Based on an ethnographic and mixed-methods research design, the article explores the social and interactive processes of disenfranchisement of perinatal grief through the mechanisms of silence, silencing and self-censorship in encounters between bereaved women and the social milieu. The analysis finds that disenfranchisement results from the constriction of the social space of bereavement along various lines of discourse, cultural values, practice and materiality, that include: the passing of time (expectations of a quick ‘recovery’); competing discourses of loss (simplistic-dominant vs. complex-subordinate meaning-making); the biometrics of pregnancy (lower gestational age being equated with less intense grief); gendered ideas of reproduction and feeling rules; asymmetries in social power; social spheres (hospital, home, community, support groups); socio-materialities and performance/ritual; and structural aspects of social and familial organization (gender, age, intergenerational and kin v. non-kin relations). These processes are intimately linked to the complication of grief by undermining support, meaning-making and continuing bonds.

This article explores the contexts, processes and motivations behind the administration of sedatives (minor tranquilisers) in the time around perinatal loss. Using a mixed methods design, an online survey of 796 women and 13 narrative interviews were conducted. The participants had experienced a stillbirth or termination of pregnancy from 16 weeks or a neonatal death in Spanish hospitals. The quantitative (univariate and CHAID decision-tree) and qualitative (narrative-linguistic) analysis found that sedative administration was pervasive across care contexts and appears to be naturalised despite contradicting practice recommendations. Sedative administration was associated with emotional control and avoidance of loss, lack of accompaniment and on occasion with managing disruptive patients. Lack of informed consent was very common, with little explanation of side-effects prior to administration. In the participants' narratives, health professionals tended to construct sedatives as benign, but for some women the effects were counterproductive to loss and grief and related to persistent regrets about decisions. The study concludes that, in the context of perinatal loss, sedative administration was highly integrated into the fabric of medicalised care. As a socio-political and cultural practice underscored by gender-based care dynamics, there seems to be an imbalance between benefit and risk to women's welfare.

Background Despite progress, stillbirth rates in many high- and upper-middle income countries remain high, and the majority of these deaths are preventable. We introduce the Ending Preventable Stillbirths (EPS) Scorecard for High- and Upper Middle-Income Countries, a tool to track progress against the Lancet’s 2016 EPS Series Call to Action, fostering transparency, consistency and accountability. Methods The Scorecard for EPS in High- and Upper-Middle Income Countries was adapted from the Scorecard for EPS in Low-Income Countries, which includes 20 indicators to track progress against the eight Call to Action targets. The Scorecard for High- and Upper-Middle Income Countries includes 23 indicators tracking progress against these same Call to Action targets. For this inaugural version of the Scorecard, 13 high- and upper-middle income countries supplied data. Data were collated and compared between and within countries. Results Data were complete for 15 of 23 indicators (65%). Five key issues were identified: (1) there is wide variation in stillbirth rates and related perinatal outcomes, (2) definitions of stillbirth and related perinatal outcomes vary widely across countries, (3) data on key risk factors for stillbirth are often missing and equity is not consistently tracked, (4) most countries lack guidelines and targets for critical areas for stillbirth prevention and care after stillbirth and have not set a national stillbirth rate target, and (5) most countries do not have mechanisms in place for reduction of stigma or guidelines around bereavement care. Conclusions This inaugural version of the Scorecard for High- and Upper-Middle Income Countries highlights important gaps in performance indicators for stillbirth both between and within countries. The Scorecard provides a basis for future assessment of progress and can be used to help hold individual countries accountable, especially for reducing stillbirth inequities in disadvantaged groups.

Abstract Objectives To investigate which objective (actions/interventions) and subjective (perceptions of care quality) outcomes of care following stillbirth or termination of pregnancy predict perceived care quality. Methods A cross-sectional descriptive study using an anonymous online survey. The population was women who had experienced a stillbirth or termination of pregnancy from ≥16 weeks of gestation, in the Spanish health system. Multiple sequential regression analysis was used to identify predictors of perceived care quality (satisfaction, willingness to recommend, competence and ability to provide loss-focused care). Results Results from 610 women were analysed. A significant regression equation (p<0.001) was found in each of the objective only and objective-subjective models. In the case of overall care (satisfaction-recommend composite), 72.0% of variance (adj. R2) was explained. In general, subjective evaluations of care are more potent predictors of perceived care quality than objective care interventions (e.g. autopsy performed). Feeling free to ‘express emotions’, ‘teamwork between doctors and nurses/midwives’, and ‘being well-informed of all steps and procedures’ were the three strongest predictors, followed by perception of ‘medical negligence’. Information provision and loss-focused interventions had the weakest influence, except in the specific ‘loss-focused’ model. Conclusions The results indicate that the ‘atmosphere’ of care is a transversal dimension related to the context of loss and trauma and has the single greatest influence on perceptions of care quality. It is necessary to use a specific ‘loss-focused’ care variable to adequately capture perceptions of the quality of bereavement care and a custom scale to measure the influence of care interventions on perceived quality.

Over the last decade, the rise of peer-to-peer online markets has become a major sociocultural and economic phenomena and been described as a collaborative or sharing economy. However, understanding their impact has been mired in controversy and disagreement. Proponents of the sharing economy hail its potential to be a panacea for many of the world’s problems, but more critical perspectives point to research that undermines these claims. The rapid growth of this type of activity has placed public administrators in particular under pressure to develop appropriate policy and regulation. However, policy development is severely hindered by a lack of data and suitable measurement techniques. Work to develop appropriate data measurement tends to focus on economic measurement at the expense of social and environmental impact. This research paper seeks to contribute to understanding this problem area by taking a comprehensive triple impact perspective (economic, social and environmental) of the object of study. Employing a Delphi technique, the research developed forty-seven impact indicators across the three areas of measurement.A lo largo de la última década, el crecimiento de las plataformas de intercambio entre iguales, descritas como economía colaborativa, representó un de los fenónenos económicos y socio-culturales más importantes. Los defensores de la economía colaborativa resaltan su potencial para convertirse en la panacea de los grandes problemas mundiales, mientras que las perspectivas críticas apuntan a investigaciones que contradicen estas ideas. El rápido crecimiento de este tipo de actividad ha puesto a la administración pública bajo la presión de tener que desarrollar medidas de regulación adecuadas. Sin embargo, el desarrollo de regulación en este sentido adolece gravemente de la falta de datos y de técnicas adecuadas para medir el impacto. Los intentos por medir este impacto están por lo general concentrads en producir indicadores económicos, a expensas de la medición del impacto social y medioambiental. Esta investigación trata de contribuir a esta cuestión desde una perspectiva holística que estudia el triple impacto (económico, social y medioambiental) de este objeto de estudio. Recurriendo a un estudio Delphi esta investigación ha desarrollado 47 indicadores de impacto en estas tres aéreas de medición.

BACKGROUND:Stillbirth, the death of a baby before birth, is associated with significant psychological and social consequences that can be mitigated by respectful and supportive bereavement care. The absence of high-level evidence to support the broad scope of perinatal bereavement practices means that offering a range of options identified as valued by parents has become an important indicator of care quality. This study aimed to describe bereavement care practices offered to parents across different high-income and middle-income countries.METHODS:An online survey of parents of stillborn babies was conducted between December 2014 and February 2015. Frequencies of nine practices were compared between high-income and middle-income countries. Differences in proportions of reported practices and their associated odds ratios were calculated to compare high-income and middle-income countries.RESULTS:Over three thousand parents (3041) with a self-reported stillbirth in the preceding five years from 40 countries responded. Fifteen countries had atleast 40 responses. Significant differences in the prevalence of offering nine bereavement care practices were reported by women in high-income countries (HICs) compared with women in middle-income countries (MICs). All nine practices were reported to occur significantly more frequently by women in HICs, including opportunity to see and hold their baby (OR = 4.8, 95% CI 4.0-5.9). The widespread occurrence of all nine practices was reported only for The Netherlands.CONCLUSIONS:Bereavement care after stillbirth varies between countries. Future research should look at why these differences occur, their impact on parents, and whether differences should be addressed, particularly how to support effective communication, decision-making, and follow-up care.

Background & Aims: Individuals with type 2 diabetes (T2DM) are at high risk of developing non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis/cirrhosis. Screening patients with T2DM and normal liver enzymes for NAFLD in primary care remains contentious. Our aim was to develop and assess a primary care pathway integrating two-tier (Fib-4 then transient elastography [TE]) liver fibrosis assessment, irrespective of aetiology, into routine annual review of all patients with T2DM. Methods: All patients aged -65 years and 2.0 for >65 years) underwent TE and were reviewed in secondary care if the liver stiffness measurement (LSM) was >8 kPa. The number of patients identified with advanced disease, service uptake, and predictors of advanced disease were assessed. Results: A total of 85/467 (18.5%) patients had raised Fib-4; 27/467(5.8%) were excluded as a result of frailty or known cirrhosis. A total of 58/467 (12.2%) were referred for TE. Twenty-five of 58 (43.1%) had an LSM of >8 kPa and 13/58 (22.4%) had an LSM >15 kPa; 4/58 (6.7%) did not attend and 5/58 (9.3%) had an invalid reading. Twenty of 440 (4.5%) patients were found to have advanced liver disease following specialist review, compared to 3 patients previously identified through standard care (odds ratio [OR] 6.71 [2.0-22.7] p = 0.0022). Alcohol (OR 1.05 [1.02-1.08] p = 0.001) and BMI (OR 1.09 [1.01-1.17] p = 0.021) were predictors of advanced disease, particularly drinking >14/21 units/week (p <0.0001) Conclusions: Incorporating 2-tier assessment of liver fibrosis into routine annual diabetes review in primary care significantly improves identification of advanced liver disease in patients with T2DM. Lay summary: People with type 2 diabetes are at increased risk of developing non-alcoholic fatty liver disease and developing more significant complications. This study looks at introducing screening for advanced liver disease into the annual diabetes reviews performed routinely in primary care; we found that significantly more people were identified as having significant liver disease through this pathway than with current standard care. (C) 2021 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).

Objective To assess the frequency of additional care, and parents' perceptions of quality, respectful care, in pregnancies subsequent to stillbirth. Design Multi‐language web‐based survey. Setting International. Population A total of 2716 parents, from 40 high‐ and middle‐income countries. Methods Data were obtained from a broader survey of parents' experiences following stillbirth. Data were analysed using descriptive statistics and stratified by geographic region. Subgroup analyses explored variation in additional care by gestational age at index stillbirth. Main outcome measures Frequency of additional care, and perceptions of quality, respectful care. Results The majority (66%) of parents conceived their subsequent pregnancy within 1 year of stillbirth. Additional antenatal care visits and ultrasound scans were provided for 67% and 70% of all parents, respectively, although there was wide variation across geographic regions. Care addressing psychosocial needs was less frequently provided, such as additional visits to a bereavement counsellor (10%) and access to named care provider's phone number (27%). Compared with parents whose stillbirth occurred at ≤ 29 weeks of gestation, parents whose stillbirth occurred at ≥ 30 weeks of gestation were more likely to receive various forms of additional care, particularly the option for early delivery after 37 weeks. Around half (47–63%) of all parents felt that elements of quality, respectful care were consistently applied, such as spending enough time with parents and involving parents in decision‐making. Conclusions Greater attention is required to providing thoughtful, empathic and collaborative care in all pregnancies following stillbirth. Specific education and training for health professionals is needed. Tweetable abstract More support for providing quality care in pregnancies after stillbirth is needed. Plain Language Summary Study rationale and design More than two million babies are stillborn every year. Most parents will conceive again soon after having a stillborn baby. These parents are more likely to have another stillborn baby in the next pregnancy than parents who have not had a stillborn baby before. The next pregnancy after stillbirth is often an extremely anxious time for parents, as they worry about whether their baby will survive. In this study we asked 2716 parents from 40 countries about the care they received during their first pregnancy after stillbirth. Parents were recruited mainly through the International Stillbirth Alliance and completed on online survey that was available in six languages. Findings Parents often had extra antenatal visits and extra ultrasound scans in the next pregnancy, but they rarely had extra emotional support. Also, many parents felt their care providers did not always listen to them and spend enough time with them, involve them in decisions, and take their concerns seriously. Parents were more likely to receive various forms of extra care in the next pregnancy if their baby had died later in pregnancy compared to earlier in pregnancy. Limitations In this study we only have information from parents who were able and willing to complete an online survey. Most of the parents were involved in charity and support groups and most parents lived in developed countries. We do not know how well the findings relate to other parents. Finally, our study does not include parents who may have tried for another pregnancy but were not able to conceive. Potential impact This study can help to improve care through the development of best practice guidelines for pregnancies following stillbirth. The results suggest that parents need better emotional support in these pregnancies, and more opportunities to participate actively in decisions about care. Extra support should be available no matter how far along in pregnancy the previous stillborn baby died.

The objective of the study was to evaluate practices in Spanish hospitals after intrauterine death in terms of medical/ technical care and bereavement support care.

Introduction In contrast to European guidelines, recent NICE and BSG guidelines state that further evidence is required to establish the cost-effectiveness of case-finding for non-alcoholic fatty liver disease (NAFLD) in high risk groups such as type 2 diabetics (T2DM) before it can be recommended. We present initial Results of a pilot of case-finding for NAFLD in T2DM patients in a GP practice in the North East of England using Fib4 scores, in order to assess the likely cost implications of such screening in the community. Methods 76 successive patients attending their GP practice for routine diabetic review had a Fib4 score calculated. Those who had Fib4 score above defined age-related cut offs (1.35 for <65 year olds,>2.00 for 65–80 year olds and >3.25 in over 80 year olds) were referred to secondary care for further evaluation (including fibroscan or liver biopsy). We looked at referral rates in order to extrapolate the number of likely referrals to secondary care and cost implications if this approach was rolled out across the local area. Results 76 successive patients were screened with Fib4 scores at diabetic review. 18 (23%) were female and 58 (77%) male, age 31–93 (mean age 64 yo) with a mean BMI of 31.08. Alcohol consumption ranged from 0–40 units with a mean of 5.4 units per week. Of 76 patients, 10 (13.15%) were found to have scores above the age related cut-off (mean age 69.8). None of these had previously been referred to secondary care. Of these, 8/10 (80%) had an ALT within ‘normal’ range and 4 (40%) had an ALT of <20, 4/10 (40% were thrombocytopenic (plt <150) and 8/10 (80%) had plt count <200. 6 of the 8 (75%) patients with raised ALT (>40) in the cohort had a Fib4 score below the age related cut-off. 5 were unsuitable for referral because of significant co-morbidities or inability to consent. 5/76 (6.57%) were referred to secondary care for consideration of Fibroscan/liver biopsy. Conclusions This initial pilot confirms that abnormal liver function tests do not correlate well with fibrosis scores, and diagnosis of NAFLD based on abnormal liver function tests are likely to miss patients with advanced fibrosis. Based on this initial pilot, the referral rate for Type 2 diabetics following Fib4 screening would be 6.57%. In our local area, with an estimated 10 000 patients with T2DM, this would generate an estimated 657 referrals. These patients would require ultrasound scans, secondary liver screens and fibroscan and/or liver biopsy to stage disease, and there would then be additional costs associated with surveillance of patients who are found to have advanced fibrosis or cirrhosis. The next step is to assess the patients referred via the pathway with Fibroscan/liver biopsy, to determine the proportion with advanced liver disease.

Although still embryonic, collaborative consumption and the sharing economy have become social and economic phenomena in just a few short years, yet there is little consensus on how to define them. The current classificatory schema or typologies of platforms have some weaknesses. Sectoral classifications, technological functionality, and discursive modes of understanding sharing and collaborative economies all provide valuable insights, but when taken individually important gaps are evident, not least in their inter-system isolation, but most particularly when technology, such as platform architecture and user interfaces, is disassociated from wider social and economic conditions of possibility. In order to build on previous research we set out to develop a more complex understanding of collaborative consumption by studying platform architecture, interface, design and informational content to examine how technological affordances of digital platforms' structure social interaction. In order to carry out the research we designed a netnographic protocol that systematised data collection across four dimensions of platforms' technological structure and informational content: functionality and usability; trust and virtual reputation; codes of conduct and community footprint. Data was collected on fifty-five platforms, including forty-seven across Belgium, Italy, Portugal and Spain, as well as eight international platforms. Following factor and cluster analysis, and on the basis of the theoretical understandings of the sharing and collaborative economy, we developed a typology that grouped platforms into three groups: network, transaction and community oriented. (C) 2016 Elsevier B.V. All rights reserved.

The discovery of a sapphire (blue corundum) bearing erratic on the granite island of Lettermore, south Connemara, has led to further discoveries of generally non-gem-grade sapphire in hornfelsed desilicated pelitic xenoliths within the 470Ma metagabbros of Connemara's Grampian Metagabbro-Gneiss Suite. The petrology and mineralogy of the erratic and the desilicated pelitic xenoliths are described. Well-established constraints on the timing of magmatism and on metamorphic conditions show that colourless corundum and a hercynite-magnetite spinel formed 470Ma ago at >900°C and the spinel later (~468Ma) unmixed to corundum, which was sometimes sapphire, and magnetite at temperatures of ~750°C and 3.5–6kb. Consideration of global sapphire occurrences indicates that sapphire can form over a wide range of P and T, i.e. greenschist to granulite facies. The Connemara sapphire formed during contact granulite facies metamorphism.

Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19 439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classifi cation, and with a better understanding of causal pathways. S ubstandard care contributes to 20–30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.

Prolactin can affect autoimmune response and evidence suggests that hyperprolactinemia can primarily precipitate autoimmunity. We postulate that patients with prolactinomas are more prone to autoimmune disease (AID).

The main question for consideration in this paper relates to the functional prerequisites for the construction of the so-called digital family' in the Spanish context. Taking inspiration from Burman's (1994; 2008) work we start from two assumptions. Firstly, we assume that representations of children and families are important in terms of power and gender. This leads to our second assumption, that when considering representations of the family we also, necessarily, need to address gender regulatory functions, as much as economic and political trends. We argue that since the middle of the last decade reports there has been an intensification of interest in children and their relations with Information and Communications Technology. We identify how a convergence of discourses around family and gender, enshrined in notions of the digital family' functions to refold the family structure back in on itself, advocating a return to traditional values in much the same way as in previous eras.

Purpose - The purpose of this paper is to examine the prevalence of alcohol use disorders (AUDs) amongst young people in the criminal justice system (CJS) in the North East of England and to compare the ability of the Alcohol Use Disorders Identification Test (AUDIT) to the Youth Justice Board ASSET tool in identifying alcohol-related need in Youth Offending Team (YOT) clients.Design/methodology/approach - A validated screening tool (AUDIT) was used to identify alcohol-related health risk or harm. Findings from AUDIT were compared with those of the standard criminogenic risk screening tool used in CJS (ASSET). An anonymous cross-sectional questionnaire was administered during a one-month period in 2008. The questionnaires were completed by 11-17-year-old offenders who were in contact with three YOTs, one Youth Offending Institution and one Secure Training Estate.Findings - In total, 429 questionnaires were completed out of a possible 639 (67 per cent). The majority (81 per cent) of the young offenders were identified as experiencing alcohol-related health risk or harm and 77 per cent scored within a possibly alcohol-dependent range. In total, 77 (30 per cent) of young people completing both assessments were identified as having an AUD by AUDIT but not identified as needing alcohol-related treatment using ASSET.Research limitations/implications - This research was confined to one geographical area of England, however, the results show that even in this area of high drinking by young people the levels of AUDs amongst young people in the CJS are very high.Social implications - There are major social implications to this research. It is imperative for changes to be made to the care pathways in place in the UK for young people coming through the CJS with alcohol-related issues.Originality/value - This paper adds to the evidence base by using well-validated tools to measure alcohol use amongst young people in the CJS in the UK.

This study takes the body (of mother and child), the technoscientific hospital landscape and professional ritual as the locus of an endeavour to understand the embodied experience of perinatal death, in order to better comprehend how alternate understandings and ontologies of motherhood, personhood and bereavement emerge during care enactments. Grounded in a descriptive and ethnographic approach the research analyses data from the entries of 22 members of a pregnancy loss support forum and 10 narrative style interviews. The research traces embodied experience from pregnancy, through diagnosis to the spatialised experience of the hospital, including the birth, postmortem contact and disposal of the corpse. Bounded by the sudden destruction of ontological security many of these women experience an existential crisis that results in a destructed stigmatised self. The research explores how overly medicalised obstetric care enacts understandings of perinatal death and bereavement that further problematizes postmortem relationships, creating toxic identities and embodied selves. Conversely, woman-centred midwifery that takes relational and social understandings as a basis for care can create the material conditions of possibility for a restoration of confidence in carnal self and a reconstruction of social bonds and order. Assembled through practice, discourse and policy, these bodies are individually, socially and politically enacted, but they are also multiple, mutable and enfolded assemblages of nature and culture. The research proposes that healthcare practice would benefit by considering natural stillbirths, just as contemporary obstetrics advocates natural childbirth.

AIM To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling. METHODS A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service utilization, readiness to change and reduction in conviction rates. RESULTS Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention. CONCLUSION Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research.