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Understanding the experience of service users in an integrated care programme for obesity and mental health: a qualitative investigation of Total Wellbeing LutonObesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semistructured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users’ experiences of integrated care: (1) ‘A user-centered system’, (2) ‘Supports behaviour change’, (3) ‘Valued social support’, (4) ‘Communication is key’, (5) ‘Flexible referral process’, and (6) ‘Positive impact on life’. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme.
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Vaccination against COVID-19: factors that influence vaccine hesitancy among an ethnically diverse community in the UKThe UK’s minority ethnic population, despite being at higher risk of COVID-19 and experiencing poorer health outcomes, continue to have lower uptake of the COVID-19 vaccine compared with their white British counterparts. Given the importance of the vaccination programme in improving health outcomes, this research sought to examine the influential factors that impact the decision to accept the COVID-19 vaccination among an ethnically diverse community. A total of 1058 residents from Luton, UK, a large town with an ethnically diverse population, completed a community survey. Questions centred around uptake or individuals’ intentions to accept the offer of COVID-19 vaccination alongside demographics, knowledge, and views on the vaccine. A binary logistic regression analysis was conducted to determine the most significant predictors of vaccine hesitancy, while respondents’ reasons for not getting vaccinated were identified using qualitative content analysis. Findings revealed that age and ethnicity were the only sociodemographic factors to predict vaccine hesitancy. Knowledge of symptoms and transmission routes, alongside ensuring information about COVID-19 was objectively sourced, were all identified as protective factors against vaccine hesitancy. Qualitative analysis revealed that ‘lack of trust in government/authori-ties’ and ‘concern of the speed of vaccine development’ were the most common reasons for non-uptake. This research reinforces the importance of age, ethnicity, and knowledge as influential factors in predicting vaccine hesitancy. Further, this study uncovers some of the barriers of uptake that can be utilised in developing promotional campaigns to reduce vaccine hesitancy in certain sections of the diverse UK population.
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‘They are kids, let them eat’: a qualitative investigation into the parental beliefs and practices of providing a healthy diet for young children among a culturally diverse and deprived population in the UKIn the UK, ethnic minority children are at greater risk of obesity and weight-related ill health compared to the wider national population. The factors that influence the provision of a healthy diet among these populations remain less understood. An interpretive qualitative study with a phenomenological perspective comprised of 24 single sex semi-structured focus groups was conducted with 110 parents (63 mothers and 47 fathers) of young children (aged 0–5 years). The participants were recruited from deprived and ethnically diverse wards in Luton, UK and self-identified as being white British, Pakistani, Bangladeshi, black African–Caribbean or Polish. The findings highlighted a wide range of inter-relating psychological and sociocultural factors that underpin parental beliefs and practices in providing children with a healthy diet. Parents, whilst aware of the importance of providing children with a healthy diet, faced challenges such as lack of time and balancing competing responsibilities, which were clear barriers to providing children with a healthy diet. Access to and affordability of healthy food and the overexposure of cheap, convenient, and unhealthy processed foods made it increasingly difficult for parents to provide a healthy diet for their growing families. Household food practices were also found to be situated within the wider context of sociocultural and religious norms around cooking and eating, along with cultural identity and upbringing.
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The genotoxic potential of mixed nitrosamines in drinking water involves oxidative stress and Nrf2 activationNitrosamine by-products in drinking water are designated as probable human carcinogens by the IARC, but the health effects of simultaneous exposure to multiple nitrosamines in drinking water remain unknown. Genotoxicity assays were used to assess the effects of both individual and mixed nitrosamines in finished drinking water produced by a large water treatment plant in Shanghai, China. Cytotoxicity and genotoxicity were measured at 1, 10-, 100- and 1000-fold actual concentrations by the Ames test, Comet assay, γ-H2AX assay, and the cytokinesisblock micronuclei assay; oxidative stress and the Nrf2 pathway were also assessed. Nitrosamines detected in drinking water included NDMA (36.45 ng/L), NDPA (44.68 ng/L), and NEMA (37.27 ng/L). Treatment with a mixture of the three nitrosamines at 1000-fold actual drinking-water concentration induced a doubling of revertants in Salmonella typhimurium strain TA100, DNA and chromosome damage in HepG2 cells, while 1–1000-fold concentrations of compounds applied singly lacked these effects. Treatment with 100- and 1000-fold concentrations increased ROS, GSH, and MDA and decreased SOD activity. Thus, nitrosamine mixtures showed greater genotoxic potential than that of the individual compounds. N-Acetylcysteine protected against the nitrosamine-induced chromosome damage, and Nrf2 pathway activation suggested that oxidative stress played pivotal roles in the genotoxic property of the nitrosamine mixtures.
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Evaluating an antimicrobial stewardship programme implemented in an intensive care unit of a large academic hospital, using the RE-AIM frameworkBackground. The threat of antimicrobial resistance driven by inappropriate and unnecessary use of antimicrobials is a global issue of great concern. Evidence-based approaches to optimising antimicrobial prescribing to improve patient care while reducing the rate of antimicrobial resistance continue to be implemented worldwide. However, the successes or failures of implementation of such approaches are seldom evaluated. Objectives. To evaluate the impact of an implemented antimicrobial stewardship programme (ASP) in reducing the spread of antimicrobial resistance in the intensive care unit (ICU) of a large academic hospital using the RE-AIM framework. Methods. A descriptive quasi-experimental study was conducted with adult patients who had been admitted to the ICU of an academic hospital in Johannesburg, South Africa. Data were extracted from patients' records using a structured questionnaire. Descriptive statistics of four RE-AIM dimensions (reach, effectiveness, adoption and implementation) and the overall impact of the implemented antimicrobial stewardship programme were calculated. Results. From the 59 participant records, 21 patients (35.6%) developed hospital-acquired infections and all were prescribed antimicrobials during their stay in the ICU. Twenty-seven pathogens (bacterial species) were isolated from samples acquired from the patients, including Staphylococcus aureus (n=6; 22.2%), Escherichia coli (n=4; 14.8%), Acinetobacter baumannii (n=4; 14.8%) and Streptococcus pnuemoniae (n=3; 11.11%), as well as 10 other bacterial species (37.0%) including Corynebacterium species, Enterococcus faecium, Haemophilus influenzae, Klebsiella species, Clostridium difficile and Salmonella species. Of the 27 pathogens isolated, 19 (70.4 %) were resistant to the prescribed antimicrobials. The overall impact of the ASP implemented in the studied facility was 67.2%. Conclusions. An ASP requires both thorough implementation and leadership support to have an impact in the reduction of antimicrobial resistance. Lack of leadership support poses a significant challenge to sustainability. There is an urgent need for behavioural change in hospital leadership.
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Should the family have a role in deceased organ donation decision-making? a systematic review of public knowledge and attitudes towards organ procurement policies in EuropeGoal: To assess public knowledge and attitudes towards the family's role in deceased organ donation in Europe. Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection were performed by two or more independent reviewers for each record. Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. Conclusions: Public views on the authority of the family in organ donation decision-making requiere further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation.
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The role of CDK4 in the pathogenesis of pancreatic cancerPancreatic cancer (PC) continues to have the lowest overall survival and the lack of effective early diagnosis. Cyclin-dependent kinase 4 (CDK4) plays a fundamental role in the orderly progression of the cell cycle, binding to cyclin D to promote the progression through the G1/2 transition. The inhibition of CDK4/6 has therefore gained substantial interest in the hope of new and effective therapeutics in multiple cancers, such as advanced metastatic breast cancer. While the use of these agents is encouraging, their potential is yet to be fully explored. In this study we used the GLOBOCAN database to understand the most recent epidemiology of PC, Human Protein Atlas and KEGG to highlight the role, prevalence, and significance on patient survival of CDK4 in PC. We found that CDK4 cannot be used as prognostic in PC and no significant differences were observed between CDK4 expression and the patient’s clinical status, though larger studies, especially concerning CDK4 protein expressions, are required for a more thorough understanding. The use of CDK4/6 inhibitors in PC is still in clinical trials. However, due to only modest improvements observed in the use of single-agent therapies, efforts have focused on combinatorial approaches.
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Enabling women to access preferred methods of contraception: a rapid review and behavioural analysisMany pregnancies in the UK are either unplanned or ambivalent. This review aimed to (i) explore barriers and facilitators to women choosing and accessing a preferred method of contraception in the United Kingdom, and (ii) identify opportunities for behavioural interventions based on examination of interventions that are currently available nationally. Three databases were searched, and experts contacted to identify grey literature for studies presenting barriers and facilitators to women choosing and accessing a preferred method of contraception, conducted in the UK and published between 2009 and October 2019. Information on barriers and facilitators were coded into overarching themes, which were then coded into Mechanisms of Actions (MoAs) as listed in the Theory and Techniques Tool. National interventions were identified by consulting stakeholders and coded into the Behaviour Change Wheel. The match between barriers/facilitators and intervention content was assessed using the Behaviour Change Wheel. We included 32 studies and identified 46 barrier and facilitator themes. The most cited MoA was Environmental Context and Resources, which primarily related to the services women had access to and care they received. Social Influences, Beliefs about Consequences (e.g., side effects) and Knowledge were also key. The behavioural analysis highlighted four priority intervention functions (Modelling, Enablement, Education and Environmental Restructuring) that can be targeted to support women to choose and access their preferred method of contraception. Relevant policy categories and behaviour change techniques are also highlighted. This review highlights factors that influence women's choices and access to contraception and recommends opportunities that may be targeted for future interventions in order to support women to access preferred contraception. Protocol was registered with PROSPERO (an international database of prospectively registered systematic reviews in health and social care) in December 2019, CRD42019161156 .
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Prevalence of Human Immunodeficiency Virus among pregnant women in NigeriaBackground Human Immunodeficiency Virus (HIV) infection among pregnant women has been associated with a number of adverse maternal and infant outcomes. Nigeria accounts for about 10% of the HIV/AIDS burden worldwide and has the second highest incidence of new HIV infections among women globally. This study estimated the overall prevalence of HIV among pregnant women in Nigeria and examined variations across the geo-political zones of the country. Methods We conducted a systematic review and meta-analysis. A comprehensive search was conducted using eight electronic databases and grey sources for studies published from 1·1·2008 to 31·8·2019. Primary studies reporting prevalence estimates of HIV among pregnant women diagnosed using a diagnostic/ screening test were identified, screened and appraised using a two-stage process. A meta-analysis was conducted with the primary outcome measure as proportion (%) of pregnant women identified as having HIV infection. Results Twenty three eligible studies involving 72,728 pregnant women were included in the meta-analysis. The overall pooled prevalence of HIV among pregnant women was 7·22% (95% CI: 5·64, 9·21). A high degree of heterogeneity (I2=97·2%) and publication bias (p = 0.728) was reported. Prevalence rate for South-East geo-political zone (17·04%, 95% CI: 9·01, 29·86) was higher compared to the overall prevalence. Conclusions Findings imply that 7 out of every 100 pregnant women in Nigeria are likely to have HIV infection. The magnitude of the issue highlight the need for targeted efforts at local, national and international levels towards prevention, diagnosis and treatment.
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Negotiating difference and belonging in families from mixed racial, ethnic and faith backgrounds in Britain: Implications for mental healthPoster presentations: abstracts Key points * Mixed-parent couples in Britain were often in sustained relationships, and a high proportion were middle class. * The couples interviewed used three typical approaches to instil a sense of belonging in their children; particular approaches were not associated with particular racial or faith combinations: o Individual: children's sense of belonging was not seen as rooted in their mixed background. o Mix: children's mixed background was understood as a factual part of their identity; all aspects were emphasised. o Single: one aspect of children's mixed background was stressed. * Couples whose approach differed in giving their children a sense of belonging were not necessarily in conflict. For some, divergent approaches were complementary. Others saw difficulties between them as humanistic, political or personality choices. * Parents identified supportive or constraining resources and relationships in creating a sense of belonging, including neighbourhoods, schools, travel, languages, grandparents and children themselves. What some regarded as supportive, others saw as drawbacks. * Mixed-parent couples can be more concerned with other issues, such as children's safety and health, unity over discipline and financial security. * The researchers conclude that it is important that family support, health, education and social services do not make assumptions about mixed families. Families who seem to share a form of mixing can differ from each other. 'Mixedness' may be insignificant for some, compared to other issues. Mixed families would benefit from policies and practice that further tackle prejudice based on race and faith.
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Acceptability and effectiveness of multi-media delivery of an exercise programme among postpartum women with lumbo pelvic pain in TaiwanRegistration of study Background and study aims Lumbo Pelvic Pain (LPP) is a common problem among pregnant women and those that have given birth within the last year (postnatal). LPP may lead to sleep problems, depression, fatigue and anxiety, and a general inability to carry out activities that involve carrying or lifting. Various treatments have been used to reduce LPP in general including physical exercise although the effect of exercise programmes in treating back pain is yet to be fully understood among postnatal women. In any case, new mothers in many Asian countries, such as Taiwan, tend to reduce physical activity after birth in accordance with traditional practices. Mothers in Taiwan receive verbal advice on exercise to be followed in the postnatal period by health care professionals before their discharge from hospital. Most of the hospitals also provide the women with a leaflet containing details of an exercise programme to manage postpartum LPP commonly referred to as back pain. However, very little is known about the uptake of this exercise programme or its benefits for postnatal women. Technology has been increasingly used in health care to deliver various treatments and technology based delivery can improve the uptake of exercise among certain groups. How acceptable different methods of teaching the exercises, using digital or print media are and how they might affect how many postnatal women take up the exercise, adhere to it and complete an exercise programme has yet to be understood. Taiwan has a world-leading position in technology with 80% of all households owning personal computers and around 84% households with high speed internet connection. This study assesses the effectiveness of an exercise programme (the intervention) designed to strengthen abdominal and global muscles delivered using Digital Versatile Disc (DVD), Internet or leaflet, on LPP among postnatal women in Taiwan, and to compare exercise uptake, adherence and completion rates.
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Effectiveness of nutrition interventions in low-and middle-income countries: a meta-reviewBackground: Undernutrition remains an unfinished agenda for a majority of low- and middle-income countries (LMICs). Numerous nutrition interventions have been implemented in LMICs and various indicators have been used to measure the impact of these interventions. The aim of this meta-review was to summarise the findings on the effectiveness of various nutrition interventions that have been implemented in LMICs on the WHO global nutrition targets-related outcomes. The six outcomes are- reducing stunting, wasting, anemia among women of reproductive age, low birthweight, childhood overweight, and improving exclusive breastfeeding. This study presents the results for one of the outcomes (stunting). Methods: We conducted a comprehensive search on 21 electronic databases, including six regional and four systematic reviews (SRs) specific databases. Two researchers independently screened identified records against the inclusion criteria. Quality of included SRs were assessed using the AMSTAR tool. Extracted data were narratively synthesised examining the direction of impact. The review protocol was registered with the EPPI-Centre. Results: Of 6,597 SRs initially identified, 28 SRs that assessed outcomes of WHO global nutrition targets-related outcomes were eligible for inclusion. We found 12 SRs that assessed stunting outcomes, these SRs synthesised 68 quantitative primary studies, from 29 LMICs. All included SRs were of high quality. Eight nutrition interventions were reported in the included SRs- five nutrition-specific (n=9) and three nutrition-sensitive (n=3). Among all interventions, two nutrition-specific (complementary feeding: n=1; dietary supplementation: n=2) interventions showed a positive effect. Conclusion: This meta-review identified, two interventions, complementary feeding and dietary supplementation, with most frequently reported evidence of positive impact on stunting. In LMICs, public health policymakers should consider these two interventions for scaling-up.
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How young, disadvantaged fathers are affected by socioeconomic and relational barriers: a UK-based qualitative studyThis article is based on the interviews of nine young, socially disadvantaged fathers from the UK. Young fathers are more likely to experience socioeconomic deprivation and disrupted pathways towards parenthood, which affect their participation in socially accepted trajectories of ‘father involvement’. Whilst this has received some attention in research, studies have largely neglected to examine the lived experiences of such fathers directly. The current article aims to address this gap, building upon the limited body of research that exists exploring the impact of socioeconomic and relational barriers on father involvement. In this study, three interrelated themes demonstrate the cyclical nature of generational disadvantage, reduced socioeconomic circumstances and disrupted relationships, providing a different perspective on the decreased levels of involvement exhibited by young fathers in prior research. The findings also enlighten our understanding of how these fathers can be better supported in policy and practice, thereby contributing to current academic debate.
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Effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth falteringProtocol for an ongoing systematic review focussed on the following review question: What is the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering?
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Barriers and facilitators to genetic testing amongst Black African women in the UKBackground Black African women have the lowest attendance of genetic testing services and the highest mortality rate of breast and ovarian cancer amongst women from ethnic minority groups in the UK. Therefore, this study aimed to identify the barriers and facilitators to genetic testing to enable these women to make informed choices if found eligible. Methods A qualitative approach was used to explore the perceptions surrounding genetic testing amongst Twenty-four women aged 23-57 Black African women in Luton. Purposive sampling combined with snowballing sampling was used as a recruitment technique. Results The findings revealed that most of the participants had no awareness or knowledge of genetic testing and limited knowledge of their family medical history for eligibility to attend genetic testing services. Facilitators including family member's health, funding by the National Health services and accessibility and awareness and education on genetic testing were identified. Conclusions This study sought to explore the perceptions of Black African women on barriers and facilitators to genetic testing to enable researchers to implement efficient intervention that would increase genetic testing attendance whilst addressing the other barriers and facilitators to alter Black African's women health seeking behaviours.
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First-time mothers’ experiences of foetal reduction in pregnancy following assisted reproductive technology treatment in Taiwan: a qualitative studyBackground Foetal reduction—removal of one or more foetuses to reduce the number of foetuses in multiple conceptions—is a procedure used for improving pregnancy outcomes following assisted reproductive technology (ART) treatment. While there is a recognition of the importance of understanding the experiences of women who undergo foetal reduction to offer appropriate help and support, studies that provide relevant insights are sparse. Our aim was to gain an in-depth understanding about first-time mothers’ experiences of foetal reduction following ART treatment in Taiwan. Methods We adopted a qualitative design based on a phenomenological approach for this study. In-depth semi-structured interviews were conducted with seven first-time mothers who underwent foetal reduction following ART treatment at a fertility centre in Taipei, Taiwan. All interviews were recorded, transcribed and analysed using the Colaizzi strategy. Results The views and experiences relating to foetal reduction reflected five key themes: hesitation, ambivalence and distress; the guilt of knowingly terminating a life; rituals and ceremonies to ease the sense of guilt; persuading oneself to consider the ‘big picture’; and wishing for a reunion in next pregnancy. Mothers often regretted that they took clinical advice to implant multiple embryos and then having had to resort to foetal reduction. There was a sense of hesitation, ambivalence and distress reflected in the views from all participants. They believed that they ended the fetuses’ lives knowingly and expressed strong feelings of guilt. Mothers often tried to persuade themselves to look at foetal reduction within the ‘big picture’ of the overall pregnancy outcome. Losing their unborn babies was as an unforgettable incident for most mothers, and they wished for a reunion with the lost baby in the next pregnancy. Conclusion Findings indicate the need for ART providers to undertake a more sensitive approach that involves detailed discussions with women and their families to tailor the embryo transfer processes to suit individual needs. Women who undergo foetal reduction should be provided with tailored interventions towards enhancing their coping strategies before and after foetal reduction taking into account the cultural and religious context.
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Racial and ethnic differences in falls among older adults: a systematic review and meta‑analysisThe aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.
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Ethnic minority women’s experiences of accessing antenatal care in high income European countries: a meta-synthesis of qualitative studiesProtocol for an ongoing systematic review focussed on the following review question: What are the key themes reflected in ethnic minority women’s experiences of accessing antenatal care in European countries?
