Exploring the implementation of an educational film within antenatal care to reduce the risk of cytomegalovirus infection in pregnancy: A qualitative study.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neuro-disability in childhood. In the absence of a licensed vaccine, adoption of hygiene-based measures may reduce the risk of CMV infection in pregnancy, however these measures are not routinely discussed with pregnant women as part of National Health Service (NHS) antenatal care in the United Kingdom (UK). METHODS: An exploratory qualitative study was conducted, underpinned by Normalization Process Theory (NPT), to investigate how an educational intervention comprising of a short film about CMV may best be implemented, sustained, and enhanced in real-world routine antenatal care settings. Video, semi-structured interviews were conducted with participants who were recruited using a purposive sample that comprised of midwives providing antenatal care from three NHS hospitals (n = 15) and participants from professional colleges and from organisations or charities providing, or with an interest in, antenatal education or health information in the UK (n = 15). FINDINGS: Midwives were reluctant to include CMV as part of early pregnancy discussions about reducing the risk of other infections due to lack of time, knowledge and absence of guidance or policies relating to CMV in antenatal education. However, the educational intervention was perceived to be a useful tool to encourage conversations and empower women to manage risk by all stakeholders, which would overcome some identified barriers. Macro-level challenges such as screening policies and lack of official guidelines to legitimise dissemination were identified. DISCUSSION: Successful implementation of education about CMV as part of routine NHS care in the UK will require an increase in awareness and knowledge about CMV amongst midwives. NPT revealed that 'coherence' and 'cognitive participation' between service members are vital to imbed CMV education in routine practice. 'Collective action' and 'reflexive monitoring' is required to sustain service changes.

Willingness of the UK public to volunteer for testing in relation to the COVID-19 pandemic.

BACKGROUND: The World Health Organization declared the rapid spread of COVID-19 around the world to be a global public health emergency. The spread of the disease is influenced by people's willingness to adopt preventative public health behaviours, such as participation in testing programmes, and risk perception can be an important determinant of engagement in such behaviours. METHODS: In this study, we present the first assessment during the first wave of the pandemic and the early stages of the first UK lockdown in April & May 2020 of how the UK public (N = 778) perceived the usefulness of testing for coronavirus and the factors that influence a person's willingness to test for coronavirus. RESULTS: None of the key demographic characteristics (age, gender, education, disability, vulnerability status, or professional expertise) were significantly related to the respondents' willingness to be tested for coronavirus. However, closely following the news media was positively related to willingness to be tested. Knowledge and perceptions about coronavirus significantly predicted willingness to test, with three significantly contributing factors: worry about the health and social impacts to self and family; personal susceptibility; and concerns about the impacts of coronavirus on specific demographic groups. Views on testing for coronavirus predicted willingness to test, with the most influential factors being importance of testing by need; negative views about widespread testing; and mistrust in doctor's advice about testing. CONCLUSIONS: Implications for effective risk communication and localised public health approaches to encouraging public to put themselves forward for testing are discussed. We strongly advocate for effective communications and localised intervention by public health authorities, using media outlets to ensure that members of the public get tested for SARs-CoV2 when required.

Changing knowledge, attitudes and behaviours towards cytomegalovirus in pregnancy through film-based antenatal education: a feasibility randomised controlled trial of a digital educational intervention.

BACKGROUND: Congenital cytomegalovirus (CMV) is the most common congenital infection globally, however information about CMV is not routinely included in antenatal education in the United Kingdom. This feasibility study aimed to gather the essential data needed to design and power a large randomised controlled trial (RCT) to investigate the efficacy of a digital intervention in reducing the risk of CMV acquisition in pregnancy. In order to do this, we carried out a single-centre RCT, which explored the knowledge, attitudes and risk reduction behaviours in women in the intervention and treatment as usual groups, pre- and post-intervention. METHODS: CMV seronegative women living with a child less than four years old, receiving antenatal care at a single UK tertiary centre, were randomised to the digital intervention or 'treatment as usual' groups. Participants completed questionnaires before the digital intervention and after and at 34 gestational weeks, and responses within groups and between groups were compared using tailored randomisation tests. CMV serology was tested in the first trimester and at the end of pregnancy. RESULTS: Of the 878 women screened, 865 samples were analysed with 43% (n = 372) being CMV seronegative and therefore eligible to take part in the RCT; of these, 103 (27.7%) women were enrolled and 87 (84%) of these completed the study. Most participants (n = 66; 64%) were unfamiliar with CMV at enrolment, however at 34 gestational weeks, women in the intervention group (n = 51) were more knowledgeable about CMV compared to the treatment as usual group (n = 52) and reported engaging in activities that may increase the risk of CMV transmission less frequently. The digital intervention was highly acceptable to pregnant women. Overall, four participants seroconverted over the course of the study: two from each study group. CONCLUSIONS: A large multi-centre RCT investigating the efficacy of a CMV digital intervention is feasible in the United Kingdom; this study has generated essential data upon which to power such a study. This single-centre feasibility RCT demonstrates that a digital educational intervention is associated with increase in knowledge about CMV and can result in behaviour change which may reduce the risk of CMV acquisition in pregnancy. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03511274 , Registered 27.04.18, http://www.Clinicaltrials.gov.

Inhibition of tumor necrosis factor improves sleep continuity in patients with treatment resistant depression and high inflammation.

Blockade of the inflammatory cytokine tumor necrosis factor (TNF) in depressed patients with increased inflammation has been associated with decreased depressive symptoms. Nevertheless, the impact of TNF blockade on sleep in depressed patients has not been examined. Accordingly, sleep parameters were measured using polysomnography in 36 patients with treatment resistant major depression at baseline and 2weeks after 3 infusions (week 8) of either the TNF antagonist infliximab (n=19) or placebo (n=17). Markers of inflammation including c-reactive protein (CRP) and TNF and its soluble receptors were also assessed along with depression measured by the 17-item Hamilton Depression Rating Scale. No differences in sleep parameters were found as a function of infliximab treatment over time. Nevertheless, wake after sleep onset (WASO), the spontaneous arousal index and sleep period time significantly decreased, and sleep efficiency significantly increased, from baseline to week 8 in infliximab-treated patients with high (CRP>5mg/L) (n=9) versus low inflammation (CRP⩽5mg/L) (n=10), controlling for changes in scores of depression. Stage 2 sleep also significantly decreased in infliximab-treated patients with high versus low inflammation. Decreases in soluble TNF receptor 1 (sTNFR1) significantly correlated with decreases in WASO and increases in sleep efficiency in infliximab-treated subjects with high inflammation. Placebo-treated subjects exhibited no sleep changes as a function of inflammation, and no correlations between inflammatory markers and sleep parameters in placebo-treated patients were found. These data suggest that inhibition of inflammation may be a viable strategy to improve sleep alterations in patients with depression and other disorders associated with increased inflammation.

A Qualitative Insight Into Factors Pertaining to Alcohol Consumption Among Young Adult Women During the COVID-19 Outbreak.

Emerging research suggests young adults, in particular women, may be especially sensitive to changes associated with the COVID-19 outbreak. This study, which is part of an ongoing research project focusing on young adulthood and substance use during the UK COVID-19 lockdown, aimed to provide an in-depth snapshot of factors that young adult women may describe as influential in their alcohol consumption during this period. Virtual semi-structured interviews were carried out on a sample of 12 (23-25 years) women between April and May 2020. The data were analysed through thematic analysis and preliminary findings led to the identification of three themes: (1) Changes to working environment, (2) Limitations on social opportunities and efforts to socialise in a 'new normal', and (3) Effects of cohabitation on increased alcohol consumption. The preliminary findings of this study highlight factors relevant to changes in alcohol use during the COVID-19 outbreak in the UK.

Experiences of pregnant women and healthcare professionals of participating in a digital antenatal CMV education intervention.

OBJECTIVE: The study aimed to explore the perspectives of participating pregnant women and Health Care Professionals (HCPs) towards receiving and providing cytomegalovirus (CMV) education so that barriers and facilitators towards incorporating CMV in routine antenatal care could be better understood. DESIGN: This process evaluation phase employed a qualitative design using individual, semi-structured, face-to-face interviews. SETTING: Recruitment and interviews took place within a large teaching hospital from an ethnically diverse area of South-west London PARTICIPANTS: The study sample included 20 participants: 15 pregnant women, and five HCPs. All participants were involved in a single centre randomized controlled trial of a digital CMV educational intervention in pregnancy. FINDINGS: Pregnant participants expressed a strong desire to receive information about CMV as part of routine antenatal care. Although HCPs were accepting of the need for CMV education, it was evident that they felt unequipped to provide this; reasons included lack of time, uncertainty about clinical pathways and concern about the potential emotive impact of CMV education. Pregnant women suggested that expressing behaviour changes as risk reduction rather than prevention, made the behaviours feel more achievable and realistic. The support of partners was considered a key factor in the successful adoption of behavioural changes by pregnant women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: There is an onus on HCPs to consider how CMV can be included as part of antenatal education, with messaging framed as risk reducing rather than prevention.