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OBJECTIVE: To examine the psychosocial factors of intention to breastfeed, perceived stress, social support, self-efficacy and their ability to predict the duration of breastfeeding in first-time mothers up to six months postnatally. DESIGN: Cross-sectional, quantitative study using a retrospective online survey. SETTING: Women across West Yorkshire, in the north of the United Kingdom. PARTICIPANTS: First-time mothers (n=98) who had given birth in the past six months. MEASURES: An online survey included three established survey instruments measuring the main study variables: The Perceived Stress Scale (Cohen et al., 1983), the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988) and the General Self-Efficacy Scale (Schwarzer and Jerusalem, 1995). The fourth variable was Intention to breastfeed and was measured using a single question. The survey was structured into five main sections 1) During pregnancy, 2) Once the baby was born, 3) Support to feed my baby, 4) Psychosocial factors and 5) Demographics. Open text responses allowed women to elaborate on their infant feeding experiences. FINDINGS: 80% of the sample said they had intended to breastfeed their baby. Although 96% initiated breastfeeding while in hospital, this decreased to 82% at one week and 75% at six weeks. By six months, the rate had dropped to below 50%. Survival Analysis using Cox's Regression found no significant predictors of duration of breastfeeding at one week and six weeks. However, a significant negative correlation between perceived stress and self-efficacy suggests that greater perceived stress is linked to lower self-efficacy. Other findings included 91% of mothers decided how they would feed their baby before they were pregnant (57%) or during pregnancy (34%) and the majority answered that breastfeeding support was most useful straight after the birth and up to one week. KEY CONCLUSIONS: The findings from this sample of new mothers showed that although many intended to breastfeed, a considerable number of them had stopped by the time their baby was six weeks old. The content analysis highlighted the multiple challenges new mothers can experience with breastfeeding and furthers understanding of the support needs of this group of women. IMPLICATIONS FOR PRACTICE: Many of the mothers had already decided how to feed their baby before the baby was born. In this sample, a quarter of those who intended to breastfeed or thought they might breastfeed had stopped by six weeks. In order to increase breastfeeding duration, new mothers with high intention to breastfeed need to be better prepared for potential breastfeeding challenges and given more support with breastfeeding shortly after their baby is born.

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OBJECTIVE: To develop and test training to improve practitioners' confidence and perceived understanding when communicating cardiovascular disease (CVD) risk using novel tools and metrics. METHODS: A CVD risk communication training workshop was developed through interviews with patients and practitioners delivering Health Checks, a literature review, NICE guidance and the UK Health Check competency framework. It was pilot-tested with practitioners delivering Health Checks in the UK. Perceived practitioner understanding and confidence were measured before and up to 10 weeks after the workshop, and changes were compared with those in a control group (who received no intervention). Perceived impact was also explored through semi-structured interviews. RESULTS: Sixty-two practitioners (34 intervention, 28 control) took part. Perceived practitioner understanding (p = .030) and perceived patient understanding (p = .007) improved significantly for those delivering Health Checks in the training group compared with controls. Practitioner confidence also improved significantly more in practitioners who attended the training (p = .001). Findings were supported by interviews with a sub-sample of practitioners (n = 13). CONCLUSION: The training workshop improved practitioners' confidence and perceived understanding of CVD risk in Health Checks. PRACTICE IMPLICATIONS: The training is an important step to improving practitioner understanding of CVD risk in Health Checks and should be implemented on a wider scale.

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The aim of this paper is to systematically review the evidence to explore whether smartphone applications that use self-regulatory strategies are beneficial for weight loss in overweight and obese adults over the age of 18 years. Sixteen electronic databases were searched for articles published up to April 2015 including MEDLINE, OVID, Ingenta, PSYCARTICLES and PSYCINFO, CINAHL, Sportdiscus, Science Direct, Web of Knowledge, Cochrane Library, JSTOR, EBSCO, Proquest, Wiley and Google Scholar. Twenty nine eligible studies were retrieved of which six studies met the inclusion criteria. Studies that recruited participants under the age of 18 years, adults with a chronic condition or did not report weight loss outcomes were excluded. Study findings were combined using a narrative synthesis. Overall, evidence suggests that smartphone applications may be a useful tool for self-regulating diet for weight loss as participants in the smartphone application group in all studies lost at least some bodyweight. However, when compared to other self-monitoring methods, there was no significant difference in the amount of weight lost. Findings should be interpreted with caution based on the design of the studies and the comparator groups used. Future research needs to be more methodologically rigorous and incorporate measures of whether eating habits become healthier in addition to measuring weight and BMI.

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Healthcare professionals are key providers of information about antipsychotic medication and may have a significant influence on the decisions that service users make about how their medication is delivered. This systematic review aimed to explore health professionals' attitudes and beliefs towards antipsychotic depot medication. A systematic search of AMED, BNI, CINAHL, EMBASE, HEALTH BUSINESS ELITE, HMIC, MEDLINE and PsycINFO was carried out, as well as hand searches of journals and citation searches. Studies were selected if the terms 'attitudes/beliefs' and 'depot/injection' were included in the title or abstract, if health professionals were participants in the study and if original data were included. The search strategy produced 131 papers. Eight relevant studies were then selected for the review. They included six cross-sectional surveys and two qualitative studies. It was shown that the research carried out is still very sparse. Depots are seen as old fashioned, stigmatizing, causingside effects and being costly, and they are often not prescribed because of a presumed adherence to oral medication. More research needs to be carried out to further explore these issues, to look at the role of non-medical prescribers and explore the relationship between health professionals' attitudes and those of service users.

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This qualitative study describes GPs' experiences of and needs for management of people from a South Asian community who have chronic pain. Semi-structured interviews were conducted with 18 GPs from practices in two PCTs in Leicester. The data was analysed using grounded theory. The results indicate that managing patients from a South Asian community with chronic pain can be challenging due to differing pain expression and presentation. Emerging themes refer to shortages of services for these patients including the need for CBT, counselling, community support and GP education and training. Potential implications of the results for service provision are discussed.

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OBJECTIVE: The implantable cardioverter defibrillator (ICD) has become the treatment of choice for ventricular arrhythmia (VA; abnormal heart rhythms) and the prevention of sudden cardiac death (SCD). Recent clinical trials have shown the ICD to be superior to anti-arrhythmic medication in reducing mortality; however, research has suggested that ICD recipients experience poor psychosocial adjustment following implantation of the device. This aim of this study was to identify the key psychological characteristics associated with ICD implantation and to establish whether poor psychosocial outcome can be attributed directly to the device and its therapy. METHOD: Studies which reported valid and reliable measures of psychological functioning in ICD patients and appropriate comparison groups were considered for inclusion in a meta-analytic review. A systematic search of electronic databases and reference lists identified 20 studies which fulfilled the inclusion criteria. RESULTS: There were no significant differences in psychosocial outcome between ICD patients and drug-maintained VA patients or between pre- and post-implant ICD patients. However, ICD patients reported significantly worse psychological functioning and physical functioning than other cardiac controls. CONCLUSION: These findings suggest that poor psychosocial outcome in ICD patients may occur as a result of variables associated with the underlying VA condition, rather than as a direct response to implantation of the device and its therapy. This holds important implications for the development and implementation of psychological interventions for patients experiencing VA, in preference to ICD-specific programmes.

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The aims of this paper were to (a) ascertain the extent of psychological distress and (b) identify the association between personality variables and psychological distress among individuals who had been exposed to an aircraft disaster in Coventry, U.K. Hundreds of people escaped death but were exposed to the impact of the disaster when a Boeing 737-2D6C 7T-VEE crashed into a woodland area on the edge of a large housing estate in Coventry, U.K. in 1994. Eighty-two residents were randomly chosen for interviews in which they were assessed using the Impact of Event Scale, the General Health Questionnaire, and the Eysenck Personality Questionnaire-R Short Scale (EPQ-R). The results showed that the Coventry residents' scores reached similar levels of intrusion and avoidance compared with standardized samples and the Lockerbie samples. Fifty-two percent reached the GHQ case level score, which was again similar to the Lockerbie residents. The Coventry residents were significantly less extroverted and neurotic than standardized samples. Stepwise multiple regression showed that there were associations between intrusion and neuroticism and intrusion and extroversion, as well as between avoidance and neuroticism.

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