Compassionate mind training for ex-service personnel with PTSD and their partners.

Posttraumatic stress disorder (PTSD) is a significant issue for a substantial proportion of Australian ex-service personnel. In addition to the functional impact on individuals, PTSD can have a significant impact on intimate partner relationships. Research has demonstrated that practicing compassion and self-compassion may be an important component of psychological therapy for survivors of trauma, while also demonstrating benefits to intimate relationships. This pilot study aimed to investigate the utility of a Compassionate Mind Training intervention for ex-service personnel with PTSD and their partners. An uncontrolled, within-subjects, longitudinal design was utilized with assessment at pre-intervention, post-intervention and 3-month follow-up. Twenty-four participants attended 12 biweekly group sessions. Self-report measures of compassion, quality of life and psychological symptoms were administered at each time point. Findings demonstrated a significant reduction in fears of compassion and PTSD symptoms for ex-service personnel at 3-month follow-up and a reduction in depressive symptoms and increase in quality-of-life and social safeness at post-intervention. Additionally, significant reductions in anxiety, stress, external shame and self-criticism at 3-month follow-up were found, and couples reported significant increases in relationship satisfaction. Findings from this pilot study demonstrate promising outcomes, warranting further investigation in a larger randomized controlled trial of Compassionate Mind Training for ex-service personnel and their partners.

Understanding the challenges and successes of implementing 'hybrid' interventions in healthcare settings: findings from a process evaluation of a patient involvement trial.

INTRODUCTION: 'Hybrid' interventions in which some intervention components are fixed across sites and others are flexible (locally created) are thought to allow for adaptation to the local context while maintaining fidelity. However, there is little evidence regarding the challenges and facilitators of implementing hybrid interventions. This paper reports on a process evaluation of a patient safety hybrid intervention called Your Care Needs You (YCNY). YCNY was tested in the Partners at Care Transitions (PACT) randomised controlled trial and aimed to enhance older patients and their families' involvement in their care in order to achieve safer transitions from hospital to home. METHODS: The process evaluation took place across eight intervention wards taking part in the PACT trial. 23 interviews and 37 informal conversations were conducted with National Health Service (NHS) staff. Patients (n=19) were interviewed twice, once in hospital and once after discharge. Interviews with staff and patients concerned the delivery and experiences of YCNY. Ethnographic observations (n=81 hours) of relevant activities (eg, multidisciplinary team meetings, handovers, etc) were undertaken. RESULTS: The main finding relates to how staff understood and engaged with YCNY, which then had a major influence on its implementation. While staff broadly valued the aims of YCNY, staff from seven out of the eight wards taking part in the process evaluation enacted YCNY in a mostly task-based manner. YCNY implementation often became a hurried activity which concentrated on delivering fixed intervention components rather than a catalyst for culture change around patient involvement. Factors such as understaffing, constraints on staff time and the COVID-19 pandemic contributed towards a 'taskification' of intervention delivery, which meant staff often did not have capacity to creatively devise flexible intervention components. However, one ward with a sense of distributed ownership of YCNY had considerable success implementing flexible components. DISCUSSION: Hybrid interventions may allow aspects of an intervention to be adapted to the local context. However, the current constrained and pressured environment of the NHS left staff with little ability to creatively engage with devising flexible intervention components, despite recognising the need for and being motivated to deliver the intervention.

Understanding the impact of Covid-19 on the delivery and receipt of prison healthcare: an international scoping review.

BACKGROUND: People being held in prison are particularly vulnerable to Covid-19 infection, as places of detention are high-risk environments for spread of infection. Due to this risk, many prisons across the globe introduced measures to reduce the risk of Covid-19 transmission. The pandemic changed almost all aspects of prison life, including prison healthcare provision. We undertook a scoping review to understand what is known about the impact of the Covid-19 pandemic on the receipt and delivery of prison healthcare. This scoping review is part of a wider mixed-methods study focusing more specifically on the impact that Covid-19 had on prison healthcare delivery in England. METHODS: We conducted an international scoping review of peer-reviewed articles published between December 2019 and January 2022, across six electronic databases. We also conducted a hand search of key journals and the reference lists of included articles. RESULTS: Twelve articles met our inclusion criteria. The articles focused primarily on prisons in high-income countries and mostly explored the impact that the pandemic had on the provision of drug treatment services. Some aspects of drug treatment services were more impacted than others, with those delivered by external providers and preparations for release particularly hindered. Whilst prison mental health services were purportedly available, there were changes regarding how these were delivered, with group therapies suspended and most consultations taking place using telehealth. The articles reported both digital and non-digital adaptations or innovations to prison healthcare services to ensure continued delivery. Collaboration between different agencies, such as the prison itself, healthcare providers, and non-governmental organisations, was key to facilitating ongoing provision of healthcare to people in prison. CONCLUSIONS: Covid-19 impacted on prison healthcare internationally, but different treatment services were affected in disparate ways, both within and between countries. The published literature concentrates on the impact on drug treatment services. Prison healthcare providers rapidly adapted their processes to attempt to maintain service provision.

Mini-puberty testosterone and infant autistic traits.

Background: Levels of steroid hormones in the first three months of life, a period referred to as 'mini-puberty', are one of the earliest physiological differences between typical males and females postnatally. Autistic traits also show consistent typical sex differences in later infancy, after the 18th month of life. Previous studies have shown prenatal testosterone is associated with later levels of autistic traits. Studies testing if postnatal testosterone levels are associated with autistic traits have reported null results. No studies to date have investigated mini-puberty longitudinally or tested for interactions with baseline sex differences or familial likelihood of autism. Methods: The 'Cambridge Human Imaging and Longitudinal Development Study' (CHILD) is a prospective enriched cohort study in Cambridge, UK. It includes physiological measurements in early infancy, as well as neurodevelopmental follow-ups over the first two years of life. A subset of the cohort also includes children with a family history of autism (a diagnosed parent or sibling). Salivary testosterone levels were assessed at two time-points, just after the 2nd and 6th month of life. Autistic traits were measured using the Quantitative Checklist of Autism in Toddlers (Q-CHAT) when the children were 18 months of age. Results: Salivary testosterone levels were significantly higher during 'mini-puberty' in the 2nd and 3rd month of life, compared to after the 6th month of life, in both males and females. There was no significant sex difference at either time-point. Log-transformed testosterone levels were not associated with autistic traits (Q-CHAT). There was no interaction effect with infant sex, autism family history or baseline testosterone levels after mini-puberty (at >6 months of age). Conclusion: Both male and female infants have elevated levels of salivary testosterone during mini-puberty but in this relatively small sample this was not associated with their later autistic traits at 18 months or their family history of autism. This suggests that prenatal rather than postnatal testosterone levels are more relevant for understanding the causes of autism. Future studies should test these relationships in larger samples.

A qualitative exploration of autistic mothers' experiences I: Pregnancy experiences.

LAY ABSTRACT: Little is known about how autistic people experience pregnancy. We interviewed 24 autistic and 21 non-autistic women during pregnancy to find out about their experiences. Autistic participants had more physical difficulties, such as nausea and pain, during pregnancy than non-autistic participants. They also sometimes felt that healthcare professionals, such as midwives, did not have a good understanding of autism and they did not always feel comfortable telling professionals about their autism diagnosis. Autistic participants told us that they needed professionals to communicate with them clearly and to make changes during appointments such as dimming lights. This research shows that autistic people would benefit from changes to pregnancy appointments and that more training about autism would help maternity care professionals to support autistic people during pregnancy.

Autistic People's Perinatal Experiences I: A Survey of Pregnancy Experiences.

Qualitative studies of autistic people's pregnancy experiences have indicated sensory and communication related barriers to accessing adequate prenatal healthcare. However, quantitative work on the topic is scarce. This online survey study explored pregnancy experiences among 417 autistic and 524 non-autistic people. Compared with non-autistic people, autistic people reported heightened sensory and physical experiences during pregnancy and were more likely to experience prenatal depression and anxiety. Autistic people experienced lower satisfaction with prenatal healthcare, including having lower perceptions of their relationships with healthcare professionals and greater difficulties with antenatal classes. This study identifies key adjustments that can be made to prenatal healthcare, including sensory and communication adjustments. The findings highlight the need for greater autism understanding and awareness among professionals.

Autistic mothers' perinatal well-being and parenting styles.

LAY ABSTRACT: Autistic people can have difficulties during pregnancy and after giving birth, such as difficulty getting health care that meets their needs. Autistic people may therefore have lower well-being than non-autistic people during this time. We asked autistic and non-autistic people to fill in questionnaires measuring stress, depression, anxiety and satisfaction with life. They were asked to do this once during pregnancy, once 2 to 3 months after giving birth and once 6 months after giving birth. At 6 months after giving birth, they also filled in questionnaires about parenting. The autistic parents had higher stress, depression and anxiety scores than the non-autistic parents. For both groups, scores for anxiety went down over time. There were no differences between the groups on satisfaction with their life or how confident they were as a parent. There were no differences between the groups on most areas of parenting style, although autistic parents scored lower on parenting discipline. This study suggests that autistic people may be more stressed, depressed and anxious than non-autistic people during pregnancy and after giving birth. Autistic people therefore need good quality support during this time. This study also suggests that autistic and non-autistic parents may be just as likely to parent in positive ways such as being sensitive to their baby's needs.

A qualitative exploration of autistic mothers' experiences II: Childbirth and postnatal experiences.

LAY ABSTRACT: Very little research has looked at how autistic people experience childbirth and the first few months of parenthood. We interviewed 21 autistic and 25 non-autistic women 2-3 months after their baby was born, to find out how they experienced giving birth and being a parent. Some autistic participants found sensory aspects of giving birth difficult, such as noise and being touched. They also wanted healthcare professionals to give them clear information while giving birth. Participants sometimes thought that healthcare professionals did not know enough about autism. Autistic and non-autistic participants both found parenthood difficult at times and autistic parents sometimes had extra difficulties, such as with planning and organising. Autistic participants also felt good at understanding their baby's needs. This research suggests that autistic people would benefit from changes to childbirth and postnatal healthcare such as being communicated with more clearly. It also indicates that healthcare professionals should receive more training about autism.

Hemothorax and Pneumothorax Secondary to Costal Involvement in Hereditary Multiple Exostoses: A Systematic Review of Reported Cases in the Literature.

Hereditary multiple exostoses (HME) are an autosomal dominant skeletal disorder characterized by the development of multiple benign osteochondromas (exostoses) that frequently involve long bones of the body. Less commonly, the ribs are a site of involvement, and long-term friction between an exostosis and pleura can produce a hemothorax or pneumothorax. The purpose of this study is to provide a comprehensive review of existing literature on pneumothorax or hemothorax secondary to costal exostosis in HME patients. We reviewed the databases of PubMed and Embase and included data as current as of February 15, 2021. All case reports included cases of hemothorax or pneumothorax in patients with a known personal or family history of HME. After evaluation for inclusion based on eligibility criteria, 18 cases were included. The average age at presentation was 11.7 years (range: 3-32), and most patients were male (83%). Hemothoraces occurred in 15 cases, while pneumothoraces occurred in three cases. All cases were evaluated using chest X-ray and CT scan, and the majority of the cases were treated with surgical resection of the exostosis, either with video-assisted thoracoscopic surgery (VATS; 61%) or thoracotomy (22%). Outcomes were successful with no cases of recurrence after surgical intervention. Although rare, costal exostosis should be considered as a differential in patients presenting with pneumothorax or hemothorax and past medical history or physical exam findings suggestive of HME. Immediate evaluation and surgical intervention to resect costal exostosis are essential to reduce the risk of recurrent life-threatening injury.

Ergonomics and Work-Related Musculoskeletal Disorders: Characteristics Among Female Interventionists.

Interventional radiology is a procedural specialty that performs minimally invasive operations under image guidance. Currently, there are inadequate ergonomic protocols for work-related musculoskeletal disorder (WMSD) prevention in interventional radiology (IR), and there is a paucity of information discerning gender differences in WMSDs. This article reviews current literature that addresses WMSDs in female physicians practicing interventional and fluoroscopic procedures, including interventional radiology, interventional cardiology, electrophysiology, vascular surgery, orthopedic surgery, neurosurgery, and gastroenterology. We searched PubMed and EBSCOhost databases for ergonomic studies that reported female physician WMSDs in the specialties listed above. After a thorough evaluation for inclusion based on eligibility criteria, 11 studies were included. From this search, there was poor female representation, averaging 25.7% of respondents. Several characteristics identified across the studies were that women were generally shorter, wore smaller glove sizes, and were younger than their male colleagues. Seventy-two percent of female proceduralists reported WMSDs versus 46.6% of their male colleagues. Additionally, women may experience more upper extremity pain than lumbar pain, which men commonly reported. Potential contributing factors to WMSDs are the size and design of procedural tools and the possible predisposition of female physicians to experience upper extremity WMSDs while performing the same operations as men. As more women enter medicine and pursue careers in procedural fields like interventional radiology, it is essential to address these discrepancies and develop ergonomically sound solutions for women.

The potential of eye-tracking as a sensitive measure of behavioural change in response to intervention.

One challenge to the development of effective interventions to support learning and behavioural change in neurodevelopmental disorders is a lack of suitable outcome measures. Eye-tracking has been used widely to chart cognitive development and clinically-relevant group differences in many populations. This proof-of-concept study investigates whether it also has the potential to act as a marker of treatment effects, by testing its sensitivity to differential change over a short period of exposure to an iPad app in typically developing children. The app targets a key skill in early social communication development, by rewarding attention to people, operationalised via a finger-tap on screen. We measured attention to images taken from the app, and a selection of matched stimuli to test generalisation of effects, at baseline and two weeks later. Children were assigned to either an app-exposure or no-app condition in the intervening period. The app exposure group showed increases in fixation on people for images from the app, and for distant-generalisation photographs, at high levels of complexity. We conclude that, with careful selection of stimuli, eye-tracking has the potential to make a valuable contribution to the range of outcome measures available for psycho-behavioural interventions in neurodevelopmental disorders.

Autism and Bilingualism: A Qualitative Interview Study of Parents' Perspectives and Experiences.

Purpose: Research into how bilingual parents of children with autism spectrum disorder (ASD) make choices about their children's language environment is scarce. This study aimed to explore this issue, focusing on understanding how bilingual parents of children with ASD may make different language exposure choices compared with bilingual parents of children without ASD. Method: Semistructured qualitative interviews were conducted with 17 bilingual parents with a child with ASD and 18 bilingual parents with a typically developing (TD) child. Results: Thematic analysis revealed that, in contrast to parents of TD children, parents with a child with ASD expressed concerns that a bilingual environment would cause confusion for their child and exacerbate language delays. This was particularly common for parents of children with lower verbal ability. Parents also identified potential benefits of bilingualism, particularly in terms of maintaining a close and affectionate bond with their child. Conclusions: Parents of children with ASD have concerns about bilingualism not present for parents of TD children, and these concerns are greater for parents of children with lower verbal ability. Future research in this area should take into account factors such as parent-child bonds as well as communication and language development.