Risk factors for congenital heart disease: The Baby Hearts Study, a population-based case-control study.

We investigated the role of maternal environmental factors in the aetiology of congenital heart disease (CHD). A population-based case-control study (242 CHD cases, 966 controls) was conducted using an iPad questionnaire for mother with linkage to maternity and first trimester prescription records. Risk of CHD was associated with low maternal education (OR adjusted for confounders 1.59; 95% confidence interval [CI], 1.02-2.49), pregestational diabetes (OR 4.04; 95% CI 1.00-16.28), self-reported maternal clotting disorders (adjOR 8.55, 95%CI 1.51-48.44), prescriptions for the anticlotting medication enoxaparin (adjOR 3.22, 95%CI 1.01-10.22) and self-reported vaginal infections (adjOR 1.69, 95%CI 1.01-2.80). There was no strong support for the hypothesis that periconceptional folic acid supplements have a protective effect, but there was a protective effect of frequent consumption of folate rich fruits (adjOR 0.64, 95%CI 0.47-0.89). Compared to the most common pre-pregnancy dietary pattern, CHD risk was associated with a poor diet low in fruit and vegetables (adjOR 1.56, 95%CI 1.05-2.34). Mothers of cases reported more pregnancy related stress (adjOR 1.69; 95% CI 1.22-2.34) and multiple stressors (adjOR 1.94, 95%CI 0.83-4.53). We found no supportive evidence for CHD risk being associated with obesity, smoking, depression or antidepressant use in this population. Our findings add to the previous evidence base to show potential for public health approaches to help prevent CHD in future by modifying environmental factors. Independent confirmation should be sought regarding elevated CHD risk associated with maternal blood clotting disorders and their treatment, since we are the first to report this.

Planning, implementation and evaluation of antenatal weight management programmes: What are the key components? A mixed methods study.

OBJECTIVE: To provide an understanding of the influential components required for the planning, delivery and evaluation of antenatal weight management programmes for women who are overweight or obese. DESIGN: Two phase sequential explanatory mixed methods design comprising of an online survey and one-to-one telephone interviews. SETTING AND PARTICIPANTS: All UK maternity services (n = 168) and local government councils (n = 417). FINDINGS: From the 378 responses, 49 maternity services and 28 local government councils reported having an antenatal weight management programme. Of the 62 responses that specified BMI as an inclusion criterion only two-fifths (40.3% n = 25) adhered to the recommended threshold to include women with a BMI ≥30 kg/m2. Although having a multi-disciplinary team was identified as fundamental when planning a programme, only 20.6% (n = 14/68) of the programmes involved service users during the planning phase. How the programme was communicated to a woman was a key factor which determined whether she partook in the programme or not. Having administrative support and staff with expertise in data collection were essential when evaluating a programme. Staff having protected time was identified as important when planning, delivering and evaluating a programme. Three overarching themes were identified from the individual interviews (n = 14) 'choices and decisions', 'demands and resources' and 'engagement and disengagement'. KEY CONCLUSIONS: National guidelines recommendations regarding service user involvement when planning programmes and the BMI threshold used for inclusion are not being met. In addition to having adequate time, personnel and finances, successful programmes are dependent on the confidence and communication skills of midwives to raise the issue of obesity with these women at the booking appointment. Without staff having the time and necessary knowledge and skills, evaluation, and hence demonstrating programme impact, will likely remain difficult. Organisational support is needed to release resources to plan, deliver and evaluate these programmes. Strategic communication strategies are needed to promote the programme to both women and staff within organisations. Future programmes need to ensure there is engagement with service users from the planning of the programme through to evaluation.

"Man in the driving seat": A grounded theory study of the psychosocial experiences of Black African and Black Caribbean men treated for prostate cancer and their partners.

OBJECTIVE: Evidence suggests that treatment side-effects of prostate cancer (CaP) substantially affect the psychosocial well-being of affected men and their partners. However, this phenomenon is poorly understood among high risk (1 in 4) Black African (BA)/Black Caribbean (BC) men and their partners, as they are currently under-represented in global research on CaP survivorship. This study explored the psychosocial experiences of BA/BC men with CaP and their partners in the United Kingdom as they lived through the side effects of CaP treatment within their own sociocultural and marital contexts. METHODS: Using constructivist grounded theory methodology, interviews and focus groups were conducted with eligible men (n = 25), partners (n = 11), and health care professionals (HCPs) (n = 11) recruited in England. Data were iteratively analysed using constant comparison following the key stages of initial, focused, and theoretical coding until saturation was achieved. RESULTS: Data analysis culminated in the development of a substantive theory "man in the driving seat," which describes the experiences of BA/BC men with CaP and their partners within their context. Culturally informed gender roles and identities influenced how men and partners responded and coped with the side effects of CaP treatment. There was a hierarchy of power within the BA/BC relationship, in which men were dominantly positioned as leaders, whilst partners mostly operated from a supportive but "accepting" position. CONCLUSION: Inclusive and culturally sensitive individual and couple-focused psychosocial support, which is devoid of stereotyping and recognises the experiences of both BA/BC men and their partners is recommended.

"Hard to reach, but not out of reach": Barriers and facilitators to recruiting Black African and Black Caribbean men with prostate cancer and their partners into qualitative research.

Access and recruitment barriers may have contributed to the underrepresentation of Black African/Caribbean men and their partners in current psychosocial research related to prostate cancer survivors. Whilst some studies have explored recruitment barriers and facilitators from participants' perspectives, little is known from researchers' point of view. This paper aimed to address this gap in the literature. Recruitment strategies included the following: cancer support groups, researchers' networks, media advertisement, religious organisations, National Health Service hospitals and snowball sampling. Thirty-six eligible participants (men = 25, partners = 11) were recruited into the study. Recruitment barriers comprised of gate-keeping and advertisement issues and the stigma associated with prostate cancer disclosure. Facilitators which aided recruitment included collaborating with National Health Service hospitals, snowball sampling, flexible data collection, building rapport with participants to gain their trust and researcher's attributes. Findings highlight that "hard to reach" Black African/Caribbean populations may be more accessible if researchers adopt flexible but strategic and culturally sensitive recruitment approaches. Such approaches should consider perceptions of stigma associated with prostate cancer within these communities and the influence gatekeepers can have in controlling access to potential participants. Increased engagement with healthcare professionals and gatekeepers could facilitate better access to Black African/Caribbean populations so that their voices can be heard and their specific needs addressed within the healthcare agenda.

Perceived determinants to alcohol consumption and misuse: a survey of university students.

AIM: Before an attempt is made to develop any population-specific behavioural change programme, it is important to know what the factors that influence behaviours are. The aim of this study was to identify what are the perceived determinants that attribute to young people's choices to both consume and misuse alcohol. METHOD: Using a descriptive survey design, a web-based questionnaire based on the Theory of Triadic Influence was administered to students aged 18-29 years at one university in Northern Ireland. RESULTS: Out of the total respondents ( n = 595), knowledge scores on alcohol consumption and the health risks associated with heavy episodic drinking were high (92.4%, n = 550). Over half (54.1%, n = 322) cited the Internet as their main source for alcohol-related information. The three most perceived influential factors of inclination to misuse alcohol were strains/conflict within the family home ( M = 2.98, standard deviation ( SD) = 0.18, 98.7%, n = 587), risk taking/curiosity behaviour ( M = 2.97, SD = 0.27, 97.3%, n = 579) and the desire not to be socially alienated ( M = 2.94, SD = 0.33, 96%, n = 571). Females were statistically significantly more likely to be influenced by desire not to be socially alienated than males ( p = .029). Religion and personal reasons were the most commonly cited reasons for not drinking. CONCLUSION: Future initiatives to reduce alcohol misuse and alcohol-related harms need to focus on changing social normative beliefs and attitudes around alcohol consumption and the family and environmental factors that influence the choice of young adult's alcohol drinking behaviour. Investment in multi-component interventions may be a useful approach.

Assessing the availability of the teratogenic drug isotretinoin outside the pregnancy prevention programme: a survey of e-pharmacies.

PURPOSE: The increase in online purchasing of medications raises safety concerns regarding teratogenic drugs. The use of the teratogenic drug 'isotretinoin' for women of childbearing age requires strict adherence to the Pregnancy Prevention Programme (PPP), a risk minimisation measure imposed on prescribers and users. We sought to determine how readily consumers can purchase isotretinoin online and the associated safety procedures and information. METHODS: A descriptive cross-sectional survey was conducted of 50 e-pharmacies identified from commonly used search engines. E-pharmacy characteristics and isotretinoin PPP specific criteria were evaluated. Purchases of isotretinoin from seven e-pharmacies not bearing authentication logos and not requiring a prescription were assessed for PPP policy adherence, purchasing procedures and compound quality. RESULTS: Forty-three (86%) of the e-pharmacies did not have an authentication seal/logo. Isotretinoin could be purchased from 42 sites without a valid prescription. Information on isotretinoin causing birth defects was lacking in 25 of the 50 sites, on not taking isotretinoin in pregnancy in 24 sites and not taking isotretinoin if planning or at risk of a pregnancy in 33 sites. Of the eight attempted purchases, seven arrived, all without any patient information leaflet. All were verified as isotretinoin. CONCLUSION: The Internet provides a loophole for purchasing of medications known to cause congenital abnormalities, which needs to be addressed by medicines regulatory agencies worldwide. The current PPP for isotretinoin may be failing to protect mothers and babies from preventable harm-clinicians need to be aware of this, and the public needs to be educated about the potential risks.

'The midwives aren't allowed to tell you': perceived infant feeding policy restrictions in a formula feeding culture - the Feeding Your Baby Study.

OBJECTIVE: to explore the expectations and experiences of postnatal mothers in relation to infant feeding, and to identify how care could be improved. DESIGN: this study used a qualitative, exploratory, descriptive design. Data were collected through one to one in-depth semi-structured interviews and focus groups. SETTING: Tayside area of Eastern Scotland. PARTICIPANTS: seven focus group interviews (n=38 participants) and 40 semi-structured one-to-one interviews with mothers with a range of infant feeding experiences i.e. exclusively breast fed; started breast feeding but changed to formula milk before 16 weeks; exclusively formula fed; or who concurrently breast and formula fed their infant. FINDINGS: a principal theme of 'Mixed and missing messages' emerged, incorporating 'Conflicting advice', 'Information gaps' and 'Pressure to breast feed' with a secondary theme of 'Emotional costs'. Several problems were identified with how women were given information, how infant feeding discussions were held, and the type of support available after the infant is born. KEY CONCLUSIONS: there was a strong perception that some midwives are not 'allowed' to discuss or provide information on formula feeding, and the women reported feeling pressurised to breast feed. Current interpretation of guidance from the UNICEF UK Baby Friendly Initiative may be restricting antenatal discussions about infant feeding. The combination of this partial preparation antenatally and postnatal support that was often inconsistent seems to incur a counter-productive emotional cost. IMPLICATIONS FOR PRACTICE: at strategic, policy and practice levels the infant feeding message needs to change to encourage a more woman-centred focus including discussions about the realities of all types of infant feeding. It is important that health providers continue to promote and support breast feeding; and that effective services are provided to women who wish to breast feed to help them to do so. However provision of information about all aspects of feeding is needed as well as support for women who do not wish to breast feed.

What is the impact of the Internet on decision-making in pregnancy? A global study.

BACKGROUND: Women need access to evidence-based information to make informed choices in pregnancy. A search for health information is one of the major reasons that people worldwide access the Internet. Recent years have witnessed an increase in Internet usage by women seeking pregnancy-related information. The aim of this study was to build on previous quantitative studies to explore women's experiences and perceptions of using the Internet for retrieving pregnancy-related information, and its influence on their decision-making processes. METHODS: This global study drew on the interpretive qualitative traditions together with a theoretical model on information seeking, adapted to understand Internet use in pregnancy and its role in relation to decision-making. Thirteen asynchronous online focus groups across five countries were conducted with 92 women who had accessed the Internet for pregnancy-related information over a 3-month period. Data were readily transferred and analyzed deductively. RESULTS: The overall analysis indicates that the Internet is having a visible impact on women's decision making in regards to all aspects of their pregnancy. The key emergent theme was the great need for information. Four broad themes also emerged: "validate information,""empowerment,""share experiences," and "assisted decision-making." Women also reported how the Internet provided support, its negative and positive aspects, and as a source of accurate, timely information. CONCLUSION: Health professionals have a responsibility to acknowledge that women access the Internet for support and pregnancy-related information to assist in their decision-making. Health professionals must learn to work in partnership with women to guide them toward evidence-based websites and be prepared to discuss the ensuing information.

A Web-based survey of midwives' perceptions of women using the Internet in pregnancy: a global phenomenon.

OBJECTIVES: to ascertain the views of midwives on Internet use in midwifery practice, to elicit the extent and nature of pregnant women's use of the Internet from a midwifery perspective, and to explore midwives' perceptions of pregnant women using the Internet as an information source. SETTING: 12 online midwifery discussion fora. DESIGN: a cross-sectional exploratory descriptive Web-based survey. METHODOLOGY: midwives from midwifery e-discussion groups who had direct contact with pregnant women were invited to share their experiences of working with women who presented them with information gleaned from the Internet. PARTICIPANTS: an international sample of 303 midwives accessed and completed a Web-based questionnaire. RESULTS: the vast majority of midwives who responded (89%, n=271) perceived an increase in Internet use among pregnant women. Midwives reported that women used the Internet to obtain information on a broad range of pregnancy-related topics. Most (86%, n=260) had experience of a pregnant woman discussing information from the Internet with them in the past year. A concerned minority (19%, n=49) regarded the information retrieved by the women to be either 'not very' or 'not at all' accurate. Two-thirds (67%, n=174) considered that the information had an effect on how the woman thought her pregnancy should be managed. KEY CONCLUSIONS: this study provides evidence of pregnant women accessing the Internet to obtain information related to their pregnancy. Midwives recognise that pregnant women are increasingly using the Internet as an accessible resource for information to inform decision-making in pregnancy. This presents a number of challenges for midwives. IMPLICATIONS FOR PRACTICE: midwives need to keep up-to-date with the latest knowledge. Midwives' skills in Internet use need to be developed so that they can be effective and competent partners in supporting post-modern women.

Internet use in pregnancy informs women's decision making: a web-based survey.

BACKGROUND: Internet access and usage is almost ubiquitous, providing new opportunities and increasing challenges for health care practitioners and users. With pregnant women reportedly turning to the Internet for information during pregnancy, a better understanding of this behavior is needed. The objective of this study was to ascertain why and how pregnant women use the Internet as a health information source, and the overall effect it had on their decision making. Kuhlthau's (1993) information-seeking model was adapted to provide the underpinning theoretical framework for the study. METHODS: The design was exploratory and descriptive. Data were collected using a valid and reliable web-based questionnaire. Over a 12-week period, 613 women from 24 countries who had confirmed that they had used the Internet for pregnancy-related information during their pregnancy completed and submitted a questionnaire. RESULTS: Most women (97%) used search engines such as Google to identify online web pages to access a large variety of pregnancy-related information and to use the Internet for pregnancy-related social networking, support, and electronic commerce (i.e., e-commerce). Almost 94 percent of women used the Internet to supplement information already provided by health professionals and 83 percent used it to influence their pregnancy decision making. Nearly half of the respondents reported dissatisfaction with information given by health professionals (48.6%) and lack of time to ask health professionals questions (46.5%) as key factors influencing them to access the Internet. Statistically, women's confidence levels significantly increased with respect to making decisions about their pregnancy after Internet usage (p < 0.05). CONCLUSIONS: In this study, the Internet played a significant part in the respondents' health information seeking and decision making in pregnancy. Health professionals need to be ready to support pregnant women in online data retrieval, interpretation, and application.