No description available.

No description available.

No description available.

No description available.

The global prediction of diabetes mellitus as forecasted by the World Health Organisation (WHO) is sombre. Accordingly, by the year 2025 the number of adults likely to be affected by diabetes has been predicted to rise to approximately 300 million. As a non-communicable disease diabetes has a tendency to indiscriminately affect individuals of any age (irrespective of gender) and culture. Diabetes Mellitus does not fully respond to medical treatment, either in the form of subcutaneous insulin or oral anti-diabetic agents, or even when a combination of both insulin and tablets are prescribed. Instead, management needs to be further supplemented by diabetes self-care activities, a guise currently presented as 'self-care' and 'empowerment', in an attempt to retard or prevent· complications associated with diabetes. This cross-cultural qualitative case study therefore sought to explore the notion of non-compliance, which is a moral, analytical and prescriptive category often attached to the career profile of diabetic patients. A multi-method approach to data collection was adopted. This comprised of a semi-structured interview expounding on the multiplex aspects of care needed to be considered during diabetes self-care activities, a 35-item questionnaire which examined the diabetes self-care activities of participants over the preceding seven days and a 7-day health diary exploring the trajectory of diabetes management. A purposeful sample 25 Asians and 24 indigenous Caucasians agreed to participate in this study. Most were recruited from the local diabetic clinic by the Diabetic Specialist Nurse (DSN). A small percentage of the Asians became involved through a snowball effect. Except for the five English speaking Asians, data from the remaining twenty Asians were collected by three paid Asian interpreters. Their methodological implications were noted. The findings revealed that some variations in certain key aspects of diabetes self-care activities were apparent in both groups. Often 'non-compliance' was based on rational decisions made by the participants using practical everyday reasoning. 'Non-compliance' further appeared to have been compounded by ineffective communication. The economic status of many precluded them from purchasing blood glucose monitors while linguistic shortcomings prevented others from reading diabetic related booklets and/or pamphlets. Participants also tended to question the value of many of the self-care activities referred in this study as 'magical rites'. Further there was a tendency to disclose the diagnosis of diabetes to significant others. Two theories are also offered as a way of understanding non-compliance during the management of diabetes mellitus. The first relates to the use of magic as a closed system of logic enabling diabetic individuals to handle uncertainty while the second refers to the notion of stigma and tainted personality. Finally, this cross-cultural case study concludes by offering a number of recommendations likely to improve diabetes self-care activities.

Background: A wealth of studies has demonstrated the detrimental effects of exposure to maternal stress in utero on emotional psychopathology in childhood. Many of these effects have been attributed to foetal programming of offspring brain development during gestation. Research has also demonstrated an association between exposure to prenatal maternal depression and offspring childhood maltreatment. The main aim of this thesis is to investigate the long-term effects of offspring exposure to prenatal maternal depression on depressive psychopathology in young adulthood, and whether exposure to childhood maltreatment contributes to this association. Secondary aims are to characterise the biological characteristics of young adult offspring who were exposed to prenatal maternal depression, in terms of hypothalamic-pituitary-adrenal (HPA) axis function, inflammation and metabolic function. Previous research has shown that abnormalities in all three systems are associated with exposure to prenatal maternal depression, childhood maltreatment and depressive psychopathology. Methods: The sample comprised 103 offspring from the South London Child Development Study (SLCDS), a prospective longitudinal birth cohort study setup in 1986 that had followed mothers and their offspring from pregnancy to 16 years. This PhD thesis continued the SLCDS by assessing the offspring at age 25. Data on offspring exposure to depression in utero (20 and 36 weeks gestation), childhood maltreatment (birth to 17 years) and young adulthood DSM-IV depressive disorders (18 to 25 years) were obtained through one-to-one clinical interviews. Biological measures of offspring HPA axis function, inflammation and metabolic function were obtained at 25 years. Results: Offspring exposed to prenatal maternal depression were significantly more likely to have a DSM-IV depressive disorder in young adulthood (18 to 25 years) compared to offspring not so exposed. Offspring exposure to childhood maltreatment and further maternal depression during childhood were found individually to mediate this association. Offspring exposed to prenatal maternal depression also exhibited significantly greater systemic inflammation at 25 years compared to non-exposed offspring, whilst offspring exposed to childhood maltreatment demonstrated HPA axis abnormalities compared to non-exposed offspring. No effect of early life adversity on metabolic function was observed. Conclusions: Exposure to prenatal maternal depression results in persistent psychological and biological changes in the offspring that are observable during young adulthood. Childhood maltreatment contributes to these pathologies. These findings have direct implications for policy development and clinical practice: identification and treatment of maternal depression during pregnancy could have a direct impact on reducing levels of child maltreatment as well as depression in the young adult population.

Obesity, defined as a body mass index of 30 kg/m2 or more, has reached epidemic proportions globally, with more than one-and-a-half billion adults overweight and at least 500 million clinically obese. The prevalence of obesity in the UK has increased by over 300% since 1980. In the UK 24% of adult women are obese and one in six women at an antenatal booking clinic is obese. Obesity has the potential for several detrimental effects on both the mother and the baby. Obese mothers are more likely to develop pre-eclampsia and eclampsia, gestational diabetes and venous thromboembolism. In addition, obese pregnant women are more likely to be induced, often resulting in complicated deliveries such as emergency Caesarean section and shoulder dystocia. Obesity significantly increases the risk of maternal mortality during or after pregnancy. Babies born to obese mothers are at an increased risk of congenital abnormalities, preterm deliveries and stillbirth, and children exposed to maternal obesity are at an increased risk of developing metabolic syndrome in later life. The aim of this work was to assess the extent and potential for the prevention of adverse impacts of obesity in pregnancy. The specific objectives were to: summarise the literature on maternal obesity and adverse pregnancy outcome; perform an epidemiological analysis using local data of obesity in pregnancy; conduct a systematic review of existing evidence on lifestyle interventions for obesity in pregnancy; and to develop and evaluate a multi-component pilot study for a community-based intervention for maternal obesity in South London. Analysis of delivery data from South London between January 2004 and May 2012 showed the overall prevalence of maternal obesity to be 15%, with considerable variation by ethnic group. There was a strong association between rising body mass index and risk of adverse pregnancy outcome, especially diabetes. The effect of obesity on diabetes in pregnancy was more pronounced in Asians and Orientals compared to other ethnic groups. Calculations of population attributable risk fractions showed that, if we were able to prevent obesity before pregnancy in this population, around one-third of diabetes in pregnancy could be prevented. The data alluded to the fact that the benefit of obesity reduction would be greater in Blacks than in other ethnic groups because of the higher prevalence of obesity in this group. A complex community-based lifestyle intervention called the Community Activity and Nutrition (CAN) programme was developed for delivery by health trainers in children’s/Sure Start centres. The research showed that it is feasible to deliver the CAN intervention in children’s/Sure Start centres (Effra in Brixton, Jessop in Herne Hill and Jubilee in Tulse Hill) in an Inner London socially deprived community. The pilot study encountered problems with recruitment resulting from understaffing and lack of participant time. However, once recruited, retention on the programme was good. There was some evidence that the intervention improved selected clinical outcomes. Further work is ongoing to establish the clinical and cost effectiveness of the intervention. If CAN is shown to be clinically effective and cost-effective, the translation of this research and adoption by policy makers into the wider community may help to ameliorate the adverse outcomes associated with obesity in pregnancy.

Research into the psychological effects of reproductive decision-making when an individual has a diagnosis of Marfan syndrome, a genetically inherited and potentially life-threatening condition, is rare and mainly quantitative in nature. In response, this study has investigated the experience of couples’ decisionmaking to have a baby when a woman has been diagnosed with Marfan syndrome. The study was conducted using unstructured interview data, analysed using the qualitative methodology of Interpretative Phenomenological Analysis (IPA). The participants were six couples with a female diagnosis of Marfan syndrome. Five couples with children provided retrospective data and one couple making the decision to have a baby provided live data. Four superordinate themes emerged: her decision is already made; creating an informed decision; finding psychosocial support; existing with the fallout of the decision. The experience of decision-making was complex and multidimensional for the males, females and couples. The women demonstrated a strong drive to have a baby despite the 50/50 odds of having a child with Marfan syndrome, whereas the men described the tension between wanting a child and coping with the potentially life-threatening risks for a woman in pregnancy and childbirth. A compelling account of the couples’ difficulties in exploring their options and assessing the risks with medical professionals emerged. It is argued that this research provides important insights for counselling psychologists and other professionals when working with individuals and couples affected by Marfan syndrome and other genetically inherited conditions at the critical time of coping with reproductive decision-making.

Maternal overweight and obesity is associated with adverse pregnancy outcomes. Both women and healthcare professionals have expressed a desire for resources to adequately support pregnant women in successful weight management. The primary aim of this research was to identify any motivational deficits for healthy diet and physical activity behaviours in first-time mothers receiving routine antenatal education and in response develop an intervention that solved these deficits, therefore improving optimal weight gain during pregnancy. Application of the ARCS Model of Motivational Instructional Design (Keller, 1987) was undertaken using a mixed method approach with six interrelated phases: Phase one: Goal setting interventions for improving weight management during pregnancy were identified through a systematic literature review. Phase two: A motivational analysis of current antenatal instruction through non-participant observation. Phase three: Maternal motivation to eat a healthy diet and exercise was explored through one-to-one telephone interviews (n=9) and a theoretical measurement tool was developed and validated in a convenience sample (n= 196) of first-time mothers Phase four: Evidence generated in phases 1-3 was collated to create an overall audience motivational profile where lack of confidence-building instruction was identified as the key motivational problem. Phase five: Motivational objectives were established and appropriate ARCS model strategies selected to solve motivational deficits. Phase six: A new resource: "Yummy Tummies" was created and evaluated positively by maternity staff and women (n=11).

No description available.