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Summary Perinatal mental health is an important public health issue, and peer support is a potentially important strategy for emotional well-being in the perinatal period. PANDA Perinatal Anxiety & Depression Australia provides support to individuals impacted by perinatal mental health issues via the National Perinatal Anxiety & Depression Helpline. Callers receive peer support from volunteers and counselling from paid professional staff. The views and experiences of PANDA peer support volunteers have not previously been studied. We conducted two focus groups and an online survey to explore the experiences of women providing volunteer peer support on the Helpline. Data collection took place in October and November 2013. Two social theories were used in framing and addressing the study aims and in interpreting our findings: the Empathy–Altruism Hypothesis, and the Helper Therapy Principle. All PANDA volunteers were invited to participate (n = 40). Eight volunteers attended a focus group, and 11 survey responses were received. Descriptive statistics were used to analyse quantitative data. All survey respondents ‘strongly agreed’ that they felt positive about being part of PANDA. Thematic analysis of data from focus groups and open-ended survey responses identified the following themes: motivated to help others, supported to support callers, helping to make a difference and emotional impacts for volunteers. Respondents described a strong desire to support others experiencing emotional distress as a motivator to volunteer. Although perinatal peer support services are designed to benefit those who receive support, this study suggests volunteers may also experience personal benefits from the role.

Advances in genomic technologies are providing people with access to earlier diagnoses, intervention, and treatment of genetic conditions. However, there are inequities in access to and experiences of genomic technologies for several communities, such as people from non-European backgrounds and people who are born outside the country in which they reside. It is crucial to understand whether and how these issues manifest in different genomic healthcare settings across the world to develop targeted interventions and ultimately reduce healthcare inequities. In this research, we aim to specifically understand the process of perinatal genetic screening in Victoria, Australia from the perspective of people born in India and relevant healthcare providers. In this protocol, we provide a practical example of how community engagement can be used to extend grounded theory methodology in the genomic healthcare context. We are using grounded theory methodology because it provides a systematic approach to explain a complex process in the context of limited existing research. Furthermore, we are engaging community and healthcare providers throughout the research process. All community methods are being conducted in English, Punjabi and Hindi languages. Potential participants are being invited to participate via community networks, professional networks, relevant organisations, social media, and snowballing. The research team are able to address any questions and support participants through the consent process. Participants may share their views via an interview or qualitative survey. Recruitment, data generation, and analysis are occurring concurrently, and will result in a grounded theory explaining the process of perinatal genetic screening. The theory will inform equitable delivery of perinatal genetic screening in Australia as well as future research with other communities facing inequities in genomic healthcare.

BackgroundCD8+ T cells are a critical component of the immune response to intracellular infections and malignancies. Recently, tissue-resident CD8+ memory cells (Trm) have been shown to provide a first line of defense against reinfection at barrier tissues such as the intestine. However, the transcriptional networks regulating tissue-adaptation processes are incompletely understood. Here, we sought to define the transcriptional orchestration of small intestinal Trm cells.MethodsTo identify gene-expression and genome-accessibility changes that arise in Trm cells in response to acute LCMV infection, we used scRNA-seq and ATAC-seq of cells from small intestine (SI), kidney, liver, salivary glands, as well as the spleen and blood. To assess the importance of the transcription factor Hic1 for the differentiation of intestinal Trm cells we used short-hairpin RNAs, inducible genetic deletion mouse models, pharmacological inhibition and Cut&Run sequencing.ResultsRNA sequencing of tissue Trm reveals shared and tissue-specific gene-expression programs, along with intra-tissue heterogeneity of Trm populations. Using transcriptional-regulatory networks, we identify the transcription factor Hic1 as a regulator for intestinal Trm differentiation. We observe that knockdown of Hic1 hinders Trm formation in the SI epithelium in response to both LCMV Armstrong and Listeria monocytogenes infection. In contrast, overexpression of Hic1 promotes Trm formation in the SI upon infection and provides protection upon reinfection. Consistent with Hic1 being a transcriptional repressor, we observe that Hic1 binding sites at genes downregulated by SI Trm lose accessibility in SI Trm. However, Hic1 enhances P2rx7 expression, an eATP receptor previously shown to be important for memory T cell differentiation and Trm homeostasis, by directly binding to its promoter, suggesting that Hic1 acts as both an activator and a repressor during SI Trm formation. Surprisingly, deletion of Hic1 after establishment of intestinal Trm cells does not reduce Trm cell numbers. In line with that, retinoic acid (RA) induces expression of Hic1 and pharmacological blockade of the RA receptor alpha reduces Trm formation, but does not impair Trm maintenance. Further, we find that SI Trm are genetically imprinted to reenter the intestine upon secondary infection, whereas this tissue-specific bias was not observed for liver and kidney Trm cells.ConclusionsIn summary, our work highlights the broad transcriptional adaptations of Trm to a range of tissue environments and highlights the importance of Hic1 as a regulator for SI Trm cell differentiation, which may be used as a framework for identifying targets that influence tissue-specific Trm populations in therapeutic contexts.

The PANDA Perinatal Anxiety & Depression Australia National Helpline provides support for people affected by perinatal mental health issues. To describe the characteristics of women contacting the Helpline, specifically callers’ health, past history and assessed risk factors. Analysis of routinely collected de-identified data of women making initial calls between July 2010 and October 2013. Five thousand eight hundred eighteen women made an initial call to the Helpline. Most were between 25 and 40 years old (79%) and married/partnered (94%); 52% were having or had their first child; and 23% were pregnant. Over half had no prior mental health diagnosis at the time of their initial call, and 40% were assessed as ‘high needs’—experiencing significant bio-psychosocial symptoms, complex situations and/or inadequate care and support. There was a 70% increase in calls to PANDA over the data collection period. Concerns recorded by PANDA staff from the initial risk assessment included inadequate treatment for a mental health condition (31%), women not feeling connected to their baby (31%), low functioning (26%) and general thoughts of suicide (18%). The Helpline experienced a significant increase in demand during the study period, and a substantial proportion of callers had complex mental health needs. PANDA plays a major role in providing support to a large number of women experiencing perinatal mental health problems.

IntroductionPregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework.Methods and analysisThe evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation.Ethics and disseminationEthics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.

Background Anxiety and depression are common in the perinatal period. Telephone interventions, including telephone peer support and counselling, have been developed to support those experiencing perinatal mental illness. PANDA Post and Antenatal Depression Association provides support to women and men experiencing perinatal mental illness via the Australian National Perinatal Depression Helpline, encompassing both volunteer peer support and professional counselling. This study aimed to explore the experiences of callers to the Helpline. Methods A cross-sectional survey design was used. All new callers from 1 st May to 30 th September 2013 were invited to participate. The survey, adapted from a previous survey of PANDA callers, included 23 questions using Likert-type scales, demographic and open-ended questions. Thematic network analysis was undertaken for responses to open-ended questions. Results 124 responses were received (124/405; 30 % response). The majority of callers had called the Helpline regarding themselves (90 %), with over one third (33 %) of all callers seeking crisis support and help. Ninety-nine per cent of respondents ‘agreed’ or ‘strongly agreed’ that staff and/or volunteers understood their concerns, and 97 % ‘agreed’ or ‘strongly agreed’ that overall PANDA had helped them. Callers described the PANDA service as uniquely tailored to the perinatal period, providing accessible, non-judgemental understanding and support, with a global theme from open-ended comments describing PANDA as ‘a safe space to be heard and receive support without judgement’. Recommendations for service changes included increased hours of availability. Conclusions Callers reported positive experiences of accessing support from the PANDA National Perinatal Depression Helpline. The Helpline was described as an accessible and acceptable telephone support for individuals experiencing perinatal mental illness. Recommendations for changes to the service included an increase in hours of operation to enable greater responsiveness at times of need, reduced waiting times, and access to continuity with the same volunteer and/or telephone counsellor. The findings of the study will be useful in informing future service provision, review, and implementation.

Research teams in high-income countries often fail to acknowledge the capacity and contributions of Community Researchers. This qualitative exploratory study used decolonising methodology and the Foundation House ‘Refugee Recovery Framework’ to understand Community Researchers’ perceptions and experiences of their role, and how research teams can integrate the knowledge they bring into research. Purposive sampling was used to facilitate the recruitment of eight Community Researchers from five different community groups working in Melbourne, Victoria. Semi-structured interviews lasting forty to sixty minutes occurred between December 2020 and January 2021. Data were analysed using reflexive thematic analysis. Findings reported in this paper include eight themes: ‘nothing about us without us’; ‘open the door’; a safe space to share; every step of the way; this does not translate; finding the right way to ask; a trauma-informed approach; and support within the workplace. The knowledge obtained demonstrates that Community Researchers facilitate meaningful participation in research for women, families, and communities of refugee or migrant background. Community Researchers’ presence, knowledge, and skills are vital in establishing culturally safe research practices and developing accessible language to facilitate conversations about sensitive research topics across multiple languages. Community Researchers can make important contributions at all stages of research, including data collection and interpretation.

When the grands opéras of Giacomo Meyerbeer were introduced to London audiences as a cluster in the mid-1800s, critics identified moments of understated musical and dramatic expression, and made little mention of more sensational dimensions, such as their impressive staging. With a focus on the 1849 staging of Le Prophète at the brand-new Royal Italian Opera in London, this article demonstrates that numerous critics were keen to endorse this new opera house, where most of the composer’s works were mounted, and that, to this end, they zeroed in on the most bare and restrained elements in his works so as to invest them with moral and intellectual relevance for Victorian audiences. Approaching Le Prophète as various London critics did is to see it anew and to consider alternatives to recent narratives which have taken material excess as a starting point for understanding the success of Meyerbeer’s grands opéras on the continent.

The articles in this special issue cast aside focus on the Opéra, in order to revisit the ways in which grands opéras were geographically mobile. London here serves as a foil to Paris.