Ante-natal HIV testing: An observational study of HIV test discussion in maternity care

There has been a vociferous call for ante-natal HIV testing but low uptake persists in the UK despite DOH guidelines. The reasons for this are complex, with many studies examining intention, offer and uptake of HIV test but few observing the process to understand the nature of HIV discussion with pregnant women. A field observational study was undertaken where researchers attended 154 ante-natal consultations. These were selected in rotation during ante-natal visits by women at four London hospital based ante-natal clinics. A standardized checklist was utilized to monitor information on HIV. A mean of 1.73 minutes was spent discussing HIV infection and testing during ante-natal consultations which lasted for a mean of 33.1 minutes. Risk factors for HIV were mentioned infrequently. When mentioned they concentrated on sexual behaviour which was raised in 11.7% of the consultations. Potential interventions to reduce vertical transmission were discussed with no more than one in five women and possible adverse implications of HIV testing with fewer than one in ten, the only exception being the implications of a positive diagnosis for the baby. Discussion of interventions was associated with HIV test uptake, but risk discussion was not. The short time spent on discussing HIV testing, combined with paucity of mention of information relevant to pregnancy are issues for concern and probably help to explain the level of uptake in the UK.     

Temporal Parts and Moral Personhood

Philosophical Studies -     

The Metacognitive Model of Generalized Anxiety Disorder in Children and Adolescents

Worry is a common phenomenon in children and adolescents, with some experiencing excessive worries that cause significant distress and interference. The metacognitive model of generalized anxiety disorder (Wells 1995, 2009) was developed to explain cognitive processes associated with pathological worry in adults, particularly the role of positive and negative beliefs about worry. This review evaluates the application of the model in understanding child and adolescent worry. Other key issues reviewed include the link between cognitive and metacognitive development and worry, and the measurement of worry and metacognitive worry in young people. Implications of these findings and directions for future research are discussed.     

Examining changes in procedural justice and their influence on problem‐solving court outcomes

The number of problem‐solving courts has grown substantially since the mid‐1990s. Research consistently indicates that participation in these courts lowers recidivism, which is often attributed to defendants’ increased perceptions of procedural justice in these programs. Yet, prior studies are limited in their focus, often examining interactions with the judge in a single court or examining defendant perceptions and outcomes at a single time point. In the present study, we investigate defendant perceptions of procedural justice with judges and case managers across multiple problem‐solving courts over time. Findings indicate that procedural justice varies across court actors and over time. Procedural justice is lower among judges than among case managers; however, changes in perceptions of procedural justice with the judge are associated with improved court outcomes. We suggest that defendant perceptions are variable and complex but important in explaining variations in outcomes.