Characterizing nutritional phenotypes using experimental nutrigenomics: Is there nutrient-specificity to different types of dietary stress?

The ability to directly measure and monitor poor nutrition in individual animals and ecological communities is hampered by methodological limitations. In this study, we use nutrigenomics to identify nutritional biomarkers in a freshwater zooplankter, Daphnia pulex, a ubiquitous primary consumer in lakes and a sentinel of environmental change. We grew animals in six ecologically relevant nutritional treatments: nutrient replete, low carbon (food), low phosphorus, low nitrogen, low calcium and high Cyanobacteria. We extracted RNA for transcriptome sequencing to identify genes that were nutrient responsive and capable of predicting nutritional status with a high degree of accuracy. We selected a list of 125 candidate genes, which were subsequently pruned to 13 predictive potential biomarkers. Using a nearest-neighbour classification algorithm, we demonstrate that these potential biomarkers are capable of classifying our samples into the correct nutritional group with 100% accuracy. The functional annotation of the selected biomarkers revealed some specific nutritional pathways and supported our hypothesis that animal responses to poor nutrition are nutrient specific and not simply different presentations of slow growth or energy limitation. This is a key step in uncovering the causes and consequences of nutritional limitation in animal consumers and their responses to small- and large-scale changes in biogeochemical cycles.

Practitioner perspectives on the use of selected fear of childbirth screening tools within a clinical context.

Fear of childbirth (FOC), or tokophobia, can influence several medical and obstetric variables, and is a significant predictor of maternal and mental health outcomes and birth experiences. Current practice in the UK does not include initial screening for tokophobia, rather, assessment and support occur under extreme circumstances e.g. maternal requests for caesarean sections or pregnancy termination requests in order to avoid childbirth. Moreover, while there are several candidate outcome measures for FOC, none have been evaluated in terms of their perceived suitability by specialist practitioners within perinatal healthcare pathways. The present study explores the perceived barriers and facilitators reported by health professionals working within the maternity and mental health services for the use of FOC candidate outcome measures. Evaluated measures included the Fear of Birth Scale, the Oxford Worries about Labour Scale, The Wijma Delivery Expectancy Scale, the Slade-Pais Expectations of Childbirth Scale the Tokophobia Severity Scale. The Tokophobia Severity Scale, followed by the Slade-Pais Expectations of Childbirth Scales were the most favourable scales selected for use according to clinicians. The identification of preferred scales and how they can be used in the local maternity system is a step towards the application of these consistently in clinical practice, to aid in the identification and assessment of FOC. The use of the correct tool at each stage of contact with the local maternity system will improve clinician confidence in the identification of FOC and facilitate the efficient implementation of treatment and support through the development of pathways of care.

The Tokophobia Severity Scale (TSS): measurement model, power and sample size considerations.

OBJECTIVE: To examine the measurement model of the Tokophobia Severity Scale and consider issues of statistical power and sample size from the original instrument development study. BACKGROUND: Fear of childbirth (FoC) and tokophobia represents an area of increasing concern within perinatal mental health research and clinical practice. Existing measures of the FoC have been criticised due to either measurement inconsistencies, difficulties in scoring or practical clinical application. Attempting to address these limitations, researchers developed the Tokophobia Severity Scale (TSS). A fundamental assumption underpinning the use of the TSS is unidimensionality, however this assertion may have been based on sub-optimal sample size and approach taken to factor structure determination. METHOD: Parallel analysis (PA), principal components analysis (PCA), exploratory factor analysis (EFA), power analysis and sample size calculation using a reconstruction of the original dataset from published summary data. RESULTS: Following replication of the original PCA, a three-factor model was found to offer a significantly better fit to data than a unidimensional model. Power analysis suggested the original study was underpowered. CONCLUSION: The TSS remains a promising tool but assumptions regarding its measurement model are based on an inadequate sample size. Sample sizes for a sufficiently powered study indicated.

Fear of childbirth measurement: appraisal of the content overlap of four instruments.

OBJECTIVE: To evaluate empirically the degree of content overlap between four self-report measures of fear of childbirth (FoC) identified as 'best in class' by a recent review. BACKGROUND: FoC and tokophobia is an area of increasing clinical concern and has been linked to poor maternal and neonatal outcomes. Clinical pathways have been established to improve care and interventions for FoC however, ambiguity and inconsistency remain regarding the most appropriate assessment measures. METHOD: A multi-rater and consensus content analysis was undertaken to determine the degree of overlap between four 'best in class' measures of FoC/tokophobia. RESULTS: The Slade-Pais expectations of childbirth scale (SPECS) was found to be the preferred measure in terms of symptom overlap of the tools evaluated, however, the overall level of overlap among these measures was weak. CONCLUSION: Limitations inherent to the current battery of preferred measures of FoC suggests both the desirability and urgency to develop a theoretically-grounded, psychometrically robust and accurate FoC assessment measure. Current measures of FoC are not interchangeable.

The complexity of co-limitation: nutrigenomics reveal non-additive interactions of calcium and phosphorus on gene expression in Daphnia pulex.

Many lakes across Canada and northern Europe have experienced declines in ambient phosphorus (P) and calcium (Ca) supply for over 20 years. While these declines might create or exacerbate nutrient limitation in aquatic food webs, our ability to detect and quantify different types of nutrient stress on zooplankton remains rudimentary. Here, we used growth bioassay experiments and whole transcriptome RNAseq, collectively nutrigenomics, to examine the nutritional phenotypes produced by low supplies of P and Ca separately and together in the freshwater zooplankter Daphnia pulex. We found that daphniids in all three nutrient-deficient categories grew slower and differed in their elemental composition. Our RNAseq results show distinct responses in singly limited treatments (Ca or P) and largely a mix of these responses in animals under low Ca and P conditions. Deeper investigation of effect magnitude and gene functional annotations reveals this patchwork of responses to cumulatively represent a co-limited nutritional phenotype. Linear discriminant analysis identified a significant separation between nutritional treatments based upon gene expression patterns with the expression patterns of just five genes needed to predict animal nutritional status with 99% accuracy. These data reveal how nutritional phenotypes are altered by individual and co-limitation of two highly important nutritional elements (Ca and P) and provide evidence that aquatic consumers can respond to limitation by more than one nutrient at a time by differentially altering their metabolism. This use of nutrigenomics demonstrates its potential to address many of the inherent complexities in studying interactions between multiple nutritional stressors in ecology and beyond.

Understanding asexual identity as a means to facilitate culturally competent care: A systematic literature review.

AIMS AND OBJECTIVES: To provide a contemporary overview of asexuality and the implications this has for healthcare practice. BACKGROUND: Individuals belonging to sexual minority groups face many barriers in accessing appropriate health care. The term "sexual minority group" is usually used to refer to lesbian women, gay, bisexual and transgender individuals. Anecdotal and research evidence suggests that those who identify as asexual have similar poor experiences. DESIGN: Systematic review and qualitative analysis. METHODS: This work uses a systematic review and qualitative analysis of the existing interview data from self-identified asexuals, to construct features of the asexual identity. The findings will help practitioners and health professionals develop an understanding of this poorly understood construct. Ultimately this work is aimed at facilitating culturally competent care in the context of asexuality. RESULTS: Qualitative analysis produced three themes, which can be used, not only to frame asexuality in a positive and normalising way, but also to provide greater understanding of asexuality, "romantic differences coupled with sexual indifference," "validation through engagement with asexual communities" and "a diversity of subasexual identities." CONCLUSIONS: Having some understanding of what it means to identify as asexual, and respecting the choices made by asexuals can markedly improve the experiences of those who embrace an asexual identity when engaging with health care. RELEVANCE TO CLINICAL PRACTICE: Anecdotal evidence, taken from one of the largest asexual online forums, suggests that a number of self-identified asexuals choose not to disclose their identity to healthcare professionals through fear of their asexual status being pathologised, problematised or judged. Given that asexuality is a poorly understood concept, this may be due to lack of understanding on behalf of healthcare providers. The review provides health professionals and practitioners working in clinical settings with some insights of the features of an asexual identity to facilitate culturally competent care.

A Home-Start peer support scheme for women with low mood following childbirth.

Perinatal mental health problems vary in impact and severity, and can have long-lasting effects on maternal health and child psychological health and development. The evidence to support the effectiveness of postnatal peer and volunteer support schemes to improve the long-term health of women is mixed, with some studies highlighting positive effects in terms of reducing symptoms of depression. Using data from a peer support scheme designed to support women with low mood following childbirth, this paper provides insight into the initial support needs of women, alongside the challenges of using volunteer and peer support services. This paper provides health visitors and others working in community settings with an understanding of how volunteer befriending services may, or may not work in community settings. The data suggests that Home-Start does have a positive impact on the lives of some women, however more work is required in order to understand which aspects of the Home-Start intervention women find effective and why.

Women's engagement with mobile device applications in pregnancy and childbirth.

Childbearing women are increasingly engaging with social media and technology. The use of apps for pregnancy and childbirth advice is a new approach to maternity provision, and has potential to impact upon midwifery. Apps are ideally placed to provide opportunities for women to access information; however, there are concerns about the quality of mobile app data in relation to evidence based midwifery. This discussion paper presents a general overview of the use of apps as an information resource, and provides a platform for debate about their position in midwifery care.

Middle eastern refugee children and adolescents mental health: A systematic review.

Psychological problems have become a substantial burden on refugee communities, with a considerable impact on refugee children's quality of life and well-being. The available studies reveal growing mental health disorders in refugee children and adolescents, particularly traumas, anxiety, and depression disorders. This review aims to examine empirical evidence relating to the mental health of refugee children and adolescents in the Middle East. Following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic literature review (2010-2020) identified 54 studies about Middle Eastern refugee children and adolescents' mental health. Eighteen studies were excluded based on their lack of relevance to the focus of the review. Of the remaining records, ten reported common mental health disorders, ten reported on Post-traumatic Stress Disorder, three reported the importance of mental health promotion in schools, while the others discussed protective factors. The results highlight a need to understand the mental health support needs of this group, add knowledge to this area of inquiry and provide baseline data regarding Middle Eastern refugee children and adolescents mental health. Differences across research designs were recorded to contextualize the quality of the study results. There is a paucity of studies investigating the causality, prevalence, risk factors, and interventions of non-traumatic-psychiatric disorders as well as the role of teacher in strengthen refugee's mental health. Limited information is available about suicidality and self-harm, protective factors, adversity, adaptation, acculturation, and social demographics in refugee children.

Environmental Stress and the Morphology of Daphnia pulex.

AbstractMorphological variation is sometimes used as an indicator of environmental stress in animals. Here, we assessed how multiple morphological traits covaried in Daphnia pulex exposed to five common forms of environmental stress (high temperature, presence of predator cues, high salinity, low food abundance, and low Ca). We measured animal body length, body width, head width, eyespot diameter, and tail spine length along with mass in animals of five different ages (3, 6, 9, 12, and 15 d). There were strong allometric relationships among all morphological traits in reference animals and strong univariate effects of environmental stress on body mass and body length. We found that environmental stressors altered bivariate relationships between select pairwise combinations of morphological traits, with effects being dependent on animal age. Multivariate analyses further revealed high connectivity among body size-related traits but that eyespot diameter and tail spine length were less tightly associated with body size. Animals exposed to natural lake water with and without supplemental food also varied in morphology, with body size differences being suggestive of starvation and other unknown nutritional deficiencies. Yet our results demonstrate that the scaling of body morphological traits of Daphnia pulex is largely invariant with possible context-dependent plasticity in eye size and tail spine lengths. The strong coordination of traits indicates tight molecular coordination of body size during development despite strong and varied environmental stress.

The impact of maternity training on knowledge, confidence, and empowerment: A mixed method pilot evaluation.

RATIONALE, AIMS, AND OBJECTIVES: Maternity training is a critical global issue. In the United Kingdom (UK), the need for safer care and patient safety is emphasized through NHS policy. Health Education England (HEE) recommends that training should support a culture of continuous learning and improvement, particularly in the area of reducing the rates of stillbirths, neonatal and maternity deaths, and other adverse outcomes, such as intrapartum brain injuries. Training has been shown to play a crucial role in improving quality of care and reducing maternal and perinatal mortality and morbidity. This evaluation was undertaken to determine both the immediate and sustained impact of multiprofessional training in cardiotocograph (CTG) interpretation and community-based simulation training in obstetric emergencies: childbirth emergencies in the community (CEC). The impact was measured in terms of practitioner knowledge, confidence, and empowerment immediately pretraining and posttraining and at 12 weeks following training. METHODS: A longitudinal mixed methods design was used. Attendees to maternity training sessions on cardiotocograph interpretation and management of childbirth emergencies in the community provided the sample. Quantitative data were collected using questionnaires to assess knowledge, confidence, and empowerment. Qualitative data were collected using open-ended questions embedded in the questionnaires. Quantitative data were analysed using within-subject t test to compare differences in the dependent variable measures. Qualitative data analysis was guided by Braun and Clarke (2013) method thematic analysis. RESULTS: The combined qualitative and quantitative results lucidly highlight that training positively impacts upon knowledge, confidence, and empowerment, an impact which is observed across three time points. CONCLUSIONS: Training in CTG and CEC is effective in improving knowledge, confidence, and empowerment across all groups. Furthermore, the provision of training packages in these subject areas facilitates improvements in the longer term.

Women with a BMI ≥ 30kg/m² and their experience of maternity care: A meta ethnographic synthesis.

OBJECTIVE: this paper is a report of a systematic review and meta-ethnography of the experiences of women with body mass index (BMI) ≥ 30kg/m² and their experience of maternity care. METHOD: systematic review methods identified 12 qualitative studies about women's experiences of maternity care when their BMI ≥ 30kg/m². Findings from the identified studies were synthesised into themes, using metaethnography. SYNTHESIS AND FINDINGS: the meta-ethnography produced four key concepts; Initial encounters, Negotiating risk, Missing out and The positive intervention, which represent the experiences of maternity care for women with BMI ≥ 30kg/m² KEY CONCLUSION: many women with BMI ≥ 30kg/m² appear to be dissatisfied with the approaches taken to discuss weight status during maternity encounters. When weight is not addressed during these encounters women appear to be equally dissatisfied. The absence of open and honest discussions about weight, the feeling of being denied of a normal experience, and an over emphasis on the risks imposed upon pregnancy and childbirth by obesity, leave women feeling dissatisfied and disenfranchised. Sensitive care and practical advice about diet and exercise can help women move towards feeling more in control of their weight management.

A Narrative Synthesis of Women's Out-of-Body Experiences During Childbirth.

INTRODUCTION: Some women have a dissociated, out-of-body experience (OBE) during childbirth, which may be described as seeing the body from above or floating above the body. This review examines this phenomenon using narratives from women who have experienced intrapartum OBEs. METHODS: A narrative synthesis of qualitative research was employed to systematically synthesize OBE narratives from existing studies. Strict inclusion and exclusion criteria were applied. The included papers were critiqued by 2 of the authors to determine the appropriateness of the narrative synthesis method, procedural transparency, and soundness of the interpretive approach. RESULTS: Women experiencing OBEs during labor and birth report a disembodied state in the presence of stress or trauma. Three forms of OBEs are described: floating above the scene, remaining close to the scene, or full separation of a body part from the main body. Women had clear recall of OBEs, describing the experience and point of occurrence. Women who reported OBEs had experienced current or previous traumatic childbirth, or trauma in a non-birth situation. OBEs as prosaic experiences were not identified. DISCUSSION: OBEs are part of the lived experience of some women giving birth. The OBEs in this review were trauma related with some women disclosing previous posttraumatic stress disorder (PTSD). It is not evident whether there is a connection between PTSD and OBEs at present, and OBEs may serve as a potential coping mechanism in the presence of trauma. Clinicians should legitimize women's disclosure of OBEs and explore and ascertain their impact, either as a normal coping mechanism or a precursor to perinatal mental illness. Research into the function of OBEs and any relationship to PTSD may assist in early interventions for childbearing women.

The Impact of Antenatal Psychological Group Interventions on Psychological Well-Being: A Systematic Review of the Qualitative and Quantitative Evidence.

Depression, anxiety and stress in the perinatal period can have serious, long-term consequences for women, their babies and their families. Over the last two decades, an increasing number of group interventions with a psychological approach have been developed to improve the psychological well-being of pregnant women. This systematic review examines interventions targeting women with elevated symptoms of, or at risk of developing, perinatal mental health problems, with the aim of understanding the successful and unsuccessful features of these interventions. We systematically searched online databases to retrieve qualitative and quantitative studies on psychological antenatal group interventions. A total number of 19 papers describing 15 studies were identified; these included interventions based on cognitive behavioural therapy, interpersonal therapy and mindfulness. Quantitative findings suggested beneficial effects in some studies, particularly for women with high baseline symptoms. However, overall there is insufficient quantitative evidence to make a general recommendation for antenatal group interventions. Qualitative findings suggest that women and their partners experience these interventions positively in terms of psychological wellbeing and providing reassurance of their 'normality'. This review suggests that there are some benefits to attending group interventions, but further research is required to fully understand their successful and unsuccessful features.

A qualitative evaluation of home-based contraceptive and sexual health care for teenage mothers.

AIM: This paper reports on the findings from a qualitative study exploring the experiences of teenage mothers using a nurse-led, home-based contraceptive service designed to prevent repeat unplanned pregnancies. The aim was to understand if, and how the service was effective in equipping teenage mothers to make informed choices about contraception, thus preventing a second pregnancy. BACKGROUND: Unplanned teenage pregnancy remains a significant focus of health and social policy in the United Kingdom (UK). Despite the long-term pattern of declining conception rates, the UK continues to report higher rates than comparable countries elsewhere in Europe. Current estimates suggest that approximately one fifth of births amongst under 18's are repeat pregnancies (Teenage Pregnancy Independent Advisory Group, 2009). Services that are designed to reduce second unplanned pregnancies are an important element in promoting teenage sexual health. However, there has been no UK research that explores this kind of service and the experiences of service users. METHODS: We conducted a qualitative interview study. From 2013-2014 we interviewed 40 teenage mothers who had engaged with the nurse-led, home-based contraceptive service. FINDINGS: The data demonstrates that the service was effective in preventing repeat pregnancies in a number of cases. Among the aspects of the service which were found to contribute to its effectiveness were privacy, convenience, flexibility, appropriately timed access, the non-judgemental attitude of staff and ongoing support.

Metaethnographic Synthesis of Fathers' Experiences of the Neonatal Intensive Care Unit Environment During Hospitalization of Their Premature Infants.

OBJECTIVE: To synthesize existing qualitative findings about fathers' experiences of the neonatal intensive care unit (NICU) environment. DATA SOURCES: Relevant key terms including preterm, father, and NICU were used to search the databases of CINAHL Plus, Academic Search Premier, MEDLINE, and PsychInfo. STUDY SELECTION: Only primary qualitative studies were included. Studies were excluded that did not focus on the NICU environment. DATA EXTRACTION: Twenty-four studies were included. All authors critically appraised and extracted data relating to fathers' experiences in the NICU using an agreed data extraction form. DATA SYNTHESIS: Findings were synthesized by translating the initial concepts and findings from an identified key paper into the data from the remaining 23 studies. Initially this was done separately by each author followed by further group discussion and synthesis. Emergent themes included Proximity, Parental Autonomy, Vulnerability, Communication and Exclusion, and Isolation. CONCLUSIONS: The needs of fathers to interact and be involved with their infants' care was a prominent factor that enhanced their experiences in the NICU. Staff in the NICU can play a key role in facilitating this interaction through encouragement and reassurance.

The impact of peer support in the context of perinatal mental illness: a meta-ethnography.

OBJECTIVE: this paper is a report of a systematic review and meta-ethnography to explore the impact of peer support in the context of perinatal mental illness (PMI). METHOD: systematic review methods identified five qualitative studies about women's experiences of PMI, and the impact peer support has on their journey towards emotional well-being. Findings from the identified studies were synthesised into themes, using meta-ethnography. SYNTHESIS AND FINDINGS: the meta-ethnography produced four themes; 'Isolation: the role of peer support', 'Seeking validation through peer support', 'The importance of social norms of motherhood', and 'Finding affirmation/a way forward; the impact of peer support'. These themes represent women's experiences of PMI, their encounters with peer support groups within that context, and the impact of such encounters on their mental health status. KEY CONCLUSION: recognising the risk of isolation and having pathways of referral to peer support networks is important, as are practitioners roles in nurturing peer support networks in perinatal care. More research is required to establish the most successful formats/structures of peer support. Practitioners should also recognise their individual and collective professional duty to challenge stereotypical depictions of motherhood wherever they arise, as this 'gold standard' benchmark of good mothering engenders guilt about not being good enough, often leaving women feeling inadequate. IMPLICATIONS FOR PRACTICE: isolation is a key factor in PMI. Practitioners should be instrumental in their acceptance and development of peer support for PMI, ensuring these networks are valued, nurtured and encouraged. This study illustrates the powerful effect of professional and social forces on how new mothers feel about themselves.

The efficacy of lavender oil on perineal trauma: a review of the evidence.

Anecdotal evidence suggests that some women find lavender oil effective at relieving some of the symptoms associated with perineal trauma following childbirth. This paper examines the literature detailing the efficacy of lavender oil in wound care in an attempt to place these findings into the context of perineal trauma. The discussion and findings may assist midwives to proceed in a more informed manner in the absence of scientific evidence to underpin the practice of lavender oil use in the perineal context.