Effects of somatic acupoint stimulation on anxiety and depression in cancer patients: An updated systematic review of randomized controlled trials.

OBJECTIVES: To explore the effectiveness of somatic acupoint stimulation (SAS) for cancer patients with anxiety and depression. METHODS: Thirteen electronic databases were searched systematically until August 2022. Randomized controlled trials (RCTs) investigating SAS for anxiety and/or depression in cancer patients were retrieved. Methodological quality of the included studies was assessed by utilizing the Cochrane Back Review Group Risk of Bias Assessment Criteria. Evidence level was assessed by using the approach of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Both meta-analysis and descriptive analysis were conducted for outcome assessment. RESULTS: Twenty-eight records were finally included including 22 journal articles and six ongoing registered clinical trials. The overall methodological quality and level of evidence of the included studies were suboptimal, with no high-quality evidence identified. Moderate evidence showed that SAS could significantly decrease the anxiety of cancer patients (Acupuncture: [random effect model, SMD = -0.52, 95% CI = -0.79 to -0.24, p = 0.0002] and Acupressure: [random effect model, SMD = -0.89, 95% CI = -1.25 to -0.52, p < 0.00001]. While for depression, although the data analysis indicated that SAS can decrease depression significantly (Acupuncture: [random effect model, SMD = -1.26, 95% CI = -2.08 to -0.44, p = 0.003] and Acupressure: [random effect model, SMD = -1.42, 95% CI = -2.41 to -0.42, p = 0.005]), relevant evidence was rated as low. No statistically significant difference was identified between true and sham acupoints stimulation for both anxiety and depression. CONCLUSIONS: This systematic review provides the latest research evidence to support SAS as a promising intervention for alleviating anxiety and depression in cancer patients. However, the research evidence should be interpreted prudently as methodological concerns were identified in some included studies, and some sub-group analyses were performed with a relatively small sample size. More rigorously designed large-scale RCTs with placebo-controlled comparisons are warranted to generate high-quality evidence. REGISTRATION: The systematic review protocol has been registered with PROSPERO (CRD42019133070).

Barriers and enablers to implementing clinical practice guidelines in primary care: an overview of systematic reviews.

OBJECTIVES: To identify the barriers and enablers to implementing clinical practice guidelines (CPGs) recommendations in primary care and to provide recommendations that could facilitate the uptake of CPGs recommendations. DESIGN: An overview of systematic reviews. DATA SOURCES: Nine electronic databases (PubMed, Cochrane Library, CINAHL, MEDLINE, PsycINFO, Web of Science, Journals @Ovid Full Text, EMBase, JBI) and three online data sources for guidelines (Turning Research Into Practice, the National Guideline Clearinghouse and the National Institute for Health and Care Excellence) were searched until May 2021. ELIGIBILITY CRITERIA: Systematic reviews, meta-analyses or other types of systematic synthesis of quantitative, qualitative or mixed-methods studies on the topic of barriers and/or enablers for CPGs implementation in primary care were included. DATA EXTRACTION AND SYNTHESIS: Two authors independently screened the studies and extracted the data using a predesigned data extraction form. The methodological quality of the included studies was appraised by using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Content analysis was used to synthesise the data. RESULTS: Twelve systematic reviews were included. The methodological quality of the included reviews was generally robust. Six categories of barriers and enablers were identified, which include (1) political, social and culture factors, (2) institutional environment and resources factors, (3) guideline itself related factors, (4) healthcare provider-related factors, (5) patient-related factors and (6) behavioural regulation-related factors. The most commonly reported barriers within the above-mentioned categories were suboptimal healthcare networks and interprofessional communication pathways, time constraints, poor applicability of CPGs in real-world practice, lack of knowledge and skills, poor motivations and adherence, and inadequate reinforcement (eg, remuneration). Presence of technical support ('institutional environment and resources factors'), and timely education and training for both primary care providers (PCPs) ('healthcare provider-related factors') and patients ('patient-related factors') were the frequently reported enablers. CONCLUSION: Policy-driven strategies should be developed to motivate different levels of implementation activities, which include optimising resources allocations, promoting integrated care models, establishing well-coordinated multidisciplinary networks, increasing technical support, encouraging PCPs and patients' engagement in guideline development, standardising the reporting of guidelines, increasing education and training, and stimulating PCPs and patients' motivations. All the activities should be conducted by fully considering the social, cultural and community contexts to ensure the success and sustainability of CPGs implementation.

An Evidence-Based Somatic Acupressure Intervention Protocol for Managing the Breast Cancer Fatigue-Sleep Disturbance-Depression Symptom Cluster: Development and Validation following the Medical Research Council Framework.

BACKGROUND: Somatic acupoint stimulation (SAS) has been frequently utilised as a promising intervention for individual cancer-related symptom management, such as fatigue, sleep disturbance and depression. However, research evidence regarding the role of SAS in mitigating the fatigue-sleep disturbance-depression symptom cluster (FSDSC) has been scant. This study was conducted to develop an evidence-based SAS intervention protocol that can be further implemented in a Phase II randomized controlled trial (RCT) to manage the FSDSC in breast cancer survivors. METHODS: The Medical Research Council Framework for Developing and Evaluating Complex Intervention (MRC framework) was employed to guide the development procedures of the SAS intervention protocol, including the identification of an existing evidence base, the identification of theories and practice standards, and the validation of the SAS intervention protocol. A content validity study was performed through an expert panel to assess the scientific and practical appropriateness of the SAS intervention protocol. The content validity index (CVI), including item-level CVI and protocol-level CVI, were calculated to evaluate the consensus level of the expert panel. RESULTS: Key components of the SAS protocol, including the acupoint formula, the SAS modality, technique, intensity and frequency were identified for both a true and placebo SAS intervention based on the best available research evidence retrieved from systematic reviews, clinical trials, and relevant theories, particularly regarding the inflammatory process, yin-yang theory, zang-fu organs and meridians theory, and acupressure practical standards. The true SAS intervention was determined as daily self-administered acupressure on specific acupoints for seven weeks. The placebo SAS was designed as light acupressure on non-acupoints with the same frequency and duration as the true SAS. Excellent content validity was achieved after one round of expert panel assessment, with all the key components of the true and placebo SAS protocols rated as content valid (CVI ranged from 0.86 to 1.00). CONCLUSIONS: A research-informed, theory-driven and practically feasible SAS intervention protocol for the FSDSC management in breast cancer survivors was developed following the MRC framework. The feasibility and acceptability of the SAS intervention will be further tested in breast cancer survivors through a Phase II RCT.

Self-Managed Non-Pharmacological Interventions for Breast Cancer Survivors: Systematic Quality Appraisal and Content Analysis of Clinical Practice Guidelines.

Background: A growing number of clinical practice guidelines (CPGs) regarding non-pharmacological interventions for breast cancer survivors are available. However, given the limitations in guideline development methodologies and inconsistent recommendations, it remains uncertain how best to design and implement non-pharmacological strategies to tailor interventions for breast cancer survivors with varied health conditions, healthcare needs, and preferences. Aim: To critically appraise and summarise available non-pharmacological interventions for symptom management and health promotion that can be self-managed by breast cancer survivors based on the recommendations of the CPGs. Methods: CPGs, which were published between January 2016 and September 2021 and described non-pharmacological interventions for breast cancer survivors, were systematically searched in six electronic databases, nine relevant guideline databases, and five cancer care society websites. The quality of the included CPGs was assessed by four evaluators using The Appraisal of Guidelines for Research and Evaluation, second edition tool. Content analysis was conducted to synthesise the characteristics of the non-pharmacological interventions recommended by the included CPGs, such as the intervention's form, duration and frequency, level of evidence, grade of recommendation, and source of evidence. Results: A total of 14 CPGs were included. Among which, only five were appraised as high quality. The "range and purpose" domain had the highest standardized percentage (84.61%), while the domain of "applicability" had the lowest (51.04%). Five CPGs were rated "recommended", seven were "recommended with modifications", and the other two were rated "not recommended". The content analysis findings summarised some commonly recommended self-managed non-pharmacological interventions in the 14 guidelines, including physical activity/exercise, meditation, hypnosis, yoga, music therapy, stress management, relaxation, massage and acupressure. Physical activity/exercise was the most frequently recommended approach to managing psychological and physical symptoms by the included guidelines. However, significant variations in the level of evidence and grade of recommendation were identified among the included CPGs. Conclusion: Recommendations for the self-managed non-pharmacological interventions were varied and limited among the 14 CPGs, and some were based on medium- and low-quality evidence. More rigorous methods are required to develop high-quality CPGs to guide clinicians in offering high-quality and tailored breast cancer survivorship care.

Sustainability of healthcare professionals' adherence to clinical practice guidelines in primary care.

BACKGROUND: Sustainability of adherence to clinical practice guidelines (CPGs) represents an important indicator of the successful implementation in the primary care setting. AIM: To explore the sustainability of primary care providers' adherence to CPGs after receiving planned guideline implementation strategies, activities, or programmes. METHODS: Cochrane Central Register of Controlled Trials (CENTRAL); Cumulative Index to Nursing and Allied Health Literature (CINAHL); EMBase; Joanna Briggs Institute; Journals@Ovid; Medline; PsycoINFO; PubMed, and Web of Science were searched from January 2000 through May 2021 to identify relevant studies. Studies evaluating the sustainability of primary care providers' (PCPs') adherence to CPGs in primary care after any planned guideline implementation strategies, activities, or programmes were included. Two reviewers extracted data from the included studies and assessed methodological quality independently. Narrative synthesis of the findings was conducted. RESULTS: Eleven studies were included. These studies evaluated the sustainability of adherence to CPGs related to drug prescribing, disease management, cancer screening, and hand hygiene in primary care. Educational outreach visits, teaching sessions, reminders, audit and feedback, and printed materials were utilized in the included studies as guideline implementation strategies. None of the included studies utilized purpose-designed measurements to evaluate the extent of sustainability. Three studies showed positive sustainability results, three studies showed mixed sustainability results, and four studies reported no significant changes in the sustainability of adherence to CPGs. Overall, it was difficult to quantify the extent to which CPG-based healthcare behaviours were fully sustained based on the variety of results reported in the included studies. CONCLUSION: Current guideline implementation strategies may potentially improve the sustainability of PCPs' adherence to CPGs. However, the literature reveals a limited body of evidence for any given guideline implementation strategy. Further research, including the development of a validated purpose-designed sustainability tool, is required to address this important clinical issue. TRIAL REGISTRATION: The study protocol has been registered at PROSPERO (No. CRD42021259748 ).

Implementing an evidence-based somatic acupressure intervention in breast cancer survivors with the symptom cluster of fatigue, sleep disturbance and depression: study protocol of a phase II randomised controlled trial.

INTRODUCTION: The fatigue-sleep disturbance-depression (FSD) symptom cluster, as one of the most common symptom clusters in breast cancer (BC) survivors, can significantly decrease patients' quality of life. Since the management of the FSD symptom cluster has been unsatisfactory with the use of pharmacological treatments alone, non-pharmacological approaches have, therefore, been recommended. Somatic acupressure (SA) is a promising approach given its potential benefits of cancer-related symptom alleviation and the convenience of self-practice. However, research evidence on using acupressure to manage the FSD symptom cluster has been limited. The proposed trial aims to examine the feasibility and preliminary effects of an evidence-based SA intervention for FSD symptom cluster management in BC survivors. METHODS AND ANALYSIS: This study will be a phase II randomised controlled trial with three study arms and 1:1:1 allocation. Fifty-one early-stage BC survivors who are experiencing the FSD symptom cluster will be randomly assigned to a true SA group, a sham SA group or a usual care group. All participants will receive an education booklet regarding FSD symptom cluster management advice as the usual care package. The participants in the true SA group will additionally receive a 7-week self-administered SA intervention. The participants in the sham SA group will additionally receive self-administered light acupressure at non-acupoints with the same frequency, session and duration as the true SA group. The primary outcomes will be feasibility outcomes related to subject recruitment and completion of study questionnaires and interventions. The secondary outcomes will be the effects of SA on fatigue, sleep disturbance, depression and quality of life. Descriptive statistics will be used to present all the outcomes. The secondary outcomes will be analysed using an intent-to-treat approach. ETHICS AND DISSEMINATION: Ethical approvals of this trial have been granted by the Human Research Ethics Committee at Charles Darwin University (H19017) and the Clinical Trial Ethics Committee at The Affiliated Hospital of Southwest Medical University (KY2019039). Findings from this trial will be published in peer-reviewed journals and presented at professional conferences. TRIAL REGISTRATION NUMBER: This trial was registered at ClinicalTrials.gov and the registration number is NCT04118140, with the stage at Recruiting.

Acupoint stimulation for cancer-related fatigue: A quantitative synthesis of randomised controlled trials.

BACKGROUND AND PURPOSE: This study aimed to identify the research evidence on acupoint stimulation (AS) for cancer-related fatigue (CRF) management. METHODS: Randomised controlled trials that utilised AS for CRF management were retrieved. The Cochrane Back Review Group Risk of Bias Tool was used for quality appraisal. RevMan 5.3 was used for meta-analysis. RESULTS: Fifteen studies were included. Both the overall (SMD = -0.95, p = 0.008) and sub-group (acupuncture: SMD = -1.25, p = 0.002; short-term AS: SMD = -0.95, p = 0.02; medium-term AS: SMD = -0.96, p = 0.003) analyses indicated that AS was more effective in alleviating CRF than standard treatment/care. A comparison between the true and sham AS interventions favoured the true AS for CRF management, although the difference did not reach statistical significance. CONCLUSION: This study identified a promising role of AS in improving CRF. However, the study findings should be interpreted prudently due to the limited quality and sample sizes of some of the included studies.

A Randomized Controlled Trial of a Non-pharmacological Intervention for Cancer-Related Dyspnea.

Objectives: To evaluate the efficacy of a brief tailored non-pharmacological intervention comprising breathing retraining and psychosocial support for managing dyspnea in cancer patients. Design: Multicenter, single blinded, parallel group, randomized controlled trial. Setting: Four major public hospitals, Brisbane, Australia. Participants: One hundred and forty four cancer patients, including 81 who received an 8-week tailored intervention and 63 who received standard care. Inclusion Criteria: Diagnosis of small or non-small cell lung cancer, mesothelioma or lung metastases; completed first line therapy for the disease; average dyspnea rating >2 on (0-10) rating scale in past week; anticipated life expectancy ≥3 months. Outcomes: The primary outcome measure was change in "worst" dyspnea at 8 weeks compared to baseline. Secondary outcomes were change in: dyspnea "at best" and "on average"; distress; perceived control over dyspnea; functional status, psychological distress; and use of non-pharmacological interventions to manage dyspnea at 8 weeks relative to baseline. Results: The mean age of participants was 67.9 (SD = 9.6) years. Compared to the control group, the intervention group demonstrated a statistically significant: (i) improvement in average dyspnea from T1(M = 4.5, SE = 0.22) to T3 (M = 3.6, SE = 0.24) vs. (M = 3.8, SE = 0.24) to (M = 4.1, SE = 0.26); (ii) greater control over dyspnea from T1 (M = 5.7, SE = 0.28) to T3 (M = 7.5, SE = 0.31) vs. (M = 6.8, SE = 0.32) to (M = 6.6, SE = 0.33); and (iii) greater reduction in anxiety from T1 (M = 5.4, SE = 0.43) to T3 (M = 4.5, SE = 0.45) vs. (M = 4.2, SE = 0.49) to (M = 4.6, SE = 0.50). This study found no intervention effect for best and worst dyspnea, distress from breathlessness, functional status, and depression over time. Conclusions: This study demonstrates efficacy of tailored non-pharmacological interventions in improving dyspnea on average, control over dyspnea, and anxiety for cancer patients. Clinical Trial Registration: The trial is registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au). The registration number is ACTRN12607000087459.

Predictors of health-related quality of life in Chinese caregivers of children with autism spectrum disorders: a cross-sectional study.

The purpose of this study was to identify the predictors of health-related quality of life (HRQOL) among caregivers of children with autism spectrum disorders (ASD) in China. Two hundred and seventy-three caregivers were surveyed using questionnaires on HRQOL, family functioning, coping style, social support, and caregiver burden. Besides socio-demographic characteristics of children with ASD and their caregivers, results demonstrate that family functioning, coping style, social support, caregiver burden are predictors of HRQOL in caregivers of children with ASD, and these predictors correlated with each other. These results indicate that comprehensive intervention, which focuses on improving caregivers' coping strategies, social support (especially from family members and friends) and family functioning, and on releasing caregiver burden, should be provided to caregivers of children with ASD.

Supportive and palliative care for lung cancer patients.

Lung cancer patients face poor survival and experience co-occurring chronic physical and psychological symptoms. These symptoms can result in significant burden, impaired physical and social function and poor quality of life. This paper provides a review of evidence based interventions that support best practice supportive and palliative care for patients with lung cancer. Specifically, interventions to manage dyspnoea, one of the most common symptoms experienced by this group, are discussed to illustrate the emerging evidence base in the field. The evidence base for the pharmacological management of dyspnoea report systemic opioids have the best available evidence to support their use. In particular, the evidence strongly supports systemic morphine preferably initiated and continued as a once daily sustained release preparation. Evidence supporting the use of a range of other adjunctive non-pharmacological interventions in managing the symptom is also emerging. Interventions to improve breathing efficiency that have been reported to be effective include pursed lip breathing, diaphragmatic breathing, positioning and pacing techniques. Psychosocial interventions seeking to reduce anxiety and distress can also improve the management of breathlessness although further studies are needed. In addition, evidence reviews have concluded that case management approaches and nurse led follow-up programs are effective in reducing breathlessness and psychological distress, providing a useful model for supporting implementation of evidence based symptom management strategies. Optimal outcomes from supportive and palliative care interventions thus require a multi-level approach, involving interventions at the patient, health professional and health service level.

Dimensions and reliability of a hospital safety climate questionnaire in Chinese health-care practice.

The aim of the current study was to examine the dimensions and reliability of a hospital safety climate questionnaire in Chinese health-care practice. To achieve this, a cross-sectional survey of health-care professionals was undertaken at a university teaching hospital in Shandong province, China. Our survey instrument demonstrated very high internal consistency, comparing well with previous research in this field conducted in other countries. Factor analysis highlighted four key dimensions of safety climate, which centred on employee personal protection, employee interactions, safety-related housekeeping and time pressures. Overall, this study suggests that hospital safety climate represents an important aspect of health-care practice in contemporary China.

Smoking rates among hospital nurses in Longkou city, China.

This study was undertaken as one of the first investigations of nurses' smoking habits in Longkou city, Shandong Province, China. An anonymous cross-sectional survey was administered as part of a larger investigation of healthcare professionals at a university teaching hospital during 2008. A total of 88 nurses responded to the survey, from whom tobacco-related data were provided by 83 of them (94%). Their overall smoking rate was very low (1%), with no male nurses reporting themselves to be current tobacco users. Overall, the current study suggests that smoking rates are very low among Chinese nurses in Longkou city, Shandong Province. These results are also consistent with studies of nurses' tobacco use conducted in other regions of China.

Tobacco smoking among doctors in mainland China: a study from Shandong province and review of the literature.

BACKGROUND: Tobacco control represents a key area in which doctors can make a significant positive impact on their patients' lives. Despite this fact, however, doctors in certain regions of China are known to smoke tobacco at rates similar to or even exceeding those seen within the general population. OBJECTIVE: This study sought to investigate the smoking habits of doctors at a teaching hospital in Shandong province, as well as providing a brief review of smoking research that has been conducted among doctors elsewhere in China. METHOD: An anonymous questionnaire survey was distributed to doctors working at a university teaching hospital in 2008, as part of a larger study of occupational health issues in the healthcare profession. RESULTS: The overall smoking prevalence rate of doctors in this study was 36.3% with significant differences observed between the genders (males: 46.7% and females: 5.3%). Age and total career length were also correlated with smoking habit, although no significant associations were found with department of employment. CONCLUSIONS: Overall, our study suggests that smoking rates among doctors in Shandong province are higher than those documented in many other countries, a finding which is consistent with previous research conducted in some other Chinese provinces. Addressing this issue from an intrinsic cultural perspective will clearly need to form the cornerstone of tobacco control efforts within the Chinese medical community in future years.

A cross-sectional analysis of the association between night-only or rotating shift work and overweight/obesity among female nurses and midwives.

OBJECTIVE: To examine the associations between shift work types and overweight/obesity among female nurses and midwives. METHODS: A cross-sectional study. Measurement included exposure variables: rotating shift work and night-only shift work; outcome variables: overweight and obesity; and potential confounding and associated variables: modifiable lifestyle factors, general health status, menopausal status, and work pattern. RESULTS: Among the 2086 participants, almost 60% were overweight/obese (31.7% overweight; 27.1% obese). After we adjusted the selected confounders, we found that rotating shift workers were 1.02 times more likely to be overweight/obese than day workers (P = 0.007; 95% confidence interval [95% CI], 1.004 to 1.03; and P = 0.02; 95% CI: 1.004 to 1.04, respectively). Night-only shift work was found to be significantly associated with obesity only (P = 0.031; relative risk, 1.02; 95% CI, 1.002 to 1.04). CONCLUSIONS: Rotating shift work was associated with both overweight and obesity; and night-only shift work was associated with obesity, not overweight.

The effects of shift work and interaction between shift work and overweight/obesity on low back pain in nurses: results from a longitudinal study.

OBJECTIVE: To examine whether shift work is a risk factor for low back pain (LBP) and the interaction effects of shift work and overweight/obesity on LBP over time among nurses. METHODS: A longitudinal study over 2 years. Measurements included reported LBP, shift work status, and selected potential confounders. RESULTS: Among 928 LBP-free nurses at baseline, 319 (34.4%) developed LBP over 2 years. After adjusting for confounders, shift workers were 1.15 times more likely to develop LBP (adjusted odds ratio [aOR], 1.15; 95% confidence interval, 1.05 to 1.40; P = 0.03). The interaction analysis showed that overweight/obese shift workers were more likely to develop LBP than day workers (overweight: aOR, 1.23 vs aOR, 1.03, respectively; obesity: aOR, 1.34 vs aOR, 1.10, respectively). CONCLUSIONS: Our findings suggest that shift workers are at a higher risk of developing LBP over time, especially those who are overweight/obese.

Does maintaining or changing shift types affect BMI? A longitudinal study.

OBJECTIVES: To examine the impact of maintaining or changing shift work status on body mass index (BMI) among female nurses and midwives. METHODS: A longitudinal study. Measurements included day work maintainers, shift work maintainers, day to shift changers and shift to day changers, changes in BMI, and potential confounders selected from baseline survey. Repeated measures analysis of covariance was employed. RESULTS: The shift to day changers had decreased in BMI over the follow-up period (mean, -3.02; SD, 5.45; P < 0.001). In contrast, the shift work maintainers and the day to shift changers had increased in BMI over follow-up period (mean, 0.56; SD, 5.47; P = 0.01 and mean, 0.13; SD, 5.64; P = 0.04, respectively). CONCLUSIONS: The analysis suggests that shift work could increase BMI.

Update on complex nonpharmacological interventions for breathlessness.

PURPOSE OF REVIEW: The study provides a review of current evidence about the role of complex nonpharmacological strategies in managing the multidimensional components of the breathlessness experience for individuals with life-limiting conditions. RECENT FINDINGS: Evidence continues to demonstrate the significant impact of breathlessness on patients' quality of life, day-to-day activity, and physical and psychosocial functioning. Recent evidence also confirms that patients draw on a number of self-initiated actions to cope with breathlessness, although many do not use strategies that are supported by a growing body of evidence from randomized controlled trials. Current literature supports the use of multicomponent, nonpharmacological interventions comprising strategies to improve breathing efficiency and reducing psychological distress to manage breathlessness. However trials of these approaches have mostly been conducted among patients with chronic obstructive pulmonary disease (COPD) or lung cancer, and few studies have investigated the benefits of nonpharmacological for patients in later stages of disease. Further investigation of interventions is required across a broader range of chronic life-limiting conditions. Addressing breathlessness and its co-occurring symptoms (symptom clusters) is also an area for future enquiry. SUMMARY: The experience of breathlessness and strategies adopted by patients to manage the experience highlight the importance of multidimensional approaches to improve outcomes for patients with life-limiting conditions. There is good evidence to support the role of multicomponent, nonpharmacological interventions in reducing breathlessness for patients with COPD and lung cancer, although further studies are required to understand the particular clinical contexts in which such interventions are appropriate.

A workforce profile comparison of practising and non-practising midwives in Australia: baseline data from the Midwives and Nurses e-Cohort Study.

Existing workforce data, as an estimate of the current capability of the midwifery workforce to provide midwifery care, is confounded by systematic reporting issues that may overestimate the potential of the existing midwifery workforce. This paper reports the characteristics of qualified Australian midwives who responded to the baseline data collection in the Midwives and Nurses e-Cohort Study and compares those who are currently practising in midwifery with those who are not. Currently practising midwives represented only 52% of those respondents who identified as midwives and the profile of the typical midwife is female, aged over 40 years, Australian, married or in a de facto relationship. She has been registered for over 10 years, educated to postgraduate diploma level and currently works in a clinical midwifery role in a hospital for less than 35 hours per week. Specific deficits in the Australian midwifery workforce namely low numbers of indigenous midwives, independent practitioners and midwives suitably qualified to teach and undertake research in academia are identified. Drawing on the nationally representative e-cohort data, this cross-sectional analysis identifies for the first time the real face of the Australian midwifery workforce and provides an evidence-based foundation for future workforce planning and a methodology for other countries interested in accurately monitoring their actual and potential midwifery workforce.

The association between shift work and unhealthy weight: a cross-sectional analysis from the Nurses and Midwives' e-cohort Study.

OBJECTIVE: To examine the association between shift work and unhealthy weight among female nurses and midwives. METHODS: A cross-sectional study. Measurement outcomes included shift work, unhealthy weight (underweight: body mass index [BMI] < 18.5; overweight: BMI 25.0 to 29.9; obesity: BMI > 30.0), diet quality, physical-activity level, alcohol consumption, and smoking status. RESULTS: Among the 2494 participants (1259 day and 1235 shift workers), only 1% of the participants were underweight, 31.8% were overweight, and 26.9% were obese. After adjusting the selected confounders, shift workers were 1.15 times more likely to be overweight/obese than day workers (P = 0.013, 95% confidence interval, 1.03 to 1.28; P = 0.02, 95% confidence interval, 1.02 to 1.30, respectively). CONCLUSIONS: Shift work is associated with higher risk of being overweight/obese. Longitudinal studies are being undertaken to better understand the causal relationship between shift work and unhealthy weight.