Striving for excellence in maternity care: The Maternity Stream of the City of Sanctuary.

yesAsylum-seeking and refugee (AS&R) women living in the UK often have complex health and social care needs, with poor underlying mental and physical health and an increased risk of negative pregnancy outcomes. Despite this, AS&R women are less likely to attend for timely maternity care and when they do, care may be poor, with staff not understanding their specific needs and displaying poor attitudes. This article discusses the Maternity Stream of the City of Sanctuary and how this charity aims to work with statutory and voluntary sector maternity-related services and groups to develop services that are inclusive for AS&R women and meet their specific needs. Volunteer AS&R women are central to the activities of the Maternity Stream and this article discusses how they engage with midwives and other maternity workers to facilitate the development of services that may ultimately improve pregnancy outcomes for AS&R women

A designer's approach: How can autistic adults with learning disabilities be involved in the design process?

Autistic adults with limited speech and additional learning disabilities who are often excluded from design research are at the heart of this project. These are people whose perceptions, experiences and interactions with their surroundings are unique, but also are people who may not be able to communicate verbally their differences to the remaining 99% of the population. This, in combination with their distinctive cognitive profile, has resulted in a lack of studies involving people living with autism, and consequently their life experiences may neither be heard nor understood and remain largely unexplored. By reflecting upon the ongoing design collaboration between The Helen Hamlyn Centre for Design and the autism charity The Kingwood Trust, this paper reflects on the approach and methods used in three design studies. Particular attention is paid towards the careful selection, adaptation and development of collaborative design methods for autistic adults and their support staff to be involved. By working beyond the boundaries of a neurotypical culture, the project aims to support the greater goal of improving the everyday experiences of people living with autism by breaking down the barriers to participation

Pregnant and seeking asylum; exploring experiences ‘from booking to baby’

YesPregnant women seeking asylum in the UK may be particularly vulnerable with poor underlying health, more complex pregnancies and an increased risk of maternal and perinatal mortality. Studies have shown that some women seeking asylum have poor experiences of maternity care. This is despite the implementation of NICE guidelines to improve care for women with complex social factors. This article reports on a phenomenological study undertaken in West Yorkshire, aiming to explore the maternity care experiences of local pregnant asylum seeking women, to inform service development. Six women were interviewed over a three-month period. The findings focused more broadly on their experiences of living in the UK whilst being an asylum seeker and pregnant rather than focusing on maternity care, although this was included. Five key themes emerged: ‘pre-booking challenges’, ‘inappropriate accommodation’, ‘being pregnant and dispersed’, ‘being alone and pregnant’ and ‘not being asked or listened to’. These findings could be used as the basis for training midwives to understand how the difficulties women experience can impact on their health and social needs

Evaluating the impact of befriending for pregnant asylum seeking and refugee women

NoPregnant asylum-seeking and refugee women are a particularly vulnerable group in society, who may be possibly living alone in poverty in inappropriate accommodation (Dunne, 2007) and experiencing hostile attitudes (Hynes and sale, 2010). They may have poor physical and mental health, placing them at an increased risk of poor pregnancy outcomes (National Institute for Health and Care Excellence (NICE), 2010). Despite this, they are less likely to attend for timely maternity care. This article discusses the evaluation to date of an ongoing befriending project located in Northern england, targeting pregnant asylum-seeking and refugee women and helping to address difficulties that they may face. Volunteer befrienders, who themselves are asylum-seeking and refugee mothers, receive training to provide support and guidance to clients. Preliminary data suggest that befriending has advantages for both client and volunteer: clients appear to develop a trusting relationship with their befriender which facilitates self-confidence and helps overcome social isolation; and the volunteers feel that they are undertaking a worthwhile role and often move onto paid employment. Befriending may be a useful resource for midwives and ultimately improve pregnancy outcomes for asylum-seeking and refugee women

Evaluation study of the suitability of instrumentation to measure ambient NH3 concentrations under field conditions

The uncertainties in emissions of ammonia (NH3) in Europe are large, partially due to the difficulty in monitoring of ambient concentrations due to its sticky nature. In the European Monitoring and Evaluation Program (EMEP) the current recommended guidelines to measure NH3 are by coated annular denuders with offline analysis. This method, however, is no longer used in most European countries and each one has taken a different strategy to monitor atmospheric ammonia due to the increase of commercial NH3 monitoring instrumentation available over the last 20 years. In June 2014, a 3 year project funded under the European Metrology Research Programme, “Metrology for Ammonia in Ambient Air” (MetNH3), started with the aim to develop metrological traceability for the measurement of NH3 in air from primary gas mixtures and instrumental standards to field application. This study presents the results from the field intercomparison (15 instruments) which was held in South East Scotland in August 2016 over an intensively managed grassland. The study compared active sampling methods to a meteorological traceable method which was developed during the project with the aim to produce a series of guidelines for ambient NH3 measurements. Preliminary results highlight both the importance of inlets and management of relative humidity in the measurement of ambient NH3 and of the requirement to carry out frequent intercomparison of NH3 instrumentation. Overall, it would be recommended from this study that a WMO-GAW world centre for NH3 would be established and support integration of standards into both routine and research measurements

Randomized controlled trial and economic evaluation of nurse-led group support for young mothers during pregnancy and the first year postpartum versus usual care

Background Child maltreatment is a significant public health problem. Group Family Nurse Partnership (gFNP) is a new intervention for young, expectant mothers implemented successfully in pilot studies. This study was designed to determine the effectiveness and cost effectiveness of gFNP in reducing risk factors for maltreatment with a potentially vulnerable population. Methods A multi-site randomized controlled parallel-arm trial and prospective economic evaluation was conducted, with allocation via remote randomization (minimization by site, maternal age group) to gFNP or usual care. Participants were expectant mothers aged <20 with at least one live birth, or 20–24 with no live births and with low educational qualifications. Data from maternal interviews at baseline and when infants were two, six and 12 months, and video recording at 12 months, were collected by researchers blind to allocation. Cost information came from weekly logs completed by gFNP family nurses and other service delivery data reported by participants. Primary outcomes measured at 12 months were parenting attitudes (Adult- Adolescent Parenting Index, AAPI-2) and maternal sensitivity (CARE index). The economic evaluation was conducted from a UK NHS and personal social services perspective with cost-effectiveness expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Main analyses were intention to treat with additional complier average causal effects (CACE) analyses. Results Between August 2013 and September 2014, 492 names of potential participants were received of whom 319 were eligible and 166 agreed to take part, 99 randomly assigned to receive gFNP and 67 to usual care. There were no between-arms differences in AAPI-2 total (7·5/10 in both, SE 0.1), difference adjusted for baseline, site and maternal age-group 0·06 (95% CI -0·15 to 0·28, p=0·59) or CARE Index (intervention 4·0 (SE 0·3); control 4·7(SE 0·4); difference adjusted for site and maternal age-group -0·68; 95% CI -1·62 to 0·16, p=0·25) scores. The probability that gFNP is cost-effective based on the QALY measure did not exceed 3%. Conclusions The trial did not support gFNP as a means of reducing the risk of child maltreatment in this population but slow recruitment adversely affected group size and consequently delivery of the intervention

Combined use of bacteriophage K and a novel bacteriophage to reduce Staphylococcus aureus biofilm formation

Biofilms are major causes of impairment of wound healing and patient morbidity. One of the most common and aggressive wound pathogens is Staphylococcus aureus, displaying a large repertoire of virulence factors and commonly reduced susceptibility to antibiotics, such as the spread of methicillin-resistant S. aureus (MRSA). Bacteriophages are obligate parasites of bacteria. They multiply intracellularly and lyse their bacterial host, releasing their progeny. We isolated a novel phage, DRA88, which has a broad host range among S. aureus bacteria. Morphologically, the phage belongs to the Myoviridae family and comprises a large double-stranded DNA (dsDNA) genome of 141,907 bp. DRA88 was mixed with phage K to produce a high-titer mixture that showed strong lytic activity against a wide range of S. aureus isolates, including representatives of the major international MRSA clones and coagulase-negative Staphylococcus. Its efficacy was assessed both in planktonic cultures and when treating established biofilms produced by three different biofilm-producing S. aureus isolates. A significant reduction of biofilm biomass over 48 h of treatment was recorded in all cases. The phage mixture may form the basis of an effective treatment for infections caused by S. aureus biofilms

Sensory enrichment for people living with dementia: increasing the benefits of multisensory environments in dementia care through design

Recent research has investigated the impact of design on providing multisensory experience for people with dementia living in care homes, particularly the quality of multisensory environments (MSEs). This interdisciplinary research evolved from a broad consideration of the role of design in dementia care enhancing the wellbeing of people living with dementia and their carers. Previous research suggests that using MSE in dementia care as a resource for meaningful engagement has beneficial effects and many MSEs have been installed in UK care homes. However, evidence indicates that these spaces often fail to benefit the residents causing staff becoming discouraged and subsequently the room becoming unused. A study investigating the current facilitation of MSE in sixteen UK care homes revealed two key issues: (1) set-up and design of existing MSEs in care environments is, in most cases, not suitable for older people; (2) there is a lack of knowledge and information for care practitioners for facilitating sensory activities and environments. Based on these findings, design criteria improving usability and accessibility for people with dementia were established and user-centred design recommendations developed. As a first step towards closing the knowledge gap amongst healthcare practitioners in providing multisensory experience, initial design guidelines were published as an online resource