Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives

Background In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives’ practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments. Methods Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments. Results Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1–7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking. Conclusions Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives’ implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community.

Dietary Research on Coffee: Improving Adjustment for Confounding

ABSTRACT Meta-analyses have reported higher levels of coffee consumption to be associated with lower mortality. In contrast, some systematic reviews have linked coffee consumption to increased risks for lung cancer and hypertension. Given these inconsistencies, this narrative review critically evaluated the methods and analyses of cohort studies investigating coffee and mortality. A specific focus was adjustment for confounding related to smoking, healthy and unhealthy foods, and alcohol. Assessment of 36 cohort samples showed that many did not adequately adjust for smoking. Consuming 1–5 cups of coffee per day was related to lower mortality among never smokers, in studies that adjusted for pack-years of smoking, and in studies adjusting for healthy and unhealthy foods. Possible reduced health benefits for coffee with added sugar have not been adequately investigated. Research on coffee and health should report separate analyses for never smokers, adjust for consumption of healthy and unhealthy foods, and for sugar added to coffee.

Evaluating the knowledge base and current training of paramedics in the southwest United States in assessing and managing toxic alcohol exposures

Introduction: The aim of this research was to use a survey to identify the cognitive capabilities of paramedics to recognize key clinical, pathophysiological and treatment features of toxic alcohol poisoning. Additionally, evaluation of affective capabilities of paramedics in terms of the level of importance paramedics assign to toxic alcohol emergencies was evaluated.Methods: The study was conducted as an anonymous online survey. Demographic data, timed choice, and open-ended questions were collected to evaluate knowledge and identify gaps in toxic alcohol poisoning training by paramedics. The survey link was sent out to EMS organizations and individual paramedics. Bivariate analysis via Pearson correlation coefficient (PCC) was used to compare variables.Results: The response rate was 72.5% (58/80). Respondents were able to identify common sources of toxic alcohol exposure to varying degrees with 58% for methanol and 89% for ethylene glycol. Data indicate that a lack of understanding of the underlying pathophysiology was related to missing education (PCC <0.05) in toxicology. Education appears to be insufficient in regards to recognizing and treating toxic alcohol exposure. A majority of respondents (80%) believe that assessment and treatment of toxic alcohol poisoning is an important component of their training.Conclusions: Although symptom recognition for toxic alcohol poisoning is present in most EMS providers, pharmacological intervention and treatment approaches are often not known. The results indicate that there is a need for educators and curriculum builders to include additional coverage of topics of toxicological importance such as the anion gap and toxic alcohol assessment, pathophysiology and treatment.

Alcohol assessment and feedback by email for university students: main findings from a randomised controlled trial

BackgroundBrief interventions can be efficacious in changing alcohol consumption and increasingly take advantage of the internet to reach high-risk populations such as students.AimsTo evaluate the effectiveness of a brief online intervention, controlling for the possible effects of the research process.MethodA three-arm parallel groups design was used to explore the magnitude of the feedback and assessment component effects. The three groups were: alcohol assessment and feedback (group 1); alcohol assessment only without feedback (group 2); and no contact, and thus neither assessment nor feedback (group 3). Outcomes were evaluated after 3 months via an invitation to participate in a brief cross-sectional lifestyle survey. The study was undertaken in two universities randomising the email addresses of all 14910 students (the AMADEUS-1 study, trial registration: ISRCTN28328154).ResultsOverall, 52% (n = 7809) of students completed follow-up, with small differences in attrition between the three groups. For each of the two primary outcomes, there was one statistically significant difference between groups, with group 1 having 3.7% fewer risky drinkers at follow-up than group 3 (P = 0.006) and group 2 scoring 0.16 points lower than group 3 on the three alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) (P = 0.039).ConclusionsThis study provides some evidence of population-level benefit attained through intervening with individual students.