Drinking in pregnancy: poor guidelines or lack of evidence?

Each year Bournemouth University (BU) holds a Festival of Learning (FoL), a week-long series of events aimed at encouraging members of the public, academics and healthcare professionals to engage with BU’s current science and research projects. This year BU’s Centre for Midwifery, Maternal and Perinatal Health (CMMPH) resumed the tradition of holding a debate during the festival on a topic relevant to maternal health and childbirth. In 2016 the FoL debate took place at the end of June and focused on the motion: " Advising pregnant women to avoid drinking alcohol during pregnancy is a symptom of the Nanny State and another step towards the medicalisation of childbirth.

The adolescent’s hospital experience: preferences for environmental design.

Aim The principle aim of this study is to examine what key aspects of the hospital built environment contribute to either a positive or negative hospital experience for the adolescent population. Background Research to date has demonstrated that adolescents in respect to Healthcare are an underserved population. In recent years with new construction and the renovation of existing healthcare facilities, attention is now being directed to the healthcare environment as a result of its’ ability to impact patient care outcomes and patient and family satisfaction. However, adolescents pose a unique demographic due to: 1) Transition of Care 2) rapidly evolving stages of development and life changes and 3) the cost vs. benefit ratio in that adolescents represent a small demographic in comparison to the overall paediatric and adult population. Appreciating, understanding and highlighting the needs of adolescents in respect to the physical environmental will assist in the design of age appropriate healthcare environments that generate healthcare benefits for this dynamic age group. Method Utilising a qualitative interpretive approach informed by Heidegger’s Hermeneutic Phenomenology,(1) a convenience sample of twelve adolescents aged 12-19 years of age living in Doha, Qatar were interviewed via open ended questions following a minimum of three days in hospital. Field notes were taken immediately after each interview with interview transcripts transcribed verbatim into narrative text via the Joanna Briggs Institute Thematic Analysis Programme (JBI-TAP). Aided by van Manen’s six steps of thematic analysis common themes were identified. Results Four main themes were identified: • The importance of physically engaging and stimulating environments that are age appropriate; • The desire for privacy and personalisation of space; • The importance of sustaining opportunities for family engagement within the hospital environment; and • The world of connectivity- the sense of normality amidst chaos. Conclusions The findings are congruent with previous research that support the overall benefits of dedicated adolescent units and age appropriate environments. The adolescent perspective rarely acknowledged in unit design needs to foster a culture of community and openness where adolescents can feel safe to articulate their physical, cognitive and psychosocial needs.Thesis (Ph.D.) -- University of Adelaide, School of Translational Health Science, 201

The ability of environmental healthcare design strategies to impact event related anxiety in paediatric patients: a comprehensive systematic review

Executive summaryBackground Children's' hospitals are by definition hospitals specialized in all aspects of children's care, but are they and if so, how is that achieved? Are healthcare facilities more than a 'space' in which to ask medical questions, seek answers and obtain treatment? Some suggest that the very design of a space can positively or negatively impact healing, hence the term referred to by those in the architectural community as 'healing spaces'. To date empirical studies to provide evidence to this effect, although growing in number, are still few. What is known is that hospitals, doctor's offices and dental offices alike unintentionally create an atmosphere, particularly for children, that add to an already heightened level of anxiety and fear. Designing a children's hospital, unlike a generalist facility, presents a unique and significant challenge. Those involved in designing such hospitals are faced with the opportunity and responsibility to care for and respond to the needs of children across the age spectrum; infants to toddlers, school aged children to adolescents. As healthcare professionals and architects, it is our responsibility to create healthcare facilities that are of purposeful design; anticipating and alleviating children's anxiety and fear wherever possible.Objectives The objective of this systematic review is to evaluate the effects of environmental design strategies in healthcare institutions such as hospitals and dental offices on event-related anxiety in the paediatric population.Inclusion Criteria This comprehensive systematic review involved children from the age of 1 to 18 years of age admitted to a healthcare facility with the primary outcomes of interest being four key design strategies: positive distraction; elimination of environmental stressors; access to social support and choice (control); and connection to nature.Search Strategy Using the Joanna Briggs defined three step search strategy, both published and unpublished studies were sought from the period of 1980 to 2010.Methods of the Review Data for each study was extracted and assessed by two independent reviewers for methodological validity prior to inclusion in the review using the Joanna Briggs Institute standardised critical appraisal instruments for Qualitative data (JBI-QARI) and for the Meta Analysis of Statistics Assessment (JBI-MAStARI).Results Twenty studies were reviewed, seven of a descriptive experimental design, three of mixed methodologies and thirteen of various qualitative research design methodologies inclusive of Observational, Grounded Theory, Ethnography and Phenomenology.Conclusions The design of the built environment does have the ability to impact either positively or negatively the level of anxiety and fear that children experience when exposed to a healthcare setting. The coping strategies engaged by and unique to each paediatric age group need to not only be understood but supported and reflected in the built environment.Implications for research Architects and healthcare researchers need to collaborate to establish a solid base of evidence related to this important area of interest. Irrespective of the challenges that researchers face in attempting to randomise, manipulate and control the numerous environmental variables that impact a question such as this, such challenges need not, nor should not, prevent or discourage future research. An innovative solution to the challenges faced by researchers in this field is the use of computer modelling and/ or simulation of the hospital environment. Through the use of simulated environments researchers can directly observe user preferences and/ physiological responses.Implication for practice This review highlights an insightful look into the preferences of children as consumers. Although sample sizes were small and results were not quantified in measurable outcomes, the ability for such studies to inform design should not be underestimated. Design strategies both from a practical perspective of minimal cost to construction projects warranting extensive resources are discussed.D. Norton-Westood, A. Pearson and S. Robertson-Malthttp://connect.jbiconnectplus.org/JBIReviewsLibrary.asp

The health-care environment through the eyes of a child - Does it soothe or provoke anxiety?

Health-care environments can be intimidating and scary places especially in the eyes of a child. When attempting to create spaces that are engaging to children, how do we know what works and are the needs the same across the age groups? In a 2011 comprehensive systematic review, a total of 20 studies were reviewed to answer the question: Can the health-care environment have an impact on children's anxiety? The results of the review showed that the built environment can support and enhance the coping strategies utilized by children, however further research is needed. The aim of this article is to summarize the findings of the review highlighting simple design strategies of minimal cost to large construction projects warranting extensive resources. Careful evaluation of space incorporating end-user input can result in age appropriate environments that support safe, quality care and enhance a positive health-care experience for all.Deborah Norton-Westwoo