Banking on Milk

Banking on Milk takes the reader on a journey through the everyday life of donor human milk banking across the United Kingdom (UK) and beyond, asking questions such as the following: Why do people decide to donate? How do parents of recipients hear about human milk? How does milk donation impact on lifestyle choices? Chapters record the practical everyday reality of work in a milk bank by drawing on extensive ethnographic observations and sensitive interview data from donors, mothers of recipients and the staff of four different milk banks from across the UK, and visits to milk banks across Europe and North America. It discusses the ongoing pressures to do with supply, demand and distribution. An empirically informed ""ethnography of the contemporary"", where both biosociality and biopower abound, this book includes an exploration of how milk banks evolved from registering wet nurses with hospitals, showing how a regulatory culture of medical authority began to quantify and organize human milk as a commodity. This book is a valuable read for all those with an interest in breastfeeding or organ and tissue donation from a range of fields, including midwifery, sociology, anthropology, geography, cultural studies and public health

Banking on Milk

Banking on Milk takes the reader on a journey through the everyday life of donor human milk banking across the United Kingdom (UK) and beyond, asking questions such as the following: Why do people decide to donate? How do parents of recipients hear about human milk? How does milk donation impact on lifestyle choices? Chapters record the practical everyday reality of work in a milk bank by drawing on extensive ethnographic observations and sensitive interview data from donors, mothers of recipients and the staff of four different milk banks from across the UK, and visits to milk banks across Europe and North America. It discusses the ongoing pressures to do with supply, demand and distribution. An empirically informed ""ethnography of the contemporary"", where both biosociality and biopower abound, this book includes an exploration of how milk banks evolved from registering wet nurses with hospitals, showing how a regulatory culture of medical authority began to quantify and organize human milk as a commodity. This book is a valuable read for all those with an interest in breastfeeding or organ and tissue donation from a range of fields, including midwifery, sociology, anthropology, geography, cultural studies and public health

Integrating a sense of coherence into the neonatal environment

Background: Family centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes. Discussion: In this paper we present a new perspective to neonatal care based on Aaron Antonovksy’s Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed. Summary: Consideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned

Molecular basis of gap junctional communication in the CNS of the leech Hirudo medicinalis

Gap junctions are intercellular channels that allow the passage of ions and small molecules between cells. In the nervous system, gap junctions mediate electrical coupling between neurons. Despite sharing a common topology and similar physiology, two unrelated gap junction protein families exist in the animal kingdom. Vertebrate gap junctions are formed by members of the connexin family, whereas invertebrate gap junctions are composed of innexin proteins. Here we report the cloning of two innexins from the leech Hirudo medicinalis. These innexins show a differential expression in the leech CNS: Hm-inx1 is expressed by every neuron in the CNS but not in glia, whereas Hm-inx2 is expressed in glia but not neurons. Heterologous expression in the paired Xenopus oocyte system demonstrated that both innexins are able to form functional homotypic gap junctions. Hm-inx1 forms channels that are not strongly gated. In contrast, Hm-inx2 forms channels that are highly voltage-dependent; these channels demonstrate properties resembling those of a double rectifier. In addition, Hm-inx1 and Hm-inx2 are able to cooperate to form heterotypic gap junctions in Xenopus oocytes. The behavior of these channels is primarily that predicted from the properties of the constituent hemichannels but also demonstrates evidence of an interaction between the two. This work represents the first demonstration of a functional gap junction protein from a Lophotrochozoan animal and supports the hypothesis that connexin-based communication is restricted to the deuterostome clade

A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

Background Implementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and ‘any’ breastfeeding. However, implementation of the BFHI is challenging. Aim To identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation. Method Seven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis. Findings Three overarching themes were identified. First the BFHI was viewed variously as a ‘desirable innovation or an unfriendly imposition’. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial. Conclusions Health care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level

Feeling the pressure - coping with chaos : breastfeeding at the end of the medical production line.

This study explored the Influences upon women's experiences of breastfeeding within postnatal ward settings. A critical ethnographic approach was adopted in two maternity units in the North of England, with 61 postnatal women and 39 midwives participating. Participant observations of 97 encounters between midwives and mothers, 106 focused interviews with mothers and 37 guided conversations with midwives were conducted. Basic, organising and global themes were constructed utilising thematic networXs analysis. The metaphor of the production line, with its notions of demand and efficient supply against linear time, illustrated the experiences of breastfeeding women. They conceptualised breastfeeding as a 'productive' project yet expressed deep mistrust in the efficacy of their bodies. Their emphasis centred on breast milk as nutrition rather than relationalily and breastfeeding. Women referred to the demanding and unpredictable ways in which their baby breached their temporal and spatial boundaries. They sought strategies to cope with the uncertainty of this embodied experience. Women felt 'subjected' to ideologically pervasive notions that 'breast Is best' and authoritative versions of how 'best to breastfeed'. An atmosphere of surveillance was experienced In relation to the institutional regulation of breastfeeding and through conducting a private and culturally ambiguous activity in a public domain. Women felt dissonant when a 'natural' process was experienced as complicated and challenging. The midwives were also 'productive' yet 'subjected', their work being time pressured, unpredictable and fragmented. In 'supplying' a service under 'demanding' conditions midwives engaged in institutionally orientated rituals and routines, approaching women in disconnected and directive ways. Consequently, breastfeedlng women's individual needs for support were rarely met. Recommendations are made for: a reconsideration of the way In which women's bodies are understood and experienced; a re-conceptuallsation of women's time; reconflguratlon of knowledge about breastfeedlng; re-visioning of relationships; and relocation of the place within which women commence breastfeeding

Global implications of the new WHO and UNICEF implementation guidance on the revised Baby-Friendly Hospital Initiative

Although breastfeeding confers both short- and long-term benefits for children and their mothers, breastfeeding practice remains suboptimal, globally. In addition to barriers including misperceptions and inappropriate marketing of breast milk substitutes, inadequate support for breastfeeding remains a challenge in many settings. To improve access to appropriate health system support, the World Health Organization (WHO) has reviewed the Baby-Friendly Hospital Initiative (BFHI), which ensures provision of optimal clinical care and support to mothers and their infants. This review has resulted in revision of the Ten Steps to Successful Breastfeeding, which form the core standards of (BFHI). These now consist of critical management procedures to support breastfeeding (Steps 1 and 2) and key clinical practices to support breastfeeding (Steps 3-10). In Step 1, there is now specific emphasis on compliance with the WHO Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions as well as on internal monitoring. There are also significant position shifts like the recommendation to "Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers," which is a departure from the earlier position of avoiding reference to these technologies. These revisions require countries and states to revise activities and tools for their local situation but without compromising the standards. [Abstract copyright: © 2018 John Wiley & Sons Ltd.

Perceptions of European medical staff on the facilitators and barriers to physical closeness between parents and infants in neonatal units

Aim Studies have provided insights into factors that may facilitate or inhibit parent–infant closeness in neonatal units, but none have specifically focused on the perspectives of senior neonatal staff. The aim of this study was to explore perceptions and experiences of consultant neonatologists and senior nurses in five European countries with regard to these issues. Methods Six small group discussions and three-one-to-one interviews were conducted with 16 consultant neonatologists and senior nurses representing nine neonatal units from Estonia, Finland, Norway, Spain and Sweden. The interviews explored facilitators and barriers to parent–infant closeness and implications for policy and practice, and thematic analysis was undertaken. Results Participants highlighted how a humanising care agenda that enabled parent–infant closeness was an aspiration, but pointed out that neonatal units were at different stages in achieving this. The facilitators and barriers to physical closeness included socio-economic factors, cultural norms, the designs of neonatal units, resource issues, leadership, staff attitudes and practices and relationships between staff and parents. Conclusion Various factors affected parent–infant closeness in neonatal units in European countries. There needs to be the political motivation, appropriate policy planning, legislation and resource allocation to increase measures that support closeness agendas in neonatal units

The relationship between zinc intake and growth in children aged 1-8 years: a systematic review and meta-analysis

BACKGROUND/OBJECTIVES: It is estimated that zinc deficiency affects 17% of the world's population, and because of periods of rapid growth children are at an increased risk of deficiency, which may lead to stunting. This paper presents a systematic review and meta-analysis of the randomised controlled trials (RCTs) that assess zinc intake and growth in children aged 1–8 years. This review is part of a larger systematic review by the European Micronutrient Recommendations Aligned Network of Excellence that aims to harmonise the approach to setting micronutrient requirements for optimal health in European populations (www.eurreca.org). SUBJECT/METHODS: Searches were performed of literature published up to and including December 2013 using MEDLINE, Embase and the Cochrane Library databases. Included studies were RCTs in apparently healthy child populations aged from 1 to 8 years that supplied zinc supplements either as capsules or as part of a fortified meal. Pooled meta-analyses were performed when appropriate. RESULTS: Nine studies met the inclusion criteria. We found no significant effect of zinc supplementation of between 2 weeks and 12 months duration on weight gain, height for age, weight for age, length for age, weight for height (WHZ) or WHZ scores in children aged 1–8 years. CONCLUSIONS: Many of the children in the included studies were already stunted and may have been suffering from multiple micronutrient deficiencies, and therefore zinc supplementation alone may have only a limited effect on growth

Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability

Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with ‘a breast pump costing around£40 provided for free on the NHS’ as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the ‘appeal and value of breast pumps’, ‘sharing the load’, ‘perceived benefits’, ‘perceived risks’ and issues related to ‘timing’. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes