Breast-feeding in a UK urban context: who breast-feeds, for how long and does it matter?

Objective: To investigate what factors relate most strongly to breast-feeding duration in order to successfully support breast-feeding mothers. Design: Prospective birth cohort study using questionnaires, routinely collected weights and health check at age 13 months. Setting: Gateshead, UK. Subjects: Parents of 923 term infants born in a defined geographical area and recruited shortly after birth, 50% of whom were breast-feeding initially. Results: Only 225 (24%) infants were still breast-fed at 6 weeks, although 136 (15%) continued beyond 4 months. Infants in the most affluent quintile were three times more likely to be initially breast-fed (P , 0.001) and five times more likely to still be feeding at 4 months (P ¼ 0.001) compared with infants in the most deprived quintile. A third of breast-fed infants were given supplementary feeds in the maternity unit and this was associated with a 10-fold increase in odds of giving up breast-feeding by discharge (P ¼ 0.001). Frequent feeding was reported as a reason for giving up in 70% of mothers at 6 weeks and 55% at 4 months. Those infants who stopped breastfeeding earliest showed the most rapid weight gain and were tallest at age 13 months. Non-breast-fed infants had 50% more family doctor contacts up to age 4 months (P ¼ 0.005). Conclusions: Initiation of breast-feeding in urban Britain remains strongly determined by socio-economic background and early cessation seems to be related to frequent feeding and rapid growth as well as a continuing failure to eradicate health practices that undermine breast-feeding. Those infants not receiving breast milk suffered increased morbidity, but the apparent association between breast-feeding duration and growth probably reflects reverse causation

Relationships Between Vocal Structures, the Airway, and Craniocervical Posture Investigated Using Magnetic Resonance Imaging

Peer reviewedPreprin

The Effects of Humming and Pitch on Craniofacial and Craniocervical Morphology Measured Using MRI

Peer reviewedPreprin

Food variety at 2 years of age is related to duration of breastfeeding

The aim of this study was to investigate the association of breastfeeding duration and food variety at 2 years of age. A secondary data analysis was undertaken of the Western Australian Pregnancy Cohort (Raine) Study, an ongoing longitudinal study. Data collected from a single 24 h dietary recall of 1905, 2 year-old children were used to calculate two food variety scores: a core food variety score (CFVS) and a fruit and vegetable variety score (FVVS). Multivariate linear regression analysis was used to identify those factors independently associated with the CFVS and FVVS. The mean CFVS was 7.52 (range 1–18) of a possible 34 food items or groups and the mean FVVS was 2.84 (range 0–10) of a possible 16 food items or groups. Breastfeeding duration was independently directly associated with the CFVS (p < 0.001) and FVVS (p < 0.001). In addition, maternal age was independently directly associated with the CFVS (p < 0.001) and FVVS (p = 0.001) as was maternal education (CFVS p < 0.001 and FVVS p = 0.043). The presence of older siblings was independently inversely associated with the CFVS (p = 0.003) and FVVS (p = 0.001). This study demonstrated a direct modest association between breastfeeding duration and food variety in 2 year-old children, independent of maternal demographic characteristics known to predict food variety in children. This finding supports the hypothesis that flavours transferred in breast milk provide repeated early exposure to different tastes and positively shape children’s food preferences and food variety.The Western Australian Pregnancy Cohort (Raine) Study is funded by the Raine Medical Research Foundation at The University of Western Australia, the National Health and Medical Research Council of Australia, the Telstra Research Foundation, the Western Australian Health Promotion Foundation, the Australian Rotary Health Research Fund and the National Heart Foundation of Australia and Beyond Blue. NHMR

Competency-based assessment of practice-based experiential learning in undergraduate pharmacy programmes.

Objective: To obtain feedback from experiential leaning (EL) leads about how competency-based assessments could be undertaken by EL facilitators, and to scope existing EL assessment structures in undergraduate Masters in Pharmacy (MPharm) programmes across the United Kingdom (UK). Methods: A cross-sectional survey was conducted utilizing a nine-item on-line survey, consisting of five open-ended and four closed-ended question. All UK universities with MPharm programmes (n=30) were invited to participate in the survey. Variables of interest were perceptions on activities and competencies that could be assessed by EL facilitators. The survey utilised a 5-point Likert-type response ranging from strongly disagree to strongly agree. Other variables of interest were tools/methods that could be used to assess competency, and perceived advantages and disadvantages of the proposed methods, the latter two captured via open-ended questions. Results: Of the 21 universities that responded (Response rate: 70%), 17 were included in the final analysis. Fourteen of the 17 (82.4%) offered the 4-year programme, while 3 (17.6%) offered both the 4-year and 5-year integrated programme. Assessments were mainly undertaken by university staff (59%), with minimal amounts undertaken during EL (39%). There was unanimous agreement (100%) that facilitators could assess students’ communication skills and professionalism during EL. No consensus, however, was achieved with regard to the tool(s) or method(s) to be used to assess student’s competencies. There were 13 responses to the open-ended comments. An advantage noted was that EL facilitator assessment of students would allow for more accurate evaluation of students in the practice setting, while acknowledging barriers such as the burden of time and the lack of consistency in marking. To address this lack of consistency, the majority highlighted the need for facilitator training. Conclusion: Minimal assessments are currently undertaken during EL, with students predominantly assessed on return to the university. No consensus could be achieved with regard to the tool(s) or method(s) to be used to assess students’ competencies, suggesting that perhaps there is no one-size-fits-all, and that the tools and methods used should be informed by the competencies being assessed

A cross-sectional study examining the nature and extent of interprofessional education in schools of pharmacy in the United Kingdom.

Interprofessional education can prepare the workforce for collaborative practice in complex health and social care systems. The aim of this study was to examine the nature and extent of interprofessional education in schools of pharmacy in the United Kingdom. An online questionnaire was developed using systems theory, published literature and input from an interprofessional expert panel. It included closed and open-ended questions and a demographic section. Following piloting, it was distributed to 31 schools of pharmacy. Descriptive statistics were used for quantitative data, a content analysis approach for qualitative data. Ten schools of pharmacy responded. All reported delivering compulsory interprofessional education. Most (80%) reported an interprofessional steering group overseeing development. Formative and/or summative assessment varied depending on year of study. Mechanism and purpose of evaluation varied, with respondents reporting Kirkpatrick Evaluation Model Levels 1-3 (100%;80%;70%). Two themes were identified: "Variation in Interprofessional Education Approaches and Opportunities" and "Factors Influencing Development and Implementation of Interprofessional Education". Formal teaching was mainly integrated into other modules; various pedagogic approaches and topics were used for campus-based activities. Respondents referred to planned interprofessional education during practice-based placements; some still at pilot stage. Overall, respondents agreed that practice-based placements offered opportunistic interprofessional education, but a more focused approach is needed to maximise student pharmacists' learning potential. Most interprofessional education offered in undergraduate pharmacy curricula in the United Kingdom is campus-based, the nature and extent of which varies between programmes. Very few examples of practice-based activities were reported. Results may inform future interprofessional education curricular developmen

Occurrence of lactational mastitis and medical management: a prospective cohort study in Glasgow

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background Lactational mastitis is a painful, debilitating condition that if inappropriately managed, may lead women to discontinue breastfeeding prematurely. The aim of this paper is to report the incidence of mastitis in the first six months postpartum in a Scottish population, its impact on breastfeeding duration and to describe the type and appropriateness of the support and management received by affected women from health professionals. Methods A longitudinal study of 420 breastfeeding women was undertaken in Glasgow in 2004/05. Participants were recruited and completed a baseline questionnaire before discharge from hospital. Cases of mastitis were reported either directly to the researchers or were detected during regular follow-up telephone interviews at weeks 3, 8, 18 and 26. Women experiencing mastitis provided further information of their symptoms and the management and advice they received from health professionals. Results In total, 74 women (18%) experienced at least one episode of mastitis. More than one half of initial episodes (53%) occurred within the first four weeks postpartum. One in ten women (6/57) were inappropriately advised to either stop breastfeeding from the affected breast or to discontinue breastfeeding altogether. Conclusion Approximately one in six women is likely to experience one or more episodes of mastitis whilst breastfeeding. A small but clinically important proportion of women continue to receive inappropriate management advice from health professionals which, if followed, could lead them to unnecessarily deprive their infants prematurely of the known nutritional and immunological benefits of breast milk

The application of visual environmental economics in the study of public preference and urban greenspace.

Urban greenspace has consistently been argued to be of great importance to the wellbeing, health, and daily lives of residents and users. This paper reports results from a study which combined the visualisation of public greenspace with environmental economics, and which aimed to develop a method by which realistic computer models of sites could be used within preference studies. As part of a methodology which employed contingent rating to establish the values placed on specific greenspace sites, three-dimensional computer models were used to produce visualisations of particular environmental conditions. Of particular importance to the study was the influence of variables including lighting, season, time of day and weather on the perception of respondents. This study followed previous work that established a suitable approach to the modelling and testing of entirely moveable physical variables within the built environment. As such, the study has firmly established that computer-generated visualisations are appropriate for use within environmental economic surveys, and that there is potential for a holistic range of attributes to be included in such studies