Seeing other women breastfeed: how vicarious experience relates to breastfeeding intention and behaviour

Vicarious experience gained through seeing women breastfeed may influence infant feeding decisions and self‐efficacy. Our aim was to measure the attributes of seeing breastfeeding and to investigate how these relate to feeding intention (primary outcome) and behaviour (secondary outcome). First, we developed a Seeing Breastfeeding Scale (SBS), which consisted of five attitudes (Cronbach's alpha of 0.86) to most recently observed breastfeeding: ‘I felt embarrassed’; ‘I felt uncomfortable’; ‘I did not know where to look’; and ‘It was lovely’ and ‘It didn't bother me’. Test–retest reliability showed agreement (with one exception, kappas ranged from 0.36 to 0.71). Second, we conducted a longitudinal survey of 418 consecutive pregnant women in rural Scotland. We selected the 259 women who had never breastfed before for further analysis. Following multiple adjustments, women who agreed that ‘It was lovely to see her breastfeed’ were more than six times more likely to intend to breastfeed compared with women who disagreed with the statement [odds ratio (OR) 6.72, 95% confidence interval (CI) 2.85–15.82]. Women who completed their full‐time education aged 17 (OR 3.09, 95% CI 1.41–6.77) or aged 19 (OR 7.41 95% CI 2.51–21.94) were more likely to initiate breastfeeding. Women who reported seeing breastfeeding within the preceding 12 months were significantly more likely to agree with the statement ‘It was lovely to see her breastfeed’ (P = 0.02). Positive attitudes to recently seen breastfeeding are more important determinants of feeding intention than age of first seeing breastfeeding, the relationship to the person seen and seeing breastfeeding in the media.     

An examination of relational dynamics of power in the context of supported (assisted) decision-making with older people and those with disabilities in an acute healthcare setting

Introduction

Supported (assisted) healthcare decision-making (ADM) focuses attention on how people with disabilities, including cognitive impairments, can be best supported to make decisions about their health and social care on an equitable basis with others. Meaningful implementation of legal frameworks for ADM challenges long-held presumptions about who has access to valued decision-making resources, influence and power within a particular socio-cultural setting. This study aims to explore the relational power dynamics around ADM with older people in acute care settings.

Methods

This study adopts a critical hermeneutic approach to qualitatively explore the lived experience of ADM from the perspectives of Health and Social Care Professionals (N = 26). This is supported by an exploration of the experiences of older people (N = 4), older people with a diagnosis of dementia (N = 4) and family carers (N = 5).

Results

We present three themes of data analysis that represent three spaces where the relational aspects of power in ADM are manifested. The first space, centralising decision-making power within multidisciplinary teams identified the privileging of physicians in traditional hierarchical leadership models that may lead to the implicit exclusion of family carers and some Health and Social Care Professionals in the ADM process. Privileging cognitive and communication competence identified a tendency to attribute decision-making autonomy to those with cognitive and communication competency. The final space, balancing the duty of care and individual autonomy, recognises acute care settings as typically risk-averse cultures that limit autonomy for decisions that carry risk, especially for those with cognitive impairment.

Conclusion

Findings indicate the need to address cultural sources of power operating through social norms premised on ageist and ableist ideologies. It is necessary to challenge institutional barriers to meaningful ADM including positional power that is associated with hierarchies of influence and protectionism. Finally, meaningful ADM requires resistance to the disempowerment created by structural, economic and social circumstances which limit choices for decision-making.

Patient or Public Contribution

A public and patient involvement panel of older people were consulted in the development of the grant application (HRB: APA-2016-1878). Representatives from Alzheimer's Society Ireland and Family Carers Ireland were steering committee members guiding design and strategy.     

Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review

Suboptimal childhood vaccination uptake results in disease outbreaks, and in developed countries is largely attributable to parental choice. To inform evidence-based interventions, we conducted a systematic review of factors underlying parental vaccination decisions. Thirty-one studies were reviewed. Outcomes and methods are disparate, which limits synthesis; however parents are consistently shown to act in line with their attitudes to combination childhood vaccinations. Vaccine-declining parents believe that vaccines are unsafe and ineffective and that the diseases they are given to prevent are mild and uncommon; they mistrust their health professionals, Government and officially-endorsed vaccine research but trust media and non-official information sources and resent perceived pressure to risk their own child's safety for public health benefit. Interventions should focus on detailed decision mechanisms including disease-related anticipated regret and perception of anecdotal information as statistically representative. Self-reported vaccine uptake, retrospective attitude assessment and unrepresentative samples limit the reliability of reviewed data – methodological improvements are required in this area.     

Prevalence of glucosamine and omega-3 fatty acid use and characteristics of users among mid-age women: Analysis of a nationally representative sample of 10,638 women

Background

There has been a dramatic increase in the use of dietary supplements over the last few decades and both omega-3 fatty acids and glucosamine are two of the best-selling dietary supplements in many countries. An understanding of omega-3 fatty acids and glucosamine consumption is of significance to health care providers and for future health promotion activities.

Methods

This research involved analysis of data collected from a nationally-representative sample of Australian women as part of the Australian Longitudinal Study on Women’s Health (ALSWH). Participants’ use of omega-3 fatty acids (FA), glucosamine, their demographics, health status and health care utilisation were measured. Analysis included logistic regression modelling.

Results

Of the 10,638 women in the study, 26.8% reported use of omega-3 FA and 15.9% glucosamine. Women with osteoarthritis (OR=2.529; 95% CI: 2.190, 2.921), other arthritis (OR= 1.618; 95% CI: 1.375, 1.905), and joint pain (OR= 2.699; 95% CI: 2.305, 3.160) were more likely to use glucosamine (all p<0.001). In contrast, those with diabetes (OR= 0.471; 95% CI: 0.343, 0.646) or depression (OR= 0.764; 95% CI: 0.657, 0.887) were less likely to use glucosamine (both p<0.001). Women with osteoarthritis (OR=1.481; 95% CI: 1.297, 1.691) and joint pain (OR= 1.456; 95% CI: 1.306, 1.622) were more likely to use omega-3 FA (all p<0.001).

Conclusions

Substantial prevalence rates for use of glucosamine and omega-3 FA amongst mid-aged women highlights the need for health practitioners and policymakers to be mindful of the possible significant role of such supplement use as part of patient health-seeking behaviours.

     

Effects of alcohol consumption on eight circulating markers of liver fibrosis

A number of circulating breakdown products of collagen or other components of extracellular matrix, matrix degrading metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) have been proposed as markers of hepatic fibrosis. However, the published results lack consistency. Since many of the patients with fibrosis studied were alcoholics, the question was raised whether recent alcohol consumption may affect the results obtained. Using sandwich-type assays of radioimmunoassay technology with corresponding antibodies, we studied eight markers of liver fibrosis: laminin, tenascin, undulin, TIMP-1, collagen VI, procollagen type III (PIIINP), hyaluronic acid (HA) and MMP-2. A group of 10 alcoholics was studied after significant alcohol consumption and following 2 weeks of abstinence, verified with repeated breath alcohol measurement. Laminin was significantly reduced at 1 week (22%) and at 2 weeks (30%). Similarly, tenascin and undulin were also significantly decreased. By contrast, TIMP-1, collagen VI, PIIINP, HA and MMP-2 did not significantly change. The mode of action of alcohol on these tests is unknown. These differences must be considered when using those measurements to assess liver fibrosis.     

The role of the vitreous in retinal detachment surgery with external buckling

PURPOSE: To prove the role of the vitreous in retinal detachment surgery with scleral buckling procedures, we retrospectively investigated the charts of patients who were operated on for retinal detachment by scleral buckling between January 1995 and June 1997. METHODS: Out of a total of 718 cases, 41 retinal detachments occurred in previously vitrectomized eyes. The buckling procedure consisted of silicone sponge explants in 513 cases (254 radial, 259 circumferential) and of encircling elements in 202 cases. Three eyes received a temporary balloon. The minimal follow-up was 3 months. RESULTS: After primary surgery in the 677 nonvitrectomized eyes, the retina was attached in 482 eyes (71.2%), after reoperation in 627 eyes (92.6%). With up to 3 reoperations (including vitrectomy with gas or silicone oil tamponade in 79 eyes), the final success rate was 98.7%. The corresponding reattachment rates in the 41 vitrectomized eyes were 82.9% after primary surgery and 97.6% after reoperation. Repeated surgery in 6 eyes consisted of successful internal tamponade by silicone oil. The reattachment rates after primary buckle procedure are of most interest to the role of the vitreous: the highest success rate (82.9%) was achieved in the vitrectomized eyes versus 71.2% in the nonvitrectomized eyes. The difference is statistically not significant. CONCLUSIONS: We therefore conclude that the absence of the vitreous has no adverse effect on the results of buckling procedures for retinal detachment. The choice of the surgical technique in treating retinal detachments in vitrectomized eyes should only determined by retinal findings such as the number and extent of breaks or the presence and stage of proliferative vitreoretinopathy.     

Appearance of age‐related macular degeneration in vitrectomized and nonvitrectomized eyes: an intraindividual case study

Purpose: This study analyses the consequences of vitreoretinal traction on the macula and in particular the impact of a vitrectomy on the development of the age‐related macular degeneration (ARMD). Methods: In this retrospective case study, 42 eyes of 21 subjects were examined. The vitreous of one eye must have been removed by vitrectomy at least 8 years ago. At that point in time, the patients had to be at least 50 years old, with a healthy vitreous body of the other eye and a healthy macula in both eyes. Both eyes were examined using an optical coherence tomography (OCT) scan, B‐scan ultrasound, a binocular slit‐lamp funduscopy and a fluorescence angiography (FAG) to evaluate the potential development stage of an ARMD and the vitreous status. Results: In the follow‐up examination, the patients had an average age of 73.6 years. In 0 of 21 vitrectomized eyes (0%), there were signs for an early ARMD. In 5 of 21 nonvitrectomized eyes (23.8%), we found ARMD‐like changes in the angiography and slit‐lamp examinations. Of these 21 eyes, five eyes presented persistent attachment of the posterior vitreous cortex to the macula, while 16 eyes showed complete posterior vitreous detachment. All five eyes (100%) with premonitory signs of an ARMD showed persistent attachment of the posterior vitreous to the macula. Conclusion: We demonstrated a positive relationship between a persistent attachment of the posterior vitreous cortex to the macula and early signs of ARMD. Although the precise mechanism of this relationship remains unclear, the role of chronic low‐grade inflammation, chronic oxidative and mechanical stress and an increase in VEGF is discussed. Persistent vitreous attachment is likely to be another risk factor for ARMD.     

A comparison of the estrogenic potencies of estradiol,ethynylestradiol, diethylstilbestrol,nonylphenol and methoxychlor in vivo and in vitro

Five natural, pharmaceutical, or xenobiotic chemicals [17beta-estradiol (E2), ethynylestradiol (EE2), diethystilbestrol (DES), methoxychlor (MXC), nonylphenol (NP)] were tested in two in vitro assays [yeast estrogen screen (YES), MCF-7 breast tumor cell proliferation (E-Screen)], and compared with previously reported results from two in vivo male sheepshead minnow vitellogenin (VTG) production studies. The purpose of this investigation was to determine how accurately the two in vitro assays predicted responses observed in live animals. EC50 values for all five chemicals were approximately one order of magnitude less sensitive in the YES assay than in the MCF-7 assay. Based on the EC50 values, DES was 1.1 (YES) to 2.5 (MCF-7) times more potent in these receptor binding assays than was E2, while EE2 was slightly less potent than E2 in the YES assay (0.7) and nearly twice as potent (1.9) as E2 in the MCF-7 assay. EE2 and DES were of approximately equal potency in the 13-day sheepshead minnow VTG production bioassay. Both MXC and NP were 10(7) times less potent than E2 in the YES assay, MXC was 10(5) times less estrogenic than E2 in the MCF-7 assay, while both were approximately 100 times less potent than E2 in the live animal bioassay. The in vitro tests were substantially less sensitive (at least 1000 times) than the sheepshead minnow VTG assay for estimating estrogenic potency of the two xenobiotic chemicals, which suggests that in vitro-based, large-scale screening programs could potentially result in many false negative evaluations.     

Echography of the posterior lens capsule before implantation of an artificial lens

Clinical echographic examinations were performed in 15 cases of traumatic cataract. As a result certain criteria were established which give some information on the condition of the posterior capsule of the lens. Echographic examination prior to reoperation enables the procedure to be optimized with regard to IOL implantation, anterior vitrectomy, or prevention of retinal detachment.