Postinfective bowel dysfunction following Campylobacter enteritis is characterised by reduced microbiota diversity and impaired microbiota recovery.

OBJECTIVES: Persistent bowel dysfunction following gastroenteritis (postinfectious (PI)-BD) is well recognised, but the associated changes in microbiota remain unclear. Our aim was to define these changes after gastroenteritis caused by a single organism, Campylobacter jejuni, examining the dynamic changes in the microbiota and the impact of antibiotics. DESIGN: A single-centre cohort study of 155 patients infected with Campylobacter jejuni. Features of the initial illness as well as current bowel symptoms and the intestinal microbiota composition were recorded soon after infection (visit 1, <40 days) as well as 40-60 days and >80 days later (visits 2 and 3). Microbiota were assessed using 16S rRNA sequencing. RESULTS: PI-BD was found in 22 of the 99 patients who completed the trial. The cases reported significantly looser stools, with more somatic and gastrointestinal symptoms. Microbiota were assessed in 22 cases who had significantly lower diversity and altered microbiota composition compared with the 44 age-matched and sex-matched controls. Moreover 60 days after infection, cases showed a significantly lower abundance of 23 taxa including phylum Firmicutes, particularly in the order Clostridiales and the family Ruminoccocaceae, increased Proteobacteria abundance and increased levels of Fusobacteria and Gammaproteobacteria. The microbiota changes were linked with diet; higher fibre consumption being associated with lower levels of Gammaproteobacteria. CONCLUSION: The microbiota of PI-BD patients appeared more disturbed by the initial infection compared with the microbiota of those who recovered. The prebiotic effect of high fibre diets may inhibit some of the disturbances seen in PI-BD. TRIAL REGISTRATION NUMBER: NCT02040922.

Make or break. Mothers' experiences of returning to paid employment and breastfeeding: a New Zealand study.

When mothers return to paid employment, which more and more are doing, they often give up breastfeeding. This qualitative study aims to describe New Zealand mothers' experiences of returning to paid employment and infant feeding. Thirty-four mothers who had given birth between 2003 and 205 were interviewed regarding their experiences and decisions about returning to paid employment following the birth of their child. The presence or absence of the factors of space, time, and support emerged as key factors in the mothers' perception of their ability to continue to breastfeed on their return to paid employment. Employers need to make changes to the workplace environment to encourage and support breastfeeding. But societal attitudes also need to change to become more supportive and positive of breastfeeding workers.

Constructing a new approach to developing evidence-based practice with nurses and older people.

PURPOSE: Providing evidence-based nursing care to older people is central to the international development agenda. This paper is a report on the first 5 years (2000-2005) of a participatory research project, the purpose of which was to collaborate with practitioners and older people to develop approaches to promote the attainment of evidence-based nursing care across Scotland. DESIGN: Many theoretical influences shaped the design of this action research study including realistic evaluation, participatory social learning theory, and descriptions of communities of practice. Multiple methods of data collection were used during four action cycles. The inaugural community of practice comprised 30 nurses, a second group of 30 nurses joined midway, followed by a third group of 15 nurses, and finally, an older person-carer community of 21 members was established. FINDINGS: Project outputs included the construction of an internet-based, practice-development college. A procedural model for developing and demonstrating care guidance drawn from a diversity of evidence and reflective of an agreed set of principles was piloted and endorsed by the national standard setting agency. A preliminary version of a promising approach to practice development, "the Caledonian Model," was delineated for future testing and refinement. CONCLUSION: This work indicates the merits of using participatory research to find solutions to the challenge of promoting evidence-based practice. Evaluation data suggest that in combination, the approaches developed in this project empower nurses to work with older people to champion developments even in seemingly unfavorable conditions.

Spatial contouring of risk: a tool for environmental epidemiology.

The possible elevation of disease rates in the proximity of site-specific environmental hazards is much investigated. Single-site studies are subject to problems of reporting bias and statistical power, and multisite studies to heterogeneity of exposure. Both types of studies usually use concentric circular regions centered on a site as a surrogate for defining the exposed and unexposed populations. This approach does not take into account the actual spatial pattern of toxicant dispersion or the spatial pattern associated with the population, and so much useful information is wasted. We report a kernel density technique to map risk contours for disease, which is not influenced by the coordinates of any putative environmental hazard and which could be married to actual spatial exposure patterns.