Midwifery 2020 (2): education and career progression

The Midwifery 2020: Delivering expectations vision is that midwives will be members of a highly skilled workforce, acting as lead professionals and coordinators of care as they deliver innovative, cost-effective, quality care across integrated health and social care contexts. They will embrace an evolving public health role and initiate and respond to change. There is, based on the key messages, an opportunity for midwifery educationalists to enhance their collaboration with service colleagues and researchers across the four U.K. countries to further develop appropriate curricula. The relationship between service and education colleagues needs, perhaps more than ever, to continue to be collaborative. The challenge is focused not only on skills and knowledge to enhance practice, but also to enthuse midwives to be actively committed and resourceful, as well as being politically sensitive to current and future service provision challenges.     

Consumer views on the potential use of mobile phones for the delivery of weight‐loss interventions

Background: The surge in the incidence of obesity and being overweight demands new options to extend the reach of weight‐loss interventions. Mobile phones provide a medium for reaching large numbers of people in a cost‐effective manner. The present study aimed to explore the potential for weight‐loss interventions to be delivered via mobile phone. Methods: A mixed methods approach was employed. A telephone survey was conducted with 306 randomly selected participants, and 10 focus groups were undertaken with 54 purposively selected participants. The telephone survey comprised questions exploring the nature and acceptability of any potential weight‐loss programme that might be delivered via mobile phones. The focus groups were conducted to explore issues of acceptability in more depth than was possible in the survey. Results: Two‐thirds of participants reported support for a mobile phone weight‐loss intervention, with greater levels of support amongst younger age groups and rural Māori (the indigenous population in New Zealand). Participants liked the idea of ready access to weight‐loss information, and associated feedback and encouragement. The results suggest that interventions would need to include aspects of social support, use tailored and personalised content, and be practical and relevant so that they appeal to consumers. Appropriate methods of providing social support using a mobile phone require further exploration. Conclusions: Mobile phones may provide a novel but acceptable way to deliver a weight‐loss intervention. They have the potential to be automatically personalised and tailored to the needs of the individual, at the same time as being delivered at a population level.     

An in vivo study of the primary and coupled rotations of the thoracic spine

OBJECTIVE: To provide preliminary data on three-dimensional thoracic spine kinematics measured in vivo. DESIGN: This study measured the three planes of thoracic spine motion in normal subjects using an external measuring device. BACKGROUND: Few studies have investigated the primary and associated coupled rotations in the thoracic spine in vivo. Most knowledge of motion characteristics comes from in vitro studies which have limitations. There is a lack of agreement on the patterns of thoracic coupled motion especially that between lateral flexion and axial rotation. METHODS: Thoracic motion was examined in 60 normal subjects (30 males, 30 females) aged 18-24 years. The primary and coupled rotations of the thoracic regions T(1-4), T(4-8), T(8-12) were measured using a 3 SPACE Fastrak system. RESULTS: The three thoracic regions displayed the characteristic variations in range and distribution of primary rotations previously described. The pattern of coupled motion varied between subjects but an ipsilateral pattern predominated between lateral flexion and axial rotation in the middle and lower thoracic regions while the upper thoracic region was found to exhibit either a contralateral or ipsilateral pattern. Gender did not influence results. CONCLUSIONS: The pattern of coupled motion in the thoracic spine demonstrated some variability between subjects in vivo. Lateral flexion and axial rotation were strongly coupled with overall, their relationship being predominantly ipsilateral.     

Morphology of the cervical intervertebral disc: implications for McKenzie's model of the disc derangement syndrome

Studies which have examined the cervical intervertebral disc have demonstrated that it is not morphologically similar to the lumbar intervertebral disc. Yet review of the clinical literature has revealed that clinicians have often based clinical theories on the assumption that the cervical and lumbar discs do have a similar structure. The purpose of this paper is to review the literature regarding the morphology of the cervical intervertebral disc in relation to McKenzie's clinical theories which claim that the nucleus pulposus of the adult cervical intervertebral disc may be repositioned. Discussion of the proposed biological mechanisms underlying examination and treatment techniques is imperative if the basis of these techniques is to be better understood.     

Breast self‐exams: Are health professionals doing their part?

Although breast cancer cannot be prevented at this time, early detection is the single most important factor in recovery. Early detection is largely dependent on discovery of the breast cancer by women through self breast examinations. This study indicates that health professionals either neglect to teach breast self‐exam (BSE) or fail to document teaching it in the patient's record. One hundred eight records of hospitalized clients who had identified risk for breast cancer were reviewed for documentation of teaching of BSE by the health professional. Even though all clients had multiple risk factors, no documentation of teaching BSE was present. These findings indicate a need for some structure in the health care system to assure that health professionals are fulfilling their obligations to teach BSE and to document it in the patient's records. Including it as part of nursing history, a standard nursing care plan, or as a part of audit criteria would assure more consistency in the teaching of BSE.     

Does self-management for return to work increase the effectiveness of vocational rehabilitation for chronic compensated musculoskeletal disorders? - Protocol for a randomised controlled trial

Background  

Musculoskeletal disorders are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. In Australia, vocational rehabilitation is provided to workers to assist them to stay in, or return to work. Self-management training may be an innovative addition to improve health and employment outcomes from vocational rehabilitation.     

Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: Subjects with single headaches

Musculoskeletal disorders are considered the underlying cause of cervicogenic headache, but neck pain is commonly associated with migraine and tension-type headaches. This study tested musculoskeletal function in these headache types. From a group of 196 community-based volunteers with headache, 73 had a single headache classifiable as migraine (n = 22), tension-type (n = 33) or cervicogenic headache (n = 18); 57 subjects acted as controls. Range of movement, manual examination of cervical segments, cervical flexor and extensor strength, the cranio-cervical flexion test (CCFT), cross-sectional area of selected extensor muscles at C2 (ultrasound imaging) and cervical kinaesthetic sense were measured by a blinded examiner. In all but one measure (kinaesthetic sense), the cervicogenic headache group were significantly different from the migraine, tension-type headache and control groups (all P < 0.001). A discriminant function analysis revealed that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the CCFT, had 100% sensitivity and 94% specificity to identify cervicogenic headache. There was no evidence that the cervical musculoskeletal impairments assessed in this study were present in the migraine and tension-type headache groups. Further research is required to validate the predictive capacity of this pattern of impairment to differentially diagnose cervicogenic headache.