• Perinatal outcomes among migrant mothers in the United Kingdom: is it a matter of biology, behaviour, policy, social determinants or access to health care?

      Puthussery, Shuby; University of Bedfordshire (Elsevier, 2016-04)
      This paper examines trends in perinatal outcomes among migrant mothers in the UK, and it explores potential contributors to disparities focusing on pregnancy, birth and the first year of life. Trends in perinatal outcomes indicate that ethnic minority grouping, regardless of migrant status, is a significant risk factor for unfavourable outcomes. It is unclear whether migrant status per se adds to this risk as within-group comparisons between UK-born and foreign-born women show variable findings. The role of biological and behavioural factors in producing excess unfavourable outcomes among ethnic minority mothers, although indicated, is yet to be fully understood. UK policies have salient aspects that address ethnic inequalities, but their wide focus obscures provisions for migrant mothers. Direct associations between socio-economic factors, ethnicity and adverse infant outcomes are evident. Evidence is consistent about differential access to and utilisation of health services among ethnic minority mothers, in particular recently arrived migrants, refugees and asylum seekers.
    • Parental factors and the risk of childhood overweight and obesity in low- and middle-income countries: a systematic review

      Puthussery, Shuby; Libonda, Liyali; Mistry, Sabuj Kanti; Norgate, Christine (Prospero, 2016-01)
      The aim of this systematic review is to identify and describe parental factors associated with the risk of childhood overweight and obesity in low- and middle-income countries.
    • An exploration of family influences on perceptions of maternal competence among UK-born South Asian mothers in Britain

      Puthussery, Shuby; Twamley, Katherine; Harding, Seeromanie; Macfarlane, Alison; University of Bedfordshire; University College London; University of Glasgow; City University London (2015)
    • The forgotten people: drug problems in later life

      Wadd, Sarah; Galvani, Sarah; University of Bedfordshire (The Big Lottery Fund, 2014-07)
      In March 2014, the Big Lottery Fund (the FUND) commissioned the Substance Misuse and Ageing Research Team (SMART) at the University of Bedfordshire to carry out a short scoping study to provide: An overview of the scale, nature and consequences of drug misuse in older people across the UK. An understanding of the extent to which substance misuse strategies in the four UK countries address the issue. Guidance on what action is most needed and where investment from independent and statutory funders might be most useful. The findings are based on analysis of existing data, a summative review of relevant policy and published literature and interviews with professionals.
    • Alcohol, other drugs and sight loss: a scoping study

      Galvani, Sarah; Livingston, Wulf; Morgan, Hannah; Wadd, Sarah; Manchester Metropolitan University; University of Bedfordshire; Glyndwr University; Lancaster University (Alcohol Research UK, 2014-12)
      The research team and Thomas Pocklington Trust have produced a guide for professionals working in substance use and sight loss.
    • Developing a community alcohol support package: an exploration with a Punjabi Sikh community

      Galvani, Sarah; Manders, Gary; Wadd, Sarah; Chaudhry, Shaheen; University of Bedfordshire (University of Bedfordshire, 2013-12)
      The objective of this research was to explore the feasibility of developing a Community Alcohol Support Package (CASP)
    • Alcohol misuse and cognitive impairment in older people

      Wadd, Sarah; Randall, James; Thake, Anna; Edwards, Kim; Galvani, Sarah; McCabe, Louise; Coleman, Alan; University of Bedfordshire; Bedford Community Mental Health Team for Older People; South Essex Partnership NHS Foundation Trust; et al. (Alcohol Research UK, 2013-12)
      The main objectives of this study were to explore: The extent and nature of cognitive impairment in older people (aged 55 and over) attending substance misuse services in the UK for alcohol problems. The difficulties which substance misuse services face when working with clients with cognitive impairment and how treatment can be modified to take account of cognitive difficulties. The extent to which older people attending substance misuse services find screening with the Montreal Cognitive Assessment (Nasreddine, et al., 2005) acceptable. The extent to which older people with a diagnosis of mild cognitive impairment or early stage dementia can be screened for alcohol problems using standard alcohol screening tools. The extent to which NHS memory assessment services are screening their clients for alcohol problems and the challenges they face in doing so.
    • Use as abuse: a feasibility study of alcohol-related elder abuse

      Sullivan, Mary Pat; Gilhooly, Mary; Victor, Christina; Gilhooly, Ken; Wadd, Sarah; Ellender, Nick; Brunel University; University of Bedfordshire; London Borough of Hillingdon (Alcohol Research UK, 2014-01)
      The purpose of this feasibility study was to collect substantive pilot data to scope the extent of alcohol-related elder abuse and neglect, and evaluate data sources and research methods to consider the development of a larger study on the role of alcohol misuse in cases of elder abuse and neglect.
    • Crisis intervention for people with severe mental illnesses

      Murphy, Suzanne; Irving, Claire B.; Adams, Clive E.; Waqar, Muhammad (Cochrane Library, 2015-12-03)
      Background A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis-intervention models of care were developed as a possible solution. Objectives To review the effects of crisis-intervention models for anyone with serious mental illness experiencing an acute episode compared to the standard care they would normally receive. If possible, to compare the effects of mobile crisis teams visiting patients' homes with crisis units based in home-like residential houses. Search methods We searched the Cochrane Schizophrenia Group’s Study-Based Register of Trials. There is no language, time, document type, or publication status limitations for inclusion of records in the register. This search was undertaken in 1998 and then updated 2003, 2006, 2010 and September 29, 2014. Selection criteria We included all randomised controlled trials of crisis-intervention models versus standard care for people with severe mental illnesses that met our inclusion criteria. Data collection and analysis We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assessed risk of bias for included studies and used GRADE to create a 'Summary of findings' table. Main results The update search September 2014 found no further new studies for inclusion, the number of studies included in this review remains eight with a total of 1144 participants. Our main outcomes of interest are hospital use, global state, mental state, quality of life, participant satisfaction and family burden. With the exception of mental state, it was not possible to pool data for these outcomes. Crisis intervention may reduce repeat admissions to hospital (excluding index admissions) at six months (1 RCT, n = 369, RR 0.75 CI 0.50 to 1.13, high quality evidence), but does appear to reduce family burden (at six months: 1 RCT, n = 120, RR 0.34 CI 0.20 to 0.59, low quality evidence), improve mental state (Brief Psychiatric Rating Scale (BPRS) three months: 2 RCTs, n = 248, MD -4.03 CI -8.18 to 0.12, low quality evidence), and improve global state (Global Assessment Scale (GAS) 20 months; 1 RCT, n = 142, MD 5.70, -0.26 to 11.66, moderate quality evidence). Participants in the crisis-intervention group were more satisfied with their care 20 months after crisis (Client Satisfaction Questionnaire (CSQ-8): 1 RCT, n = 137, MD 5.40 CI 3.91 to 6.89, moderate quality evidence). However, quality of life scores at six months were similar between treatment groups (Manchester Short Assessment of quality of life (MANSA); 1 RCT, n = 226, MD -1.50 CI -5.15 to 2.15, low quality evidence). Favourable results for crisis intervention were also found for leaving the study early and family satisfaction. No differences in death rates were found. Some studies suggested crisis intervention to be more cost-effective than hospital care but all numerical data were either skewed or unusable. We identified no data on staff satisfaction, carer input, complications with medication or number of relapses. Authors' conclusions Care based on crisis-intervention principles, with or without an ongoing homecare package, appears to be a viable and acceptable way of treating people with serious mental illnesses. However only eight small studies with unclear blinding, reporting and attrition bias could be included and evidence for the main outcomes of interest is low to moderate quality. If this approach is to be widely implemented it would seem that more evaluative studies are still needed
    • Warfarin and aspirin in patients with heart failure and sinus Rhythm

      Homma, Shunichi; Thompson, John L.P.; Pullicino, Patrick M.; Levin, Bruce; Freudenberger, Ronald S.; Teerlink, John R.; Ammon, Susan E.; Graham, Susan; Sacco, Ralph L.; Mann, Douglas L.; et al. (New England Journal of Medicine, 2012-05-17)
    • Value of serum pregnancy-associated plasma protein A for predicting cardiovascular events among patients presenting with cardiac chest pain

      von Haehling, Stephan; Doehner, Wolfram; Jankowska, Ewa A.; Ponikowski, Piotr; Stellos, Konstantinos; Puntmann, Valentina O.; Nagel, Eike; Anker, Stefan D.; Gawaz, Meinrad; Bigalke, Boris; et al. (Canadian Medical Association, 2013-04-16)
      Pregnancy-associated plasma protein A (PAPP-A) has been suggested as a candidate marker for the identification of unstable plaques in coronary arteries. We assessed the value of PAPP-A for predicting short-term cardiovascular events in a large cohort of patients presenting with cardiac chest pain.
    • Ursodeoxycholic acid in patients with chronic heart failure: a double-blind, randomized, placebo-controlled, crossover trial

      von Haehling, Stephan; Schefold, Joerg C.; Jankowska, Ewa A.; Springer, Jochen; Vazir, Ali; Kalra, Paul R.; Sandek, Anja; Fauler, Günter; Stojakovic, Tatjana; Trauner, Michael; et al. (American College of Cardiology, 2012-02-07)
      This study sought to assess the effects of ursodeoxycholic acid (UDCA) on endothelial function and inflammatory markers in patients with chronic heart failure (CHF).
    • UK-born ethnic minority women and their experiences of feeding their newborn infant

      Twamley, Katherine; Puthussery, Shuby; Harding, Seeromanie; Baron, Maurina; Macfarlane, Alison; City University; University of Glasgow (Elsevier, 2011-10)
      to explore the factors that impact on UK-born ethnic minority women's experiences of and decisions around feeding their infant.
    • The behaviour of young children with social communication disorders during dyadic interaction with peers

      Murphy, Suzanne; Faulkner, Dorothy; Farley, Laura R. (Springer, 2014-02)
      Children with social communication disorders are known to experience more problematic peer relations than typically-developing children. However, detailed observation of their behaviour and communication during interaction with peers has not previously been undertaken. Micro-analytic observational methods were used to analyse the audio-taped interaction of children (N = 112) selected from mainstream schools (ages 5-6 years-old) on a computerised dyadic collaborative task. Comparisons were made between children with average-to-high- and low-pragmatic language skill as measured by the Test of Pragmatic Skills. Dyads were composed of an average-to-high-skilled child plus a low-skilled child (32 dyads), or of two average-to-high-skilled children (24 dyads). Consistently with their pragmatic language scores, low-skilled children were more likely to ignore other children's questions and requests than were average-to-high-skilled children. When average-to-high-skilled children worked with low-skilled children, as opposed to with other average-to-high-skilled children, they showed some sensitivity and adaptation to these children's difficulties; they used significantly more directives, clarification and provided more information. However, there was a cost in terms of the emotional tone of these interactions; when working with low-skilled children, the average-to-high-skilled children expressed considerably more negative feelings towards their partners than with another average-to-high-skilled child. In conclusion, observation of the interaction of average-to-high- and low-skilled children suggests promise for peer-assisted interventions and specifies which communicative behaviours could be targeted. However, care should be taken to manage the affective climate of these interactions for the benefit of all children involved.
    • Talking about end-of-life care: the perspectives of older South Asians living in East London

      Venkatasalu, Munikumar R.; Arthur, Antony; Seymour, Jane; Northumbria University; University of East Anglia; University of Nottingham (SAGE, 2013-07-02)
      The National End-of-life Care Strategy for England identifies that a lack of open discussion about death and dying can be a barrier to achieving good quality end-of-life care. South Asians constitute the single largest ethnic minority group in the United Kingdom, yet little is known about their attitudes and expectations towards the discussion of death and dying. In this study, set in East London, five focus groups and 29 in-depth, semi-structured interviews were conducted with a total of 55 older adults aged between 52 and 78 years. Participants from six South Asian ethnic groups were recruited from 11 local community organisations. A constructivist grounded theory approach was used to analyse the data. Findings revealed two key themes which capture the perspectives of older South Asian study participants towards end-of-life care discussions. The theme ‘avoidance as a cultural norm’ relates to the relative absence of discussions around death and dying experienced by participants. Participants neither expected to have discussions about their own death and dying within their family, nor to assume any involvement in decision-making. The second theme ‘avoidance as protection’ relates to beliefs and experiences about the delegation of decision-making to family members. Future research should explore the perspectives of second-generation adult children towards end-of-life care discussions.
    • Simvastatin reduces wasting and improves cardiac function as well as outcome in experimental cancer cachexia

      Palus, Sandra; von Haehling, Stephan; Flach, Valerie C.; Tschirner, Anika; Doehner, Wolfram; Anker, Stefan D.; Springer, Jochen; Charité Medical School; IRCCS San Raffaele; University of East Anglia (Elsevier, 2013-10-09)
      Chronic inflammation is common in cancer cachexia (CC) and directly involved in the atrophy seen in this condition. Recently, several groups have described a form of cardiomyopathy in CC animal models. Hence, we investigated the effect of simvastatin with its known anti-inflammatory and cardioprotective effects in a rat model of CC.
    • Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project

      Rodríguez-Mañas, Leocadio; Féart, Catherine; Mann, Giovanni; Viña, Jose; Chatterji, Somnath; Chodzko-Zajko, Wojtek; Gonzalez-Colaço Harmand, Magali; Bergman, Howard; Carcaillon, Laure; Nicholson, Caroline; et al. (Oxford University Press, 2013-01)
      Background. There is no consensus regarding the definition of frailty for clinical uses. Methods. A modified Delphi process was used to attempt to achieve consensus definition. Experts were selected from different fields and organized into five Focus Groups. A questionnaire was developed and sent to experts in the area of frailty. Responses and comments were analyzed using a pre-established strategy. Statements with an agreement more than or equal to 80% were accepted. Results. Overall, 44% of the statements regarding the concept of frailty and 18% of the statements regarding diagnostic criteria were accepted. There was consensus on the value of screening for frailty and about the identification of six domains of frailty for inclusion in a clinical definition, but no agreement was reached concerning a specific set of clinical/laboratory biomarkers useful for diagnosis. Conclusions. There is agreement on the usefulness of defining frailty in clinical settings as well as on its main dimensions. However, additional research is needed before an operative definition of frailty can be established.
    • Prevention of liver cancer cachexia-induced cardiac wasting and heart failure

      Springer, Jochen; Tschirner, Anika; Haghikia, Arash; von Haehling, Stephan; Lal, Hind; Grzesiak, Aleksandra; Kaschina, Elena; Palus, Sandra; Pötsch, Maeike; von Websky, Karoline; et al. (Oxford University Press, 2013-08-29)
      Aims Symptoms of cancer cachexia (CC) include fatigue, shortness of breath, and impaired exercise capacity, which are also hallmark symptoms of heart failure (HF). Herein, we evaluate the effects of drugs commonly used to treat HF (bisoprolol, imidapril, spironolactone) on development of cardiac wasting, HF, and death in the rat hepatoma CC model (AH-130). Methods and results Tumour-bearing rats showed a progressive loss of body weight and left-ventricular (LV) mass that was associated with a progressive deterioration in cardiac function. Strikingly, bisoprolol and spironolactone significantly reduced wasting of LV mass, attenuated cardiac dysfunction, and improved survival. In contrast, imidapril had no beneficial effect. Several key anabolic and catabolic pathways were dysregulated in the cachectic hearts and, in addition, we found enhanced fibrosis that was corrected by treatment with spironolactone. Finally, we found cardiac wasting and fibrotic remodelling in patients who died as a result of CC. In living cancer patients, with and without cachexia, serum levels of brain natriuretic peptide and aldosterone were elevated. Conclusion Systemic effects of tumours lead not only to CC but also to cardiac wasting, associated with LV-dysfunction, fibrotic remodelling, and increased mortality. These adverse effects of the tumour on the heart and on survival can be mitigated by treatment with either the β-blocker bisoprolol or the aldosterone antagonist spironolactone. We suggest that clinical trials employing these agents be considered to attempt to limit this devastating complication of cancer.
    • Overweight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial

      Doehner, Wolfram; Schenkel, Johannes; Anker, Stefan D.; Springer, Jochen; Audebert, Heinrich J. (Oxford University Press, 2013-01)
      The aim of the study was to evaluate the association of the body mass index (BMI) with mortality and with non-fatal functional outcome in patients with acute stroke or transient ischaemic attack (TIA). Obesity is an established risk factors in primary cardiovascular disease prevention including stroke. The impact of overweight in patients with stroke or TIA on secondary fatal and non-fatal functional outcomes is less well established.