Emotional and psychological impact of abortion: a critique

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Abortion Care: The Staff Perspective

Working in abortion care presented a unique set of social, emotional and practical challenges for staff. Because of working in abortion care some staff expressed a sense of isolation from other colleagues. They said that those who didn’t work in abortion care considered it an unpopular job and perceived patients requesting abortion as more ‘challenging ‘and ‘problematic’ than other patients, partly because of the additional time required but also because of the emotional investment which is associated with the role. Staff’s sense of isolation was manifested because they felt they couldn’t talk to others about their job. Irrespective of their perceived sense of isolation the desire to provide a service for women in need was a motivational factor for those staff who had chosen to work in this area. Although staff, said personal opinions did not have a place in the delivery of care some were unable to disassociate themselves professionally from their own deeply held personal convictions. In addition, some said that they felt unable to voice opposition to an expectation that they would work in this area if it was included as part of a wider women’s health remit. They indicated that sometimes their feelings were compromised by this aspect of the role indicating they felt unable to exercise their right to conscientious objection. The subject of repeat abortion provoked particularly negative staff emotions for personal and professional reasons, especially if patients repeatedly accessed abortion services because of non use of contraception. Often staff admitted they wanted to ‘lecture’ patients about the issue and some implied that eventually patients may be less likely to receive good care in these instances. However staff reported that women who requested abortion for foetal abnormality were likely to receive more sympathy, understanding and care. The practical challenges mainly concerned whether facilities were appropriate, available and accessible for patient care. Staff recommended that facilities ideally shouldn’t be sited near ante-natal or post-natal areas and there should be provision locally for late gestation abortion and swift access

Menopause, sexuality and culture: Is there a universal experience?

Menopause is a universal phenomenon, but do all women experience a universal event? The aim of this article is to identify common trends or patterns occurring exclusively within certain different cultures, and whether these have an effect on how menopause is experienced or perceived by those women. This paper will first consider the physiological changes that occur during menopause and will then look at psychosocial influences that may affect women’s perception and experience of menopause

From Kama Sutra to dot.com- The History, Myths and Management of Premature Ejaculation

As long as man has breathed, his quest for the perfect sexual experience seems to have eluded him. Often the experience has been brought to an abrupt end by the misery of premature ejaculation. This paper will look at the history of premature ejaculation, charting the importance of this event throughout the years and across cultures. It will look at all modern day therapies and will discuss the implications of introducing pharmocotherapy to a problem that has been traditionally treated by sex therapy

Dose–response effect of a whey protein preload on within-day energy intake in lean subjects

The effect of consuming different amounts of whey protein on appetite and energy intake was investigated in two separate studies using randomised, crossover designs. Healthy-weight men and women (range: BMI 19·0–25·0 kg/m2, age 19·4–40·4 years) consumed one of four 400 ml liquid preloads, followed by an ad libitum test meal 90 min later. In study 1, preloads were 1675 kJ with 12·5, 25 or 50 % of energy from protein, and in study 2, preloads were 1047 kJ with 10, 20 or 40 % energy from protein. Flavoured water was used as the control in both the studies. Appetite ratings were collected immediately before 30, 60 and 90 min after consuming the preloads; and immediately, 30 and 60 min after consuming the test meal. In study 1, energy intake following the control preload (4136 (sem 337) kJ) was significantly higher than each of the 12·5 % (3520 (sem 296) kJ), 25 % (3384 (sem 265) kJ) and 50 % (2853 (sem 244) kJ) protein preloads (P < 0·05). Intake after the 12·5 % preload was significantly higher than following 25 and 50 % preloads (P < 0·05). In study 2, energy intake following the control preload (4801 (sem 325) kJ) was higher than following the 10 % (4205 (sem 310) kJ), 20 % (3988 (sem 250) kJ) and 40 % (3801 (sem 245) kJ) protein preloads (P < 0·05). There were no differences in subjective appetite ratings between preloads in either study. These findings indicate a dose–response effect of protein content of the preload on energy intake at a subsequent meal

Broaching the brook : daylighting, community and the ‘stickiness’ of water

Over the last century, under the modern hydraulic model, waterways across the world have been heavily canalized and culverted, driven into underground pipes, drains and sewers. This hydraulic approach has hardwired an isolated water network into the urban fabric, fragmenting erstwhile patterns and dynamics of life, both human and nonhuman. Ecologically, it has been hugely damaging, reducing water quality and biotic diversity, but also socially, disconnecting citizens from the waterways that service and characterize the city. Consequently, since the 1990s, waterway restoration has become widespread as a design solution to degraded rivers and streams, reinstating compromised hydrological, geomorphological and ecological processes. Deculverting or ‘daylighting’, the focus of this paper, is a radical form of restoration, opening up subterranean, culverted waterways often forgotten by communities above ground. Yet, as this paper emphasizes, waterway restoration has tended to privilege ecological over social objectives, while public engagement in project conceptualization has been limited, conducted ‘downstream’ subsequent to planning and design stages. Restoration schemes have therefore tended to reflect the concerns of professionals rather than communities, overlooking their potential for social renewal and change. Drawing on workshop data collected through participatory mapping exercises, this paper explores the case for daylighting a culverted brook in Urmston, Greater Manchester, focusing in particular on the preferences, concerns and knowledge of local residents. The paper compares professional and community perspectives on the preferred scheme design and potential benefits of daylighting, drawing out differences and tensions between them, temporarily ‘unblackboxing’ the brook. It is ventured that daylighting can unleash the social ‘stickiness’ of water, its proclivity to draw and bind together, to revitalize the park, enhancing connection to wildness, attachment to place and sense of community. This is particularly crucial in the face of decreased local authority funding and related crises in park management

The influence of maternal diet on intestinal adaptation in the mother and offspring

The effect of maternal nutrition on fetal and offspring growth and risk of disease in later life is well established. Animal models have shown that the small intestine can be preferentially affected by growth restriction compared with other organs, yet the effect of maternal diet on gastrointestinal (GI) development has not been well studied. Furthermore, both the maternal GI tract and microbiome undergo significant adaptations during pregnancy in response to the increased nutritional demands of the growing fetus, which may be further modulated by the maternal diet. Inadequate development of the GI tract may result in an increase in intestinal permeability, as demonstrated in inflammatory bowel diseases. Compromised gut barrier function has been linked to the development of obesity through the passage of endotoxin on Gram-negative bacteria leading to low-level inflammation of the liver and adipose tissue. The aim of this thesis was to use two animal models of maternal dietary manipulation that are representative of suboptimal nutrition characterised by the nutritional excess of macronutrients found in many Western diets. The effect of either fat in the form of palm oil and carbohydrate in the form of fructose were therefore examined with particular focus on the gut. This was undertaken in a pig model to examine the effects around the time of birth and in the juvenile offspring, whilst in a rat model both the mothers and offspring were studied. Addition of 10% fructose to drinking water in two generations of pregnant Wistar rats induced impaired glucose tolerance and raised serum triglycerides, but only in the second generation. Sequencing of the maternal microbiome in first generation dams through pregnancy revealed significant changes in microbial diversity from pre-mating to late pregnancy, both between and within dams. Consumption of the fructose diet led to further changes in microbial diversity. Offspring of fructose-fed mothers were growth restricted and had significantly shorter small intestines compared to controls. Changes in gene expression in the ileum and jejunum were indicative of raised intestinal permeability in second-generation dams, and included the epithelial tight junction genes occludin (OCLN), claudin (CLDN) and junctional adhesion molecule (JAM). In both generations the fructose diet significantly upregulated glucose transporters 2 and 5, and sodium-glucose linked transporter 1 in the ileum and jejunum suggesting that a relatively low level supplementation of fructose gradually increases the absorptive capacity of the small intestine for both glucose and fructose. This may explain the significantly impaired glucose tolerance and insulin resistance observed in second-generation offspring. To study maternal fat supplementation, sows were fed a standard commercial diet supplemented with palm oil (6.6% added to commercial feed) throughout gestation. Median birth weight offspring born to fat supplemented mothers sampled at 7 days demonstrated no growth restriction, but significant downregulation in OCLN, CLDN and JAMA expression, suggesting increased intestinal permeability. No changes in offspring body composition were observed at either time point, and effects on gene expression did not persist up to 6 months of age. In conclusion, a suboptimal diet through pregnancy in which macronutrient composition is raised has the potential to compromise gut function in the mother and offspring. The magnitude of effect can however be temporary and dependent on the animal model used as well as the macronutrient targeted

Skipping Breakfast Leads to Weight Loss but Also Elevated Cholesterol Compared with Consuming Daily Breakfasts of Oat Porridge or Frosted Cornflakes in Overweight Individuals: A Randomised Controlled Trial

Eating breakfast may reduce appetite, body weight and CVD risk factors, but the breakfast type that produces the greatest health benefits remains unclear. We compared the effects of consuming a high-fibre breakfast, a non-fibre breakfast, or no-breakfast control on body weight, CVD risk factors and appetite. A total of thirty-six overweight participants (eighteen men and eighteen women) (mean age 33·9 (SD 7·5) years, mean BMI 32·8 (SD 4·7) kg/m2) were randomly assigned to consume oat porridge (n = 12), frosted cornflakes (n = 12) or a water control (n = 12) breakfast daily for 4 weeks. Appetite ratings were collected on the first day and weekly thereafter. Before and after the intervention, body weight, composition, blood pressure and resting energy expenditure (REE) were measured and a fasting blood sample was collected. Across the 4 weeks, fullness was higher and hunger was lower in the oat porridge group compared with the control group (P \u3c 0·05). Mean weight change over the intervention was significantly different in the control group (−1·18 (SD 1·16) kg) compared with both the cornflakes (−0·12 (SD 1·34) kg) and oat porridge (+0·26 (SD 0·91) kg) groups (P \u3c 0·05). However, the control group also showed elevated total cholesterol concentrations relative to the cornflakes and oat porridge groups (P \u3c 0·05). There were no differences between groups in changes in body composition, blood pressure, REE or other CVD risk factors. In conclusion, although skipping breakfast led to weight loss, it also resulted in increased total cholesterol concentrations compared with eating either oat porridge or frosted cornflakes for breakfast

Replacing meat with alternative plant-based products (RE-MAP):a randomized controlled trial of a multicomponent behavioral intervention to reduce meat consumption

BACKGROUND: Reducing meat consumption could protect the environment and human health. OBJECTIVES: We tested the impact of a behavioral intervention to reduce meat consumption. METHODS: Adult volunteers who regularly consumed meat were recruited from the general public and randomized 1:1 to an intervention or control condition. The intervention comprised free meat substitutes for 4 weeks, information about the benefits of eating less meat, success stories, and recipes. The control group received no intervention or advice on dietary change. The primary outcome was daily meat consumption after 4 weeks, assessed by a 7-day food diary, and repeated after 8 weeks as a secondary outcome. Other secondary and exploratory outcomes included the consumption of meat substitutes, cardiovascular risk factors, psychosocial variables related to meat consumption, and the nutritional composition of the diet. We also estimated the intervention's environmental impact. We evaluated the intervention using generalized linear mixed-effects models. RESULTS: Between June 2018 and October 2019, 115 participants were randomized. The baseline meat consumption values were 134 g/d in the control group and 130 g/d in the intervention group. Relative to the control condition, the intervention reduced meat consumption at 4 weeks by 63 g/d (95% CI: 44–82; P < 0.0001; n = 114) and at 8 weeks by 39 g/d (95% CI: 16–62; P = 0.0009; n = 113), adjusting for sex and baseline consumption. The intervention significantly increased the consumption of meat substitutes without changing the intakes of other principal food groups. The intervention increased intentions, positive attitudes, perceived control, and subjective norms of eating a low-meat diet and using meat substitutes, and decreased attachment to meat. At 8 weeks, 55% of intervention recipients identified as meat eaters, compared to 89% of participants in the control group. CONCLUSIONS: A behavioral program involving free meat substitutes can reduce meat intake and change psychosocial constructs consistent with a sustained reduction in meat intake

RAMESES publication standards: realist syntheses

PMCID: PMC3558331This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited