The perceived impact of services rendered by Lay Counsellors

Student Number : 0009222T - MA research report - School of Human and Community Development - Faculty of HumanitiesThe aim of this exploratory study was to determine whether victims of crime who have encountered face-to-face interventions with lay counsellors, perceive these interventions as helpful, hindering or having no effect on their ability to cope after a traumatic incident. Five participants were selected for this qualitative study. A semi-structured interview schedule was constructed by the researcher to guide the interview process and thematic content analysis was used to analyse the data. The main emergent themes related to symptoms experienced by participants, time, victim support centres, perceptions of lay counsellors, short-term interventions, the model used and the participants overall perceptions of the services rendered by lay counsellors. Although the results were too varied to conclude the perceived effectiveness of interventions, the results are invaluable in gaining an in-depth understanding of the perceived impact of the services rendered by lay counsellors and what factors influence these perceptions

Investigating socioeconomic disparities in cancer survival using geographic area-based measures

Many studies in developed countries around the world have reported variations in cancer survival associated with socioeconomic status. Understanding the causes of survival disparities is of continued interest to inform interventions targeting disparities, and monitoring survival trends over time to evaluate the effectiveness of such interventions. Cancer survival is a useful measure in evaluating cancer control efforts, giving a quantifiable measure of the effectiveness of diagnostic and treatment services, and the management of cancer care. Ecologic analyses are widely used for evaluating the effectiveness of a population intervention. Increased socioeconomic variability within geographic area-units makes it difficult to isolate the discrete effect of socioeconomic status on cancer survival, particularly when using few, or large, geographic units. Despite recent research interest in socioeconomic disparities in cancer outcomes, NSW cancer-registry data has not been used to track temporal trends in survival disparities for many years. Furthermore, no study in NSW has investigated how the geographic area-level at which SES is measured impacts the survival disparities detected. This thesis analyses trends in socioeconomic survival disparities over time for ten major cancers in New South Wales, demonstrating that recent health and social policies in NSW have accompanied an increase in cancer survival overall, but they have not been associated with a reduction in socioeconomic inequalities. This thesis also compares two different area-units for measuring socioeconomic disparities in cancer survival in NSW, showing that while patient SES classification differed between area-units, the impact on cancer survival disparities of SES misclassification when using the larger area-unit was relatively small and inconsistent. Overall, this thesis emphasizes the importance of assessing progress toward eliminating cancer survival inequalities and has important implications for predicting and planning for the future needs of cancer care services in NSW. This thesis also contributes to the field of epidemiology by improving our understanding of the impact of using area-based measures of differing geographical precision when investigating socioeconomic inequalities in health outcomes

Frenotomy with breastfeeding support versus breastfeeding support alone for infants with tongue-tie and breastfeeding difficulties: the FROSTTIE RCT

BackgroundTongue-tie can be diagnosed in 3–11% of babies, with some studies reporting almost universal breastfeeding difficulties, and others reporting very few feeding difficulties that relate to the tongue-tie itself, instead noting that incorrect positioning and attachment are the primary reasons behind the observed breastfeeding difficulties and not the tongue-tie itself. The only existing trials of frenotomy are small and underpowered and/or include only very short-term or subjective outcomes.ObjectiveTo investigate whether frenotomy is clinically and cost-effective to promote continuation of breastfeeding at 3 months in infants with breastfeeding difficulties diagnosed with tongue-tie.DesignA multicentre, unblinded, randomised, parallel group controlled trial.SettingTwelve infant feeding services in the UK.ParticipantsInfants aged up to 10 weeks referred to an infant feeding service (by a parent, midwife or other breastfeeding support service) with breastfeeding difficulties and judged to have tongue-tie.InterventionsInfants were randomly allocated to frenotomy with standard breastfeeding support or standard breastfeeding support without frenotomy.Main outcome measuresPrimary outcome was any breastmilk feeding at 3 months according to maternal self-report. Secondary outcomes included mother’s pain, exclusive breastmilk feeding, exclusive direct breastfeeding, frenotomy, adverse events, maternal anxiety and depression, maternal and infant NHS health-care resource use, cost-effectiveness, and any breastmilk feeding at 6 months of age.ResultsBetween March 2019 and November 2020, 169 infants were randomised, 80 to the frenotomy with breastfeeding support arm and 89 to the breastfeeding support arm from a planned sample size of 870 infants. The trial was stopped in the context of the COVID-19 pandemic due to withdrawal of breastfeeding support services, slow recruitment and crossover between arms. In the frenotomy with breastfeeding support arm 74/80 infants (93%) received their allocated intervention, compared to 23/89 (26%) in the breastfeeding support arm. Primary outcome data were available for 163/169 infants (96%). There was no evidence of a difference between the arms in the rate of breastmilk feeding at 3 months, which was high in both groups (67/76, 88% vs. 75/87, 86%; adjusted risk ratio 1.02, 95% confidence interval 0.90 to 1.16). Adverse events were reported for three infants after surgery [bleeding (n = 1), salivary duct damage (n = 1), accidental cut to the tongue and salivary duct damage (n = 1)]. Cost-effectiveness could not be determined with the information available.LimitationsThe statistical power of the analysis was extremely limited due to not achieving the target sample size and the high proportion of infants in the breastfeeding support arm who underwent frenotomy.ConclusionsThis trial does not provide sufficient information to assess whether frenotomy in addition to breastfeeding support improves breastfeeding rates in infants diagnosed with tongue-tie.Future workThere is a clear lack of equipoise in the UK concerning the use of frenotomy, however, the effectiveness and cost-effectiveness of the procedure still need to be established. Other study designs will need to be considered to address this objective.Trial registrationThis trial is registered as ISRCTN 10268851

Prognostic factors of colostomy free survival in patients presenting with locally advanced anal canal carcinoma: A pooled analysis of two prospective trials (KANAL 2 and ACCORD 03)

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