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Family education programs (FEPs) target caregiving-related psychological distress for carers of relatives/friends diagnosed with serious mental health conditions. While FEPs are efficacious in reducing distress, the mechanisms are not fully known. Peer group support and greater mental health knowledge are proposed to reduce carers' psychological distress by reducing stigmatising attitudes and self-blame, and strengthening carers' relationship with their relative.
Adult carers (n = 1016) who participated in Wellways Australia's FEP from 2009 to 2016 completed self-report questionnaires at the core program's start and end, during the consolidation period, and at a 6-month follow-up. Those who enrolled early completed questionnaires prior to a wait-list period. We used linear mixed-effects modelling to assess the program's effectiveness using a naturalistic wait-list control longitudinal design, and multivariate latent growth modelling to test a theory-based process change model.
While there was no significant change over the wait-list period, psychological distress, self-blame and stigmatising attitudes significantly decreased, and communication and relationship quality/feelings increased from the core program's start to its end. Changes were maintained throughout the consolidation period and follow-up. Peer group support significantly predicted the declining trajectory of distress. Peer group support and greater knowledge significantly predicted declining levels of self-blame and stigmatising attitudes, and increasing levels of communication.
This is the first study to quantitatively validate the mechanisms underlying the effect of FEPs on carers' psychological distress. Peer group support is key in modifying carers' appraisals of their friend/relatives' condition. Continued implementation of FEPs within mental health service systems is warranted.
Early Pregnancy Ultrasound is a comprehensive and hands-on practical guide that is essential for all health professionals working in the field of early pregnancy. It is highly illustrated with ultrasound images of normal and abnormal pregnancies. It demonstrates how ultrasound can be used to identify and manage complications in early pregnancy. As well as sample ultrasound scan images, the text includes annotated schematic diagrams, tables, flow diagrams, and lists of key learning points, making it an easily accessible learning tool. Early Pregnancy Ultrasound is a key resource for obstetricians, gynaecologists, midwives, nurses and sonographers. It is also an essential text for medical trainees undertaking the Royal College of Obstetricians and Gynaecologists (RCOG) Advanced Training Module in Early Pregnancy, or any trainee interested in early pregnancy.
The majority of ectopic pregnancies occur within the Fallopian tube, with most implanted in the ampullary region. A number of risk factors have been identified for ectopic pregnancy. Transvaginal ultrasound (TVU) has now become the diagnostic technique of choice for ectopic pregnancy. Historically, laparotomy with salpingectomy was the standard treatment for ectopic pregnancy. Laparoscopic surgery has been shown to be superior to laparotomy, making it the surgical approach of choice. A number of drugs have been used for the treatment of ectopic pregnancy including potassium chloride, prostaglandins, hyperosmolar glucose, mifepristone and actinomycin D. However, the most commonly used drug in clinical practice for the treatment of ectopic pregnancy is methotrexate. The reported success rates for expectant management range between 48-100%. Subsequent hysterosalpingography has shown patency for the affected tube in up to 93% of cases of ectopic pregnancy managed expectantly.