Identifying the factors that influence midwives' perineal practice at the time of birth in the United Kingdom.

OBJECTIVE: The Obstetric Anal Sphincter Injuries (OASI) Care Bundle is designed to reduce the incidence of obstetric anal sphincter injuries. However, introducing behavioural change requires an understanding of current practice. This study aims to establish midwives practise at the time of birth, and the factors that influence this. DESIGN: Quantitative research - a national online survey. SETTING: Nationwide - United Kingdom (UK). Participants 563 midwives from across the UK. METHODS: An online survey of midwives' practice. Midwives were invited to participate through the Supervisor of Midwives network. Consent was sought on the landing page. Data analysis using descriptive and inferential statistics, with sub group analyses were used to explore variations in practice. Measurements Number of midwives using "hands on" the perineum and the influences on midwives' perineal practice at the time of birth. FINDINGS: Most midwives preferred to use "hands on" the perineum at the time of birth (61.4%). "Hands on" practise was significantly associated with where midwives worked (p<0.001), risk factors for OASI (p<0.001), and the approach that they were taught in their midwifery training (p<0.01). Midwives expressed lack of confidence in some areas with a third unsure that they could identify the third degree tear category b (38.2%) or c (34.3%). KEY CONCLUSIONS: There has been a growth in the number of midwives using "hands on" at the time of birth but midwives feel that they require additional training in regards to identifying an OASI. The study should be repeated following the roll out of the OASI care bundle, to identify its impact on midwives' perineal practice. IMPLICATIONS FOR PRACTICE: The study identified that there needs to be an improvement in the recognition of OASI by midwives, and in future repeating the study would identify whether the OASI care bundle has influenced midwives' practice.

Factors associated with contraceptive use in rural Nepal: Gender and decision-making.

INTRODUCTION: Gender norms and roles influence many decisions related to reproductive health behaviours including contraceptive use. There are very few studies related to gender norms and decision-making in contraceptive use in Nepal, hence this paper addresses these issues in a quantitative study. METHODS: A secondary data analysis of a primary study conducted in 2012 as a quantitative cross-sectional study in four villages of a hilly district in Nepal. This study included data that were collected from either the woman or the man in 440 couples of childbearing age with at least one child. The secondary analysis included (adjusted) regression analysis to investigate factors associated with contraception use with the variables of interest being gender roles and decision-making, whilst considering demographic and socio-economic controls. RESULTS: The secondary data analysis found gender roles were associated with current/ever use of contraceptives as reported by the respondents. Socio-economic factors such as husband's and wife's education and gender roles such as indicators showing sharing of childcare responsibilities affected contraceptive use positively. However, decision making regarding contraceptive use was not found to be associated with current/ever use of contraceptives. CONCLUSION: Gender has a role in the use of contraceptive, however decision-making may not be associated with contraceptive use. Educational, health promotional and family planning programmes are recommended to promote use of contraceptives. It is important that husbands get involved in these programmes to encourage discussions related to contraceptive use.

Quality of life in survivors of adult haematological malignancy.

BACKGROUND: Survivors of haematological malignancies endure long-term effects of both treatment and disease. This paper examines factors that influence their quality of life through reporting on the results of a survey. METHODS: Survey using previously validated quality of life questionnaires for use in cancer management. Participants were adults aged 18 and over who had completed treatment for a haematological malignancy and were between 1 and 5 years post-treatment. FINDINGS: A total of 131 participants, median age of 66, completed questionnaires (66% response rate). Significant associations were found between age, global quality of life, physical and role functioning. Men reported better physical functioning and lower symptom scores than women. Employed participants reported better quality of life. Increasing age was associated with lowest quality of life. Best role functioning was also noted in participants who lived beyond 2.5 years following treatment completion. The survey suggested a gender difference with men reporting better physical functioning, fewer symptoms of pain and less loss of sleep compared with women. CONCLUSION: This study contributes to the underdeveloped area of care for and research into adult haematological cancer survivors. Knowledge and understanding of the factors that affect the quality of life of such adults may provide an insight into implementation measures.

Factors related to choice of place of birth in a district in Nepal.

OBJECTIVE: In Nepal, both percentage of women giving birth at health facility and proportion of birth assisted by skilled birth attendant is very low. The purpose of this research was to identify predictors for choice of place of birth: either at home, primary health care facility (including birthing centres) or at tertiary health care facilites (hospitals and clinics). METHODS: A cross-sectional household survey was conducted in seven village development committee of a district lying in plain area of Nepal: Nawalparasi. A structured interview questionnaire was developed and administered face-to-face. Descriptive analysis along with chi-square test and multinomial logistic regression was used to identify the predictors of giving birth at a health care facility. RESULTS: Women were significantly more likely to give birth at health care facilities compared to home if the distance was less than one hour, belonged to advantaged caste, had radio, television and motorbike/scooter, decision maker for place of birth was husband, reported their frequency of antenatal (ANC) visits at 4 or more and belonged to age group 15-19. CONCLUSION: The analysis indicates that husbands of women giving birth influence the choice of place of birth. The findings highlight importance of having four or more ANC visits to the health institutions and that it should be located within one-hour walking distance. Inequity in utilisation of childbirth services at health institutions exists as showed by low utilisation of such services by disadvantaged caste.

Stress at work: Factors associated with cognitive disorganisation among private sector professionals.

This study explores psychological and psychological variables associated with perceived stress at work. A total of 100 international participants consented to donating a hair sample and completing a work-related stress survey. Logistic regression was used to investigate associations with low/high cognitive disorganisation using data collected from hair cortisol analysis and self-report questionnaires. High cognitive disorganisation scores were associated with high cardiopulmonary and anger scores. Low perceived self-efficacy was associated with high cognitive disorganisation. An association was found between low cortisol and low perceived self-efficacy. The relationship between high cognitive disorganisation and low self-efficacy endorses previous claims linking performance to perceived high self-efficacy.

More than just ticking a box how patient and public involvement improved the research design and funding application for a project to evaluate a cycling intervention for hip osteoarthritis.

PLAIN ENGLISH SUMMARY: Involving patients and the public in research helps to ensure that research remains relevant, and has an impact on the people it aims to benefit. Funding bodies now require patients and the public to be involved at all stages of research. Patients and members of the public were involved from the outset in research into a cycling and education programme for hip osteoarthritis. A group discussion took place with six participants from a trial of the programme. The group provided feedback on several areas including the relevance of the research, how the researchers proposed to recruit patients, the research design, the programme itself (including what they liked/didn't like about it), and how the researchers could publicise the research findings. The feedback received was invaluable, and helped shape the entire research project and funding application. The cycling and education programme has been extended in line with comments received from the group. They also helped identify the best way of gathering information from research participants and had suggestions for sharing the results, both of which were incorporated into the funding application. Often involving patients and the public in research can be seen as a 'tick box' exercise. However, this example shows how crucial involving patients and the public in research design is. It also shows how the funding application was made stronger as a result of patient input. Researchers should be encouraged to work closely with patients and the public to ensure their research is of the highest quality. ABSTRACT: Background Involving patients and the public in research is an essential activity to ensure relevant, accessible, and appropriate research. There is increasing obligation from funding bodies on researchers to have well thought through plans for involving the public, and indeed it is often a condition for funding. Patient and public involvement activity in this project was conducted to inform a funding application to investigate the effectiveness of a cycling and education intervention in the treatment of hip osteoarthritis. Methods Six participants from a feasibility programme of the intervention attended a two-hour patient and public involvement consultation group to provide feedback on various aspects of the proposed research and intervention. During the consultation group, two independent facilitators followed a detailed plan formulated with the research team. Feedback was validated by the attendees via email following the consultation, and a report was issued to the research team. Further feedback on subsequent changes was sought via email and telephone with members of a Patient Advisory Group. Results The patient and public involvement consultation group provided invaluable feedback and suggestions which impacted on the design and quality of the research project and the intervention. Key changes to the intervention included extending the duration of the cycling programme from six to eight weeks, and inclusion of an exercise diary to promote adherence to the intervention. Key feedback regarding the design of the research and funding application included suggestions for methods of dissemination, and confirmation of the primary outcome measure. Conclusions Patient and public involvement was crucial to the design of the proposed research and intervention. It informed many aspects of the research design and made the funding application stronger as a result. Involving patients and the public in research is much more than an obligation, or 'tick box' exercise. It can change and improve research quality, which is crucial when answering questions that are meaningful and important to patients, and which leads to increased impact. Collaboration with patients and the public should be planned and reported from the conception of a research idea where the impact of such input can be considerable.

Clinical risk factors for underlying gastrointestinal malignancy in iron deficiency anaemia: the IDIOM study.

OBJECTIVE: Ten percent of adults presenting with iron deficiency anaemia (IDA) have underlying cancer. This analysis - the Iron Deficiency as an Indicator Of Malignancy (IDIOM) study - was undertaken to assess whether five simple clinical parameters can usefully predict the likelihood of gastrointestinal (GI) malignancy on subsequent investigation of patients with IDA. DESIGN: Retrospective observational study, with multivariable analysis of the predictive value of sex, age, haemoglobin concentration (Hb), mean red cell volume (MCV) and iron studies for the risk of underlying GI malignancy. SETTING: District General Hospital IDA clinic. PATIENTS: 720 adults with confirmed IDA. RESULTS: Sex, age and Hb were strongly associated with the risk of GI malignancy-the parsimonious model including only these variables yielded ORs of 4.0 (95% CI 2.3 to 7.0) for males compared with females; 3.3 (95% CI 1.7 to 6.4) for age >70 years compared with ≤70 years; and 5.3 (95% CI 2.4 to 11.7) for a Hb of ≤91.4 g/L compared with ≥111.5 g/L. Combining these risk factors identified a subgroup (12% of the study population) at particularly low risk (<2% likelihood), and a second subgroup (16% of the study population) at especially high risk (>20% likelihood) of underlying GI malignancy. CONCLUSIONS: Three simple and objective clinical parameters can be combined to provide a clinically useful cancer risk stratification model for subjects with IDA. This may assist with patient counselling and the prioritisation of investigational resources.

Identifying factors associated with performance in a mock CSA: perceptions from trainees and trainers from one deanery.

BACKGROUND: The Clinical Skills Assessment (CSA) exam is a required component to obtain Membership to the Royal College of General Practitioners (MRCGP). This initial study was part of a wider initiative to reduce the first-time failure rates of the real CSA exam with further follow-up studies planned. METHODS AND ANALYSIS: Second-year GP specialty trainees (ST2) took part in a mock CSA exam. GP trainers from Dorset were invited to help facilitate the session as part of a 'trainers' education day'. Trainers were given a 3-hour updating training session led by a CSA examiner on how the mock CSAs were scored prior to observing and facilitating the mock exams. Trainee characteristics were analysed with a view to identifying what combination of factors were associated with performance in the mock CSA exam. Particular attention was placed on linguistic skills since a number of recent high-profile cases involving communication difficulties have attracted media interest. Open-ended responses were collected from feedback questionnaires in order to obtain perceptions about exam preparation and support. RESULTS: Thirty GP trainees attended a mock CSA training day as well as over 60 GP trainers. IMG characteristics were associated with poor performance in the mock CSA exam. Open-ended responses from trainees indicated that future preparation would be more focused in light of the mock CSA. As a result of attending the training day the GP trainers felt they had picked up skills and knowledge to help their GP registrars pass the CSA exam in the future. CONCLUSIONS: This study identified characteristics that may help predict success in the mock CSA exam. These characteristics were similar to national statistics for the real CSA exam. Overall feedback from the day was positive to such an extent that further CSA mock days have been planned in the Dorset General Practice Vocational Training Scheme (GPVTS) and interest has been expressed from other GP training schools in the region for using a mock system in the training of new GPs.

Associations between household and neighbourhood socioeconomic status and systolic blood pressure among urban South African adolescents.

Factors resulting in high risk for cardiovascular disease have been well studied in high income countries, but have been less well researched in low/middle income countries. This is despite robust theoretical evidence of environmental transitions in such countries which could result in biological adaptations that lead to increased hypertension and cardiovascular disease risk. Data from the South African Birth to Twenty cohort, Bone Health sub-sample (n = 358, 47% female), were used to model associations between household socioeconomic status (SES) in infancy, household/neighbourhood SES at age 16 years, and systolic blood pressure (multivariate linear regression) and risk for systolic pre-hypertension (binary logistic regression). Bivariate analyses revealed household/neighbourhood SES measures that were significantly associated with increased systolic blood pressure. These significant associations included improved household sanitation in infancy/16 years, caregiver owning the house in infancy and being in a higher tertile (higher SES) of indices measuring school problems/environment or neighbourhood services/problems/crime at 16 years of age. Multivariate analyses adjusted for sex, maternal age, birth weight, parity, smoking, term birth, height/body mass index at 16 years. In adjusted analyses, only one SES variable remained significant for females: those in the middle tertile of the crime prevention index had higher systolic blood pressure (ß = 3.52, SE = 1.61) compared with the highest tertile (i.e. those with the highest crime prevention). In adjusted analyses, no SES variables were significantly associated with the systolic blood pressure of boys, or with the risk of systolic pre-hypertension in either sex. The lack of association between SES and systolic blood pressure/systolic pre-hypertension at age 16 years is consistent with other studies showing an equalization of adolescent health inequalities. Further testing of the association between SES and systolic blood pressure would be recommended in adulthood to see whether the lack of association persists.

Approaches for assessing the role of household socioeconomic status on child anthropometric measures in urban South Africa.

The objectives of this article were to compare the variance explained in anthropometric outcomes when using individual measures of socioeconomic status (SES) versus different approaches to create SES indices within the urban African context, and to examine the influence of SES measured during infancy on child anthropometric outcomes at 7/8 years. Data from the 1990 Birth-to-Twenty cohort study set in Johannesburg-Soweto, South Africa, were used (n = 888). Linear regression models were used to investigate the association between SES (individual and index measures) during infancy and anthropometric measures at age 7/8 years, controlling for sex, age, and population group. Both individual and index measures of SES explained similar proportions of the variance for each anthropometric outcome. SES measured during infancy influenced weight more than height at age 7/8 years in Johannesburg-Soweto. Positive associations were found between SES and the anthropometric measures--ownership of a car, telephone, and having an inside flush toilet were the most significant SES variables. The similarities observed in the variance explained relating to the anthropometric outcomes suggest that researchers who want to adjust for SES in analyses could use an SES index to make statistical models more parsimonious. However, using such indices loses information relating to the specific socioeconomic factors that are important for explaining child anthropometrics. If the purpose of the research is to make policy recommendations for the improvement of child growth, individual SES variables would provide more specific information to target interventions.

Current socio-economic measures, and not those measured during infancy, affect bone mass in poor urban South african children.

Understanding the impact of socio-economic status (SES) on physical development in children is important, especially in developing countries where considerable inequalities persist. This is the first study to examine the association between SES on bone development at the whole body, femoral neck, and lumbar spine in black children living in Soweto and Johannesburg, South Africa. Linear regression models were used to study associations between SES during infancy and current SES, anthropometric, and DXA-derived bone mass in 9/10-yr-old children (n = 309). Findings suggest that current SES measures, rather than SES during infancy, are stronger predictors of current whole body bone area (BA) and whole body BMC after adjusting for body size, pubertal development, physical activity, habitual dietary calcium intake, and body composition. SES had no significant effect on either hip or spine bone mass. Caregiver's marital/cohabiting status (indicator of social support) and whether there was a television in the home (indicator of greater income) at age 9/10 yr were the most important socio-economic determinants of whole body BA and BMC. SES has a significant independent effect on whole body BMC through its impact on BA. This suggests that poverty alleviation policies in South Africa could have a positive effect on bone health.