Jaynie Rance

Body image concerns during pregnancy are associated with a shorter breast feeding duration

OBJECTIVE breast feeding is affected by numerous psycho-social factors. Antenatal concerns such as embarrassment regarding public feeding and the impact of breast feeding upon breast shape are known to lead to artificial milk use. However, although work has explored the relationship between maternal weight and infant feeding, wider body image concerns have not been examined. The aim of the current study was to explore the association between maternal body image concerns during pregnancy upon intended and actual breast feeding duration. DESIGN a two stage self report questionnaire completed during pregnancy and at six months post partum. SETTING mothers were recruited from local mother and infant groups, nurseries and online mother and infant forums. PARTICIPANTS 128 pregnant women completed both stages. MEASURES phase one: completion of a questionnaire exploring body image during pregnancy (concerns about stretch marks, weight gain and appearance) and planned breast feeding duration during the second/third trimester of pregnancy (body image, weight, intended duration) followed by a second questionnaire measuring actual breast feeding duration and breast feeding experiences. FINDINGS factor analysis revealed three primary body image concerns: pregnancy body image, prospective postnatal body image and dieting during pregnancy. Higher concerns on all three factors were associated with both intended and actual shorter breast feeding duration. Amongst mothers who stopped breast feeding before six months, those with higher body image concerns were more likely to report stopping due to embarrassment or the perceived impact upon their breast shape. The relationship was not explained by maternal weight, although a higher residual weight gain at six months was associated with a shorter breast feeding duration. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE mothers who are affected negatively by changes to their body during pregnancy may be less likely to plan to or initiate breast feeding potentially due to underlying issues such as embarrassment or perceived impact of feeding upon their appearance. The findings are important to those working with women during pregnancy and the postpartum period in understanding the impact of body image upon intention and ability to initiate and continue breast feeding.

Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties

Abstract Aims To examine the relationship between specific reasons for stopping breastfeeding and depressive symptoms in the postnatal period. Background Difficulty breastfeeding has been connected to postnatal depression although it is unclear whether difficulty breastfeeding precedes or succeeds a diagnosis. However, the concept of ‘breastfeeding difficulty’ is wide and includes biological, psychological and social factors. Design A cross‐sectional self‐report survey. Methods Data were collected between December 2012 and February 2013. 217 women with an infant aged 0‐6 months who had started breastfeeding at birth but had stopped before 6 months old completed a questionnaire examining breastfeeding duration and reasons for stopping breastfeeding. They further completed a copy of the Edinburgh Postnatal Depression Scale. Results A short breastfeeding duration and multiple reasons for stopping breastfeeding were associated with higher depression score. However, in a regression analysis only the specific reasons of stopping breastfeeding for physical difficulty and pain remained predictive of depression score. Conclusions Understanding womens specific reasons for stopping breastfeeding rather than breastfeeding duration is critical in understanding womens breastfeeding experience and providing women with emotional support. Issues with pain and physical breastfeeding were most indicative of postnatal depression in comparison to psychosocial reasons highlighting the importance of spending time with new mothers to help them with issues such as latch.

How much of a priority is treating erectile dysfunction? A study of patients' perceptions.

Background Erectile dysfunction (ED) is one complication of diabetes for which the treatment is rationed. Despite considerable public debate there has been no formal assessment of the views of patients and sufferers of the priority of treating ED.

Living with an implantable cardioverter defibrillator: The patients' experience

OBJECTIVES To explore the lived experiences of implantable cardioverter defibrillator (ICD) recipients. BACKGROUND Previous research suggests ICD recipients experience significant psychological distress with a focus on shock anxiety. In response, avoidant behaviors are often used which can lead to reduced quality of life, cardiac fitness and increased risk of arrhythmia. METHODS A qualitative study using semi-structured interviews with a purposive sample of 18 recipients who had either received or not received an ICD shock was conducted. Data were analyzed using a thematic approach. RESULTS Three themes with sub-themes were defined: (i) physical consequences; (ii) emotional consequences (feeling vulnerable and uncertain; anxiety and depression); and (iii) coping with the ICD (avoidance/restrictive behaviors; acceptance; concealment). CONCLUSION ICD recipients might be helped by a psycho-social intervention that corrects false beliefs about exercise and offers some simple stress management techniques. Additional elements might include helping recipients to re-evaluate goals and find a valued sense of self which this study found aided ICD acceptance.

Community led active schools programme (CLASP) exploring the implementation of health interventions in primary schools: headteachers’ perspectives

BackgroundSchools are repeatedly utilised as a key setting for health interventions. However, the translation of effective research findings to the school setting can be problematic. In order to improve effective translation of future interventions, it is imperative key challenges and facilitators of implementing health interventions be understood from a school’s perspective.MethodsNineteen semi-structured interviews were conducted in primary schools (headteachers n = 16, deputy headteacher n = 1, healthy school co-ordinator n = 2). Interviews were transcribed verbatim and analysed using thematic analysis.ResultsThe main challenges for schools in implementing health interventions were; government-led academic priorities, initiative overload, low autonomy for schools, lack of staff support, lack of facilities and resources, litigation risk and parental engagement. Recommendations to increase the application of interventions into the school setting included; better planning and organisation, greater collaboration with schools and external partners and elements addressing sustainability. Child-centred and cross-curricular approaches, inclusive whole school approaches and assurances to be supportive of the school ethos were also favoured for consideration.ConclusionsThis work explores schools’ perspectives regarding the implementation of health interventions and utilises these thoughts to create guidelines for developing future school-based interventions. Recommendations include the need to account for variability between school environments, staff and pupils. Interventions with an element of adaptability were preferred over the delivery of blanket fixed interventions. Involving schools in the developmental stage would add useful insights to ensure the interventions can be tailored to best suit each individual schools’ needs and improve implementation.

Headteachers’ prior beliefs on child health and their engagement in school based health interventions: a qualitative study

BackgroundSchools play an important role in promoting the health of children. However, little consideration is often given to the influence that headteachers’ and school staff’s prior beliefs have on the implementation of public health interventions. This study examined primary school headteachers’ and school health co-ordinators’ views regarding child health in order to provide greater insights on the school’s perspective for those designing future school-based health interventions.MethodsA qualitative study was conducted using 19 semi-structured interviews with headteachers, deputy headteachers and school health co-ordinators in the primary school setting. All transcripts were analysed using thematic analysis.ResultsWhilst many participants in this study believed good health was vital for learning, wide variance was evident regarding the perceived health of school pupils and the magnitude of responsibility schools should take in addressing child health behaviours. Although staff in this study acknowledged the importance of their role, many believed the responsibility placed upon schools for health promotion was becoming too much; suggesting health interventions need to better integrate school, parental and societal components. With mental health highlighted as an increasing priority in many schools, incorporating wellbeing outcomes into future school based health interventions is advocated to ensure a more holistic understanding of child health is gained.ConclusionUnderstanding the health beliefs of school staff when designing interventions is crucial as there appears to be a greater likelihood of interventions being successfully adopted if staff perceive a health issue as important among their pupils. An increased dependability on schools for addressing health was expressed by headteachers in this study, highlighting a need for better understanding of parental, child and key stakeholder perspectives on responsibility for child health. Without this understanding, there is potential for certain child health issues to be ignored.

Perceptions of asthma and exercise in adolescents with and without asthma

ABSTRACT Objective: To elicit the views of adolescents, with and without asthma, about exercise and asthma, and the perceived benefits of and barriers to participation. The adolescent views elicited would subsequently inform the design of a high-intensity exercise intervention to improve asthma control. Methods: Fifty-four adolescents (age 13.1 ± 0.9 years; 26 with asthma) participated in twelve semi-structured group interviews. Questions were structured around knowledge, attitudes and beliefs towards asthma and its impact on exercise participation and lifestyle. The interviews were transcribed verbatim, thematically analysed and presented via diagrams of emergent themes. Ethical approval was granted by the institutional research ethics committee. Results: Fear of an asthma attack emerged as the main barrier to exercise, with many adolescents with asthma withdrawing from exercise as a coping strategy; many healthy adolescents perceived this withdrawal as laziness or an excuse. Despite this, the majority (81%) of adolescents with asthma reported exercise to be their most enjoyable activity. Adolescents suggested incorporating mixed activities, such as team games (e.g., rounders, football, netball), for future interventions to ensure adherence. Conclusions: Whilst exercise is important in the management of asthma, the tendency of those with asthma to withdraw from exercise to avoid adverse events could be addressed through a games-based high-intensity exercise intervention. Furthermore, educating all adolescents on asthma could simultaneously reduce stigmatisation and enhance exercise engagement.

Examining patterns in opioid prescribing for non-cancer-related pain in Wales: preliminary data from a retrospective cross-sectional study using large datasets

Objectives: To examine trends in strong opioid prescribing in a primary care population in Wales and identify if factors such as age, deprivation and recorded diagnosis of depression or anxiety may have influenced any changes noted. Design: Trend, cross-sectional and longitudinal analyses of routine data from the Primary Care General Practice database and accessed via the Secure Anonymised Information Linkage (SAIL) databank. Setting: A total of 345 Primary Care practices in Wales. Participants: Anonymised records of 1,223,503 people aged 18 or over, receiving at least one opioid prescription between 1 January 2005 and 31 December 2015 were analysed. People with a cancer diagnosis (10.1%) were excluded from the detailed analysis. Results: During the study period, 26,180,200 opioid prescriptions were issued to 1,223,503 individuals (55.9% female, 89.9% non-cancer diagnoses). The greatest increase in annual prescribing was in the 18–24 age group (10,470%), from 0.08 to 8.3 prescriptions/1000 population, although the 85+ age group had the highest prescribing rates across the study period (from 149.9 to 288.5 prescriptions/1000 population). The number of people with recorded diagnoses of depression or anxiety and prescribed strong opioids increased from 1.2 to 5.1 people/1000 population (328%). The increase was 366.9% in areas of highest deprivation compared to 310.3 in the least. Areas of greatest deprivation had more than twice the rate of strong opioid prescribing than the least deprived areas of Wales. Conclusion: The study highlights a large increase in strong opioid prescribing for non-cancer pain, in Wales between 2005 and 2015. Population groups of interest include the youngest and oldest adult age groups and people with depression or anxiety particularly if living in the most deprived communities. Based on this evidence, development of a Welsh national guidance on safe and rational prescribing of opioids in chronic pain would be advisable to prevent further escalation of these medicines. Summary points This is the first large-scale, observational study of opioid prescribing in Wales. Over 1 million individual, anonymised medical records have been searched in order to develop the study cohort, thus reducing recall bias. Diagnosis and intervention coding in the Primary Care General Practice database is limited at input and may lead to under-reporting of diagnoses. There are limitations to the data available through the Secure Anonymised Information Linkage databank because anonymously linked dispensing data (what people collect from the pharmacy) are not currently available. Consequently, the results presented here could be seen as an ‘intention to treat’ and may under- or overestimate what people in Wales actually consume.

Understanding the importance of therapeutic relationships in the development of self-management behaviours during cancer rehabilitation: a qualitative research protocol

Introduction Cancer is a growing health, social and economic problem. 1 in 3 people in the UK will develop cancer in their lifetime. With survival rates rising to over 50%, the long-term needs of cancer survivors are of growing importance. Cancer rehabilitation is tailored to address the physical or psychosocial decline in ability to engage in daily activities. Its use is supported by high-quality international, multicentre research. Incorporating strategies for self-management behaviour development into rehabilitation can prepare individuals for cancer survivorship. However, healthcare professionals will need to adjust their therapeutic interactions accordingly. Research is yet to clarify the impact of the therapeutic relationship on rehabilitation outcomes in cancer. This study aims to explore the impact of therapeutic relationships on self-management behaviours after cancer. Methods and analysis This qualitative study aims to understand cancer rehabilitation participants’ beliefs regarding the importance of therapeutic relationships in developing self-management behaviours. A sample representative of a local cancer rehabilitation cohort will be asked to complete a semistructured interview to identify their perspectives on the importance of therapeutic relationships in cancer rehabilitation. Data obtained from the interviews will be analysed, coded and entered into a Delphi questionnaire for circulation to a local cancer rehabilitation population to determine if the views expressed by the interviewees are supported by group consensus. Ethics and dissemination This study was approved by Wales Research Ethics Committee 6 (15/WA/0331) in April 2016. Findings will be disseminated through the first authors doctoral thesis; peer-reviewed journals; local, national and international conference presentations; and public events involving research participants and the general public.