An Exploration of Health Professional Support for Breastfeeding

Despite research consistently demonstrating the benefits of breastfeeding, Ireland has one of the lowest rates of breastfeeding in Europe with rates at discharge from hospital being 45% (Health Research and Information Division, 2009). Increasing emphasis is being placed on the role of health professionals in promoting and supporting breastfeeding (Sikorski et al., 2003). Little data are available in Ireland regarding health professionals’ perspectives on breastfeeding and women’s experience of professional support. The research consisted of two phases, a mixed methods study exploring health professional support for breastfeeding and an evaluation of an intervention to raise awareness of breastfeeding amongst health professionals and the general public. The mixed methods study consisted of a quantitative cross-sectional survey which investigated different aspects of community health professionals’ (n=256), knowledge and attitudes towards breastfeeding, their self efficacy in dealing with breastfeeding issues and issues around breastfeeding education. This was followed by two qualitative studies, one of which explored the issues for health professionals, in both the community and hospital setting (n=58) in providing support for breastfeeding, and, the other of which examined women’s (n=22) experience of professional support for breastfeeding in the first year postnatally. Grounded theory methods (Strauss & Corbin, 1990) guided data collection and analysis in both qualitative studies. A cross-sectional mixed methods study was also conducted to evaluate the role of forum theatre in creating awareness of breastfeeding. In summary, the quantitative study identified significant differences (p=0.001) as to whether respondents felt they had sufficient skills to provide breastfeeding support, with 82% of PHNs, 54% of GPs and 32% of practice nurses agreeing with this. Interest in attending training about breastfeeding in the next year was assessed and GPs were the least likely to want to attend. The qualitative study with health professionals identified the key issues in professional support for breastfeeding. Health professionals were found to have different levels of ‘ownership’ towards breastfeeding and this affected their level of engagement with the subject. Barriers to providing support were also identified such as having a lack of time, conflicting information and lack of confidence in supporting breastfeeding. The qualitative study of women’s experience of professional support demonstrated that breastfeeding is not something that a woman simply decides to do or not but that instead she needs to navigate through ‘the world of breastfeeding’ which was defined by the woman’s own world, the medical world and the world of support. The evaluation provided preliminary evidence for the potential of using forum theatre to change attitudes to breastfeeding and also for its use in training health professionals. This study has provided a greater understanding of professional support for breastfeeding. In order that women are adequately supported both in the antenatal and postnatal periods, health professional education around breastfeeding needs to be addressed and also alterative forms of support such as peer support on postnatal wards should be considered

Valuing Breastfeeding: Health Care Professionals’ Experiences of Delivering a Conditional Cash Transfer Scheme for Breastfeeding in Areas With Low Breastfeeding Rates

Alongside a randomized controlled trial testing the effectiveness of offering a cash transfer scheme (shopping vouchers) to mothers in areas with low breastfeeding rates, qualitative interviews were conducted with health care professionals delivering the scheme to explore their experiences. Health care professionals (n = 34; mainly midwives and health visitors) were interviewed in depth. Transcripts from recorded interviews were analyzed using a Framework Analysis approach. There was widespread acceptance of the scheme by health care professionals, with prior concerns regarding bribery and coercion being quickly allayed. Health care professionals reported that the scheme fitted in well with their routine ways of promoting and endorsing breastfeeding. They described their experiences of women’s positive reaction toward the scheme and how the scheme encouraged breastfeeding and gave breastfeeding higher value. Health care professionals reported that the incentives helped them engage women and promote and support breastfeeding in areas with low breastfeeding rates

The Infrared Properties of Super Star Clusters: Predictions from Three-Dimensional Radiative Transfer Models

With high-resolution infrared data becoming available that can probe the formation of high-mass stellar clusters for the first time, models that make testable predictions of these objects are necessary. We utilize a three-dimensional radiative transfer code, including a hierarchically clumped medium, to study the earliest stages of super star cluster evolution. We explore a range of parameter space in geometric sequences that mimic the evolution of an embedded super star cluster. The inclusion of a hierarchically clumped medium can make the envelope porous, in accordance with previous models and supporting observational evidence. The infrared luminosity inferred from observations can differ by a factor of two from the true value in the clumpiest envelopes depending on the viewing angle. The infrared spectral energy distribution also varies with viewing angle for clumpy envelopes, creating a range in possible observable infrared colors and magnitudes, silicate feature depths and dust continua. General observable features of cluster evolution differ between envelopes that are relatively opaque or transparent to mid-infrared photons. The [70]-[160] color can be used to determine star formation efficiency; the Spitzer IRAC/MIPS [8.0]-[24] color is able to constrain Rin and Rout values; and the IRAC [3.6]-[5.8] color is sensitive to the fraction of the dust distributed in clumps. Finally, in a comparison of these models to data of ultracompact HII regions, we find good agreement, suggesting that these models are physically relevant, and will provide useful diagnostic ability for datasets of resolved, embedded SSCs with the advent of high-resolution infrared telescopes like JWST.Comment: ApJ, accepted, to be published in the 729 -1 issue. 17 pages with 18 figure

Supporting home care for the dying: an evaluation of healthcare professionals' perspectives of an individually tailored hospice at home service

AIMS AND OBJECTIVES: To explore health care professionals' perspective of hospice at home service that has different components, individually tailored to meet the needs of patients. BACKGROUND: Over 50% of adults diagnosed with a terminal illness and the majority of people who have cancer, prefer to be cared for and to die in their own home. Despite this, most deaths occur in hospital. Increasing the options available for patients, including their place of care and death is central to current UK policy initiatives. Hospice at home services aim to support patients to remain at home, yet there are wide variations in the design of services and delivery. A hospice at home service was developed to provide various components (accompanied transfer home, crisis intervention and hospice aides) that could be tailored to meet the individual needs of patients. DESIGN: An evaluation study. METHODS: Data were collected from 75 health care professionals. District nurses participated in one focus group (13) and 31 completed an electronic survey. Palliative care specialist nurses participated in a focus group (9). One hospital discharge co-ordinator and two general practitioners participated in semi-structured interviews and a further 19 general practitioners completed the electronic survey. RESULTS: Health care professionals reported the impact and value of each of the components of the service, as helping to support patients to remain at home, by individually tailoring care. They also positively reported that support for family carers appeared to enable them to continue coping, rapid access to the service was suggested to contribute to faster hospital discharges and the crisis intervention service was identified as helping patients remain in their own home, where they wanted to be. CONCLUSIONS: Health care professionals perceived that the additional individualised support provided by this service contributed to enabling patients to continue be cared for and to die at home in their place of choice. RELEVANCE TO CLINICAL PRACTICE: This service offers various components of a hospice at home service, enabling a tailor made package to meet individual and local area needs. Developing an individually tailored package of care appears to be able to meet specific needs

Oral tolerance to cancer can be abrogated by T regulatory cell inhibition

Oral administration of tumour cells induces an immune hypo-responsiveness known as oral tolerance. We have previously shown that oral tolerance to a cancer is tumour antigen specific, non-cross-reactive and confers a tumour growth advantage. We investigated the utilisation of regulatory T cell (Treg) depletion on oral tolerance to a cancer and its ability to control tumour growth. Balb/C mice were gavage fed homogenised tumour tissue – JBS fibrosarcoma (to induce oral tolerance to a cancer), or PBS as control. Growth of subcutaneous JBS tumours were measured; splenic tissue excised and flow cytometry used to quantify and compare systemic Tregs and T effector (Teff) cell populations. Prior to and/or following tumour feeding, mice were intraperitoneally administered anti-CD25, to inactivate systemic Tregs, or given isotype antibody as a control. Mice which were orally tolerised prior to subcutaneous tumour induction, displayed significantly higher systemic Treg levels (14% vs 6%) and faster tumour growth rates than controls (p<0.05). Complete regression of tumours were only seen after Treg inactivation and occurred in all groups - this was not inhibited by tumour feeding. The cure rates for Treg inactivation were 60% during tolerisation, 75% during tumour growth and 100% during inactivation for both tolerisation and tumour growth. Depletion of Tregs gave rise to an increased number of Teff cells. Treg depletion post-tolerisation and post-tumour induction led to the complete regression of all tumours on tumour bearing mice. Oral administration of tumour tissue, confers a tumour growth advantage and is accompanied by an increase in systemic Treg levels. The administration of anti-CD25 Ab decreased Treg numbers and caused an increase in Teffs. Most notably Treg cell inhibition overcame established oral tolerance with consequent tumor regression, especially relevant to foregut cancers where oral tolerance is likely to be induced by the shedding of tumour tissue into the gut

Culture-enriched metagenomic sequencing enables in-depth profiling of the cystic fibrosis lung microbiota

Amplicon sequencing (for example, of the 16S rRNA gene) identifies the presence and relative abundance of microbial community members. However, metagenomic sequencing is needed to identify the genetic content and functional potential of a community. Metagenomics is challenging in samples dominated by host DNA, such as those from the skin, tissue and respiratory tract. Here, we combine advances in amplicon and metagenomic sequencing with culture-enriched molecular profiling to study the human microbiota. Using the cystic fibrosis lung as an example, we cultured an average of 82.13% of the operational taxonomic units representing 99.3% of the relative abundance identified in direct sequencing of sputum samples; importantly, culture enrichment identified 63.3% more operational taxonomic units than direct sequencing. We developed the PLate Coverage Algorithm (PLCA) to determine a representative subset of culture plates on which to conduct culture-enriched metagenomics, resulting in the recovery of greater taxonomic diversity—including of low-abundance taxa—with better metagenome-assembled genomes, longer contigs and better functional annotations when compared to culture-independent methods. The PLCA is also applied as a proof of principle to a previously published gut microbiota dataset. Culture-enriched molecular profiling can be used to better understand the role of the human microbiota in health and disease

Valuing breastfeeding: a qualitative study of women's experiences of a financial incentive scheme for breastfeeding

BACKGROUND: A cluster randomised controlled trial of a financial incentive for breastfeeding conducted in areas with low breastfeeding rates in the UK reported a statistically significant increase in breastfeeding at 6-8 weeks. In this paper we report an analysis of interviews with women eligible for the scheme, exploring their experiences and perceptions of the scheme and its impact on breastfeeding to support the interpretation of the results of the trial. METHODS: Semi-structured interviews were carried out with 35 women eligible for the scheme during the feasibility and trial stages. All interviews were recorded and verbatim transcripts analysed using a Framework Analysis approach. RESULTS: Women reported that their decisions about infant feeding were influenced by the behaviours and beliefs of their family and friends, socio-cultural norms and by health and practical considerations. They were generally positive about the scheme, and felt valued for the effort involved in breastfeeding. The vouchers were frequently described as a reward, a bonus and something to look forward to, and helping women keep going with their breastfeeding. They were often perceived as compensation for the difficulties women encountered during breastfeeding. The scheme was not thought to make a difference to mothers who were strongly against breastfeeding. However, women did believe the scheme would help normalise breastfeeding, influence those who were undecided and help women to keep going with breastfeeding and reach key milestones e.g. 6 weeks or 3 months. CONCLUSIONS: The scheme was acceptable to women, who perceived it as rewarding and valuing them for breastfeeding. Women reported that the scheme could raise awareness of breastfeeding and encourage its normalisation. This provides a possible mechanism of action to explain the results of the trial. TRIAL REGISTRATION: The trial is registered with the ISRCTN registry, number 44898617 , https://www.isrctn.com

Healthcare providers' views on the acceptability of financial incentives for breastfeeding:a qualitative study

BACKGROUND: Despite a gradual increase in breastfeeding rates, overall in the UK there are wide variations, with a trend towards breastfeeding rates at 6–8 weeks remaining below 40% in less affluent areas. While financial incentives have been used with varying success to encourage positive health related behaviour change, there is little research on their use in encouraging breastfeeding. In this paper, we report on healthcare providers’ views around whether using financial incentives in areas with low breastfeeding rates would be acceptable in principle. This research was part of a larger project looking at the development and feasibility testing of a financial incentive scheme for breastfeeding in preparation for a cluster randomised controlled trial. METHODS: Fifty–three healthcare providers were interviewed about their views on financial incentives for breastfeeding. Participants were purposively sampled to include a wide range of experience and roles associated with supporting mothers with infant feeding. Semi-structured individual and group interviews were conducted. Data were analysed thematically drawing on the principles of Framework Analysis. RESULTS: The key theme emerging from healthcare providers’ views on the acceptability of financial incentives for breastfeeding was their possible impact on ‘facilitating or impeding relationships’. Within this theme several additional aspects were discussed: the mother’s relationship with her healthcare provider and services, with her baby and her family, and with the wider community. In addition, a key priority for healthcare providers was that an incentive scheme should not impact negatively on their professional integrity and responsibility towards women. CONCLUSION: Healthcare providers believe that financial incentives could have both positive and negative impacts on a mother’s relationship with her family, baby and healthcare provider. When designing a financial incentive scheme we must take care to minimise the potential negative impacts that have been highlighted, while at the same time recognising the potential positive impacts for women in areas where breastfeeding rates are low