RSS 1.0Health and Social Care
The Faculty of Health and Social Care has a long history at University of Chester, being established in the early 1990s as the School of Nursing and Midwifery. A wide variety of programmes are delivered by the Faculty including foundation degrees, undergraduate degrees and postgraduate degrees. All branches (adult, mental health, learning disability and child) of pre-registration nursing can be undertaken, as well as pre-qualification courses in Midwifery and Social Work. Social Work programmes are available at both undergraduate and masters levels. The Faculty also offers a wide ranging and exciting portfolio of post-qualifying programmes with an inter-professional focus. Within the Faculty, research is viewed as integral to the working life of staff, in partnership with local and regional providers of care. The Faculty has a research office which coordinates the activity of the Faculty. The strategic focus is on further development in community/primary care, users and carers support and inter-professional learning. There are opportunities to register for a PhD, with supervision from recognised experts in their field. Individual Professors, Readers and Teaching Fellows lead their own research developments in subjects closely related to practice-based care. These include clinical interventions in eating disorders, supporting individuals with learning disabilities in the penal system, interventions in forensic mental health, supporting carers and users of services, safety factors for single practitioners in the community and pedagogical research.
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Enhancing undergraduate nurses’ online learning engagement: A mixed methods studyAim: To evaluate a structured, student-focused online learning environment (OLE) for delivering applied sciences for nursing. Background: Online learning can impair the learning experience for students, but it promotes flexible access to study. Design: A mixed-methods study was used to explore and analyze students’ experiences and preferences for two different delivery models. The original online module space consisted of an information repository. The new OLE was a structured bioscience for nursing module, designed to scaffold student learning to achieve learning outcomes using a variety of different methods to support diverse learning styles. Outcome measures used were student satisfaction, student assessments and qualitative data from module feedback questionnaires and focus groups. Methods: Questionnaires on the OLE experience were administered to students (n = 52) and results compared with previous module feedback. Two student focus groups (n = 7) explored these responses in more depth. Results: A redesigned OLE, with student learning as its focus, improved student engagement with the module space. Interactive learning experiences made students feel better prepared for assessment. Students gained greater digital capabilities by using the OLE. The flexibility and potential to re-watch teaching sessions was welcomed. Conclusions: OLEs should be designed collaboratively with learning technologists and regularly reviewed to avoid overwhelming students with irrelevant or outdated materials. Flexible, online learning is ubiquitous, requiring a user-friendly and effective OLE for nursing students.
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An ethnographic study exploring health visitors' engagement with fathers of children under five years old: A Bourdieusian perspectiveThe health visiting service within the United Kingdom (UK) provides an essential public health service for all families with children under the age of five years old, under the wider umbrella of the 0-19 service. Despite maternity and postnatal policy stipulating a ‘family-centred’ approach to care delivery, the wider literature suggests that fathers can often feel marginalised within the health visiting service. An indirect corollary to this is that men’s mental health (MH) illness has been steadily increasing over several years. This is an area that health visitors (HVs) are available to assess and offer support to fathers, yet do not appear to be doing. A critical ethnographic approach was used to explore HVs engagement with fathers, through a combination of observations of HV practice, semi-structured interviews and field notes. The research took place in a health visiting service in the Northwest of England, with a sample of qualified HVs. Spradley’s framework for data analysis was employed to make sense of the findings and a Bourdieusian lens was used as a conduit for exploring individual HV practice within the wider scope of organisational custom and practice. Three themes emerged from the findings which include man in a van - barriers to HV engagement with fathers; toxic masculinity and feminist health visiting - a disconnect; and the ‘forgotten husband’s club - father’s mental health and the health visiting service. The findings highlight that organisational barriers exist, which impede HV engagement with fathers, alongside toxic masculinity, which has gathered momentum as a concept in contemporary society. Similarly, men’s MH remains an underassessed area of practice for HVs, leaving fathers feeling ‘forgotten’ by services. Implications for practice include policy review surrounding paternity leave, a review of commissioning of health visiting services, including delivery of universal antenatal contacts, designated electronic records for fathers and increased screening of paternal MH at routine HV contacts.
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A qualitative exploration of the practice learning experiences of third‐year nursing students: challenges and opportunitiesAim: This study investigated the practice‐based learning experiences of third‐year nursing students under the Nursing and Midwifery Council (NMC) Future Nurse Standards (2018). The study identified enablers and barriers to proficiency achievement and explored how these experiences inform their preparation for roles as registered nurses and future practice supervisors. Background: The study focused on nursing students who began their undergraduate programs in September 2020, the first cohort under the NMC Future Nurse Standards (2018). Conducted during the COVID‐19 pandemic, the research explored clinical practice learning experiences across three higher education institutions in England, highlighting the challenges in meeting required proficiencies. Design: A qualitative approach was used, underpinned by hermeneutic phenomenology. Focus group discussions with 17 final‐year nursing students were undertaken. Methods: Thematic analysis was employed to explore shared experiences of practice‐based learning. Ethical approval was obtained, and data saturation ensured robust findings. Results: Five themes emerged: the physical and emotional impact of practice learning, lack of confidence in the process of assessment due to inconsistency, being prepared for practice, the impact of the practice supervisor/assessor, and what might help. Students described the process of achieving proficiencies as exhausting and emotionally draining, with assessment inconsistencies and limited supervisor engagement contributing to stress, isolation, and reduced learning opportunities. Conclusion: While students navigated the pandemic’s impact on education, practice supervisors/assessors were seen as pivotal yet overstretched or insufficiently prepared. Findings highlight the need for standardized assessments, improved supervisor training, and tailored preplacement support to enhance practice‐based learning and better prepare students for registration and future supervisory responsibilities.
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Creative health placements offer student nurses diverse and valuable learning opportunitiesBackground and purpose: This is a perspective on Ridgway et al ‘Creative health a joke or valuable learning experience'. Creative health encompasses creative and arts activities that benefit health and well-being. The article evaluates a creative health placement designed to facilitate students’ learning about creative health and social prescribing, with opportunities to take part in arts activities.
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Clinical spectrum and prognostic predictors of Guillain-Barré Syndrome: A prospective observational study from South IndiaIntroduction: Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy and a leading cause of acute flaccid paralysis. Though uncommon, it carries substantial morbidity and mortality. Indian prospective data remain limited, prompting this study to evaluate clinical patterns, complications, and prognostic determinants in a tertiary care cohort. Study: This prospective observational study was conducted at Madras Medical College, Chennai, between May 2024 and May 2025. Ninety consecutive patients aged 12 years and above fulfilling the Asbury and Cornblath criteria for GBS were included. Clinical details, cerebrospinal fluid (CSF) parameters, and electrophysiological subtypes were documented. Patients received intravenous immunoglobulin (IVIG), plasma exchange (PLEX), or supportive care. Outcomes assessed were ventilation requirement, complications, mortality, and functional status at discharge using the modified Rankin Scale (mRS). Results: Ninety patients (mean age 38.5 years) were studied, with a slight male predominance. Antecedent infections were common, mainly respiratory or gastrointestinal. Most patients (over 80%) presented with ascending symmetrical weakness, predominantly of the pure motor type. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the commonest electrophysiological subtype, followed by axonal variants. About one-fourth required intensive care unit (ICU) admission, and one-fifth needed mechanical ventilation. At discharge, one-third regained independent ambulation, while 9% died. Poor outcomes were associated with older age, cranial nerve and autonomic involvement, and axonal forms. Conclusion: GBS in this cohort predominantly affected young to middle-aged adults, with classical ascending weakness and AIDP as the commonest pattern, though axonal forms were frequent. One-third recovered well, but nearly half remained disabled and 9% died. Early recognition of predictors such as older age, cranial nerve palsy, autonomic dysfunction, and axonal subtypes is crucial for risk stratification and intensive management.
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Quantifying the optimal factor VIII levels to achieve patient-centric and clinician-relevant outcomes among people with hemophilia A: a SHELF elicitation studyBackground: Hemophilia A is an inherited bleeding disorder caused by a deficiency of clotting factor VIII (FVIII), leading to joint bleeding and arthropathy. While prophylactic FVIII therapy reduces bleeding, evidence suggests maintaining higher FVIII levels (FL) may better protect joint health, particularly in physically active individuals and those with joint damage. However, data on optimal FLs required to prevent joint deterioration and complications remains limited. Research design and methods: This study utilized the Sheffield Elicitation Framework (SHELF) methodology to elicit expert opinions on optimal FLs for patient-centric and clinical outcomes. Five European hemophilia experts participated in virtual workshops, providing probability-based estimates of FLs required to prevent bleed-related hospitalizations, orthopedic procedures, target joint incidence, and support physical activity without additional infusions or joint damage. Results: Experts consistently recommended higher FLs for individuals with joint damage than for those without. Optimal average FLs ranged from 24% to 51%, exceeding traditionally recommended prophylactic trough levels (3–5%). Considerable uncertainty was noted around FLs for physical activity, reflecting the complexity of individualized care. Conclusions: Standard prophylaxis regimens may not provide sufficient protection for all patients, particularly those with joint damage. A personalized treatment approach, targeting higher FLs when necessary, may be critical for optimizing outcomes.
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Children’s rights, deinstitutionalisation and the development of foster care services across the worldIn many countries, foster care is an established system for looking after children who cannot live with their birth families. It is accepted as a preferable form of provision when compared to institutional arrangements. Deinstitutionalisation is founded upon theories of child development, most particularly attachment theory, which suggest that children are more likely to flourish in family settings as opposed to institutions. The implementation of a foster care system accords with the United Nations Convention on the Rights of the Child and the associated recommendations. But is it feasible to apply these rights and recommendations across the world? How transferable is the system of foster care? By making use of the literature, this paper draws attention to some of the challenges and complexities that accompany attempts at implementing this child care strategy in some of the world’s regions.
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Correction to: The LUCID study: living with ulcerative colitis; identifying the socioeconomic burden in EuropeAfter publication of this article [1], the authors reported that the author name “Avedano” was incorrectly written as “Avendano”. The original article [1] has been updated.
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Self-compassion and veteran's health: A scoping reviewThere is evidence to suggest that self-compassion is related to positive health and wellbeing outcomes, therefore, this paper explores this concept within the military veteran population. The aim of this review was to identify research and explore the evidence-based of self-compassion as a protective factor, from negative health outcomes, amongst military veterans. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guided the undertaking and reporting of this review. Databases (CINAHL, EBSCO, MEDLINE, PsycInfo, SocINDEX, Web of Science), manual searches of grey literature, websites, and reference lists of retrieved articles, were explored to identify peer-reviewed English language studies published from 2000 to 2019. Searches included any study that measured self-compassion or involved self-compassion education/training. A narrative synthesis was utilized. Searches retrieved 89 articles; 17 studies met the inclusion criteria. All studies were conducted in the US and included veterans, with three also including partners. There was heterogeneity between studies’ designs, methodologies, and characteristics. Of these studies, 11 examined associated factors, eight measured improvements in health or well-being outcomes, and six reported feasibility and acceptability of self-compassion strategies. Self-compassion seems to be particularly beneficial for veterans who have experienced trauma, suffering from Post-Traumatic Stress Disorder, trauma-related guilt, depression (or at risk of suicide), and for those who have been in combat and deployed. Limited evidence was found for Schizophrenia and alcohol misuse. Self-compassion appears to have a protective role with positive outcomes for mental and physical health in veterans, in particular for trauma-related psychopathology symptoms.
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Professional doctorates in health and social care: A qualitative exploration of their impact and outcomes by two northern universitiesAim: To explore the experiences, outcomes and impact identified by current and past students of undertaking a professional doctorate (PD) in health and/or social care on themselves, their employing organisations and their professional domain. Background: Professional Doctorates are intended to equip graduates with critical and creative thinking skills, and the ability to understand, question and produce evidence relevant to health and social care policy, practice and education. They are costly in terms of time, effort and resources for student and employer, but there is little empirical evidence to support these claims. Methodology: This modified constructivist grounded theory study used a qualitative methods approach, that included both questionnaires (mainly free text answers with a few demographic and numerical questions) and in-depth semi-structured interviews. Current (n=42), graduate (n=4) and previous (2) professional doctorate students completed the questionnaires. The interviews were conducted online with 12 current students from three different health and/or social care programmes from two universities in England. Descriptive demographic and numerical student experience and outcome data were presented to provide context for the study. The qualitative data from both datasets were analysed using Braun and Clarke’s (2022) thematic analysis. Results/Findings: Ten themes were identified, five relating to individual impact. These included: positive outcomes on personal growth and validation; improved ability to deal with complexity; more mixed effects from both challenges and support in academia; as well as some career development opportunities. Frustrations were found by some in their current role. Employers were seen as gaining employees with enhanced assessment skills, making a stronger contribution to organisational development. Doctoral students also brought esteem to employing organisations by virtue of their academic status. Professional impact could be limited by the expectations, support and culture of their employing organisation and in the way doctorates are viewed by the profession. Policy development was evidenced, but it was often a slow process, needing opportunity, mentorship and time to be fully realised. Conclusions/Recommendations: Participants valued their professional doctorate experience and the way it transformed their world view, professional knowledge and confidence. Some students felt conflict between their developing professional self-concept and the support, recognition and scope for development on the part of their employer, although some evidenced career progression. Employers should engage with staff undertaking professional doctorates in order to provide support and optimise organisation benefits. More research is needed to explore the perspectives of employers and professional organisations. It is also necessary to evaluate longer-term outcomes for the postdoctoral professional.
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Person-centred care in the management of imaging-related anxiety in diagnostic radiography: a scoping review exploring cancer and non-cancer populationsIntroduction: The potential anxiety invoked by diagnostic imaging procedures intensifies in cancer diagnoses, with the term ‘scanxiety’ originating from the additional fear associated with cancer imaging. This emphasises the importance of a person-centred approach to care. This scoping review mapped the literature regarding imaging-related anxiety, ‘scanxiety’, and person-centred care. Methods: Databases used were Cinahl Plus; Proquest; PubMed; Scopus; Web of Science; PsycINFO, and Cochrane. Broad search terms were utilised to maximise results, with specific inclusion and exclusion criteria. Limiters were English language articles within the previous 10 years. Further to systematic filtering and critical appraisal, 60 studies were included. Results: Findings were organised in four themes: ‘Quantification and causes of anxiety’; ‘The nature of imaging procedures’; ‘Perceptions of Person-centredness’; and ‘Service and staffing factors’. MRI and PET/CT cause the highest procedural stress. Fear of results causes greater, and more sustained, anxiety in cancer patients than other groups, creating complex emotional needs. The physiological effects of anxiety can adversely affect image quality and ability to complete scans. Human interaction is central to managing anxiety, but service pressures and staff emotional labour influence care delivery. Most existing person-centred care research in imaging relates to generic populations, with limited focus on how diagnostic radiography staff can support people with cancer. Conclusion: Although the psychosocial needs of those undergoing cancer imaging are greater than in other diagnoses, more research is needed into the benefits of a person-centred approach and the support and education needs of staff working in this field. Implications for practice: Understanding experiences of cancer imaging, from both patient and staff perspectives, including any facilitators and barriers to care, would support development of a model for person-centred care in this specialist area.
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Enhancing equality, equity, diversity and inclusion in rare disease research in the United KingdomBackground: Inclusion of under-represented rare-disease communities in research remains limited, threatening representativeness and equity. Methods: To assess equality, equity, diversity, and inclusion in research and identify barriers to participation faced by the rare disease community, utilising a mixed-methods online survey of a convenience sample of community advocates using Likert scales and free response options. Results: The findings from seventeen stakeholders in the rare disease community showed unanimous agreement that anxiety, fear, safety concerns, and lack of trust hinder participation in research. A total of 82% agreed or strongly agreed that additional financial resources are needed, and 76% agreed or strongly agreed that research grant applications often lack sufficient funds. The free-text responses demonstrate that the rare disease communities are keen to be involved in research but faces barriers to inclusion. Rare disease communities are willing to participate in research, but those responsible for research need to address the challenges related to language, misconceptions and fear. Conclusions: Key legislation in the United Kingdom, specifically the Proposed Patient and Public Involvement Strategy 2020–2025, emphasises the importance of involving patients and the public in health and social care. This survey marks the first step toward gaining valuable insights into the challenges faced by this community in participating in healthcare research, which is crucial for developing a solid evidence base for their treatment and care. Involving stakeholders is essential in health and social care policy and practice, rooted in advocacy and social justice.
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Rural inpatient hospitals and substance use—a 10-year retrospective analysisAims: To determine the burden and nature of substance use presentations within a defined rural region and provide an estimate of the prevalence and subsequent local needs. Method: Anonymised secondary data, based on hospital inpatient enquiry (HiPE) records dated 2010–2021 from three sites, were analysed using descriptive and inferential statistics. Result: Despite similar gender distributions across the three hospitals, approximately 3:1 male to female, substance-related admissions varied significantly across hospitals (p < .001). Hospital C had the highest alcohol-related admissions 3537(98.6%), followed by Hospital A for opiates 369(12.3%) and Hospital B for cannabis 161 (2.2%). Only 1151(8.2%) of patients received substance use treatment. Discharge destinations also differed (p < .001), with Hospital A having higher patient transfer rates 301(10%) and self-discharge/absconding incidents 415(13.8%) compared to Hospitals B 261(3.6%) and 442(6%) and C 175(4.9%) and 200(5.6%) respectively. Alcohol-related disorders were among the top five non-communicable diseases for men across all sites, and for women in two of the three hospitals, indicating a widespread but gender-variable burden of alcohol-related harm. Discussion: The data demonstrates significant disparities in substance-related admissions, discharges, and treatment across the hospitals, highlighting the need for integrated care pathways, personalized services, and targeted professional development to address substance use presentations effectively. The findings underscore that a one-size-fits-all approach is insufficient.
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Correction to: Ethnic and minority group differences in engagement with COVID-19 vaccination programmes – at Pandemic Pace; when vaccine confidence in mass rollout meets local vaccine hesitancyIn the original publication of this article [1] an error was introduced during the publication process in the reference numbering. This caused all citations after 13 to be incorrect. The citations in the original article have now been corrected.
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(In)action on the social and commercial determinants of health: a call to arms to push the agenda forwardIn this article, Noonan contends that boosting public support is vital for increasing pressure on the Government to enact change for the common good. He argues that the public health community can build public support for the required structural changes by challenging misinformation and sharing a new story.
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A third way: Off-team practice educators in social work educationIn Social Work, Practice Educators (PEs) are termed ‘on-site’ or ‘off-site’ depending on whether they work in the same location as the student they are supporting, or are ‘physically located away from the learners practice area’. Here, we trial and examine a third model: ‘off-team’ practice education. An off-team PE works in the same local authority (LA) as the student but in a different team, providing some familiarity and distance. We hypothesized that this model could be more favorable to LAs, providing some advantages of off-site and on-site models. Using focus groups, we explored student and PE experiences of the off-team model and compared them with experiences of the on-site model. We found that off team education offers a viable pathway for supporting students, but there are differences to recognize to maximize advantages and mitigate disadvantages. The significance of our study for practice education lies in its exploration of the potentials and limitations of the off-team model, particularly regarding supervision, assessment, and the development of professional relationships. We conclude by offering reflections on how educators might more effectively operationalize both on-site and off-team models to maximize their respective strengths.
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Understanding the perceptions, beliefs, attitudes and engagement in selective anti-microbial self-medication practices in a community in Greater Monrovia, Liberia: A constructivist grounded theoryBackground: In Greater Monrovia (GM), Liberia, self-medication is a prevalent practice, with individuals often using medications to manage conditions like diarrhoea and respiratory tract infections (RTIs) without professional consultation. Cultural beliefs, perceived cost savings, and a desire for autonomy in health management drive this practice. Commonly used medications include antibiotics like Flagyl, doxycycline, and tetracycline for diarrhoea, and ceftriaxone, erythromycin, and ciprofloxacin for RTIs and typhoid fever. Alongside nonpharmaceutical medicines, herbal remedies such as guava leaves and ginger-lime mixtures are also widely used. However, the unregulated use of these substances contributes to significant public health risks, including antimicrobial resistance (AMR), which is exacerbated by poor access to healthcare and low levels of health literacy in Liberia. Despite the high prevalence of self-medication, there has been limited research into the perceptions, beliefs, and attitudes of Liberians toward this practice. Aim: This thesis aims to explore the perceptions, beliefs, attitudes, and experiences of Liberians regarding self-medication, specifically in the context of managing diarrhoea and RTIs. The research further analyses how these practices contribute to the development of AMR and seeks to propose policy recommendations to mitigate the negative consequences of self-medication in Liberia. Method and Design: The study adopts a qualitative design, using in-depth, semi-structured interviews to collect data from residents in Greater Monrovia (GM). Data were gathered from 26 participants (physicians, pharmacists, patients, and residents) in GM, who were selected using purposive and theoretical sampling methods. The research is underpinned by constructivist grounded theory alongside symbolic interactionism, with Kathy Charmaz's approach providing the methodological framework. The conceptual framework guiding the study is the Socio-Ecological Model (SEM), which helps understand the behavioural factors influencing individuals' decisions to self-medicate. The research follows a constructivist paradigm, utilising an interpretivist approach to explore the social and healthcare barriers contributing to self-medication practices in the region. Findings: Analysis of the interview data revealed three major themes that influence self-medication in GM, Liberia: (1) barriers to accessing healthcare services, (2) the impact of low literacy and education on unsafe medication practices, and (3) the lack of a structured medication dispensing policy. Participants commonly self-medicate for a wide range of conditions, including hypertension, hepatitis-related symptoms, diarrhoea, RTIs, and general body pains. The findings suggest that the practice of self-medication is heavily influenced by socioeconomic factors, the accessibility of medications, and the lack of healthcare infrastructure. Conclusions: The study concludes that self-medication in GM is driven not only by personal beliefs but also by systemic factors such as poor healthcare infrastructure, socioeconomic barriers, and a lack of education regarding the risks of improper medication use. While some participants are aware of the potential dangers of self-medication, they often disregard these risks due to limited healthcare options and perceived autonomy over their health. The study recommends implementing stricter regulations on the sale of antibiotics and other prescription medications, alongside strategies to improve healthcare accessibility and public health promotion education. Monitoring medication sales and enforcing prescriptions could play a crucial role in reducing self-medication practices and mitigating the rise of antimicrobial resistance in Liberia.
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Impact of severe Hemophilia on costs and quality of life in South American men: Findings from the CHESS LATAM studySevere hemophilia is a rare bleeding disorder, associated with high socioeconomic costs and burden. The "Cost of Hemophilia in Latin America: A Socioeconomic Survey" (CHESS LATAM) study aimed to quantify this burden across 4 Latin American countries; Argentina, Brazil, Chile, and Colombia. Demographic, clinical, and medical data of patients were captured through their hemophilia specialists during the period between September 2020 and May 2021. Direct medical resource use was captured by a physician survey, and direct nonmedical and indirect costs were captured via a patient survey. Health-related quality of life was also captured from a patient perspective. Local country-specific unit costs were applied to resource use to calculate per-patient costs over a 12-month period. Physician data were captured for a total of 830 patients. For a subsample, 153 (18% of the sample) associated patient surveys were completed. Annual cost of severe hemophilia across the 4 countries was estimated at less than US$ 104 000 (International$ 234 237) per patient. Factor replacement therapy accounted for the majority of costs (up to 99%). Indirect costs were driven by patient and caregiver work loss. The results of the CHESS LATAM study highlight the large burden faced by patients with severe hemophilia A and B in Latin America. Despite the dominating treatment costs, the indirect impact of hemophilia on the patients and those who care for them was still substantial and should not be dismissed. [Abstract copyright: Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.]
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Fruit and vegetable intake in minority ethnic groups in the UK: Analysis from ‘Understanding Society’ and UK BiobankObjective: To examine differences in fruit and vegetable intake and food insecurity between Black African and Caribbean and South Asian (Indian, Pakistani and Bangladeshi) ethnic minority groups with a White (British) reference population in the UK. This study was part of the TANGERINE project (nuTritional heAlth aNd aGeing in oldER ethnIc miNoritiEs). Design: Longitudinal analysis using multilevel logistic regression from Understanding Society, and a cross-sectional comparison with UK Biobank. Setting: Understanding Society waves 2 (2010-2012), 5 (2013-2015), 7 (2015-2017), 9 (2017-2019) 11 (2019-2021), and 13 (2021-2023). UK Biobank baseline data (2006-2010). Participants: Understanding Society: adults aged 16 years and above (approximately 44,000 households). UK Biobank: participants aged 37-73 years (n=502,412). Results: At wave 2, African, Caribbean, Pakistani, and Bangladeshi participants in Understanding Society had lower odds of daily vegetable intake than White British/Irish participants, with Pakistanis showing the lowest intake. These disparities persisted after adjusting for socioeconomic position (SEP) at individual and area level, particularly for Caribbean and Pakistani groups. Indians consistently had higher odds of vegetable intake. Ethnic differences in fruit intake were smaller and largely attenuated by SEP adjustment. Food insecurity was more prevalent in all ethnic minority groups (except Indians) and associated with lower vegetable and fruit intake, though SEP explains more of the ethnic difference. Conclusions: Ethnic differences in fruit and vegetable intake are at least partially explained by SEP, with persistent vegetable consumption disparities after adjustment. Culturally tailored interventions addressing affordability, accessibility, and SEP disparities are needed to improve dietary behaviours among minority ethnic groups.
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Exploring the relationship between personalization of care and participation in sport activities among people with severe Hemophilia A across Europe: Post hoc analysis of the CHESS II studyTo describe the demographic and clinical characteristics of patients with hemophilia A receiving different levels of treatment personalization (TP), and to assess the relationship between TP and sport active time (SAT). This post hoc analysis of the CHESS II study used data from physician-completed patient record forms and patient self-completion forms for adult males receiving prophylaxis for severe hemophilia A in Europe between November 2018 and October 2020. SAT was assessed using propensity score matching (PSM) across levels of TP, including pharmacokinetic (PK)-guided and non-PK-guided. Of 54 patients, 32 (59.3%) received TP. Of these, 22 (68.8%) and 10 (31.3%) received non-PK-guided and PK-guided treatment, respectively. Median age varied between the TP and no-TP groups (29.5 and 34.0 years, respectively). Median (IQR) annual bleeding incidence was higher with non-PK-guided vs PK-guided TP (4.0 [3.0-8.0] vs 3.5 [2.0-4.0]). Median (IQR) problem joints were similar with non-PK-guided and PK-guided TP (1.0 [0.0-1.0] and 1.0 [0.0-2.0]). Patients in the TP vs no-TP group had higher median (IQR) SAT per month (3.3 [1.8-6.2] vs 1.8 [0.7-5.0] hours). Median (IQR) SAT per month was higher with PK-guided vs non-PK-guided TP (4.0 [3.0-20.0] vs 3.0 [1.3-5.3] hours). After controlling for confounding in the PSM model, SAT remained higher with TP vs no-TP and with PK-guided vs non-PK-guided TP. In both PSM models, P values were <0.05 for the average treatment effect and <0.01 for the average treatment effect on the treated. Sensitivity analyses confirmed the robustness of the PSM. Patients receiving TP vs no-TP had higher median SAT. Of those with TP, those receiving PK-guided vs non-PK-guided TP experienced lower bleeding rates and higher SAT. PK-guided TP may help patients to be more active, potentially gaining the clinical and psychosocial benefits of exercise. [Abstract copyright: © 2025 The Takeda Pharmaceutical Company Limited (Takeda).]
