Feeding behaviour and its relationship to weight gain in infancy: behaviour and its relationship to weight gain

This thesis involved a longitudinal study of 30 healthy infants from 6 weeks to 15 months to investigate the relationship between feeding behaviour and weight gain in infancy. Poor infant weight gain is associated with adverse outcomes in childhood (e.g. Skuse, Pickles, Wolke, et al 1994) and adulthood (e.g. Fall, Vijayakumar, Barker, et al 1995). Previous research has investigated the relationship between feeding behaviour and concurrent weight, but with a few exceptions there has been little previous work on the relationship between feeding behaviour and weight gain in infants. Feeding behaviour was measured at four breastfeeds in 32 infants at six weeks and later in 30 of the same infants at 12 months during solids feeding. Birthweight was obtained from parents' child health records and weight was measured at 6 weeks, 3 months and thereafter every 3 months until 15 months. Sucking patterns during milk feeding were found to be independently associated with infant weight gain, but there was no independent association between solids feeding behaviour and weight gain. Other independent predictors of weight gain were; infant sex, milk intake during breastfeeding and age of introduction of solids. An analysis of associations between milk and solids feeding behaviour found some evidence of parallels within infants across the two different types of feeding and the implications of this are discussed. A new method for the analysis of breastfed infants' sucking patterns which resolves the serious problems of the already published methods was developed during die course of the study and an outline of this is provided. Previously unavailable data on (1) the behaviour of one year olds during solids feeding and (2) the components of variation in milk and solids feeding behaviour are discussed

The rhetoric of public mourning : the case study of the Ellis Park cleansing ceremony

Bibliography: leaves 39-41

Consent or Caring? Issues of Autonomy and Paternalism in the Treatment of Anorexia Nervosa

Denial is a characteristic feature of anorexia nervosa (AN) that may lead to treatment refusal. If an individual is refusing treatment autonomously, it should be accepted, while a lack of autonomy indicates paternalistic intervention may be justified. AN has the highest mortality rate of any mental disorder, so accepting refusal means accepting the risk of death, so should only be done with the certainty that it is autonomous. The current research is theoretical, reviewing the literature on ethical issues relating to autonomy and paternalism in AN in order to evaluate the evidence base for these assumptions. The aim is to develop a procedural model for establishing autonomy in those with AN. The result is the anorexia nervosa autonomous decision-making model (ANDMM), which provides guidance for responding to autonomous and non-autonomous treatment refusal

How do surgeons think they learn about communication? A qualitative study

Context Communication education has become integral to pre‐ and post‐qualification clinical curricula, but it is not informed by research into how practitioners think that good communication arises. Objectives This study was conducted to explore how surgeons conceptualise their communication with patients with breast cancer in order to inform the design and delivery of communication curricula. Methods We carried out 19 interviews with eight breast surgeons. Each interview centred on a specific consultation with a different patient. We analysed the transcripts of the surgeons’ interviews qualitatively using a constant comparative approach. Results All of the surgeons described communication as central to their role. Communication could be learned to some extent, not from formal training, but by selectively incorporating practices they observed in other practitioners and by being mindful in consultations. Surgeons explained that their own values and character shaped how they communicated and what they wanted to achieve, and constrained what could be learned. Conclusions These surgeons’ understanding of communication is consistent with recent suggestions that communication education: (i) should place practitioners’ goals at its centre, and (ii) might be enhanced by approaches that support ‘mindful’ practice. By contrast, surgeons’ understanding diverged markedly from the current emphasis on ‘communication skills’. Research that explores practitioners’ perspectives might help educators to design communication curricula that engage practitioners by seeking to enhance their own ways of learning about communication

Perspectives of patients with haematological cancer on how clinicians meet their information needs: "Managing" information versus "giving" it

Objectives: Practitioners treating patients with haematological cancers have extensive clinical information available to give to patients, and patients need to be informed. However, many patients want to be protected from having information that is too detailed or threatening. To illuminate how practitioners can address this dilemma and help patients feel appropriately informed, we explored patients' experience of feeling informed or uninformed. Methods: Semi‐structured interviews were conducted with 20 patients who had been diagnosed with haematological cancer and had recently received results from clinical investigations or from evaluations of treatment response. Inductive and interpretive analysis of the transcribed audio‐recorded interviews drew on constant comparison. Results: Patients described the need for practitioners carefully to manage the information that they provided, and many felt alarmed by information that they did not experience as having been managed for them. A few patients who had difficulty trusting practitioners were not content with the information provided. Conclusions: These findings can be understood using attachment theory, whereby practitioners' careful management of information demonstrates their care for patients, and patients' trust in the practitioner enables them to feel informed. It follows that, when patients do not feel informed, the solution will not necessarily be more information but might be to help patients feel more secure in a caring clinical relationship

How experience makes a difference: practitioners' views on the use of deferred consent in paediatric and neonatal emergency care trials

BACKGROUND: In 2008 UK legislation was amended to enable the use of deferred consent for paediatric emergency care (EC) trials in recognition of the practical and ethical difficulties of obtaining prospective consent in an emergency situation. However, ambiguity about how to make deferred consent acceptable to parents, children and practitioners remains. In particular, little is known about practitioners’ views and experiences of seeking deferred consent in this setting. METHODS: As part of a wider study investigating consent methods in paediatric emergency care trials (called CONNECT), a 20 item online questionnaire was sent by email inviting practitioners (doctors and nurses) who were involved in talking with families about children’s and young people’s (aged 0–16 years) participation in UK EC trials. To ensure those with and without experience of deferred consent were included, practitioners were sampled using a combination of purposive and snowball sampling methods. Simple descriptive statistics were used to analyse the quantitative data, whilst the constant comparative method was used to analyse qualitative data. Elements of a symbiotic empirical ethics approach was used to integrate empirical evidence and bioethical literature to explore the data and draw practice orientated conclusions. RESULTS: Views on deferred consent differed depending upon whether or not practitioners were experienced in this consent method. Practitioners who had no experience of deferred consent reported negative perceptions of this consent method; these practitioners were concerned about the impact that deferred consent would have upon the parent-practitioner relationship. In contrast, practitioners experienced in deferred consent described how families had been receptive to the consent method, if conducted sensitively and in a time appropriate manner. Experienced practitioners also described how deferred consent had improved recruitment, parental decision-making capacity and parent-practitioner relationships in the emergency care setting. CONCLUSIONS: The views of practitioners with first-hand experience of deferred consent should be considered in the design and ethical review of future paediatric EC trials; the design and ethical review of such trials should not solely be informed by the beliefs of those without experience of using deferred consent. Further research involving parents and children is required to inform practitioner training and normative guidance on the use and appropriateness of deferred consent in emergency settings

Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study

Anxiety disorders are among the most common mental health disorders experienced by children, but only a minority of these children access professional help. Understanding the difficulties parents face seeking support for child anxiety disorders could inform targeted interventions to improve treatment access. The aims of the study were to identify barriers and facilitators to seeking and accessing professional support for child anxiety disorders, and ways to minimise these barriers. A qualitative interview study was conducted with parents of 16 children (aged 7–11 years) with anxiety disorders identified through screening in schools. Barriers and facilitators were identified in relation to four distinct stages in the help-seeking process: parents recognising the anxiety difficulty, parents recognising the need for professional support, parents contacting professionals, and families receiving professional support. Barriers and facilitators at each stage related to the child’s difficulties, the role of the parent, and parent perceptions of professionals and services. Findings illustrate the need (1) for readily available tools to help parents and professionals identify clinically significant anxiety in children, (2) to ensure that families and professionals can easily access guidance on the help-seeking process and available support, and (3) to ensure existing services offer sufficient provision for less severe difficulties that incorporates direct support for parents