Search

Background: The World Health Organization (WHO) recommends that women with HIV breastfeed for a minimum of one year. In contrast, United Kingdom (UK) guidelines encourage formula feeding, but breastfeeding can be supported under certain circumstances. Infant-feeding decisions often involve personal and social networks. Currently, little research addresses how individuals with HIV in high-income countries navigate infant-feeding decisions with the father of their children. Methods: Semi-structured remote interviews were conducted with UK-based individuals with a confirmed HIV positive diagnosis who were pregnant or one-year postpartum, and two partners. Using purposive sampling, pregnant and postpartum participants were recruited through HIV NHS clinics and community-based organisations, and where possible, fathers were recruited via them. Data were analysed using thematic analysis and organised using NVivo 12. Results: Of the 36 women interviewed, 28 were postpartum. The majority were of Black African descent (n = 22) and born outside the UK. The key factors in women navigating HIV and infant-feeding discussions with respect to their baby's father were the latter's: (1) awareness of woman's HIV status; (2) relationship with the woman; (3) confidence in infant-feeding decision; (4) support and opinion about woman's infant-feeding intentions. Most women made a joint decision with biological fathers when in a long-term (> one year) relationship with them. Single women tended not to discuss their infant-feeding decision with the father of their child, often for safety reasons. Conclusion: Women in ongoing relationships with the father of their child valued their support and opinions regarding infant-feeding. In contrast, single women chose not to involve the father for reasons of privacy and safety. Clinical teams and community-based organisations should support mothers in discussing infant-feeding decisions regardless of relationship status. When appropriate, they should also support discussions with their partners, but remain sensitive to circumstances where this may put women at risk. [ABSTRACT FROM AUTHOR]

Copyright of People & Nature is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Open dialogue (OD) is a person-centred social network model of crisis and continuing mental healthcare, which promotes agency and long-term recovery in mental illness. Peer support workers who have lived experience of mental illness play a key role in OD in the UK, as they enhance shared understanding of mental health crisis as part of the OD model and provide a sense of belonging and social inclusion. These elements are in alignment with the shared decision making (SDM) approach in mental health, which focuses on person-centred communication in treatment decision-making. The previously documented benefits of peer-led SDM include increased engagement with services, symptom reduction, increased employment opportunities, and reduced utilization of mental and general health services. While the contribution of peer support and SDM principles to OD has been acknowledged, there is only a small body of literature surrounding this development, and little guidance on how peer support can enhance treatment decision-making and other aspects of OD. This viewpoint, which was co-authored by people with lived experience of mental illness, clinicians, and researchers, discusses practical implications and recommendations for research and training for the provision of a co-produced OD model grounded in peer support and SDM. [ABSTRACT FROM AUTHOR]

Background: Individuals with primary and secondary immunodeficiency (PID/SID) were showntobeat riskofpooroutcomesduringtheearly stagesoftheSARS-CoV-2pandemic. SARS-CoV-2 vaccines demonstrate reduced immunogenicity in these patients. Objectives: To understand whether the risk of severe COVID-19 in individuals with PID or SID has changed following the deployment of vaccination and therapeutics in the context of the emergence of novel viral variants of concern. Methods: The outcomes of two cohorts of patients with PID and SID were compared: the first, infected between March and July 2020, prior to vaccination and treatments, the second after these intervention became available between January 2021 and April 2022. Results: 22.7% of immunodeficient patients have been infected at least once with SARS-CoV-2 since the start of the pandemic, compared to over 70% of the general population. Immunodeficient patients were typically infected later in the pandemic when the B.1.1.529 (Omicron) variant was dominant. This delay was associated with receipt of more vaccine doses and higher pre-infection seroprevalence. Compared to March-July 2020, hospitalization rates (53.3% vs 17.9%, p<0.0001) and mortality (Infection fatality rate 20.0% vs 3.4%, p=0.0003) have significantly reduced for patients with PID but remain elevated compared to the general population. The presence of a serological response to vaccination was associated with a reduced duration of viral detection by PCR in the nasopharynx. Early outpatient treatment with antivirals or monoclonal antibodies reduced hospitalization during the Omicron wave. Conclusions: Most individuals with immunodeficiency in the United Kingdom remain SARS-CoV-2 infection naïve. Vaccination, widespread availability of outpatient treatments and, possibly, the emergence of the B.1.1.529 variant have led to significant improvements in morbidity and mortality followings SARS-CoV-2 infection since the start of the pandemic. However, individuals with PID and SID remain at significantly increased risk of poor outcomes compared to the general population; mitigation, vaccination and treatment strategies must be optimized to minimize the ongoing burden of the pandemic in these vulnerable cohorts. [ABSTRACT FROM AUTHOR]

Home visitors can support parents who have low levels of emotional well-being. While support may be effective for some families, the circumstances in which it is effective are less well understood. Longitudinal administrative data from Home-Start UK were analysed to identify how the nature of support was related to changes in parental emotional well-being, and whether these effects were the same for families with different risk factors. Sub-groups were identified of people experiencing problems with various aspects of emotional well-being: mental ill health (n  = 1,289), social isolation (n  = 1,413) and low self-esteem (n  = 1,400). Multiple linear regression models were used to explore the relationships between the nature of support and the rate of improvement. These effects were considered in subgroups of families with domestic violence problems, disabled parents, a disabled child, large family sizes or multiple risks. More frequent visits and support being provided by paid workers, as opposed to volunteers were related to faster improvements. Paid worker support was particularly related to faster improvements in families with domestic abuse, disabled parents and multiple risks. However, volunteer support seemed just as effective for large families and those with disabled children. These findings have implications for those providing and commissioning home visiting services. [ABSTRACT FROM AUTHOR]

Background: In the absence of research into therapies and care pathways for long COVID, guidance based on 'emerging experience' is needed.Aim: To provide a rapid expert guide for GPs and long COVID clinical services.Design and Setting: A Delphi study was conducted with a panel of primary and secondary care doctors.Method: Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of 'strongly agree', 'agree', or 'neither agree nor disagree' from 90% or more of responders were taken as showing consensus.Results: Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support.Conclusion: Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed. [ABSTRACT FROM AUTHOR]

The findings of the Archbishop’s Council in their 2004 report, to the effect that traditional forms of church in Britain are under threat because of changing cultural patterns, emphasise the need to re-think church for our contemporary contexts. The ‘Fresh Expressions of church’ movement is one such initiative identified and approved of by the Archbishop’s Council. This article reports on research undertaken in a practical theological interpretation of The Filling Station, a Christian ministry that has grown significantly in its 10-year history and was formed as a missional endeavour in recognition of declining church attendance in traditional churches in Britain. This work explores whether The Filling Station is a Fresh Expression of church and whether it meets the values of authentic missional churches. In examining whether The Filling Station ought to be considered for import into appropriate local congregational contexts, it enquires whether it satisfactorily addresses prevailing social trends affecting churches, including consumerism and the need for identity. [ABSTRACT FROM AUTHOR]

The Mental Capacity Act requires that where a person (P) lacks capacity to make a decision her wishes and feelings be taken into account when deciding what is in her best interests. This article considers how the Court of Protection evaluates evidence from P concerning her wishes and feelings. It finds that the Court ignores evidence regarding current wishes and fails to engage with more ambiguous evidence where P desires conflicting outcomes or may be concealing her true feelings. This is unhelpful since it makes the resulting judgment unconvincing to observers. It is legally problematic, since the Court should be following the practices of other decision-makers under the Mental Capacity Act (MCA). And it is ethically problematic since it undermines P's dignity and does not treat P as an actor whose evidence regarding her wishes and feelings has intrinsic status which the Court must make active efforts to engage with or discount rather than ignore. [ABSTRACT FROM AUTHOR]

Background Usher syndrome (USH) is an autosomal recessive disorder comprising retinitis pigmentosa, hearing loss and, in some cases, vestibular dysfunction. It is clinically and genetically heterogeneous with three distinctive clinical types (I–III) and nine Usher genes identified. This study is a comprehensive clinical and genetic analysis of 172 Usher patients and evaluates the contribution of digenic inheritance. Methods The genes MYO7A, USH1C, CDH23, PCDH15, USH1G, USH2A, GPR98, WHRN, CLRN1 and the candidate gene SLC4A7 were sequenced in 172 UK Usher patients, regardless of clinical type. Results No subject had definite mutations (nonsense, frameshift or consensus splice site mutations) in two different USH genes. Novel missense variants were classified UV1-4 (unclassified variant): UV4 is 'probably pathogenic', based on control frequency <0.23%, identification in trans to a pathogenic/probably pathogenic mutation and segregation with USH in only one family; and UV3 ('likely pathogenic') as above, but no information on phase. Overall 79% of identified pathogenic/UV4/UV3 variants were truncating and 21% were missense changes. MYO7A accounted for 53.2%, and USH1C for 14.9% of USH1 families (USH1C: c.496+1G>A being the most common USH1 mutation in the cohort). USH2A was responsible for 79.3% of USH2 families and GPR98 for only 6.6%. No mutations were found in USH1G, WHRN or SLC4A7. Conclusions One or two pathogenic/likely pathogenic variants were identified in 86% of cases. No convincing cases of digenic inheritance were found. It is concluded that digenic inheritance does not make a significant contribution to Usher syndrome; the observation of multiple variants in different genes is likely to reflect polymorphic variation, rather than digenic effects. [ABSTRACT FROM AUTHOR]

Purpose--This paper's aim is to analyses ethnic group differences in self reported limiting long term illness (LLTI) among middle-aged men and women in England and Wales and compare patterns of variation in 1991 and2001. Design/methodology/approach--The methodology is a cross-sectional analysis of two nationally representative cohorts aged 40-59 in 1991 and 2001, respectively. Seven ethnic minority groups were selected from the Office for National Statistics Longitudinal Study of England and Wales (White Irish, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African and Chinese). Logistic regression estimated the odds ratio for having a LLTI in each ethnic minority group compared to White British. The odds of having a LLTI in 2001 compared to 1991, by sex, were adjusted stepwise for differences in age, social class, car ownership, household overcrowding and tenure and length of residence. Findings--All ethnic groups reported a higher prevalence of LLTI in 2001 than in 1991. The rise in LLTI was largest in White Irish, Bangladeshi and Pakistani and smallest in Black African and Chinese groups. Controlling for socioeconomic factors had a weak influence on the risk of limiting long term illness in men and women. Controlling for length of residence attenuated the risk of LLTI in 2001 in White Irish and Pakistani men, and Indian men and women. Practical implications- Emerging ethnic differences highlight a growing need for differential health services to manage the increase in LLTI and demands for illness management. Originality/value--The paper illustrates that ethnic differences in LLTI changed during the 1990s with some groups becoming more disadvantaged relative to the White British population and others less so. [ABSTRACT FROM AUTHOR]

The period between 1950 and 1975 marked a dramatic shift in food retailing in Britain with the introduction of self-service stores and supermarkets. It also witnessed a significant rise in shoplifting, which many contemporary observers blamed on the introduction of self-service retailing. Using material from the retail trade press, newspaper reports, contemporary academic and marketing studies, and the publications of consumer associations, this article reflects on the fractured nature of the public discourse surrounding shoplifting in the early post-war period and looks at the factors that made self-service food retailing such a potentially problematic innovation. We argue that an ambivalence arose because shoplifting was regarded as a 'housewives' crime', and because of some of the specific characteristics of the self-service innovation. The introduction of self-service retailing not only fundamentally altered the relationship between consumers and retailers, and between consumers and goods, but had the effect of throwing into question existing definitions and perceptions of consumer crime. This article will show that there was considerable public debate and disagreement over who was to blame for the sudden surge in the crime, over what could be done to prevent it, and over how to treat those accused and convicted of shoplifting. Some of the ambiguities in public responses to shoplifting evident in our period were witnessed in the earlier experiences of the nineteenth-century department store. Then, as in the 1950s, public debate on the causes of shoplifting occurred within the context of broader critiques of consumerism. [ABSTRACT FROM AUTHOR]

Background: Most research on the mental health of UK armed forces personnel has been conducted either before or after deployment; there is scant evidence concerning personnel while they are on deployment.Aims: To assess the mental health of UK armed forces personnel deployed in Iraq and identify gaps in the provision of support on operations.Method: Personnel completed a questionnaire about their deployment experiences and health status. Primary outcomes were psychological distress (General Health Questionnaire-12, GHQ-12), symptoms of post-traumatic stress disorder (PTSD) and self-rating of overall health.Results: Of 611 participants, 20.5% scored above the cut-off on the GHQ-12 and 3.4% scored as having probable PTSD. Higher risk of psychological distress was associated with younger age, female gender, weaker unit cohesion, poorer perceived leadership and non-receipt of a pre-deployment stress brief. Perceived threat to life, poorer perceived leadership and non-receipt of a stress brief were risk factors for symptoms of PTSD. Better self-rated overall health was associated with being a commissioned officer, stronger unit cohesion and having taken a period of rest and recuperation. Personnel who reported sick for any reason during deployment were more likely to report psychological symptoms. Around 11% reported currently being interested in receiving help for a psychological problem.Conclusions: In an established operational theatre the prevalence of common psychopathology was similar to rates found in non-deployed military samples. However, there remains scope for further improving in-theatre support mechanisms, raising awareness of the link between reporting sick and mental health and ensuring implementation of current policy to deliver pre-deployment stress briefs. [ABSTRACT FROM AUTHOR]

The advent of self-service and supermarket retailing marked a significant departure from the counter-service format that had dominated food shopping in - Britain until the 1950s. But reactions of shoppers to this new mode of shopping are poorly understood. The Reconstructing Consumer Landscapes Project was designed to cast light on the complexities of consumer reaction to changes in food shopping between 1945 and 1975 through a large-scale survey combined with one hundred and twenty-two semi-structured oral history interviews. This article introduces approaches to understanding consumers, and looks, in particular at the ways in which academic scholars have characterised the reactions of consumers to the rise of self-service and supermarket shopping. The article then highlights some of the strengths we observed in our use of oral history interviewing in reconstructing the experiences of shoppers in early supermarkets. We also discuss our use of a content analysis approach to analyse material from the interviews and what this has revealed about consumer reactions as seen in interviewees' accounts of their first experiences of supermarket shopping. [ABSTRACT FROM AUTHOR]

Examines judicial perspectives on the relevance of prior sexual history in serious sex offense cases under section 41 of the British Youth Justice and Criminal Evidence Act 1999. Opinion of judges on the act's provision; Overview of judicial discretion and rape shield legislation in other jurisdictions; Similarities between section 41 of the act and the Canadian twin myths model.

Presents an update on the progress in the development of children's commissioners across Great Britain, as of January 2003. Provisions in the 1991 United Nations Convention on the Rights of the Child concerning the establishment of children's commissioners; Variations in the legislation that have developed in the different regions of the country.

A letter to the editor is presented in response to an article by Stephen May on developing a scholarship of primary health care in the June 27, 2015 issue.

A letter to the editor is presented on cross-species transmission of equine influenza virus in Great Britain.

A letter to the editor is presented discussing British legislation governing the use of medical devices for cognitive enhancement as of 2013.

Objectives: To determine the utility of an in-practice test kit to detect protective serum antibody against canine distemper virus, canine adenovirus and canine parvovirus type 2 in a sample of the UK dog population., Materials and Methods: Serum samples from 486 dogs, last vaccinated between less than 1 month and 124 months previously, were tested with the VacciCheck™ test kit for protective antibodies against distemper, adenovirus and parvovirus type 2., Results: A high proportion of the dogs tested (93·6%) had protective antibody against all three of the core vaccine antigens: 95·7% of the dogs were seropositive against canine distemper virus, 97·3% against canine adenovirus and 98·5% against canine parvovirus type 2. The small number of dogs that were seronegative for one or more of the antigens (n = 31) may have had waning of previous serum antibody or may have been rare genetic non-responders to that specific antigen., Clinical Significance: UK veterinarians can be reassured that triennial revaccination of adult dogs with core vaccines provides long-lived protective immunity. In-practice serological test kits are a valuable tool for informing decision-making about canine core revaccination., (© 2017 British Small Animal Veterinary Association.)