Evaluation of environmental features that support breastfeeding: A photovoice study.

The United Kingdom (UK) has some of the lowest breastfeeding rates in the world, and Stoke-on-Trent has some of the lowest breastfeeding rates and highest infant mortality rates in the UK. Vicarious experience of formula feeding, formula feeding culture, and a lack of physical environments to support breastfeeding are known barriers to uptake and maintenance. Improving physical environments and increasing the visibility of breastfeeding in public would help to challenge these barriers. This research employs a participatory approach to understand the facilitators and barriers to breastfeeding in public. Nine breastfeeding peer supporters were recruited as co-researcher for a photovoice study. Co-researchers collated images of features in environments which they felt either supported or acted as a barrier to public breastfeeding. An analysis workshop was held to review the data collected and produce collaboratively agreed findings. Various environmental features were highlighted as facilitators to breastfeeding including family rooms, welcoming signage, supportive staff members, and displays of information about breastfeeding. In addition, poorly designed family rooms, lack of inclusivity within breastfeeding spaces, breastfeeding spaces within toilets and a lack of information were barriers to public breastfeeding. This research illustrates that while some environments are well designed to support breastfeeding many others are not. Environments often lack basic provision and/or make token gestures towards breastfeeding support, such as welcome signage, without providing the infrastructure needed to support breastfeeding. More education about breastfeeding friendly spaces and resources for putting this information into practice are needed for environment owners, managers, and policy makers.

An online questionnaire study investigating the impact of psychosocial factors on the duration of breastfeeding.

OBJECTIVE: To examine the psychosocial factors of intention to breastfeed, perceived stress, social support, self-efficacy and their ability to predict the duration of breastfeeding in first-time mothers up to six months postnatally. DESIGN: Cross-sectional, quantitative study using a retrospective online survey. SETTING: Women across West Yorkshire, in the north of the United Kingdom. PARTICIPANTS: First-time mothers (n=98) who had given birth in the past six months. MEASURES: An online survey included three established survey instruments measuring the main study variables: The Perceived Stress Scale (Cohen et al., 1983), the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988) and the General Self-Efficacy Scale (Schwarzer and Jerusalem, 1995). The fourth variable was Intention to breastfeed and was measured using a single question. The survey was structured into five main sections 1) During pregnancy, 2) Once the baby was born, 3) Support to feed my baby, 4) Psychosocial factors and 5) Demographics. Open text responses allowed women to elaborate on their infant feeding experiences. FINDINGS: 80% of the sample said they had intended to breastfeed their baby. Although 96% initiated breastfeeding while in hospital, this decreased to 82% at one week and 75% at six weeks. By six months, the rate had dropped to below 50%. Survival Analysis using Cox's Regression found no significant predictors of duration of breastfeeding at one week and six weeks. However, a significant negative correlation between perceived stress and self-efficacy suggests that greater perceived stress is linked to lower self-efficacy. Other findings included 91% of mothers decided how they would feed their baby before they were pregnant (57%) or during pregnancy (34%) and the majority answered that breastfeeding support was most useful straight after the birth and up to one week. KEY CONCLUSIONS: The findings from this sample of new mothers showed that although many intended to breastfeed, a considerable number of them had stopped by the time their baby was six weeks old. The content analysis highlighted the multiple challenges new mothers can experience with breastfeeding and furthers understanding of the support needs of this group of women. IMPLICATIONS FOR PRACTICE: Many of the mothers had already decided how to feed their baby before the baby was born. In this sample, a quarter of those who intended to breastfeed or thought they might breastfeed had stopped by six weeks. In order to increase breastfeeding duration, new mothers with high intention to breastfeed need to be better prepared for potential breastfeeding challenges and given more support with breastfeeding shortly after their baby is born.

A photo-elicitation exploration of UK mothers' experiences of extended breastfeeding.

In this qualitative study we explored the experiences of women breastfeeding children over 12 months of age. Data were collected from 24 participants using semi-structured photo-elicitation interviews and photo-prompted online surveys. Participants took photographs of their extended breastfeeding experiences over one week and reflected on how the events depicted made them feel, and what they represented in terms of their experience. Data were analysed using Interpretative Phenomenological Analysis. Four themes were developed; parenting through breastfeeding: meeting the needs of my child, my body is not my own, social influences on the breastfeeding experience, and thinking about stopping: my choice or theirs? Findings highlight that extended breastfeeding was experienced as beneficial for both mother and child, promoting closeness, and bonding, and providing a valued parenting tool. However, some mothers reported conflict between their desire for child-led extended breastfeeding and the need to regain autonomy and control of their own bodies. The dangers of negative societal responses to extended breastfeeding and risks to mental health posed by cultural constructions of 'ideal' motherhood are discussed.

Questionnaire measures of self-directed ageing stereotype in older adults: a systematic review of measurement properties.

The population is ageing, but while average life expectancy continues to increase, healthy life expectancy has not necessarily matched this and negative ageing stereotypes remain prevalent. Self-directed ageing stereotypes are hypothesised to play an important role in older adults' health and well-being; however, a wide variety of terms and measures are used to explore this construct meaning there is a lack of clarity within the literature. A review was conducted to identify tools used to measure self-directed ageing stereotype in older adults and evaluate their quality. Searches identified 109 papers incorporating 40 different measures. Most common were the Philadelphia Geriatric Centre Morale Scale Attitude Towards Own Ageing (ATOA) subscale, Ageing Perceptions Questionnaire (APQ) and Attitudes to Ageing Questionnaire. Despite being most frequently used, the ATOA was developed to measure morale in older adults rather than self-directed ageing stereotypes. Over 25 terms were used to describe the concept, and it is suggested that for consistency the term "self-directed ageing stereotype" be adopted universally. Across measures, poor reporting of psychometric properties made it difficult to assess scale quality and more research is needed to fully assess measures before conclusions can be drawn as to the best tool; however, the Brief-APQ appears to hold most promise. Future research must address this issue before interventions to reduce negative self-directed ageing stereotypes can be developed and fully evaluated.

Cyclosporine-induced alterations in the hypothalamic hypophyseal gonadal axis in transplant patients.

We evaluated the response of 20 male patients, 13 cadaveric kidney and 7 heart transplant recipients, to the administration of 100 micrograms GnRH (gonadotropin-releasing hormone) and 500 micrograms TRH (thyrotropic-releasing hormone). All of the heart transplant recipients and 7 of the kidney transplant patients were receiving a combination of cyclosporine, azathioprine and prednisone; while the 6 remaining kidney transplant patients received azathioprine and prednisone. The patients receiving cyclosporine had decreased plasma levels of prolactin, and manifested a blunted response to TRH administration for prolactin and TSH. The heart transplant patients had a blunted response of LH and FSH to the administration of GnRH. The levels of testosterone were found to be low in all patients regardless of the immunosuppressant therapy. Despite the low testosterone levels, no increment in the concentration of LH or FSH was present. Intramuscular administration of HCG (human chorionic gonadotropin) (Ayerst Laboratories, New York, N.Y.) failed to increase the testosterone concentration in 5 of 6 patients with renal transplants, 3 taking cyclosporine and 3 taking azathioprine. This study suggests that cyclosporine has a selective effect on the hypothalamus and/or hypophysis, resulting in lower baseline levels of plasma prolactin and a pituitary insensitivity to TRH administration. In addition, FSH and LH were low or normal in the presence of low testosterone levels, suggesting that the hypothalamic pituitary gonadal axis is impaired. Furthermore, there may be a direct toxic effect of the immunosuppressant medications on the gonads, manifested as lower testosterone levels and inability to respond to the administration of HCG.

Regional hyperthermia for deep-seated malignancies using the BSD annular array.

Forty-four patients were treated using the BSD-1000 Annular Phased Array between April 1983 and December 1986. There were 32 pelvic, nine abdominal, two extremity, and one thoracic sites treated. Mean tumour volume was 646 cc. Thirty-nine patients had concurrent radiation therapy, receiving a mean dose of 38 Gy. Mean average temperature was 41.0 +/- 1.4 degrees C. Most patients experienced local or systemic toxicity, requiring temporary treatment interruption in 33 patients, and termination of treatment in eight. Chronic complications were seen in four, but these were in patients receiving high total radiation doses as well. There were six complete and five partial responses. Among the 32 patients with pelvic tumours, mean tumour volume was 317 cc, mean radiation dose was 42 Gy, and mean average temperature was 41.3 +/- 1.2 degrees C. There were five complete and four partial responses. Achieving tumour temperatures greater than or equal to 42 degrees C with the annular array is difficult, due to both systemic and local toxicity. To improve clinical hyperthermia for thoracic, abdominal, and pelvic tumours, new technologies such as steerable phased array microwave systems; scanned, focused ultrasound; and permanently implantable thermoregulating ferromagnetic seeds, or new approaches such as using drugs to alter blood flow, or combining hyperthermia with antineoplastic drugs or biological agents, will be necessary.

Spontaneous breathing with a T-piece circuit: minimum fresh gas/minute volume ratio which prevents rebreathing.

Thirty adults undergoing elective superficial surgery under enflurane-nitrous oxide anesthesia which intubated and breathing spontaneously via a modified Mapleson D (Brain) T-piece circuit were studied with their consent. Total fresh gas flows which were initially high were adjusted downward until minimal rebreathing (inspired CO2 tension of 5 to 10 mmHg) was present. At this point both fresh gas flow (VF) and minute volume (VE) were recorded, and the ratio of the two (VF/VE) was calculated. The mean VF/VE ratio was found to be 1.89 +/- 0.27 (SD). Linear regression was used to plot VF against VE breathing frequency, tidal volume, age, weight, and end-tidal CO2 tension. Significant correlation was found only with VE (r2 = 0.48, P less than 0.001) and frequency (r2 = 0.44, P less than 0.001). When the ratio VF/VE was plotted against the same variables, no significant correlations was found. This study showed a wide variability in the minimum VF/VE ratio which prevents rebreathing. The respiratory waveform, which was not studied, probably played a role in determining the VF/VE. Nevertheless, 87 per cent of our patients required a VF/VE ratio of 2.0 or less to prevent rebreathing. If one is especially concerned about rebreathing, VE should be measured in the VF adjusted to about twice the measured.