On the relevance of the “genetics-based” approach to medicine for sociological perspectives on medical specialization

This paper draws on a study on the development of medical genetics as a medical specialism in the UK and Canada to reflect on how local and national contexts affect specialty formation. The paper begins by supporting earlier findings in the literature that stress, first, technological innovations as driving specialty formation, and, second, the domination of physicians in the division of medical labour. Beyond this, however, the paper explores the specific circumstances under which geneticists set about turning their work into a medical specialism based on a “genetics-based approach” to illness and how “medical genetics” as a specialism was assessed and configured to fit national and regional health service requirements

Towards reducing variations in infant mortality and morbidity : a population-based approach

Background: Our aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity. Objective: To undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates. Design: Two interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies. Setting: Cohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester. Data sources: For stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies. Main outcome measures: Detailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies. Results: The deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs. Conclusions: Health professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background

A novel peer-support intervention using motivational interviewing for breastfeeding maintenance: a UK feasibility study

Although most UK mothers start breastfeeding, fewer than half breastfeed exclusively for more than 1 week and only one in 100 breastfeed for > 6 months. Most stop breastfeeding before they had planned to. We wanted to see if it was possible to help women breastfeed for longer by using buddies trained in motivational interviewing. This is a form of counselling that motivates people to change their behaviour by exploring their thoughts and worries and helping them to set their own goals. The intervention we studied was called Mam-Kind. Mam-Kind buddies met mothers before their babies were born and provided support for 2 weeks afterwards. Before we embark on an expensive randomised trial of Mam-Kind, we wanted to see if it was acceptable to women and feasible to deliver. Eight buddies delivered Mam-Kind to 70 women from three areas with high levels of social deprivation and teenage pregnancy and low rates of breastfeeding. We interviewed mothers, buddies and health-care professionals to get their views. We found that Mam-Kind was acceptable and feasible to deliver. Mothers reported that buddies provided reassurance, were non-judgemental and were easily contactable. The buddies reported that it was sometimes difficult to use their motivational skills while providing breastfeeding support. It is feasible to design and collect appropriate health economic information. We used this information to refine the training and content of the intervention. The refined Mam-Kind intervention should now be tested in a controlled study to see if it really works to help women continue breastfeeding for longer