"I think maybe 10 years seems a bit long." Beliefs and attitudes of women who had never used intrauterine contraception

Aim To explore, in a general practice setting, the concerns, beliefs and attitudes about intrauterine contraception (IUC) reported by women, who had never used the methods. Methods We used a sequential mixed-method (QUAL/quant) approach. A pragmatic, self-selecting sample of 30 women, aged 18–46 years, who had never used IUC), was recruited through seven general practices in South East England. Themes arising from qualitative interviews were used to construct a quantitative survey, completed by a pragmatic sample of 1195 women, aged 18–49 years, attending 32 general practices in the same region, between February and August 2015. Results Qualitative themes were concerns about the long-acting nature of IUC, concerns about body boundaries, and informal knowledge of IUC, especially ‘friend of a friend’ stories. Women were not sure if the devices can be removed before their full 5- or 10-year duration of use, and felt that these timeframes did not fit with their reproductive intentions. Quantitative survey data showed that the most commonly endorsed concerns among never-users were painful fitting (55.8%), unpleasant removal of the device (60.1%), and concern about having a device ’inside me' (60.2%). Conclusions To facilitate fully informed contraceptive choice, information provided to women considering IUC should be tailored to more fully address the concerns expressed by never-users, particularly around the details of insertion and removal, and concerns about the adverse, long-term effects of the device. Women need to be reassured that IUC can be removed and fertility restored at any time following insertion

From old Wales to New South Wales : locating Welsh immigrants in colonial records 1875-1885

The history of immigration into Australia is central to the history of European Australia itself. This thesis presents the results of a study of migration from Wales to New South Wales in the latter half of the nineteenth century. The primary data for this study are New South Wales colonial immigration, shipping and census records. The records from the years 1875 to 1885 have proved to be a rich source of information about the migration of people from counties in Wales to New South Wales. A major purpose of this study has been to determine what sort of information about patterns of migration is recoverable and what questions can be asked and answered using the data retrieved. This thesis challenges the assumption, implicit or explicit in previously published work on the Welsh in Australia, that little in the way of useful statistical data was recoverable due to the historic and official submergence of Wales into England. It has been shown that accurate and detailed data on assisted immigrants from Wales can be recovered from the colonial records. Significant findings are presented regarding counties of origin, occupations, places of settlement, evidence of chain and stage migration, family group and individual male and female migration patterns and evidence of links between communities in Wales and New South Wales. Interpretation of these findings provides valuable evidence relevant to long-standing debates about whether Welsh migration patterns were distinctly different from the rest of the British Isles. The urban and industrial background of the majority of immigrants from Wales argues against widely accepted views about factors influencing internal movement from rural to industrial areas and the conclusion that there was little emigration overseas from industrial Wales. The recovered data about the Welsh immigrants to New South Wales demonstrate a need to re-examine traditional assumptions about Welsh migration in general and to Australia in particular

Size structure analysis of the dominant trees in a South African savanna

The population dynamics of six major tree species from the Nylsvley savanna were inferred from their present size structures. An attempt to determine age structure was prevented by confusing ‘growth’ rings. The two Acacia species and three of the dominants from the Burkea savanna show approximately stable age structures. Reduced numbers in some size classes, as a result of unknown past events indicate that the population of mature trees in the future will fluctuate, regardless of future conditions. Sclerocarya birrea has a markedly unstable structure, with no immature trees and no evidence of successful regeneration

Predictors of Non-use of Intrauterine Contraception among women aged 18-49 years in a General practice setting in the UK

Objectives: Our research examined the barriers to the uptake of Intrauterine Contraception (IUC) by women in a general practice setting in the UK. This paper reports predictors of non-use of IUC in this context. Design: We used a mixed method QUAL/Quant approach in which initial qualitative research provides a framework for subsequent larger quantitative surveys. Utilising findings derived from 30 qualitative interviews, a quantitative survey was developed and distributed to a pragmatic sample of 1195 women, aged 18-49 years, who were recruited through 32 participating GP practices in an area of England, UK. Outcome measures were percentage of attributes or responses in the sample and use or non-use of IUC. Results were analysed using descriptive statistical analysis and binary logistic regression, using Use/Non-Use as a binary response variable. Results: Attitudinal variables which were the strongest predictors of non-use of IUC were; an adverse opinion on long acting aspect of IUC (OR=8.34), disliking the thought of IUC inside the body (OR=3.138), concerns about IUC causing difficulties becoming pregnant in the future (OR=2.587), concerns about womb damage (OR=2.224), having heard adverse opinions about levonorgestrel - releasing IUS (Mirena®) (OR= 2.551), having an adverse opinion of having light, irregular periods (OR=2.382) and having an adverse opinion of having no periods (OR=2.018). Conclusions: Concerns about the long-acting nature of IUC and persisting concerns about the safety of IUC may act as barriers to its use. Information for women, tailored to specifically address these concerns, is needed

Guided self-help cognitive behavioural therapy for depression in primary care : a randomised controlled trial

Peer reviewedPublisher PD

Provider-based barriers to provision of intrauterine contraception in general practice

Objectives: Intrauterine contraception (IUC) is highly effective, safe and long-lasting, but is not a popular method of contraception among British women. This study examined barriers to the uptake of IUC in general practice in England. Method: A sequential mixed-method approach to explore the views of practitioners regarding the provision of IUC. We e-surveyed 208 practitioners from 69 practices in a region of England and subsequently interviewed 14 practitioners from eight practices. Results: Just under half of general practitioners (GPs) (46.8%; 58/124), and only 8.2% (4/49) of nurses reported being trained to fit IUC. Lack of knowledge of IUC was a barrier to fitting, and also to recommending IUC, especially by practitioners who were not trained to fit. There was discordance between reported knowledge of eligibility for IUC and the likelihood of recommending IUC. Respondents were less likely to recommend IUC to young, nulliparous women, women who had experienced a previous ectopic pregnancy, a recent sexually transmitted infection (STI), or an abnormal cervical smear. The qualitative data indicate that risk aversion and limited training, together with practitioners’ assessments that women are uninterested, may lead to IUC being precluded as a suitable method. Conclusions: Increased practitioner education, for those not trained to fit IUC, may remove a barrier to the uptake of IUC in general practice. More research is required on the discordance between the practitioners’ views on the characteristics of women considered suitable for IUC, and the criteria set out in the UK Medical Eligibility Criteria (UKMEC) guidelines

Pain Management in Cancer Center Inpatients:A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach—The Edinburgh Pain Assessment and Management Tool

Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC. The primary outcome was change in the percentage of study participants in each center with a clinically significant (≥ 2 point) improvement in worst pain (using the Brief Pain Inventory Short Form) from admission to 3 to 5 days after admission. Secondary outcomes included quality of analgesic prescribing and opioid-related adverse effects. Results Ten centers were randomly assigned to EPAT, and nine were assigned to UC. We enrolled 1,921 patients and obtained outcome data from 93% (n = 1,795). Participants (mean age, 60 years; 49% women) had a variety of cancer types. For centers randomly assigned to EPAT, the percentage of participants with a clinically significant improvement in worst pain increased from 47.7% to 54.1%, and for those randomly assigned to continue UC, this percentage decreased from 50.6% to 46.4%. The absolute difference was 10.7% (95% CI, 0.2% to 21.1%; P = .046) and it increased to 15.4% (95% CI, 5.8% to 25.0%; P = .004) when two centers that failed to implement EPAT were excluded. EPAT centers had greater improvements in prescribing practice and in the Brief Pain Inventory Short Form pain subscale score. Other pain and distress outcomes and opioid adverse effects did not differ between EPAT and UC. Conclusion A systematic integrated approach improves pain outcomes for inpatients in cancer centers without increasing opioid adverse effects

Adaptations to iron deficiency: cardiac functional responsiveness to norepinephrine, arterial remodeling, and the effect of beta-blockade on cardiac hypertrophy.

BackgroundIron deficiency (ID) results in ventricular hypertrophy, believed to involve sympathetic stimulation. We hypothesized that with ID 1) intravenous norepinephrine would alter heart rate (HR) and contractility, 2) abdominal aorta would be larger and more distensible, and 3) the beta-blocker propanolol would reduce hypertrophy.Methods1) 30 CD rats were fed an ID or replete diet for 1 week or 1 month. Norepinephrine was infused via jugular vein; pressure was monitored at carotid artery. Saline infusions were used as a control. The pressure trace was analyzed for HR, contractility, systolic and diastolic pressures. 2) Abdominal aorta catheters inflated the aorta, while digital microscopic images were recorded at stepwise pressures to measure arterial diameter and distensibility. 3) An additional 10 rats (5 ID, 5 control) were given a daily injection of propanolol or saline. After 1 month, the hearts were excised and weighed.ResultsEnhanced contractility, but not HR, was associated with ID hypertrophic hearts. Systolic and diastolic blood pressures were consistent with an increase in arterial diameter associated with ID. Aortic diameter at 100 mmHg and distensibility were increased with ID. Propanolol was associated with an increase in heart to body mass ratio.ConclusionsID cardiac hypertrophy results in an increased inotropic, but not chronotropic response to the sympathetic neurotransmitter, norepinephrine. Increased aortic diameter is consistent with a flow-dependent vascular remodeling; increased distensibility may reflect decreased vascular collagen content. The failure of propanolol to prevent hypertrophy suggests that ID hypertrophy is not mediated via beta-adrenergic neurotransmission