Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: a qualitative study within a randomised controlled trial

Objective: To explore the difficulties experienced by lay-workers, women and health professionals involved in a peer-mentoring programme for first-time mothers living in socially disadvantaged areas. Design: Qualitative study; semi-structured interviews with lay-worker peer-mentoring programme participants at two separate stages of the programme (antenatal and postnatal). Setting: Community based. Participants: 11 women receiving peer-mentoring support (from first hospital antenatal visit to one year postnatal); 11 lay-workers; 2 research midwives. Results: Lay-workers had difficulty initiating contact with women and failure to establish contact affected their morale adversely. They felt that women understood their intended role poorly and attempted to develop relationships with them by sharing personal experiences and offering friendship; women who participated in the programme appreciated this. Developing a peer-mentor relationship was difficult if women lacked interest in the programme or in continuing contact. External influences on peer-mentoring uptake and delivery included family and friends who could prevent or encourage women’s participation and cause difficulties for the lay-worker both in delivering support and arranging follow-up. Lay-workers providing support to women from a different ethnic background experienced difficulties relating to both language and culture: these were perceived to affect peer-mentor relationships adversely. Major personal difficulties for lay-workers related to time constraints in reconciling mentoring requirements with demands of family and other work. Informing midwives of these difficulties helped identify solutions through training and ongoing professional support for the lay-workers. Conclusions: Lay-worker peer support is appreciated by first time mothers but difficulties in initiating contact, developing peer-mentor relationships and external influences such as family, ethnicity and time constraints are relevant to poor uptake and high staff turnover. In developing peer support programmes, awareness of potential difficulties and of how professional support can help resolve these should improve uptake and thus optimise the evaluations of their effectiveness.

Ethnic habitus and young children: a case study of Northern Ireland

This article presents the findings of an exploratory survey of the ethnic attitudes and identities of a random sample (n=352) of three–six-year-old children in Northern Ireland. The survey represents one of the first of its kind to explore how young children's awareness of ethnic differences develops in contexts where ethnicity is not marked by visible, physical differences. In drawing upon the notion of an ‘ethnic habitus’, the article shows how young children from the two majority ethno-religious groups in the region – Catholic and Protestants – are already acquiring the cultural dispositions and habits of their respective groups even though, at the earlier ages, they have little awareness or understanding of what these dispositions represent. The article shows that young children are capable of developing ethnic identities and prejudices in the absence of physical cues and discusses the implications of these findings for practice as well as for understanding the effects of racial and ethnic divisions on young children in other social contexts.

Kawamoto’s "Dojoji Temple": Puppetry, Gesture and Myth

Dojoji Temple ( Dōjōji, 1976) is a short puppet animation directed by Kihachirō Kawamoto. Influenced by Bunraku (Japanese puppet plays), emaki (painted scroll), Noh theatre and Japanese myth, Dojoji Temple tells of a woman’s unrequited love for a young priest. Heartbroken, she then transforms into a sea serpent and goes after the priest for revenge. While Kawamoto’s animation is rich with Japanese aesthetics and tragedy, his animation is peopled by puppets who do not speak. Limited and restrained though the puppets may be, their animated gestures speak volumes of powerful emotions. For our article, we will select several scenes from the animation, and interpret their actions so that we can further understand the mythical world of Dojoji Temple and the essential being of puppetry. Our gesture analysis will take into account cinematographic compositions, sound and bodily attires, among other elements.

A survey of sewer rehabilitation in Malaysia: application of trenchless technologies

This work presents a review of applicable sewer rehabilitation options using trenchless technology in Malaysia. The typical problems faced in wastewater collection systems are analysed and factors that determine the selection method are outlined. This study also highlights the necessary steps to be taken prior to the rehabilitation work. The trenchless technology reviewed here comprises repair, renovation and replacement options. The cost-effectiveness of different rehabilitation methods was identified to assess the economic viability of various options in the Malaysian context. This study reveals that not all the trenchless technologies available in the market are suitable for use in Malaysia, mainly due to incompatibility of the rehabilitation materials used. Furthermore, as trenchless rehabilitation generally involves higher capital outlay than open-cut methods, the choice of rehabilitation method has to be made on a case-to-case basis.

Using survey data to explore preschool children’s ethnic awareness and attitudes

This article presents the findings of a large-scale survey (n = 1049) of ethnic awareness and attitudes among three to four-year-old children in Northern Ireland. In drawing upon and applying Bourdieu’s notion of habitus, the article demonstrates how, even at this age, the children are already beginning to embody and internalize the cultural habits and dispositions of their respective ethnic groups; namely the Protestant and Catholic communities. This is illustrated in the present article in relation to the children’s attitudes towards particular national flags and awareness of specific sports associated with their respective communities. Informed by the work of Bourdieu, the article concludes by arguing for the need for greater use of quantitative methods in conjunction with in-depth qualitative and ethnographic research to help further our understanding of the influence of ethnicity in young children’s lives.

Refractory asthma in the UK: cross-sectional findings from a UK multicentre registry

Introduction: Refractory asthma represents a significant unmet clinical need where the evidence base for the assessment and therapeutic management is limited. The British Thoracic Society (BTS) Difficult Asthma Network has established an online National Registry to standardise specialist UK difficult asthma services and to facilitate research into the assessment and clinical management of difficult asthma.
Methods: Data from 382 well characterised patients, who fulfilled the American Thoracic Society definition for refractory asthma attending four specialist UK centres—Royal Brompton Hospital, London, Glenfield Hospital, Leicester, University Hospital of South Manchester and Belfast City Hospital—were used to compare patient demographics, disease characteristics and healthcare utilisation.
Results: Many demographic variables including gender, ethnicity and smoking prevalence were similar in UK centres and consistent with other published cohorts of refractory asthma. However, multiple demographic factors such as employment, family history, atopy prevalence, lung function, rates of hospital admission/unscheduled healthcare visits and medication usage were different from published data and significantly different between UK centres. General linear modelling with unscheduled healthcare visits, rescue oral steroids and hospital admissions as dependent variables all identified a significant association with clinical centre; different associations were identified when centre was not included as a factor.
Conclusion: Whilst there are similarities in UK patients with refractory asthma consistent with other comparable published cohorts, there are also differences, which may reflect different patient populations. These differences in important population characteristics were also identified within different UK specialist centres. Pooling multicentre data on subjects with refractory asthma may miss important differences and potentially confound attempts to phenotype this population.

An Ecological Correlation Study of Late Age-Related Macular Degeneration and the Complement Factor H Y402H Polymorphism

PURPOSE:
To investigate whether variation in the distribution of the risk allele frequency of the Y402H single-nucleotide polymorphism (SNP) across various ethnicities and geographic regions reflects differences in the prevalence of late age-related macular degeneration (AMD) in those ethnicities.

METHODS:
Published data were obtained via a systematic search. Study samples were grouped into clusters by ethnicity and geographic location and the Spearman correlation coefficient of the prevalence of late AMD and risk allele frequencies was calculated across clusters.

RESULTS:
Across all ethnicities, AMD prevalence was seen to increase with age. Populations of European descent had both higher risk allele frequencies and prevalence of late AMD than did Japanese, Chinese, and Hispanic descendants. Results for African descendants were anomalous: although allele frequency was similar to that in European populations, the age-specific prevalence of late AMD was considerably lower. The correlation coefficient for the association between allele frequency and AMD prevalence was 0.40 (95% confidence interval [CI] = -0.36 to 0.84, P = 0.28) in all populations combined and 0.71 (95% CI = 0.02-0.94, P = 0.04) when people of African descent were excluded.

CONCLUSIONS:
Evidence was found at the population level to support a positive association between the Y204H risk allele and the prevalence of AMD after exclusion of studies undertaken on persons of African ancestry. Data in African, Middle Eastern, and South American populations are needed to provide a better understanding of the association of late AMD genetic risk across ethnicities.

Community Cohesion and Social Inclusion: Unravelling a Complex Relationship

In a global context of an emphasis on identity politics and a ‘cultural turn’ in social analysis, deep concern has been expressed about multiethnic Britain becoming a broken society with many ‘sleepwalking’ into segregation and separatism. Given the close correspondence between areas of acute ethnic segregation and those of multiple deprivation, intercommunal tensions have included disputes about the equitable allocation of scarce urban resources across ethnicity. This creates the possibility that urban programmes may inadvertently accentuate intercommunal tension and confound efforts to synchronise cohesion and inclusion agendas. Following recent debates about the implications of increased diversity, influenced by arguments that multiculturalism has encouraged ‘parallel lives’, an emergent policy framework emphasises more proactive integration to promote ‘common belonging’. Criticism of this agenda includes its confusion between community and social cohesion, and its disproportionate focus on cultural aspects such as identity formation and recognition, relative to structural issues of income and class. In exploring this contested terrain in Britain, the article suggests that the longer-term debate about segregation, deprivation and community differentials in Northern Ireland can offer useful insight for Britain’s policy discourse.

Escalators, Elevators and Travelators: The Occupational Mobility of Migrants to South-East England

In a meritocratic society it is assumed that the chance of achieving occupational mobility (OM) is not strongly influenced by one's starting position in terms of class or ethnicity. This paper seeks to explain the drivers of the high levels of OM achieved by one ethnically defined group: the Scots. Educational attainment is shown to be particularly important. A second level of interest is the changing role of internal migrants to a global city in the face of increased international skilled immigration. We investigate whether there is any evidence that the OM of internal migrants is being hindered as a result. The evidence points instead to immobile local labour being more disadvantaged occupationally than mobile labour from peripheral regions of the state.

Systematic review and meta-analysis of the association between complement component 3 and age-related macular degeneration: A HUGE review and meta-analysis

We performed a meta-analysis to estimate the magnitude of C3 gene polymorphism effects, and their possible mode of action, on age-related macular degeneration (AMD). The meta-analysis included 16 studies for rs2230199 and 7 studies for rs1047286. Data extraction and risk of bias assessments were performed in duplicate, and heterogeneity and publication bias were explored. There was moderate evidence for association between both polymorphisms and AMD in individuals of European descent. For rs2230199, patients with CG and GG genotypes were 1.44 (95% CI: 1.33 – 1.56) and 1.88 (95% CI: 1.59 – 2.23) times more likely to have AMD than patients with CC genotype. For rs1047286, those with GA and AA genotypes had 1.27 (95% CI: 1.15 – 1.41) and 1.70 (95% CI: 1.27 – 2.11) times higher risk of AMD than those with GG genotypes. These gene effects suggested an additive model. The population attributable risks for the GG/GC and AA/GA genotypes are approximately 5-10%. Stratification of studies on the basis of ethnicity indicates that these variants are very infrequent in Asian populations and the significance of the effect observed is based largely on the high frequency of these variants within individuals of European descent. This meta-analysis supports the association between C3 and AMD and provides a robust estimate of the genetic risk.