Aust Fam Physician
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Multicenter Study
A comparison of vitamin D levels in two antenatal populations in regional Western Australia--'Tjindoo Ba Thonee Thurra': sunshine for the pregnant belly.
There is a known increased risk of vitamin D deficiency in darker skinned people living in in temperate latitudes, but there is limited literature specifically on Australian Aboriginal women and their vitamin D status in pregnancy. ⋯ Aboriginal patients from the Aboriginal Community Controlled Health Service (ACCHS) had lower serum vitamin D levels (mean 46.7, SD 21.7 nmol/L), compared with their non-Aboriginal women (mean 65.4, SD 18.4 nmol/L, P CONCLUSION: We believe this is the first study to compare vitamin D levels in pregnant Aboriginal women with non-Aboriginal women living in the same community at temperate latitude.
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New mothers frequently experience breastfeeding problems, in particular nipple pain. This is often attributed to compression, skin damage, infection or dermatitis. ⋯ Our clinical reasoning model resolves the complexity of pain into three categories: local stimulation, external influences and central modulation. Tissue pathology, damage or inflammation leads to local stimulation of nociceptors. External influences such as creams and breast pumps, as well as factors related to the mother, the infant and the maternal-infant interaction, may exacerbate the pain. Central nervous system modulation includes the enhancement of nociceptive transmission at the spinal cord and modification of the descending inhibitory influences. A broad range of factors can modulate pain through central mechanisms including maternal illness, exhaustion, lack of support, anxiety, depression or history of abuse. General practitioners (GPs) can use this model to explain nipple pain in complex settings, thus increasing management options for women.
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Historical Article
A historical perspective of the barriers to generalism.
As early as the late 19th century, there were calls to give greater emphasis to general practice. The momentum picked up after the Second World War. The voices calling for more generalism reached a crescendo in the late 1960s. Optimism was very high in the following two decades. Today, there is a pervasive sense of lost opportunity as generalism continues to languish behind the increasing momentum of specialisation of medicine. ⋯ The tensions between sectors that promote generalism continue to this day. The ongoing antagonism between the plough, the town and the gown remains a dominant factor that shapes the path to generalism. Political activism seems to be an effective tool in promoting greater generalism.