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  • A 12 week double-blind randomised controlled trial investigating the effect of dietary supplementation with 5000 IU/day (125 µg/day) vitamin D in adults with asthma

    Mushtaq, Sohail; Watkins, Stephanie; Harrison, Tanja; University of Chester (Cambridge University Press, 2024-05-16)
    Vitamin D deficiency has previously been linked to higher rates of exacerbation and reduced lung function in asthmatics. Previous randomised controlled trials (RCT) investigating the effect of vitamin D supplementation have mainly focussed on children with asthma. Trials involving adults have typically used bolus dosing regimes and the main outcomes have been patient focussed without investigating underlying inflammation. The present study aimed to conduct a 12-week placebo-controlled RCT administering a daily 5000 IU (125 µg) vitamin D3 supplement to adults with mild to moderate asthma. A total of 32 participants were randomised to receive either the 5000 IU vitamin D3 supplement or an identical matching placebo. The primary outcome of the study was lung function measured by ratio of FEV1:FVC (effect size 2.5) with secondary outcomes including asthma symptoms and inflammatory biomarkers. There was a small but statistically significant higher increase in the mean (± SD) ratio of FEV1: FVC from baseline to post-intervention in the vitamin D group (+ 0.05 ± 0.06) compared to the placebo group (+ 0.006 ± 0.04, p = 0.04). There was no effect of the intervention on asthma control test scores, or the inflammatory biomarkers measured. There was a moderate, significant association between baseline plasma 25(OH)D concentration and baseline plasma IL-10 (r = 0.527, p = 0.005) and TNF-α (r = -0.498. p = 0.008) concentrations. A daily vitamin D3 supplement led to slightly improved lung function in adult asthmatics and may be a useful adjunct to existing asthma control strategies, particularly for individuals with suboptimal vitamin D status.
  • Characterisation of the Muscle Protein Synthetic Response to Resistance Exercise in Healthy Adults: A Systematic Review and Exploratory Meta-Analysis

    Davies, Robert W.; Lynch, Arthur E.; Kumar, Uttam; Jakeman, Philip M.; University of Chester; University of Limerick (Hindawi, 2024-04-30)
    Background and Objective: The rate of skeletal muscle protein synthesis (MPS) is the principal driving force underpinning the muscular adaptive response to resistance exercise (RE). This study aims to consolidate the literature, characterise MPS response to RE, and assess the impact of key covariates. Methods: Five electronic databases (PubMed (Medline), Web of Science, Embase, Sport Discus, and Cochrane Library) were searched for controlled trials that assessed the MPS response to RE in healthy, adult humans, postabsorptive state. Individual study and random-effects meta-analysis arewere used to inform the effects of RE and covariates on MPS. Results from 79 controlled trials with 237 participants were analysed. Results: Analysis of the pooled effects revealed robust increases in MPS following RE (weighted mean difference (WMD): 0.032% h−1, 95% CI: [0.024, 0.041] % h−1, I2 = 92%, k = 37, P<0.001). However, the magnitude of the increase in MPS was lower in older adults (>50 y: WMD: 0.015% h−1, 95% CI: [0.007, 0.022] % h−1, I2 = 76%, k = 12, P=0.002) compared to younger adults (<35 y: WMD: 0.041% h−1, 95% CI: [0.030, 0.052] % h−1, I2 = 88%, k = 25, P<0.001). Individual studies have reported that the temporal proximity of the RE, muscle group, muscle protein fraction, RE training experience, and the loading parameters of the RE (i.e., intensity, workload, and effort) appeared to affect the MPS response to RE, whereas sex or type of muscle contraction does not. Conclusion: A single bout of RE can sustain measurable increases in postabsorptive MPS soon after RE cessation and up to 48 h post-RE. However, there is substantial heterogeneity in the magnitude and time course of the MPS response between trials, which appears to be influenced by participants’ age and/or the loading parameters of the RE itself.
  • Exploring different stroke populations’ information needs: a cross-sectional study in England

    Harfoush, Allam; Chatterjee, Kausik; Deery, Elizabeth; Hamdallah, Hanady; University of Chester; Countess of Chester Hospital; Ulster University (BMC, 2024-05-06)
    Background: While tailored information might have the potential to motivate stroke survivors to make essential lifestyle changes and improve long-term outcomes, how this varies among different stroke populations is not yet fully understood. Method: From November 2022 to May 2023, stroke survivors in the UK, who were clinically stable, participated in a community-based, descriptive cross-sectional study. Participants rated several information themes on a Likert scale from one to five, indicating the relevance of each information group to them. Data were analysed using Wilcoxon and chi-squared tests on SPSS. Descriptive statistics were employed for examining the preferred information delivery method, timing, personnel, and frequency. Results: Seventy survivors, with an average age of 67 ± 19 (61% males), were recruited. Survivors emphasised the importance of symptoms, risk factors, and recovery information during hospital stay, while medication and lifestyle change information were more significant in the community. Subgroup analysis revealed distinct patterns: First-time stroke survivors highlighted the importance of social and financial support (acute phase median Likert score 3, chronic phase median Likert score 4; p < 0.01), while those with prior strokes emphasised information on driving and working after stroke (acute phase median Likert score 4, chronic phase median Likert score 3; p < 0.05). Survivors recruited after six months of stroke prioritised knowledge of carer support in the community (acute phase median Likert score 3.5, chronic phase median Likert score 4; p < 0.01). Conclusion: Survivors’ information needs differ depending on factors such as the recovery phase, type of stroke, time since diagnosis, and the presence of a previous stroke. Considering these factors is essential when developing or providing information to stroke survivors.
  • Correction: Wiśniewska et al. Heterospecific Fear and Avoidance Behaviour in Domestic Horses (Equus caballus). Animals 2021, 11, 3081

    Wiśniewska, Anna; Janczarek, Iwona; Wilk, Izabela; Tkaczyk, Ewelina; Mierzicka, Martyna; Stanley, Christina R.; Górecka‐Bruzda, Aleksandra; University of Life Sciences in Lublin; University of Chester; Polish Academy of Sciences (MDPI, 2022-08-10)
    Correction to original article
  • Non-alcoholic fatty liver disease and coexisting depression, anxiety and/or stress in adults: a systematic review and meta-analysis

    Shea, Sue; Lionis, Christos; Kite, Chris; Lagojda, Lukasz; Uthman, Olalekan; Dallaway, Alexander; Atkinson, Lou; Chaggar, Surinderjeet S.; Randeva, Harpal S.; Kyrou, Ioannis; et al. (Frontiers Media, 2024-04-16)
    Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease, affecting 25-30% of the general population globally. The condition is even more prevalent in individuals with obesity and is frequently linked to the metabolic syndrome. Given the known associations between the metabolic syndrome and common mental health issues, it is likely that such a relationship also exists between NAFLD and mental health problems. However, studies in this field remain limited. Accordingly, the aim of this systematic review and meta-analysis was to explore the prevalence of one or more common mental health conditions (i.e., depression, anxiety, and/or stress) in adults with NAFLD. Methods: PubMed, EBSCOhost, ProQuest, Ovid, Web of Science, and Scopus were searched in order to identify studies reporting the prevalence of depression, anxiety, and/or stress among adults with NAFLD. A random-effects model was utilized to calculate the pooled prevalence and confidence intervals for depression, anxiety and stress. Results: In total, 31 studies were eligible for inclusion, involving 2,126,593 adults with NAFLD. Meta-analyses yielded a pooled prevalence of 26.3% (95% CI: 19.2 to 34) for depression, 37.2% (95% CI: 21.6 to 54.3%) for anxiety, and 51.4% (95% CI: 5.5 to 95.8%) for stress among adults with NAFLD. Conclusion: The present findings suggest a high prevalence of mental health morbidity among adults with NAFLD. Given the related public health impact, this finding should prompt further research to investigate such associations and elucidate potential associations between NAFLD and mental health morbidity, exploring potential shared underlying pathophysiologic mechanisms. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021288934.
  • The long term effects of uncoupling interventions as a therapy for dementia in humans

    Holt, Alan G.; Davies, Adrian M. (Elsevier, 2024-04-15)
    In this paper we use simulation methods to study a hypothetical uncoupling agent as a therapy for dementia. We simulate the proliferation of mitochondrial deletion mutants amongst a population of wild-type in human neurons. Mitochondria play a key role in ATP generation. Clonal expansion can lead to the wild-type being overwhelmed by deletions such that a diminished population can no longer fulfil a cell's energy requirement, eventually leading to its demise. The intention of uncoupling is to reduce the formation of deletion mutants by reducing mutation rate. However, a consequence of uncoupling is that the energy production efficacy is also reduced which in turn increases wild-type copy number in order to compensate for the energy deficit. The results of this paper showed that uncoupling reduced the severity of dementia, however, there was some increase in cognitive dysfunction pre-onset of dementia. The effectiveness of uncoupling was dependent upon the timing of intervention relative to the onset of dementia and would necessitate predicting its onset many years in advance. [Abstract copyright: Copyright © 2024 Elsevier Ltd. All rights reserved.]
  • Decadal Analysis of ESBL-Escherichia coli Antibiotic Resistance Patterns in Urine Samples from Nepal: A Systematic Review and Meta-Analysis

    Rana Chhetri, Bibek; Thapa, Rajat; Banjara, Megha Raj; University of Chester; Angel Fertility Clinic, Kathmandu; Tribhuvan University (Nepal Health Research Council, 2024-03-22)
    This systematic review aimed to determine the antimicrobial resistance pattern of the extended-spectrum β-lactamases producing Escherichia coli (ESBL-EC) in urine samples in Nepal. Systematic literature review was conducted to locate all articles reporting ESBL-EC in urine samples published between January 2012 to December 2022. The Egger's weighted regression analysis was done to assess the publication bias. A random-effects model was used to calculate the pooled prevalence and corresponding 95% confidence interval due to significant between-study heterogeneity. The strength of correlation between multidrug resistance and ESBL production in E.coli strains was determined using Pearson's correlation coefficient. The data were analyzed using R-language 4.2.2. software. The combined prevalence of E.coli in urine samples was found to be 14 % (95% CI, 11-18), while the overall pooled prevalence of ESBL E.coli and MDR E.coli were 30% (95% CI, 20-42) and 70% (95% CI, 38-90) respectively. A strong positive correlation of 0.99 (95% CI, 0.89-1.0) was found between ESBL production and MDR among E.coli isolates. Imipenem was the drug of choice against ESBL-E.coli in urine specimens. Our analyses showed the overall ESBL-EC and MDR-EC burden in Nepal is considerably high. Likewise, the study also infers an increasing trend of antibiotic resistance pattern of ESBL-EC in urine samples.
  • An investigation of the effects of repurposed drugs on human neuroblastoma and glioblastoma cell lines

    Johnson, Eustace; Kharawatkar, Abhishek (University of Chester, 2023-06)
    Neuroblastoma is an aggressive and highly metastatic extracranial tumour of the sympathetic nervous system commonly seen in children, whereas, glioblastoma multiforme is an aggressive and highly proliferative intracranial tumour of the central nervous system seen more in adults. The cellular heterogeneity and molecular pathogenesis of both of these tumours have limited the development of successful treatments. The combined effects of the lipid-lowering drug, bezafibrate (BEZ) and the contraceptive drug, medroxyprogesterone acetate (MPA) (combined as BaP) has shown promising anti-cancer effects on blood cancers like myeloid leukaemia, Burkitt’s lymphoma and chronic lymphoid leukaemia, and osteosarcoma, with elevated levels of reactive oxygen species and down-regulation of lipogenic enzymes implicated in the mechanisms of action for these drug treatments. The aim of this study was to determine the effects of these combined drugs on neuronal cancers, using the SH-SY5Y neuroblastoma and U-87MG glioblastoma cell lines as model systems. BEZ treatment alone was shown to have a significant and BEZ concentration-dependent inhibitory effect on SH-SY5Y and U-87MG viable cell proliferation, whereas MPA treatment alone was shown to have very little effect on the cells. The combination of the drugs was shown to have a significant and drug concentration-dependent inhibitory effect on SH-SY5Y and U-87MG viable cell proliferation to a greater extent than BEZ treatment alone. These anti-cancerous effects were associated with increased cell death, and elevated levels of reactive oxygen species (ROS) in both cell lines after 24 hours of treatment. Levels of the lipogenic enzymes, stearoyl CoA desaturase-1 and fatty acid synthase were seen to be significantly lower in SH-SY5Y and U-87MG cells than in blood cancer cell lines. Further, oleic acid supplementation rescued SH-SY5Y neuroblastoma cells, but in serum not serum free conditions only. Oleic acid supplementation of U-87MG cells did not rescue their susceptibility to BaP treatment. Inclusion of valproic acid combined with BaP (termed VBaP) enhanced the effects of BaP treatment on SH-SY5Y and U-87MG cells, as well as U266 multiple myeloma cells. This is important, as higher concentrations of BEZ are nephrotoxic. The effects of VBaP on U-87MG cells also were explored in a 3D alginate culture system to mimic the microenvironment of the brain. In this situation, VBaP treatment still inhibited U-87MG cell growth and also was effective at inhibited established tumour spheroids. Hence, this thesis has examined whether drug repurposed drug treatments that have been established in blood cancers may also have application in neuronal cancers, and demonstrated that this is possible.
  • Yellow Stickers: A mixed methods study exploring household food poverty experiences, in the UK

    Fallows, Stephen; Brannigan, Angela (University of Chester, 2023-07)
    Background: As more and more British people struggle to make ends meet and turn to food banks to feed themselves, food poverty has become a serious and growing public health concern in the United Kingdom (UK). There is a clear need for effective policies and interventions to prevent and alleviate food poverty. Aim: This thesis aimed to explore household food poverty experiences in order to develop an understanding of the current nature and vulnerability of food poverty in the UK. The research findings inform policy and practice in improving food and nutrition security for those most vulnerable. Methods: A sequential exploratory mixed methods design was adopted for this thesis, where the qualitative phase of data collection and analysis informed the quantitative phase. The first qualitative phase of the study was conducted in Greater Manchester and comprised of two exploratory investigations, in which in-depth interviews were carried out. The first study explored food poverty experiences, and coping practices from forty-two food insecure householders visiting food banks, food pantries, and community centres. The second study explored the perspectives of twenty-six frontline service providers on the local nature and vulnerability of food poverty along with programme responses to alleviate food hardships. The interviews were examined using thematic analysis. The findings generated from these two studies informed the development of the quantitative follow-up study. This study examined the prevalence and risk factors of food insecurity among single mother households using secondary data from the Family Resources Survey (2019/20). Descriptive statistics and multi-logistic analyses were used to analyse the quantitative data. Key findings: The findings from study 1, revealed that food insecure householders often employ multiple coping practices such as resourceful shopping and budgeting practices, cutting back on food quality and intake, and seeking support from food banks, family or friends. Regardless, regular and extended disruptions in food access and eating were commonly reported because of limited money. In study 2, frontline service providers described cost-of-living gaps in working wages and welfare benefits, exacerbated by rising living costs were driving local food poverty issues. Single mother families and single men, were found to be disproportionately accessing food banks compared to other households. Although, food banks have grown substantially in response to rising need and they provide immediate relief from hunger for a few days, there was a deep sense of shame associated with accessing them. Moreover, food banks like other community food aid programmes have limited ability to reduce and prevent food poverty since they do not address the driving factors behind income poverty. In the third study, high levels of food insecurity were found among single mother households. Thirty percent of single mother households were classified as being food insecure, however, in households with three or more children this rose to 41 percent. Conclusions: The findings in this thesis highlight serious food security concerns for welfare recipients and low waged workers. It is a particular salient problem among single mothers and their children who experience high levels of food insecurity. Given the adverse health and social consequences of food poverty the government should prioritise and lead on this issue through policy initiatives and legislation that tackle income poverty alongside efforts that support and strengthen third sector responses in alleviating food poverty in the UK.
  • Profile of Patients with Maxillofacial Space Infections and Associated Risk Factors

    Gadicherla, Srikanth; Manglani, Kirti; Pentapati, Kalyana C.; Kudva, Adarsh; Aramanadka, Chithra; Chandravel, Rajaji; Manipal Academy of Higher Education; University of Chester (Hindawi, 2024-04-09)
    Objective: To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay. Materials and Methods: We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay. Results: A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age (P=0.015; OR: 2.98) and evidence of bacterial culture (P=0.001; OR:6.64) were potential predictors associated with increased hospital stay. Conclusion: Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.
  • Defining the Most Potent Osteoinductive Culture Conditions for MC3T3-E1 Cells Reveals No Implication of Oxidative Stress or Energy Metabolism

    Semicheva, Alexandra; Ersoy, Ufuk; Vasilaki, Aphrodite; Myrtziou, Ioanna; Kanakis, Ioannis; University of Chester; University of Liverpool (MDPI, 2024-04-10)
    The MC3T3-E1 preosteoblastic cell line is widely utilised as a reliable in vitro system to assess bone formation. However, the experimental growth conditions for these cells hugely diverge, and, particularly, the osteogenic medium (OSM)’s composition varies in research studies. Therefore, we aimed to define the ideal culture conditions for MC3T3-E1 subclone 4 cells with regard to their mineralization capacity and explore if oxidative stress or the cellular metabolism processes are implicated. Cells were treated with nine different combinations of long-lasting ascorbate (Asc) and β-glycerophosphate (βGP), and osteogenesis/calcification was evaluated at three different time-points by qPCR, Western blotting, and bone nodule staining. Key molecules of the oxidative and metabolic pathways were also assessed. It was found that sufficient mineral deposition was achieved only in the 150 μg.mL−1/2 mM Asc/βGP combination on day 21 in OSM, and this was supported by Runx2, Alpl, Bglap, and Col1a1 expression level increases. NOX2 and SOD2 as well as PGC1α and Tfam were also monitored as indicators of redox and metabolic processes, respectively, where no differences were observed. Elevation in OCN protein levels and ALP activity showed that mineralisation comes as a result of these differences. This work defines the most appropriate culture conditions for MC3T3-E1 cells and could be used by other research laboratories in this field.
  • The experiences of dietary acculturation of international students in an ethnically un-diverse city and its impact on dietary health

    Ellahi, Basma; Osei-Kwasi, Hibbah; Fallows, Stephen; Nwaugochi, Ifeanyi E. (University of Chester, 2023-08)
    Background: Dietary acculturation occurs when people, including students, move to a new host country and their habitual diet changes. Several factors impact international students’ dietary acculturation, including the diversity of the area. Students’ eating habits are reported to be poorer in less ethnically diverse areas where access to their cultural foods may be limited. However, these settings provide a unique opportunity to study the processes (influencers, challenges, and enablers) for eating a culturally acceptable healthy diet in the host country. This study explores the immediate and longitudinal experiences of dietary acculturation for international students in a university and city with low ethnic diversity. Methods: Using an interpretivist design, data were collected longitudinally, at baseline (0-2 months), at six months and one year of sojournment from a purposive sample of international students studying at a university location in the northwest of England, United Kingdom. Focus groups, one-to-one interviews and diet diaries were utilised respectively across the year, progressively focussing the discussion on the lived experience of accessing a healthy and culturally acceptable diet and dietary acculturation. The data were transcribed verbatim and analysed using an inductive thematic approach with the guide of hermeneutic phenomenology. Analysis at baseline, six months, and one year was undertaken, followed by a trajectory analysis to understand the impact of studying and living in a city with little ethnic diversity on international students’ food and health experiences. Results: The analysis shows that international students at the University struggled with adjusting to British cuisine and culture, leading to irregular eating habits that impacted mental health and well-being. The study found that inadequate assistance from the University with regard to diet played a significant role. Over the course of the three phases of the study, participants had limited opportunities to access a broad assortment of foods due to the constrained availability, accessibility, and affordability of familiar options in both the University cafeteria and the city of Chester. Trajectory analysis findings highlight four central issues in accessing culturally acceptable healthy diets at a university located in a less ethnically diverse area: i) the capability and capacity to cook for one’s self; ii) orientation, catering menus, and lack of support from the institution; iii) accessing community support networks; iv) the need to improve cultural awareness, acceptance, and inclusion. The lack of social support, inclusion, and the feeling of no sense of belonging were critical determinants of the student’s experiences. Perceived discriminatory experiences contributed to poorer mental health among participants and performance in their studies. This study suggests that it is imperative to fully grasp the importance of on-campus catering to the dietary requirements of international students for food offerings and menus in this setting. Such inclusion can go a long way towards creating a sense of belonging and promoting integration within universities that have low levels of ethnic diversity. Furthermore, the study sheds light on the development of segregation apparent in classroom settings and academic progress, which begins to perpetuate in higher education and may continue into everyday life. Conclusion: The availability of familiar food is crucial for maintaining a healthy diet, directly affecting one’s well-being. Through promoting inclusivity and a sense of belonging, we can address the negative impact on mental health that comes with feeling disconnected. The lack of availability of culturally acceptable ethnic foods was key, and students reported feelings of exclusion linked to being unable to obtain what they would like to eat easily. Wider community support from friends, family, and local organisations was crucial in developing healthier dietary habits and, crucially, a sense of community and settling. By supporting students in this way, we help them have a positive journey of acculturation, leading to overall success. Therefore, the University in this study needs to create activities and programmes that could bring balance to the entire student population’s dietary experiences. This would promote belongingness within the student group, according to the findings of this study. In addition, this thesis emphasises the importance of university leaders acknowledging the presence of perceived discrimination and implementing an actionable plan with measurable objectives that fosters inclusivity. This research has shown the importance of inclusivity, belonging, and integration for the dietary acculturation experiences of international students who live in a less diverse city. Whilst the research is undertaken in one such city, their findings are applicable to similar settings.
  • Congenital heart disease and comorbidities in primary care: a cross-sectional study

    Ellison, Sarah; Partington, James; Watkin, Anna; Buckels, Chris; Jaydeokar, Sujeet (MA Healthcare, 2024-03-02)
    Background/Aims: Patients with congenital heart disease are living longer as a result of surgical and medical advances. General practice is key in identifying and supporting lifelong care, yet there is a lack of research into congenital heart disease in this area. This study aimed to explore the prevalence and comorbidities of patients with congenital heart disease compared to those without congenital heart disease in primary care settings in Cheshire, England. Methods: This cross-sectional study used routinely collected health data from the NHS general practice population information disease database within primary care in Cheshire. Clinical read codes for congenital heart disease were added to the current data analytics risk stratification tool. Searches for patients of all ages with and without congenital heart disease were undertaken in July 2022. A total of 765 576 patients were included in the study. Results: Of 765 576 patient records, 6419 patients were coded with congenital heart disease, a prevalence of 0.8%, with a comparatively younger age compared with the non-congenital heart disease cohort. Patients with congenital heart disease were three times more likely to have heart failure (odds ratio=3.36; 95% confidence interval=2.96−3.81) or stroke (odds ratio=3.58; 95% confidence interval=3.24–3.94). The most frequent comorbidities in both groups were hypertension, anxiety and depression, with no significant difference between the groups. Among those with congenital heart disease, the prevalence of a learning disability was more than eight times higher than those without congenital heart disease (odds ratio=9.23; 95% confidence interval=8.16–10.55) and autism was three times more likely (odds ratio=2.98; 95% confidence interval=2.32–3.84) in those with congenital heart disease. Conclusions: There are high rates of comorbidities in the congenital heart disease population in primary care. Innovative use of digital instruments can enable identification and risk stratification of patients with congenital heart disease to support lifelong care. Congenital heart disease guidance should include primary care settings to create opportunities for mutual learning that can enhance collaborative practice.
  • Sports participation among Norwegian youth: a study of early sporting careers

    Johansen, Patrick F.; Green, Ken; Thurston, Miranda (Taylor & Francis, 2024-03-26)
    Despite a growing body of evidence suggesting that establishing sporting repertoires during youth is intimately related to ongoing participation in sport, little is known about how such repertoires develop during the crucial early teenage years, when the sporting habits that provide a basis for sporting careers take shape. The aim of the study was, therefore, to describe the structure of young people’s sporting repertoires as they move through a key formative period, as a basis for theorising their retention in sports participation. By providing a detailed analysis of a cohort of young Norwegians as they progressed through lower-secondary into upper-secondary school (13–16-year-olds), this study offers insights into how different sporting forms fluctuate during a period typically characterised by heavy drop-out and drop-off from sports participation. Data were obtained from a longitudinal cohort study of Norwegian youngsters attending 11 lower secondary schools based on annual surveys conducted from grade 8 through to grade 10 and used to describe cohort changes in sports participation rates and sporting forms over time. The noticeable movement between sporting forms alongside the marked shift towards informal sports during the period is likely to provide an important insight into how Norwegian teenagers not only maintain high levels of participation during the teenage years but also enhance their sporting repertoires in a manner likely to sustain sports participation through youth into early adulthood.
  • Factors associated with young children being overweight on entry to primary school

    Hall, Joanne; Wee, Christine; Harries, Anthony D.; Cheshire and Wirral Partnership NHS Foundation Trust; University of Chester; International Union Against Tuberculosis and Lung Disease; London School of Hygiene and Tropical Medicine (MA Healthcare, 2024-03-02)
    Childhood obesity is a serious public health challenge, and there is limited evidence to show which pre-school interventions may prevent its occurrence. This study assessed whether selected factors, including contact with the Starting Well 0–19 service for children aged 1–3 years in north-west England, influenced children's risk of being overweight at primary school entry. It found that families with the most contact with the service (an integrated health visitor and children's centre offer) were more at risk. The findings show that the focus of these contacts does not positively influence risk factors for later overweight prevalence. The study findings replicate a known association between deprivation and children being overweight. Families having the highest contact levels with the Starting Well service had a significant association with their children being overweight at entry to primary school. This provides an opportunity to target these families with healthy lifestyle interventions and reduce the potential risk of childhood obesity.
  • Retinol-binding protein 4 (RBP4) circulating levels and gestational diabetes mellitus: a systematic review and meta-analysis

    Leca, Bianca M.; Kite, Chris; Lagojda, Lukasz; Davasgaium, Allan; Dallaway, Alex; Chatha, Kamaljit Kaur; Randeva, Harpal S.; Kyrou, Ioannis; University Hospitals Coventry and Warwickshire NHS Trust; University of Warwick; University of Wolverhampton; Coventry University; Aston University; University of Derby; Agricultural University of Athens (Frontiers Media, 2024-03-12)
    Background: Gestational diabetes mellitus (GDM) is a prevalent condition where diabetes is diagnosed during pregnancy, affecting both maternal and fetal outcomes. Retinol-binding protein 4 (RBP4) is a circulating adipokine which belongs to the lipocalin family and acts as a specific carrier protein that delivers retinol (vitamin A) from the liver to the peripheral tissues. Growing data indicate that circulating RBP4 levels may positively correlate with GDM. Thus, this systematic review and meta-analysis aimed to investigate the potential relationship between circulating RBP4 levels and GDM when measured at various stages of pregnancy. Methods: MEDLINE, CINAHL, EMCARE, EMBASE, Scopus, and Web of Science databases were searched to identify studies comparing pregnant women with and without GDM, whose circulating RBP4 levels were measured in at least one pregnancy trimester. Findings were reported using standardized mean difference (SMD) and random-effects models were used to account for variability among studies. Furthermore, the risk of bias was assessed using the RoBANS tool. Results: Out of the 34 studies identified, 32 were included in the meta-analysis (seven with circulating RBP4 levels measured in the first trimester, 19 at 24–28 weeks, and 14 at >28 weeks of pregnancy). RBP4 levels were statistically higher in the GDM group than in controls when measured during all these pregnancy stages, with the noted RBP4 SMD being 0.322 in the first trimester (95% CI: 0.126–0.517; p < 0.001; 946 GDM cases vs. 1701 non-GDM controls); 0.628 at 24–28 weeks of gestation (95% CI: 0.290–0.966; p < 0.001; 1776 GDM cases vs. 1942 controls); and 0.875 at >28 weeks of gestation (95% CI: 0.252–1.498; p = 0.006; 870 GDM cases vs. 1942 non-GDM controls). Significant study heterogeneity was noted for all three pregnancy timepoints. Conclusion: The present findings indicate consistently higher circulating RBP4 levels in GDM cases compared to non-GDM controls, suggesting the potential relevance of RBP4 as a biomarker for GDM. However, the documented substantial study heterogeneity, alongside imprecision in effect estimates, underscores the need for further research and standardization of measurement methods to elucidate whether RBP4 can be utilized in clinical practice as a potential GDM biomarker. Systematic review registration: PROSPERO (CRD42022340097: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340097).
  • Best practice for embryology staffing in HFEA licensed assisted conception centres-guidance from Association of Reproductive & Clinical Scientists

    Kasraie, Jason; Kennedy, Hannah; Shrewsbury and Telford Hospitals NHS Trust; University of Chester; Bristol Centre for Reproductive Medicine (Taylor & Francis, 2024-12-31)
    The Association of Reproductive and Clinical Scientists (ARCS) has long promoted the importance of externally accredited training and assessment of scientific staff within assisted conception centres to ensure professional registration and relevant training at all levels. This not only gives scientific staff the opportunity to empower themselves but also acts to ensure assisted conception centres maintain the highest standards of care and quality for patients whilst meeting HFEA requirements for staffing and training. It also provides assurance to patients that treatment is being delivered by highly trained and competent staff. Clinical embryology practice requires intense concentration, with increasingly complex treatment plans and options coupled with the ever-present consequences of clinical error at the forefront of practitioners’ minds, exhaustion and burn out are very real risks. Overloading embryology teams is likely to lead to increased error rates and serious incidents. This guideline aims to bring the sector in line with other Clinical Science specialities to optimise patient care, increase safety, reduce risk (including the risk of legal action against centres and individuals), ensure the use of recognised job titles with appropriate levels of remuneration, and provide centres with a template to work towards for appropriate levels of scientific staffing.
  • Methadone as an adjuvant analgesic

    Shahab, Julita; Willis, Derek; Severn Hospice, Telford; Severn Hospice, Shrewsbury; University of Chester (BMJ Publishing Group, 2024-03-01)
    Methadone as an 'adjuvant' has proven to be effective and safe to be used in conjunction with opioids. Generally, only a low dose is required to improve pain control. [Abstract copyright: © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.]
  • Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management

    Kumar, Kartik; Ponnuswamy, Aravind; Capstick, Toby Gd; Chen, Christabelle; McCabe, Douglas; Hurst, Rhys; Morrison, Lisa; Moore, Fiona; Gallardo, Matt; Keane, Jennie; et al. (Elsevier, 2024-01-17)
    Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause significant disease in both immunocompromised and immunocompetent individuals. The incidence of NTM pulmonary disease (NTM-PD) is rising globally. Diagnostic challenges persist and treatment efficacy is variable. This article provides an overview of NTM-PD for clinicians. We discuss how common it is, who is at risk, how it is diagnosed and the multidisciplinary approach to its clinical management. [Abstract copyright: Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.]
  • ISRA9PHL0474 Monad & Kimud Shoals Factsheet

    Oliver, Simon P.; Cases, Gary; Brown, James; Gokoz, Alp; Faringstam, Isabelle; Gonzalez-Pestana, Adrianna; The University of Chester; IUCN Shark Group; The Thresher Shark Research and Conservation Project; Project Sharklink
    Monad & Kimud Shoals are located southeast of Malapascua Island in the Central Visayan Sea, central Philippines. The Visayan Sea is a relatively shallow area with frequent wind- driven vertical mixing due to its shallow nature, and land-based nutrient run-off which play an important role in supplementing the overall primary production. Monad & Kimud Shoals are shallow seamounts, 7 km apart. The top of the seamounts forms a plateau at 15 to 25 m depth. This area overlaps with the Sulu-Sulawesi Marine Ecoregion an Ecologically and Biologically Significant Marine Area (EBSA), and two marine protected areas. Within this area there are: threatened species and distinctive attributes (Pelagic Thresher Alopias pelagicus).

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