• Acceptability, usability and weight loss outcomes in a randomized cross-over study of commercially available portion size tools in an overweight South Asian community

      Ellahi, Basma; Aitken, Amanda; Dikmen, Derya; Erdogan, Bilge Seyhan; Makda, Munibah; Razaq, Rifat; University of Chester; Hacettepe University (MDPI, 2022-06-23)
      South Asian women living in the UK are particularly at high risk of obesity-related complications, such as type 2 diabetes and cardio-vascular disease. Exposure to large portion sizes is a risk factor for obesity. Specifically, designed tableware helps individuals to manage weight through controlling food portion sizes. Thirty-one (n=31) overweight or obese South Asian adult women participated in a randomised cross-over trial aimed to assess efficacy, acceptance and weight change for two guided/calibrated commercially available portion control tools (Utensil set and Crockery Set) used in free-living conditions. Data on acceptance, perceived changes in portion size, frequency, and meal type was collected using paper questionnaires and 3-day diet dairies. Scores describing acceptance, ease of use and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed for significance using multivariate variance analysis for repeated measurements. A reduction in BMI was observed at each point of measurement (p=0.007). For overall tool use, the crockery set scored higher in all areas of acceptance, ease of use, perceived efficacy for all comparisons. Self-selected portion sizes increased for salads and decreased for cooking oil and breakfast cereals with both tools. Further research to scale up and evaluate similar weight management interventions for this group are warranted.
    • Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home

      Mabhala, Mzwandile A.; Yohannes, Asmait; Asmait Skin Care (MDPI, 2019-11-21)
      Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories—education, employment, and health—emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one’s way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health.
    • Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home

      Mabhala, Mzwandile; Yohannes, Asmait; University of Chester; Asmait Skin Care (MDPI, 2019-11-21)
      Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories—education, employment, and health—emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one’s way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health.
    • Does the Association between Depressive Symptomatology and Physical Activity Depend on Body Image Perception? A Survey of Students from Seven Universities in the UK

      El Ansari, Walid; Stockton, Christine; Phillips, Ceri; Mabhala, Mzwandile A.; Stoate, Mary; Adetunji, Hamed; Deeny, Pat; John, Jill; Davies, Shân; Parke, Sian; et al. (MDPI, 2011-01-25)
      This cross-sectional study assessed the association between depression and PA in university students of both genders and the role of body image perception as a potential effect modifier. Undergraduate students (N = 3706) from seven universities in the UK completed a self-administered questionnaire that assessed sociodemographic information; a range of health, health behaviour and health awareness related factors; the modified version of Beck’s Depression Inventory (M-BDI); educational achievement, and different levels of physical activity (PA), such as moderate PA (at least 5 days per week moderate exercise of at least 30 minutes), and vigorous PA (at least 3 days per week vigorous exercise of at least 20 minutes). Only 12.4% of the sample achieved the international recommended level for moderate PA, and 33.1% achieved the recommendations for vigorous PA. Both moderate and vigorous PA were inversely related to the M-BDI score. Physically active students, regardless of the type of PA, were significantly more likely to perceive their health as good, to have higher health awareness, to perform strengthening exercises, and to be males. The stratified analyses indicated that the association between depression and PA differed by body image. In students perceiving their body image as ‘just right’, moderate (>4th percentile) and high (>5th percentile) M-BDI scores were inversely related to vigorous PA. However, in students who perceived their body image as ‘overweight’, the inverse association was only significant in those with high M-BDI scores. We conclude that the positive effect of PA on depression could be down modulated by the negative impact of a ‘distorted’ body image on depression. The practical implications of these findings are that PA programmes targeting persons with depressive symptoms should include effective components to enhance body image perception.
    • Feeling Healthy? A Survey of Physical and Psychological Wellbeing of Students from Seven Universities in the UK

      El Ansari, Walid; Stock, Christiane; Snelgrove, Sherrill; Hu, Xiaoling; Parke, Sian; Davies, Shân; John, Jill; Adetunji, Hamed; Stoate, Mary; Deeny, Pat; et al. (MDPI, 2011-04-27)
      Abstract: University students’ physical and psychological health and wellbeing are important and comprise many variables. This study assessed perceived health status in addition to a range of physical and psychological wellbeing indicators of 3,706 undergraduate students from seven universities in England, Wales and Northern Ireland. We compared differences in these variables between males and females, and across the participating universities. The data was collected in 2007–2008. A self-administered questionnaire assessed socio-demographic information (e.g., gender, age), self-reported physical and psychological health data, as well as questions on health awareness, health service use, social support, burdens and stressors and university study related questions. While females generally reported more health problems and psychological burdens, male students felt that they received/had fewer persons to depend on for social support. The comparisons of health and wellbeing variables across the different universities suggested some evidence of ‘clustering’ of the variables under study, whereby favourable situations would be exhibited by a cluster of the variables that is encountered at some universities; and conversely, the clustering of less favourable variables as exhibited at other universities. We conclude that the level of health complaints and psychological problems/burdens is relatively high and calls for increased awareness of university administrators, leaders and policy makers to the health and well-being needs of their students. The observed clustering effects also indicate the need for local (university-specific) health and wellbeing profiles as basis and guidance for relevant health promotion programmes at universities.
    • Homelessness Is Socially Created: Cluster Analysis of Social Determinants of Homelessness (SODH) in North West England in 2020

      Mabhala, Mzwandile; Esealuka, Winifred Adaobi; Nwufo, Amanda Nkolika; Enyinna, Chinwe; Mabhala, Chelsea Nonkosi; Udechukwu, Treasure; Reid, John; Yohannes, Asmait; University of Chester; University of East Anglia; École des Hautes Études en Santé Publique; Asmait Skincare and Design (MDPI, 2021-03-16)
      Abstract: Poverty creates social conditions that increase the likelihood of homelessness. These include exposure to traumatic life experiences; social disadvantages such as poor educational experiences; being raised in a broken family, care homes or foster care; physical, emotional, and sexual abuse; and neglect at an early age. These conditions reduce people’s ability to negotiate through life challenges. This cross-sectional study documents the clustering and frequency of adverse social conditions among 152 homeless people from four cities in North West England between January and August 2020. Two-step cluster analysis showed that having parents with a criminal record, care history, and child neglect/abuse history was predictive of homelessness. The cluster of indicator variables among homeless people included sexual abuse (χ2 (N = 152) = 220.684, p < 0.001, Cramer’s V = 0.7), inappropriate sexual behaviour (χ2 (N = 152) = 207.737, p < 0.001, Cramer’s V = 0.7), emotional neglect (χ2 (N = 152) = 181.671, p < 0.001, Cramer’s V = 0.7), physical abuse by step-parent (χ2 (N = 152) = 195.882, p < 0.001, Cramer’s V = 0.8), and physical neglect (χ2 (N = 152) = 205.632, p < 0.001, Cramer’s V = 0.8). Poverty and homelessness are intertwined because of the high prevalence of poverty among the homeless. Poverty sets up a chain of interactions between social conditions that increase the likelihood of unfavourable outcomes: homelessness is at the end of the interaction chain. Interventions supporting families to rise out of poverty may also reduce entry into homelessness.
    • How Do I Look? Body Image Perceptions among University Students from England and Denmark

      El Ansari, Walid; Vodder Clausen, Susanne; Mabhala, Mzwandile A.; Stockton, Christine; University of Gloucestershire; University of Chester; Benfield University (MDPI, 2010-02-21)
      This study examined differences in body image perception between university students in two European countries, United Kingdom and Denmark. A total of 816 British and 548 Danish university students participated in a cross-sectional survey. A self-administered questionnaire assessed socio-demographic information, body image perception (as “too thin”, “just right” or “too fat”), and the association of related factors with body image perception (nutrition behaviour, social support, perceived stressors and quality of life). The proportions of students who perceived themselves as “too thin”, “just right”, or “too fat” were 8.6%, 37.7%, and 53.7% respectively. Multi-factorial logistic regression analysis showed that students who perceived themselves as “too fat” were more likely to be from the British university, to be females, to be older than 30 years, to report stress due to their financial situation and were less likely to have a high quality of life. The findings highlight the need for interventions with focus on healthy food choices whilst acknowledging financial stressors and quality of life.
    • How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals

      Lakoh, Sulaiman; Maruta, Anna; Kallon, Christiana; Deen, Gibrilla F.; Russell, James B. W.; Fofanah, Bobson D.; Kamara, Ibrahim F.; Kanu, Joseph S.; Kamara, Dauda; Molleh, Bailah; et al. (MDPI, 2022-03-23)
      Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs.
    • Interaction between Dietary Fat Intake and Metabolic Genetic Risk Score on 25-Hydroxyvitamin D Concentrations in a Turkish Adult Population

      Isgin-Atici, Kubra; Alathari, Buthaina E.; Turan-Demirci, Busra; Sendur, Suleyman Nahit; Incilay, Lay; Ellahi, Basma; Alikasifoglu, Mehmet; Erbas, Tomris; Buyuktuncer, Zehra; Santhanakrishnan, Vimaleswaran Karani; et al. (MDPI, 2022-01-17)
      Previous studies have pointed out a link between vitamin D status and metabolic traits, however, consistent evidence has not been provided yet. This cross-sectional study has used a nutrigenetic approach to investigate the interaction between metabolic-genetic risk score (GRS) and dietary intake on serum 25-hydroxyvitamin D [25(OH)D] concentrations in 396 unrelated Turkish adults, aged 24-50 years. Serum 25(OH)D concentration was significantly lower in those with a metabolic-GRS ≥ 1 risk allele than those with a metabolic-GRS < 1 risk allele (p = 0.020). A significant interaction between metabolic-GRS and dietary fat intake (energy%) on serum 25(OH)D levels was identified (Pinteraction = 0.040). Participants carrying a metabolic-GRS ≥ 1 risk allele and consuming a high fat diet (≥38% of energy = 122.3 ± 52.51 g/day) had significantly lower serum 25(OH)D concentration (p = 0.006) in comparison to those consuming a low-fat diet (<38% of energy = 82.5 ± 37.36 g/d). In conclusion, our study suggests a novel interaction between metabolic-GRS and dietary fat intake on serum 25(OH)D level, which emphasises that following the current dietary fat intake recommendation (<35% total fat) could be important in reducing the prevalence of vitamin D deficiency in this Turkish population. Nevertheless, further larger studies are needed to verify this interaction, before implementing personalized dietary recommendations for the maintenance of optimal vitamin D status.
    • Interaction between Metabolic Genetic Risk Score and Dietary Fatty Acid Intake on Central Obesity in a Ghanaian Population

      Alsulami, Sooad; Nyakotey, David; Dudek, Kamila; Bawah, Abdul-Malik; Lovegrove, Julie; Annan, Reggie; Ellahi, Basma; Karani, Santhanakrishnan Vimaleswaran; University of Reading, University of Chester and Kumasi University (MDPI, 2020-07-27)
      Obesity is a multifactorial condition arising from the interaction between genetic and lifestyle factors. We aimed to assess the impact of lifestyle and genetic factors on obesity-related traits in 302 healthy Ghanaian adults. Dietary intake and physical activity were assessed using a 3 day repeated 24 h dietary recall and global physical activity questionnaire, respectively. Twelve single nucleotide polymorphisms (SNPs) were used to construct 4-SNP, 8-SNP and 12-SNP genetic risk scores (GRSs). The 4-SNP GRS showed significant interactions with dietary fat intakes on waist circumference (WC) (Total fat, Pinteraction = 0.01; saturated fatty acids (SFA), Pinteraction = 0.02; polyunsaturated fatty acids (PUFA), Pinteraction = 0.01 and monounsaturated fatty acids (MUFA), Pinteraction = 0.01). Among individuals with higher intakes of total fat (>47 g/d), SFA (>14 g/d), PUFA (>16 g/d) and MUFA (>16 g/d), individuals with ≥3 risk alleles had a significantly higher WC compared to those with <3 risk alleles. This is the first study of its kind in this population, suggesting that a higher consumption of dietary fatty acid may have the potential to increase the genetic susceptibility of becoming centrally obese. These results support the general dietary recommendations to decrease the intakes of total fat and SFA, to reduce the risk of obesity, particularly in individuals with a higher genetic predisposition to central obesity.
    • Interactions between Vitamin D Genetic Risk and Dietary Factors on Metabolic Disease-Related Outcomes in Ghanaian Adults

      Alathari, Buthaina E.; Nyakotey, David A.; Bawah, Abdul-Malik; Lovegrove, Julie A.; Annan, Reginald A.; Ellahi, Basma; Vimaleswaran, Karani S.; University of Reading; The Public Authority for Applied Education and Training, Kuwait; Kwame Nkrumah University of Science and Technology; University of Auckland; University of Chester (MDPI, 2022-07-04)
      The Ghanaian population is experiencing an upsurge in obesity and type 2 diabetes (T2D) due to rapid urbanization. Besides dietary factors, vitamin D-related genetic determinants have also been shown to contribute to the development of obesity and T2D. Hence, we aimed to examine the interactions between dietary factors and vitamin D-related genetic variants on obesity and T2D related outcomes in a Ghanaian population. Three hundred and two healthy Ghanaian adults (25–60 years old) from Oforikrom, Municipality in Kumasi, Ghana were randomly recruited and had genetic tests, dietary consumption analysis, and anthropometric and biochemical measurements of glucose, HbA1c, insulin, cholesterol, and triglycerides taken. A significant interaction was identified between vitamin D-GRS and fiber intake (g/day) on BMI (pinteraction = 0.020) where those who were consuming low fiber (≤16.19 g/d) and carrying more than two risk alleles for vitamin D deficiency (p = 0.01) had a significantly higher BMI. In addition, an interaction between vitamin D-GRS and fat intake (g/day) on HbA1c (total fat, pinteraction = 0.029) was found, where participants who had a lower total fat intake (≤36.5 g/d), despite carrying more than two risk alleles, had significantly lower HbA1c (p = 0.049). In summary, our study has identified novel gene–diet interactions of vitamin D-GRS with dietary fiber and fat intakes on metabolic traits in Ghanaian adults.
    • Population Health Screening after Environmental Pollution

      Stewart, Alex G.; orcid: 0000-0002-4931-5340; email: dragonsteeth@doctors.org.uk; Wilkinson, Ewan; orcid: 0000-0002-2167-8756; email: ewilkinson@chester.ac.uk (MDPI, 2020-11-24)
      Following environmental pollution exposure, calls to screen the population for disease or disease markers are often made. Population screening is a cross-sectional review of a population to find latent cases or biomarkers of disease that indicate the possibility of disease development; it differs from environmental screening or an epidemiological survey. Recognized standard approaches have been developed over 60 years to ensure quality and effectiveness in complex programs. We surveyed the literature for papers on health screening following environmental exposures and checked them for reference to accepted criteria such as those of Wilson and Jungner. We applied these criteria to three situations covering source/hazard (arsenic contaminated land), pathway/exposure (radiation release), and receptor/disease (lead poisoning). We identified 36 relevant papers. Although across the papers the whole range of criteria were addressed, no paper or program utilized recognized criteria. Issues and gaps identified included limited strategic approaches, lack of treatment, environmental prevention being seen as the screening outcome instead of treatment of identified individuals, and programs which did not fit the World Health Organization screening description. Robust discussion in the literature is needed to consider the organization and role of health screening following environmental exposures.
    • Promoting a healthy diet in young adults: The role of nutrition labelling

      Buyuktuncer, Zehra; Ayaz, Aylin; Dedebayrakta, Damla; Inan-Eroglu, Elif; Ellahi, Basma; Besler, Halit T.; Hacettepe University; University of Chester; Eastern Mediterranean University (MDPI, 2018-09-20)
      The use of the nutrition facts label has been associated with healthy eating behaviours for adults. However, the relationship between nutrition facts label use and overall diet quality is not well known in young adults, a vulnerable group that acquire lifelong eating behaviours during this period of life. This study aimed to assess if the use of information on the nutrition facts label is associated with a higher diet quality in young adults. In this cross-sectional study, 958 university students, aged 18-34 years were recruited. Nutrition facts label use was recorded. Dietary intake was assessed using 24-hour dietary recall. Healthy Eating Index-2005 (HEI-2005) scores were calculated. HEI-2005 score was significantly associated with using nutrition facts label (P < 0.001). The mean total HEI-2005 score was 60.7±10.11, 62.4±11.43 and 67.1±12.23 respectively for Never, Sometimes and Every time users of nutrition facts label (P < 0.001). Subgroup scores of HEI-2005 for total fruits, whole fruits, total vegetables, whole grains, milk, oils, saturated fat, and calories from solid fat, alcohol and added sugar (SoFAAS) were significantly higher in regular nutrition facts label users (P < 0.05, for each). This study showed that young adults who regularly use nutrition facts label have a higher diet quality.
    • Student Nurses Undertaking Acute Hospital Paid Placements during COVID-19: Rationale for Opting-In? A Qualitative Inquiry

      McSherry, Robert; email: r.mcsherry@chester.ac.uk; Eost-Telling, Charlotte; orcid: 0000-0002-9568-3195; email: c.eosttelling@chester.ac.uk; Stevens, Dean; email: d.stevens@chester.ac.uk; Bailey, Jan; email: j.bailey@chester.ac.uk; Crompton, Rhian; email: r.crompton@chester.ac.uk; Taylor, Louise; email: l.taylor@chester.ac.uk; Kingston, Paul; email: p.kingston@chester.ac.uk; Simpson, Angela; email: a.simpson@chester.ac.uk (MDPI, 2021-08-05)
      The research aim was to evaluate the rationale of undergraduate final-year student nurses to undertake paid clinical placements during COVID-19 (Wave 1). The nursing profession reacted innovatively to meet demands placed on the National Health Service during COVID-19. Temporary changes to professional regulation enabled final-year United Kingdom nursing students to voluntarily undertake paid placements in the National Health Service. Neither full-time employees nor full-time students, volunteers undertook a unique hybrid role bolstering the front-line health workforce. Using reflective qualitative inquiry, 17 volunteers evaluated reasoning for entering practice in acute hospitals. Online surveys based around the UK Nursing and Midwifery Council Competency Framework (NMC 2012) were completed weekly for 6 weeks. Data were thematically analysed. Six themes were identified, including sense of duty, and opting-in or out. These highlighted the importance of collaboration and the tripartite relationship between University, host and student during placement, and the influence of these on the learning experience. Several significant insights emerged for nurse education and curricula during pandemics related to patient safety, safety climate and governance. The insights were used to develop a “Student Nurses Placement Framework” with recommendations for Pre-During-Post placement, offering a guide for future nursing workforce recruitment and retention.