• Exploring factors that impact the decision to use assistive telecare: perspectives of family care-givers of older people in the United Kingdom

      Cook, Erica Jane; Randhawa, Gurch; Guppy, Andrew; Sharp, Chloe; Barton, Garry; Bateman, Andrew; Crawford-White, Jane; University of Bedfordshire; University of East Anglia; Cambridgeshire Community Services (Cambridge University Press, 2017-05-01)
      In the United Kingdom (UK), an ageing population met with the reduction of social care funding has led to reduced support for older people marked with an increased demand on family care-givers. Assistive telecare (AT) devices are viewed as an innovative and effective way to support older people. However, there is limited research which has explored adoption of AT from the perspectives of family care-givers. In-depth, semi-structured interviews were conducted with 14 family care-givers of patients who used the Assistive Telehealth and Telecare service in Cambridgeshire, UK. Family care-givers were either the spouse (N = 8) or child of the patient (N = 6). The patients' age ranged from 75 to 98, and either received a telecare standalone device or connected service. Framework analysis was used to analyse the transcripts. This study revealed that family care-givers play a crucial role in supporting the patient's decision to adopt and engage with AT devices. Knowledge and awareness, perceived responsibility, usefulness and usability, alongside functionality of the equipment, were influential factors in the decision-making process. AT devices were viewed positively, considered easy to use, useful and functional, with reassurance of the patient's safety being a core reason for adoption. Efforts to increase adoption and engagement should adapt recruitment strategies and service pathways to support both the patient and their care-giver.
    • Exploring how newly qualified dentists perceive certain legal and ethical issues in view of the GDC standards

      Thakrar, Bindiya; Wassif, Hoda; Denchic Dental Spa; University of Bedfordshire (Springer Nature, 2021-03-11)
      Introduction This study focuses on how the legal and ethical requirements presented by the General Dental Council (GDC) in their Standards for the dental team (2013) document are perceived by newly qualified dentists; that is, those who have been qualified for less than five years.Aim The aim of the study was to investigate how the GDC guidance and the set standards for the dental team are perceived and understood by newly qualified dental practitioners, and how the guidance and the standards influence clinicians' decision-making. The study explored the newly qualified dentists' exposure to law and ethics, the GDC and their regulatory document, together with the clinical and non-clinical influence of this regulation on daily practice.Methods Empirical qualitative data were collected using semi-structured interviews of nine newly qualified dentists, with an average of 80 minutes for each interview. The data were analysed using thematic analysis.Results Three main themes were identified through the newly qualified dentists' perceptions of the GDC selected standards. These included sense of fear, morale and the business of dental practice, with further subthemes identified.Conclusion Results from this study present an opportunity and a challenge, as there is some fear and uncertainty among newly qualified dentists about the application of some of the GDC standards in practice. Further training in law and ethics as well as additional support for newly qualified dental practitioners is needed.
    • Exploring the factors that influence the decision to adopt and engage with an integrated assistive telehealth and telecare service in Cambridgeshire, UK: a nested qualitative study of patient ‘users’ and ‘non-users’

      Cook, Erica Jane; Randhawa, Gurch; Sharp, Chloe; Ali, Nasreen; Guppy, Andy; Barton, Garry; Bateman, Andrew; Crawford-White, Jane; University of Bedfordshire (BioMed Central, 2016-04-19)
      Background: There is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare. Methods: Qualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of ‘users’ and ‘non-users’ using this service. ‘Users’ were defined as patients who used the service (N = 28) with ‘non-users’ defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method. Results: This study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on ‘usability’, ‘usefulness of equipment’, and ‘threat to identity and independence’. Conclusions: The paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more negative feelings towards technology. In addition, there is a clear need for continued product development and innovation to not only increase usability and functionality of equipment but also to motivate other sections of the population who could benefit from such services. Uncovering these factors has important policy implications in how services can improve access and patient support through the application of assistive technology which could in turn reduce unnecessary cost and burden on overstretched health services.
    • Exploring the use of action research to stimulate and evaluate workplace health promotion

      Wilkinson, Emma; Elander, Elizabeth; Woolaway, Martin; Bedfordshire Health Authority (Sage, 1997-06-01)
      This article descrbes a health authority's approach to setting up and evaluating a coronary heart disease prevention programme through the workplace.  The Bedfordshire Healthy Workplace Project was set up in 1992 to 'stinulate interest and activity in workplace health promotion' and has developed an action research model to evaluate the impact of working with local employers on coronary heart disease risk behaviour.  Action research as a methdology for health promotion research, and some of the main benefits and barriers are discussed.
    • Facilitators and barriers of implementing and delivering social prescribing services: a systematic review

      Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch; University of Bedfordshire (BioMed Central, 2018-02-07)
      BACKGROUND: Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. METHODS: We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. RESULTS: Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. CONCLUSION: The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers to guide the implementation and delivery of future Social Prescribing services. More high quality research and transparent reporting of findings is needed in this field
    • Factors associated with the implementation of non-pharmaceutical interventions for reducing coronavirus disease 2019 (COVID-19): a systematic review

      Regmi, Krishna; Lwin, Cho Mar; University of Bedfordshire; University of Dundee; University of Medicine Mandalay (MDPI, 2021-04-17)
      There has been much discussion recently about the importance of implementing nonpharmaceutical interventions (NPIs) to protect the public from coronavirus disease 2019 (COVID19) infection. Different governments across the world have adopted NPIs (e.g., social distancing, quarantine, isolation, lockdowns, curfews, travel restrictions, closures of schools and colleges). Two fundamental strategies, namely a strict containment strategy—also called suppression strategy— and a mitigation strategy have been adopted in different countries, mainly to reduce the reproduction number (R) to below one and hence to reduce case numbers to low levels or eliminate humanto-human transmission, as well as to use NPIs to interrupt transmission completely and to reduce the health impact of epidemics, respectively. However, the adoption of these NPI strategies is varied and the factors impacting NPI are inconsistent and unclear. This study, therefore, aimed to review the factors associated with the implementation of NPIs (social distancing, social isolation and quarantine) for reducing COVID-19. Following PRISMA guidelines, we searched for published and unpublished studies, undertaking a systematic search of: MEDLINE, EMBASE, Allied and Complementary Medicine, COVID-19 Research, WHO database on COVID-19, and Google Scholar. Thirtythree studies were included in the study. Seven descriptive themes emerged on enablers and barriers to NPIs: the positive impact of NPIs, effective public health interventions, positive change in people’s behaviour and concerns about COVID-19, the role of mass media, physical and psychological impacts, and ethnicity/age associated with COVID-19. This study has highlighted that the effectiveness of NPIs in isolation is likely to be limited, therefore, a combination of multiple measures e.g., SD, isolation and quarantine, and workplace distancing appeared more effective in reducing COVID-19. Studies suggest that targeted approaches alongside social distancing might be the way forward, and more acceptable. Further research to promote country- and context-specific adoption of NPIs to deliver public health measures is needed. Studies comparing the effectiveness of interventions and strategies will help provide more evidence for future pandemics.
    • Factors impacting social distancing measures for preventing coronavirus disease 2019 [COVID-19]: a systematic review

      Regmi, Krishna; Lwin, Cho Mar (Research Square, 2020-06-23)
      This is a preprint. Preprints are preliminary reports that have not undergone peer review. They should not be considered conclusive, used to inform clinical practice, or referenced by the media as validated information. Background: Social distancing measures (SDMs) protect the health of the public from coronavirus 2019 (COVID-19) infection. However, the impact of SDMs has been inconsistent and unclear. This study aims to review the factors impacting SDMs (e.g. isolation, quarantine) for reducing the transmission of COVID-19. Methods: A systematic review was conducted. We searched MEDLINE, EMBASE, Allied & Complementary Medicine, COVID-19 Research and WHO database on COVID-19 for primary studies assessing the enablers and barriers associated with SDMs, and reported in accordance with PRISMA statement. We used JBI Critical Appraisal Checklist for the cross-sectional survey and Qualitative Research to assess the methodological qualities and synthesised performing thematic analysis. Two reviewers independently screened the papers and extracted data. Results: A total of 1235 citations were identified, of which 16 were found to be relevant. The studies reported in two broad categories, under seven separate themes: positive impact of SDMs, effective public health interventions, positive change in people’s behaviour, worries and concerns about COVID-19, roles of mass media, physical and psychological impacts, and ethnicity/age associated with COVID-19. Conclusion: The identified evidence signals that SDMs are generally effective for preventing or reducing transmission. There is a scope and need to find the best methods and approaches at the primary healthcare level in terms of developing objective measures and interventions to establish the link between different factors and SDMs and reducing transmission of COVID-19 trend effectively, efficiently and equitably.
    • Factors in implementation of clinical commissioning policy in improving health and wellbeing and/or reducing health inequalities in the English NHS: a systematic review of the evidence

      Regmi, Krishna; Mudyarabikwa, Oliver; University of Bedfordshire; Coventry University (Research Square, 2020-06-25)
      This is a preprint. Preprints are preliminary reports that have not undergone peer review. They should not be considered conclusive, used to inform clinical practice, or referenced by the media as validated information. Objective: This study aimed to identify and synthesise the factors in implementing clinical commissioning policy in improving health and/or reducing health inequalities in the English NHS. Methods: Systematic review was conducted. We searched Medline, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies that assessed the enablers and barriers, and reported in accordance with PRISMA statement. Methodological quality was appraised using JBI Critical Appraisal tools and Mixed Methods Appraisal Tool [MMAT] to assess the methodological qualities, and synthesised performing thematic analysis. Two reviewers independently screened the papers and extracted data. Results: We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: agenda of health inequalities not fully addressed; poor evidence for reducing health inequalities; reform through restructuring of organisations, and strategic approaches. Conclusion: This study provides useful factors – enablers and barriers – to implement and deliver clinical commissioning policy in improving health and wellbeing. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities improving equitable access, health outcomes and effective partnerships.
    • Factors influencing HIV disclosure among people living with HIV/AIDS in Nigeria: a systematic review using narrative synthesis and meta-analysis

      Adeoye, Dorcas Ibukun; Evans, Hala; Hewson, David; Pappas, Yannis; University of Bedfordshire (Elsevier, 2016-04-05)
      Objectives: To critically review, appraise and evaluate quality of evidence on HIV disclosure among people living with HIV/AIDS (PLWHA) in Nigeria, and to identify a possible gap in knowledge on HIV/AIDS and disclosure.Study design: A systematic review using narrative synthesis and meta-analysis.Methods: MedLine, PsycINFO, PubMed Central, Scopus and CINAHL were searched. Data were extracted with the use of spread sheet. An analysis of heterogeneity was performed for the disclosure rate and the presence of a supportive reaction from partners. A metaanalysis was performed for the disclosure rates to sexual partners, with data available for all ten studies.Results: Ten studies met the inclusion criteria. The outcomes show that HIV disclosure of sero-positive status is most common between spouses or sexual partners than disclosure to relatives/family members, friends, pastor/Imam or work colleagues/employers. The participants in most of these studies are women, and amongst the most influential factors on disclosure are gender, anticipated outcome, marital status and knowledge of partners' status. Some studies reported non-disclosure as a way of limiting stigma. Almost all of the studies highlighted that there is fear of stigma and social exclusion associated with disclosure.Conclusion: This review discusses the overall experience of HIV disclosure on the management of the disease and barriers to disclosure. We found that PLWHA in Nigeria disclosed to at least one person within their social networks. Stigma is still a major consideration for PLWHA who experience a range of misconceptions around HIV transmission. The findings of this study may inform local policies and plans for improving the PLWHA quality of life. Targeted policies to increase disclosure of sero-positive status and reduce stigma may facilitate disease prevention. The methodological rigour of the included studies was appraised low. (C) 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
    • Factors that facilitate or hinder whole system integrated care for obesity and mental health: a scoping review protocol

      Liapi, Fani; Chater, Angel M.; Randhawa, Gurch; Pappas, Yannis; University of Bedfordshire (BMJ, 2021-08-10)
      Integrated care aims to improve population health. Obesity and mental health are major health issues worldwide. The complexity of the multifactorial drivers of these public health problems has led to the adoption of a whole system approach. This review aims to highlight factors that influence the planning, implementation and evaluation of whole system integrated care for these conditions. Using the framework of Arksey and O' Malley, we will perform a comprehensive search in the following databases: MEDLINE, CINAHL, PsychINFO, PubMed, British Nursing Database, Web of Science, Health Systems Evidence, Cochrane Library and University of York Centre for Reviews and Dissemination. Further hand-search of reference lists and the grey literature will be conducted. The search will be restricted to articles published from 2000 to 2020. The review is expected to be completed by August 2021. Full texts of the potential studies will be screened for the inclusion criteria. Quality of studies will be appraised. Narrative synthesis will be completed using data extracted from the included studies. A favourable ethics opinion for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC937). This review expects to identify information relating to factors that facilitate or hinder whole system integrated care for obesity and mental health. The finding from this review will be widely disseminated to stakeholders to inform implementation of whole system integrated care initiatives.
    • Faculty development: learning from the student whilst developing the higher order thinking skills of right-to-try adult learners within the higher education setting: a self-directed reflective process

      Beckwith, Mary A.R.; Beckwith, Philip; University of Bedfordshire (Chinese American Scholars Association, 2015-01-01)
      Two members of the Operating Department Practice (ODP) lecturing team were surprised to receive poor National Student Survey results surrounding student assessment feedback despite positive remarks from the external examiners. A studentcentred intervention was sought that would encourage meaningful engagement with their assessment feedback by employing self-directed and reflective learning that would aid in the development of the higher-order thinking so vitally needed in the students’ pursuit of providing quality perioperative patient care. A learning activity involving positive reinforcement of the feedback through the use of the Reflectionfor-Learning model (Beckwith & Beckwith, 2008) was created. This intervention asks students to engage in this Reflection-for-Learning process and articulate their personal action plan based upon their assessment feedback. This method has led to improvements in learner engagement with the assessment feedback and a 100% overall satisfaction rating from the students in a subsequent National Student Survey. An unexpected development has been the movement toward a mutually supportive relationship between lecturers and students as students transform into empowered learners willing to shape their own learning experiences.
    • Father's involvement in pregnancy and early years and its impact on children's development among families living in Luton's most disadvantaged areas

      Donald, Louisa; Puthussery, Shuby; Davidson, Rosemary; Randhawa, Gurch; University of Bedfordshire (2016-02-17)
      With consistent and positive father involvement, child outcomes are significantly better. However, father involvement exists within a family, which exists within a social context, and it is therefore influenced and determined, to varying degrees, by a variety of external, societal, familial and economic factors. It is therefore observable that in vulnerable areas, or circumstances, father involvement is impacted as is child development. Luton has consistently performed significantly worse than the England average for a variety of outcomes and has increased in rank from the 69th most deprived area of 326 authorities to the 59th between the years 2010 and 2015 (Public Health England, 2016, Department of Health, 2011, Research and Geospatial Information, 2015).
    • Faulty genes: consanguinity in the Pakistani community’

      Ali, Nasreen; McLean, Carl; Rehman, Hamid; University of Bedfordshire; ICM Research; ETHNOS Research and Consultancy (Emerald Publishing, 2012-06-22)
      Purpose – This paper seeks to discuss the attitudes and beliefs of the Pakistani/Kashmiri community in Birmingham towards the cultural practice of consanguineous (cousin) marriage and health, and how an understanding of Pakistani/Kashmiri community views may help institute good practice for health care professionals. Design/methodology/approach – A qualitative research study using eight gender‐ and age‐specific focus group discussions and eight in‐depth one‐to‐one interviews with participants who were in consanguineous relationships. All participants were from the Pakistani/Kashmiri community and residents of Springfield ward in Birmingham. Findings – The findings illustrate Pakistani/Kashmiri attitudes towards consanguinity and health. There was awareness of still births and genetic conditions but a poor understanding of genetics; respondents were reluctant to accept the link between cousin marriages and birth issues and explanations for still births and impairments were largely attributed to the “will of God”. Female respondents were in favour of screening for genetic conditions but would not terminate pregnancies as this was contrary to Islamic ideas about pre‐destiny and all respondents wanted more medical and Islamic scholarly information on cousin marriage and how it is linked to disabilities. Clearly there is a need to improve healthcare outcomes and reduce infant mortality in the Pakistani/Kashmiri community. Research limitations/implications – Research findings correspond with previous studies that have explored ethnic minority knowledge and attitudes to health and healthcare services and the need for culturally competent services.
    • The feasibility of finger prick autologous blood (FAB) as a novel treatment for severe dry eye disease (DED): protocol for a randomised controlled trial

      Balal, Shafi; Udoh, Arit; Pappas, Yannis; Cook, Erica Jane; Barton, Garry; Hassan, Ali; Hayden, Karen; Bourne, Rupert Richard Alexander; Ahmad, Sajjad; Pardhan, Shahina; et al. (BMJ, 2018-10-31)
      The research team at the two participating sites will approach patients with severe DED for this study. Recruitment will take place over 12 months and we expect to recruit 60 patients in total. The primary outcome of this feasibility study is to estimate the proportion of eligible patients approached who consent to and comply with study procedures including treatment regimen and completion of required questionnaires. The secondary outcome measures, although not powered for in this feasibility, include corneal inflammation (assessed by the Oxford corneal staining guide), patient pain and symptoms scores (assessed by the Ocular Surface Disease Index Score), and objective signs of DED as indicated by visual acuity (assessed by Schirmer's test, tear break-up time, lower and/or upper tear meniscus height measurement). Other secondary outcomes include patients' quality of life (assessed using the validated EQ-5D-5L Questionnaire), cost to the National Health Service (NHS) and patient (assessed via use of NHS services and privately purchased over-the-counter treatment related to DED) and safety measure of pressure within the eye (assessed by the Intraocular Pressure (IOP) Score). This protocol and any subsequent amendments, along with any accompanying material provided to the participant in addition to any advertising material used in this trial have been approved by the East of England - Cambridgeshire and Hertfordshire Research Ethics Committee (REC reference: 17/EE/0508). Written approval from the committee was obtained and subsequently submitted to the respective Trust's Research and Development (R&D) office with final NHS R&D approval obtained. Data obtained from this study will be published in a suitable peer-review journal and will also presented at international ophthalmic conferences including the American Academy of Ophthalmology, the Royal College of Ophthalmology Annual Congress, the Association for Research and Vision and Ophthalmology, and the European Society of Cataract and Refractive Surgery. Information will be provided to patient groups and charities such as the Sjogren's Society and the Royal National Institute of Blind People. This will also be shared with the study participants as well as with relevant patient groups and charities. NCT03395431; Pre-results. Patients with severe dry eye disease (DED) often have limited treatment options with standard non-surgical management focused on the use of artificial tears for lubrication and anti-inflammatory drugs. However, artificial tears do not address the extraordinary complexity of human tears. Crudely, human tears with its vast constituents is essentially filtered blood. Blood and several blood-derived products including autologous serum, have been studied as tear substitutes. This study proposes to test the use of whole, fresh, autologous blood obtained from a finger prick for treatment of severe DED. METHODS AND ANALYSIS ETHICS AND DISSEMINATION TRIAL REGISTRATION NUMBER INTRODUCTION
    • First-time mothers’ experiences of foetal reduction in pregnancy following assisted reproductive technology treatment in Taiwan: a qualitative study

      Huang, Mei-Zen; Sun, Yi-Chin; Gau, Meei-Ling; Puthussery, Shuby; Kao, Chien-Huei; ; National Taipei University of Nursing and Health Sciences; University of Bedfordshire (Biomed Central, 2021-11-02)
      Background 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.
    • First-time mothers’ experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan

      Huang, Mei-Zen; Sun, Yi-Chin; Gau, Meei-Ling; Puthussery, Shuby; Kao, Chien-Huei; National Tainan Junior College of Nursing; National Taipei University of Nursing and Health Sciences; University of Bedfordshire (BioMed Central, 2019-03-29)
      Background Assisted Reproductive Technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Method Twelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. Results The mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’; ‘ensuring health and safety of the foetus’; and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Conclusion Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes.
    • Fluency in the consulting room

      Ali, Nasreen (Royal College of General Practitioners, 2003-01-01)
    • Fractal time series analysis of postural stability in elderly and control subjects

      Amoud, Hassan; Abadi, Mohamed; Hewson, David; Michel-Pellegrino, Valerie; Doussot, Michel; Duchêne, Jacques (BioMed Central, 2007-05-01)
      The study of balance using stabilogram analysis is of particular interest in the study of falls. Although simple statistical parameters derived from the stabilogram have been shown to predict risk of falls, such measures offer little insight into the underlying control mechanisms responsible for degradation in balance. In contrast, fractal and non-linear time-series analysis of stabilograms, such as estimations of the Hurst exponent (H), may provide information related to the underlying motor control strategies governing postural stability. In order to be adapted for a home-based follow-up of balance, such methods need to be robust, regardless of the experimental protocol, while producing time-series that are as short as possible. The present study compares two methods of calculating H: Detrended Fluctuation Analysis (DFA) and Stabilogram Diffusion Analysis (SDA) for elderly and control subjects, as well as evaluating the effect of recording duration. Centre of pressure signals were obtained from 90 young adult subjects and 10 elderly subjects. Data were sampled at 100 Hz for 30 s, including stepping onto and off the force plate. Estimations of H were made using sliding windows of 10, 5, and 2.5 s durations, with windows slid forward in 1-s increments. Multivariate analysis of variance was used to test for the effect of time, age and estimation method on the Hurst exponent, while the intra-class correlation coefficient (ICC) was used as a measure of reliability. Both SDA and DFA methods were able to identify differences in postural stability between control and elderly subjects for time series as short as 5 s, with ICC values as high as 0.75 for DFA. Both methods would be well-suited to non-invasive longitudinal assessment of balance. In addition, reliable estimations of H were obtained from time series as short as 5 s. BACKGROUND METHODS RESULTS CONCLUSION
    • A fusion-based approach to identify the phases of the sit-to-stand test in older people

      Shukla, Brajesh K.; Jain, Hiteshi; Vijay, Vivek; Yadav, Sandeep; Hewson, David; Indian Institute of Technology Jodhpur; University of Bedfordshire (Institute of Electrical and Electronics Engineers Inc., 2020-04-06)
      Automated clinical tests that assess quality of geriatric screening tests such as the Five-Times-Sit- To-Stand (5STS) and the Timed-Up-and-Go (TUG) are being designed to assess the decline in functional ability of elderly. The existing techniques to assess the quality of these physical activities include sensor-based techniques including body mounted sensors, force sensors and, vision and imaging sensors. These sensors have their own advantages and disadvantages towards the task of clinical assessment. In this work, we introduce a fusion- based technique to combine multiple sensors leveraging advantages of individual sensors, in such a way that the resulting assessment is more accurate. We evaluate our technique for 5STS test using a fusion of a chair and RGB sensors. In a test of 15 older people, there was no significant difference in performance between the two sensors, obtaining 76% and 73% for the RGB and chair, respectively. However, a significant improvement was obtained for the fusion technique, with 90% accuracy for all the phases of the STS test. The proposed fusion technique was observed to be better than the individual sensor assessment.
    • The genotoxic potential of mixed nitrosamines in drinking water involves oxidative stress and Nrf2 activation

      Dong, Lei; Jiang, Zhiqiang; Yang, Lili; Hu, Fen; Zheng, Weiwei; Xue, Peng; Jiang, Songhui; Andersen, Melvin E.; Crabbe, M. James C.; Qu, Weidong; et al. (Elsevier, 2021-12-07)
      Nitrosamine 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.