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Townsend B, Fenwick J, McInnes R, Sidebotham M. Taking the reins: A grounded theory study of women's experiences of negotiating water immersion for labour and birth after a previous caesarean section. Women Birth 2023; 36:e227-e236. [PMID: 35927211 DOI: 10.1016/j.wombi.2022.07.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Women seeking a vaginal birth after a caesarean section (VBAC) frequently want to keep their subsequent labour and birth free from intervention. Water immersion (WI) during labour is potentially an effective tool for women having a VBAC for its natural pain-relieving properties. However, negotiating access to WI can be difficult, especially in the context of VBAC. AIM To explore women's experiences of negotiating WI for labour and birth in the context of VBAC. METHODOLOGY This Grounded Theory study followed Strauss and Corbin's framework and analytic process. Twenty-five women planning or using WI for their VBAC labour or birth were recruited from two midwifery practices and a social media group across Australia. Participants were interviewed during pregnancy and/or postnatally. FINDINGS 'Taking the reins', the core category explaining the women's experiences of assuming authority over their birth, comprised five categories: 'Robbed of my previous birth experience'; 'My eyes were opened'; 'Water is my tool for a successful VBAC'; 'Actioning my choices and rights for WI', and 'Empowered to take back control'. 'Wanting natural and normal' was the driving force behind women's desire to birth vaginally. Two mediating factors: Having someone in your corner and Rules for birth facilitated or hindered their birth choices, respectively. CONCLUSION The women became active participants in their healthcare by seeking information and options to keep their birth experience natural and normal. Support from other women and advocacy in the form of continuity of midwifery care was crucial in successfully negotiating WI for their VBAC when navigating the complex health system.
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Affiliation(s)
- B Townsend
- School of Nursing and Midwifery, Griffith University, Australia.
| | - J Fenwick
- Transforming Maternity Care Collaborative, Australia
| | - R McInnes
- School of Nursing and Midwifery, Griffith University, Australia
| | - M Sidebotham
- School of Nursing and Midwifery, Griffith University, Australia.
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Colori A, Hawkins M, Mitchell A, Hiley C, Dubash S, Johnson U, Fenwick J, Mendes R, Carnell D, Wilson J. PO-1199 Cardiac disease and tumour below T7 confer poorer prognosis following radical radiotherapy for NSCLC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Balfour D, Looney P, Turtle L, Fenwick J, Boukerroui D, Sage J. PO-1661 Investigation into the impact of AI-enhanced CBCTs on CBCT-CT deformable image registration. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Rulach R, Fenwick J, Harrow S. P05.09 Thoracic Re-Irradiation Dose Constraints for Late Lung Fibrosis: Preliminary Modelling Results. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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5
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Fenwick J. SP-0497: The BTV turns 21: Current status of clinical trials and future directions. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00519-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Rulach R, Fenwick J, Harrow S. Thoracic re-irradiation dose constraints: early results from a literature review. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Turtle L, Willett A, Leadbetter J, Brada M, Fenwick J. OC-0307 Feasibility of cardiac sparing in isotoxic dose escalated radiotherapy for NSCLC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Lawless C, Hatton M, Faivre-Finn C, Landau D, Boyd K, Fenwick J, Lester J, Mccartney E, Paul J, Shaw A, Simoes R. P2.01-43 ADSCaN: A Randomised Phase II Study of Accelerated, Dose Escalated, Sequential Chemo-Radiotherapy in Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Beech J, Germetaki T, Judge M, Paton N, Collins J, Garbutt A, Braun M, Fenwick J, Saunders MP. Management and grading of EGFR inhibitor-induced cutaneous toxicity. Future Oncol 2018; 14:2531-2541. [DOI: 10.2217/fon-2018-0187] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Janette Beech
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | - Theodora Germetaki
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | - Mary Judge
- Department of Dermatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Nina Paton
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | - Joanne Collins
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | | | - Michael Braun
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | - Jill Fenwick
- Merck Serono Ltd., Feltham, UK (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Mark P Saunders
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
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10
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Skwarski M, Mcgowan D, Bradley K, Fenwick J, Gleeson F, Horne A, Maughan T, Mckenna W, Mohammed S, Muschel R, Ng S, Panakis N, Strauss V, Stuart R, Vallis K, Macpherson R, Higgins G. P1.13-31 Safety and Tumour Hypoxia Modifying Effect of Buparlisib with Radiotherapy in NSCLC: A Phase I Dose Escalation Study. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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11
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Toohill J, Fenwick J, Sidebotham M, Gamble J, Creedy DK. Trauma and fear in Australian midwives. Women Birth 2018; 32:64-71. [PMID: 29759933 DOI: 10.1016/j.wombi.2018.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 01/25/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Relatively little is known about the extent of trauma and birth-related fear in midwives and how this might affect practice. AIM (1) Determine prevalence of birth related trauma and fear in midwives and associations with midwives' confidence to advise women during pregnancy of their birth options and to provide care in labour. (2) Describe midwives' experiences of birth related trauma and/or fear. METHOD A mixed methods design. A convenience sample of midwives (n=249) completed an anonymous online survey. Descriptive and inferential statistics were used to analyse the quantitative data. Latent content analysis was used to extrapolate meaning from the 170 midwives who wrote about their experiences of personal and/or professional trauma. RESULTS The majority of midwives (93.6%) reported professional (n=199, 85.4%) and/or personal (n=97, 41.6%) traumatic birth experiences. Eight percent (n=20) reported being highly fearful of birth. Trauma was not associated with practice concerns but fear was. Midwives categorised as having 'high fear' reported more practice concerns (Med 23.5, n=20) than midwives with 'low fear' (Med 8, n=212) (U=1396, z=-3.79, p<0.001, r=0.24). Reasons for personal trauma included experiencing assault, intervention and stillbirth. Professional trauma related to both witnessing and experiencing disrespectful care and subsequently feeling complicit in the provision of poor care. Feeling unsupported in the workplace and fearing litigation intensified trauma. CONCLUSION High fear was associated with lower confidence to support childbearing women. Fear and trauma in midwives warrants further investigation to better understand the impact on professional practice.
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Affiliation(s)
- J Toohill
- School of Nursing and Midwifery, Griffith University, Australia.
| | - J Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia; Clinical Chair, Gold Coast University Hospital, Australia.
| | - M Sidebotham
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - J Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - D K Creedy
- Menzies Health Institute Queensland, Griffith University, Australia.
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Toohill J, Callander E, Gamble J, Creedy DK, Fenwick J. A cost effectiveness analysis of midwife psycho-education for fearful pregnant women - a health system perspective for the antenatal period. BMC Pregnancy Childbirth 2017; 17:217. [PMID: 28693447 PMCID: PMC5504805 DOI: 10.1186/s12884-017-1404-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Psycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth. Method One thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores (n = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education (n = 170) at 24 and 34 weeks of pregnancy or to the control group (n = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups. Result Of 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group n = 91; Control Group n = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls (n = 60, 66% vs. n = 54, 58%; OR 2.34). Mean ‘treatment’ cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant (p = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145. Conclusion Costs of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers. Trial registration Australian New Zealand Controlled Trials Registry ACTRN12612000526875, 17th May 2012 (retrospectively registered one week after enrolment of first participant).
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Affiliation(s)
- J Toohill
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia. .,Office of the Chief Nursing and Midwifery Officer, Queensland Department of Health, Brisbane, 4001, Australia.
| | - E Callander
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, 4812, Australia
| | - J Gamble
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia
| | - D K Creedy
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia
| | - J Fenwick
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia.,Gold Coast University Hospital, Southport, 4215, Australia
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13
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Fenwick J, Brittain H, Gamble J. Australian private midwives with hospital visiting rights in Queensland: Structures and processes impacting clinical outcomes. Women Birth 2017; 30:497-505. [PMID: 28522387 DOI: 10.1016/j.wombi.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Reporting the outcomes for women and newborns accessing private midwives with visiting rights in Australia is important, especially since this data cannot currently be disaggregated from routinely collected perinatal data. AIM 1) Evaluate the outcomes of women and newborns cared for by midwives with visiting access at one Queensland facility and 2) explore private midwives views about the structures and processes contributing to clinical outcomes. METHODS Mixed methods. An audit of the 'all risk' 529 women receiving private midwifery care. Data were compared with national core maternity variables using Chi square statistics. Telephone interviews were conducted with six private midwives and data analysed using thematic analysis. FINDINGS Compared to national data, women with a private midwife were significantly more likely to be having a first baby (49.5% vs 43.6% p=0.007), to commence labour spontaneously (84.7% vs 52.7%, p<0.001), experience a spontaneous vaginal birth (79% vs 54%, p<0.001) and not require pharmacological pain relief (52.9% vs 23.1%, p<0.001). The caesarean section rate was significantly lower than the national rate (13% vs 32.8%, p<0.001). In addition fewer babies required admission to the Newborn Care Unit (5.1% vs 16%, p<0.001). Midwives were proud of their achievements. Continuity of care was considered fundamental to achieving quality outcomes. Midwives valued the governance processes embedded around the model. CONCLUSIONS Private midwives with access to the public system is safe. Ensuring national data collection accurately captures outcomes relative to model of care in both the public and private sector should be prioritised.
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Affiliation(s)
- J Fenwick
- Menzies Health Institute Queensland: Maternal, Newborn and Families Research Group, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Australia; Women-Newborn-Children Services Gold Coast University Hospital, Maternal, Newborn and Families Research Group, Australia.
| | - H Brittain
- Women-Newborn-Children Services Gold Coast University Hospital, Maternal, Newborn and Families Research Group, Australia.
| | - J Gamble
- Menzies Health Institute Queensland: Maternal, Newborn and Families Research Group, School of Nursing & Midwifery, Griffith University, Australia.
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14
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Christophides D, Gilbert A, Appelt A, Fenwick J, Lilley J, Sebag-Montefiore D. OC-0255: Practical use of principal component analysis in radiotherapy planning. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30698-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Bendall L, Partridge M, Hawkins M, Fenwick J. EP-1626: Predicting motion of normal tissue using incomplete real-time data during lung radiotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Foran B, Fenwick J, Byrne B, Christian J. PO-054: Cisplatin use in UK head and neck cancer management: a clinician survey of current practice. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Foran B, Fenwick J, Byrne B, Christian J. PO-080: Challenges and opportunities in head and neck cancer research in the UK: a survey of oncologists. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Christian J, Fenwick J, Foran B. PO-126: Consenting patients for late-effects of head and neck radiotherapy: an audit of UK oncology practice. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Creedy DK, Sidebotham M, Gamble J, Pallant J, Fenwick J. Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey. BMC Pregnancy Childbirth 2017; 17:13. [PMID: 28068942 PMCID: PMC5223536 DOI: 10.1186/s12884-016-1212-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 12/29/2016] [Indexed: 11/24/2022] Open
Abstract
Background The health and wellbeing of midwives are important considerations for workforce retention and quality care. The occurrence and relationships among mental health conditions such as burnout and depression have received little attention. We investigated the prevalence of burnout, depression, anxiety and stress in Australian midwives. Methods An online survey was conducted in September 2014. Participants were recruited through the Australian College of Midwives and professional networks. The survey sought personal and professional details. Standard measures included the Copenhagen Burnout Inventory (CBI) (Personal, Work and Client subscales), and Depression, Anxiety, and Stress Scale (DASS). The sample was collapsed into two groups according to DASS clinical cut-offs (normal/mild versus moderate/severe/extreme). Effect size statistics were calculated and judged according to Cohen’s guidelines. Results One thousand thirty-seven surveys were received. Respondents were predominantly female (98%), with an average age of 46.43 years, and 16.51 years of practice. Using a CBI subscale cut-off score of 50 and above (moderate and higher), 64.9% (n = 643) reported personal burnout; 43.8% (n = 428) reported work-related burnout; and 10.4% (n = 102) reported client-related burnout. All burnout subscales were significantly correlated with depression, anxiety and stress, particularly personal and work-related burnout with Spearman’s rho correlations ranging from .51 to .63 (p < .001). Around 20% of midwives reported moderate/ severe/ extreme levels of depression (17.3%); anxiety (20.4%), and stress (22.1%) symptoms. Mann-Whitney U tests revealed significant differences between groups with depression (r = .43), anxiety (r = .41) and stress (r = 48) having a medium size effect on burnout. Conclusion Prevalence of personal and work-related burnout in Australian midwives was high. The physical and psychological exhaustion associated with the different types of burnout were reflected in symptoms of depression, anxiety and stress symptoms. Further research is needed to support the personal well-being of midwives and minimize workplace burnout by developing short and long term strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1212-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D K Creedy
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia.
| | - M Sidebotham
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
| | - J Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
| | - Julie Pallant
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
| | - J Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia.,Gold Coast University Hospital, Southport, Australia
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20
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Lawless C, Landau D, Faivre-Finn C, Boyd K, Lester J, Fenwick J, Maguire J, McCartney E, Paul J, Parsons E, Peek A, Haswell T, Hatton M. 171: ADSCaN: A Randomised Phase II study of Accelerated, Dose escalated, Sequential Chemo-radiotherapy in Non-Small Cell Lung Cancer (NSCLC). Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Pallant JF, Haines HM, Green P, Toohill J, Gamble J, Creedy DK, Fenwick J. Assessment of the dimensionality of the Wijma delivery expectancy/experience questionnaire using factor analysis and Rasch analysis. BMC Pregnancy Childbirth 2016; 16:361. [PMID: 27871320 PMCID: PMC5117613 DOI: 10.1186/s12884-016-1157-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/14/2016] [Indexed: 12/04/2022] Open
Abstract
Background Fear of childbirth has negative consequences for a woman's physical and emotional wellbeing. The most commonly used measurement tool for childbirth fear is the Wijma Delivery Expectancy Questionnaire (WDEQ-A). Although originally conceptualized as unidimensional, subsequent investigations have suggested it is multidimensional. This study aimed to undertake a detailed psychometric assessment of the WDEQ-A; exploring the dimensionality and identifying possible subscales that may have clinical and research utility. Methods WDEQ-A was administered to a sample of 1410 Australian women in mid-pregnancy. The dimensionality of WDEQ-A was explored using exploratory (EFA) and confirmatory factor analysis (CFA), and Rasch analysis. Results EFA identified a four factor solution. CFA failed to support the unidimensional structure of the original WDEQ-A, but confirmed the four factor solution identified by EFA. Rasch analysis was used to refine the four subscales (Negative emotions: five items; Lack of positive emotions: five items; Social isolation: four items; Moment of birth: three items). Each WDEQ-A Revised subscale showed good fit to the Rasch model and adequate internal consistency reliability. The correlation between Negative emotions and Lack of positive emotions was strong, however Moment of birth and Social isolation showed much lower intercorrelations, suggesting they should not be added to create a total score. Conclusion This study supports the findings of other investigations that suggest the WDEQ-A is multidimensional and should not be used in its original form. The WDEQ-A Revised may provide researchers with a more refined, psychometrically sound tool to explore the differential impact of aspects of childbirth fear. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1157-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J F Pallant
- Department of Rural Health, The University of Melbourne, Graham St, Shepparton, Australia
| | - H M Haines
- Department of Rural Health, The University of Melbourne, Graham St, Shepparton, Australia.
| | - P Green
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - J Toohill
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - J Gamble
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - D K Creedy
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - J Fenwick
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia.,Gold Coast University Hospital Southport, Queensland, 4215, Australia
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22
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Cullen D, Sidebotham M, Gamble J, Fenwick J. Young student's motivations to choose an undergraduate midwifery program. Women Birth 2016; 29:234-9. [DOI: 10.1016/j.wombi.2015.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/25/2015] [Accepted: 10/28/2015] [Indexed: 11/30/2022]
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23
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Tickle N, Sidebotham M, Fenwick J, Gamble J. Women's experiences of having a Bachelor of Midwifery student provide continuity of care. Women Birth 2016; 29:245-51. [DOI: 10.1016/j.wombi.2015.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 10/26/2015] [Accepted: 11/02/2015] [Indexed: 11/25/2022]
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24
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Fenwick J, Cullen D, Gamble J, Sidebotham M. Being a young midwifery student: A qualitative exploration. Midwifery 2016; 39:27-34. [PMID: 27321717 DOI: 10.1016/j.midw.2016.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/21/2016] [Accepted: 04/24/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND undergraduate midwifery programmes offer opportunities for school leavers and young people (aged less than 21 years) to enter the profession. There is limited research exploring this age groups experience of their Bachelor of Midwifery programme. In order to retain these students we need to ensure that their experiences of undertaking a Bachelor of Midwifery program are positive and barriers and challenges are minimised. AIM this study explored young midwifery students' experience of their Bachelor of Midwifery program. METHOD a descriptive exploratory qualitative approach was used to explore the experiences of eleven students aged 20 years or less on enrolment. Data was collected using face-to-face or telephone-recorded interviews. Thematic analysis was used to analysis the data set. FINDINGS three major themes described the young students' experiences. The first labelled 'The challenges of being young' presented a number of age related challenges including transport issues with on-call commitments as some students had not gained a driver's license. Students experienced some degree of prejudice relating to their age from their older student peers and some clinical staff during placements. 'Finding your way' was the second theme and described the strategies students used to build confidence and competence both in the university and clinical environment. The young students reported a strong commitment to the profession. They demonstrated high levels of connection with women and found the continuity of care experiences invaluable to their learning. The final theme 'Making the transition from teenager to midwife' demonstrated some unique insights into how studying to become a midwife impacted upon their personal and professional growth. CONCLUSION the young students in this study encountered some unique issues related to their age. However as they progressed through the program they developed confidence in themselves and visualised themselves as having a long midwifery career. They were strongly motivated towards providing woman-centred maternity care and considered their continuity of care experiences fundamental to them developing a strong sense of themselves as midwives. Attracting and retaining young students is essential if the profession is to realise its goal of ensuring all women have access to a known midwife.
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Affiliation(s)
- J Fenwick
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Australia.
| | - D Cullen
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Australia
| | - J Gamble
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
| | - M Sidebotham
- Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia.
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Townsend B, Fenwick J, Thomson V, Foureur M. The birth bed: A qualitative study on the views of midwives regarding the use of the bed in the birth space. Women Birth 2016; 29:80-4. [DOI: 10.1016/j.wombi.2015.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/30/2015] [Accepted: 08/16/2015] [Indexed: 11/28/2022]
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Landau D, Faivre-Finn C, Lester J, Maguire J, Paul J, Mccartney E, Haswell T, Boyd K, Fenwick J, Parsons E, Taggart D, Hatton M, Lawless C. 188 ADSCaN: a randomised phase II study of Accelerated, Dose escalated, Sequential, Chemo-radiotherapy in Non-Small Cell Lung Cancer. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Turkstra E, Creedy DK, Fenwick J, Buist A, Scuffham PA, Gamble J. Health services utilization of women following a traumatic birth. Arch Womens Ment Health 2015; 18:829-32. [PMID: 25577338 DOI: 10.1007/s00737-014-0495-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Abstract
This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.
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Affiliation(s)
- E Turkstra
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia. .,Griffith Health Institute, Griffith University, Queensland, Australia.
| | - D K Creedy
- Griffith Health Institute, Griffith University, Queensland, Australia.
| | - J Fenwick
- Griffith Health Institute, Griffith University and Gold Coast Hospital, Queensland, Australia.
| | - A Buist
- University of Melbourne, Melbourne, Australia.
| | - P A Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia. .,Griffith Health Institute, Griffith University, Queensland, Australia.
| | - J Gamble
- Griffith Health Institute, Griffith University, Queensland, Australia.
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Lord SR, Patel N, Liu D, Fenwick J, Frezza C, Costa SHD, Gaude E, Zhang Q, Wakelam M, Gleeson F, Haider S, Buffa F, Harris AL. Abstract A24: Integration of tumor metabolomics, cancer genome sequencing and dynamic functional imaging to assess the metabolic effects of metformin in breast cancer. Cancer Prev Res (Phila) 2015. [DOI: 10.1158/1940-6215.prev-14-a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
There is great interest in the effects on cancer metabolism of the diabetes drug, metformin and its potential as a cancer treatment. Despite intense investigation it is still not clear as to its metabolic effects on primary human cancer in vivo. 41 patients with primary breast cancer were recruited to a ‘window of opportunity study’ prior to neoadjuvant chemotherapy. Before and after 2 weeks of metformin, dynamic 18F-FDG PET-CT scans were carried out, breast core biopsies of the primary tumour taken for RNASeq, metabolomics and immunohistochemistry analysis and host serum metabolic markers assessed.
Metabolomic mass spectrometry analysis revealed an increase in the ADP/ATP and AMP/ATP ratio (fold change 8.6 and 24.9, respectively, p = 0.07 and p = 0.14) after metformin treatment.
RNA sequencing of the first 21 paired samples showed upregulation of many genes encoding components of complex 1, and the TCA cycle, glutaminolysis, and glycolysis pathways. Several genes encoding for glucose and glutamine transport were amongst those most consistently upregulated, including GLUT1, SLC38A1 and SLC7A5 (all p<0.0001).
Dynamic PET-CT analysis of the first 17 paired scans demonstrated a trend toward a decrease in the variable K2 post-metformin (an estimate of 18F-FDG efflux from tumour intracellular pool back to blood), but with much variability between paired scans (0.70±0.11 vs 0.51±0.05 (p=0.14)).
There was a decrease in serum C-peptide (0.56±0.04nmol/L vs 0.48±0.02nmol/L, pre- and post-metformin, p=0.003) consistent with reduced host insulin secretion. This is the first study in the clinical setting to show that metformin can cause an energy stress in cancer cells. The effect on mRNA expression was compatible with direct mitochondrial effects on the cancer cell leading to upregulation of the glutaminolysis and glycolysis pathways. The decrease in efflux of radiolabelled glucose may indicate retention of glucose possibly secondary to changes in blood glucose availability. We expect this study will help define biomarker development and future treatment strategies for metformin, in particular potential combination therapy.
Note: This abstract was not presented at the conference.
Citation Format: Simon R. Lord, Nilay Patel, D. Liu, J. Fenwick, C. Frezza, S. Henriques da Costa, E. Gaude, Q. Zhang, M. Wakelam, F. Gleeson, S. Haider, F. Buffa, A. L. Harris. Integration of tumor metabolomics, cancer genome sequencing and dynamic functional imaging to assess the metabolic effects of metformin in breast cancer [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A24.
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Affiliation(s)
| | - Nilay Patel
- 2Oxford Cancer Imaging Centre, Oxford, United Kingdom,
| | - D. Liu
- 2Oxford Cancer Imaging Centre, Oxford, United Kingdom,
| | - J. Fenwick
- 2Oxford Cancer Imaging Centre, Oxford, United Kingdom,
| | - C. Frezza
- 3University of Cambridge, Cambridge, United Kingdom
| | | | - E. Gaude
- 3University of Cambridge, Cambridge, United Kingdom
| | - Q. Zhang
- 3University of Cambridge, Cambridge, United Kingdom
| | - M. Wakelam
- 3University of Cambridge, Cambridge, United Kingdom
| | - F. Gleeson
- 2Oxford Cancer Imaging Centre, Oxford, United Kingdom,
| | - S. Haider
- 1University of Oxford, Oxford, United Kingdom,
| | - F. Buffa
- 1University of Oxford, Oxford, United Kingdom,
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Pallant J, Dixon L, Sidebotham M, Fenwick J. Further validation of the perceptions of empowerment in midwifery scale. Midwifery 2015; 31:941-5. [DOI: 10.1016/j.midw.2015.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/12/2015] [Accepted: 05/25/2015] [Indexed: 11/28/2022]
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Haines HM, Pallant JF, Fenwick J, Gamble J, Creedy DK, Toohill J, Hildingsson I. Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort. Sex Reprod Healthc 2015; 6:204-10. [PMID: 26614602 DOI: 10.1016/j.srhc.2015.05.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/01/2015] [Accepted: 05/11/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice. AIM To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women. METHOD Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics. RESULTS 1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean. CONCLUSION This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.
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Affiliation(s)
- H M Haines
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia; Northeast Health, Green St, Wangaratta, Victoria, Australia.
| | - J F Pallant
- Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia
| | - J Fenwick
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia; Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland 4215, Australia
| | - J Gamble
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - D K Creedy
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - J Toohill
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - I Hildingsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Fenwick J, Toohill J, Creedy D, Smith J, Gamble J. Sources, responses and moderators of childbirth fear in Australian women: A qualitative investigation. Midwifery 2015; 31:239-46. [DOI: 10.1016/j.midw.2014.09.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 11/29/2022]
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Hackett S, Liu D, Chalkidou A, Marsden P, Landau D, Fenwick J. PO-0914: Simultaneous estimation of input functions from dynamic 18F-FLT studies of the head and neck. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Turkstra E, Gamble J, Creedy DK, Fenwick J, Barclay L, Buist A, Ryding EL, Scuffham PA. PRIME: impact of previous mental health problems on health-related quality of life in women with childbirth trauma. Arch Womens Ment Health 2013; 16:561-4. [PMID: 24091921 DOI: 10.1007/s00737-013-0384-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/15/2013] [Indexed: 11/27/2022]
Abstract
We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n = 137) or parenting support (n = 125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06; 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08; 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.
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Affiliation(s)
- E Turkstra
- Centre for Applied Health Economics, Griffith Health Institute, Griffith University, Brisbane, QLD, Australia,
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Jaroudi S, Konstantinidis M, Alfarawati S, Fragouli E, Wells D, Bianchi V, Jaroudi SJS, Baban DBD, Knight SKS, Borini ABA, Fragouli EFE, Wells DWD, Basile N, Bronet F, Nogales MC, Martinez E, Ariza M, Agudo D, Florensa M, Riqueros M, Meseguer M, Hyslop L, Prathalingam N, Clapham E, Nowak L, Dunkley E, Fenwick J, Byerley S, Murdoch A, Herbert M, Wong KM, Van Echten-Arends J, Korevaar JC, van der Veen F, Repping S, Mastenbroek S, Assou S, Haouzi D, Ferrieres A, Dechaud H, Hamamah S. Session 27: Genes and chromosomes in oocytes and embryos. Hum Reprod 2013. [DOI: 10.1093/humrep/det155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Landau D, Laurence V, Illsley M, Hughes S, Miles E, Ngai Y, Hughes L, Khan I, Mayles P, Fenwick J. 54P A PHASE I/II TRIAL OF CONCURRENT CHEMO-RADIATION WITH DOSE-ESCALATED RADIOTHERAPY IN PATIENTS WITH STAGE II OR STAGE III NON-SMALL CELL LUNG CANCER. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Landau D, Miles E, Illsley M, Laurence V, Hughes S, Ngai Y, Hughes L, Khan I, Mayles H, Mayles P, Fenwick J. 186 A phase I/II trial of concurrent chemo-radiation with dose-escalated radiotherapy in patients with stage II or stage III non-small cell lung cancer. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70186-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brunner T, Fokas E, Eccles C, Fenwick J, McKenna G. A Comparison of 4 Target Volume Definitions for Pancreatic Cancer: Two Concepts Including the Lymphatics (RTOG and ARO) and 2 Concepts Only Treating the Primary Tumor (Michigan and UK-SCALOP). Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Burns E, Schmied V, Fenwick J, Sheehan A. Liquid gold from the milk bar: constructions of breastmilk and breastfeeding women in the language and practices of midwives. Soc Sci Med 2012; 75:1737-45. [PMID: 22906527 DOI: 10.1016/j.socscimed.2012.07.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 07/21/2012] [Accepted: 07/30/2012] [Indexed: 11/29/2022]
Abstract
Midwives are the main health professional group providing support and assistance to women during the early establishment of breastfeeding. In published accounts of early breastfeeding experiences women report high levels of dissatisfaction with health professional support. To gain an understanding of this dissatisfaction, we examined the way in which midwives represent breastmilk and construct breastfeeding women in their interactions. Seventy seven women and seventy six midwives at two maternity units in NSW, Australia, participated in this study. Eighty five interactions between a midwife and a breastfeeding woman were observed and audio recorded during the first week after birth. In addition, data were collected through observation of nine parenting education sessions, interviews with 23 women following discharge, and 11 managers and lactation consultants (collected between October 2008 and September 2009). Discourse analysis was used to analyse the transcribed interactions, and interview data. The analysis revealed that midwives prioritised both colostrum and mature breastmilk as a 'precious resource', essential for the health and wellbeing of the infant and mother. References to breastmilk as 'liquid gold' were both verbal and implied. Within this discourse, the production and acquisition of 'liquid gold' appeared to be privileged over the process of breastfeeding and women were, at times, positioned as incompetent operators of their bodily 'equipment', lacking knowledge and skill in breastfeeding. In this context breastfeeding became constructed as a manufacturing process for a demanding consumer. The approach taken by midwives revealed an intensive focus on nutrition to the exclusion of relational communication and support. The findings indicate the need to challenge the current 'disciplinary' and 'technological' practices used by midwives when providing breastfeeding support and the need for a cultural change in postnatal care.
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Affiliation(s)
- E Burns
- School of Nursing & Midwifery, University of Western Sydney, Parramatta Campus, Building EB, Locked Bag 1297, Penrith South DC, NSW 1297, Australia.
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Jones B, Wilson P, Nagano A, Fenwick J, McKenna G. Dilemmas concerning dose distribution and the influence of relative biological effect in proton beam therapy of medulloblastoma. Br J Radiol 2012; 85:e912-8. [PMID: 22553304 DOI: 10.1259/bjr/24498486] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To improve medulloblastoma proton therapy. Although considered ideal for proton therapy, there are potential disadvantages. Expected benefits include reduced radiation-induced cancer and circulatory complications, while avoiding small brain volumes of dose in-homogeneity when compared with conventional X-rays. Several aspects of proton therapy might contribute to reduced tumour control due to (a) the use of more homogenous dose levels which can result in under-dosage, (b) differences in relative biological effectiveness (RBE) between that prescription RBE of 1.1 and the RBE of brain and spinal cord (likely to exceed 1.1) and in medulloblastoma cells (where RBE is likely to be below 1.1). Such changes, although speculative for RBE, might result in potential underdosage of tumour cells and a higher bio-effect in brain tissue. METHODS Dose distributions for X-ray and proton treatment are compared, with allocation of likely RBE values for fast growing medullolastoma cells and stable central nervous system tissue. RESULTS These physical and radiobiological factors are shown to combine to give a higher risk of tumour recurrence with further risks on tumour control when dose reduction schedules used for X-ray therapy are replicated for proton therapy for "low-risk" patients. CONCLUSION The dose distributions and prescribed doses of proton therapy, taking into account RBE, in children and adults with medulloblastoma, need to be reconsidered.
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Affiliation(s)
- B Jones
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK.
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Wilkinson D, Miles E, Fenwick J, Mayles P, Mayles H, Laurence V, Hughes S, Landau D. EP-1425 PRE-TRIAL PLANNING QA FOR THE IDEAL-CRT TRIAL: DOSE ESCALATION IN NSCLC. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71758-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lester J, Nixon L, Mayles P, Mayles H, Tsang Y, Ionescu A, Courtier N, Nahum A, Fenwick J, Eswar C, Malik Z, Mohammed N, Griffiths G. 156 The I-START trial: ISoToxic Accelerated RadioTherapy in locally advanced non-small cell lung cancer. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70157-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hamilton-Craig C, Fenwick J, Lapish K, Fitzgerald B. Coronary CT Angiography is Cost-Saving When Used Appropriately in a Private Outpatient Cardiology Service. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jellis C, Sacre J, Wright J, Jenkins C, Jeffriess L, Haluska B, Kennedy D, Fenwick J, Martin J, Marwick T. A Randomised Trial of Spironolactone use in Subclinical Diabetic Cardiomyopathy: Anti-Fibrotic Effects on Myocardial Structure and Function. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nahum A, Uzan J, Jain P, Malik Z, Fenwick J, Baker C. SU-E-T-657: Quantitative Tumour Control Predictions for the Radiotherapy of Non-Small-Cell Lung Tumours. Med Phys 2011. [DOI: 10.1118/1.3612620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Panettieri V, Fenwick J, Malik Z, Landau D, Mayles P, Nahum A, Jain P. 399 poster ISOTOXIC DOSE-ESCALATION IN NSCLC RADIOTHERAPY: TARGET DOSE COVERAGE AS A FUNCTION OF DOSE-CALCULATION ALGORITHM, MULTILEAF PENUMBRA MARGIN, AND BREATHING MOTION. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70521-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Krywonos J, Fenwick J, Elkut F, Jenkinson I, Liu Y, Brunt J, Scott A, Malik Z, Eswar C, Ren X. MRI image-based FE modelling of the pelvis system and bladder filling. Comput Methods Biomech Biomed Engin 2010; 13:669-76. [DOI: 10.1080/10255840903446961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Arya AK, El-Fert A, Devling T, Eccles RM, Aslam MA, Rubbi CP, Vlatković N, Fenwick J, Lloyd BH, Sibson DR, Jones TM, Boyd MT. Nutlin-3, the small-molecule inhibitor of MDM2, promotes senescence and radiosensitises laryngeal carcinoma cells harbouring wild-type p53. Br J Cancer 2010; 103:186-95. [PMID: 20588277 PMCID: PMC2906734 DOI: 10.1038/sj.bjc.6605739] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Primary radiotherapy (RT) is a mainstay of treatment for laryngeal squamous cell carcinoma (LSCC). Although the cure rates for early (T1) vocal cord tumours are high, RT proves ineffective in up to a third of T3 carcinomas. Moreover, RT is associated with debilitating early- and late-treatment-related toxicity, thus finding means to de-escalate therapy, while retaining/augmenting therapeutic effectiveness, is highly desirable. p53 is a key mediator of radiation responses; we therefore investigated whether Nutlin-3, a small-molecule inhibitor of MDM2 (mouse double minute 2; an essential negative regulator of p53), might radiosensitise LSCC cells. METHODS We performed clonogenic assays to measure radiosensitivity in a panel of LSCC cell lines (for which we determined p53 mutational status) in the presence and absence of Nutlin-3. RESULTS LSCC cells harbouring wild-type p53 were significantly radiosensitised by Nutlin-3 (P<0.0001; log-rank scale), and displayed increased cell cycle arrest and significantly increased senescence (P<0.001) in the absence of increased apoptosis; thus, our data suggest that senescence may mediate this increased radiosensitivity. CONCLUSION This is the first study showing Nutlin-3 as an effective radiosensitiser in LSCC cells that retain wild-type p53. The clinical application of Nutlin-3 might improve local recurrence rates or allow treatment de-escalation in these patients.
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Affiliation(s)
- A K Arya
- Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, 5th Floor. UCD Building, Daulby Street, Liverpool L69 3GA, UK
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Fenwick J. Slogan standards. Br Dent J 2009; 207:194. [DOI: 10.1038/sj.bdj.2009.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Arya A, Devlin T, El-Fert A, Banfield M, Rubbi C, Lloyd B, Fenwick J, Jones T, Boyd M. The use of Nutlin-3 as a radiosensitiser in laryngeal carcinoma cells harbouring wild-type p53. Clin Otolaryngol 2008. [DOI: 10.1111/j.1749-4486.2008.01843_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Malik Z, Eswar C, Dobson J, Fenwick J, Nahum A. 31 Dose-individualisation for lung cancer radiotherapy —are we ready? Lung Cancer 2007. [DOI: 10.1016/s0169-5002(07)70357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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