Evaluation of the East Lothian Tutoring Initiative (ELTI)

The East Lothian Tutoring Initiative (ELTI) was developed in rapid response to growing concerns about the widening achievement gap amongst pupils from disadvantaged backgrounds, who had been disproportionately disadvantaged as a result of COVID-related school lockdowns and associated interruptions to their learning. The initiative was informed by evidence that tutoring can substantially improve learning outcomes for children from disadvantaged backgrounds and can help to close "the poverty-related attainment gap"

Between empathy and anger: healthcare workers’ perspectives on patient disengagement from antiretroviral treatment in Khayelitsha, South Africa - a qualitative study

Background & objectives: The benefits of long-term adherence to antiretroviral therapy (ART) are countered by interruptions in care or disengagement from care. Healthcare workers (HCWs) play an important role in patient engagement and negative or authoritarian attitudes can drive patients to disengage. However, little is known about HCWs’ perspectives on disengagement. We explored HCWs’ perspectives on ART disengagement in Khayelitsha, a peri-urban area in South Africa with a high HIV burden. Method: Semi-structured interviews were conducted with 30 HCWs in a primary care HIV clinic to explore their perspectives of patients who disengage from ART. HCWs interviewed included clinical (doctors and nurses) and support staff (counsellors, social workers, data clerks, security guards, and occupational therapists). The interview guide asked HCWs about their experience working with patients who interrupt treatment and return to care. Transcripts were audio-recorded, transcribed, and analysed using an inductive thematic analysis approach. Results: Most participants were knowledgeable about the complexities of disengagement and barriers to sustaining engagement with ART, raising their concerns that disengagement poses a significant public health problem. Participants expressed empathy for patients who interrupted treatment, particularly when the challenges that led to their disengagement were considered reasonable by the HCWs. However, many also expressed feelings of anger and frustration towards these patients, partly because they reported an increase in workload as a result. Some staff, mainly those taking chronic medication themselves, perceived patients who disengage from ART as not taking adequate responsibility for their own health. Conclusion: Lifelong engagement with HIV care is influenced by many factors including disclosure, family support, and HCW interactions. Findings from this study show that HCWs had contradictory feelings towards disengaged patients, experiencing both empathy and anger. Understanding this could contribute to the development of more nuanced interventions to support staff and encourage true person-centred care, to improve patient outcomes

Empowering stroke survivors beyond inpatient rehabilitation: the STRIDE program

Objective The timeframe from hospital discharge to the commencement of outpatient therapies represents a crucial yet often overlooked period in post-stroke recovery. We designed an eight-week post-stroke management program (STRIDE, Stroke Management Training and Inpatient Rehabilitation Discharge Education) targeting individuals discharging from an inpatient rehabilitation facility to home. The primary aims of this pilot study were to determine STRIDE feasibility and participant engagement. Methods Participants with first or recurrent stroke were enrolled. Each week, participants monitored and recorded their daily activity, completed a 15-min educational module and quiz, and partook in weekly and biweekly communication with a fellow participant and STRIDE coordinator, respectively. Feasibility was evaluated by successful initiation of STRIDE and enrollment of the target population. We also assessed participant adherence and conducted semi-structured exit interviews. Results Of the 99 individuals screened, 20 individuals were enrolled (7 females, 28.6 ± 15.7 days post-stroke). Several participants were unable to begin the program (n = 6) or complete the program (n = 4). Overall, participants completing at least 1 week of STRIDE (n = 14) demonstrated adherence with education module and quiz completion and communication with the STRIDE coordinator. Participant feedback from interviews was largely positive, underscoring the value of STRIDE during early post-stroke recovery. Conclusions These findings support the feasibility of an initiated multi-faceted stroke management program. Participant dropout was a limitation and serves as a consideration when designing future iterations of STRIDE. With the long-term goal of promoting autonomy and investment in one's continued recovery beyond the inpatient setting, STRIDE bridges the transition from hospital to home

Empowering stroke survivors beyond inpatient rehabilitation: the STRIDE program

ObjectiveThe timeframe from hospital discharge to the commencement of outpatient therapies represents a crucial yet often overlooked period in post-stroke recovery. We designed an eight-week post-stroke management program (STRIDE, Stroke Management Training and Inpatient Rehabilitation Discharge Education) targeting individuals discharging from an inpatient rehabilitation facility to home. The primary aims of this pilot study were to determine STRIDE feasibility and participant engagement.MethodsParticipants with first or recurrent stroke were enrolled. Each week, participants monitored and recorded their daily activity, completed a 15-min educational module and quiz, and partook in weekly and biweekly communication with a fellow participant and STRIDE coordinator, respectively. Feasibility was evaluated by successful initiation of STRIDE and enrollment of the target population. We also assessed participant adherence and conducted semi-structured exit interviews.ResultsOf the 99 individuals screened, 20 individuals were enrolled (7 females, 28.6 ± 15.7 days post-stroke). Several participants were unable to begin the program (n = 6) or complete the program (n = 4). Overall, participants completing at least 1 week of STRIDE (n = 14) demonstrated adherence with education module and quiz completion and communication with the STRIDE coordinator. Participant feedback from interviews was largely positive, underscoring the value of STRIDE during early post-stroke recovery.ConclusionsThese findings support the feasibility of an initiated multi-faceted stroke management program. Participant dropout was a limitation and serves as a consideration when designing future iterations of STRIDE. With the long-term goal of promoting autonomy and investment in one's continued recovery beyond the inpatient setting, STRIDE bridges the transition from hospital to home

Care in subsequent pregnancies following stillbirth: An international survey of parents

Objective: To assess the frequency of additional care, and parents' perceptions of quality, respectful care in pregnancies subsequent to stillbirth. Design: Multi-language web-based survey. Setting: International. Population: 2,716 parents, from 40 high- and middle-income countries. Methods: Data were obtained from a broader survey of parentsâ experiences of stillbirth. Data were analyzed using descriptive statistics and stratified by geographical region. Subgroup analyses explored variation in additional care by gestational age at index stillbirth. Main outcome measures: Frequency of additional care, and perceptions of quality, respectful care. Results: The majority (66%) of parents conceived their subsequent pregnancy within one year of stillbirth. Additional antenatal care visits and ultrasound scans were provided for 67% and 70% of all parents, respectively, although there was wide variation across geographical regions. Care addressing psychosocial needs was less frequently provided, such as visits to a bereavement counsellor (10%) and access to named care provider's phone number (27%). Compared to parents whose stillbirth occurred at 29 weeks' gestation or less, parents whose stillbirth occurred at 30 weeksâ gestation or greater were more likely to receive various forms of additional care, particularly the option for early delivery after 37 weeks. Around half (47-63%) of all parents felt that elements of quality, respectful care were consistently applied, such as spending enough time with parents and involving parents in decision-making. Conclusions: Care in pregnancies subsequent to stillbirth appears inconsistent. Greater attention is required to providing thoughtful, empathic, and collaborative care in all pregnancies following stillbirth. Training for health professionals is needed

Stillbirths: recall to action in high-income countries.

Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.Mater Research Institute – The University of Queensland provided infrastructure and funding for the research team to enable this work to be undertaken. The Canadian Research Chair in Psychosocial Family Health provided funding for revision of the translation of the French web-based survey of care providers.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/S0140-6736(15)01020-

Re: Impact of holding the baby following stillbirth on maternal mental health and well-being: findings from a national survey. BMJ Open 2016;6(8):e010996

Response to 'Impact of holding the baby following stillbirth on maternal mental health and well-being: findings from a national survey' BMJ Open 2016, 6(8), e010996 (9pp). doi: 10.1136/bmjopen-2015-010996. Response available at: https://bmjopen.bmj.com/content/6/8/e010996.responses (Accessed: 19 January 2023)Dear Editor: We were interested in the recent article by Redshaw et al. which reported higher rates of mental health and relationship difficulties among women who held their stillborn baby.1 We agree this is an important topic, but after reviewing the article in depth, we would like to raise several concerns. (1) We note that this was a retrospective survey with a 30.2% response rate in which just 3% of women did not see and 16% did not hold their baby; these limitations were acknowledged but we believe they also restrict the ability to draw broad conclusions. (2) There was little exploration into the reasons why women did not hold their babies and if they had any regrets about their decisions. While four out of five women reported they did not hold because they could not or did not want to, the study did not account for the fact that women who declined may be fundamentally different at baseline, so that mental health outcomes may be due to underlying differences in mothers rather than their choices or experiences at birth. (3) While the authors emphasize that holding was associated with a trend toward worse mental health outcomes, their actual multivariable analyses show that at 9 months, the only statistically significant difference was higher odds of anxiety. Pre-existing anxiety could contribute to a woman's hesitance to hold the baby after delivery and separately serves as a predictor of postpartum mental health. (4) Even though there are many validated, widely-tested measures to assess postpartum depression,2-5 anxiety,6 and PTSD,7, 8 in both live birth and bereaved mothers, this study used non-validated self-report measures which leads to the need for very cautious interpretation of the results. (5) The factors which have been demonstrated to be strong predictors of postpartum depression and PTSD include prior mental health conditions, interpersonal violence, and lack of social support.9-12 This study did not measure or control for any of these factors. (6) Another issue not addressed in this article is the well-acknowledged preference by parents to be given the option to see or hold their baby and strong evidence that the majority of women are satisfied with their decision.10, 13 Events surrounding the birth of a stillborn baby can have lasting impact on how a mother experiences, remembers, and copes with this event.14 The decision to see or hold a stillborn baby warrants additional investigation, but research must adjust for the known confounders which have been shown to predict development of mental health problems. Moreover, there should be recognition that the experience of a mother at the time of delivery is complex, and multiple pre-existing and intrapartum factors may affect subsequent outcomes and grief. In summary, we believe it is not possible to reach a conclusion from this study about whether the decision to see or hold a stillborn baby is detrimental or helpful to bereaved parents and urge research to gain a more nuanced understanding of the factors which contribute to parental experiences at the time of delivery and which may influence long-term mental health outcomes. We strongly urge health care providers to continue to offer women the option to hold their stillborn baby, and to make this offer in a respectful, supportive, and normative manner