Victoria Team

Expressionists of the Twenty-First Century: The Commodification and Commercialization of Expressed Breast Milk

Breast milk expression has been promoted as liberating for women and as offering them more choices, but there has been little research on womens experiences of it and even less critical commentary on the consequences of its incorporation into mainstream behavior. Drawing on narratives of women in the United Kingdom about breastfeeding, we explore the increasingly popular practice of expressing and feeding expressed breast milk. We argue that breast milk has become commodified, breastfeeding commercialized and technologized, and the mother–infant relationship disrupted. We suggest that breastfeeding as a process is being undermined by vested interests that portray it as unreliable and reconstruct it in artificial feeding terms, so playing on womens insecurities. The major beneficiaries of expression are fathers who want increased involvement in infant care and commercial enterprises that aim to maximize profits for shareholders.

Family caregivers: Russian-speaking Australian women's access to welfare support.

In Australia, rapid population ageing, and government efforts to support people who are chronically ill, elderly or with disabilities to live in their own homes, has led to the primary responsibility of care being undertaken by families. Through its social policies, the Australian government provides income and other types of support to informal caregivers. This article explores how Australian social policy and womens understanding of their roles impact on their access to welfare support. Qualitative research was conducted in Melbourne between February and June 2006. In-depth interviews were undertaken with eight Russian-speaking women involved in caregiving, purposively recruited through ethnic associations, and with four community service providers. Women based their expectations of the gendered and private nature of their role on the social policies in countries of their origin and, hence, did not attempt to access welfare support unless they were referred by health and welfare professionals. In addition, poor referral by professionals, influenced by past societal attitudes that caregiving is a gendered role, contributed to womens limited access to welfare benefits. Changes in the implementation of social policy are proposed to increase caregivers’ access to welfare support and efficient utilisation of existing resources.

Integration of complementary and alternative medicine information and advice in chronic disease management guidelines.

The growing evidence on the benefits and risks of complementary and alternative medicine (CAM) and its high rate of use (69% of Australians) - particularly for chronic or recurrent conditions - means increasing attention on CAM. However, few people disclose CAM use to their GP, and health professionals tend to inadequately discuss CAM-related issues with their patients, partly due to insufficient knowledge. As clinical and non-clinical chronic condition management guidelines are a means to educate primary health care practitioners, we undertook a content analysis of guidelines relevant to two common chronic conditions - cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) - to assess their provision of CAM-related information. Ten current Australian guidelines were reviewed, revealing scant CAM content. When available, the CAM-relevant information was brief, in some cases unclear, inconclusive and lacking in direction to the GP or health care provider. Although we focus on CVD and T2DM, we argue the value of all chronic condition management guidelines integrating relevant evidence-informed information and advice on CAM risks, benefits and referrals, to increase GP awareness and knowledge of appropriate CAM therapies, and potentially to facilitate doctor-client discussion about CAM.

Internet advertising of artificial tanning in Australia.

Artificial tanning, defined as deliberate exposure to ultraviolet rays produced by artificial tanning devices, is a new and emerging public health issue in Australia and globally. Epidemiological research suggests that artificial tanning may contribute to the incidence of melanoma, nonmelanoma skin cancer as well as other health problems. Given that Australia has a high incidence of skin cancer, we have undertaken a study to explore how artificial tanning has been promoted to its users. The aim was to analyze the completeness and accuracy of information about artificial tanning. A content analysis of web sites of tanning salons and distributors of tanning equipment in Australia was conducted. A total of 22 web sites were analyzed. None of the solarium operators or distributors of equipment provided full information about the risks of artificial tanning. Fifty-nine percent of web advertisements had no information and 41% provided only partial information regarding the risks of artificial tanning. Pictures with the image of bronze-tanned bodies, predominantly women, were used by all web advertisers. In light of the success of sun-safety campaigns in Australia, the findings of future epidemiological research on the prevalence of artificial tanning and sociological and anthropological research on why people utilize artificial tanning should be a basis for developing effective targeted health promotion on the elimination of artificial tanning in the country.

From state care to self-care: cancer screening behaviours among Russian-speaking Australian women

In this article, we report on a small qualitative scale study with immigrant Russian-speaking Australian women, carers of dependent family members. Drawing on in-depth interviews, we explore womens health-related behaviours, in particular their participation in breast and cervical cancer screening. Differences in preventive health care policies in country of origin and Australia explain their poor participation in cancer screening. Our participants had grown up in the former Soviet Union, where health checks were compulsory but where advice about frequency and timing was the responsibility of doctors. Following migration, women continued to believe that the responsibility for checks was their doctors, and they maintained that, compared with their experience of preventive medicine in the former Soviet Union, Australian practice was poor. Women argued that if reproductive health screening were important in cancer prevention, then health care providers would take a lead role to ensure that all women participated. Data suggest how womens participation in screening may be improved.

What is the effect of exercise on wound healing in patients with venous leg ulcers? A systematic review

Standard best practice for the treatment of venous leg ulcers (VLUs) is compression bandaging of the lower leg to reduce hydrostatic pressure. There is considerable variation in reported healing rates when using this gold‐standard approach; therefore, a systematic and robust evaluation of other interventions is required. Exercise interventions, in addition to standard compression therapy, could improve wound‐healing time and prevent their recurrence. We have conducted a systematic review to examine the effects of exercise on wound characteristics, including time to heal, size and recurrence, pain, quality of life, adverse events, and economic outcomes. This review was registered with PROSPERO 2016:CRD42016046407. A systematic search of Ovid Medline, Ovid EMBASE, Ovid CINAHL, The Cochrane Library, PsycINFO, Web of Science, and PEDro was conducted on January 30, 2017, for randomised control trials to examine the effects of exercise on time to heal, size and recurrence, pain, quality of life, adverse events, and economic outcomes. Six studies met the inclusion criteria, but all had design flaws leading to biases, most commonly performance and selective reporting bias. Three studies compared a progressive resistance exercise programme (PREG) plus compression with compression alone for a period of 12 weeks. Low‐quality evidence indicates the following: possibly no difference in the proportion of ulcers healed (risk ratio [RR] 1.14, 95% CI 0.71 to 1.84, I2 36%; 3 trials, 116 participants); probably no difference in quality of life (mean difference [MD] 3 points better on 100 point scale with exercise, 95% CI −1.89 to 7.89, 1 trial, 59 participants); possible increase in the risk of adverse events with exercise (OR 1.32, 95% CI 0.95 to 1.85, 1 RCT, 40 participants); and no difference in ankle range of motion and calf muscle pump. Evidence was downgraded due to susceptibility to bias and imprecision. Recurrence, pain, and economic outcomes were not measured in these trials, and time to healing was measured but not fully reported in 1 trial. We are uncertain of the effects of other interventions (community‐based exercise and behaviour modification, ten thousand steps, supervised vs unsupervised exercise) due to the availability of low‐ or very low‐quality evidence only from single trials. The review highlights the need for further research, with larger sample sizes, to properly address the significance of the effect of exercise on VLU wound characteristics.

The theory of agency and breastfeeding

Objective: In this paper, we apply psychological agency theory to women’s interviews of their breastfeeding experiences to understand the role of agency in relation to breastfeeding initiation, maintenance and duration. Design: Qualitative, video interviews were collected from 49 women in the UK from a wide range of ethnic, religious, educational and employment backgrounds about their breastfeeding experiences. We undertook secondary analysis of the data focusing on their accounts of vulnerability and agency. Findings: Women’s agency was impacted by a variety of factors including their own vulnerability, knowledge, expectations and experience, the feeding environment and the support of health professionals in sharing decision-making and dealing with uncertainty. Conclusion: Health professionals as co-agents with women are well positioned to maintain, enhance or restore women’s sense of agency. Breastfeeding goals should be included in women’s birth plans. Training related to agency, continuity of care, and staffing and workload management supported by national breastfeeding policies could improve breastfeeding rates and experiences.

Expressed Breast Milk as Commodity: Disembodied Motherhood and Involved Fatherhood

Exclusive breastfeeding for at least six months is the recommended method of infant feeding (World Health Organization [WHO] and United Nations Children’s Fund [UNICEF], 2003). Breastfeeding is being promoted as the social norm in the US, UK, and Australasia in an attempt to replace formula feeding (American Academy of Pediatrics, 2012; Australian Health Ministers’ Conference, 2009; The Royal College of Paediatrics & Child Health (RCPCH), 2011), which became popular from the 1940s (Stevens et al., 2009). Breastfeeding women often feed expressed breast milk (EBM) to their own infants although EBM feeding is different from breastfeeding. Some women share, donate, and/or sell excess EBM.

Barriers and enablers to patient recruitment for randomised controlled trials on treatment of chronic wounds: A systematic review

Randomised controlled trials represent the gold standard in intervention efficacy evaluation. However, suboptimal recruitment affects completion and the power of a therapeutic trial in detecting treatment differences. We conducted a systematic review to examine the barriers and enablers to patient recruitment for randomised controlled trials on chronic wound treatment. Review registration was under PROSPERO 2017:CRD42017062438. We conducted a systematic search of Ovid MEDLINE, EBSCOhost CINAHL, Ovid Cochrane Library, Ovid EMBASE, and Ovid PsycINFO databases in June 2017 for chronic wound treatment randomised controlled trials. Twenty‐seven randomised controlled trials or qualitative studies met the inclusion criteria. Among the 24 randomised controlled trials, 21 were assessed as low quality in relation to recruitment, and 3 were assessed as high quality. All 27 studies reported barriers to recruitment in chronic wound randomised controlled trials. The reported barriers to recruitment were: study‐related, patient‐related, clinician‐related, health system‐related, and/or operational‐related. No study reported recruitment enablers. To enhance randomised controlled trial recruitment, we propose the need for improved integration of research and clinical practice. To alleviate the problems arising from inadequate reporting of randomised controlled trials, the Consolidated Standards of Reporting Trials Statement could include an additional item on recruitment barriers. This approach will allow for increased awareness of the potential barriers to recruitment for Randomised controlled trials (RCTs) in both wound management and other health care research.

Pressure injury identification, measurement, coding, and reporting: Key challenges and opportunities

Pressure injury (PI) rates are a commonly used indicator of performance of health care facilities, both in acute and subacute settings. However, measuring PI rates in an accurate and reproducible fashion has been challenging. The consequences of poor measurement may include failure to identify poorly performing institutions or incorrect accusations of poor quality care. In this article, we describe the main challenges in identification, coding, and reporting of PIs. Issues include inconsistent identification of PIs at the time of admission, variations in the intensity of PI detection, and differing approaches to coding and the adjustment for differing risks amongst different patient population. These are compounded by differences in the epidemiological approach because rates will differ according to whether patients are surveyed cross‐sectionally (eg, on a set day per month) or if the survey is undertaken at discharge. In some cases, financial incentives may also influence PI reporting. We also discuss potential strategies for improving data collection and benchmarking as an aid to reducing PI prevalence.