How did UK social distancing restrictions affect the lives of women experiencing intimate partner violence during the COVID-19 pandemic? A qualitative exploration of survivor views.

BACKGROUND: Increased numbers of domestic abuse cases were reported at the start of the COVID-19 pandemic. Many people experiencing abuse faced barriers to seeking support with service closures affecting the sector. Available evidence suggests women are overrepresented in the reported cases of intimate partner violence (IPV) and we aimed to learn more about how their lives were impacted by social distancing restrictions. METHODS: We conducted an online qualitative interview study, using reflexive thematic analysis. Interviews were conducted between April 2021 and March 2022. 18 women in the UK with past experiences of IPV provided informed consent and participated in this study. RESULTS: During the analysis, we identified five themes relating to the impact of lockdown restrictions on participants' lives, including: (1) Lockdown meant being confined to a place where abuse was escalating, (2) Barriers to accessing support, including "cancelled" services and missed opportunities to intervene during interactions in lockdown with frontline workers. (3) Increased feelings of fear, isolation, and loss of control, particularly during the early stages of the pandemic from the combination of abuse and pandemic-related changes to daily life. (4) Some forms of support were more accessible during the pandemic, such as provision of online psychological support and social groups. Participants also accessed new forms of support for the first time during the pandemic, in some cases sparked by posts and content on social media about abuse awareness. (5) For some, psychosocial wellbeing transformed during the pandemic, with several participants using the word "freedom" when reflecting on their experience of simultaneously escaping abuse and living through the COVID-19 pandemic. CONCLUSIONS: In this study, we explored the views of female survivors of IPV in the UK during the COVID-19 pandemic. Our results highlight the importance of combined public awareness campaigns and community intervention points for victims to safely seek help during social distancing restrictions. Having the time and space to reflect on healing after escaping abuse was described by women in our study as a benefit from their lives in lockdown, which is a factor that could be incorporated into future initiatives developed to support people subjected to violence and abuse.

Factors affecting the mental health of pregnant women using UK maternity services during the COVID-19 pandemic: a qualitative interview study.

BACKGROUND: People using maternity services in the United Kingdom (UK) have faced significant changes brought on by the COVID-19 pandemic and social distancing regulations. We focused on the experiences of pregnant women using UK maternity services during the pandemic and the impact of social distancing rules on their mental health and wellbeing. METHODS: We conducted 23 qualitative semi-structured interviews from June 2020 to August 2021, with women from across the UK who experienced a pregnancy during the pandemic. Nineteen participants in the study carried their pregnancy to term and four had experienced a miscarriage during the pandemic. Interviews took place remotely over video or telephone call, discussing topics such as mental health during pregnancy and use of UK maternity services. We used reflexive thematic analysis to analyse interview transcripts. RESULTS: We generated six higher order themes: [1] Some pregnancy discomforts alleviated by social distancing measures, [2] The importance of relationships that support coping and adjustment, [3] Missed pregnancy and parenthood experiences, [4] The mental health consequences of birth partner and visitor restrictions, [5] Maternity services under pressure, and [6] Lack of connection with staff. Many participants felt a sense of loss over a pregnancy experience that differed so remarkably to what they had expected because of the pandemic. Supportive relationships were important to help cope with pregnancy and pandemic-related changes; but feelings of isolation were compounded for some participants because opportunities to build social connections through face-to-face parent groups were unavailable. Participants also described feeling alone due to restrictions on their partners being present when accessing UK maternity services. CONCLUSIONS: Our findings highlight some of the changes that may have affected pregnant women's mental health during the COVID-19 pandemic. Reduced social support and being unable to have a partner or support person present during maternity service use were the greatest concerns reported by participants in this study. Absence of birth partners removed a protective buffer in times of uncertainty and distress. This suggests that the availability of a birth partner or support person must be prioritised wherever possible in times of pandemics to protect the mental health of people experiencing pregnancy and miscarriage.

A qualitative study about the mental health and wellbeing of older adults in the UK during the COVID-19 pandemic.

OBJECTIVES: The objective of this study was to examine factors that threatened and protected the wellbeing of older adults living in the UK during social distancing restrictions due to the COVID-19 pandemic. METHODS: Semi-structured telephone or video interviews with 20 adults aged over 70. Purposive sampling methods were used to increase diversity within the group. Transcripts were analysed using reflexive thematic analysis. RESULTS: Participants described potential threats to their wellbeing during the pandemic, including fears for mortality, grieving normal life, and concerns for the future. Participants also described activities and behaviours that helped to protect their mental health, including adopting a slower pace of life, maintaining routine, socialising, and using past coping skills. Many participants drew on their resilience and life experience to self-manage fear and uncertainty associated with the pandemic, using their time during lockdown to reflect or organise end-of-life affairs. DISCUSSION: This study provides UK-based evidence that while some older adults experienced challenges during the first wave of COVID-19, many were resilient throughout social distancing restrictions despite early reported concerns of mental health consequences among the older adult population. Our findings highlight the importance of maintaining access to essentials to promote feelings of normality and use of social support to help reduce uncertainty in times of pandemics.

The impact of the COVID-19 pandemic on mental health and well-being of people living with a long-term physical health condition: a qualitative study.

BACKGROUND: The COVID-19 pandemic and associated restrictions caused major global disruption. Individuals with long-term physical health conditions (LTCs) are at higher risk of severe illness and often subject to the strictest pandemic guidance, so may be disproportionally affected. The aim of this study was to qualitatively explore how living with a LTC during the COVID-19 pandemic affected people's mental health and wellbeing. METHODS: Participants were people living with LTCs who participated in telephone/video call interviews based on a semi-structured topic guide. Key themes and subthemes were determined using deductive and inductive thematic analysis. RESULTS: The sample included 32 participants with LTCs (most commonly cancer, respiratory conditions or cardiovascular diseases), mean age 57 (SD 13) years, 66% female and 72% white British. There were four overarching themes specific to living with a LTC. These were 1) high levels of fear and anxiety related to perceived consequences of catching COVID-19, 2) impact of shielding/isolation on mental health and wellbeing, 3) experience of healthcare during the pandemic and 4) anxiety created by uncertainty about the future. Fourteen subthemes were identified, including concerns about accessing essential supplies and the importance of social support. Individuals who lived alone and were advised to shield could be profoundly negatively affected. CONCLUSIONS: This study found that there were a number of aspects of living with a LTC during the pandemic that had a significant impact on mental health and well-being. There should be focus on how best to provide practical and social support to people with LTCs during a pandemic, particularly if they have to shield or isolate.

Sensitivity to emotion, empathy and theory of mind: adult performance following childhood TBI.

PRIMARY OBJECTIVE: To examine deficits in emotion perception for adults who had experienced a traumatic brain injury (TBI) during childhood and investigate relationships between emotion perception skills, empathy and Theory of Mind (ToM). DESIGN: Participants consisted of a random selection of individuals (n = 52) who had previously been recruited for a larger study. All participants had experienced an injury event as a child (0-17 years) (mild TBI, moderate/severe TBI or fractured limb) and were now aged between 18-30 years, with a minimum of 5 years post-injury. METHODS AND PROCEDURE: Each participant completed an emotion-sensitivity task, facial expression recognition task, the faux pas test (ToM) and the Interpersonal Reactivity Inventory (IRI: Empathy). MAIN OUTCOMES: Individuals with moderate/severe TBI were less sensitive to emotion and less accurate at facial expression recognition than those with mild TBI and orthopaedic controls. Difficulty with affective ToM but not empathy was also found. The emotion-sensitivity and the facial expression recognition tasks were unrelated, with only emotion sensitivity but not expression recognition related to ToM and IRI empathy. CONCLUSIONS: The current findings indicated that deficits in social skills are long lasting and raises the issue of whether intervention to improve sensitivity to genuine emotion can influence more complex social skills and improve quality of social interactions for individuals following TBI.

Public knowledge of 'concussion' and the different terminology used to communicate about mild traumatic brain injury (MTBI).

PRIMARY OBJECTIVE: The primary objective was to investigate the public's general knowledge about concussion (mild traumatic brain injury) and to examine whether terminology influenced attributions made about individuals who experience concussion. DESIGN: A random selection of the community was polled to identify public understanding of concussion. To encourage candid responses, a self-report survey method was used. METHODS AND PROCEDURES: One hundred and three members of the general public were asked to indicate if they associated specific attributes with brain injury or head injury, depending on the randomly assigned questionnaire they completed. Participants also completed a questionnaire about their knowledge of concussion and were asked to indicate whether they or someone they knew had experienced an injury to the head. MAIN OUTCOMES AND RESULTS: Participants incorrectly evaluated 20% (2/10) of statements regarding concussion knowledge and were relatively uncertain about another 20% (2/10) of statements. Negative attributes were associated more with brain than head injury, although those with prior experience made more positive attributions than those without. Fifty-nine per cent of participants who had experienced a concussion stated they had no brain/head injury. CONCLUSIONS: Overall, public knowledge about concussion and different terminology associated with this injury type is substantially inaccurate. More accurate information is required to increase understanding.

Community attitudes toward individuals with traumatic brain injury.

Explicit and implicit attitudes toward people who have sustained traumatic brain injury (TBI) were investigated to determine if negative attitudes exist and if the terminology used (brain vs. head injury) exacerbated predicted negativity. Participants (n = 103) rated Tony (brain/head injury) and Peter (limb-injury) on 10 characteristics using a 7-point scale. Familiarity with brain injury was also measured. Implicit Association Tests (IAT) assessed potential negative bias. Tony (M = 36.84) was judged more negatively than Peter (M = 31.69). The term "brain" versus "head" injury resulted in more negative evaluations (Ms = 38.72 vs. 34.78). Participants familiar with TBI were more positive toward Tony than those unfamiliar (Ms = 34.98 vs. 39.80). Only those unfamiliar with TBI demonstrated implicit negative bias. Negative attitudes toward TBI are expressed explicitly with individuals openly endorsing less desirable characteristics. When people have more knowledge about or experience with brain injury, they are less likely to endorse negative stereotypes.

An investigation of the pre-injury risk factors associated with children who experience traumatic brain injury.

BACKGROUND AND OBJECTIVE: Traumatic brain injury (TBI) is a frequently occurring event in childhood that may have significant ongoing effects. Little is known about the child and family characteristics that predispose children to these injuries. A greater understanding of the risk factors associated with childhood TBI may provide an opportunity to prevent their occurrence. METHODS: Information provided by a large birth cohort study (n=1265) was used to determine the child and family risk factors of TBI in children aged 0-15 years (n=187). All information regarding child, family, and injury events were collected prospectively and unrelated to the injury event itself. Child variables included in the analysis were sex and the level of behavioural problems. Parental variables included were family socioeconomic status, mother's age, education level, depressive symptoms, number of adverse life events experienced by the family, and parenting style. RESULTS: The most important risk factors were sex, adverse life events, and parenting style. The results suggest evidence of modest increases in the rate of TBI for those in the highest risk categories (male, >or=4 life events per annum, high maternal punitiveness) compared to the lowest risk categories, with hazard ratios in the region of 1.4-1.6. CONCLUSIONS: Overall characteristics of both the family and child predicted a TBI event. An increased understanding of risks associated with TBI in childhood will provide an avenue to prevent these injuries by targeting at-risk families and aiding the development of appropriate intervention strategies.

Long-term behavioural outcomes of pre-school mild traumatic brain injury.

Abstract Background Mild traumatic brain injury (MTBI) is a leading cause of injury for children during their pre-school years. However, there is little information regarding the long-term outcomes of these injuries. Method We used fully prospective data from an epidemiological study of a birth cohort to examine behavioural effects associated with MTBI during the pre-school years. Cases of confirmed MTBI were divided into two groups, those that had received outpatient medical attention, and those that had been admitted to hospital for a brief period of observation (inpatient cases). The remainder of the cohort served as a reference control group. Results Mother/teacher ratings for behaviours associated with attention deficit/hyperactivity disorder and oppositional defiant/conduct disorder, obtained yearly from age 7 to 13, revealed evidence of deficits after inpatient MTBI (n = 21), relative to more minor outpatient injury MTBI (n = 55) and the reference control group (n = 852). For the inpatient group there was evidence of increasing deficits over years 7-13. Conclusions More severe pre-school MTBI may be associated with persistent negative effects in terms of psychosocial development. The vulnerability of pre-school children to MTBI signals a pressing need to identify high-risk cases that may benefit from monitoring and early intervention.

Cognitive characteristics associated with mild cognitive impairment in Parkinson's disease.

BACKGROUND: Cognitive deficits are common in Parkinson's disease (PD), but the range of deficits is variable. The aim of this study was to identify different cognitive subgroups associated with PD. METHODS: A broad range of neuropsychological measures and cognitive domains were used in a cluster analysis to identify subgroups of patients. RESULTS: Three subgroups of patients were identified. Compared to controls, one PD subgroup showed no or minimal cognitive impairment (PD-NCI), a second group showed a variable or uncertain pattern of mild to severe cognitive impairments (PD-UCI), and a third group had evidence of severe cognitive impairment across most cognitive domains (mild cognitive impairment; PD-MCI). The subgroups did not differ with regard to age, motor impairment, or disease duration. CONCLUSIONS: Patients with PD are heterogeneous with regard to cognitive presentation and it may be possible to identify patients in the preclinical stage of dementia. The identification of preclinical dementia in PD patients (PD-MCI) provides an opportunity to understand cognitive decline in PD and its progression to dementia.

Change in life roles and quality of life for older adults after traumatic brain injury.

BACKGROUND: Traumatic Brain Injury (TBI) is a major health problem for adults aged 50-65 years. Mild/moderate TBI in older adults has implications for the workforce and the individual's quality of life (QOL). OBJECTIVE: To compare changes in life roles, QOL, daily activity performance, perceptions of support available and rehabilitative experiences among older adults with predominantly mTBI and orthopaedic injury (OI). METHODS: The study included 15 individuals with TBI (13 mild, 2 moderate) and 15 with OI (50-65 years), with injuries sustained more than 6 months prior to. A semi-structured interview retrieved background information, and satisfaction with life roles and daily activities. The World Health Organisation Quality of Life Questionnaire - 100 Version was used to examine QOL, and The Role Checklist was administered to assessed change in life roles. RESULTS: Independent samples t-tests revealed older adults with mTBI experienced more role losses, had lower QOL, and were less satisfied with daily activity performance than those with OI. Regression analysis revealed mTBI significantly predicts QOL (except physical domain) when controlling for gender, age at injury and time since injury. CONCLUSIONS: Findings demonstrate the detrimental impact of predominantly mild TBI on older adults' life roles and QOL, and highlights need for services that adequately support older adults who have experienced mTBI, so they can return to their pre-injury life roles and maintain QOL.

Planning in Parkinson's disease: a matter of problem structure?

Although the Tower of London (TOL) has been extensively used to assess planning ability in patients with Parkinson's disease (PD), the reported presence or extent of any planning deficits has been inconsistent. This may partly be due to the heterogeneity of the TOL tasks used and a failure to consider how structural problem parameters may affect task complexity. In the present study, planning in PD patients was assessed by systematically manipulating TOL problem structure. Results clearly disprove the identity assumption of problems with an equal number of minimum moves. Instead, substantial parts of planning performance were related to more subtle aspects of problem structure, such as subgoaling patterns and goal hierarchy. Planning in PD patients was not impaired in general but was affected when the information provided by the problem states was ambiguous in terms of the sequential order of subgoals, but not by increases in search depth.

A profile of neuropsychiatric problems and their relationship to quality of life for Parkinson's disease patients without dementia.

Neuropsychiatric problems are common in Parkinson's disease (PD) but there is little information regarding how they impact on quality of life. PD patients without dementia (49) were assessed for low mood/depression, fatigue, apathy, sleep problems and hallucinations. Measures of quality of life and motor function were also obtained. Over 77% of the patients reported symptoms consistent with one or more neuropsychiatric problems. Low mood/depression, anxiety and the presence of hallucinations predicted poorer quality of life after controlling for motor symptoms. Additional to the motor symptoms, we found that specific neuropsychiatric problems may impact on quality of life for PD patients.

Preinjury characteristics of children with mild traumatic brain injury: Is "other injury" an appropriate comparison group"?

BACKGROUND: Mild traumatic brain injury (mTBI) has been associated with ongoing problems in children and young people. However, there remains to be considerable debate regarding whether outcomes are a result of brain impairment, or simply reflect preinjury characteristics of the child or family. To reliably assess outcomes, an appropriate control group is required. AIMS: This study aimed to identify the preinjury characteristics of children with mTBI, and to examine whether an "other injury to the head" group is an appropriate comparison to control for preinjury characteristics of children with mTBI. METHOD: Parents of 290 children admitted to the emergency department with either a diagnosis of mTBI (n = 186, M = 6.44 years) or a superficial injury to the head (SIH) (n = 104, M = 5.40 years) were assessed. Parents completed three questionnaires examining behavioral problems (Clinical Assessment of Behavior), parental stress (Parenting Stress Index), and background variables (e.g., medical issues, socioeconomic factors). RESULTS: A series of chi-square analyses and multivariate analysis of variance tests revealed no differences for behavior, parental stress, and other preexisting problems between children with mTBI and those with SIH. CONCLUSIONS: Children who experience a mTBI event present similarly to individuals with a SIH, and SIH is an appropriate comparison group to examine the outcomes of childhood mTBI, as it may help minimize any confounding effects of preexisting issues associated with mTBI.

Assessing the sensitivity and specificity of cognitive screening measures for people with Parkinson's disease.

INTRODUCTION: While cognitive impairment is a recognised feature of Parkinson's disease (PD), few studies have evaluated the validity of brief cognitive screening measures compared to a comprehensive neuropsychological assessment. This studies aim was to evaluate the sensitivity and specificity of the Mini-Mental State Examination (MMSE), Modified Mini-Mental State Examination and Dementia Rating Scale (DRS-2) to detect cognitive impairment in individuals with PD. METHOD: Fifty-eight participants were administered the MMSE, 3MS, DRS-2 and a neuropsychological battery. ROC analyses were conducted to assess their effectiveness in classifying cognitive impairment. RESULTS: None of the three measures demonstrated good sensitivity or specificity to detect single domain cognitive impairment. For detecting impairment on two or more cognitive domains, the MMSE and DRS-2 yielded excellent sensitivity (88%) and specificity (78% and 76% respectively), at cut-off scores of 28 and 136 respectively. The 3MS demonstrated excellent sensitivity (88%) and good specificity (60%) at cut off score of 94. CONCLUSION: The MMSE and DRS-2 have excellent discriminant ability to classify multi-domain cognitive impairment in PD, however, their ability to detect more focal cognitive impairment is limited. Given that focal domain may be an indicator that could be useful in early detection of cognitive impairment for people with PD, this finding has implication for the use of these measures as screening tools in clinical practice.

Detection of Echinococcus granulosus coproantigens in faeces from naturally infected rural domestic dogs in south eastern Australia.

OBJECTIVE: To investigate the occurrence of Echinococcus granulosus in rural domestic dogs in farming areas around Yass, New South Wales, and Mansfield and Whitfield, Victoria. DESIGN: Faeces were collected per-rectally from farm dogs voluntarily presented by their owners in four farming districts in New South Wales and two in Victoria. PROCEDURE: Faeces were collected in the field, an extract prepared from each sample and E granulosus coproantigens detected in an ELISA. Farmers were also questioned about their dog feeding and worming practices. RESULTS: Echinococcus granulosus coproantigens were detected in 99 of 344 dogs (29%) from 95 farms in south eastern New South Wales and 38 of 217 dogs (17.5%) from 43 farms in Victoria. Cross-reactions between E granulosus coproantigen trapping antibody and coproantigens in faeces from dogs monospecifically infected with other species of intestinal helminthes (Taenia ovis, T hydatigena, T pisiformis, Spirometra ericacei, Dipylidium caninum, hookworm, Toxocara canis, Trichuris vulpis) were not evident. Dietary and worming data revealed many owners fed raw meat and occasionally offal from domestic livestock and wildlife to their dogs and few owners wormed their dogs frequently enough to preclude the chance of patent E granulosus being present in their dogs. CONCLUSION: Echinococcus granulosus occurs commonly in rural dogs in south eastern Australia and an education program promoting the public health importance of responsible management of rural dogs is urgently needed.

Developing a condition-specific measure of health for patients with dyspepsia and ulcer-related symptoms.

A patient-administered instrument for dyspepsia and symptoms suggestive of duodenal or gastric ulcer, based on the type of questions asked when taking a patient's history, was developed and tested using the following steps: literature reviews, devising the questions, testing the responses to the questions using factor analysis and internal consistency, assessing test-retest reliability, and validating the questionnaire by comparing patient responses to the SF-36 health survey questionnaire. The main sample consisted of 135 patients referred to an outpatient clinic with dyspepsia, and 152 patients in general practice who were not referred to a specialist. The final instrument produced a Cronbach's alpha of 0.72 and an intraclass correlation coefficient of 0.69. Patient scores on the dyspepsia questionnaire had small to moderate correlations with the SF-36 health survey, the largest correlation being with the SF-36 scale of pain. Patient scores were significantly related to general practitioner perceptions of symptom severity, family history of gastric ulcer disease, and whether the patient was referred. The questions asked in taking a clinical history from a patient with dyspepsia and other symptoms suggestive of ulcer disease can be used to construct a valid and reliable measure of the effect of dyspepsia on health.

Opsonic requirements of Helicobacter pylori.

The opsonic requirements of Helicobacter pylori were investigated in a series of experiments with human polymorphonuclear leucocytes (PMNL). Pre-incubation of H. pylori with pooled normal human serum (NHS) in concentrations of 5-20% significantly increased the uptake of radiolabelled bacteria by PMNL. Treatment of the bacteria with NHS 30% caused the release of radiolabel and this effect was abolished by heating serum to 56 degrees C, suggesting that H. pylori is serum-sensitive and that complement is involved. Opsonisation of H. pylori with NHS concentrations of 10-30% significantly increased PMNL chemiluminescence. Removal of specific antibody had no effect. Removal of either the classical or alternative complement pathways produced no significant change in PMNL chemiluminescence, indicating that either pathway is sufficient for opsonisation on its own. The results confirm that complement is the most efficient opsonin for H. pylori.

The UVB content of 'UVA fluorescent lamps' and its erythemal effectiveness in human skin.

The UVB emission from ten different types of 'UVA fluorescent lamp' has been measured by spectroradiometry. The mean ratio of UVB emission to UVA emission was found to be 0.94 +/- 0.35 (1 SD)%. By weighting the spectral irradiance of each lamp by the DIN standard erythemal curve, the mean erythemally effective UVB emission (normalised to 297 nm), expressed as a percentage of the UVA emission, was 0.076 +/- 0.049 (1 SD)%.