaken; participants were recruited from eight sites (UK). Cases were adults diagnosed with RA (without diabetes) and the presence of a validated foot ulcer, defined as a full thickness skin defect occurring in isolation on / below the midline of the malleoli and requiring > 14 days to heal. Controls met the same criteria but were ulcer naive. Clinical examination included loss of sensation (10g monofilament); ankle-brachial pressure index (ABPI); forefoot deformity (Platto); plantar pressures (PressureStat); RA disease activity (36 swollen/tender joint counts) and the presence of vasculitis. History taking included past ulceration/foot surgery; current medication and smoking status. Participants completed the Health Assessment Questionnaire (HAQ) and Foot Impact Scale. A total of 83 cases with 112 current ulcers and 190 ulcer naïve controls participated. Cases were significantly older (mean age 71 years; 95 % confidence interval [CI], 69-73 vs. 62 years, 60-64) and had longer RA disease duration (mean 22 years; 19-25 vs. 15, 13-17). Univariate analysis showed that risk of ulceration increases with loss of sensation; abnormality of ABPI and foot deformity. Plantar pressures and joint counts were not significant predictors. HAQ score and history of foot surgery were strongly associated with ulceration (odds ratio [OR] = 1.704, 95 % CI 1.274-2.280 and OR = 2.256, 95 % CI 1.294-3.932). Three cases and two controls presented with suspected cutaneous vasculitis. In logistic regression modelling, ABPI (OR = 0.04; 95 % CI, 0.01-0.28) forefoot deformity (OR = 1.14; 95 % CI, 1.08-1.21) and loss of sensation (OR = 1.22; 95 % CI, 1.10-1.36) predicted risk of ulceration. In patients with RA, ABPI, forefoot deformity and loss of sensation predict risk of ulceration but, in contrast with diabetes, raised plantar pressures do not predict risk

Making maternity and neonatal care personalised in the COVID-19 pandemic: Results from the Babies Born Better survey in the UK and the Netherlands

Background The COVID-19 pandemic had a severe impact on women’s birth experiences. To date, there are no studies that use both quantitative and qualitative data to compare women’s birth experiences before and during the pandemic, across more than one country. Aim To examine women’s birth experiences during the COVID-19 pandemic and to compare the experiences of women who gave birth in the United Kingdom (UK) or the Netherlands (NL) either before or during the pandemic. Method This study is based on analyses of quantitative and qualitative data from the online Babies Born Better survey. Responses recorded by women giving birth in the UK and the NL between June and December 2020 have been used, encompassing women who gave birth between 2017 and 2020. Quantitative data were analysed descriptively, and chi-squared tests were performed to compare women who gave birth pre- versus during pandemic and separately by country. Qualitative data was analysed by inductive thematic analysis. Findings Respondents in both the UK and the NL who gave birth during the pandemic were as likely, or, if they had a self-reported above average standard of life, more likely to rate their labour and birth experience positively when compared to women who gave birth pre-pandemic. This was despite the fact that those labouring in the pandemic reported a lack of support and limits placed on freedom of choice. Two potential explanatory themes were identified in the qualitative data: respondents had lower expectations of care during the pandemic, and they appreciated the efforts of staff to give individualised care, despite the rules. Conclusion Our study implies that many women labouring during the COVID-19 pandemic experienced restrictions, but their experience was mitigated by staff actions. However, personalised care should not be maintained by the good will of care providers, but should be a priority in maternity care policy to benefit all service users equitably