Browsing by Author "Walker, S."

Now showing 1 - 13 of 13

Associations between ADHD symptoms and maternal and birth outcomes: An exploratory analysis in a multi-country cohort of expectant mothers
(SAGE Publications, 2022) Murray, A.L.; Taut, D; Baban, A.; Hemady, C.L.; Walker, S.; Osafo, J.; Sikander, S.; Tomlinson, M.; Toit, S.D.; Marlow, M.; Ward, C.L.; Fernando, A.; Madrid, B.; Van, T.V.; Tuyen, H.D.; Dunne, M.; Hughes, C.; Fearon, P.; Valdebenito, S.; Eisner, M.
OBJECTIVE: ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and fetal development; however, there has been almost no research examining their impact during pregnancy. We aimed to address this gap. METHOD: We used data (n = 1,204) from a longitudinal birth cohort study spanning eight countries to address this gap. RESULTS: ADHD symptoms in the third trimester of pregnancy were associated with lower social support from family (b = -0.16, p = .031), friends (b = -0.16, p = .024), and significant others (b = -0.09, p = .001); higher stress (b = 0.34, p < .001) and depressive symptoms (b = 0.31, p < .001), and increased likelihood of an unwanted pregnancy (b = 0.30, p = .009). Significant associations with tobacco use (b = 0.36, p = .023) and premature birth (b = 0.35, p = .007) did not survive correction for multiple comparisons and there were no significant associations with alcohol use, low birth weight, or unplanned pregnancy. CONCLUSION: Results suggest that women with ADHD symptoms could benefit from earlier, more regular screening for mental health difficulties and greater mental health support during pregnancy.
Correction to: Prenatal attachment: Using measurement invariance to test the validity of comparisons across eight culturally diverse countries
(Springer, 2021) Foley, S.; Hughes, C.; Murray, A.L.; Baban, A.; Fernando, A.D.; Madrid, B.; Osafo, J.; Sikander, S.; Abbasi, F.; Walker, S.; Van, T.V.; Luong-Thanh, B.Y.; Tomlinson, M.; Fearon, P.; Ward, C.L.; Valdebenito, S.; Eisner, M.
[This corrects the article Archives of Women's Mental Health.2021; 24(4): 619-625] Erratum for Prenatal attachment: using measurement invariance to test the validity of comparisons across eight culturally diverse countries
The Impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries
(Elsevier/North-Holland Biomedical Press., 2021) Brown, R.H.; Eisner, M.; Walker, S.; Tomlinson, M.; Fearon, P.; Dunne, M.P.; Valdebenito, S.; Hughes, C.; Ward, C.L.; Sikander, S.; Osafo, J.; Madrid, B.; Baban, A.; Van Thang, V.; Fernando, A.D.; Murray, A.L.
BACKGROUND: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. METHODS: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement. RESULTS: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. LIMITATIONS: As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. CONCLUSIONS: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage. KEYWORDS: Adverse childhood experiences; Birth cohort; Depressive symptoms; Maternal-foetal-attachment; Prenatal.
The Intergenerational effects of intimate partner violence in pregnancy: mediating pathways and implications for prevention.
(Sage Publications, 2020) Murray, A. L.; Kaiser, D.; Valdebenito, S.; Hughes, C.; Baban, A.; Fernando, A.D.; Madrid, B.; Ward, C. L.; Osafo, J.; Dunne, M.; Sikander, S.; Walker, S.; Van Thang, V.; Tomlinson, M.; Eisner, M.
Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal-fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPV
Measuring antenatal depressive symptoms across the world: A validation and cross-country invariance analysis of the Patient Health Questionnaire-9 (PHQ-9) in eight diverse low-resource settings
(American Psychological Association, 2022) Murray, A.L.; Hemady, C.L.; Do, H.; Dunne, M.; Foley, S.; Osafo, J.; Sikander, S.; Madrid, B.; Baban, A.; Taut, D.; Ward, C.L.; Fernando, A.; Thang, V.V.; Eisner, M.; Hughes, C.; Fearon, P.; Valdebenito, S.; Tomlinson, M.; Pathmeswaran, A.; Walker, S.
Measures that produce valid and reliable antenatal depressive symptom scores in low-resource country contexts are important for efforts to illuminate risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates analyses of similarities and differences across contexts. To date, however, few studies have evaluated the psychometric properties and comparability of the most widely used antenatal depressive symptom measures across diverse cultural, political, and social contexts. To address this gap, we used data from the Evidence for Better Lives Study-Foundational Research (EBLS-FR) project to examine the internal consistency reliability, nomological network validity, and cross-country measurement invariance of the nine-item version of the Patient Health Questionnaire (PHQ-9) in antenatal samples across eight low-resource contexts. We found that the PHQ-9 scores had good internal consistency across all eight countries. Correlations between PHQ-9 scores and constructs conceptually associated with depression were generally consistent, with a few exceptions. In measurement invariance analyses, only partial metric invariance held and only across four of the countries. Our results suggest that the PHQ-9 yields internally consistent scores when administered in culturally diverse antenatal populations; however, the meaning of the scores may vary. Thus, interpretation of PHQ-9 scores should consider local meanings of symptoms of depression to ensure that context-specific conceptualizations and manifestations of antenatal depressive symptoms are adequately reflected. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Molecular phylogeny of Bipolaris and Curvularia species associated with browntop millet.
(International Research Symposium on Pure and Applied Sciences, 2017 Faculty of Science, University of Kelaniya, Sri Lanka., 2017) Manamgoda, D. S.; Bauchan, G. R.; Berry, A.; Walker, S.; Castlebury, L.A.
Browntop millet (Urochloa ramosa, Poaceae) is a warm season grass commonly used as a cover crop in pasture management systems. This species is inexpensive compared to other forage crops and its ability to easily reseed and to remain viable in the soil for years makes browntop millet an excellent regenerating food plot for wildlife. The genera Bipolaris and Curvularia (Pleosporaceae) are closely related and comprise many pathogenic species associated with poaceous hosts. Of these, only B. setariae and C. hawaiiensis have previously been reported from U. ramosa. The taxa belonging in these sister genera are often difficult to identify based on morphology alone, especially when co-occurring on a single host. In May 2015, infected seeds of U. ramosa grown in Tifton, Georgia, USA were observed and collected. Conidia and conidiophores were observed using compound and dissecting light microscopy. Single spore isolation techniques were used to obtain pure cultures, which were also observed scanning electron microscopy. Genomic DNA was extracted from isolates of Bipolaris and Curvularia using the DNeasy Plant Mini Kit (Qiagen). The ITS, GPDH, TEF and RPB gene regions were amplified and the resulting amplicons were sequenced using the BigDye Terminator v. 3.1 on an Applied Biosystems 3130xl Genetic Analyzer. Phylogenetic analyses were carried out using maximum parsimony and maximum likelihood methods. Five Curvularia and nine Bipolaris cultures were isolated, and a total of 42 new DNA sequences were generated in this study. GPDH gene region resolved most species in both genera. Maximum parsimony analysis of combined ITS, GPDH and TEF loci for Bipolaris included 58 isolates and 81 isolates for Curvularia. Based on morphological and phylogenetic data, the isolates found on the seeds of U. ramosa are identified as Bipolaris yamadai, Curvularia geniculata and a previously undescribed species of Curvularia. To our knowledge, these are the first records of these fungal species in association with U. ramosa. Surface ornamentation and texture of Curvularia conidia were clearly observed under SEM than under light microscope. Although other conidial cells are smooth, basal cell of the conidium can be either smooth or verrucose and this was used as a morphological character to delimit some members of the “geniculata” group. Curvularia geniculata, C. urochloae and B. yamadai had conidia with smooth basal cell under SEM. Therefore SEM imaging will be useful to observe micromorphological characters that are difficult to distinguish using conventional light microscopy. The discovery of these potentially pathogenic fungi on an economically important host provides new insights for disease surveillance to plant pathologists, quarantine officials and others with interests in plant disease management.
Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding: A survey of all UK medical schools
(SAGE Publications, 2017) Walker, S.; Gibbins, J.; Paes, P.; Adams, A.; Chandratilake, M.; Gishen, F.; Lodge, P.; Wee, B.; Barclay, S.
BACKGROUND: A proportion of newly qualified doctors report feeling unprepared to manage patients with palliative care and end-of-life needs. This may be related to barriers within their institution during undergraduate training. Information is limited regarding the current organisation of palliative care teaching across UK medical schools. AIMS: To investigate the evolution and structure of palliative care teaching at UK medical schools. DESIGN: Anonymised, web-based questionnaire. Settings/participants: Results were obtained from palliative care course organisers at all 30 UK medical schools. RESULTS: The palliative care course was established through active planning (13/30, 43%), ad hoc development (10, 33%) or combination of approaches (7, 23%). The place of palliative care teaching within the curriculum varied. A student-selected palliative care component was offered by 29/30 (97%). All medical schools sought student feedback. The course was reviewed in 26/30 (87%) but not in 4. Similarly, a course organiser was responsible for the palliative care programme in 26/30 but not in 4. A total of 22 respondents spent a mean of 3.9 h (median 2.5)/week in supporting/delivering palliative care education (<1-16 h). In all, 17/29 (59%) had attended a teaching course or shared duties with a colleague who had done so. Course organisers received titular recognition in 18/27 (67%; no title 9 (33%); unknown 3 (11%)). An academic department of Palliative Medicine existed in 12/30 (40%) medical schools. Funding was not universally transparent. Palliative care teaching was associated with some form of funding in 20/30 (66%). CONCLUSION: Development, organisation, course evaluation and funding for palliative care teaching at UK medical schools are variable. This may have implications for delivery of effective palliative care education for medical students.
Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: a latent class analysis
(BioMed Central,London, 2022) Hemady, C.L.; Speyer, L.G.; Murray, A.L.; Brown, R.H.; Meinck, F.; Fry, D.; Do, H.; Sikander, S.; Madrid, B.; Fernando, A.; Walker, S.; Dunne, M.; Foley, S.; Hughes, C.; Osafo, J.; Baban, A.; Taut, D.; Ward, C.L.; Thang, V.V.; Fearon, P.; Tomlinson, M.; Valdebenito, S.; Eisner, M.
Background: This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). Methods: A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed. Results: Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes.Conclusion: Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.
Perceived stress during the prenatal period: assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity
(Springer, 2022) Katus, L.; Foley, S.; Murray, A.L.; Thanh, B.Y.L.; Taut, D.; Baban, A.; Madrid, B.; Fernando, A.D.; Sikander, S.; Ward, C.L.; Osafo, J.; Marlow, M.; Toit, S.D.; Walker, S.; Van Vo, T.; Fearon, P.; Valdebenito, S.; Eisner, M.P.; Hughes, C.
Maternal prenatal stress places a substantial burden on mother's mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pregnancy losses) and adverse life circumstances (e.g. poverty, community violence), put mothers at increased risk of experiencing prenatal stress. The ten-item Perceived Stress Scale (PSS-10) is a widely recognised index of subjective experience of stress that is increasingly used in LMICs. However, evidence for its measurement equivalence across settings is lacking. This study aims to assess measurement invariance of the PSS-10 across eight LMICs and across birth parity. This research was carried out as part of the Evidence for Better Lives Study (EBLS, vrc.crim.cam.ac.uk/vrcresearch/EBLS). The PSS-10 was administered to N = 1,208 expectant mothers from Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam during the third trimester of pregnancy. Confirmatory factor analysis suggested a good model fit of a two-factor model across all sites, with items on experiences of stress loading onto a negative factor and items on perceived coping onto a positive factor. Configural and metric, but not full or partial scalar invariance, were established across all sites. Configural, metric and full scalar invariance could be established across birth parity. On average, first-time mothers reported less stress than mothers who already had children. Our findings indicate that the PSS-10 holds utility in assessing stress across a broad range of culturally diverse settings; however, caution should be taken when comparing mean stress levels across sites.
Prenatal attachment: using measurement invariance to test the validity of comparisons across eight culturally diverse countries
(Springer, 2021) Foley, S.; Hughes, C.; Murray, A.L.; Baban, A.; Fernando, A.D.; Madrid, B.; Osafo, J.; Sikander, S.; Abbasi, F.; Walker, S.; Luong-Thanh, B.Y.; Bảo, Y.L.T.; Tomlinson, M.; Fearon, P.; Ward, C.L.; Valdebenito, S.; Eisner, M.
ABSTRACT: Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18-48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk. KEYWORDS: Cross-cultural; Lower-middle income; Maternal-fetal attachment; Measurement invariance; Parity; Pregnancy.
Preparing future doctors for palliative care: views of course organisers
(BMJ Publishing Group, 2018) Walker, S.; Gibbins, J.; Paes, P.; Barclay, S.; Adams, A.; Chandratilake, M.; Gishen, F.; Lodge, P.; Wee, B.
BACKGROUND: Effective training at medical school is essential to prepare new doctors to safely manage patients with palliative care (PC) and end of life care (EOLC) needs. The contribution of undergraduate PC course organisers is central but their collective views regarding role are unknown. OBJECTIVE: To survey attitudes of PC course organisers regarding their course, organisation, the adequacy of training provided and level of personal satisfaction. METHODS: An anonymised, multifactorial, web-based questionnaire was devised, tested, modified and then sent to lead PC course organisers at all UK medical schools. RESULTS: Data were obtained from all 30 UK medical schools. Organisers agreed/strongly agreed (=agreed) that their PC course was highly rated by students (26, 87%). 25 (83%) agreed their course 'enabled misconceptions and fears about PC, death, dying and bereavement to be addressed', 'delivered quality PC training' (23, 77%), 'fulfilled General Medical Council requirements' (19, 63%), 'prepared students well to care for patients with PC/EOLC needs' (18, 60%) and 'enabled students to visit a hospice and see the role of doctors in caring for the dying' (17, 57%). Concerns were limited capacity to accommodate students (agreed 20, 66%) and variability in teaching according to location (15, 50%). Most agreed their institution recognised PC training as important (22, 73%), they felt supported by colleagues (21, 70%) and experienced cooperation between stakeholders (20, 67%). All agreed that PC training was essential for undergraduates, while 29 (97%) supported inclusion of a hospice visit in the curriculum. 27 agreed that their role was satisfying (90%), 3 disagreed (10%). CONCLUSIONS: Approximately two-thirds of organisers were generally positive about their PC course, institution and role. A minority expressed concerns; these may reflect suboptimal PC training at their medical school and poor preparation of new doctors.
Progress and divergence in palliativecare education for medical students: A comparative survey of UK course structure, content, delivery, contact with patients and assessment of learning
(SAGE Publications, 2016) Walker, S.; Gibbins, J.; Barclay, S.; Adams, A.; Paes, P.; Chandratilake, M.; Gishen, F.; Lodge, P.; Wee, B.
BACKGROUND: Effective undergraduate education is required to enable newly qualified doctors to safely care for patients with palliative care and end-of-life needs. The status of palliative care teaching for UK medical students is unknown. AIM: To investigate palliative care training at UK medical schools and compare with data collected in 2000. DESIGN: An anonymised, web-based multifactorial questionnaire. SETTINGS/PARTICIPANTS: Results were obtained from palliative care course organisers at all 30 medical schools in 2013 and compared with 23 medical schools (24 programmes) in 2000. RESULTS: All continue to deliver mandatory teaching on 'last days of life, death and bereavement'. Time devoted to palliative care teaching time varied (2000: 6-100 h, mean 20 h; 2013: 7-98 h, mean 36 h, median 25 h). Current palliative care teaching is more integrated. There was little change in core topics and teaching methods. New features include 'involvement in clinical areas', participation of patient and carers and attendance at multidisciplinary team meetings. Hospice visits are offered (22/24 (92%) vs 27/30 (90%)) although they do not always involve patient contact. There has been an increase in students' assessments (2000: 6/24, 25% vs 2013: 25/30, 83%) using a mixture of formative and summative methods. Some course organisers lack an overview of what is delivered locally. CONCLUSION: Undergraduate palliative care training continues to evolve with greater integration, increased teaching, new delivery methods and wider assessment. There is a trend towards increased patient contact and clinical involvement. A minority of medical schools offer limited teaching and patient contact which could impact on the delivery of safe palliative care by newly qualified doctors.
What research questions should the next generation of birth cohort studies address? An International delphi study of experts
(Elsevier, 2021) Brown, R. H.; Eisner, M.; Valdebenito, S.; Walker, S.; Tomlinson, M.; Hughes, C.; Ward, C. L.; Osafo, J.; Sikander, S.; Fearon, P.; Dunne, M. P.; Madrid, B.; Baban, A.; Van Thang, V.; Fernando, A. D.; Murray, A. L.
OBJECTIVE: Birth cohort studies (BCS) have generated a wealth of invaluable basic scientific and policy-relevant information on a wide range of issues in child health and development. This study sought to explore what research questions are currently a priority for the next generation of BCS using a 3-round Delphi survey of interdisciplinary experts. METHODS: Twenty-four (Round I, N = 17; Round II, N = 21; Round III, N = 18) experts across a wide range of fields (eg, psychology, public health, and maternal/child health) agreed to participate. In Round I, the expert panel was invited to freely respond to the question, "what are the key scientific questions future birth cohort studies should address?" Content analysis of answers was used to identify 47 questions for rating on perceived importance by the panel in Round II and consensus-achieving questions were identified. Questions that did not reach consensus in Round II were posed again for expert re-rating in Round III. RESULTS: Twenty six of 47 questions reached consensus in Round II, with an additional 6 reaching consensus in Round III. Consensus-achieving questions rated highly on importance spanned a number of topics, including environmental effects on child development, intergenerational transmission of disadvantage, and designing BCS to inform intervention strategies. CONCLUSION: Investigating the effects of family/environmental factors and social disadvantage on a child's development should be prioritized in designing future BCS. The panel also recommended that future BCS are designed to inform intervention strategies. KEYWORS: Delphi method; birth cohort studies; consensus; research priorities.