• Decentralising health services: a global perspective

      Regmi, Krishna (Springer Publication, 2014-01-01)
    • Demography in public health intelligence

      Gee, Ivan; Regmi, Krishna (Springer International Publishing, 2016-12-31)
      Demography is the scientific study of human population. For the last few decades, demographic models and methods have been frequently used to analyse or measure the births, deaths and migration within human populations. Public health practitioners and public health analysts regularly require information about health demography, which deals with the contents and methods of demography within the context of health and healthcare. In other words, health demography deals with the demographic attributes that may infl uence or concern health status and health behaviour, as well as the health-related phenomena which infl uence the demographic attributes of the population (Pol and Thomas 2013). Following an overview of health demography, this chapter will discuss the nature and extent of public health problems within the context of present and future patterns of demographic change. This chapter will also highlight some applications, concepts and methods related to health. After reading this chapter you should be able to: • Define the concept and meaning of populations • Discuss the nature and extent of public health problems within the context of present and future patterns of demographic change • Examine sources of population data and their strengths and weaknesses.
    • Design and validation of the Grip-ball for measurement of hand grip strength

      Jaber, Rana; Hewson, David; Duchêne, Jacques (Elsevier, 2012-12-01)
      The Grip-ball is a new dynamometer used to evaluate grip strength, as well as for use in home-based rehabilitation of the hand and forearm. The Grip-ball consists of pressure and temperature sensors and an electronic wireless communication system contained in an airtight ball. That can be inflated to different pressures. The device has advantages over standard dynamometers in that it looks like a simple ball, and can wirelessly communicate via Bluetooth to any compatible receiver, thus have potential to be used for clinical assessment and rehabilitation in a remote setting. The reliability and reproducibility of the device were assessed for the pressure sensor itself, as well as the relationship between the force applied and the pressure measured by the Grip-ball. The initial validation was performed using the pressure sensor without the ball in order to confirm the accuracy of the sensor used. A second validation study was conducted using the Grip-ball rather than just its sensor to examine the relationship between the pressure measured inside the ball and force applied. The results showed that there is a very good correlation (r=0.997, p<0.05) between the pressure measured by the Grip-ball sensor and that measured by a Vigorimeter, thus confirming the reliability of the sensor used in the Grip-ball. A quadratic regression equation was calculated in order to predict the force applied based on the pressure measured inside the ball, and the initial pressure to which the ball was inflated (R(2)=0.97, standard error 10.9N). Such a finding compares favourably with the variability inherent in Jamar recordings, thus indicating that the Grip-ball could be used to assess grip force. An industrial version of the Grip-ball, which is currently under development, will be able to be used for the entire range of grip force in the population.
    • Designing an experimental and a reference robot to test and evaluate the impact of cultural competence in socially assistive robotics

      Recchiuto, Carmine Tommaso; Papadopoulos, Chris; Hill, Tetiana; Castro, Nina; Bruno, Barbara; Papadopoulos, Irena; Sgorbissa, Antonio; University of Genova; University of Bedfordshire; Advinia Healthcare; et al. (IEEE, 2020-01-13)
      The article focusses on the work performed in preparation for an experimental trial aimed at evaluating the impact of a culturally competent robot for care home assistance. Indeed, it has been estabilished that the user's cultural identity plays an important role during the interaction with a robotic system and cultural competence may be one of the key elements for increasing capabilities of socially assistive robots. Specifically, the paper describes part of the work carried out for the definition and implementation of two different robotic systems for the care of older adults: a culturally competent robot, that shows its awareness of the user's cultural identity, and a reference robot, non culturally competent, but with the same functionalities of the former. The design of both robots is here described in detail, together with the key elements that make a socially assistive robot culturally competent, which should be absent in the non-culturally competent counterpart. Examples of the experimental phase of the CARESSES project, with a fictional user are reported, giving a hint of the validness of the proposed approach.
    • Detection of the critical point interval of postural control strategy using wavelet transform analysis

      Singh, Neeraj Kumar; Snoussi, Hichem; Hewson, David; Duchêne, Jacques; Universite de Technology de Troyes (Scitepress, 2009-12-31)
    • Development of a monitoring system for physical frailty in independent elderly

      Hewson, David; Jaber, Rana; Chkeir, Aly; Hammoud, Ali; Gupta, Dhruv; Bassement, Jennifer; Vermeulen, Joan; Yadav, Sandeep; de Witte, Luc P.; Duchêne, Jacques; et al. (IEEE, 2013-12-31)
      Frailty is of increasing concern due to the associated decrease in independence of elderly who suffer from the condition. An innovative system was designed in order to objectively quantify the level of frailty based on a series of remote tests, each of which used objects similar to those found in peoples' homes. A modified ball, known as the Grip-ball was used to evaluate maximal grip force and exhaustion during an entirely remote assessment. A smartphone equipped with a tri-axial accelerometer was used to estimate gait velocity and physical activity level. Finally, a bathroom scale was used to assess involuntary weight loss. The smart phone processes all of the data generated, before it is transferred to a remote server where the user, their entourage, and any medical professionals with authorization can access the data. This innovative system could enable the onset of frailty to be detected early, thus giving sufficient time for a targeted intervention program to be implemented, thereby increasing independence for elderly users.
    • The development of a stigma support intervention to improve the mental health of family carers of autistic children: suggestions from the autism community

      Lodder, Annemarie; Papadopoulos, Chris; Randhawa, Gurch (Akadémiai Kiadó, 2019-06-03)
      Parents and family carers of autistic children report poorer mental health than any other parents. Stigma surrounding autism plays a significant role in the mental health of family carers of autistic children, often leaving families feeling isolated. Yet there are currently no interventions available to support families with stigma. In order to guide the design and development of an intervention to improve the psychological well-being of parents and carers of autistic children by addressing the stigma they may experience, we surveyed the autism community (n = 112) about their views and suggestions to make such intervention more successful. The thematic analysis of the qualitative responses revealed that respondents wished for public awareness to be raised and suggested that education would be the key to this. Respondents also – recommended that parental self-esteem and self-compassion skills should be increased and that they would benefit from ‘ready-made’
    • Development of a system that provides tailored feedback and advice to elderly people regarding physical functioning

      Vermeulen, Joan; Neyens, Jacques C.L.; Spreeuwenberg, Marieke D.; van Rossum, Erik; Sipers, Walther; Hewson, David; de Witte, Luc P. (IOS Press, 2011-12-31)
      Objective: To collaborate with relevant stakeholders and end-users to develop an innovative and feasible system that monitors physical functioning and provides tailored feedback and advice to community-dwelling elderly people. Main content of paper: Technological innovations can contribute to bridging the gap between demand and supply of care in frail elderly people. The progression of physical functioning in elderly people can be monitored using technology and via the same technology, functioning-related feedback and advice can be provided to the elderly user and care providers. This may support self-management. However, when developing and introducing new technology, it is important that relevant stakeholders and end-users accept the technology and are able to use it. Therefore, a feedback and advisory system was developed in close collaboration with elderly people, engineers, researchers, geriatricians, physiotherapists, and other health care professionals. All these stakeholders provided input during interviews and expert-meetings on issues such as: which physical indicators should be measured, how (often) should they be measured, how should feedback and advice be provided, and how to embed the technology in daily living and in health care? During this iterative process, aspects of the system were adjusted based on the input of all stakeholders. Results: The technological system that was developed consists of three devices; a bathroom scale monitoring weight and balance, a Grip-ball monitoring grip strength and a mobile phone with a built-in accelerometer monitoring physical activity and gait. The information about these physical indicators is sent to the mobile phone via blue-tooth. The users will receive feedback and advice regarding their own physical functioning on the screen of the mobile phone using text messages and/or spoken messages. The tailored advices relate to individually relevant and realistic goals that aim to maintain or improve physical functioning. The mobile phone also sends the information to an online database that is accessible for care professionals. Conclusion: In collaboration with different stakeholders and end-users, an innovative feedback and advisory system was developed for community-dwelling elderly people. The system can also be used by health care professionals to monitor the progression of physical functioning of their clients. By ensuring that all relevant stakeholders and end-users were able to provide their input during the development process, the feasibility and acceptability of the current system have been optimized. This resulted in a unique system that might relief part of the burden that frailty places on elderly people and on health care systems.
    • Development of an instrumented chair to identify the phases of the sit-to-stand movement

      Shukla, Brajesh K.; Jain, Hiteshi; Singh, Sandeep; Vijay, Vivek; Yadav, Sandeep; Hewson, David; Indian Institute of Technology Jodhpur; University of Bedfordshire (Springer Science and Business Media Deutschland GmbH, 2020-11-30)
      Instrumented versions of functional geriatric screening tests have been developed to improve clinical precision. Several different instrumented versions of the Sit-to-Stand (iSTS) test have been developed using a range of sensors such as accelerometers and cameras. An instrumented chair equipped with load cells and an ultrasound sensor was developed to detect phases of the STS (Sit to Stand). The chair was designed to be able to detect all the phases of the STS, including when the person was not in contact with the chair. Performance of the iSTS chair was compared between an RGB camera approach, and a data-fusion approach using the load-cell and ultrasound equipped chair. Ten adult subjects were tested performing the 5STS at two self-selected speeds. The accuracy of the load cell equipped chair was 70%, while the RGB camera achieved 76% accuracy. The ultrasound version of the chair and the fusion of the RGB and load cells technique both achieved significantly better accuracy at 86% and 89%, respectively. The new version of the instrumented chair obtained a high degree of accuracy in detecting the different phases of the STS and is suitable to detect STS phases without requiring additional sensors. Future work will test older subjects and aim to develop new parameters based on the phases of the STS as indicators of physical performance.
    • Developmental associations between victimization and body mass index from 3 to 10 years in a population sample

      Qualter, Pamela; Murphy, Suzanne; Abbott, Janice; Gardner, Kathryn J.; Japel, Christa; Vitaro, Frank; Boivin, Michel; Tremblay, Richard E. (Wiley periodicals inc, 2015-02-17)
      In the current prospective study, we investigated (1) whether high and low BMI in early childhood puts a child at risk of victimization by their peers, and (2) whether being victimized increases BMI over the short- and long-term, independent of the effect of BMI on victimization. We also examined whether gender moderated these prospective associations. Participants were 1,344 children who were assessed yearly from ages 3 to 10 years as part of the Québec Longitudinal Study of Child Development (QLSCD). BMI predicted annual increases in victimization for girls aged 6 years and over; for boys aged 7 and 8 years of age, higher BMI reduced victimization over the school year. Further, victimization predicted annual increases in BMI for girls after age 6 years. When these short-term effects were held constant, victimization was also shown to have a three and 5-year influence on annual BMI changes for girls from age 3 years. These short- and long-term cross-lagged effects were evident when the effects of family adversity were controlled. The findings support those from previous prospective research showing a link between higher BMI and victimization, but only for girls. Further, being victimized increased the likelihood that girls would put on weight over time, which then increased future victimization. The implications of these prospective findings for interventions are considered. 
    • Diagnosis and decision-making in telemedicine

      Pappas, Yannis; Vseteckova, Jitka; Mastellos, Nikolas; Greenfield, Geva; Randhawa, Gurch; University of Bedfordshire; Open University; Imperial College London (SAGE, 2018-10-08)
      This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider-patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care-specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decision-making. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients.
    • Differences in the pregnancy gestation period and mean birth weights in infants born to Indian, Pakistani, Bangladeshi and white British mothers in Luton, UK: a retrospective analysis of routinely collected data

      Garcia, Rebecca; Ali, Nasreen; Guppy, Andy; Griffiths, Malcolm; Randhawa, Gurch; University of Bedfordshire; Luton & Dunstable University Hospital NHS Foundation Trust (BMJ Publishing, 2017-08-11)
      Objective To compare mean birth weights and gestational age at delivery of infants born to Indian, Pakistani, Bangladeshi and white British mothers in Luton, UK. Design Retrospective analysis using routinely recorded secondary data in Ciconia Maternity information System, between 2008 and 2013. Setting Luton, UK. Participants Mothers whose ethnicity was recorded as white British, Bangladeshi, Pakistani or Indian and living in Luton, aged over 16, who had a live singleton birth over 24 weeks of gestation were included in the analysis (n=14 871). Outcome measures Primary outcome measures were mean birth weight and gestational age at delivery. Results After controlling for maternal age, smoking, diabetes, gestation age, parity and maternal height and body mass index at booking, a significant difference in infants’ mean birth weight was found between white British and Indian, Pakistani and Bangladeshi infants, F(3, 12 287)=300.32, p<0.0001. The partial Eta-squared for maternal ethnicity was η2=0.067. The adjusted mean birth weight for white British infants was found to be 3377.89 g (95% CI 3365.34 to 3390.44); Indian infants, 3033.09 g (95% CI 3038.63 to 3103.55); Pakistani infants, 3129.49 g (95% CI 3114.5 to 3144.48); and Bangladeshi infants, 3064.21 g (95% CI 3041.36 to 3087.06). There was a significant association in preterm delivery found in primipara Indian mothers, compared with Indian mothers (Wald=8.192, df 1, p<0.005). Conclusions Results show important differences in adjusted mean birth weight between Indian, Pakistani, Bangladeshi and white British women. Moreover, an association was found between primipara Indian mothers and preterm delivery, when compared with Pakistani, Bangladeshi and white British women.
    • The differential incorporation of CAM into the medical establishment: the case of acupuncture and homeopathy in Portugal

      Almeida, Joana (2014-12-17)
      This paper examines the differential incorporation of acupuncture and homeopathy into the medical establishment in Portugal. While the former has been incorporated into the medical establishment, the latter is still banned by the Medical Council, yet remains in practice by medical doctors in the country. Drawing on the insider viewpoints of medical doctors committed to these two therapies, the findings of this paper suggest that the rhetoric of insufficient scientific evidence of homeopathy still prevails within the medical establishment. However, two other factors were emphasised: the medical prejudice or ‘resistance to innovation’ of the Portuguese Medical Council and the idiosyncrasies of acupuncture and homeopathy, which have made them amendable to biomedicine (or not). This paper argues that the differential responses of the Portuguese medical establishment to acupuncture and homeopathy are due to reasons beyond that given of the medical rhetoric of insufficient scientific evidence for homeopathy, and which extend to issues of professional status and power. This paper suggests that the emerging commercial interest of the pharmaceutical industry in homeopathy’s pharmacopeia worldwide could enhance homeopathy’s status in the country and could therefore pressurise the medical orthodoxy to redress its position towards this therapy.
    • Do predictors of mental health differ between home and international students studying in the UK?

      Penn-Jones, Catrin Pedder; Lodder, Annemarie; Papadopoulos, Chris (Emerald, 2019-04-08)
      Purpose Previous research has found that international students can experience poor mental health, low levels of life satisfaction, self-esteem and high levels of loneliness when studying in a foreign country. No study has directly compared these between international and home students studying in the UK. The paper aims to discuss these issues. Design/methodology/approach A total of 247 students completed an online survey at the University of Bedfordshire. Findings The hypothesis that international students experience higher loneliness, lower self-esteem, lower life satisfaction and poorer general mental health than home students was rejected. Home students had significantly lower self-esteem, life satisfaction and general mental health scores. Black ethnicity and home student status significantly predicted general mental health and self-esteem in regression analyses. The predictive utility of home student status was maintained when other variables were controlled for in regression models. Originality/value This research suggests that the UK universities should ensure that both home and international students are adequately supported for their mental health.
    • Does clinical simulation stimulate higher order thinking and the skills of higher order thinking in medical education?

      Beckwith, Philip (CASA, 2018-01-20)
      Higher Education Institutions (HEI’s) have invested in high fidelity clinical simulation centres incorporating all three areas of the perioperative pathway. It is suggested clinical simulation contributes to increased patient safety and is therefore encouraged in undergraduate operating department practice (ODP) courses (College of Operating Department Practice [CODP], 2011). A search of the literature, however, fails to uncover studies of the effectiveness of clinical simulation in the field of operating department practice. Studies from medicine and nursing exist, albeit from the perspective of the students’ experience and the lecturers’ delivering the simulation. The reapproved Diploma of Higher Education Operating Department Practice resulted in the introduction of clinical simulation in the first term whilst the classroom instruction remained unchanged. Therefore a comparison can be drawn between the cohort with classroom instruction only and the following cohort that received the blended theory and simulated learning.
    • Does intentional asphyxiation by strangulation have addictive properties?

      Chater, Angel M.; University of Bedfordshire (Wiley, 2020-09-04)
      Background and aims Intentional asphyxiation leads to cerebral hypoxia, starving the brain of oxygen and inducing hypoxic euphoria, but carries a serious risk of accidental death, especially if practised alone. This article raises the question as to whether it could usefully be regarded as having addictive properties. Methods and results A review of the literature, together with eight case study vignettes, are presented. Intentional asphyxiation can occur with or without sexual activity. Initiation often occurs in adolescence, with development in some cases of an entrenched behaviour pattern, driven by a strong euphoriant effect, without adequate safeguarding from serious harm, and being undertaken by people with co‐morbidities. There does not appear to be strong evidence of seeking support for cessation of the practice. Discussion Intentional asphyxiation behaviours may have addictive properties and understanding this aspect of the problem may be fruitful in guiding research and interventions aimed at addressing it.
    • Does the use of a serious game and the grip-ball decrease discomfort in older people when assessing maximal grip-strength?

      Chkeir, Aly; Voilmy, Dimitri; Duchêne, Jacques; Hewson, David; University of Technology of Troyes (Springer, 2016-09-17)
      Grip strength testing is a common tool in healthcare evaluation due its predictive ability for a range of concerns including nutritional status, fall risk, and frailty. With respect to frailty, grip strength is one of the Fried criteria, which is the most widely used frailty assessment tool. One problem with maximal grip strength testing is that values might underestimate maximal force due to problems with motivation or discomfort associated with the maximal test. An innovative serious game using the Grip-ball dynamometer was designed to measure grip strength in comparison to the frailty threshold of Fried. Discomfort levels were assessed using a visual-analogue scale for the Serious Game, the Grip-ball in a standard test, and the Jamar dynamometer, which is the gold standard for grip-strength testing. Discomfort was significantly higher for the Jamar, which had a 95% confidence interval of 6.2-7.5, in comparison to 1.5-2.4 for the Grip-ball and 0.7-1.3 for the Serious Game. The Serious Game was able to identify individuals who were not able to produce sufficient grip force to pass the Fried threshold for frailty, while improving comfort levels for the users when compared to a Jamar dynamometer.
    • Domo-Grip: functional evaluation and rehabilitation using grip

      Hewson, David; Li, Ke; Frèrejean, Alexis; Hogrel, Jean-Yves; Duchêne, Jacques (IEEE, 2010-11-11)
      Grip force measurement is routinely used to identify pathologies, evaluate muscular function, and as part of rehabilitation. Grip force has also been shown to be a good indicator of the capacity of elderly to live independently owing to its strong relationship with clinical tests such as the Index of Activities of Daily Living. An autonomous, communicant grip-force measurement device is presented in this paper in order to perform grip-force evaluation at home. The Domo-Grip system consists of the Grip-Ball, the Grip-Box, and Grip-Soft. The Grip-Ball measures the pressure resulting from grip force, the Grip-Box serves as the communication hub, while Grip-Soft is an interactive software suite. The Domo-Grip system can be used as part of a home-based rehabilitation, and also for functional evaluation as part of an assessment of the capacity of elderly to live autonomously.
    • Driving anger in Ukraine: appraisals, not trait driving anger, predict anger intensity while driving

      Stephens, A.N.; Hill, Tetiana; Sullman, M.J.M. (Elsevier Ltd, 2015-12-16)
      Trait driving anger is often, but not always, found to predict both the intensity of anger while driving and subsequent crash-related behaviours. However, a number of studies have not found support for a direct relationship between one's tendency to become angry and anger reported while driving, suggesting that other factors may mediate this relationship. The present self-report study investigated whether, in anger provoking driving situations, the appraisals made by drivers influence the relationship between trait and state anger. A sample of 339 drivers from Ukraine completed the 33-item version of the Driver Anger Scale (DAS; Deffenbacher et al.; 1994) and eight questions about their most recent experience of driving anger. A structural equation model found that the intensity of anger experienced was predicted by the negative evaluations of the situation, which was in turn predicted by trait driving anger. However, trait driving anger itself did not predict anger intensity; supporting the hypothesis that evaluations of the driving situation mediate the relationship between trait and state anger. Further, the unique structure of the DAS required to fit the data from the Ukrainian sample, may indicate that the anger inducing situations in Ukraine are different to those of a more developed country. Future research is needed to investigate driving anger in Ukraine in a broader sample and also to confirm the role of the appraisal process in the development of driving anger in both developed and undeveloped countries.
    • The EASR corpora of European Portuguese, French, Hungarian and Polish elderly speech

      Hamalainen, Annika; Avelar, Jairo; Rodrigues, Silvia; Dias, Miguel Sales; Kolesinski, Artur; Fegyo, Tibor; Nemeth, Geza; Csobanka, Petra; Lan, Karine; Hewson, David (European Language Resources Association, 2014-12-31)
      Currently available speech recognisers do not usually work well with elderly speech. This is because several characteristics of speech (e.g. fundamental frequency, jitter, shimmer and harmonic noise ratio) change with age and because the acoustic models used by speech recognisers are typically trained with speech collected from younger adults only. To develop speech-driven applications capable of successfully recognising elderly speech, this type of speech data is needed for training acoustic models from scratch or for adapting acoustic models trained with younger adults’ speech. However, the availability of suitable elderly speech corpora is still very limited. This paper describes an ongoing project to design, collect, transcribe and annotate large elderly speech corpora for four European languages: Portuguese, French, Hungarian and Polish. The Portuguese, French and Polish corpora contain read speech only, whereas the Hungarian corpus also contains spontaneous command and control type of speech. Depending on the language in question, the corpora contain 76 to 205 hours of speech collected from 328 to 986 speakers aged 60 and over. The final corpora will come with manually verified orthographic transcriptions, as well as annotations for filled pauses, noises and damaged words.