Background The UK figures suggest that rates of breastfeeding are low compared to other countries. While initial breastfeeding rates have increased, figures are still low for those continuing to breastfeed at 6 months. Aims To understand the experiences of breastfeeding women and what affects their ability to continue breastfeeding. Methods A total of 41 women aged 18-45 years who had attempted to breastfeed between 2011 and 2016 took part in semi-structured interviews, analysed using a thematic approach. Findings Four main themes were identified: attachment, provision of information and support, sociocultural pressures and maternal role. The study found that women reported more positive attachment to their infant when breastfeeding. Conclusions While women were often highly motivated to breastfeed, they often did not receive sufficient information and support, often leading to early cessation. Women highlighted the societal pressures to breastfeed and how this was incorporated into the perception of what it was to be a ‘mother’.
Acquired Brain Injury (ABI) is a collective term referring to any alteration to brain function that occurs as a result of a wide range of illness and injuries which occur after birth. These may be from trauma (traumatic brain injury; TBI) such as road traffic accidents, falls and other external forces, such as assaults, or non-traumatic causes (such as strokes, tumours or infections; Headway, 2015).
Introduction An Acquired brain injury (ABI) is any damage to the brain, from any cause, that happens during or after birth. Figures suggest that approximately 350,000 people in the UK experience an ABI every year (Headway, 2018a). ABIs are caused by damage to the brain from a traumatic cause (for example road traffic accidents, falls or other external forces) or non-traumatic cause (such as stroke or infections; Headway, 2018a). Physical symptoms include mobility issues, speech difficulties, sensory impairment and fatigue (Haywood, 2010; Marshall et al., 2007). Cognitive problems include language loss, impairments in attention, concentration and memory (King and Tyerman, 2003; Konrad et al., 2011). Some cognitive difficulties are specifically associated with impairments in executive functioning impacting on planning, organisation, initiating activity, problem solving, and decision-making, and often associated with impaired insight into the level of disability (Maas, Menon and Adelson, 2017). Behavioural problems can include irritability and aggression, obsessive behaviour and impulsivity (Arciniegas and Wortzel, 2014; Kelly et al., 2008). Further emotional difficulties include mood swings, anxiety and depression and wider personality changes (Holloway, 2014). The difficulties faced by ABI survivors can make community rehabilitation and reintegration challenging. ABI survivors may have multiple contacts with health and social care services, including (but not limited to); adult or children's social care, primary health care, community mental health care, housing services, employment services, benefits agencies, homelessness organisations,
BackgroundPrevious studies have shown that differential exposure to lifestyle factors may mediate the association between education and coronary heart diseases (CHD). However, few studies have examined the potential roles of allostatic load (AL) or differential susceptibility.Methods25 310 men and 26 018 women aged 35–74 and CHD free at baseline were identified from 21 European cohorts and followed for a median of 10 years, to investigate the mediating role of AL, as well as of smoking, alcohol use and body mass index (BMI), on educational differences in CHD incidence, applying marginal structural models and three-way decomposition.ResultsAL is a mediator of the association between educational status and CHD incidence, with the highest proportion mediated observed among women and largely attributable to differential exposure, (28% (95% CI 19% to 44%)), with 8% (95% CI 0% to 16%) attributable to differential susceptibility. The mediating effects of smoking, alcohol and BMI, compared with AL, were relatively small for both men and women.ConclusionOverall, the educational inequalities in CHD incidence were partially mediated through differential exposure to AL. By contrast, the mediation of the educational gradient in CHD by investigated lifestyle risk factors was limited. As differential susceptibility in men was found to have a predominant role in the accumulation of AL in low educational classes, the investigation of AL-related risk factors is warranted.
BackgroundWe investigate whether socially disadvantaged individuals are more susceptible to the detrimental effects of smoking and alcohol intake on allostatic load (AL), a marker of physiological ‘wear and tear’, resulting from adaptation to chronic stress.MethodsIn a cross-sectional analysis, 27 019 men and 26 738 women aged 35–74 years were identified from 21 European cohorts in the BiomarCaRE consortium. We defined three educational classes (EDs) according to years of schooling and an AL score as the sum of z-scores of eight selected biomarkers from the cardiovascular, metabolic and inflammatory systems. We used the Oaxaca-Blinder decomposition to disentangle the ED gradient in AL score into the differential exposure (DE, attributable to different distribution of smoking and alcohol intake across EDs) and the differential susceptibility (DS, attributable to a different effect of risk factors on AL across EDs) components.ResultsLess-educated men (mean AL difference: 0.68, 95% CI 0.57 to 0.79) and women (1.52, 95% CI 1.40 to 1.64) had higher AL scores. DE accounted for 7% and 6% of the gradient in men and women, respectively. In men, combining smoking and alcohol intake, DS accounted for 42% of the gradient (smoking DS coefficient=0.177, 26% of the gradient; alcohol DS coefficient=0.109; 16%, not statistically significant). DS contribution increased to 69% in metabolic markers. DS estimates were consistent across age groups, irrespective of comorbidities and robust to unmeasured confounding. No DS was observed in women.ConclusionsIn men, a DS mechanism substantially contributes to the educational class gradient in allostatic load.
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