Search

Background and objectives There is significant evidence from large-scale, industrial and post-industrial societies that greater income and wealth inequality is negatively associated with both population health and increasing health inequalities. However, whether such relationships are inevitable and should be expected to impact the health of small-scale societies as they become more market-integrated is less clear. Methodology Here, using mixed-effect models we explore the relationship between health, wealth, wealth inequality and health inequalities in a small-scale foraging population from the Philippines, the Agta. Results Across 11 camps we find small to moderate degrees of wealth inequality (maximal Gini Coefficient 0.44) which is highest in the most permanent camps, where individuals engage more heavily in the formal market. However, in both adults (n = 161) and children (n = 215) we find little evidence that either wealth or wealth inequality associates with ill health, except for one measure of nutritional condition – red blood cell count. Conclusions and implications We interpret these results in the light of high levels of cooperation among the Agta which may buffer against the detrimental effects of wealth inequality documented in industrial and post-industrial societies. We observe little intergenerational wealth transmission, highlighting the fluid nature of wealth, and thus wealth inequality, particularly in mobile communities. The deterioration of nutritional status, as indicated by red blood cell counts, requires further investigation before concluding the Agta's extensive cooperation networks may be beginning to breakdown in the face of increasing inequality.

Background Shorter breastfeeding duration is associated with detrimental consequences for infant health/development and maternal health. Previous studies suggest social support is essential in maintaining breast/chest-feeding and helping to improve general infant feeding experiences. Public health bodies therefore work to support breastfeeding in the UK, yet UK breastfeeding rates continue to be one of the lowest globally. With this, a better understanding of the effectiveness and quality of infant feeding support is required. In the UK, health visitors (community public health nurses specialising in working with families with a child aged 0–5 years) have been positioned as one of the key providers of breast/chest-feeding support. Research evidence suggests that both inadequate informational support and poor/negative emotional support can lead to poor breastfeeding experiences and early breastfeeding cessation. Thus, this study tests the hypothesis that emotional support from health visitors moderates the relationship between informational support and breastfeeding duration/infant feeding experience among UK mothers. Methods We ran cox and binary logistic regression models on data from 565 UK mothers, collected as part of a 2017–2018 retrospective online survey on social support and infant feeding. Results Informational support, compared to emotional support, was a less important predictor of both breastfeeding duration and experience. Supportive emotional support with unhelpful or absent informational support was associated with the lowest hazard of breastfeeding cessation before 3 months. Results for breastfeeding experience followed similar trends, where positive experience was associated with supportive emotional and unhelpful informational support. Negative experiences were less consistent; however, a higher probability of negative experience was found when both types of support were reported as unsupportive. Conclusions Our findings point to the importance of health visitors providing emotional support to bolster the continuation of breastfeeding and encourage a positive subjective experience of infant feeding. The emphasis of emotional support in our results encourages increased allocation of resources and training opportunities to ensure health visitors are able to provide enhanced emotional support. Lowering health visitors caseloads to allow for personalised care is just one actionable example that may improve breastfeeding outcomes in the UK.

Humans exhibit a broad range of post-marital residence patterns and there is growing recognition that post-marital residence predicts women's reproductive success; however, the nature of the relationship is probably dependent on whether co-resident kin are cooperators or competitors. Here, we explore this relationship in a Tibetan population, where couples practice a mixture of post-marital residence patterns, co-residing in the same village with the wife's parents, the husband's parents or endogamously with both sets of parents. Using detailed demographic data from 17 villages we find that women who live with only their own parents have an earlier age at first birth (AFB) and age at last birth (ALB) than women who live with only their parents-in-law. Women who co-reside with both sets of parents have the earliest AFB and ALB. However, those with co-resident older siblings postponed reproduction, suggestive of competition-related delay. Shifts to earlier reproductive timing were also observed in relation to the imposition of family planning policies, in line with Fisherian expectations. Our study provides evidence of the costs and benefits to women's direct fitness of co-residing with different kin, against a backdrop of adaptive responses to cultural constraints on completed fertility.

Financial dependence on an abusive partner is a threat to long-term safety for survivors of interpersonal violence. This study piloted a process to identify and address barriers to implementation of financial capability and asset building (FCAB) programming for survivors in one domestic and sexual violence agency. A tiered implementation approach included (a) a participatory diagnostic evaluation with clients ( n = 10), staff ( n = 10), and stakeholders ( n = 3); (b) an expert panel to prioritize the barriers and propose implementation strategies; and (c) the development of a tailored action plan. The formative evaluation identified limited staff financial knowledge, self-efficacy, and incentives as barriers. The tailored action plan included research-tested implementation strategies: (a) conduct ongoing training for staff, (b) identify “champions,” and (c) change the record system. Monitoring and evaluation of the action plan is ongoing; the process provides a replicable method for social service agencies to improve FCAB programming and to ultimately improve economic conditions for clients.

Among the estimated 800,000 children in the United Kingdom with disability, challenges include lack of access to leisureactivities, opportunities for independent development and social contact. Sho...

Aims This study examines the impact of COVID-19 lockdown on postpartum mothers in England, with the aim of identifying opportunities to improve maternal experience and wellbeing. The postpartum/postnatal period is widely acknowledged as a time when mothers require greater levels of support from multiple sources. However, stay-at-home orders, commonly known as “lockdown,” deployed in some countries to limit COVID-19 transmission reduced access to support. In England, many postpartum mothers navigated household isolation within an intensive mothering and expert parenting culture. Examining the impact of lockdown may reveal strengths and weaknesses in current policy and practice. Subject and methods We conducted online focus groups involving 20 mothers living in London, England, with “lockdown babies,” following up on our earlier online survey on social support and maternal wellbeing. We thematically analysed focus group transcripts, and identified key themes around Lockdown Experience and Determinants of Lockdown Experience. Results Participants raised some positives of lockdown, including fostering connections and protection from external expectations, but also raised many negatives, including social isolation, institutional abandonment, and intense relationships within the household. Potential reasons behind variations in lockdown experience include physical environments, timing of birth, and number of children. Our findings reflect how current systems may be “trapping” some families into the male-breadwinner/female-caregiver family model, while intensive mothering and expert parenting culture may be increasing maternal stress and undermining responsive mothering. Conclusions Facilitating partners to stay at home during the postpartum period (e.g., increasing paternity leave and flexible working) and establishing peer/community support to decentre reliance on professional parenting experts may promote positive postpartum maternal experience and wellbeing.

This article explores an inflection point for a community of cryptography advocates as they grappled with a series of cascading failures. Drawing on 3 years of ethnographic observation and interviews at conferences devoted to building privacy systems, I consider how a determinist conception of encryption technologies inhibited the widespread adoption of privacy technologies. I develop the frame of “survival of the cryptic” to call attention to the way this conception fails to acknowledge how power shapes the conditions of surveillance: that race and racism, gender and misogyny affect not only who is most impacted by surveillance but also how the encryption technologies developed to inhibit surveillance were designed—and, as importantly, who they were designed for. I conclude by offering a new imaginary for encryption that draws on queer, black and feminist thought by centering the need to create safe and autonomous spaces for collective survival under conditions of mass surveillance.

In 1976, two researchers declared a revolution in cryptography: With the invention of public key encryption, cryptography could be used not only to share secret messages, but to secure and authenticate communications networks, and, eventually, to enable radically new kinds of social relationships facilitated by networked communication technology. This article explores a series of transformations in the meaning of cryptography in the 1960s and 1970s that led to the declaration of a revolution. Drawing on archival materials, the article considers how public key cryptography was the product of an emerging consensus among cryptographers of the importance of privacy in the wake of abuses of surveillance powers by government agencies. Shaped by a changing technological and political environment, it situates cryptography at the center of a focused effort to assert control over information in an era of sociopolitical upheaval, concluding that the invention of public key encryption both marked a change in the imaginary surrounding cryptography and offered a technical solution that foreclosed other approaches to addressing the problem of surveillance.

Ongoing political, environmental, and economic crises require infrastructures that can respond to crises in ways that do not replicate and reinforce inequality. To this end, we use a case study method of analysis that compares the authors’ previous work on Internet infrastructure at the levels of development, governance, and use to explore how these imaginaries promote or impede people-centered change in the development and maintenance of Internet infrastructure. This theoretical work puts the three existing cases in conversation to better understand how Internet infrastructure alternatives presented as radical, new, or non-hierarchical present shortcomings and opportunities, so that it might be more possible to imagine better, more truly radical, people-centered alternatives. From this comparison, we close our discussion with three heuristics for radical infrastructure: the need for pushing for alternative ensembles of support, busting the myth of technosolutionism, re-politicizing Internet infrastructure, and encouraging technical communities to build around cooperativity, not connectivity.

Delayed and impaired bone fracture healing are associated with diabetic populations. This is a challenging problem for orthopaedic surgeons especially in the US where the percentage of type 2 diabetic patients continues to climb at an alarming rate. Limited treatment options exist for orthopaedic surgeons to improve fracture healing, and the most commonly used therapies involve placement of proteins (bone morphogenetic protein), graft tissue, or demineralized bone matrix at the fracture site. We have previously demonstrated that local administration of the main megakaryocyte growth factor, thrombopoietin, enhances bone healing. Here we demonstrate the utility of systemically administering thrombopoietin mimetic peptides (TMPs) to improve impaired fracture healing in a mouse model of type 2 diabetes. Briefly, 120 male mice on a C57BL/6 background were placed on a low fat diet (LFD) or high fat diet (HFD) for 12 weeks prior to undergoing a surgically created femoral fracture. Mice were treated with 33 nmol/kg of TMP or saline immediately after surgery and daily for the following week. Mice were euthanized at 1, 2, and 4 weeks post-surgery (n=10/group). Here, we confirmed that HFD resulted in impaired fracture healing. We also showed accelerated bone union and increased callus formation in TMP treated mice compared to saline groups, irrespective of diet (p

Megakaryocytes play a pivotal role in the bone fracture healing process through enhancing osteoblast proliferation, osteoclastogenesis, and angiogenesis. Current fracture repair therapies require direct implantation during surgery (BMP-2, grafts etc.), which has limitations. In order to address this, a novel drug, compound MAK122, was created with targeting technology that directs its actions to the fracture site without needing to be implanted during surgery, limiting undesirable offsite effects, increasing the quantity of drug at the fracture site, and allowing for non-invasive treatment following assessment of the natural healing process. Therefore, this study examined the ability of MAK122 to stimulate megakaryocytes and subsequent bone healing. To accomplish this, male mice on a C57BL/6 background underwent a surgically induced femoral fracture. Following surgery, the mice were injected daily for the first 7 days with either saline (vehicle) or MAK122. Mice were then euthanized 2, 3 and 4 weeks post-surgery. Fracture healing was assessed by standard and novel methodologies. Biweekly X-rays were evaluated and bone union was scored showing that MAK122 accelerated bone healing compared to controls. Ex vivo µCT analysis demonstrated that MAK122 increased callus volume and the percentage of mineralized callus tissue compared to vehicle treatment. Biomechanical testing showed that MAK122 treatment resulted in stronger repairs as compared to vehicle treated controls with nearly a 2-fold increase in twist to failure and toughness parameters. Additionally, histological assessment demonstrated accelerated remodeling in MAK122 treated femurs compared to those treated with saline. Taken together, these pre-clinical data suggest that MAK122 is capable of promoting an environment in which megakaryocytes can favorably influence bone remodeling mechanisms, expediting fracture repair in murine models. Though further pharmacokinetic, pharmacodynamic, and toxicology studies are required, MAK122 displays potential to serve as a state-of-the-art therapy for improving fracture healing in humans.

Non-union bone fracture occurs in 5-10% of fracture injuries. Interventions include surgery with local implantation of autograft, allograft, demineralized bone matrix, and/or bone morphogenetic proteins. These types of fracture injuries are also accompanied by acute and chronic pain states. In most instances, opioids are provided to injured patients during and after surgery. With the opioid crisis, identifying new analgesic therapies that could reduce or eliminate opioid use, while also improving bone healing is important. Here we show the ability of a novel compound, MAK123, to both enhance bone healing and reduce pain behavior in a surgically induced femoral fracture mouse model. Briefly, 20 male C57BL/6 mice underwent a surgically induced femoral fracture and then were treated with 0, 2, 6, or 20 mg/kg, 3X/week for the 3 week study duration. Weekly X-rays were used to examine healing progression. Prior to euthanasia, mice underwent behavioral testing to measure evoked pain behaviors. Upon euthanasia, ex vivo µCT imaging and analysis was completed to assess fracture callus size and composition. While all doses of MAK123 tested resulted in improved healing, the 6mg/kg dose resulted in accelerated bone healing and a significant increase in mineralized callus volume (p

Background Parents and children with complex additional needs (CAN) admitted to paediatric wards can experience communication difficulties with health workers. This can result in frustration, delays, errors, and distress. Hospital passports (HPs) can improve patient-centred care and in-patient experiences. HPs help children and carers communicate their needs, values, and other essential information. They are recommended by the children’s charity Wellchild. Objectives As part of a service improvement project, we sought the views of parents, nurses and paediatric doctors, before and after piloting a HP. Methods We surveyed parents of CAN and paediatric doctors and nurses in the Royal Gwent Hospital, Newport and Serennu Children’s Centre, Rogerstone, anonymously for the month of July 2019. Questions concerned previous experience of HPs, desirability and recommendations. Thematic analysis was applied to open-ended question responses, to identify themes and sub-themes. Following this, a pilot was created. Paediatric Consultants and carers of CAN were then resurveyed during the month of October 2020, to assess awareness, frequency of use and initial feedback. Results 20 staff and four parents (mostly of children with neurodisability) responded. 55% of staff were aware of HPs. All reported a need to improve the communication between staff and families, and that HPs could help. Themes and sub-themes arising from the first survey open-ended questions were as follows: Communication – assistive technology awareness, carers constantly repeating themselves, forgetting vital information in acute situations Dignity – giving children a voice, ways to examine and speak to the child, Child/parent/carer ownership of HP Routines – children and families find disruptions upsetting, likes and dislikes, how to soothe Importance of updating – accessibility of paper and online version, difficulty of updating Key quotes from a parent, and staff member about how they thought HPs could improve their child’s experience were as follows. ‘Communication, especially if the child is not verbal. People assume that she doesn’t understand or hear what’s said. People don’t talk to her or look at her.’ ‘This is a brilliant idea and there is a high need for patients with complex needs to have a voice. Often I have cared for a child with complex needs and parents are not present. It has been difficult to gather up-to-date information on patient.’ On resurveying, 70% of consultants stated they were aware of HP availability, that they aided junior members of staff caring for complex patients and would be helpful for transition-aged CAN. However, fewer had distributed them. Barriers included lack of awareness and time in the outpatient setting, and language barriers, where it was concluded HPs were most needed. Parent feedback stated HPs prevented repetition and allowed CAN control over the information they shared. Conclusions Staff and parents stated a need for HPs, which should focus on the communication of vital information between staff and families and prevent repetition. They should contribute to dignity for CAN, include information about routines, soothing, and likes and dislikes. They should be accessible and easy to keep updated. More work is needed to raise awareness and overcome barriers to implementation, and to obtain further feedback for improvement.

Background Postnatal depression (PND) is highly detrimental for both mother and baby, with a pre-COVID-19 estimated prevalence of up to 23% in Europe. Low social support is a key risk factor for developing PND. Social distancing measures designed to limit COVID-19 transmission likely created unprecedented barriers for mothers to access social support. We explore how social support networks existed during the UK’s first national lockdown amongst London mothers with infants, and their associations with postnatal depressive symptoms. Methods Using self-reported social network data from 162 London-based mothers with infants aged ≤6 months collected in May-June 2020 (during the first lockdown), we conduct a concurrent design mixed-method study. We quantitatively describe communication within maternal support networks, using quasi-Poisson regression models to analyse associations with postnatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). In parallel, we thematically analyse open-text data to explore and understand the experiences of mothers with infants during England’s lockdown. Results Quantitative findings: Levels of depressive symptoms were high in our sample, with 47.5% of participants meeting the >=11EPDS cut-off for potential postnatal depression.On average, women kept in contact with 10–11 people remotely (via WhatsApp, Zoom etc), and saw one family member other than their partner, suggesting high compliance with lockdown rules. The number of seen in person, and remote communication with a higher proportion of those not seen, negatively predicted depressive symptoms (RRR = 0.950 – 0.996 across models). However, a higher proportion of relatives seen in person was associated with increased depressive symptoms (RRR=1.003; 95% CI 1.001–1.006), suggesting family members may have broken lockdown rules to support mums in need. Qualitative findings: We identified four themes. Some mothers in our sample felt lockdown ‘protected’ family time which led to better bonding, often facilitated by high levels of support from the partner (theme 1). However, many experienced the ‘burden of constant mothering’ without anyone around to help (theme 2). Mothers felt remote contact was ‘not as good’ and led to reduced or inadequate support (theme 3). Mothers grieved for lost opportunities for them and their baby, and worried about the developmental impact on their baby (theme 4). Overall, these experiences coexisted with feelings of isolation, exhaustion, worry, inadequacy, guilt, and increased stress. Conclusion Results suggest the strict lockdown in the UK may have increased the risk of postnatal depression, reflected in the high levels of PND symptoms and poor maternal experiences in our sample.

368 Background: Pancreas cancer (PC) survival is among the lowest of all malignancies. While limited advances in treatment are a major driver of this reality, ample opportunity exists to improve outcomes by reducing care variation, providingcoordinated, comprehensive care, and accelerating research. Learning health networks (LHNs) improve outcomes in pediatric diseases through such mechanisms, yet are not widely implemented in adult care. We aimed to develop, implement, and collect initial outcomes of the first oncology LHN, the Canopy Cancer Collective (CCC). Methods: In 2019, we established CCC to apply to PC the LHN model, including core tenets of continuous quality improvement (QI), data-sharing, empowered interdisciplinary teams and a stakeholder community including individuals with PC, and focus on community-defined improvable “outcomes that matter”. Six care centers were selected to join the LHN, and engaged in a collaborative design process to co-create a set of improvement aims and change ideas. Center team members received training in basic QI methods/tools guided by the IHI Model for Improvement and were coached to apply these to local improvement efforts. LHN infrastructure and technology enabled sharing of new ideas, best practices, and results amongst centers. Eight more centers joined in 2021, and an outcomes database built and implemented. Results generated by this database will inform center-specific and Network-wide improvement efforts and allow the LHN to undertake research. Results: Currently, 14 care centers are active participants in the CCC LHN. Five key outcomes have been defined as key targets, and centers have co-created and tested change ideas organized around key drivers of excellent PC care including proactive, timely care, aligned/prepared multidisciplinary teams, informed, activated patients, and accurate diagnosis and disease classification. 100% of care centers are trained in QI methods and actively testing change ideas. For example, in May 2022, 11 centers reporting on monthly QI activities met on average 4 times to advance QI projects, deploying a mean of 2.9 plan-do-study-act (PDSA) cycles (range, 0-5) focused on key drivers and outcomes, including reduced time to treatment, increased trial enrollment, assessment of patient experience, and improved data capture. Conclusions: Building a sustainable LHN for PC centers is feasible and has set the stage for improving patient and provider outcomes through iterative community-building, continuous improvement, and sharing of data and multidisciplinary best practices. Results lay the foundation for expansion not only in PC, but translation to other complex malignancies that will benefit from transformative, system-based approaches to outcome improvement.

Social support is a known determinant of breastfeeding behaviour and is generally considered beneficial. However, social support encompasses a myriad of different supportive acts, providing scope for diverse infant feeding outcomes. Given the vulnerability of postpartum mental health, this paper aims to explore both how support prolongs breastfeeding and which forms of support promote the positive experience of all infant feeding. Using survey data collected online from 515 UK mothers with infants aged 0-108 weeks, Cox regression models assessed the relationship between receiving different types of support, support need and breastfeeding duration. Quasi-binomial logistic regression models assessed the relationship between receiving support, infant feeding mode and maternal experience of infant feeding. Rates of negative infant feeding experience indicate the widespread need for support: e.g. 38% of currently, 47% of no longer and 31% of never breastfeeding women found infant feeding stressful. Overall, practical support via infant feeding broadly predicted shorter breastfeeding durations and poorer feeding experience; results in relation to other forms of support were more complex. Our findings indicate different forms of support have different associations with infant feeding experience. They also highlight the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Purpose: Postnatal maternal mental health suffered early in the COVID-19 pandemic; here we explore the continuing trajectory of postnatal depressive symptoms in the UK. Methods: We report descriptive statistics from a five-wave online survey. Results: The following percentages of participants met the ≥11 Edinburgh Postnatal Depression Scale cut-off for postnatal depression: 47.5% (May-June 2020), 32.8% (July 2020), 51.3% (late 2020), 54.0% (February 2021), 38.2% (September 2021). Conclusions: Health services must be alert to high support needs of this cohort.

A teacher educator and college librarian collaboratively designed and taught teacher education workshops about finding and evaluating what works in teaching. This study investigated interactions of...

Objectives: Physical breastfeeding problems can lead women to terminate breastfeeding earlier than planned. In high-income countries, breastfeeding problems have been attributed to the cultural and individual “inexperience” of breastfeeding, ultimately leading to lower breastfeeding rates. Yet, cross-cultural evidence suggests breastfeeding problems still occur in contexts where breastfeeding is common, prolonged and seen publicly. This suggests breastfeeding problems are not unusual and do not necessarily lead to breastfeeding cessation. Having evolved a cooperative childrearing system, what matters for breastfeeding continuation may be the availability of social support during the postnatal period. Here, we test the hypothesis that social support buffers mothers from the negative impact breastfeeding problems have on duration. Methods: We run cox models on a sample of 566 UK mothers who completed a retrospective online survey about infant feeding and social support in 2017-2018. Results: Breastfeeding problems were important predictors of cessation; however, the direction of the effect was dependent on the type of problem. These relationships were also moderated by informational, practical and emotional support from a range of supporters. Helpful support for discomfort issues (blocked ducts, too much milk) significantly reduced the hazard of cessation, as predicted. However, helpful support for reported milk insufficiency increased the hazard of cessation. Conclusions: Experiencing breastfeeding problems is the norm, but its impact may be mitigated via social support. Working from an interdisciplinary approach, our results highlight that a wide range of supporters who provide different types of support have potential to influence maternal breastfeeding experience.