Challenges of a Pregnancy Gone Wrong: Pregnancy Complications, Illness Perceptions and Distress

Women with pregnancy complications need to cope with a pregnancy that can have life changing consequences. The objective of this research project was to understand the experience of women who had been diagnosed with a pregnancy complication. The research involved an exploratory investigation into illness perceptions of pregnant women with complications and how these relate to depression and anxiety. First a literature review was divided into two parts. The first part dealt with anxiety specific to pregnancy complications. The second part dealt with illness perceptions. Since no published literature on illness perceptions in pregnancy complications was found, a literature review was conducted into illness perceptions in hypertension, diabetes and pain which are all closely associated to pregnancy complications. The research was divided into two studies. The first was a mixed method study in which six women were interviewed regarding their experience in dealing with a pregnancy complication and a pilot was conducted using the Illness Perception Questionnaire (Revised). The second study consisted of an online survey further exploring the relationship between illness perceptions and distress in this population. Recruitment for participation proved very difficult and there were only thirty-six participants who complete the full online study. This survey comprised of a battery of self-report questionnaires including background information, rating of health scale, the Illness Perception Questionnaire (Brief), Edinburgh Postnatal Depression Scale and State Trait Anxiety Inventory Scale (State). Results from both studies indicated that women in experienced significantly higher degrees of distress and anxiety than those in normal populations. They perceived their pregnancy complications as being outside of their personal control and they don’t see treatment as likely to be effective in controlling their medical condition. They also perceived their pregnancy complication as having high consequences in their lives and they are concerned about the impact of the pregnancy complication has on themselves and on their child. The women who did not have detectable symptoms (asymptomatic) and who could not directly experience cues to their illness were significantly more depressed. This research adds to the international findings on illness perceptions in general and is a starting point for understanding illness perceptions for women with pregnancy complications. The psychological needs of women with pregnancy complications are significant, and are often under-rated and under-evaluated by treatment providers. Understanding illness perceptions of this population can provide a framework for the development of further interventions for this vulnerable population

Targeted disruption of the heat shock protein 20–phosphodiesterase 4D (PDE4D) interaction protects against pathological cardiac remodelling in a mouse model of hypertrophy

Phosphorylated heat shock protein 20 (HSP20) is cardioprotective. Using human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and a mouse model of pressure overload mediated hypertrophy, we show that peptide disruption of the HSP20–phosphodiesterase 4D (PDE4D) complex results in attenuation of action potential prolongation and protection against adverse cardiac remodelling. The later was evidenced by improved contractility, decreased heart weight to body weight ratio, and reduced interstitial and perivascular fibrosis. This study demonstrates that disruption of the specific HSP20–PDE4D interaction leads to attenuation of pathological cardiac remodelling

An investment case analysis for the prevention and treatment of adolescent mental disorders and suicide in England

BackgroundAdolescent mental health (AMH) needs in England have increased dramatically and needs exceed treatment availability. This study undertook a comparative assessment of the health and economic return on investment (ROI) of interventions to prevent and treat mental disorders among adolescents (10–19 years) and examined intervention affordability and readiness.MethodsInterventions were identified following a review of published and grey literature. A Markov model followed a simulated adolescent cohort to estimate implementation costs and health, education, and economic benefits. Intervention affordability was assessed, comparing annual cost per adolescent with NHS England per capita spending, and an expert panel assessed intervention readiness using a validated framework.ResultsOver 10- and 80-year horizons, interventions to treat mild anxiety and mild depression were most cost-effective, with the highest individual lifetime ROI (GBP 5822 GBP 1 and GBP 257: GBP 1). Preventing anxiety and depression was most affordable and ‘implementation ready’ and offered the highest health and economic benefits. A priority package (anxiety and depression prevention; mild anxiety and mild depression treatment) would avert 5 million disability-adjusted life-years (DALYS) and achieve an ROI of GBP 15: GBP 1 over 10 years or 11.5 million DALYs (ROI of GBP 55: GBP 1) over 80 years.ConclusionThe economic benefits from preventing and treating common adolescent mental disorders equivalent to 25% of NHS England’s annual spending in 2021 over 10 years and 91% over 80 years. Preventing and early treatment for anxiety and depression had the highest ROIs and strong implementation readiness.<br/

The Coloured Drawing of the Dulle Griet in the Kunstpalast, Düsseldorf : New Findings on its Status and Dating

editorial reviewedThe Düsseldorf coloured drawing of the Dulle Griet was examined at the Royal Institute for Cultural Heritage (KIK-IRPA) in Brussels in collaboration with the Kunstpalast, Düsseldorf, using infrared reflectography, infrared photography, transmitted light photography, macro-XRF and micro-Raman spectroscopy. The study of the paper revealed the watermark of Niklaus Heusler, a Basel paper manufacturer, giving 1578 as the earliest possible execution date for the drawing, and thus confirming its status as a copy. Examination and analysis of the colours suggest that they are most likely original. Various hypotheses are proposed as to the drawing’s original function, attribution and context, taking into account the early history of Bruegel’s Dulle Griet. Thanks to its early dating, the drawing is a key witness to the appearance of the Dulle Griet painting at an early stage in its history, and as such it provided fundamental help during the conservation campaign. Certain colours and motifs that have altered over time in the painting remain more legible in the drawing

Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania

Background: Every year, more than a million of the world’s newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities – for example, improving steps to help newborns breathe at birth – have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation. Methods: Cross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care. Results: Index scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities. Conclusions: Within two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania

Effectiveness of the capsaicin 8% patch in the management of peripheral neuropathic pain in European clinical practice: the ASCEND study

Background In randomised studies, the capsaicin 8% patch has demonstrated effective pain relief in patients with peripheral neuropathic pain (PNP) arising from different aetiologies. Methods ASCEND was an open-label, non-interventional study of patients with non-diabetes-related PNP who received capsaicin 8% patch treatment, according to usual clinical practice, and were followed for ≤52 weeks. Co-primary endpoints were percentage change in the mean numeric pain rating scale (NPRS) ‘average daily pain’ score from baseline to the average of Weeks 2 and 8 following first treatment; and median time from first to second treatment. The primary analysis was intended to assess analgesic equivalence between post-herpetic neuralgia (PHN) and other PNP aetiologies. Health-related quality of life (HRQoL, using EQ-5D), Patient Global Impression of Change (PGIC) and tolerability were also assessed. Results Following first application, patients experienced a 26.6% (95% CI: 23.6, 29.62; n = 412) reduction in mean NPRS score from baseline to Weeks 2 and 8. Equivalence was demonstrated between PHN and the neuropathic back pain, post-operative and post-traumatic neuropathic pain and ‘other’ PNP aetiology subgroups. The median time from first to second treatment was 191 days (95% CI: 147, 235; n = 181). Forty-four percent of all patients were responders (≥30% reduction in NPRS score from baseline to Weeks 2 and 8) following first treatment, and 86.9% (n = 159/183) remained so at Week 12. A sustained pain response was observed until Week 52, with a 37.0% (95% CI: 31.3, 42.7; n = 176) reduction in mean NPRS score from baseline. Patients with the shortest duration of pain (0–0.72 years) experienced the highest pain response from baseline to Weeks 2 and 8. Mean EQ-5D index score improved by 0.199 utils (responders: 0.292 utils) from baseline to Week 2 and was maintained until Week 52. Most patients reported improvements in PGIC at Week 2 and at all follow-up assessments regardless of number of treatments received. Adverse events were primarily mild or moderate reversible application site reactions. Conclusion In European clinical practice, the capsaicin 8% patch provided effective and sustained pain relief, substantially improved HRQoL, improved overall health status and was generally well tolerated in a heterogeneous PNP population

Analysis of dose using CBCT and synthetic CT during head and neck radiotherapy: A single centre feasibility study

Objectives: The study aimed to assess the suitability of deformable image registration (DIR) software to generate synthetic CT (sCT) scans for dose verification during radiotherapy to the head and neck. Planning and synthetic CT dose volume histograms were compared to evaluate dosimetric changes during the treatment course. Methods: Eligible patients had locally advanced (stage III, IVa and IVb) oropharyngeal cancer treated with primary radiotherapy. Weekly CBCT images were acquired post treatment at fractions 1, 6, 11, 16, 21 and 26 over a 30 fraction treatment course. Each CBCT was deformed with the planning CT to generate a sCT which was used to calculate the dose at that point in the treatment. A repeat planning CT2 was acquired at fraction 16 and deformed with the fraction 16 CBCT to compare differences between the calculations mid-treatment. Results: 20 patients were evaluated generating 138 synthetic CT sets. The single fraction mean dose to PTV_HR between the synthetic and planning CT did not vary, although dose to 95% of PTV_HR was smaller at week 6 compared to planning (difference 2.0%, 95% CI (0.8 to 3.1), p = 0.0). There was no statistically significant difference in PRV_brainstem or PRV_spinal cord maximum dose, although greater variation using the sCT calculations was reported. The mean dose to structures based on the fraction 16 sCT and CT2 scans were similar. Conclusions: Synthetic CT provides comparable dose calculations to those of a repeat planning CT; however the limitations of DIR must be understood before it is applied within the clinical setting