Suchergebnisse

In the UK, national guidelines recommend that all HIV‐positive women should refrain from breastfeeding for prevention of mother to child transmission (PMTCT). However, the World Health Organisation recommends that HIV positive mothers from low income countries should exclusively breastfeed until six months and continue until twelve months with anti‐retroviral therapy (ART) for mother and/or child. In our clinic, a high proportion of HIV positive women are from Africa and mixed messages regarding breast feeding may occur. The decision to not breast feed is sensitive and difficult, particularly where bottle feeding may be associated with HIV. A 2010 BHIVA position statement suggests that in exceptional circumstances breastfeeding may be supported with intense monitoring if the mother has an undetectable viral load. However, there is currently not sufficient evidence regarding transmission or ART toxicity. After a clinic disclosure of breastfeeding at four months post‐delivery, we examined our current practice to investigate how monitoring may need to change if breastfeeding were supported in certain circumstances. A review of notes was undertaken to consider ART and viral load in the post natal‐period to assess potential risks of breastfeeding in our cohort. All HIV‐positive pregnant women who delivered during 2009–10 were eligible. 41 women were identified as having a live delivery of which 30 (73.2%) identified as Black African. 18 (44.0%) were new diagnoses in pregnancy. In total, 28 (68.2%) were on ART, or ART was indicated for the mother, and 13 for PMTCT only (table 1).










BL‐median (IQR)
W12‐median (IQR)
p




Distance at 6MWT (m)
658 (605–691)
715 (IQR 690–830)
<0.0001


DEXA spine (z‐score)
−1.15 (−1.7/−0.7)
−1.05 (−1.4/−0.3)
0.002


DEXA spine (z‐score)(TDF‐treated pts)
−1.4 (−1.7/−0.7)
−1.3 (−1.55/−0.5)
0.002


DEXA femoral neck (z‐score)(walk only)
−0.8 (−1.4/−0.2)
−0.5 (−1.2/−0.2)
0.047


DEXA femoral ward (z‐score)(walk only)
−1 (−1.9/−0.6)
−0.75 (−1.4/−0.2)
0.004


BMI
25.7 (24.6–26.3)
24.9 (21.4−26)
0.0016


Waist circumference (cm)
93 (87−100)
92 (85.5−98.5)
0.029


LDL cholesterol (mg/dL)
126 (113−154.5)
116 (96–137.5)
0.0003




A viral load greater than 100 was found in 4 (9.8%) at delivery. All of the babies delivered were HIV negative. The mean time to post‐delivery viral load was 65.4 days (range 24–584). Of those who were meant to be undetectable on ART, 6/28 (21.4%) had a viral load >100 copies/ml. 12(92.3%) of those who took ART for PMTCT were detectable at post‐delivery viral load. Our clinic review suggests that if breast feeding is to be supported in certain circumstances: i) increased frequency of monitoring will be necessary for those on ART; ii) those on ART for PMTCT only would need to continue ART in the post natal period with such monitoring.

THE WEAPONS NOW IN EXISTENCE ARE LARGELY A MATTER OF CHOICE, AND THAT CHOICE, BY ITS NATURE, IS COMPLEX. A GOOD DEAL HAS BEEN SAID AND WRITTEN ABOUT THE INEVITABILITY OF TECHNOLOGY IN WEAPON DEVELOPMENT. CERTAINLY ONCE A DEVELOPMENTAL SEQUENCE HAS BEGUN, THE TECHNOLOGICAL IMPERATIVE BECOMES ALMOST ABSOLUTE. YET AT THE BEGINNING AND END OF EVERY SUCH SEQUENCE IS A POINT WHEN HUMAN PREFERENCE CAN AND DOES EXERT ITSELF. THESE PREFERENCES ARE AS MUCH A PART OF THE ARMS COMPETITION AS THERMAL IMAGING SIGHTS, LOOK-DOWN SHOOT-DOWN RADAR, OR A HOST OF OTHER ULTRASOPHISTICATED DEVICES NOW IN MILITARY SERVICE. YET FOR ONE REASON OR ANOTHER THEY HAVE SELDOM BECOME THE SUBJECT OF RIGOROUS, INTENSIVE STUDY. THIS SITUATION SHOULD NOT BE ALLOWED TO PERSIST. WEAPONS ARE FAR TOO IMPORTANT TO OUR FUTURE TO BE TREATED AS ALIEN AND SOMEHOW ANTITHETICAL TO HUMAN NATURE. FOR BETTER OR WORSE, WE ARE WHAT WE FIGHT WITH.

INTRODUCTION Throughout Europe midwives called for increasing professionalisation of midwifery during the 1980s and 1990s. While the Bologna Declaration, in 1999, supported this development in education and research, it remains unclear how other fields, such as practice, have fared so far. This study therefore aimed to explore the current state of professionalisation of midwifery in Europe. METHODS An exploratory inquiry was conducted with an on-line semi- structured questionnaire. Its content was based on the Greenwood sociological criteria for a profession. Descriptive statistics and thematic content analysis were used to analyse the data. Participants were national delegates from member countries to the European Midwives Association. RESULTS Delegates from 29 European countries took part. In most countries, progress towards professionalisation of midwifery has been made through the move of education into higher education, coupled with opportunities for postgraduate education and research. Lack of progress was noted, in particular in regard to midwifery practice, regulation, and leadership in health care provision and education. Most countries had a code of ethics for midwives as well as a midwifery association. Based on organisational collaborations with other disciplines, the sustainability of a distinct professional culture was unclear. An increased focus on future development of midwifery practice was proposed. CONCLUSIONS Progress in midwifery education and research has taken place. However, midwives' current roles in practice as well as leadership and their influence on healthcare culture and politics are matters of concern. Future efforts for advancing professionalisation in Europe should focus on the challenges in these areas.