The prevalence of breast-feeding in south Leicestershire

Breastfeeding and lung function at school age: does maternal asthma modify the effect?

RATIONALE

The evidence for an effect of breastfeeding on lung function is conflicting, in particular whether the effect is modified by maternal asthma.

OBJECTIVES

To explore the association between breastfeeding and school-age lung function.

METHODS

In the Leicestershire Cohort Studies we assessed duration of breastfeeding (not breastfed, ≤3 months, 4-6 months, and >6 months), other exposures, and respiratory symptoms by repeated questionnaires. Post-bronchodilator FVC, FEV(1), peak expiratory flow (PEF), forced midexpiratory flow (FEF(50)), and skin prick tests were measured at age 12 years. We performed multivariable linear regression and tested potential causal pathways (N = 1,458).

MEASUREMENTS AND MAIN RESULTS

In the entire sample, FEF(50) was higher by 130 and 164 ml in children breastfed for 4 to 6 months and longer than 6 months, respectively, compared with those not breastfed (P = 0.048 and 0.041), with larger effects if the mother had asthma. FVC and FEV(1) were associated with breastfeeding only in children of mothers with asthma (P for interaction, 0.018 and 0.008): FVC was increased by 123 and 164 ml for those breastfed 4 to 6 months or longer than 6 months, respectively (P = 0.177 and 0.040) and FEV(1) was increased by 148 and 167 ml, respectively (P = 0.050 and 0.016). Results were unchanged after adjustment for respiratory infections in infancy and asthma and atopy in the child.

CONCLUSIONS

In this cohort, breastfeeding for more than 4 months was associated with increased FEF(50) and, in children of mothers with asthma, with increased FEV(1) and FVC. It seems that the effect is not mediated via avoidance of early infections or atopy but rather through a direct effect on lung growth.

A study on how mental health practitioners address ethical issues in clinical audit

Although much debate has taken place within the literature on the differences between research and clinical audit, the ethical dimensions of audit have frequently been neglected. Furthermore, no research has of yet explored what ethical issues auditors consider in relation to their projects or how they manage them in practice. Using data collected from audit documentation, semi-structured interviews and a researcher-administered questionnaire, this study sought to advance this position by exploring how 14 clinicians undertook audits in one mental health Trust addressed the ethical dimensions of their project. Analysis of the data revealed that the Trust had no formal mechanisms for reviewing and monitoring audit projects whilst other informal mechanisms were not utilized by all auditors. A number of projects had contact with both clinicians and service users through interviews, focus groups and questionnaires; however, issues such as informed consent, confidentiality and anonymity were not adequately addressed by auditors. The implications of these findings are discussed and recommendations for practice outlined.