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Characteristics, treatment and care of pregnant women living with hepatitis B in England: findings from a national audit
- Heather Bailey, Eleni Nastouli, Sharon Webb, Catherine Peckham, Claire Thorne
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- Journal:
- Epidemiology & Infection / Volume 151 / 2023
- Published online by Cambridge University Press:
- 02 March 2023, e50
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Around 0.4% of pregnant women in England have chronic hepatitis B virus (HBV) infection and need services to prevent vertical transmission. In this national audit, sociodemographic, clinical and laboratory information was requested from all maternity units in England for hepatitis B surface antigen-positive women initiating antenatal care in 2014. We describe these women's characteristics and indicators of access to/uptake of healthcare. Of 2542 pregnancies in 2538 women, median maternal age was 31 [IQR 27, 35] years, 94% (1986/2109) were non-UK born (25% (228/923) having arrived into the UK <2 years previously) and 32% (794/2473) had ⩾2 previous live births. In 39%, English levels were basic/less than basic. Antenatal care was initiated at median 11.3 [IQR 9.6, 14] gestation weeks, and ‘late’ (⩾20 weeks) in 10% (251/2491). In 70% (1783/2533) of pregnancies, HBV had been previously diagnosed and 11.8% (288/2450) had ⩾1 marker of higher infectivity. Missed specialist appointments were reported in 18% (426/2339). Late antenatal care and/or missed specialist appointments were more common in pregnancies among women lacking basic English, arriving in the UK ⩽2 years previously, newly HBV diagnosed, aged <25 years and/or with ⩾2 previous live births. We show overlapping groups of pregnant women with chronic HBV vulnerable to delayed or incomplete care.
Exploring determinants of self-management in adults with severe mental illness: a qualitative evidence synthesis
- Claire Carswell, Jennifer Brown, Abisola Balogun, Jo Taylor, Peter Coventry, Charlotte Kitchen, Ian Kellar, Emily Peckham, Sue Bellass, Sarah Alderson, Jennie Lister, Richard Holt, Catherine Hewitt, Rowena Jacobs, David Shiers, Jan Boehnke, Ramzi Ajjan, Najma Siddiqi, On behalf of the DIAMONDS Research team
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S13
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Aims
To systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs.
BackgroundPeople living with serious mental illness (SMI) have a reduced life expectancy by around 15–20 years, mainly due to the high prevalence of long-term physical conditions such as diabetes and heart disease. People with SMI face many challenges when trying to manage their physical health. Little is known about the determinants of self-management – managing the emotional and practical issues – of long-term conditions (LTCs) for people with SMI.
MethodSix databases, including CINAHL and MEDLINE, were searched to identify qualitative studies that explored people's perceptions about determinants of self-management in adults with SMI (with or without comorbid LTCs). Self-management was defined according to the American Association of Diabetes Educator's self-care behaviours (AADE7). Determinants were defined according to the Capabilities, Opportunity, Motivations and Behaviours (COM-B) framework. Eligible studies were purposively sampled for synthesis according to the richness of the data (assessed using Ames et al (2017)'s data richness scale), and thematically synthesised.
ResultTwenty-six articles were included in the synthesis. Seven studies focused on self-management of LTCs, with the remaining articles exploring self-management of SMI. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the additional burden of SMI; living with comorbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; routine, structure and planning. Capabilities for self-management were linked to people's perceptions about the support they received for their SMI and LTC from healthcare professionals, family and friends. Opportunities for self-management were more commonly expressed in the context of social and environmental factors. Motivation for self-management was influenced by beliefs and attitudes, whilst being closely related to the burden of SMI.
ConclusionThe themes identified from the synthesis suggest that capabilities, opportunities and motivations for self-management can be negatively influenced by the experience of SMI, whilst social and professional support, improved access to resources, and increased involvement in care, could promote self-management. Support programmes for people with SMI and LTCs need to account for these experiences and adapt to meet the unique needs of this population.
Challenges and solutions to nicotine replacement therapy access: observations from SCIMITAR+
- Catherine E. Arundel, Emily Peckham, Della Bailey, Suzanne Crosland, Paul Heron, Simon Gilbody
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- Journal:
- BJPsych Open / Volume 6 / Issue 6 / November 2020
- Published online by Cambridge University Press:
- 15 October 2020, e120
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Background
Given that smoking results in poor physical and mental health, reducing tobacco harm is of high importance. Recommendations published by the National Institute for Health and Care Excellence to reduce smoking harms included provision of support, use of nicotine containing products and commissioning of smoking cessation services.
AimsThis report explores the difficulties in obtaining such support, as observed in a recently conducted randomised controlled trial in patients with severe mental ill health, and outlines suggestions to improve facilitation of provision.
MethodData collected during the Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+) (trial Registration ISRCTN72955454), was reviewed to identify the difficulties experienced, across the trial, with regards to access and provision of nicotine replacements therapy (NRT). Actions taken to facilitate access and provision of NRT were collated to outline how provision could be better facilitated.
ResultsAccess to NRT varied across study settings and in some instances proved impossible for patients to access. Difficulty in access was irrespective of a diagnosis of severe mental ill health. Where NRT was provided, this was not always provided in accordance with NICE guidelines.
ConclusionsAvailability of smoking cessation support, and NRT provision would benefit from being made clearer, simpler and more easily accessible so as to enhance smoking cessation rates.
Smoking cessation in severe mental illness: combined long-term quit rates from the UK SCIMITAR trials programme
- Simon Gilbody, Emily Peckham, Della Bailey, Catherine Arundel, Paul Heron, Suzanne Crosland, Caroline Fairhurst, Catherine Hewitt, Jinshuo Li, members of the SCIMITAR+ collaborative
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- Journal:
- The British Journal of Psychiatry / Volume 218 / Issue 2 / February 2021
- Published online by Cambridge University Press:
- 30 August 2019, pp. 95-97
- Print publication:
- February 2021
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Smoking contributes to health inequalities for people with severe mental illness (SMI). Although smoking cessation interventions are effective in the short term, there are few long-term trial-based estimates of abstinence. The SCIMITAR trials programme includes the largest trial to date of a smoking cessation intervention for people with SMI, but this was underpowered to detect anticipated long-term quit rates. By pooling pilot and full-trial data we found that quit rates were maintained at 12 months (OR = 1.67, 95% CI 1.02–2.73, P = 0.04). Policymakers can now be confident that bespoke smoking cessation interventions produce successful short- and long-term quitting.
Standard smoking cessation services in sites participating in the SCIMITAR+ trial for people with severe mental ill health
- Paul Heron, Tayla McCloud, Catherine Arundel, Della Bailey, Suzy Ker, Jinshuo Li, Masuma Mishu, David Osborn, Steve Parrott, Emily Peckham, Alison Stribling, Simon Gilbody
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- Journal:
- BJPsych Bulletin / Volume 44 / Issue 1 / February 2020
- Published online by Cambridge University Press:
- 04 June 2019, pp. 6-11
- Print publication:
- February 2020
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Aims and method
The SCIMITAR+ trial was commissioned to evaluate the effectiveness of a bespoke smoking cessation intervention for people with severe mental ill health compared with usual services. It is difficult to define what constitutes usual care in smoking cessation services. We aimed to define what this was during the trial. Twenty-two National Health Service healthcare providers participated in a bespoke survey asking about usual care in their area.
ResultsAll sites offered smoking cessation support; however, service provider and service type varied substantially. In some cases services were not streamlined, meaning that people received smoking cessation counselling from one organisation and smoking cessation medication from another.
Clinical implicationsTo better implement the National Institute for Health and Care Excellence guideline PH48, clearer referral pathways need to be implemented and communicated to patients, staff and carers. People with severe mental ill health need to be able to access services that combine nicotine replacement therapy and behavioural support in a streamlined manner.
Contributor affiliations
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael Selzer, Stephanie Clarke, Leonardo Cohen, Gert Kwakkel, Robert Miller, Case Western Reserve University, Ohio
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- Book:
- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 May 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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Contributor affiliations
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- By Frank Andrasik, Melissa R. Andrews, Ana Inés Ansaldo, Evangelos G. Antzoulatos, Lianhua Bai, Ellen Barrett, Linamara Battistella, Nicolas Bayle, Michael S. Beattie, Peter J. Beek, Serafin Beer, Heinrich Binder, Claire Bindschaedler, Sarah Blanton, Tasia Bobish, Michael L. Boninger, Joseph F. Bonner, Chadwick B. Boulay, Vanessa S. Boyce, Anna-Katharine Brem, Jacqueline C. Bresnahan, Floor E. Buma, Mary Bartlett Bunge, John H. Byrne, Jeffrey R. Capadona, Stefano F. Cappa, Diana D. Cardenas, Leeanne M. Carey, S. Thomas Carmichael, Glauco A. P. Caurin, Pablo Celnik, Kimberly M. Christian, Stephanie Clarke, Leonardo G. Cohen, Adriana B. Conforto, Rory A. Cooper, Rosemarie Cooper, Steven C. Cramer, Armin Curt, Mark D’Esposito, Matthew B. Dalva, Gavriel David, Brandon Delia, Wenbin Deng, Volker Dietz, Bruce H. Dobkin, Marco Domeniconi, Edith Durand, Tracey Vause Earland, Georg Ebersbach, Jonathan J. Evans, James W. Fawcett, Uri Feintuch, Toby A. Ferguson, Marie T. Filbin, Diasinou Fioravante, Itzhak Fischer, Agnes Floel, Herta Flor, Karim Fouad, Richard S. J. Frackowiak, Peter H. Gorman, Thomas W. Gould, Jean-Michel Gracies, Amparo Gutierrez, Kurt Haas, C.D. Hall, Hans-Peter Hartung, Zhigang He, Jordan Hecker, Susan J. Herdman, Seth Herman, Leigh R. Hochberg, Ahmet Höke, Fay B. Horak, Jared C. Horvath, Richard L. Huganir, Friedhelm C. Hummel, Beata Jarosiewicz, Frances E. Jensen, Michael Jöbges, Larry M. Jordan, Jon H. Kaas, Andres M. Kanner, Noomi Katz, Matthew S. Kayser, Annmarie Kelleher, Gerd Kempermann, Timothy E. Kennedy, Jürg Kesselring, Fary Khan, Rachel Kizony, Jeffery D. Kocsis, Boudewijn J. Kollen, Hubertus Köller, John W. Krakauer, Hermano I. Krebs, Gert Kwakkel, Bradley Lang, Catherine E. Lang, Helmar C. Lehmann, Angelo C. Lepore, Glenn S. Le Prell, Mindy F. Levin, Joel M. Levine, David A. Low, Marilyn MacKay-Lyons, Jeffrey D. Macklis, Margaret Mak, Francine Malouin, William C. Mann, Paul D. Marasco, Christopher J. Mathias, Laura McClure, Jan Mehrholz, Lorne M. Mendell, Robert H. Miller, Carol Milligan, Beth Mineo, Simon W. Moore, Jennifer Morgan, Charbel E-H. Moussa, Martin Munz, Randolph J. Nudo, Joseph J. Pancrazio, Theresa Pape, Alvaro Pascual-Leone, Kristin M. Pearson-Fuhrhop, P. Hunter Peckham, Tamara L. Pelleshi, Catherine Verrier Piersol, Thomas Platz, Marcus Pohl, Dejan B. Popović, Andrew M. Poulos, Maulik Purohit, Hui-Xin Qi, Debbie Rand, Mahendra S. Rao, Josef P. Rauschecker, Aimee Reiss, Carol L. Richards, Keith M. Robinson, Melvyn Roerdink, John C. Rosenbek, Serge Rossignol, Edward S. Ruthazer, Arash Sahraie, Krishnankutty Sathian, Marc H. Schieber, Brian J. Schmidt, Michael E. Selzer, Mijail D. Serruya, Himanshu Sharma, Michael Shifman, Jerry Silver, Thomas Sinkjær, George M. Smith, Young-Jin Son, Tim Spencer, John D. Steeves, Oswald Steward, Sheela Stuart, Austin J. Sumner, Chin Lik Tan, Robert W. Teasell, Gareth Thomas, Aiko K. Thompson, Richard F. Thompson, Wesley J. Thompson, Erika Timar, Ceri T. Trevethan, Christopher Trimby, Gary R. Turner, Mark H. Tuszynski, Erna A. van Niekerk, Ricardo Viana, Difei Wang, Anthony B. Ward, Nick S. Ward, Stephen G. Waxman, Patrice L. Weiss, Jörg Wissel, Steven L. Wolf, Jonathan R. Wolpaw, Sharon Wood-Dauphinee, Ross D. Zafonte, Binhai Zheng, Richard D. Zorowitz
- Edited by Michael E. Selzer, Stephanie Clarke, Leonardo G. Cohen, Gert Kwakkel, Robert H. Miller, Case Western Reserve University, Ohio
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- Book:
- Textbook of Neural Repair and Rehabilitation
- Published online:
- 05 June 2014
- Print publication:
- 24 April 2014, pp ix-xvi
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five - Children’s health
- Edited by Shirley Dex, Heather Joshi
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- Book:
- Children of the 21st Century
- Published by:
- Bristol University Press
- Published online:
- 22 January 2022
- Print publication:
- 12 October 2005, pp 133-158
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Summary
Children in the UK are growing up against a background of changing family size and structure as well as changing demographic, economic and societal circumstances, which together have important implications for their health (Peckham, 1998). It is important to understand how the changes in patterns of caring for children and family context influence health in early childhood and the adoption of child health promoting behaviours by parents and carers. In recent years, there has been increasing interest in the contribution of these changes to obesity, asthma and related allergic diseases, autoimmune conditions, and disorders of social communication and behaviour (Gent et al 1994; Bach, 2002; Lobstein et al, 2004). The factors underlying these trends remain poorly understood, although they are clearly of great public health and human importance. The importance of an interdisciplinary perspective combining social, environmental and biological approaches to elucidate their causes is increasingly recognised.
Plan of this chapter
In this chapter, after considering the data sources in more detail, we describe the health during infancy of the cohort children through investigating the baby's birthweight, its infant weight at 8-9 months, and the early nutrition and patterns of breastfeeding. A range of parental and community influences on the baby's health are then considered – namely, parental smoking and alcohol use, immunisation, health problems and other use of services. Finally, the chapter examines indicators of good health in infancy and concludes with the implications of the findings for child health policy.
Data sources
At the first contact with the families when the children were aged around 9 months, information was obtained by parental (usually maternal) report on a wide range of measures. This included those relevant to the prevention of illness and promotion of health in the child, such as breastfeeding, parental smoking and immunisation status, and to conditions and illnesses that have implications for growth and development. Also included were measures which provide a baseline for examining later patterns and trajectories which will change with increasing age – for example, birthweight and bodyweight.
Data were also enhanced with respect to child health information by verifying maternal reports at the time of interview from information recorded in the personal child health record (Walton et al, 2005) and, subsequently, by linkage to routine birth registration records and health service information either at the individual or health service level (Bartington et al, 2005; Tate et al, 2005).
1 - Infections in pregnancy: introduction
- Marie-Louise Newell, Institute of Child Health, University College London, James McIntyre, University of the Witwatersrand, Johannesburg
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- Book:
- Congenital and Perinatal Infections
- Published online:
- 06 July 2010
- Print publication:
- 28 August 2000, pp 3-14
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Summary
Introduction
Infections in pregnancy that can be transmitted from mother to child are of particular concern since congenital or perinatal infections may be associated with adverse sequelae. Maternal infections that have the potential of infecting the fetus or newborn infant are listed in Table 1.1 and include viral, bacterial and protozoal infections. The consequences and management of individual infections are discussed in detail elsewhere in this book. The purpose of the present chapter is to present an overview of the salient features and issues that arise in relation to the detection and management of infections in pregnancy, largely from a population perspective. This epidemiological knowledge is needed to establish a causal relationship between an infection and the outcome, to inform decisions about screening in pregnancy and also to ensure the most appropriate management of a woman with a specific diagnosed infection in pregnancy.
All the infections listed in Table 1.1 can cause fetal or perinatal infection, sometimes associated with an adverse outcome such as fetal loss, stillbirth, prematurity, fetal damage, or acute neonatal infection. For some congenital infections there may be no evidence of symptoms or signs of infection in the neonatal period and it may be weeks, months or even years before damage first becomes apparent (Table 1.2).
Mode of acquisition of infection
The route by which the fetus or newborn acquires the infection has important implications for the management of the infection in pregnancy, or in the neonatal period, and for the development of appropriate intervention programmes to prevent mother-to-child transmission. Infections of the newborn maybe acquired in utero (congenital infection), around the time of delivery (intrapartum infection) or in the neonatal period (postpartum infection) (Table 1.3).
Mother-to-child transmission of hepatitis B infection
- Part of
- Marie-Louise Newell, Catherine Peckham
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- Journal:
- Fetal and Maternal Medicine Review / Volume 10 / Issue 2 / May 1998
- Published online by Cambridge University Press:
- 02 April 2001, pp. 109-119
- Print publication:
- May 1998
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Most transmission of hepatitis B virus (HBV) infection occurs around the time of delivery through contact with contaminated vaginal secretions or blood. Hence, interventions to reduce vertical transmission of HBV depend on identification of the infected woman during pregnancy so that the newborn infant exposed to infection can be given immunoglobulin immediately after birth, and a course of immunization can be started.