Association between maternal depression symptoms across the first eleven years of their child’s life and subsequent offspring suicidal ideation

Depression is common, especially in women of child-bearing age; prevalence estimates for this group range from 8% to 12%, and there is robust evidence that maternal depression is associated with mental health problems in offspring. Suicidal behaviour is a growing concern amongst young people and those exposed to maternal depression are likely to be especially at high risk. The aim of this study was to utilise a large, prospective population cohort to examine the relationship between depression symptom trajectories in mothers over the first eleven years of their child’s life and subsequent adolescent suicidal ideation. An additional aim was to test if associations were explained by maternal suicide attempt and offspring depressive disorder. Data were utilised from a population-based birth cohort: the Avon Longitudinal Study of Parents and Children. Maternal depression symptoms were assessed repeatedly from pregnancy to child age 11 years. Offspring suicidal ideation was assessed at age 16 years. Using multiple imputation, data for 10,559 families were analysed. Using latent class growth analysis, five distinct classes of maternal depression symptoms were identified (minimal, mild, increasing, sub-threshold, chronic-severe). The prevalence of past-year suicidal ideation at age 16 years was 15% (95% CI: 14-17%). Compared to offspring of mothers with minimal symptoms, the greatest risk of suicidal ideation was found for offspring of mothers with chronic-severe symptoms [OR 3.04 (95% CI 2.19,4.21)], with evidence for smaller increases in risk of suicidal ideation in offspring of mothers with sub-threshold, increasing and mild symptoms. These associations were not fully accounted for by maternal suicide attempt or offspring depression diagnosis. Twenty-six percent of non-depressed offspring of mothers with chronic-severe depression symptoms reported suicidal ideation. Risk for suicidal ideation should be considered in young people whose mothers have a history of sustained high levels of depression symptoms, even when the offspring themselves do not have a depression diagnosis

Dose response of the 16p11.2 distal copy number variant on intracranial volume and basal ganglia

Carriers of large recurrent copy number variants (CNVs) have a higher risk of developing neurodevelopmental disorders. The 16p11.2 distal CNV predisposes carriers to e.g., autism spectrum disorder and schizophrenia. We compared subcortical brain volumes of 12 16p11.2 distal deletion and 12 duplication carriers to 6882 non-carriers from the large-scale brain Magnetic Resonance Imaging collaboration, ENIGMA-CNV. After stringent CNV calling procedures, and standardized FreeSurfer image analysis, we found negative dose-response associations with copy number on intracranial volume and on regional caudate, pallidum and putamen volumes (β = −0.71 to −1.37; P < 0.0005). In an independent sample, consistent results were obtained, with significant effects in the pallidum (β = −0.95, P = 0.0042). The two data sets combined showed significant negative dose-response for the accumbens, caudate, pallidum, putamen and ICV (P = 0.0032, 8.9 × 10⁻⁶, 1.7 × 10⁻⁹, 3.5 × 10⁻¹² and 1.0 × 10⁻⁴, respectively). Full scale IQ was lower in both deletion and duplication carriers compared to non-carriers. This is the first brain MRI study of the impact of the 16p11.2 distal CNV, and we demonstrate a specific effect on subcortical brain structures, suggesting a neuropathological pattern underlying the neurodevelopmental syndromes

“If you don't have enough equipment, you're not going to provide quality services”: Healthcare workers’ perceptions on improving the quality of antenatal care in rural Tanzania

Introduction: To reduce maternal mortality in rural Tanzania, improving antenatal care remains an urgent priority. Therefore, the availability of qualified and motivated staff providing antenatal care is an essential precondition for high-quality maternal healthcare. However, it is still unclear which factors affect the performance of healthcare workers in this setting, and what they perceive is necessary to improve the quality of antenatal care. The aim of this research was to identify factors that could, according to healthcare workers, improve their performance and thereby improve the quality of antenatal care in rural Tanzania. Methods: Semi-structured in-depth interviews were conducted with sixteen healthcare workers of different education levels and from different health facilities in Magu District, Tanzania. Questions were asked about their experiences, opinions, and motivations related to the provision and quality of antenatal care, as well as their perceptions of the value of using an e-health application during consultations. Results: Healthcare workers possess a positive attitude towards antenatal care and acknowledge its importance. Despite the existing social pressure from both colleagues and clients to perform well, this study identified differences in the quality of antenatal care provision and the level of motivation between healthcare workers. In addition, participants felt capable of providing antenatal care but complained about the poor working conditions (e.g. lack of electricity, equipment or medication), and indicated a need for more training and better supervision. Furthermore, when asked whether an electronic clinical decision and support system could improve the quality of antenatal care and their working conditions, healthcare workers expressed a positive attitude towards such a system. Discussion: In order to change the status quo in antenatal care provision in Tanzania, attention should be paid to reducing the work challenges experienced by healthcare workers. This could be achieved through providing training opportunities, supportive leadership, and the improvement of physical working conditions, for example by the implementation of an electronic clinical decision and support system. © 2020 The Author

“If you don't have enough equipment, you're not going to provide quality services”: Healthcare workers’ perceptions on improving the quality of antenatal care in rural Tanzania

Introduction: To reduce maternal mortality in rural Tanzania, improving antenatal care remains an urgent priority. Therefore, the availability of qualified and motivated staff providing antenatal care is an essential precondition for high-quality maternal healthcare. However, it is still unclear which factors affect the performance of healthcare workers in this setting, and what they perceive is necessary to improve the quality of antenatal care. The aim of this research was to identify factors that could, according to healthcare workers, improve their performance and thereby improve the quality of antenatal care in rural Tanzania. Methods: Semi-structured in-depth interviews were conducted with sixteen healthcare workers of different education levels and from different health facilities in Magu District, Tanzania. Questions were asked about their experiences, opinions, and motivations related to the provision and quality of antenatal care, as well as their perceptions of the value of using an e-health application during consultations. Results: Healthcare workers possess a positive attitude towards antenatal care and acknowledge its importance. Despite the existing social pressure from both colleagues and clients to perform well, this study identified differences in the quality of antenatal care provision and the level of motivation between healthcare workers. In addition, participants felt capable of providing antenatal care but complained about the poor working conditions (e.g. lack of electricity, equipment or medication), and indicated a need for more training and better supervision. Furthermore, when asked whether an electronic clinical decision and support system could improve the quality of antenatal care and their working conditions, healthcare workers expressed a positive attitude towards such a system. Discussion: In order to change the status quo in antenatal care provision in Tanzania, attention should be paid to reducing the work challenges experienced by healthcare workers. This could be achieved through providing training opportunities, supportive leadership, and the improvement of physical working conditions, for example by the implementation of an electronic clinical decision and support system. © 2020 The Author

Psychological aspects in patients with advanced cancer receiving lifelong systemic treatment: Protocol for a scoping review

Introduction A better understanding of the molecular, genetic and immunological characteristics of cancer and the introduction of new systemic treatment regimens in the last decades, has led to better treatment outcomes and increased survival rates for patients with previously short lived cancers. However, there is no uniform description to refer to this growing group of patients with advanced cancer who now respond to new systemic treatments for longer periods. Furthermore, little is known about the unique psychological challenges these patients face, living with ongoing uncertainty about the course of their disease and life expectancy. The objective of this scoping review is to identify the psychological aspects experienced by, and the definitions used to refer to patients with advanced cancer receiving lifelong systemic treatment. Methods and analysis This review will be among the first to summarise literature on the psychological issues in the growing group of advanced cancer patients undergoing long-Term systemic treatment. Articles will be retrieved from six databases (MEDLINE, Embase, Web of Science, PsycINFO, CINAHL and the Cochrane Database of Systematic Reviews) and reviewed for eligibility by two investigators independently. Definitions and psychological challenges will be extracted and narratively summarised following a descriptive approach. Furthermore, results will contribute in providing a uniform definition for this patient group, and help to identify knowledge gaps to give direction to further research in this field. Ethics and dissemination No ethical approval is required. The results of the scoping review will be submitted for publication to a scientific journal and presented at relevant conferences

Prevalence and Macrolide Resistance of Mycoplasma genitalium in South African Women

International audienceRemnant specimens from 601 women obtained in a cross-sectional study from rural South Africa were tested for Mycoplasma genitalium. Overall, 10.8% of women were infected with M. genitalium either in the vagina or in the rectum. Macrolide resistance, although of low prevalence, in M. genitalium is described for the first time in Sub-Saharan Africa