Changes in attitudes to childbirth in modern times illustrated over three generations in Iraq.

OBJECTIVE: To describe changes in attitudes and expectations of labor over the previous six decades, comparing the Iraqi generation who labored at home without medical assistance with their descendants. STUDY DESIGN: We used semi-structured telephone interviews with 22 women across three generations of one extended family living and giving birth in Iraq between the 1950s and the 2010s. Qualitative data were analyzed thematically using open, axial, and selective coding. RESULTS: Each generation experienced a paradigm shift in childbirth, from exclusive home births to hospital-directed maternity care, to a trend that favors planned cesarean birth, driven by generation-specific changes in outlook. Emerging themes included social influences, changing technology, and medical professionals' recommendations; all of these affected attitudes toward childbirth and pregnancy. There were generational disconnects in perceptions concerning the reasons childbirth has changed over the past 60 years, with the youngest generation citing wider pressures regarding body image and marital relationships as two of the factors affecting preferences in childbirth options. CONCLUSIONS: Societal changes and availability of healthcare services affect women's choices and experiences of childbirth. To be successful, efforts to improve women's experiences in labor, as well as maternal and neonatal outcomes, must consider these wider sociocultural issues.

Single-copy Snail upregulation causes partial epithelial-mesenchymal transition in colon cancer cells.

BACKGROUND: Epithelial-mesenchymal transition (EMT) is an embryonic programme implicated in cancer stem cells, metastasis and therapeutic resistance. Its role in cancer progression remains controversial because the transition can be partial or complete in different models and contexts. METHODS: Using human colon cancer DLD-1 cells, we engineered a cell line with a single-copy of Snail that was doxycycline-inducible and compared it to existing EMT models in DLD-1. The effect of Snail upregulation was characterised functionally, morphologically, and by transcriptional profiling and protein expression. RESULTS: Induction with doxycycline increased Snail expression to a level similar to that observed in cancer cell lines spontaneously expressing Snail and results in partial EMT. In comparison, higher levels of overexpression arising from introduction of episomal-Snail, results in complete EMT. DLD-1 cells with partial EMT show chemoresistance in vitro, increased tumour growth in vivo and decreased apoptosis. CONCLUSIONS: These findings highlight that the amount of bioavailable Snail can dictate phenotypic outcome and that partial EMT may be a preferred outcome of models operating within a natural range of Snail overexpression.

Making every contact count: Can healthcare professionals do more to avoid preventable child deaths?

BACKGROUND: Healthcare professionals (HCPs) have a responsibility and unique opportunities to identify and act on safeguarding concerns. Child Safeguarding Practice Reviews (CSPRs) are produced in the United Kingdom when a child has died or been seriously harmed, and abuse or neglect is suspected or confirmed. To our knowledge there is no recent systematic analysis of CSPRs from an HCP perspective. OBJECTIVE: To establish if HCPs are acting in an appropriate and safe manner when confronted with cases of potential child abuse and neglect and recommend areas for further improvement. PARTICIPANTS AND SETTINGS: CSPR abstracts published on a specialist UK database between 2018 and 2021 involving the death of a child. METHODS: After applying the exclusion criteria we used stratified random sampling to select one third of eligible reports. Using a systematic framework, common qualitative themes were extracted and analyzed. RESULTS: 42 of 125 eligible CSPRs were analyzed. Child deaths were more common in male children and those aged under one. We identified areas where communication could be further improved including better understanding of the referral process, coordination at discharge, and communication between primary and secondary care. We found that HCPs were not well equipped to identify risk factors for child abuse such as poor parental health and complex family structures. CONCLUSIONS: There is significant scope for improvement in strengthening the knowledge and skill base of HCPs in identifying and acting on signs of child abuse. We propose improvements in terms of staff training, resources and better systems to ensure HCPs respond to safeguarding concerns safely and appropriately.

Care of pregnant women with epilepsy in the United Kingdom: A national survey of healthcare professionals.

OBJECTIVES: To map the care provided to pregnant women with epilepsy in UK maternity units and identify future research priorities by conducting a nationwide survey of healthcare professionals. STUDY DESIGN: A prospective cross-sectional electronic survey was conducted between 29 April and 30 October 2021. The survey included 23 questions developed and refined with relevant stakeholders, including a woman with lived experience of epilepsy and pregnancy. We used descriptive analyses to summarise responses and estimated proportions with medians and interquartile ranges. RESULTS: 144 individual healthcare professionals from 94 hospitals, representing 77 NHS Trusts, participated in the survey. Obstetricians were the most common responders (45%, 65/144) and almost half (47%, 7/15) of regions had a survey response rate per NHS Trust greater than 50%. Six pregnant women with epilepsy, on average, were booked into antenatal care per hospital per month, and 49% (46/94) of hospitals saw women for specialist antenatal care in the first trimester. The care provided across healthcare systems varied, with multiple pathways for referral to specialist care within regions. Midwife referral was the most used care pathway (80%, 75/94). Less than a third of hospitals (31%, 29/94) ran joint obstetric/neurology clinics for pregnant women with epilepsy. Most survey respondents (81%, 117/144) were confident talking to pregnant women about their risk of seizures but only a minority (20%, 29/144) used validated calculators to assess this risk. There was broad agreement across healthcare professionals that the priorities for research should focus on how to improve communication and address pregnant women's concerns regarding epilepsy and pregnancy, and to develop further understanding on the optimal use and long-term effects of anti-seizure medication. CONCLUSION: Our UK nationwide survey of hospital-based maternity services for pregnant women with epilepsy identified wide variation in when, how and by whom these women are seen, with differences between and within the UK regions. This survey highlights areas for improvement in the care of pregnant women with epilepsy.

Nosocomial COVID: the moral and clinical imperative for worldwide data collection and action.

There is a wide disparity worldwide in data collection and sharing of rates of hospital-acquired coronavirus disease (COVID). There is an ethical imperative that such information is systematically gathered, distributed and acted on to reduce rates of this form of preventable and devastating transmission during a pandemic.

Gene structure and expression of serotonin receptor HTR2C in hypothalamic samples from infanticidal and control sows.

BACKGROUND: The serotonin pathways have been implicated in behavioural phenotypes in a number of species, including human, rat, mouse, dog and chicken. Components of the pathways, including the receptors, are major targets for drugs used to treat a variety of physiological and psychiatric conditions in humans. In our previous studies we have identified genetic loci potentially contributing to maternal infanticide in pigs, which includes a locus on the porcine X chromosome long arm. The serotonin receptor HTR2C maps to this region, and is therefore an attractive candidate for further study based on its function and its position in the genome. RESULTS: In this paper we describe the structure of the major transcripts produced from the porcine HTR2C locus using cDNA prepared from porcine hypothalamic and pooled total brain samples. We have confirmed conservation of sites altered by RNA editing in other mammalian species, and identified polymorphisms in the gene sequence. Finally, we have analysed expression and editing of HTR2C in hypothalamus samples from infanticidal and control animals. CONCLUSIONS: The results confirm that although the expression of the long transcriptional variant of HTR2C is raised in infanticidal animals, the overall patterns of editing in the hypothalamus are similar between the two states.Sequences associated with the cDNA and genomic structures of HTR2C reported in this paper are deposited in GenBank under accession numbers FR720593, FR720594 and FR744452.