A repeated cross‐sectional analysis of breastfeeding initiation rates in Ireland for two decades and 10 recommended priorities for improvement

Despite a number of public health and policy‐based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid‐West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross‐sectional study analysed breastfeeding initiation trends in the Mid‐West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose ‘10 Priorities’ to increase the breastfeeding initiation rates in Ireland. </p

Exercise compared to mindfulness for physical and mental wellbeing in medical students

Physical Activity (PA) and Mindfulness-Based Stress Reduction (MBSR) both have positive effects on medical student well-being. The ‘MED-WELL’ programme is a curricular intervention that combines PA and education on exercise as medicine. This trial evaluates whether there is a mean difference in outcomes of participants of an exercise intervention, the ‘MED-WELL’ programme, versus a control group which engages in a MBSR programme. Methods All second-year medical students were voluntarily allocated into the intervention or control group. Data on overall health and well-being, sleep quality, loneliness, current level of PA, and confidence in prescribing exercise as medicine was analysed from both groups at baseline and after eight weeks. Results Within groups the intervention and control groups showed statistically significant improvements in overall well-being (p=0.010, p=0.005 respectively) and in sleep quality (p<0.001, p=0.007 respectively). The intervention group had statistically significant improvements in levels of PA (p=0.003) and confidence in prescribing exercise (p<0.001). However, there were no statistically significant differences in changes in outcome measures between groups. Conclusion This study has shown that participants in an exercise intervention, the ‘MED-WELL’ programme, had similar improvements in overall wellbeing and sleep quality to those in a control group who participated in a MBSR programme of the same duration

Lessons learned from a pandemic: implications for a combined exercise and educational programme for medical students

Background: The ‘MED-WELL’ programme is a combined exercise and educational intervention designed to promote well-being among medical students and educate students about prescribing exercise as medicine in clinical practice. Due to COVID-19 public health restrictions of social distancing the ‘MED-WELL’ programme was ofered online instead  of in-person in 2021. The aim of this study is to compare the experiences of participants in the ‘MED-WELL’ programme  online to those that previously participated in the same programme in-person to understand the student experience  and optimize programme delivery. Methods: Purposive sampling was used to recruit 20 participants to a qualitative study using semi-structured interviews. Ten study participants took part in the ‘MED-WELL’ programme when it was ofered in-person, and the other ten  study participants took part in the programme when it was ofered online. All interviews were audio-recorded and  transcribed using Microsoft Teams. A combined inductive and deductive approach was used for analysis. An inductive  thematic analysis was utilized to categorize data into higher order codes, themes, and overarching themes. The theory  of online learning provided the theoretical framework for a deductive approach. Results: Analysis of the data produced fve overarching themes: ‘student-student’, ‘student-teacher’, ‘student-content’,  ‘student-environment’, and ‘efects of a pandemic’. The frst four themes detail distinct types of interaction that participants had with various entities of the 'MED-WELL’ programme and the efects that these interactions had on participant experiences. ‘Efects of a pandemic’ refers to the context of delivering the ‘MED-WELL’ programme online during  a pandemic and how this mode of delivery infuenced participants and the programme. Conclusions: Optimizing the ‘MED-WELL’ programme relies on an understanding of how participants interact with  diferent entities of the programme and are motivated to attend and engage. Participants tended to favour an in-person mode of delivery, however certain advantages of delivering the programme online were also identifed. The fndings from this study can be used to inform similar experiential and educational exercise interventions, and may  help plan for potential future restrictions on in-person educational and exercise-based programmes. </p

A feasibility study of an exercise intervention to educate and promote health and well-being among medical students: the ‘MED-WELL’ programme

Background: Medical School programme workloads challenge the physical and mental health of students particularly in compressed graduate entry programmes. There is evidence that physical activity (PA) can improve holistic care and help maintain wellness among medical students. We tested the feasibility of introducing an exercise programme to the medical school curriculum which would educate and promote health and well-being among its students. Methods: This study was conducted in a single graduate entry medical school at the University of Limerick (UL). The ‘MED-WELL’ programme was a six-week programme of 1 hour-long weekly sessions, each involving a different type of PA (45 min). These sessions were prefaced by an interactive lecture about how to incorporate exercise theory into daily medical practice (15 min). The study was conducted in a single graduate entry medical school at UL and involved year one and year two graduate entry medical students. Three parameters were used to test feasibility: 1. Recruitment and retention of participants, 2. Acceptability of the programme and 3. Efficacy in terms of health and well-being. The latter was assessed by administering questionnaires pre and post the intervention. The questionnaires used the following validated measurement scales: EQ-VAS; WHO-5 Well-Being Index; 3-item Loneliness Scale; Social Support Measure 3-item scale. Free text boxes also encouraged participants to discuss the merits of the programme Results: In total, 26% (74/286 students) participated in the programme. Of those who participated, 69 students (93%) attended one or more sessions of the programme and completed questionnaires at baseline and at followup. Significant improvements were seen in scores after the programme in the WHO-5 Well-Being Index which increased from 63.2 (95%CI: 48–78.4) to 67.5 (95%CI: 55.1–79.9); (P < 0.01), the sleep scale which increased from 3.1 (95%CI: 2.2–4.0) to 3.5 (95%CI: 2.5–4.5); (P < 0.001), and the loneliness scale which decreased from 4.1 (95%CI: 2.7– 5.5) to 3.5 (95%CI: 2.5–4.5); (P < 0.005). Students level of PA during a typical week also increased from 3.7 (95%CI: 2.1–5.4) to 4.0 (95%CI, 3.5–4.5); (P < 0.05). Conclusion: This study has shown it is feasible to deliver this programme in a medical school’s curriculum. The programme seems to be of benefit and is acceptable to students. Well-designed randomised controlled trials are needed to measure outcomes, durability of effect, and cost effectivenes