A Western Australian Survey of Breastfeeding Initiation, Prevalence and Early Cessation Patterns

Objective: This paper reports on current initiation and prevalence rates, in Western Australia, differentiating ‘any’ breastfeeding with ‘exclusive’ breastfeeding whilst exploring patterns and reasons for stopping breastfeeding. The results presented are part of a larger study examining women’s perceptions of care and wellbeing in the early postnatal period. Methods: A cross sectional survey was used to examine infant feeding practices during the hospital stay and at 9 weeks post birth from Western Australian women with a registered live birth between February and June 2006. Results: Data obtained from 2,669 women revealed a 93% (n = 2,472) initiation rate of any breastfeeding. More multiparous women (73.5%) were exclusively breastfeeding in hospital compared to primiparous women (65.2%), which decreased to 57.1 and 49.2%, respectively at 9 weeks. Of those who had ceased by 9 weeks, more multiparous women (71.1%) ceased before 3 weeks. Reasons cited for ceasing in order of frequency were insufficient milk supply, infant related reasons, pain and discomfort and emotional reasons. Younger maternal age, primiparous women, lower maternal education levels, offering a combination of breast milk and formula in hospital and caesarean birth were significant independent predictors of early cessation. Conclusions: Although initiation rates including “any” breast milk are meeting NHMRC dietary guidelines of 90%, the 60% target of exclusive breastfeeding is not being achieved for 3 months or in fact at 9 weeks. Targeted support for at risk groups such as younger, less well-educated, primiparous women must continue. Evidence based policies to protect breastfeeding must address the practice of offering formula to breastfed infants in hospital and the impact of increasing interventions such as caesarean births

Matters of Learning and Education: Sociomaterial approaches in ethnographic research

In this chapter we outline a “sociomaterial” configuration that has been circulating in the broader social sciences with useful potential for understanding dynamics of learning, pedagogy, curriculum, policy, and so forth. This approach seeks to examine critically how the social and material not only are entangled in what some call “assemblages” of the human and nonhuman, but also constitute the practices and knowings that comprise education. The chapter focuses in particular on methodologies for researching professional learning and knowing as sociomaterial practice. We draw examples from three doctoral studies-in-progress of learning in different settings: engineers in project teams developing environmental technologies, artists learning to balance multiple activities of art, market and bureaucracy, and health-care workers learning to implement a new technology in a paediatric diabetes clinic. These examples illustrate the insights as well as the dilemmas in working with sociomaterial approaches to make visible the materialities of learning. One key contribution here is the first hand voices of new researchers experimenting with these approaches. The methods and theories are difficult to apply, and the stories here help to reveal the strategies that student researchers adopted to work through the challenges of sociomaterial approaches

Midwives in the United Kingdom: levels of burnout, depression, anxiety and stress and associated predictors

Objective The overall study aim was to explore the relationship between the emotional wellbeing of UK midwives and their work environment. Specific research questions were to: assess levels of burnout, depression, anxiety and stress experienced by UK midwives; compare levels of burnout, depression, anxiety and stress identified in this sample of UK midwives, with levels reported in Australia, New Zealand and Sweden; identify demographic and work-related factors associated with elevated levels of burnout, depression, anxiety and stress. Design Cross sectional research design using an online survey. The WHELM survey tool was developed within the Australian maternity context and includes a number of validated measures: The Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21), as well as items from the Royal College of Midwives (RCM) ‘Why Midwives Leave’ study (Ball et al., 2002). Setting United Kingdom. Participants An on-line survey was distributed via the RCM to all full midwife members in 2017 (n = 31,898). Data analysis The demographic and work-related characteristics of the sample were analysed using descriptive analyses. Levels of depression, anxiety, stress and burnout, measured by the CBI and DASS scores, were analysed using non-parametric statistical tests. Comparisons were made between groups based on demographic and work characteristics. Mann-Whitney U tests were used for two group comparisons, and Kruskal Wallis tests were used for groups with 2+ groups. Given the large number of analyses undertaken, statistically significant comparisons were identified with a conservative alpha level (p < .01). Findings A total of 1997 midwives responded to the survey, representing 16% of the RCM membership. The key results indicate that the UK's midwifery workforce is experiencing significant levels of emotional distress. 83% (n = 1464) of participants scored moderate and above for personal burnout and 67% (n = 1167) recorded moderate and above for work-related burnout. Client-related burnout was low at 15.5% (n = 268). Over one third of participants scored in the moderate/severe/extreme range for stress (36.7%), anxiety (38%) and depression (33%). Personal and work-related burnout scores, and stress, anxiety and depression scores were well above results from other countries in which the WHELM study has been conducted to date. Midwives were more likely to record high levels of burnout, depression, anxiety and stress if they were aged 40 and below; reported having a disability; had less than 10 years’ experience; worked in a clinical midwifery setting, particularly if they worked in rotation in hospital and in integrated hospital/community settings. Key conclusions and implications for practice Many UK midwives are experiencing high levels of stress, burnout, anxiety and depression, which should be of serious concern to the profession and its leaders. NHS employed clinical midwives are at much greater risk of emotional distress than others surveyed, which has serious implications for the delivery of high quality, safe maternity care. It is also of serious concern that younger, more recently qualified midwives recorded some of the highest burnout, stress, anxiety and depression scores, as did midwives who self-reported a disability. There is considerable scope for change across the service. Proactive support needs to be offered to younger, recently qualified midwives and midwives with a disability to help sustain their emotional wellbeing. The profession needs to lobby for systems level changes in how UK maternity care is resourced and provided. Making this happen will require support and commitment from a range of relevant stakeholders, at regional and national levels

"Overwhelmed and out of my depth" : responses from early career midwives in the United Kingdom to the Work, Health and Emotional Lives of Midwives study

Background Efforts to resolve the longstanding and growing staffing crisis in midwifery in the United Kingdom have been hampered by very poor retention rates, with early career midwives the most likely to report burnout and intention to leave the profession. Aims To establish the key, self-described factors of satisfaction and dissatisfaction at work for early career midwives in the United Kingdom, and suggest appropriate and effective retention strategies. Methods Thematic analysis was undertaken on a subset of free text responses from midwives who had been qualified for five years or less, collected as part of the United Kingdom arm of the Work, Health and Emotional Lives of Midwives project. Findings Midwives described feeling immense pressure caused by an unremittingly heavy workload and poor staffing. Where relationships with colleagues were strong, they were described as a protective factor against stress; conversely, negative working relationships compounded pressures. Despite the challenges, many of the midwives reported taking great pleasure in their work, describing it as a source of pride and self-esteem. Midwives valued being treated as individuals and having some control over their shift pattern and area of work. Discussion These results, which reveal the strain on early career midwives, are consistent with the findings of other large studies on midwives’ wellbeing. All available levers should be used to retain and motivate existing staff, and recruit new staff; in the meantime, considerable creativity and effort should be exercised to improve working conditions. Conclusion This analysis provides a ‘roadmap’ for improving staff wellbeing and potentially retention

A Qualitative Analysis of Women's Short Accounts of Labour and Birth in a Western Australian Public Tertiary Hospital

This paper reports the findings of the postnatal qualitative arm of a larger study,which investigated women's prenatal and postnatal levels of childbirth fear. Women's expectations and experiences of labour and birth in a Western Australian public tertiary hospital were identified following thematic analysis of short written accounts from 141 participants who had given birth in the previous 6 to 14 weeks. Four major categories emerged to describe features and mediating factors in the trajectory of childbirth and the early puerperium "Anticipating Labour and Birth", "Labour and birth Depicted", "Mediating Factors and their consequences" and "Evaluating, Resolving, and Looking Ahead" portray women's comparative reflections on expectations and realities of birth, on mediating influences, and on moving on from their experience. These findings will provide maternity care professionals with insight into the personal and environmental features of the childbirth setting which colours women's recollections. Being aware of what women value during labour and birth will reinforce the need for professionals to provide care using a mindful approach that considers the potential psychological, emotional and behavioural implications of events

Orally active antischistosomal early leads identified from the open access malaria box.

BACKGROUND: Worldwide hundreds of millions of schistosomiasis patients rely on treatment with a single drug, praziquantel. Therapeutic limitations and the threat of praziquantel resistance underline the need to discover and develop next generation drugs. METHODOLOGY: We studied the antischistosomal properties of the Medicines for Malaria Venture (MMV) malaria box containing 200 diverse drug-like and 200 probe-like compounds with confirmed in vitro activity against Plasmodium falciparum. Compounds were tested against schistosomula and adult Schistosoma mansoni in vitro. Based on in vitro performance, available pharmacokinetic profiles and toxicity data, selected compounds were investigated in vivo. PRINCIPAL FINDINGS: Promising antischistosomal activity (IC50: 1.4-9.5 µM) was observed for 34 compounds against schistosomula. Three compounds presented IC50 values between 0.8 and 1.3 µM against adult S. mansoni. Two promising early leads were identified, namely a N,N'-diarylurea and a 2,3-dianilinoquinoxaline. Treatment of S. mansoni infected mice with a single oral 400 mg/kg dose of these drugs resulted in significant worm burden reductions of 52.5% and 40.8%, respectively. CONCLUSIONS/SIGNIFICANCE: The two candidates identified by investigating the MMV malaria box are characterized by good pharmacokinetic profiles, low cytotoxic potential and easy chemistry and therefore offer an excellent starting point for antischistosomal drug discovery and development

International randomised controlled trial for the treatment of newly diagnosed EWING sarcoma family of tumours - EURO EWING 2012 Protocol

[Background] Although there have been multiple randomised trials in newly diagnosed Ewing sarcoma family of tumours (ESFT) and these have been conducted over many years and involved many international cooperative groups, the outcomes for all stages of disease have plateaued. Internationally, the standard treatment of ESFT is not defined, and there is a need to add new agents other than conventional chemotherapy to improve outcomes. This trial will compare two different induction/consolidation chemotherapy regimens: (1) vincristine, ifosfamide, doxorubicin and etoposide (VIDE) induction and vincristine, actinomycin D, ifosfamide or cyclophosphamide, or busulfan and mephalan (VAI/VAC/BuMel) consolidation and (2) vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide (VDC/IE) induction and ifosfamide and etoposide, vincristine and cyclophosphamide, vincristine, actinomycin D and ifosfamide, or busulfan and mephalan (IE/VC/VAI/BuMel) consolidation (randomisation 1, or R1). A second randomisation (R2) will determine whether the addition of zoledronic acid to consolidation chemotherapy, as assigned at R1, is associated with improved clinical outcome.[Methods] EURO EWING 2012 is an international, multicentre, phase III, open-label randomised controlled trial. There are two randomisations: R1 and R2. Patients are randomly assigned at two different time points: at entry to the trial (R1) and following local control therapy (R2). The primary outcome measure is event-free survival. The secondary outcome measures include overall survival, adverse events and toxicity, histological response of the primary tumour, response of the primary tumour, regional lymph nodes or metastases (or both), and achievement of local control at the end of treatment.[Discussion] This study will establish which is the “standard regimen” of chemotherapy, taking into account both clinical outcomes and toxicity. This will form the chemotherapy backbone for future interventional studies where we may want to add new targeted agents. It will also determine the role of zoledronic acid in conjunction with the separate EE2008 trial. Any trial in ESFT needs to take into account the rarity of the tumour and consider that international cooperation is needed to provide answers in a timely manner.[Trial registration] Registered with EudraCT number 2012-002107-17 on 26 February 2012. Registered with ISRCTN number 92192408 on 4 November 2013.This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement n°602856. The NCC in France, CLB, receives additional funding from SFCE and Ligue contre le cancer. The coordinating sponsor (the University of Birmingham, Birmingham, UK) is funded by Cancer Research UK (grant award reference C5952/A14745)

Interpreting ambiguous ‘trace’ results in Schistosoma mansoni CCA Tests: Estimating sensitivity and specificity of ambiguous results with no gold standard

Background The development of new diagnostics is an important tool in the fight against disease. Latent Class Analysis (LCA) is used to estimate the sensitivity and specificity of tests in the absence of a gold standard. The main field diagnostic for Schistosoma mansoni infection, Kato-Katz (KK), is not very sensitive at low infection intensities. A point-of-care circulating cathodic antigen (CCA) test has been shown to be more sensitive than KK. However, CCA can return an ambiguous ‘trace’ result between ‘positive’ and ‘negative’, and much debate has focused on interpretation of traces results. Methodology/Principle findings We show how LCA can be extended to include ambiguous trace results and analyse S. mansoni studies from both Côte d’Ivoire (CdI) and Uganda. We compare the diagnostic performance of KK and CCA and the observed results by each test to the estimated infection prevalence in the population. Prevalence by KK was higher in CdI (13.4%) than in Uganda (6.1%), but prevalence by CCA was similar between countries, both when trace was assumed to be negative (CCAtn: 11.7% in CdI and 9.7% in Uganda) and positive (CCAtp: 20.1% in CdI and 22.5% in Uganda). The estimated sensitivity of CCA was more consistent between countries than the estimated sensitivity of KK, and estimated infection prevalence did not significantly differ between CdI (20.5%) and Uganda (19.1%). The prevalence by CCA with trace as positive did not differ significantly from estimates of infection prevalence in either country, whereas both KK and CCA with trace as negative significantly underestimated infection prevalence in both countries. Conclusions Incorporation of ambiguous results into an LCA enables the effect of different treatment thresholds to be directly assessed and is applicable in many fields. Our results showed that CCA with trace as positive most accurately estimated infection prevalence