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Breastfeeding rates in the UK remain persistently low, with a rapid fall off during the first 6–8 weeks. The work of healthcare and public health practitioners impacts on mothers' experiences of infant feeding. Support, promotion and protection of breastfeeding are a national priority. Semi-structured qualitative interviews were undertaken with mothers who had experience of breastfeeding. Participants were engaged with a local Children's Centre (indicating engagement with public health provision) and their babies were up to 6-month old (to increase recall of early experiences). Twenty-four participants were recruited and interviews thematically analysed. Mothers identified matters significant in relation to public health provision for breastfeeding, including three stages of time of significance for breastfeeding impact. These interlinked critical stages impact on a mother's experiences. Joined up public health practice providing breastfeeding support and information before birth, around the time of the birth, and once home is significant in mother's accounts. Breastfeeding support, in both healthcare and public health contexts, needs to be highly attuned to different stages in the experiences of mothers. Breastfeeding continuation is influenced by support experienced antenatally, perinatally, and in early weeks. To enhance the initiation and retention of breastfeeding, public health practice must pay attention to these stages. Breastfeeding support needs to begin prior to birth and be given throughout the postnatal period and beyond. [ABSTRACT FROM AUTHOR]

Telecommunications systems seem to offer health care providers, professionals and patients a plethora of opportunities to respond to social and geographical inequalities in health care provision, and a new field of health care endeavor has emerged -- `telemedicine'. This paper presents results from a three year ethnographic study of the development and implementation of telemedicine systems in a British region. We explore how attempts to put into service one `telemedicine' system failed to get beyond the draft of a written protocol. Our analysis focuses on the contests between clinicians, technical experts and external evaluators over what kinds of knowledge and practice count in developing a protocol and evaluating a clinical intervention. We show how the introduction and implementation of `hard' technologies (systems hardware) can be undermined in practice by `soft' technologies (the practices through which evaluative knowledge is produced). Keywords: Telemedicine; Social construction; Medical knowledge; Evaluation; UK

A telepsychiatry referral service for patients suffering from anxiety and depression was evaluated from a user perspective. Low-cost video-phones linked a psychiatrist to two general practices in the north-west of England. Quantitative data were collected using a semistructured interview schedule. Twenty-two patients and 13 doctors were interviewed after a video-link consultation. Some users were very positive about the service and recognized its potential benefits, while others were more ambivalent. Patients saw the service as a means of obtaining additional expert' advice. General practitioners felt that the service might adversely affect the doctor-patient relationship in psychiatry. Both patients and clinicians recognized that the video-link modified normal interaction. Users need to adapt to this form of communication. An induction session is recommended for both patients and clinicians. [ABSTRACT FROM AUTHOR]

We assessed patient satisfaction with a nurse-led store-and-forward teledermatology service in Manchester. A teledermatology nurse obtained the patient's history, took digital photographs of the patient's skin lesion and then sent the information to a hospital dermatologist, who responded with management advice the following week. Of 141 patients who attended their teledermatology appointment, 123 (50 male, 73 female) completed the study questionnaire (87%). The average age of respondents was 42 years (SD 17, range 18–90 years). Ninety-three per cent reported that they were happy with the teleconsultation while 86% reported that it was more convenient than going to the outpatient clinic. Forty per cent agreed that they would feel more comfortable seeing the dermatologist in person while only 58% were comfortable with not speaking to the dermatologist about their skin condition. The absence of interaction with the dermatologist and the delay in receiving management advice may have contributed to the somewhat low satisfaction rates. [ABSTRACT FROM AUTHOR]