Criterios de calidad del agua

Many mothers described the difficulties in getting relief from their childcare responsibilities when they were ill. This problem was particularly challenging for mothers with limited support networks and in particular single mothers. Some mothers simply felt that they did not have access to adequate support to enable them to change their daily routine to accommodate their illness.

R12:1 got three children to look after and a mother-in-law and work, I can’t. I just have to get on with it. I can V take time out I can V go to bed so I ju st carry on and get on with it (35-year-old mother, average deprivation rural ward).

R26:1 don’t keep the kids away from other kids i f they are ill or whatever or i f they got a cough. We ju st carry on regardless, kind o f get on with it really (33-year-old mother, average deprivation rural ward).

R ll: I don't have time to be ill; no one will look after her i f I d o n ’t (talking about her child) (18-year-old mother, high deprivation urban ward).

Some parents also encouraged children to maintain their normal activity by attending school or nursery when suffering from colds and sore throats. Here, the use of OTCMs appeared to have a social role. ‘Dosing up’ with OTCMs was seen as useful in enabling the child to continue normal activity (n=5). This reduced the burden of care, allowing parents to fulfil their usual daily responsibilities. Indeed, Alloey et al, (2004) has reported that medicines may be used as a way of coping with illness when social pressures require the individual to continue as normal.

R19:1 think, i f i t ’s ju st a cold, its best to dose them up and send them to school as normal and I can go to work (38-year-old mother, average deprivation rural ward).

However, the majority of mothers in this sample were not currently employed and did not talk of administering medication to their children as a way of enabling them

to continue with work. Most mothers reflected the ease in which their child’s illness could be accommodated by the parents, which is consistent with the findings of Cornwell (1984). Most mothers in my sample, who were not working outside their home, resided in rural wards, which were areas o f average or low deprivation. These respondents, in Vuckovic’s (1999) terms, appeared to suffer less of a ‘time famine’

in the face o f childhood illness than working parents.

6.3.2 Reservation about Medicines

Despite the universal use of OTCMs, a minority o f respondents indicated that they had reservations about overly liberal use of medicines. Some middle class parents described their use of OTCMs as conditional; they were used only in ‘severe’ cases or as a ‘last resort’. Two respondents stated they chose not to consume any

medicines, (although one later contradicted this statement by naming several OTCMs which they had used in ‘severe’ cases) despite experiencing fairly unpleasant symptoms, and two respondents believed that overusing OTCMs medicines reduced their effectiveness.

R14:1 don’t tend to use them unless I have to. I had a bad cough with the last one and I had some kind ofpastille they were something that my dad had found, they were some herbal thing (38-year-old mother, low deprivation rural ward).

R 17:1 didn’t take anything at all. Iju st had to go to bed. Honey and lemon, that’s all I was taking (34-year-old mother, low deprivation urban ward).

R14:1 always try to keep my drug intake to a minimum and try not to take too much i f I can. Because I think i t ’s very easy ju st to pop pills and then when you really need them they d o n ’t have the effect on you, because you body has got used to them (36- year-old mother, low deprivation rural ward).

Another unusual respondent expressed her reservations about pharmaceutical remedies in general, believing that they were not tailored to individuals’ needs.

Britten (1996) has reported similar reservations about generic medication.

R25:1 feel that when you go to a homeopath you have a fu ll and comprehensive consultation and you are not ju st applying a generic medicine to a generic problem.

And I think that is the way that we should be using any kind o f treatment (40-year- old mother, low deprivation rural ward).

R7: Well, (long silent pause) I wonder why I d o n ’t really like medicines? (Silent pause). I suppose i f I thought that we were really sick then I would take them with

no quibble. I've had three caesareans so I know what it is to take medication and I ’ve got no problems with taking it. But I need a good reason (38-year-old mother, urban low deprivation ward).

Conversely, one middle class parent expressed reservations about natural remedies and asserted confidence in pharmaceutical medicines. This respondent did not use complementary therapies despite encouragement from friends.

R6:1 do have a friend, my next door neighbour and a lady from our church, she felt very strongly that whatever she was taking into her body that she had to be happy with and she w asn’t very happy with massive amounts o f drugs and whatever in normal medicines. So she is training at the moment to be a homeopath. I t ’s taken her a few years and weekend schools and things like this, so she feels very strongly about them. But I am very sceptical because I have trust in the traditional, proper medicine, the proper medical professional. She has often offered me a consultation and I have kind o f avoided offending her by saying ‘no I don't believe because I have more faith in the medical profession ’, i t ’s um its sort ofproven medical evidence rather than possible remedies. I ju st wouldn ’t trust them. Natural and all that kind o f side o f it, yeah, that’s great but I think I would still be sceptical about whether it works or not (33-year-old mother, low deprivation rural ward).

6.3.3 The use o f Complementary, Alternative, Home and Traditional Remedies In addition to the widespread use of OTCMs, a small number of respondents described their use of CAMs. Several respondents reported self-medicating with herbal and natural medicines although a few had consulted complementary

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practitioners («=4). The use of herbal remedies was most widely reported by middle class parents and those with a health or science background. These respondents described self-medication with a variety of teas, tablets and syrups and believed that these both helped prevent and treat a number of different types of URTIs and related symptoms (n= 19). The types of herbal remedies reported by the respondents are summarised in Table 6.5.

Table 6.5 Herbal Remedies used bv Respondents

Remedies N um ber of times mentioned

Echinacea 12

Almost a quarter of respondents reported using Echinacea. Its use by the public to treat the common cold has been previously reported (Caruso and Gwaltney, 2005).

Echinacea originates from central and South Western America and is considered to boost the immune system. Its popularity has grown in line with that of other CAMs, but there is little empirical evidence to support its therapeutic benefit (Caruso and Gwaltney, 2005). There has been a growing popularity in the use of CAMs and consistent with previous studies, respondents residing within areas of average and low deprivation were more likely to report using complementary medicines than

respondents from areas of high deprivation (Sharma, 1992). Only one respondent from an electoral ward with high levels o f deprivation reported CAM use.

Variations in the use of complementary therapies across regions may be related to access, local availability, and affordability (Sharma, 1992). Gender also appears to influence the use of CAMs with more women reporting the use of complementary therapies than men, although the reasons for this are unclear.

Respondents often reported a preference for natural therapies - considered by some to be more ‘healthy’ than mass-produced pharmaceutical products. For these respondents, reservations about OTCMs were related to perceptions of pharmaceutical compounds as ‘artificial’, ‘manufactured’, ‘unnatural’ and

‘chemical’. Concerns about the perceived unnaturalness of medicines, the potential side effects and a preference for not ‘taking drugs’ has been previously reported (Britten, 1996). Perceptions of natural things as always good, and chemical or manufactured things as predominately bad, are miss founded. For example, the naturally occurring compound opium is harmful when abused.

R24: Because I am very aware o f chemicals and things that we put into our bodies, that we should not be putting in really. And I know how I feel... That since I have actually cut out, stopped taking so many antibiotics, stopped taking so much caffeine. I drink herbal teas. I know I fe e l better. So when this homeopathic thing came along I was ju st starting to become aware o f what I really should be putting into my body and when this course became available I thought well yeah, I would give that a go and it has hit home to me a bit more that what I am doing (using homeopathic and natural remedies) is the right thing (29-year-old woman, low deprivation rural ward).

In addition to the use of OTCMs and CAMs, respondents reported using home remedies to reduce symptoms and speed recovery including sugar and onion (n= 1),

mustard compress { n -1), brimstone and treacle and goose grease (n=l), although the later two remedies were merely listed as remedies used in the past, rather than remedies currently used. Home remedies also included alcohol, such as ‘honey whiskey water and sugar’ (n= 1), brandy («=1), and combinations of common foods such as ‘milk and eggs’ (n= 1), raspberry vinegar («=1), Lucozade (carbonated beverage high in glucose), grapes and chocolate (n=l). The most popular home remedy was hot lemon and honey drinks (n= 12).

Compared to the number o f respondents that used OTCMs (n=45), comparatively few respondents used home remedies (n= 12). Although home remedies were once important ways of dealing with minor illness, they lost some of their popularity as a result of the growth in commercial pharmaceutical production and the rise of

professionally endorsed medicines (Pratt, 1976). As a result, members o f the public may now lack the skill needed to prepare home remedies, prefer the convenience of pre-prepared preparations or have no faith in the efficacy of home remedies.

Middle class parents and respondents with a health or science background often considered vitamin supplements, in particular vitamin C, to be beneficial. Often individuals from these two groups would attempt to increase their vitamin intake by either consuming a proprietary preparation in the form of tablets or pastilles or by increasing consumption of fruit or fruit juice.

R19:1 usually take fresh juice, orange juice or something; we squeeze quite a lot here fo r the restaurant so i t ’s quite good to have w hat’s left over. I up juice (38- year-old mother, average deprivation rural ward).

R14: Err, vitamin C essentially, but I try to do that through natural sources like drink orange juice and increase oranges and fru it intake. Because I had run out o f fruit completely so kiwis or whatever was available. I try to get my son to eat fruit

though it s a bit o f a battle (38-year-old mother, low deprivation rural ward).

Taking vitamin and mineral supplements became popular during the 1800’s when physicians commonly prescribed vitamins as tonics (Crelin, 2004). The use of vitamin C for URTI has been reported elsewhere (Helman, 1978: Braun et al, 2000), but recent research suggests there is little therapeutic benefit in well-nourished western populations (Hemila et al, 2007). Other dietary supplements described by the respondents in this study were cod liver oil (n= 1), ‘Omega 3’ («=1), and one respondent described supplementing his diet with zinc through consuming pumpkin and sunflower seeds.

Behavioural responses aimed at promoting recovery included keeping warm, taking hot food or drinks, and increasing consumption of fluids. These behavioral

responses may be consistent with the hot-cold belief system if they are perceived as restoring the balance between wet/dry and hot/cold states. But these beliefs may also be consistent with a biomedical model of illness: if you are pyrexic you may lose fluid through sweat and increasing fluid intake helps maintain normal fluid balance. Illness behaviour, such as this, has been reported in other North American and UK samples (Patcher, 1989; Braun et al, 2000; Helman, 1978).

R4: Well, mainly the first thing I try to do is errr try to keep, wrap up warm, keep indoors, i f I possibly can and I normally take hot drinks. I would probably go to bed, drink lots o f liquid, rest and hope that in a couple o f days (56-year-old man, average deprivation post-industrial ward).

Respondents reported nasal congestion as a particularly troublesome symptom.

There were a number o f tried and tested ways of reducing congestion most of which involved increasing humidity. Some people inhaled steam (n= 12), one mother placed a wet flannel on the radiator, and one inhaled the steam generated by a household shower. Tilting the head of the bed so that the head was higher than the chest (‘propped up’ or semi-recumbent) (n=3) and saline nasal drops to loosen chest secretions (n= 1) were also described as ways of relieving congestion.

R32: Relieve the congestion as much as you can. I ’m the sort o f guy that goes and gets a bath o f steaming water and puts a bath towel over my head (72-year-old man, low deprivation rural ward).

Consistent with previous studies, some respondents believed that resting was an effective strategy to deal with colds and other URTIs (Vingilis, 1999). Respondents in this study, however, believed that one could rest without going to bed by ‘taking it easy’, or ‘staying in’. Children, in particular, were perceived to benefit from rest.

R16: when I get a cold I ’d usually go to bed (26-year-old mother, average deprivation urban ward).

R12: I ’ll let them have a day o ff school and let them rest in bed and give them some Calpol (35-year-old mother, average deprivation rural ward).