A systematic review of systematic reviews to improve maternal mental health and well-being

Objective: to identify non-invasive interventions in the perinatal period that could enable midwives to offer effective support to women within the area of maternal mental health and well-being.

Methods: a total of 9 databases were searched: MEDLINE, PubMed, EBSCO (CINAHL/British Nursing Index), MIDIRS Online Database, Web of Science, The Cochrane library, CRD (NHS EED/DARE/HTA), Joanne Briggs Institute and EconLit. A systematic search strategy was formulated using key MeSH terms and related text words for midwifery, study aim, study design and mental health. Inclusion criteria were articles published from 1999 onwards, English language publications and articles originating from economically developed countries, indicated by membership of the Organisation for Economic Co-operation and Development (OECD). Data were independently extracted using a data collection form, which recorded data on the number of papers reviewed, time frame of the review, objectives, key findings and recommendations. Summary data tables were set up outlining key data for each study and findings were organised into related groups. The methodological quality of the reviews was assessed based on predefined quality assessment criteria for reviews.

Findings: 32 reviews were identified as examining interventions that could be used or co-ordinated by midwives in relation to some aspect of maternal mental health and well-being from the antenatal to the postnatal period and met the inclusion criteria. The review highlighted that based on current systematic review evidence it would be premature to consider introducing any of the identified interventions into midwifery training or practice. However there were a number of examples of possible interventions worthy of further research including midwifery led models of care in the prevention of postpartum depression, psychological and psychosocial interventions for treating postpartum depression and facilitation/co-ordination of parent-training programmes. No reviews were identified that supported a specific midwifery role in maternal mental health and well-being in pregnancy, and yet, this is the point of most intensive contact.

Key conclusions and implications for practice: This systematic review of systematic reviews provides a valuable overview of the current strengths and gaps in relation to maternal mental health interventions in the perinatal period. While there was little evidence identified to inform the current role of midwives in maternal mental health, the review provides the opportunity to reflect on what is achievable by midwives now and in the future and the need for high quality randomised controlled trials to inform a strategic approach to promoting maternal mental health in midwifery.

The influence of market deregulation on fast food consumption and body mass index:A cross-national time series analysis

Objective
To investigate the effect of fast food consumption on mean population body mass index (BMI) and explore the possible influence of market deregulation on fast food consumption and BMI.

Methods
The within-country association between fast food consumption and BMI in 25 high-income member countries of the Organisation for Economic Co-operation and Development between 1999 and 2008 was explored through multivariate panel regression models, after adjustment for per capita gross domestic product, urbanization, trade openness, lifestyle indicators and other covariates. The possible mediating effect of annual per capita intake of soft drinks, animal fats and total calories on the association between fast food consumption and BMI was also analysed. Two-stage least squares regression models were conducted, using economic freedom as an instrumental variable, to study the causal effect of fast food consumption on BMI.

Findings
After adjustment for covariates, each 1-unit increase in annual fast food transactions per capita was associated with an increase of 0.033 kg/m2 in age-standardized BMI (95% confidence interval, CI: 0.013–0.052). Only the intake of soft drinks – not animal fat or total calories – mediated the observed association (β: 0.030; 95% CI: 0.010–0.050). Economic freedom was an independent predictor of fast food consumption (β: 0.27; 95% CI: 0.16–0.37). When economic freedom was used as an instrumental variable, the association between fast food and BMI weakened but remained significant (β: 0.023; 95% CI: 0.001–0.045).

Conclusion
Fast food consumption is an independent predictor of mean BMI in high-income countries. Market deregulation policies may contribute to the obesity epidemic by facilitating the spread of fast food.

Mathematics background of engineering students in Northern Ireland and Finland

The Organisation for Economic Co-operation and Development investigated numeracy proficiency among adults of working age in 23 countries across the world. Finland had the highest mean numeracy proficiency for people in the 16 – 24 age group while Northern Ireland’s score was below the mean for all the countries. An international collaboration has been undertaken to investigate the prevalence of mathematics within the secondary education systems in Northern Ireland and Finland, to highlight particular issues associated with transition into university and consider whether aspects of the Finnish experience are applicable elsewhere. In both Northern Ireland and Finland, at age 16, about half of school students continue into upper secondary level following their compulsory education. The upper secondary curriculum in Northern Ireland involves a focus on three subjects while Finnish students study a very wide range of subjects with about two-thirds of the courses being compulsory. The number of compulsory courses in maths is proportionally large; this means that all upper secondary pupils in Finland (about 55% of the population) follow a curriculum which has a formal maths content of 8%, at the very minimum. In contrast, recent data have indicated that only about 13% of Northern Ireland school leavers studied mathematics in upper secondary school. The compulsory courses of the advanced maths syllabus in Finland are largely composed of pure maths with a small amount of statistics but no mechanics. They lack some topics (for example, in advanced calculus and numerical methods for integration) which are core in Northern Ireland. This is not surprising given the much broader curriculum within upper secondary education in Finland. In both countries, there is a wide variation in the mathematical skills of school leavers. However, given the prevalence of maths within upper secondary education in Finland, it is to be expected that young adults in that country demonstrate high numeracy proficiency.

Human height since 1820

Average height is an important indicator of people’s well-being. It is also a relatively undistorted and easy-to-measure indicator, which makes it particularly suitable for comparisons across time and space. Drawing upon an extensive body of research, the chapter describes the strengths and weaknesses of this indicator. It finds that during the 19th century, average height in Western Offshoots was much higher than elsewhere. Differences between Western Europe and the rest of the world (Eastern Europe, East Asia) were marginal, in spite of the much higher real incomes in the former region. This changed after about 1870, when people’s height began to increase in Western Europe, whereas this lagged behind elsewhere. Africans were relatively tall during much of the period studied, but experienced declining height in many countries after the 1960s. People in Southeast Asia stayed relatively short throughout the period.

Shifting Thresholds, Contested Meanings: Governance, Cross-border Co-operation and the Ulster Unionist Identity

Cross-border (North/South) co-operation between the Republic of Ireland and Northern Ireland was an indelible feature of the form of governance provided by the Belfast Good Friday Agreement (1998). Previous efforts to establish North/South co-operation had all foundered but the establishment and initial operation of the Agreement's cross-border institutions proved to be uncontroversial. However, during its implementation, other areas of the Agreement gave Ulster unionists more pressing cause for concern. These areas of concern included the release of paramilitary prisoners, police reform, the 'decommissioning' of Irish Republican Army (IRA) weaponry, and the unionist perception that the 'Britishness of Northern Ireland' was being actively eroded. These concerns served to emphasise and strengthen political and cultural borders between communities at a regional and local level within Northern Ireland. They also threatened the pro-Agreement unionists' contestation of unionist ideological orthodoxy, a contestation that was undertaken in an attempt to adapt the Ulster unionist identity to the shifting thresholds of the state.

The International Regulatory Regime on Capital Flows

Capital controls and exchange restrictions are used to restrict international capital flows during economic crises. This paper looks at the legal implications of these restrictions and explores the current international regulatory framework applicable to international capital movements and current payments. It shows how international capital flows suffer from the lack of a comprehensive and coherent regulatory framework that would harmonize the patchwork of
multilateral, regional, and bilateral treaties that currently regulate this issue. These treaties include the Articles of Agreement of the International Monetary Fund (IMF Articles), the General Agreement on Trade in Services (GATS), free-trade agreements, the European Union treaty, bilateral investment treaties, and the Organization for Economic Co-operation and Development (OECD) Code of Liberalization of Capital Movements (OECD Code of Capital Movement). Each
of these instruments regulate differently capital movements with little coordination with other areas of law. This situation sometimes leads to regulatory overlaps and conflict between different sources of law. Given the strong links between capital movements and trade in services, this paper pays particular attention to the rules of the GATS on capital flows and discusses the policy space available in the GATS for restricting capital flows in times of crisis.