Environmental justice, capabilities, and the theorization of well-being

Environmental justice (EJ) scholarship is increasingly framing justice in terms of capabilities. This paper argues that capabilities are fundamentally about well-being and as such there is a need to more explicitly theorize well-being. We explore how capabilities have come to be influential in EJ and how well-being has been approached so far in EJ specifically and human geography more broadly. We then introduce a body of literature from social psychology which has grappled theoretically with questions about well-being, using the insights we gain from it to reflect on some possible trajectories and challenges for EJ as it engages with well-being

Supporting teenage mothers to initiate breastfeeding and developing a support intervention to increase breastfeeding rates in a vulnerable group - the importance of place

Background Not being breastfed is internationally considered to have a lifelong impact on morbidity and mortality. In the UK and other developed nations, adolescent mothers are among those least likely to breastfeed and require additional support to do so due to their unique developmental position. Evidence indicates that many young mothers who intend to breastfeed never initiate breastfeeding or stop soon after giving birth, and there may be factors in the UK health system or wider society preventing the success of breastfeeding support interventions. These considerations led to a two-phase investigation which aimed to study the context of breastfeeding support and evaluate a targeted breastfeeding support intervention for young women. Methods A realist evaluation framework was used. 83 UK health professionals responded to an e-questionnaire. Focus groups and interviews were conducted with 15 young mothers (aged 16-20) in Oxford, England. A breastfeeding support package was then developed and implemented on a UK postnatal ward for six months. A concurrent mixed methods evaluation was carried out. Each component of the investigation was analysed thematically using inductive content analysis. Ethical approval was received. Findings Young women appear motivated to breastfeed to show that they are good mothers. However, breastfeeding can alienate them from their families at a time when they need to be accepted in their new mothering role. Young mothers can feel disempowered after birth and like 'fish out of water' on the postnatal ward. A need was identified for proactive breastfeeding support from health professionals focusing on relational care, particularly as some maternity professionals displayed negative attitudes to teenage mothers and breastfeeding. Despite staff training developing a more positive and enabling attitude towards young women, much of the proposed support package proved impossible to implement in a busy, task-orientated medical environment where time, convenience, control, and individual staff beliefs were used as yardsticks to determine the acceptability of different aspects of care. Conclusion This study highlights the importance of proactive, relational breastfeeding support for young mothers. Such support requires a facilitative environment in order to be implemented successfully. It is suggested that such an environment could be created on the postnatal ward if midwives and MSWs created workplace communities and claimed ownership of their time and space. Action Learning may facilitate this process

Implementing localised curriculum drawing on a funds of knowledge perspective: Teacher perceptions and challenges

In recent years in New Zealand, there has been a policy shift towards schools ‘localising’ the national curriculum to align with the context, aspirations, and knowledge of the local community and student population. In relation to mathematics education, this requires educators to understand and value the mathematical connections between diverse students’ funds of knowledge and use these to develop mathematical tasks. This article draws on interview responses from a case study of eight teachers from one low socio-economic, culturally diverse school to investigate their initial perceptions and actions to develop an appropriate localised mathematics curriculum drawing on diverse students’ funds of knowledge. The findings indicate that teachers viewed it as important to use real and relevant contexts in mathematics teaching. Interview responses indicated that both students and their families were seen as important sources of information. However, there were challenges for teachers to recognise students’ funds of knowledge related to mathematics beyond schooling or generic experiences

Criminal Investigation and Enforcement of the Antitrust Laws in the Health Care Field

Criminal enforcement of the antitrust laws has only recently become a serious issue in health care. It is likely to remain one of the Justice Department\u27s priorities. However, providers of healthcare can avoid the risk of criminal liability

Firefighters and acute myocardial infarction: understanding mechanisms and reducing risk

Acute myocardial infarction is the commonest cause of death in firefighters, accounting for 45% of all deaths on duty. Compared with an average life expectancy of 77 years in the general population, the average age of cardiovascular death in firefighters is 50 years suggesting that occupational hazards are responsible for premature disease. The risk of acute myocardial infarction is increased 12- to 136-fold during rescue and firefighting duties, and is likely to reflect a combination of factors including strenuous physical exertion, mental stress, heat and pollutant exposure. Previous studies have established that the duties of a firefighter, in particular fire suppression, put inordinate strain on the cardiovascular system yet the exact mechanisms underlying the increased risk of myocardial infarction remain poorly defined. In a series of studies, I assessed the effect of occupation-specific risk factors on cardiovascular health in a combination of controlled and real-life studies in order to better define these mechanisms, hypothesising that exposure to high temperatures, strenuous physical exertion, psychological stress and air pollution either alone or in combination caused vascular dysfunction and thrombosis. In order to assess if firefighters had a greater cumulative risk of cardiovascular disease due to their occupation at baseline, I assessed the cardiovascular function of group of healthy, off-duty firefighters and compared this to a group of healthy age- and sex-matched off-duty police officers; an occupational group with similar responsibilities but a much lower risk of on-duty cardiovascular events. I was able to demonstrate that traditional cardiovascular risk factors, vascular endothelial function and thrombogenicity were similar in the two groups concluding that the excess of cardiovascular events and deaths in on-duty firefighters are due to the acute and transient effects of strenuous physical exertion, psychological stress, heat and exposure to air pollutants. Having established that off-duty firefighters had no apparent increased risk of cardiovascular events, I then went on to clarify the effects of combustion derived air pollution in the form of wood smoke on the cardiovascular system. The suppression of wildland or forest fires is globally the single most important duty of the fire service. Previous work within our institution has demonstrated the adverse effects of combustion derived air pollution, in the form of diesel exhaust, on the cardiovascular system. In a similar fashion, I assessed the effect of a wood smoke inhalation in a group of healthy off-duty firefighters by performing controlled exposures to wood smoke utilising a unique and well characterised facility. Interestingly, unlike diesel-exhaust, the exposure to wood smoke had no adverse effect on vascular endothelial function or thrombogenicity in this group concluding that cardiovascular events during wildland fire suppression may not be directly related to wood smoke inhalation but instead precipitated by other mechanisms such as strenuous physical exertion or dehydration. Latterly, I proceeded to evaluate the effects of strenuous physical exertion and heat exposure by comprehensively assessing a number of cardiovascular end points following controlled exposure to a fire simulation activity in a group of healthy, off-duty firefighters. I was able to demonstrate that exposure to extreme heat and physical exertion impaired vasomotor function and increased thrombus formation. Moreover, I demonstrated cardiac troponin concentrations increased suggesting that fire suppression activity may cause myocardial injury. These important findings suggest pathogenic mechanisms to explain the association between fire suppression activity and acute myocardial infarction. In the final phase of work, I endeavoured to assess the effects of real-life firefighter activities on the cardiovascular system. In an ambitious study, I attempted to undertake a comprehensive assessment of cardiovascular function in healthy firefighters following three periods of duty: fire suppression, alarm response and non-emergency activity. I was unable to complete enough studies to adequately power an analysis and draw any firm conclusions about the effect of these duties on cardiovascular health. Further work is required in a real-world setting to more clearly define the occupational risk factors underlying the increased risk of cardiovascular events associated with specific firefighter duties Understanding the biological mechanisms and environmental factors that predispose firefighters to cardiovascular events is essential if we are to develop effective methods for the prevention of acute myocardial infarction on-duty. This body of work has greatly improved the understanding of the mechanisms underlying the increased risk of cardiovascular events on duty and calls for the immediate evaluation of current practice in order to minimise risk to firefighters in the future. Examples of where improvements should be made include strategies to ensure adequate hydration and cooling following exposure to heat and physical exertion, change to working patterns to limit the duration of extreme exposures, and education, training and screening programmes to reduce the impact of traditional and occupational cardiovascular risk factors

The influence of social relationships on men's weight

There is a clear link between the development of obesity with poor diet and exercise behaviours. In the UK, excess weight is more prevalent among men than women: 41% of men and 31% of women are classed as overweight (BMI 25.0 -29.9 kg/m2); 68% and 58% of men and women respectively are overweight or obese (BMI≥ 25 kg/m2). An increase in BMI is also associated with a greater risk of mortality in men than in women however men are under-represented in lifestyle interventions for weight loss: In 2016, 7% of Slimming World members were men. It has been argued that men may perceive larger bodies to be more masculine and more desirable to women. Furthermore, factors contributing to male obesity such as eating large portions and consuming large volumes of alcohol, can be viewed as quintessentially masculine behaviours. To promote weight loss and reduce obesity among men, it is useful to understand which social interactions influence male weight loss behaviours. It is known that men in heterosexual relationships often gain weight after getting married, however the extent of women’s influence on men’s food intake and weight is unclear. Research studies investigating the influence that women and female partners have on male dietary and weight loss have been mixed; while some suggests they have a positive impact, other research suggests the impact is mixed or negative. Friends, peers and colleagues are also referenced regarding men’s diet and physical activity behaviours and behavioural intentions. The qualitative literature in the UK which explores how social relationships influence men’s weight and weight-related behaviours is, however, limited, therefore this research study sought to address this literature gap. The primary research question was to explore men’s perceptions and attitudes of dietary and physical activity behaviours in relation to weight and weight management

Developing and evaluating an online learning tool to improve midwives’ accuracy of visual estimation of blood loss during waterbirth: an experimental study

Objective: The principal objective was to test the effectiveness of an online learning tool to improve midwives’ accuracy of blood loss estimations in a birthing pool environment. The secondary objective was to assess the acceptability of the online learning tool to the midwives using it. Design: A one group pre-test, post-test experiment with immediate and six weeks follow-up to test ability together with an online questionnaire to assess perceived usefulness of an online learning tool. Setting: A large NHS maternity hospital comprising an acute care obstetric unit, a small district unit labour ward, one alongside midwifery-led unit and three freestanding midwifery-led units. Participants: Volunteer NHS employed midwives who had experience in caring for women labouring and giving birth in water (n = 24). Intervention: An online learning tool comprising six randomly ordered short video simulations of blood loss in a birthing pool in real time, and a tutorial giving verbal and pictorial guidance on making accurate blood loss estimations in water was developed then piloted. Midwives’ accuracy scores for estimating blood loss in each of the videos were calculated at three timepoints; pre and immediately post the learning component, and six weeks later. The estimated blood loss volume was subtracted from the actual blood loss volume, to give the difference between estimated and real blood loss in millilitres (ml) which was then converted to percentage difference to standardise comparison across the six volumes. The differences between pre- and post-learning for each of the six blood volumes was analysed using a repeated measures ANOVA. Statistical significance was set at p < 0.05. An online questionnaire incorporated questions using Likert scales to gauge confidence and competence and free text. Free text responses were analysed using a modified form of inductive content analysis. Findings: Twenty-two midwives completed the online learning and immediate post-test, 14 completed a post-test after six weeks, and 15 responded to the online questionnaire. Pre-test results showed under-estimation of all blood loss volumes and particularly for the two largest volumes (1000 and 1100 ml). Across all volumes, accuracy of estimation was significantly improved at post-test 1. Accuracy diminished slightly, but overall improvement remained, at post-test 2. Participants rated the online tool positively and made suggestions for refining it. Key conclusions and implications for practice: This is the first study measuring the accuracy of midwives’ blood loss estimations in a birthing pool using real-time simulations and testing the effectiveness of an online learning tool to improve this important skill. Our findings indicate a need to develop interventions to improve midwives’ accuracy at visually estimating blood loss in water, and the potential of an online approach. Most women who labour and/or give birth in water do so in midwifery-led settings without immediate access to medical support. Accuracy in blood loss estimations is an essential core skil

Foot and Mouth Disease and Cryptosporidiosis: Possible Interaction between Two Emerging Infectious Diseases

During 2001, a large outbreak of foot and mouth disease occurred in the United Kingdom, during which approximately 2,030 confirmed cases of the disease were reported, >6 million animals were slaughtered, and strict restrictions on access to the countryside were imposed. We report a dramatic decline in the reported incidence of human cryptosporidiosis in northwest England during weeks 13–38 in 2001, compared with the previous 11 years. This decline coincided with the period of foot and mouth restrictions. No similar reduction occurred in the other 26 weeks of the year. We also noted a substantial decline in the proportion of human infections caused by the bovine strain (genotype 2) of Cryptosporidium parvum during weeks 13–38 that year but not during the other weeks

How does pelvic girdle pain impact on a woman's experience of her pregnancy and the puerperium?

Background. Pelvic girdle pain is a prevalent condition during pregnancy. The associated pain can be constant and extremely distressing for women; however, the pathogenesis is still unclear. It is important to gain insight into women’s experiences of pelvic girdle pain in order to improve these with a view to impacting positively on their physical symptoms, while also improving overall wellbeing and mental health throughout pregnancy and the puerperium. Aims and Objectives. To use published literature to gain an insight into how pelvic girdle pain can impact on a woman’s experience of pregnancy and the puerperium, to provide meaningful, evidence-based, recommendations for midwifery practice. Method. A systematic literature review of qualitative research was undertaken. Database searches using Cumulative Index to Nursing and Allied Health, British Nursing Index, PsycINFO, and PubMed identified seven studies published between 2005 and 2014 in Sweden and England. Each paper was quality appraised in order to inform assessment of the credibility of findings. Following Noblit and Hare’s (1988) seven-step process for metaethnography, findings from each paper were synthesised into key themes which were then developed into a new conceptual model. Results. A conceptual model, consisting of five key themes, was identified. The central theme is ‘loss of identity and control’, the themes leading on from this are: ‘adapting to pain’, ‘inadequacy and independence’, ‘expectations and perceptions of others’, and ‘psychological strain’. The model highlights the link between mental wellbeing and perceived intensity of pain. Conclusions. Pelvic girdle pain has a debilitating impact on the lives of pregnant women and further research is necessary to identify effective treatment methods