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The purpose of the Listening Event was to enable a wide range of people, including professionals working in statutory, voluntary and other organisations and members of the public, to ‘have a say’ about health and social care and what we as a University can do for and with these partners and the public. We particularly wanted to hear about key concerns of the University such as:\ud • Strengthening community engagement and partnerships\ud • Health and social care training we should be providing, for whom, and how this is delivered\ud • Ideas relating to the University themes including media, use of space and buildings, human rights, social justice and security \ud • Research topics we should be addressing\ud However the main strength of the Listening Event approach is that topics for discussion are mostly led by participants who attend. On this occasion, the\ud discussion topics were very much focused on the concerns of participants and lots of information and ideas were generated. The task now is for the event planning team to review the discussion notes and identify what can be\ud addressed and how, in the short, medium and long term. This planning will be taking place over the Autumn in 2011, and any participants or readers of this report are more than welcome to get in touch to work with us or add their views.\ud The purpose of this report is to record all discussion summaries for sharing amongst participants and others. It is important that participants especially get to read what others had said at the event. The report will lead to changes in University practices such as the content of some of our courses and new business ideas and relationships will also be explored. The event itself provided a useful means of public engagement that others may wish to adopt.

Background In early breast cancer, variations in local treatment that substantially affect the risk of locoregional recurrence could also affect long-term breast cancer mortality. To examine this relationship, collaborative meta-analyses were undertaken, based on individual patient data, of the relevant randomised trials that began by 1995. Methods Information was available on 42 000 women in 78 randomised treatment comparisons (radiotherapy vs no radiotherapy, 23 500; more vs less surgery, 9300; more surgery vs radiotherapy, 9300). 24 types of local treatment comparison were identified. To help relate the effect on local (ie, locoregional) recurrence to that on breast cancer mortality, these were grouped according to whether or not the 5-year local recurrence risk exceeded 10% (10%, 25 000 women). Findings About three-quarters of the eventual local recurrence risk occurred during the first 5 years. In the comparisons that involved little (10%) differences, however, 5-year local recurrence risks were 7% active versus 26% control (absolute reduction 19%), and 15-year breast cancer mortality risks were 44·6% versus 49·5% (absolute reduction 5·0%, SE 0·8, 2p These 25 000 women included 7300 with breast-conserving surgery (BCS) in trials of radiotherapy (generally just to the conserved breast), with 5-year local recurrence risks (mainly in the conserved breast, as most had axillary clearance and node-negative disease) 7% versus 26% (reduction 19%), and 15-year breast cancer mortality risks 30·5% versus 35·9% (reduction 5·4%, SE 1·7, 2p=0·0002; overall mortality reduction 5·3%, SE 1·8, 2p=0·005). They also included 8500 with mastectomy, axillary clearance, and node-positive disease in trials of radiotherapy (generally to the chest wall and regional lymph nodes), with similar absolute gains from radiotherapy; 5-year local recurrence risks (mainly at these sites) 6% versus 23% (reduction 17%), and 15-year breast cancer mortality risks 54·7% versus 60·1% (reduction 5·4%, SE 1·3, 2p=0·0002; overall mortality reduction 4·4%, SE 1·2, 2p=0·0009). Radiotherapy produced similar proportional reductions in local recurrence in all women (irrespective of age or tumour characteristics) and in all major trials of radiotherapy versus not (recent or older; with or without systemic therapy), so large absolute reductions in local recurrence were seen only if the control risk was large. To help assess the life-threatening side-effects of radiotherapy, the trials of radiotherapy versus not were combined with those of radiotherapy versus more surgery. There was, at least with some of the older radiotherapy regimens, a significant excess incidence of contralateral breast cancer (rate ratio 1·18, SE 0·06, 2p=0·002) and a significant excess of non-breast-cancer mortality in irradiated women (rate ratio 1·12, SE 0·04, 2p=0·001). Both were slight during the first 5 years, but continued after year 15. The excess mortality was mainly from heart disease (rate ratio 1·27, SE 0·07, 2p=0·0001) and lung cancer (rate ratio 1·78, SE 0·22, 2p=0·0004). Interpretation In these trials, avoidance of a local recurrence in the conserved breast after BCS and avoidance of a local recurrence elsewhere (eg, the chest wall or regional nodes) after mastectomy were of comparable relevance to 15-year breast cancer mortality. Differences in local treatment that substantially affect local recurrence rates would, in the hypothetical absence of any other causes of death, avoid about one breast cancer death over the next 15 years for every four local recurrences avoided, and should reduce 15-year overall mortality.

Acupuncture is potentially an effective treatment for common conditions of pregnancy and labour pain with midwives being well placed to offer it. The aims of this study were to explore the experiences of pregnant women receiving acupuncture treatment from midwives, to provide insight into their perceptions of effect including the influence and value of the midwife on this experience. The lack of qualitative evidence has provided the rationale for this study. Within a phenomenological methodology an 'Interpretative Phenomenological Analysis' (IPA) approach was adopted, with 10 women attending the Salford Midwifery Acupuncture Service (SMAS) being recruited to this study. Data was collected via semi-structured interviews and the IPA analysis identified five main themes; justification of choice, relief & relaxation, trust & understanding, regaining self, discovering and sharing a secret. The women were happy to access acupuncture if recommended by a health professional; they gained pain relief and improved function, with more ability to care for their children and to continue working. They were grateful for the opportunity to access acupuncture, finding it enjoyable and reporting intense emotional and physical sensations. It offered prolonged effect, improving sleep and wellbeing, and it correlated well with purported neurophysiological mechanisms. Responses seemed more intense than in previous reports, possibly due to their pregnant state or heightened affective component. A midwife-acupuncturist was advantageous having knowledge and understanding of pregnancy, with ‘understanding’ being more important than professional background. The women felt optimistic and empowered to make plans for birth and parenthood and were wishing to share their experiences with others. The ‘lay network’ was an important factor within the women’s choice to access acupuncture. These findings indicate acupuncture is an acceptable treatment which can provide relief, improved wellbeing and support normality. Midwives could offer acupuncture as an adjunct to their role to facilitate individualised reflexive practice.

Background: The risk of a woman dying from avoidable complications during pregnancy and childbirth has declined significantly in high income-countries but has remained unacceptably high in most of the middle- and low-income countries. In Nigeria, pregnancy and childbirth have continued to represent a period of sorrow and tragedy for several families. For instance, a woman in Nigeria is more than 200 times per pregnancy and childbirth more likely to die than a woman from other middle or low-income countries. To-date, previous studies indicate a dearth of information regarding the socio-cultural factors that contribute to maternal mortality in Nigeria. Methodology: This qualitative study aimed to explore and describe the perceived socio-cultural factors impacting on maternal mortality and strategies for its reduction in South-Eastern Nigeria. Data was collected using focus group discussions involving 10 women with children and 10 women without children. Individual interviews were also conducted involving another 19 participants. These comprised women of reproductive age who did not participate in the focus group discussion, doctors, midwives, traditional birth attendants, a village head, a religious leader, a youth leader, and a women’s leader.\ud The findings: show a dominant discourse of culturally based perceptions of deep-rooted cultural and religious belief systems. Most of the community members constructed a system of beliefs about pregnancy, childbirth, and maternal mortality, which shaped decision-making regarding the uptake of maternal services. However, a dichotomy existed amongst the professionals about the use of either culturally based worldviews or biomedical knowledge to inform practice. These culturally grounded perceptions were facilitated by the deliberate or unintentional actions of people in government impacting their lack of will to formulate policies and provide resources that would encourage women to utilise maternity services, as well as motivate professionals to deliver effective maternal health services. This thesis also uncovered knowledge beyond cultural meaning-making and revealed that social complexities, such as economic status, the attitude of the healthcare workers and social networks, were issues contributing to the low uptake of maternity services and potentially the high rate of maternal deaths. Specifically, it was found that the poor economic status of some pregnant women, the unfriendly attitude of healthcare professionals, and negative advice from members of their social networks influenced women’s maternity healthcare-seeking behaviour, thereby potentially increasing maternal deaths. Overall, findings revealed that women’s behaviour, which might have contributed to the high maternal death rate, stemmed from cultural, social, and contextual factors. Lastly, perceived strategies for the reduction in maternal deaths, such as free-maternal healthcare services, the assimilation of TBAs into hospital-based midwifery practice and culturally sensitive services, were found in this study and could be used by policy makers to improve maternal wellbeing, ensuring maternity services meet the needs of women and families. \ud Conclusion: The findings suggest the need for cultural shifts in meaning-making and attitude to promote maternal wellbeing. This study contributed to knowledge in this field and can be used to enhance culturally sensitive maternal care, as well as knowledge that is relevant for policy intervention, ensuring pregnancy and childbirth is safer.