Optimising baby to breast attachment (OBBA) : a mixed methods study

PhD ThesisPurpose – Only around 1% of mothers breastfeed their infants exclusively for the recommended first 6 months of life. Many problems causing early breastfeeding (BF) cessation can be caused by poor baby to breast attachment (BBA). The purpose of this research was to use BF mothers as co-designers to develop, refine, feasibility test and process evaluate a complex intervention which would teach new mothers how to optimise BBA in the first six weeks of BF. Design – The research was designed in three phases with the MRC framework as the overarching architecture Methodology – A mixed methods methodology enabled the collection of qualitative and quantitative data. Methods - Phase one used cognitive interviewing techniques to elicit women’s responses to undertake development and refinement of the intervention; Phase two was a pilot randomised controlled trial (RCT) to test the feasibility of delivering the intervention within a clinical setting and collect data to inform the design of a future definitive study; Phase three used in-depth interviews with women to undertake a thorough process evaluation and collect contextual information which was further expanded using focus groups with BF supporters. Findings – Feasibility was demonstrated and data collected to inform the design of a future definitive study. Although women used the intervention in different ways the key messages of when and how to optimise attachment was delivered. Possible enhancements to the intervention were identified. Health professionals felt the intervention was useful and had the potential to reduce their workload. Limitations – The pilot RCT was not powered to compare outcomes. A maximum variation sample used throughout all three phases sought to include as many different perspectives as possible. Originality – An intervention co-designed by women for women easily transfers information on why, when and how to optimise BBA, which may reduce the number of BF problems causing BF cessation. Next – A test of effectiveness including costs is now required.National Institute for Health Research (NIHR)’s Doctoral Research Training Programm

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Posttraumatic Stress Disorder in Anorexia Nervosa

Comorbidity among eating disorders, traumatic events, and post traumatic stress disorder (PTSD) has been reported in several studies. The main objectives of this study were to describe the nature of traumatic events experienced and to explore the relation between PTSD and anorexia nervosa (AN) in a sample of women

Hepatitis D double reflex testing of all hepatitis B carriers in low-HBV- and high-HBV/HDV-prevalence countries

Hepatitis D virus (HDV) infection occurs as a coinfection with hepatitis B and increases the risk of hepatocellular carcinoma, decompensated cirrhosis, and mortality compared to hepatitis B virus (HBV) monoinfection. Reliable estimates of the prevalence of HDV infection and disease burden are essential to formulate strategies to find coinfected individuals more effectively and efficiently. The global prevalence of HBV infections was estimated to be 262,240,000 in 2021. Only 1,994,000 of the HBV infections were newly diagnosed in 2021, with more than half of the new diagnoses made in China. Our initial estimates indicated a much lower prevalence of HDV antibody (anti-HDV) and HDV RNA positivity than previously reported in published studies. Accurate estimates of HDV prevalence are needed. The most effective method to generate estimates of the prevalence of anti-HDV and HDV RNA positivity and to find undiagnosed individuals at the national level is to implement double reflex testing. This requires anti-HDV testing of all hepatitis B surface antigen-positive individuals and HDV RNA testing of all anti-HDV-positive individuals. This strategy is manageable for healthcare systems since the number of newly diagnosed HBV cases is low. At the global level, a comprehensive HDV screening strategy would require only 1,994,000 HDV antibody tests and less than 89,000 HDV PCR tests. Double reflex testing is the preferred strategy in countries with a low prevalence of HBV and those with a high prevalence of both HBV and HDV. For example, in the European Union and North America only 35,000 and 22,000 cases, respectively, will require anti-HDV testing annually

Proceedings of Patient Reported Outcome Measure’s (PROMs) Conference Oxford 2017: Advances in Patient Reported Outcomes Research

A33-Effects of Out-of-Pocket (OOP) Payments and Financial Distress on Quality of Life (QoL) of People with Parkinson’s (PwP) and their Carer