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    ABSTRACT: The aim of this study was to evaluate the effect of prenatal exposure to lead, cadmium and mercury levels on the secondary sex ratio. Whole blood samples were collected from pregnant women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) study at a median gestational age of 11 weeks and were analysed for lead, cadmium and mercury. Regression analysis was used to identify associations between maternal lead, cadmium and mercury levels and the secondary sex ratio with adjustment for confounders. There was no evidence for associations between maternal lead, cadmium or mercury levels and the secondary sex ratio in this sample. It appears unlikely that alterations in the secondary sex ratio are influenced by exposure to heavy metals, but further work should be done in large cohorts in other countries to confirm these findings.
    Full-text · Article · Jul 2014 · Reproductive Toxicology
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    ABSTRACT: A randomised, parallel group, pragmatic trial. A large UK maternity hospital. Term infants <2 weeks old with a mild or moderate degree of tongue-tie, and their mothers who were having difficulties breastfeeding. To determine if immediate frenotomy was better than standard breastfeeding support. Participants were randomised to an early frenotomy intervention group or a 'standard care' comparison group. Primary outcome was breastfeeding at 5 days, with secondary outcomes of breastfeeding self-efficacy and pain on feeding. Final assessment was at 8 weeks; 20 also had qualitative interviews. Researchers assessing outcomes, but not participants, were blinded to group assignment. 107 infants were randomised, 55 to the intervention group and 52 to the comparison group. Five-day outcome measures were available for 53 (96%) of the intervention group and 52 (100%) of the comparison group, and intention-to-treat analysis showed no difference in the primary outcome-Latch, Audible swallowing, nipple Type, Comfort, Hold score. Frenotomy did improve the tongue-tie and increased maternal breastfeeding self-efficacy. At 5 days, there was a 15.5% increase in bottle feeding in the comparison group compared with a 7.5% increase in the intervention group.After the 5-day clinic, 44 of the comparison group had requested a frenotomy; by 8 weeks only 6 (12%) were breastfeeding without a frenotomy. At 8 weeks, there were no differences between groups in the breastfeeding measures or in the infant weight. No adverse events were observed. Early frenotomy did not result in an objective improvement in breastfeeding but was associated with improved self-efficacy. The majority in the comparison arm opted for the intervention after 5 days.
    Full-text · Article · Nov 2013 · Archives of Disease in Childhood - Fetal and Neonatal Edition
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    ABSTRACT: There is growing concern about lack of compassion in nursing. Impact of Injuries, which is the parent study (Kendrick et al, 2011) of this independent nested study, collected patient accounts of care received by physiotherapists and nurses. While physiotherapists were generally described as caring, nursing care was less consistent and sometimes uncaring. This embedded study conducted semi-structured interviews in 2012 with 11 physiotherapists and 12 nurses in four English hospitals to obtain perspectives on the provision of care. Physiotherapists presented a distinct identity with caring both integral to the role and sustained by structural and organisational factors. Nurses had a diffuse identity with limited control within a medical and business model of care. They appeared 'under siege' and were nostalgic for caring, which was frequently subordinate to other demands. Both nurses and physiotherapists faced challenges but nurses felt the context of their work was not conducive to caring. This article draws comparisons between these professions and makes informed recommendations to improve nursing practice and patient care.
    No preview · Article · Oct 2013 · British journal of nursing (Mark Allen Publishing)
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