• The criminal justice voluntary sector: concepts and an agenda for an emerging field

      Tomczak, Philippa; Buck, Gillian; University of Nottingham; University of Chester (The Howard League and John Wiley & Sons Ltd, 2019-09-04)
      Volunteers and voluntary organisations play significant roles pervading criminal justice. They are key actors, with unrecognised potential to shore up criminal justice and/or collaboratively reshape social justice. Unlike public and for-profit agents, criminal justice volunteers and voluntary organisations (CJVVOs) have been neglected by scholars. We call for analyses of diverse CJVVOs, in national and comparative contexts. We provide three categories to highlight distinctive organising auspices, which hold across criminal justice: statutory volunteers, quasi-statutory volunteers and voluntary organisations. The unknown implications of these different forms of non-state, non-profit justice involvement deserve far greater attention from academics, policymakers and practitioners.
    • Inadequate dried blood spot samples for Early Infant Diagnosis, how common and what are the reasons for rejection in Zimbabwe?

      Chiku, Charles; Zolfo, Maria; Senkoro, Mbazi; Mabhala, Mzwandile A.; Tweya, Hannock; Musasa, Patience; Shukusho, Fungai D.; Mazarura, Exervia; Mushavi, Angela; Mangwanya, Douglas; et al. (PLoS, 2019-08-31)
      Background Early infant diagnosis (EID) of HIV in infants provides an opportunity for early detection of the infection and early access to Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of HIV-exposed infants, born from HIV positive mothers. However, DBS rejection rates have been exceeding in Zimbabwe the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL). The aim of this study was to determine the DBS samples rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the sample was collected. Methods Analytic cross-sectional study using routine DBS samples data from the NMRL in Harare, Zimbabwe, between January and December 2017. Results A total of 34.950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected and reasons for rejections were: insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross contamination (6%), mismatch information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities had five times likelihood to be rejected compared to those from a central hospital. Conclusion Rejection rates were above the set target of 2%. The reasons for rejection were ‘pre-analytical’ errors including labeling errors, sample damage, missing or inconsistent data, and insufficient volume. Samples collected at primary healthcare facilities had higher rejection rates.
    • Emergency hormonal contraceptive service provision via community pharmacies in the UK: a systematic review of pharmacists’ and young women’s views, perspectives and experiences

      Chirewa, B; orcid: 0000-0003-2784-8274; Wakhisi, A (SAGE Publications, 2019-08-12)
      Aims: Unintended pregnancy among young people remains a major public health problem in the UK, despite recent evidence suggesting that the number of teenage pregnancies in England is falling. Community pharmacies have the potential to reduce health inequalities among young women through improved and appropriate access to sexual health services. This study seeks to examine the views, perceptions and experiences of young women and community pharmacists concerning emergency hormonal contraceptive (EHC) provision from community pharmacies in the UK. Methods: Six electronic databases were searched for articles published in English between 2000 and 2017. Titles and abstracts were screened by two researchers according to the inclusion criteria. Results: A total of eight papers reporting studies carried out within the UK were included. Five key themes were identified from the perspectives of young women: convenience and ease of access, embarrassment and non-judgemental services, free services, confidentiality and pharmacist being helpful. Six key themes were identified from the perspectives of the pharmacists: concerns about supply of EHC, improved access, no need for appointment, confidentiality, free EHC and training. Conclusions: The review suggests that services should be designed based on the views, perceptions and experiences of the service users and providers in order to reduce inequities to access of EHC. Pharmacists who provide EHC should continuously upgrade their knowledge base through training if the sexual health needs of the young women who access pharmacies are to be adequately met.
    • Common causes of EID sample rejection in Zimbabwe and how to mitigate them

      editor: Torpey, Kwasi; Chiku, Charles; orcid: 0000-0003-3455-598X; email: charleschiku@gmail.com; Zolfo, Maria; Senkoro, Mbazi; Mabhala, Mzwandile A.; Tweya, Hannock; Musasa, Patience; Shukusho, Fungai D.; Mazarura, Exervia; Mushavi, Angela; et al. (Public Library of Science, 2019-08-08)
      Early infant diagnosis (EID) of HIV provides an opportunity for early HIV detection and access to appropriate Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of exposed infants, born to HIV-positive mothers. However, DBS rejection rates in Zimbabwe have been exceeding the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL), in Harare. The aim of this study was to determine the DBS sample rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the samples were collected. This is an analytical cross-sectional study using routine DBS sample data from the NMRL in Harare, Zimbabwe, between January and December 2017.A total of 34 950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected. Reasons for rejection were insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross-contamination (6%), mismatch of information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities were five times more likely to be rejected compared to those from a central hospital. Rejection rates were above the set target of <2%. The reasons for rejection were ‘pre-analytical’ errors including labelling errors, missing or inconsistent data, and insufficient blood collected. Samples collected at primary healthcare facilities had higher rejection rates.
    • Use of storytelling and audio podcasts in qualitative research

      Sutton, Julie E.; University of Chester (RCNI, 2019-08-01)
      The author discusses the use of service user story telling through the medium of audio podcasts, in service evaluation. The author argues this is an effective way to promote service user participation in service improvement projects and highlights how audio podcasts can stimulate emotional connections in service evaluators leading to informed identification of priorities for change
    • ‘Being different’: realities of life experiences as constructed by persons with albinism in Nigeria

      Mabhala, Andi; Keeling, June; Buck, Gill; Keen, Adam; Olagunju, Adeolu (University of ChesterUniversity of Chester, 2019-08)
      In Nigeria, persons with albinism (PWA) continue to face a higher burden of health and social challenges in the society compared with the general population. PWA experience multi-faceted social injustices such as stigma, discrimination and exclusion from education, employment and social participation. These injustices are driven by the Nigerian society because of sociocultural perceptions and stereotypes associated with albinism which can be attributable to the lack of adequate understanding of the condition. This research aimed to understand how the realities of being a PWA in Nigeria could be conceptualised based on their life experiences to develop a substantive theory of their social wellbeing status. By adopting constructivist grounded theory methodology, forty-two in-depth interviews were conducted amongst eleven PWA. Analysis identified three categories each of which embodies the multiple realities of disadvantages and exclusion experienced within the home, schooling, working and social environments at different stages of life. The concept of ‘Being different’ emerged from these categories to offer a theoretical explanation of what it means to be a PWA in Nigeria. The realities of ‘being different’ constitute processual social injustices for PWA because of how the Nigerian society is socio-culturally and institutionally configured to magnify the limitations of albinism above the rights and social liberties of the individual. This research identified albinism as a disability and concluded that PWA are owed a moral and ethical obligation by the Nigerian society for them to be able to access the liberties and support necessary to secure their health and social wellbeing. The sustainable fulfilment of this moral and ethical obligation necessitates an inter-institutional collaboration and vigilance that should address the layers of injustices meted to PWA. This study adds an original contribution to knowledge by offering a theoretical concept to qualify the social status of PWA in Nigeria, and thus, could be useful to inform appropriate health and social care interventions.
    • ‘Paradigm shift? Biomedical science and social work thinking’

      Carey, Malcolm; University of Chester (Routledge, 2019-07-17)
      This chapter examines the relationship between biomedical science and social work thinking. It looks at the similarities and differences between two unique but increasingly closely associated ‘helping professions’. As part of the discussion, the role of paradigm, power and ideological disparities and distinct traditions are stressed, as well as the impact of ongoing policy-led reforms which continue to bring each profession closer together.
    • Exploring Public Perceptions and Understanding of Dementia: Analysing Narratives from the Mass Observation Project

      Olsen, Veronica; Taylor, Louise; Whiteley, Kirsty; Ellerton, Annie; Kingston, Paul; Bailey, Jan; University of Chester (Sage, 2019-07-10)
      Over 850,000 people living in the United Kingdom have been diagnosed with dementia, yet knowledge about this condition amongst the general population remains relatively poor. Many studies have evaluated the level of public knowledge and understanding about dementia from a research and professional service perspective, however none have considered this condition from the perspective of the wider public. In this preliminary overview, we analyse and describe high level narratives collected from 143 respondents to a dementia Directive commissioned to the Mass Observation Project. These narratives present a perspective on the public knowledge and understanding about dementia not previously considered, where respondents have written openly about their own experiences, and reflected on their perception of the wider public’s knowledge and understanding about dementia. This unique perspective importantly enhances our knowledge about the public’s understanding and awareness of dementia, and informs the main areas of public concern found in the analysis: care responsibilities, impact on relationships, and fears about developing dementia.
    • Clinical holding: ethical guidance for children's nurses working in the UK.

      Page, Andrea; Hejlskov Elvén, Bo; Seabra, Suzanne; Warren, Alison; McDonnell, Andrew; Lucy Mortiboys, Imogen; Vanes, Nicola (2019-07-09)
      This article explores ethical decision-making surrounding clinical holding of children and young people in healthcare environments with the aim of enhancing autonomy and engagement on their behalf. A considerable body of evidence, published over the last 20 years, suggests that this complex and challenging area of practice is not always well managed, with mixed messages about the nature of consent, choice and negotiated practice countered by best interests decisions taking precedence ahead of the child's wishes. An ethical framework is proposed comprising four levels of value-based interventions and how they may be applied in clinical practice, allowing for increased engagement, empowerment and support on behalf of children and young people in relation to clinical holding decisions. [Abstract copyright: ©2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.]
    • Some ethical limitations of privatisation within social work and social care in England for children and young people

      Carey, Malcolm; University of Chester (Routledge, 2019-07-01)
      The article considers some of the ethical impications of the ongoing privatisation of social care and social work services.
    • Stigma: a linguistic analysis of personality disorder in the UK popular press, 2008-2017.

      Bowen, Matt; University of Chester (Wiley, 2019-06-25)
      Introduction: Many people with a diagnosis of personality disorder experience stigma, and the press’ representations may contribute to those processes. To date little is known about how the press write about people with personality disorder and analysis of language used is often limited to checklists of words to avoid. Aim: The aim of the study was to explore the linguistic characteristics of press articles about personality disorder in popular tabloids in the UK and consider the implications for stigmatisation. Method: Corpus linguistics was used to examine a 50% sample of all articles published by the popular press in the UK, from 2008 to 2017, that referred to personality disorder (n=260). Results: The findings identified a range of words that constructed narratives of violence. Discussion: The method enabled the findings to expand the current level of knowledge in the field, identifying patterns in the use of the language of violence, which may contribute to the processes of self-stigma. Implications for Practice: Greater understanding of the messages in the press can sensitize nurses to common misconceptions about the disorder, how these may have become internalised and the need for psycho-social interventions to address the impact of self-stigma on self-esteem.
    • A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe

      Machekera, Shepherd; Wilkinson, Ewan; Hinderaker, Sven G.; Mabhala, Mzwandile A.; Zishiri, Christopher; Ncube, Ronald; Sandy, Charles; Timire, Collins; Takarinda, Kudakwashe; Sengai, Tonderai; et al. (International Union Against Tuberculosis and Lung Disease, 2019-06-21)
      Setting: 10 districts and 3 cities in Zimbabwe Objective: To compare the yield and relative cost of identifying a case of tuberculosis (TB) if the National TB Programme (NTP) used one of three World Health Organisation (WHO)-recommended algorithms (2c,2d,3b) instead of Zimbabwe’s active case finding (ACF) algorithm Design: Cross-sectional study using data from the Zimbabwe ACF project. Results: 38,574 people were screened from April-December 2017 and 488 (1.3%) were diagnosed with TB. WHO-2d had the least number of people needing a chest X-ray (CXR) at 13,710 (35.5%) and bacteriological confirmation at 2,595 (6.7%). If the NTP had used the WHO recommended algorithms, fewer TB cases would have been diagnosed - 18% (88 cases) with algorithm 2b, 25% (122 cases) algorithm 2d, and only 7% (34 cases) with algorithm 3b. The relative cost-per-case of TB diagnosed for the Zimbabwe algorithm at $565 was over three times that of WHO 3b algorithm ($180) which was the cheapest. Conclusion: The Zimbabwe ACF algorithm had the highest yield but at a considerable cost when compared to WHO algorithms. The trade-off between cost and yield needs to be reviewed by the NTP and changing to use algorithm 3d considered.
    • A Whole Systems Approach to Hospital Waste Management in Rural Uganda

      Kwikiriza, Stuart; Stewart, Alex G.; Mutahunga, Birungi; Dobson, Andrew E.; Wilkinson, Ewan (Frontiers Media S.A., 2019-06-06)
      Introduction: Safe waste management protects hospital staff, the public, and the local environment. The handling of hospital waste in Bwindi Community Hospital did not appear to conform to the hospital waste management plan, exhibiting poor waste segregation, transportation, storage, and disposal which could lead to environmental and occupational risks. Methods: We undertook a mixed-methods study. We used semi-structured interviews to assess the awareness of clinical and non-clinical staff of waste types, risks, good practice, and concerns about hospital waste management. We quantified waste production by five departments for 1 month. We assessed the standard of practice in segregation, onsite transportation, use of personal protective equipment, onsite storage of solid waste, and disposal of compostable waste and chemicals. Results: Clinical staff had good awareness of waste (types, risk) overall, but the knowledge of non-clinical staff was much poorer. There was a general lack of insight into correct personal or departmental practice, resulting in incorrect segregation of clinical and compostable waste at source (>93% of time), and incorrect onsite transportation (94% of time). In 1 month the five departments produced 5,398 kg of hazardous and non-hazardous waste (12; 88%, respectively). Good practice included the correct use of sharps and vial boxes and keeping the clinical area clear of litter (90% of the time); placentae buried immediately (>80% of the time); gloves were worn everyday by waste handlers, but correct heavy-duty gloves <33% of the time, reflecting the variable use of other personal protective equipment. Chemical waste drained to underground soakaways, but tracking further disposal was not possible. Correct segregation of clinical and compostable waste at source, and correct onsite transportation, only occurred 6% of the time. Conclusion: Waste management was generally below the required WHO standards. This exposes people and the wider environment, including the nearby world heritage site, home to the endangered mountain gorilla, to unnecessary risks. It is likely that the same is true in similar situations elsewhere. Precautions, protection, and dynamic policy making should be prioritized in these hospital settings and developing countries.
    • Experiences of sleep hygiene education as an intervention for sleep problems in children with developmental disabilities: Findings from an exploratory study.

      Sutton, Julie E.; Huws, Jaci C.; Burton, Christopher R.; University of Chester and Bangor University (Wiley, 2019-05-16)
      Behavioural sleep problems in children with developmental disabilities that involves advising parents on sleep‐promoting behaviours; however, it is supported by a limited evidence base. Materials and methods: This exploratory study aimed to enhance qualitative understanding and explore stakeholder perceptions about experience, current practice and ideas around the implementation of SHE. Parents of children with developmental disabilities and sleep problems (N = 9) and sleep practitioners (N = 11) took part in semi‐structured interviews and focus groups, and data were thematically analysed. Results and discussion: The analysis identified four parent themes: Beliefs about sleep problems; Getting professional help; Ways of knowing about sleep; and Visions of sleep support. Two practitioner themes were also identified: Sleep service accessibility and Inconsistent sleep support. Conclusion: The findings provide further insight into how parents of children with developmental disabilities experience sleep problems, and how SHE is currently implemented. These have implications for both policy and practice.
    • Utilising a Bourdieusian lens to explore emerging health visitor practice education experiences within the context of the Health Visitor Implementation Plan

      Gidman, Jan; Taylor, Lou; Haydock, Deborah (University of Chester, 2019-05-14)
      The Health Visitor Implementation Plan (HVIP) (DH, 2011a) changed the recruitment criteria for health visiting and the way health visitor (HV) practice placements were supported. Several universities offered accelerated '2+1' programmes, where a graduate with a health related degree obtained accreditation of prior learning and completed pre-registration nurse training in two rather than three years. This was then followed by a one-year post-registration Health Visitor programme. This widening of recruitment afforded a unique opportunity to explore the experiences of 2+1 HV students, practice teachers (PTs) and mentors, and emerging practice education models within the context of the HVIP. Findings are considered through the lens of Bourdieu’s theory of practice. The study adopted an interpretive phenomenological design to gain a deeper understanding of the experiences of students, PTs and mentors. In-depth semistructured conversational interviews were undertaken with four HV 2+1 students, two PTs and two mentors. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis. Findings viewed through a Bourdieusian lens indicate that policy change in the form of the HVIP affected the structure of the social field, resulting in a period of transition when some participants had difficulty adapting to the changed social context. Long arm models of practice education added to the complexity of the PT role, including the additional responsibility of overseeing numerous students and mentors. Mentors reported feeling under pressure, exacerbated by working in inexperienced teams; and frustration that their contribution to the HVIP was disregarded, compounded by a lack of opportunity for professional progression. Students undertaking different routes into nursing are affected by extrinsic views and this affects evolving habitus and enculturation. When students’ prior experience is valued, this strengthens the students’ perception of their ‘field’ position. Placement changes, particularly during consolidation, can be detrimental as they affect habitus formation and student learning and impact upon assessment processes. The research offers new insights into health visiting practice education and the impact of policy change on practice settings. The findings have implications outside health visiting in the current context of changes to nurse education and the introduction of the new NMC (2018b) standards for student supervision and assessment. New knowledge is offered with regards to the significance of transition periods, changing roles, and the potential impact upon the provision of student practice placements and those who support them. Recommendations are made for further areas of research, practice placement providers and HEIs.
    • Stigma: a linguistic analysis of the UK red-top tabloids press’s representation of schizophrenia

      Bowen, Matt; Kinderman, Peter; Cooke, Anne; University of Chester; Liverpool University; Canterbury University (SAGE publications, 2019-05-10)
      Aims. Media representations of mental health problems may influence readers’ understanding of, and attitude towards, people who have received psychiatric diagnoses. Negative beliefs and attitudes may then lead to discriminatory behaviour, which is understood as stigma. This study explored the language used in popular national newspapers when writing about schizophrenia and considered how this may have contributed to the processes of stigmatisation towards people with this diagnosis. Methods. Using corpus linguistic methods, a sample of newspaper articles over a 24 month period that mentioned the word ‘schizophrenia’ was compared with a similar sample of articles about diabetes. This enabled a theory-driven exploration of linguistic characteristics to explore stigmatising messages, whilst supported by statistical tests (Log-Likelihood) to compare the data sets and identify words with a high relative frequency. Results. Analysis of the ‘schizophrenia’ data set identified that overtly stigmatising language (e.g. “schizo”) was relatively infrequent, but that there was frequent use of linguistic signatures of violence. Articles frequently used graphic language referring to: acts of violence, descriptions of violent acts, implements used in violence, identity labels and exemplars of well-known individuals who had committed violent acts. The word ‘schizophrenic’ was used with a high frequency (n=108) and most commonly to name individuals who had committed acts of violence. Discussion. The study suggests that whilst the press have largely avoided the use of words that press guidance has steered them away from (e.g. “schizo” and “psycho”) that they still use a range of graphic language to present people with a diagnosis of schizophrenia as frighteningly ‘other’ and as prone to violence. This repetition of negative stereotypical messages may well contribute to the processes of stigmatisation many people who experience psychosis have to contend.
    • Stigma: the representation of mental health in UK newspaper twitter feeds.

      Bowen, Matt; Lovell, Andy; University of Chester (Taylor & Francis, 2019-05-10)
      Background The press’ representation of mental illness often includes images of people as dangerous, and there is evidence that this contributes to stigmatising understandings about mental illness. Little is known about how newspapers portray mental health on their Twitter feeds. Aims To explore the representation of mental health in the UK national press’ Twitter feeds. Method Content analysis was used to code the Tweets produced by UK national press in two time periods, 2014 and 2017. Chi-square analysis was used to identify trends. Results The analysis identified a significant reduction in the proportion of tweets that were characterised as Bad News between 2014 and 2017 (χ2 = 14.476, d.f. = 1, p < .001) and a significant increase in the tweets characterised as Understanding (χ2 = 9.398, d.f. = 1, p = .002). However, in 2017, 24% of the tweets were still characterised as Bad News. Readers did not retweet Bad News stories significantly more frequently than they were produced. Conclusions There is a positive direction of travel in the representations of mental health in the Twitter feeds of the UK press, but the level of Bad News stories remains a concern.
    • Epidermolysis bullosa: how social support affects quality of life

      Butterworth, Sondra; Mitchell, Andrew E. P.; Mason-Whitehead, Elizabeth; Martin, Kate; University of Chester (EMAP, 2019-05-01)
      Measuring quality of life has become an increasingly important method of evaluating the effect of health and social care interventions. The rare genetic condition epidermolysis bullosa is known to have a deep social impact on people’s quality of life, but most research into the condition is focused on its biomedical aspects and attempts to find a cure. A literature review has explored the relationship between social support and quality of life in people with epidermolysis bullosa. It concludes that, while more research is needed, social support does have a positive impact on quality of life and that professionals should adopt a bio-psychosocial approach to management.
    • Predictors of mortality and survival in type 1 diabetes: a retrospective cohort study of type 1 diabetes mellitus (T1D) in the Wirral Peninsula

      Akata, Eloho (University of ChesterUniversity of Chester, 2019-05)
      Background: The prevalence of T1D is rising, despite improvements in the management of this condition. It presents a risk of premature and excess mortality, which impacts survival and life expectancy. Aim: The study aim was to assess mortality, identify predicting risk factors for mortality and survival in T1D in the Wirral. A systematic review was done to establish present current evidence of all-cause and cause-specific mortality amongst T1D patients. Methods: A retrospective cohort study design, 1786 patients diagnosed with T1D extracted from the Wirral Diabetes Register (WDR). The follow-up period was between 1st of January, 2000 to 31st December, 2012. The primary outcome measured was all-cause mortality. Results: 1458 participants with T1D meet the inclusion criteria, after a follow-up period of 12 years, 113(7.75%) deaths were recorded. While the incidence rate was steady over the study period, the prevalence rate continued to increase over the study period. Significant predictors of mortality in this cohort were age of diagnosis, duration of diabetes, HbA1c,systolic blood pressure (SBP), diastolic blood pressure (DBP), and triglyceride levels. The predicting risk gender, age at diagnosis, duration of T1D, BMI, serum creatinine levels, SBP, total cholesterol, LDL, HDL, TC\HDL, and LDL\HDL showed a linear increase in mortality risk. IMD and DBP followed a U-shaped relationship with relative and absolute mortality, while HbA1c levels reveal a sinusoidal pattern with the highest risk of mortality at the levels ≤ 5.9% (41 mmol/mol). The risk of mortality for the predicting risk factors for this study ranged between 5% and 9%. Maximal risk of mortality of 9% was recorded in the predicting risks of smoking, BMI, SBP, and DBP. The risk of mortality of 8% was recorded for IMD, serum creatinine, total cholesterol, TG, LDL\HDL ratio, and TSH. The risk of mortality of 7% was recorded for the predicting variables of HbA1c, HDL, LDL, and TC\HDL ratio. The minimum risk of mortality of 5% was recorded for the predictor variable of the duration of diabetes. The significant predictors of mortality were the age at diagnosis, duration of diagnosis, systolic and diastolic blood pressure, HbA1c. The burden of mortality rest disproportionately with females who had higher relative risk of mortality of 4 times that of their male counterparts, however, the burden of premature mortality as recorded by the years of potential life lost was slightly higher in males (1797[53.6%]) as compare to females (1553[46.4%]). Of the 113 deaths recorded for the cohort that indicated a proportion of 7.75% of the total T1D patients, records for only 37 participants were retrieved. The principal cause of death in this cohort was malignancy-related 8 deaths (21.6%), this was followed by cardiovascular disease and sepsis, each having 6 deaths (16.2%) respectively. Cerebrovascular disease accounted for 5 deaths (13.5%). Death from diabetes complications (hypoglycaemia) was recorded in 1 patient (2.7%). There were marked reductions in life expectancy for this cohort. Life expectancy at 40 years for females was to an average age mortality of 66.2 years as compared to males 78.3 years. There has been improved survival for T1D in this cohort, 77.185 years [95% CI: 75.191 – 79.179] in males and 76.011 years [95% CI: 73.169 – 78.000] in females. The systematic review highlighted increased mortality in those with T1D as compared to the general population, females showed greater risk of vascular complications as compared to the males with T1D. 35 studies were included. Results showed all-cause mortality RR 3.73 (95% CI 3.19, 4.36) compared to general population, with gender specific mortality RR 1.17 (95% CI 1.06, 1.29). For cause specific mortality risk (overall and gender specific): cardiovascular v disease RR 3.48 (95% CI 3.14, 3.86) and RR 1.41 (95% CI 0.92, 2.17); renal disease RR 1.06 (95% CI 0.89, 1.26) and RR 0.63 (95% CI 0.38, 1.04); neoplasms RR 1.03 (95% CI 0.92, 1.16) and RR 1.18 (95% CI 0.75, 1.86); cerebrovascular disease according to gender RR 0.99 (95% CI 0.66, 1.48), and accidents and suicides according to gender RR 2.30 (95% CI 1.31, 4.06). Conclusion In conclusion, the study highlighted significant mortality risk in females as compared to their male counterparts; there has been progress in the survival of patients with T1D. However, life expectancy remains reduced as compared to those without the condition. Prevalence of T1D continues to increase, and the complex interplay of the predictor variables support the need for an individualised approach to care.
    • Development and delivery of the trainee nursing associate pilot curriculum.

      Roulston, Christina; Davies, Miriam (2019-04-11)
      This article discusses the recently launched curriculum for nursing associates and the authors' involvement in the development of a medicine management module. This required recognition of the challenges in an ever-changing healthcare environment with, in this instance, limited guidance from the Nursing and Midwifery Council and associated professional organisations and with multiple stakeholders to satisfy. Curriculum development therefore required consideration of the concerns of service users and providers regarding the integration of this new, poorly understood role, its potential effect on skill mix and lack of knowledge regarding proposed regulation.