When I can be my whole authentic self, I feel safe and know that I belong: a photovoice study exploring what culturally safe pregnancy care is to Karen women of refugee background in Victoria, Australia.

OBJECTIVES: Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. DESIGN: A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. RESULTS: Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. CONCLUSION: When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background.

Pathways, Contexts, and Voices of Shame and Compassion: A Grounded Theory of the Evolution of Perinatal Suicidality.

There is an urgent need to generate deeper understandings of how suicidality manifests and evolves during pregnancy and the following year. Several perinatal studies have examined the incidence of suicidal thoughts and behaviours and associated social and obstetric risk factors; however, there is very limited research offering insights into women's experiences of suicidality at this time in their lives. This study aimed to generate a theory to explain how suicidality evolves in the perinatal period. A grounded theory design was used with data generated using anonymous online surveys (119 participants) and in-depth interviews (20 participants) with women who received pregnancy care in the past 5 years in Australia. The developed theory holds shame as a core concept. Origins and contexts of shame reflect current epidemiological understandings of risk for perinatal suicide, including experiences of gender-based violence, adverse childhood experiences, and a history of mental health difficulties. When women feel that they are defective, are unworthy of love and belonging, and do not possess what it takes to be a good mother, they can conclude that their family is better off without them. Pathways beyond shame were facilitated by compassionate and rehumanising care from family, friends, and care providers. Findings demonstrate that perinatal suicidality is a complex multidimensional phenomenon, influenced by socio-cultural expectations of motherhood and interpersonal, systemic, and intergenerational experiences of trauma. Increasing the prominence of perinatal suicide prevention within health professional education and practice, and addressing systemic barriers to compassionate health care are critical first steps to addressing perinatal suicide.

Altered Fluorescence of Buccal Cells as a Candidate Biomarker for Areca Nut Chewing.

Background: Betel nut is used by an estimated 600 million people globally and is the 4th most widely used psychoactive substance in the world. Its use has been shown to cause oral and esophageal cancers. Therefore, cessation programs are needed in which an effective biomarker can be employed. Objectives: Buccal cells are highly exposed to the betel nut during its use and are also easy to collect. However, it is unknown if there are significant changes to these cells upon exposure or how long any changes may last as the turnover of buccal cells is relatively fast. We sought to determine if optical changes could be detected on buccal cells after exposure to betel nut and if detected, how long these changes were sustained. Methods: Flow cytometry was employed to determine whether fluorescence intensities differ between buccal cells exposed to betel nut and naïve cells. We further characterized the optical signature of buccal cells exposed to betel nut and other polyphenol-rich substances using lambda scans performed on a laser scanning confocal microscope. Results: We demonstrate that the fluorescence of betel nut exposed cells is greater than that of cells exposed to other optically active compounds such as polyphenol-rich foods. We also demonstrate that the fluorescence spectra of betel nut quid exposed cells are distinct from that of cells exposed to other polyphenol-rich substances. Conclusions: We conclude that detecting the altered fluorescence of buccal cells following exposure to betel nut quid may serve as a candidate biomarker for betel nut quid use.

Peer supporters' experiences on an Australian perinatal mental health helpline.

Perinatal mental health is an important public health issue, and peer support is a potentially important strategy for emotional well-being in the perinatal period. PANDA Perinatal Anxiety & Depression Australia provides support to individuals impacted by perinatal mental health issues via the National Perinatal Anxiety & Depression Helpline. Callers receive peer support from volunteers and counselling from paid professional staff. The views and experiences of PANDA peer support volunteers have not previously been studied. We conducted two focus groups and an online survey to explore the experiences of women providing volunteer peer support on the Helpline. Data collection took place in October and November 2013. Two social theories were used in framing and addressing the study aims and in interpreting our findings: the Empathy-Altruism Hypothesis, and the Helper Therapy Principle. All PANDA volunteers were invited to participate (n = 40). Eight volunteers attended a focus group, and 11 survey responses were received. Descriptive statistics were used to analyse quantitative data. All survey respondents 'strongly agreed' that they felt positive about being part of PANDA. Thematic analysis of data from focus groups and open-ended survey responses identified the following themes: motivated to help others, supported to support callers, helping to make a difference and emotional impacts for volunteers. Respondents described a strong desire to support others experiencing emotional distress as a motivator to volunteer. Although perinatal peer support services are designed to benefit those who receive support, this study suggests volunteers may also experience personal benefits from the role.

Characteristics of women calling the PANDA Perinatal Anxiety & Depression Australia National Helpline: a cross-sectional study.

The PANDA Perinatal Anxiety & Depression Australia National Helpline provides support for people affected by perinatal mental health issues. To describe the characteristics of women contacting the Helpline, specifically callers' health, past history and assessed risk factors. Analysis of routinely collected de-identified data of women making initial calls between July 2010 and October 2013. Five thousand eight hundred eighteen women made an initial call to the Helpline. Most were between 25 and 40 years old (79%) and married/partnered (94%); 52% were having or had their first child; and 23% were pregnant. Over half had no prior mental health diagnosis at the time of their initial call, and 40% were assessed as 'high needs'-experiencing significant bio-psychosocial symptoms, complex situations and/or inadequate care and support. There was a 70% increase in calls to PANDA over the data collection period. Concerns recorded by PANDA staff from the initial risk assessment included inadequate treatment for a mental health condition (31%), women not feeling connected to their baby (31%), low functioning (26%) and general thoughts of suicide (18%). The Helpline experienced a significant increase in demand during the study period, and a substantial proportion of callers had complex mental health needs. PANDA plays a major role in providing support to a large number of women experiencing perinatal mental health problems.

Exploring the views and experiences of callers to the PANDA Post and Antenatal Depression Association Australian National Perinatal Depression Helpline: a cross-sectional survey.

BACKGROUND: Anxiety and depression are common in the perinatal period. Telephone interventions, including telephone peer support and counselling, have been developed to support those experiencing perinatal mental illness. PANDA Post and Antenatal Depression Association provides support to women and men experiencing perinatal mental illness via the Australian National Perinatal Depression Helpline, encompassing both volunteer peer support and professional counselling. This study aimed to explore the experiences of callers to the Helpline. METHODS: A cross-sectional survey design was used. All new callers from 1(st) May to 30(th) September 2013 were invited to participate. The survey, adapted from a previous survey of PANDA callers, included 23 questions using Likert-type scales, demographic and open-ended questions. Thematic network analysis was undertaken for responses to open-ended questions. RESULTS: 124 responses were received (124/405; 30% response). The majority of callers had called the Helpline regarding themselves (90%), with over one third (33%) of all callers seeking crisis support and help. Ninety-nine per cent of respondents 'agreed' or 'strongly agreed' that staff and/or volunteers understood their concerns, and 97% 'agreed' or 'strongly agreed' that overall PANDA had helped them. Callers described the PANDA service as uniquely tailored to the perinatal period, providing accessible, non-judgemental understanding and support, with a global theme from open-ended comments describing PANDA as 'a safe space to be heard and receive support without judgement'. Recommendations for service changes included increased hours of availability. CONCLUSIONS: Callers reported positive experiences of accessing support from the PANDA National Perinatal Depression Helpline. The Helpline was described as an accessible and acceptable telephone support for individuals experiencing perinatal mental illness. Recommendations for changes to the service included an increase in hours of operation to enable greater responsiveness at times of need, reduced waiting times, and access to continuity with the same volunteer and/or telephone counsellor. The findings of the study will be useful in informing future service provision, review, and implementation.

The BLEED pilot study: determining the usability of a medical device before the clinical trial.

AIM: To discuss the methods of a study which will aim to determine the usability of a medical device not yet approved for use in a clinical trial. BACKGROUND: The Blood Loss Estimation and Evaluation of Drape (BLEED) pilot aims to determine the usability of a drape which measures blood loss during third stage labour. Third stage blood loss is usually estimated visually. This method has been found to be inaccurate. The drape has been tested in developing countries overseas and has been found to more accurately measure third stage blood loss when compared with visual methods. The usability of the drape has not yet been evaluated. REVIEW METHODS: Before starting the BLEED pilot study, the risks to the participants were evaluated and the drape was determined to pose minimal risk of harm for participants. The pilot study will involve recruitment of women and health professionals who will use the drape to measure third stage blood loss and then complete a survey about their opinion of the drape's usability. The data will be used to determine the suitability of using the drape in a clinical trial. DISCUSSION: The benefits of pursing this programme of research outweigh the challenges. The drape has been validated as more accurate than visual estimation for evaluating blood loss during third stage labour, yet the usability has not been established and a clinical trial is needed. This programme of research will determine if routine use of this drape in research and practice is justified. CONCLUSION: This work will assist health professionals who are considering ways to improve clinical outcomes and will particularly inform researchers who are interested in piloting new devices in maternity care. While adherence to monitoring requirements and governance of clinical trials is essential, the system has become complicated for investigator-initiated research using devices. Despite these challenges, the authors of this paper believe that this research programme is justified. IMPLICATIONS FOR PRACTICE: The complexity of navigating documentation and governance required for clinical trials may deter some healthcare professionals who plan to initiate research that involves the use of a medical device. While adherence to monitoring requirements and governance of clinical research is essential, research involving the evaluation of emerging medical technologies can be complicated, particularly for an investigator-initiated (clinician) researcher who does not have the support of a biotech company. These issues may deter clinician researchers from initiating trials and impede their ability to implement clinical research. Despite the challenges, the effectiveness and safety of technologies must be evaluated for their effectiveness in improving clinical outcomes for patients.

No one asked us: Understanding the lived experiences of midwives providing care in the north west suburbs of Melbourne during the COVID-19 pandemic: An interpretive phenomenology.

PROBLEM: Within the Victorian healthcare system, a rapid response to the COVID-19 pandemic has necessitated frequent and ongoing changes to midwifery practice. BACKGROUND: Midwives are a vital workforce at risk of burnout, attrition, and trauma. Emotional consequences of the pandemic for midwives remain largely unknown. AIM: To understand the lived experiences of midwives providing care in the north west suburbs of Melbourne, Victoria during the pandemic. METHODS: Purposive and snowball sampling facilitated the recruitment of eight midwives in the north west suburbs of Melbourne, Victoria. Semi-structured interviews were audio recorded and transcribed, occurring via telephone or video between September and October 2020. Interpretive phenomenology was the methodology used, informed by the writings of Heidegger and Gadamer. FINDINGS: Insights gleaned from the data embody a range of understandings. The unknown cost of change and adaptation; waves of the virus; balancing risk; telehealth; personal protective equipment; stripping away support; the privilege of abiding by the restrictions; separation, distress, uncertainty; and, professional strength. DISCUSSION: Experiences of midwives during the pandemic are characterised by sensations of voicelessness and professional invisibility. Distinctive differences in personal wellbeing and professional satisfaction exist between midwives working with and without continuity of care. CONCLUSION: This paper voices the lived experiences of Victorian midwives, in the midst of an extended lockdown, during the COVID-19 pandemic. Knowledge obtained from this research provides important understandings for leaders, policymakers, and healthcare systems, in planning a long-term response to the pandemic that supports the wellbeing and longevity of a vital workforce.

Having a Say in Research Directions: The Role of Community Researchers in Participatory Research with Communities of Refugee and Migrant Background.

Research teams in high-income countries often fail to acknowledge the capacity and contributions of Community Researchers. This qualitative exploratory study used decolonising methodology and the Foundation House 'Refugee Recovery Framework' to understand Community Researchers' perceptions and experiences of their role, and how research teams can integrate the knowledge they bring into research. Purposive sampling was used to facilitate the recruitment of eight Community Researchers from five different community groups working in Melbourne, Victoria. Semi-structured interviews lasting forty to sixty minutes occurred between December 2020 and January 2021. Data were analysed using reflexive thematic analysis. Findings reported in this paper include eight themes: 'nothing about us without us'; 'open the door'; a safe space to share; every step of the way; this does not translate; finding the right way to ask; a trauma-informed approach; and support within the workplace. The knowledge obtained demonstrates that Community Researchers facilitate meaningful participation in research for women, families, and communities of refugee or migrant background. Community Researchers' presence, knowledge, and skills are vital in establishing culturally safe research practices and developing accessible language to facilitate conversations about sensitive research topics across multiple languages. Community Researchers can make important contributions at all stages of research, including data collection and interpretation.

Group Pregnancy Care for refugee background women: a codesigned, multimethod evaluation protocol applying a community engagement framework and an interrupted time series design.

INTRODUCTION: Pregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework. METHODS AND ANALYSIS: The evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation. ETHICS AND DISSEMINATION: Ethics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.

'I need help': Reasons new and re-engaging callers contact the PANDA-Perinatal Anxiety and Depression Australia National Helpline.

In Australia, the PANDA-Perinatal Anxiety & Depression Australia National Helpline (the Helpline) offers support to callers impacted by emotional health challenges in the perinatal period. Callers receive counselling from professional staff and peer support from volunteers. An understanding of factors that contribute to callers' experiences of emotional distress, as well as potential barriers and facilitators to help-seeking, can be used to inform future service design and delivery. A caller intake form is completed by Helpline staff when an individual contacts the service for the first time, or re-engages after a period of non-contact. We analysed all intake forms of individuals calling about their own emotional wellbeing from the middle month of each season in 2014: January, April, July, and October. Content analysis was undertaken, focusing on caller profile, patterns of help-seeking, and reasons for caller engagement. Of the 365 calls, the majority were from women (n = 358, 98%) who were pregnant (n = 59, 16%) or had a child ≤12 months of age (n = 241, 75%). Many were seeking support regarding depression (n = 186, 51%) or anxiety (n = 162, 44%), with a number seeking help for both (n = 71, 20%). Almost a third were identified as being 'at risk', including a number who were experiencing thoughts of suicide or self-harm. Complex interrelating factors contributed to callers' emotional distress, including: stressful life events; pregnancy, birthing and parenting experiences; social isolation; and histories of mental health difficulties. Significant numbers of parents experience emotional health challenges in the perinatal period, but many do not receive adequate treatment. Complex factors contribute to callers' distress, highlighting the need for health professionals to undertake thorough psychosocial assessments during the perinatal period so those that need additional support are identified, and appropriate care provided. Telephone Helplines like PANDAs assist overcoming barriers to care and provide specialised perinatal mental health support to families.

Areca alkaloids measured from buccal cells using DART-MS serve as accurate biomarkers for areca nut chewing.

BACKGROUND: Areca nut (AN) chewing is carcinogenic and biomarkers reflecting it are urgently needed to determine the effectiveness of emergent cessation programs. Buccal cells (BCs) may serve as an ideal matrix to measure such biomarkers; however, their utility for this purpose is unknown. Direct analysis in real time-mass spectrometry (DART-MS) is a sensitive technique that analyzes materials in the open air and requires minimal/no sample preparation. We utilized DART-MS to analyze BCs to test the usefulness of this method in measuring areca alkaloids as biomarkers for AN chewing. METHODS: We applied DART-MS in positive-ion mode to quantitate over time human BCs: (a) exposed ex vivo to betel quid extracts (BQE) consisting of young AN, Piper betle L. leaf, slaked lime, and tobacco; and (b) obtained from seven chewers before and after BQ chewing. Quantification was performed by normalizing DART-MS alkaloid signal intensities to cholesterol intensities. RESULTS: Signals for areca alkaloids arecoline and arecaidine-guvacoline were detected in BCs exposed ex vivo to BQE up to 7 days (the last day tested) after exposure and in BCs from chewers up to 3 days (the last day tested) post chewing. DISCUSSION: The presence of alkaloid signals in BQ-exposed BCs verified BCs as a valid matrix and DART-MS as a suitable technique to measure biomarkers for AN chewing and provided reliable information on AN chewing timing. CONCLUSION: DART-MS analyses of BCs can be used to accurately determine areca alkaloids as AN chewing biomarkers up to 3 days post chewing and possibly longer.

Evaluating a standardised clinical assessment tool for pre-registration midwifery students: A cross-sectional survey of midwifery students and midwives in Australia.

BACKGROUND: Assessment of clinical competence is a core component of midwifery education. Clinical assessment tools have been developed to help increase consistency and overcome subjectivity of assessment. AIM: The study had two main aims. The first was to explore midwifery students and educators/clinical midwives' views and experiences of a common clinical assessment tool used for all preregistration midwifery programmes in Victoria and the University of South Australia. The second was to assess the need for changes to the tool to align with developments in clinical practice and evidence-based care. METHODS: A cross-sectional, web-based survey including Likert-type scales and open-ended questions was utilised. SETTING: Students enrolled in all four entry pathways to midwifery at seven Victorian and one South Australian university and educators/clinical midwives across both states. FINDINGS: One hundred and ninety-one midwifery students' and 86 educators/clinical midwives responded. Overall, students and educators/clinical midwives were positive about the Clinical Assessment Tool with over 90% reporting that it covered the necessary midwifery skills. Students and educators/clinical midwives reported high levels of satisfaction with the content of the learning tools. Only 4% of educators/clinical midwives and 6% of students rated the Clinical Assessment Tool as poor overall. Changes to some learning tools were necessary in order to reflect recent practice and evidence. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A common clinical assessment tool for evaluating midwifery students' clinical practice may facilitate the provision of consistent, reliable and objective assessment of student skills and competency.

Extreme UV-A sensitivity of the filamentous gliding bacterium Vitreoscilla stercoraria.

Strains of the filamentous gliding bacterium Vitreoscilla, LB13 and C1, are shown to be highly sensitive to UV-A (320-400 nm), with an LD50 of less than 20 kJ m(-2). Vitreoscilla LB13 can be protected from UV-A by including superoxide dismutase and catalase, separately or in combination, during the exposure, indicating an involvement of reactive oxygen species. LB13A, a photo-insensitive strain derived from LB13, is described.