Royal Hospital for Women

IntroductionPsychodynamic group therapy (PDGT) for schizophrenia offers a therapeutic space where patients can explore conflicts considered pathognomonic for the disorder. This study examines the role of PDGT during a crisis, focusing on psychotic dilemmas as described by Mentzos while also exploring the relevance of psychodynamic psychosis theory in ensuring effective psychotherapeutic care.Materials and methodsUsing qualitative content analysis, we analyzed transcribed audio recordings of therapy sessions during the COVID-19 pandemic. Thematic categories were inductively developed and examined within Mentzos’ psychodynamic framework.ResultsFour key themes emerged: (1) Loss of something meaningful, reflecting existential fears intensified by the crisis; (2) Paranoia, manifesting as distrust toward external structures; (3) Care and self-care, illustrating oscillations between autonomy and dependence; and (4) Closeness and distance in relationships, highlighting struggles of relationship formation, especially in times of rigid social boundaries. These themes mirror the psychotic dilemmas identified by Mentzos, reinforcing their relevance in crisis settings. The findings suggest that PDGT enables patients to explore these dilemmas and negotiate interpersonal conflicts. However, the crisis environment led to therapy disruptions, impacting group cohesion and participation, likely exacerbating symptoms in some patients.ConclusionPsychodynamic group therapy is crucial in supporting patients with schizophrenia, especially during crises, by enabling engagement with core conflicts through relationships rather than symptom formation. However, maintaining therapeutic continuity remains a challenge. Future research should examine group cohesion in various crises and its link to delusional symptoms, as well as strategies to stabilize group therapy and expand PDGT access internationally.

Abstract Aims Gestational diabetes mellitus (GDM) is the most common pregnancy-related medical complication. GDM is linked to aberrant immune responses in both mothers and offsprings, specifically, the subsequent development of inflammatory diseases. Whereas prior research has focused on specific immune cell subsets, a comprehensive overview of the impacts of GDM on maternal and fetal immune landscape is lacking. Here, we aim to comprehensively decipher how GDM modulates various immune cell populations in mothers and offsprings. Methods A prospective, longitudinal case-control study was carried out. Maternal blood from GDM-affected (GDM, n=18) and non-GDM-affected (Ctrl, n=21) mothers were collected at ante-(36-38 weeks of gestation) and post-partum (6-8 weeks post-partum) timepoints. Cord blood from GDM (n=7) and Ctrl (n=11) pregnancies were collected upon C-section. They were analyzed with the state-of-the-art cytometry by time of flight (CyTOF) with a 40-marker panel. Additionally, a publicly available RNA-seq dataset for cord blood mononuclear cells was re-analyzed to confirm results from CyTOF experiments. Results Compared to Ctrl, GDM was associated with more activated maternal T cell subsets ante-partum, including increased CD45RO + and Ki67 + CD4 + T cell populations, which reverted post-partum. GDM-affected maternal innate lymphoid cell (ILC) also exhibited increased granzyme B production ante-partum. On the other hand, in GDM-impacted cord blood, fetal T and B cells were more activated, displaying less naïve and more effector phenotypes, further supported by RNA-seq analyses. Conclusions Our comprehensive analyses revealed that GDM is linked to profound changes in the immune landscapes of the mothers (ante-/post-partum) and foetuses (at birth), casting novel insights towards GDM pathophysiology. Longitudinal immune profiling might be warranted for early detection and stratification of risk, and development of targeted interventions to prevent inflammatory disorders in GDM mothers and their offspring. Research in context What is already known about this subject? The maternal and intrauterine environments are important contributors to long-term health outcomes of mothers and offsprings . Some maternal and fetal immunity changes have been observed in gestational diabetes mellitus (GDM)-affected pregnancies . GDM is associated with increased risk of later-life metabolic and inflammatory diseases in mothers as well as offsprings . What is the key question? What are the longitudinal alterations in maternal and fetal immune landscapes in GDM-affected pregnancies? What are the new findings? High-dimensional immune profiling provided the most comprehensive overview of alterations in maternal and fetal immune landscapes associated with GDM . GDM is associated with skewing of maternal CD4 + T cell and ILC towards activated phenotypes ante-partum . GDM is linked to more activated fetal T and B cell profiles . How might this impact on clinical practice in the foreseeable future? Understanding the complex alterations in the maternal and fetal immune landscape in GDM-affected pregnancy provides insights into the long-term impacts of GDM on the mother and offspring .

BackgroundModerate-late preterm infants born at 32–35 completed weeks’ gestation constitute a large proportion of all preterm births (< 37-week gestation), yet they are not well represented in the newborn resuscitation literature. Preterm infants often receive respiratory support in the delivery room, and recommendations exist to guide the use of supplemental oxygen when providing this support. However, there are minimal data regarding the best initial supplementary oxygen concentration for moderate-late preterm infants requiring respiratory support at birth, resulting in practice variation. The aim of this trial is to compare initial supplementary oxygen concentrations of 30% and 21% (air) in preterm infants of 32–35 weeks’ gestation who require respiratory support in the delivery room, with a primary outcome of the need for ongoing respiratory support upon leaving the delivery room.MethodsThis is a prospective, unblinded, multicenter, cluster-randomized, crossover trial in Australian maternity hospitals comparing initial supplementary oxygen concentrations of 30% and 21% (air) in moderate-late preterm infants who require respiratory support at birth. Eligible infants are those born from 32 + 0 to 35 + 6 weeks’ gestation without major cardiorespiratory or craniofacial anomalies, who are receiving active care, and who receive respiratory support in the delivery room within the first three minutes after birth. The primary outcome is the need for ongoing respiratory support upon leaving the delivery room. The trial will recruit a minimum of 1200 infants from at least 20 study sites in Australia using a waiver of consent process.DiscussionThe AIROPLANE trial is a pragmatic study in an underrepresented population using a novel study design. It will be the first randomized study of initial supplementary oxygen concentration during respiratory support in the delivery room to exclusively recruit moderate-late preterm infants. The results will address an important evidence gap and will inform future international guidelines.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12621001267842. Registered on 20th September 2021.

BackgroundInfertility is an underrecognized disease which affects over 17% of the reproductive age population worldwide. However, availability of, and access to, assisted reproductive technology (ART) is variable across countries. There are significant challenges relating to awareness, financial and other barriers to care, cultural considerations, and the level of support provided to people undergoing care. Previous studies have explored these challenges, but less attention has been given to the policy implications. As the need for fertility care rises, we investigate the evidence that policy changes can be implemented to improve access to ART treatment.MethodsA review of literature was conducted on fertility policy challenges and developments, covering fertility recognition and awareness; cultural and religious considerations; and access to ART treatment, psycho-social care, and supplementary care. Nine medical and academic experts were invited to validate secondary research findings and provide their perspectives on policy implications. The experts covered different specialties and geographic expertise. Experts participated in individual 60-minute interviews, then a half-day Policy Forum discussion was held virtually in May 2023.ResultsLack of recognition of infertility as a disease, low financial coverage of fertility services, limited psychosocial support, and cultural considerations are substantial barriers to fertility services access. Some countries have limited reimbursement of services or offer only private care, significantly limiting treatment access. Others restrict reimbursement based on age, gender and family status, which creates access inequities. Policy action is needed to mitigate these challenges and to ensure timely and equitable access to fertility care. Decision-makers need to collectively recognize infertility as a disease, rather than just a social issue. Equity of access to infertility services should be ensured by expanding the availability of public funding, along with review and rationalisation of criteria for treatment reimbursement. To improve engagement in treatment and support through the fertility journey, access to psychosocial care should be expanded and included as a core service.ConclusionMajor obstacles to accessing ART treatment have been identified across regions globally, highlighting the urgent need for national policy action to enhance care quality by reviewing current legislation, improving patient and physician education, refining reimbursement procedures, and expanding psychosocial support services.

Despite the associated major morbidities, advances in neonatal care units have improved the survival rates of extremely preterm infants. However, the varying survival rates make it challenging to set policy decisions around the standardization of care. Therefore, this study aimed to determine the global survival rate of extremely preterm infants and to compare it across different income levels and over time during the last two decades. A comprehensive systematic search was conducted across major databases, including PubMed/Medline, EMBASE, CINAHL, Web of Science, Scopus, AJOL, Google Scholar and Google, to identify relevant articles. All peer-reviewed studies reported the survival rate of extremely preterm infants (born before 29 weeks' gestation) between January 1st, 2000, and June 25th, 2024, were included. Outcomes were compared between Epoch 1 (2000-2015, Millennium Developmental Goals period) and Epoch 2 (2016-2024, Sustainable Developmental Goals period). DerSimonian‒Laird random effects model was fitted to estimate the pooled weighted outcomes. A total of 217 studies involving 917,176 infants were included. Based on published data, 61.4% (95% CI: 58.13-64.81) of extremely preterm infants survived to discharge, and 51.7% (95% CI: 44.25-59.22) of survivors were discharged without major morbidity. Survival rate was significantly lower in low- and middle-income countries (44.3%) compared to high-income countries (69.3%). Among low- and middle-income countries, survival improved from 38% during the epoch 1 to 44.8% during the epoch 2. While in high-income countries it was 69.9% during epoch 1 and 64.2% during epoch 2. These findings are based on reported literature; may not fully reflect outcomes in low-resource settings where data are limited and underreported. Variability in the inclusion and care of borderline viable infants also contributes to the heterogeneity and uncertainty of the estimates. Survival of extremely preterm infants varies widely across settings, with fewer than half surviving in low- and middle-income countries. While some improvement was observed in these regions during the Sustainable Developmental Goals period, comparisons across epochs and regions should be interpreted cautiously due to differences in data availability and population characteristics. These variations underscore the need for context-specific strategies that balance available resources, cultural values, and ethical considerations. Further population-level data, particularly from low-and middle-income countries, are essential to inform equitable global neonatal care policies. PROSPERO (CDR42023447612 (PROSPERO (york.ac.uk)). Not applicable.

There are limited data on what obstetricians and gynaecologists (O&G) know and think about supporting breastfeeding women. To investigate breastfeeding attitudes, knowledge and confidence of Australian and New Zealand O&G specialists and trainees in educating, assessing and managing breastfeeding women. An online REDCap survey was distributed via email in February 2023 to fellows and trainees of the Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG). The survey included questions on demographic characteristics, knowledge, attitudes and confidence about breastfeeding. Of 312 (11%) respondents, 63% were > 40 years old, 78% female and two-thirds had personally breastfed. Half had no formal breastfeeding education. Mean score related to attitude was 4.8/7 (71.1%) with higher scores associated with extra training (β = 0.44 (95% CI 0.04, 0.84)) and personal breastfeeding (β = 0.37 (95% CI 0.15, 0.60)). Mean correctly answered knowledge score was 9/12 (75%). After adjusting for covariates, the main factors associated with higher knowledge were personal breastfeeding (β = 0.45 (95% CI 0.21, 0.69)) and being female (β = 0.58 (95% CI 0.10, 1.07)). Overall mean confidence score was 4.8/7 (68.6%); however, only 37% felt confident in managing breastfeeding challenges, and 60% would value more breastfeeding education. Factors associated with increased confidence included personal breastfeeding (β = 0.52 (95% CI 0.31, 0.73)), increased age (β = 0.39 (95% CI 0.64, 0.71)), and extra training (β = 0.84 (95% CI 0.46, 1.21)). Confidence about breastfeeding in RANZCOG specialists and trainees was low. The majority of respondents wanted more formal and improved breastfeeding education and training. Breastfeeding educational resources and ongoing training should be developed for O&G trainees and specialists.

Targeted e-learning can improve GP knowledge and confidence, and can support the implementation of the national congenital CMV risk-reduction guidelines.