Work-related post-traumatic stress symptoms in obstetricians and gynaecologists: findings from INDIGO, a mixed-methods study with a cross-sectional survey and in-depth interviews.

OBJECTIVES: To explore obstetricians' and gynaecologists' experiences of work-related traumatic events, to measure the prevalence and predictors of post-traumatic stress disorder (PTSD), any impacts on personal and professional lives, and any support needs. DESIGN: Mixed methods: cross-sectional survey and in-depth interviews. SAMPLE AND SETTING: Fellows, members and trainees of the Royal College of Obstetricians and Gynaecologists (RCOG). METHODS: A survey was sent to 6300 fellows, members and trainees of RCOG. 1095 people responded. Then 43 in-depth interviews with trauma-exposed participants were completed and analysed by template analysis. MAIN OUTCOME MEASURES: Exposure to traumatic work-related events and PTSD, personal and professional impacts, and whether there was any need for support. Interviews explored the impact of trauma, what helped or hindered psychological recovery, and any assistance wanted. RESULTS: Two-thirds reported exposure to traumatic work-related events. Of these, 18% of both consultants and trainees reported clinically significant PTSD symptoms. Staff of black or minority ethnicity were at increased risk of PTSD. Clinically significant PTSD symptoms were associated with lower job satisfaction, emotional exhaustion and depersonalisation. Organisational impacts included sick leave, and 'seriously considering leaving the profession'. 91% wanted a system of care. The culture in obstetrics and gynaecology was identified as a barrier to trauma support. A strategy to manage the impact of work-place trauma is proposed. CONCLUSIONS: Exposure to work-related trauma is a feature of the experience of obstetricians and gynaecologists. Some will suffer PTSD with high personal, professional and organisational impacts. A system of care is needed. TWEETABLE ABSTRACT: 18% of obstetrics and gynaecology doctors experience post-traumatic stress disorder after traumatic events at work.

Identifying fear of childbirth in a UK population: qualitative examination of the clarity and acceptability of existing measurement tools in a small UK sample.

BACKGROUND: Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research. METHODS: Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale - fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item. RESULTS: All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC. CONCLUSIONS: Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population.

Establishing a valid construct of fear of childbirth: findings from in-depth interviews with women and midwives.

BACKGROUND: Fear of childbirth (FOC) can have a negative impact on a woman's psychological wellbeing during pregnancy and her experience of birth. It has also been associated with adverse obstetric outcomes and postpartum mental health difficulties. However the FOC construct is itself poorly defined. This study aimed to systematically identify the key elements of FOC as reported by women themselves. METHODS: Semi-structured interviews with pregnant women (n = 10) who reported to be fearful of childbirth and telephone interviews with consultant midwives (n = 13) who regularly work with women who are fearful of childbirth were conducted. Interviews were analysed using thematic analysis for each group independently to provide two sources of information. Findings were reviewed in conjunction with a third source, a recently published meta-synthesis of existing literature of women's own accounts of FOC. The key elements of FOC were determined via presence in two out of the three sources at least one of which was from women themselves, i.e. the reports of the women interviewed or the meta-synthesis. RESULTS: Seven themes were identified by the women and the consultant midwives: Fear of not knowing and not being able to plan for the unpredictable, Fear of harm or stress to the baby, Fear of inability to cope with the pain, Fear of harm to self in labour and postnatally, Fear of being 'done to', Fear of not having a voice in decision making and Fear of being abandoned and alone. One further theme was generated by the women and supported by the reports included the meta-synthesis: Fear about my body's ability to give birth. Two further themes were generated by the consultant midwives and were present also in the meta-synthesis: Fear of internal loss of control and Terrified of birth and not knowing why. CONCLUSIONS: Ten key elements in women's FOC were identified. These can now be used to inform development of measurement tools with verified content validity to identify women experiencing FOC, to support timely access to support during pregnancy.

Attributions, criticism and warmth in mothers of children with intellectual disability and challenging behaviour: a pilot study.

BACKGROUND: Associations between parental expressed emotion (EE) or parental attributions and the problem behaviours of children with intellectual disability (ID) have been explored in ID research. However, a more detailed examination of the attributional model of EE has not been reported. In the present study, we partially replicated and extended research focused on mothers of typically developing children with behaviour problems. METHODS: Twenty-seven mothers of children with ID and behaviour problems aged 4-9 years were interviewed about their most problematic behaviours exhibited by their child, and completed a Five Minute Speech Sample. Interview transcripts and speech samples were coded for maternal EE and spontaneous causal attributions regarding the child's behaviour problems. Data were also collected on maternal well-being, and the child's behaviour problems. RESULTS: Mothers typically made attributions that were internal to the child, controllable by the child, personal to the child and stable for the child. Maternal attributions of being able to control the child's behaviour were associated with high maternal criticism and low warmth. Maternal depression was more strongly associated with the child's behaviour problems when mothers were coded as high in criticism or low in warmth. CONCLUSIONS: Patterns of maternal attributions about their child's behaviour problems and their consequences for maternal well-being and maternal-child relationships require more research attention. Implications for practice are discussed, including the potential for maternal attributions to be incompatible with the focus of positive behaviour supports offered to families.

Functional characteristics of N8, a new recombinant FVIII.

The aim of this study was to evaluate the in vitro function of the new recombinant factor VIII (FVIII) compound, N8. The specific activity of N8 as measured in a FVIII:C one-stage clot assay was 9300±400 IU mg(-1) based on the analysis of seven individual batches. The ratio between the FVIII:C activity measured in clot and chromogenic assays was 1.00 (95% confidence interval 0.97-1.03). N8 bound to von Willebrand factor with Kd values of 0.2 nm when measured by ELISA and by surface plasmon resonance. FVIIIa cofactor activity was determined from the kinetic parameters of factor IXa-catalysed factor X (FX) activation. The rate of activation of N8 by thrombin as well as Km and kcat for FX activation was in the same range as those observed for Advate®. The rate of activated protein C (APC)-catalysed inactivation was similar for activated N8 and Advate®. N8 improved thrombin generation in a dose-dependent manner and induced similar rates of thrombin generation as Advate® and the plasma-derived FVIII product Haemate®. Using thromboelastography (TEG®), N8 was shown to improve the clot formation and clot stability in whole blood from haemophilia A patients. Comparable potency and efficacy of N8 and Advate® was found based on TEG® parameters. Finally, similar binding profiles to immobilized lipoprotein receptor-related protein (LRP) of N8 and Advate® were observed. The study demonstrated that N8 is fully functional in a variety of assays measuring FVIII activity. No functional differences were found between N8 and comparator compounds.

[Neonatal mortality and morbidity in gestational age shorter than 30 weeks for babies treated primarily in a central hospital. Follow-up studies of an unselected, consecutive patient group]. / Neonatal mortalitet og morbiditet ved svangerskabslaengde mindre end 30 fulde uger for børn behandlet primaert på et centralsygehus. Efterundersøgelse af en uselekteret, konsekutiv patientgruppe.

AIM: The aim of the study was to investigate the mortality and morbidity of very premature babies treated at a Danish county hospital in the mid-1990s. MATERIALS AND METHOD: The 62 survivors of 70 consecutive babies born in 1993-1997 were given a neuropaediatric follow-up examination at a corrected mean age of 49 (22-69) months. The mean gestational age was 27 (24-29) weeks and the mean birth weight was 1012 (550-1374) g. RESULTS: Eight babies (11%) died within 28 days of birth. Four (6%) had an intracerebral haemorrhage, grade 3-4; four (6%) had retinopathy of prematurity; and three (4%) had bronchopulmonary dysplasia at 36 weeks of gestation. Four of the survivors developed cerebral palsy. Two of these babies and a neurologically normal baby had visual impairments. None developed epilepsy. DISCUSSION: Thus, our babies had a low mortality and only a few complications at long-term follow-up. Early nasal continuous positive airway pressure and early supplementation with a surfactant seem to be essential for these positive results in our most premature babies.

Influence of movements on contaminant transport in an operating room.

UNLABELLED: The influence of persons' movements on contaminant transport during an orthopedic surgical operation is examined. Orthopedic surgical operations require an ultra clean environment usually provided by a LAF device (laminar airflow). During hip replacements bone cement is sometimes applied. Due to practical reasons cement mixing is performed outside the LAF area. During the cement transport from the mixing location to the surgeon there is a potential risk of bacterial transport to the clean zone. This phenomenon is examined by smoke visualization and computational fluid dynamics (CFD). The movements are modeled by CFD using distributed momentum sources as well as a turbulent kinetic energy source. A significant risk of contaminant transport from the less clean zone to the ultra clean zone is found. The results indicate that it is possible to simulate the influence of movements using a relatively simple CFD model that considers the significant influence of a transient phenomenon in an approximate way. PRACTICAL IMPLICATIONS: In real-life ventilated enclosures like operating rooms movements take place. Persons' movements may influence the local flow field as well as the contaminant field substantially. Most often movements are ignored in simulations due to the complexity of the phenomenon. This paper presents an indirect and simple method to consider the influence of movements that may enable modelers to include this important phenomenon in the engineering application of CFD. This may improve practical risk assessment--for instance risk assessment of unintended transport of bacteria during orthopedic surgical operations that may jeopardize the hygiene.

Hospitalized children with chronic illness: parental caregiving needs and valuing parental expertise.

Parents who care for a child with a chronic illness are forced to relinquish much of the control of the child's care when the child is hospitalized. By using the family systems theory as the underlying framework, the amount of control that parents of children with chronic illness wanted over their hospitalized child's care, and the degree to which parents felt health care professionals valued their expertise, was examined in a national sample of 50 parent caregivers. Participation in information sharing and technical care were areas over which parents wanted the most control. Nurses and attending physicians were rated highest in valuing parental expertise. Content analysis of an open-ended question on parental control revealed that parents felt a higher quality care was given at home than in the hospital; nurses were too busy or understaffed to provide optimal care in the hospital; and the child's control of care and decision making should increase as the child grew older.