• I can't sit down - easing genital tract trauma

      Steen, Mary; Leeds Teaching Hospitals NHS Trust, (Mark Allen, 2005-05-01)
      This article discusses the high prevalence of genital tract trauma and its many negative consequences for women, such as being unable to sit down comfortably. Its highlights how suture technique and suture material can significantly contribute to the severity of perineal pain and discomfort and the importance of asking women about their ‘pain experience’. Treatments to alleviate the pain and discomfort are then reviewed. In conclusion, it would appear that a combination of systemic and localised treatments is necessary to achieve adequate pain relief which will meet individual women’s needs.
    • I wanted to feel the way they did: Mimesis as a situational dynamic of peer mentoring by ex-offenders

      Buck, Gillian; University of Chester (Taylor & Francis, 2016-10-10)
      Despite growing enthusiasm for peer mentoring as a criminal justice intervention, very little is known about what actually happens within these relationships. Drawing on an ethnographic study of peer mentoring in the North of England this article will foreground the concept of inspiration” in these settings. It will argue that Rene Girard’s theory of mimesis offers a framework with which to analyze role modeling in mentoring relationships and that a Girardian reading also offers interesting insights into the unresolved problem of the origins of personal change.
    • Ice packs and cooling gel pads versus no localised treatment for relief of perineal pain: A randomised controlled trial

      Steen, Mary; Marchant, Paul; Royal College of Midwives/University of Central Lancashire ; Leeds Metropolitan University (TenAlps, 2007-06-01)
      Background: Trauma to the perineum is extremely common during childbirth and the intensity of perineal pain has been reported to vary from being mild to very severe in nature. Aim: To evaluate the effectiveness of two localised cooling treatments (ice pack and cooling gel pad) compared with a no localised treatment group at relieving perineal pain. Method: A randomised controlled trial conducted in a large maternity unit in the north of England and followed up in women's own homes in which 450 women who had either undergone a normal or instrumental delivery that required suturing of an episiotomy or second-degree tear were randomly assigned to three treatment groups. Results: The response rate was 316 out of 450(71%). Perineal pain was most severe when sitting compared to lying down or walking and there was a significant difference between the three groups in estimates of overall pain when sitting on day four (Kruskal-Wallis test,df=2 p=0.01). Estimates of overall pain were lower in the gel pad group, and the difference between the three groups was significant at days five and day ten (Kruskal-Wallis test,df=2 p=0.02, p=0.01). On days two, three and five, significance was measured when making a binary comparison of reported 'moderate' or 'severe' pain with 'none' or 'mild' (chi-square test, p=0.04,p=0.04, p=0.02). Using a summary pain measurement, mothers experienced fewer painful days in the gel pad group but this did not reach statistical significance (Kruskal-Wallis test, df=2 p=0.26). The use of analgesia was reported to be similar in all three groups. Maternal satisfaction with their overall care was rated more highly in the gel pad group when compared to the two other groups (Kruskal-Wallis test, df=2 p>0.001). Conclusions: Cooling treatments can alleviate pain when compared to no localised treatment. Women appeared to find the cooling gel pad to be a more acceptable treatment.
    • Impact & interpretation: Museums and universities in collaboration

      McKay, Ian S. H.; University of Chester (2012-10-03)
      This presentation gives feedback on a conference called "Impact and interpretation: Museums and universities in collaboration" held at the Thackeray Museum in colloboration with the University of Leeds.
    • The impact of prostate cancer on men's everyday life

      Appleton, Lynda; Wyatt, Debbie; Perkins, Elizabeth; Parker, Claire; Crane, Julie; Jones, Audrey; Moorhead, Lynne; Brown, Vanessa; Wall, Christine; Pagett, Marie; et al. (Wiley, 2014-09-10)
      Prostate cancer impacts on the daily lives of men, particularly their physical and emotional health, relationships and social life. This paper highlights how men cope with disease and treatment and the strategies they employ to manage their diagnosis alongside daily life. Twenty seven men were interviewed prior to radiotherapy and 6-8 and 12-18 months post radiotherapy, to explore how they managed their disease at different stages of their treatment pathway. A grounded theory approach was used to collect and analyse the data. Five main themes emerged: pathway to diagnosis; interpretation of the diagnosis; making sense of cancer in daily life; managing the impact of treatment and living with prostate cancer in the long-term. Prostate cancer was diagnosed using the PSA test, rectal examination and biopsy. Many men did not understand the consequences of a high PSA reading before they undertook the test. Painful investigative biopsies being viewed as the worst part of the disease experience. Radiotherapy was considered less invasive compared to other treatments, however preparatory regimes were often associated with stress and inconvenience. Men used various strategies to accommodate prostate cancer in the long-term, particularly when masculine identity was challenged as a result of bodily changes arising from treatment.
    • The impact of severe haemophilia and the presence of target joints on health-related quality-of-life

      O’Hara, Jamie; Walsh, Shaun; Camp, Charlotte; Mazza, Giuseppe; Carroll, Liz; Hoxer, Christina; Wilkinson, Lars; University of Chester; HCD Economics; University College London; The Haemophilia Society; Novo Nordisk (BioMed Central, 2018-05-02)
      Background: Joint damage remains a major complication associated with haemophilia and is widely accepted as one of the most debilitating symptoms for persons with severe haemophilia. The aim of this study is to describe how complications of haemophilia such as target joints influence health-related quality of life (HRQOL). Methods: Data on hemophilia patients without inhibitors were drawn from the ‘Cost of Haemophilia across Europe – a Socioeconomic Survey’ (CHESS) study, a cost-of-illness assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the UK). Physicians provided clinical and sociodemographic information for 1285 adult patients, 551 of whom completed corresponding questionnaires, including EQ-5D. A generalised linear model was developed to investigate the relationship between EQ-5D index score and target joint status (defined in the CHESS study as areas of chronic synovitis), adjusted for patient covariates including socio-demographic characteristics and comorbidities. Results: Five hundred and fifteen patients (42% of the sample) provided an EQ-5D response; a total of 692 target joints were recorded across the sample. Mean EQ-5D index score for patients with no target joints was 0.875 (standard deviation [SD] 0.179); for patients with one or more target joints, mean index score was 0.731 (SD 0.285). Compared to having no target joints, having one or more target joints was associated with lower index scores (average marginal effect (AME) -0.120; SD 0.0262; p < 0.000). Conclusions: This study found that the presence of chronic synovitis has a significant negative impact on HRQOL for adults with severe haemophilia. Prevention, early diagnosis and treatment of target joints should be an important consideration for clinicians and patients when managing haemophilia.
    • Impact of type of child growth intervention program on caregivers’ child feeding knowledge and practices: A comparative study in Ga West Municipality, Ghana

      Agbozo, Faith; Colecraft, Esi; Ellahi, Basma; University of Ghana; University of Chester (Wiley, 2015-12-02)
      Community-Based Growth Promotion (CBGP) delivered by community volunteers aims at enhancing the traditional Growth Monitoring and Promotion (GMP) programme delivered by community health nurses through the promotion of optimum infant and young child feeding (IYCF) leading to improved child growth. This study compared IYCF knowledge and practices among caregiver-child pairs (0-24 months) receiving child welfare services from CBGP (n=124) and GMP (n=108) programmes. Semi-structured questionnaires were used to interview caregivers on IYCF knowledge/practices and validated food frequency questionnaire used to record infants’ food intakes. Group differences were determined using Chi-square and independent samples t-tests (p<0.05; 95% CI). Mean IYCF knowledge scores were similar (CBGP:10.84±1.69 vs. GMP:10.23±1.38, p=0.062). However, more CBGP caregivers (17%) were highly knowledgeable than their GMP counterparts (5%) (p=0.011). Early breastfeeding initiation (CBGP:54% vs. GMP:28%, p<0.0001), exclusive breastfeeding (CBGP:73% vs. GMP:56%, p=0.001) and timely complementary feeding (CBGP:72% vs. GMP:49%, p=0.014) were reportedly higher among CBGP caregivers. Underweight was 11% (CBGP:8% vs. GMP:14%, p=0.154. Mean dietary diversity scores (10 food groups) were similar (CBGP:4.49±1.89 vs. GMP:3.87±1.89, p=0.057) but more CBGP caregivers (77%) achieved minimum dietary diversity than their GMP counterparts (61%) (p=0.035). Few caregivers achieved minimum meal frequency (CBGP:31% vs. GMP:29%, p=0.486) and minimum acceptable diet (CBGP:23% vs. GMP:21%, p=0.464) indicators. Number of children under 5 years owned by caregiver (AOR: 0.405; 95% CI: 1.13-78.53, p=0.038), her educational level (AOR: 0.112; 95% CI: 0.02-0.90, p=0.040) and IYCF knowledge (AOR: 0.140; 95% CI: 0.03-0.79, p=0.026) significantly predicted optimum child feeding. Nutrition education on optimum complementary feeding and birth spacing strategies should intensify.
    • Impact on Practice

      Lovell, Andy; University of Chester (EMAP, 2018-02-01)
      An article discussing the difficulties that professionals, particularly nurses, have when undertaking doctoral studies, because of managerial perceptions of how their work might have an impact on practice and the tension this sometimes creates.
    • 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.
    • Inhibitor clinical burden of disease: a comparative analysis of the CHESS data.

      Oladapo, Abiola; Lu, Mei; Walsh, Shaun; O'Hara, Jamie; Kauf, Teresa L. (2018-11-09)
      BACKGROUND:Patients with hemophilia and inhibitors generally face greater disease burden compared to patients without inhibitors. While raising awareness of relative burden may improve the standard of care for patients with inhibitors, comparative data are sparse. Analyzing data drawn from the Cost of Haemophilia across Europe - a Socioeconomic Survey (CHESS) study, the aim of this study was to compare the clinical burden of disease in patients with severe hemophilia with and without inhibitors. Hemophilia specialists (N = 139) across five European countries completed an online survey between January-April 2015, providing demographic, clinical and 12-month ambulatory/secondary care activity data for 1285 patients. Patients with hemophilia who currently presented with inhibitors and those who never had inhibitors were matched on baseline characteristics via propensity score matching. Outcomes were compared between the two cohorts using a paired t-test or Wilcoxon signed-rank or McNemar's test. RESULTS:The proportion of patients who currently presented with inhibitors was 4.5% (58/1285). Compared to PS-matched patients without inhibitors, patients with inhibitors experienced more than twice the mean annual number of bleeds (mean ± standard deviation, 8.29 ± 9.18 vs 3.72 ± 3.95; p < .0001) and joint bleeds (2.17 ± 1.90 vs 0.98 ± 1.15; p < .0001), and required more hemophilia-related (mean ± standard deviation, 1.79 ± 1.83 vs 0.64 ± 1.13) and bleed-related hospitalizations (1.86 ± 1.88 vs 0.81 ± 1.26), hemophilia-related consultations (9.30 ± 4.99 vs 6.77 ± 4.47), and outpatient visits (22.09 ± 17.77 vs 11.48 ± 16.00) (all, p < .001). More than one-half (53.5%) experienced moderate/severe pain necessitating medication compared to one-third (32.8%) of patients without inhibitors (p = .01). CONCLUSIONS:Patients with hemophilia and inhibitors exhibited greater clinical burden and higher resource utilization compared to their peers without inhibitors. Strategies for improving the standard of care may alleviate burden in this population.
    • Intellectual disability and autism: A life history approach to understanding self-injury

      Lovell, Andy; Skellern, Joanne; University of Chester (NOVA Publishers, 2012-07-25)
      This chapter relates to a qualitative research study into the lives of a number of individuals with intellectual disabilities and a propensity for self-injury.
    • Intellectual disability and violence: Conclusions from a trilogy of projects

      Skellern, Joanne; Lovell, Andy; University of Chester (Kavanah, 2011-10)
      This conference paper discusses a series of studies undertaken between 2007 and 2011 exploring different dimensions of the relationship between intellectual disability and violence.
    • 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.
    • Interaction between TCF7L2 polymorphism and dietary fat intake on high density lipoprotein cholesterol

      Bodhini, Dhanasekaran; Gaal, Szilvia; Shatwan, Israa M.; Ramya, Kandaswamy; Ellahi, Basma; Surendran, Shelini; Sudha, Vasudevan; Anjana, Mohan R.; Mohan, Viswanathan; Lovegrove, Julie A.; et al. (Public Library of Science, 2017-11-28)
      Recent evidence suggests that lifestyle factors influence the association between the Melanocortin 4 receptor (MC4R) and Transcription Factor 7-Like 2 (TCF7L2) gene variants and cardio-metabolic traits in several populations; however, the available research is limited among the Asian Indian population. Hence, the present study examined whether the association between the MC4R single nucleotide polymorphism (SNP) (rs17782313) and two SNPs of the TCF7L2 gene (rs12255372 and rs7903146) and cardio-metabolic traits is modified by dietary factors and physical activity. This cross sectional study included a random sample of normal glucose tolerant (NGT) (n=821) and participants with type 2 diabetes (T2D) (n=861) recruited from the urban part of the Chennai Urban Rural Epidemiology Study (CURES). A validated food frequency questionnaire (FFQ) was used for dietary assessment and self-reported physical activity measures were collected. The threshold for significance was set at P=0.00023 based on Bonferroni correction for multiple testing [(0.05/210 (3 SNPs x 14 outcomes x 5 lifestyle factors)]. After Bonferroni correction, there was a significant interaction between the TCF7L2 rs12255372 SNP and fat intake (g/day) (Pinteraction=0.0001) on high-density lipoprotein cholesterol (HDL-C), where the ‘T’ allele carriers in the lowest tertile of total fat intake had higher HDL-C (P=0.008) and those in the highest tertile (P=0.017) had lower HDL-C compared to the GG homozygotes. In a secondary analysis of SNPs with the subtypes of fat, there was also a significant interaction between the SNP rs12255372 and polyunsaturated fatty acids (PUFA, g/day) (Pinteraction<0.0001) on HDL-C, where the minor allele carriers had higher HDL-C in the lowest PUFA tertile (P=0.024) and those in the highest PUFA tertile had lower HDL-C (P=0.028) than GG homozygotes. In addition, a significant interaction was also seen between TCF7L2 SNP rs12255372 and fibre intake (g/day) on HDL-C (Pinteraction<0.0001). None of the other interactions between the SNPs and lifestyle factors were statistically significant after correction for multiple testing. Our findings indicate that the association between TCF7L2 SNP rs12255372 and HDL-C may be modified by dietary fat intake in this Asian Indian population.
    • Introduction

      Harlow, Elizabeth; University of Chester (Whiting & Birch, 2011-08-05)
    • Introduction - "How to write well: for students of health and social care"

      Keeling, June J.; Williams, Julie; Chapman, Hazel M.; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      The aim of this book is to demystify academic writing for undergraduate students in health and social care education. You are probably required to submit several assignments throughout your programme of study, which may take different formats such as a written essay, a poster or a dissertation. The allocation of marks for your assignments will be primarily dependent upon two factors: content and academic writing. This book focuses on the many aspects that impact on the quality of academic writing and will help you to develop the essential skills required for your undergraduate level study and to achieve success. Academic writing is a skill that develops with practice and therefore the book takes you through a step-by-step guide of how to improve your academic writing, thereby enabling you to improve your own writing skills.
    • Introduction to Pharmacodynamics

      Robertson, Deborah A. F.; University of Chester (Mark Allen Healthcare Ltd, 2017-04-16)
      In this second article in the series of ‘bite sized’ pharmacology we will start to look at the principles of pharmacodynamics. It is important that prescribers are aware of the actions their drugs have in the body after administration. They should know the SITE of action (where the drug works), the MODE of action (how the drug works) and the time to ONSET and DURATION of action (when the drug starts to work and how long for). This helps prescribers decide on drug choice, drug dose and the dose schedule as well as the length of time the drug needs to be prescribed for. This knowledge can also assist the prescriber in prediction and prevention (or minimising) of adverse drug reactions and to help educate their patients on possible side effects. In this article we will look at SITEs of action; receptors, ion channels, enzymes, and transport systems. We will also introduce the concepts of agonism and antagonism and their relationship to MODE of action.
    • Introduction to Pharmacokinetics

      Robertson, Deborah A. F.; University of Chester (Mark Allen Healthcare Ltd, 2017-03-16)
      Pharmacology is an area many nurse prescribers tell me that they worry about. This is whether they are prescribing students or qualified prescribers. They are very aware of the importance of pharmacological knowledge and its impact on safe prescribing. They typically want to know how much information they need to know and what depth and breadth that information should take. Another area they worry about is how many drugs they need to be familiar with? This series of pharmacology articles will explore some concepts in pharmacology to support the prescriber in developing that knowledge. This article begins by examining the basic concepts of pharmacokinetics to allow the reader to improve their understanding of drug handling within the body. It will explore the processes of absorption, distribution, metabolism and excretion to chart a drugs ‘route’ from administration to elimination.
    • An introduction to problem based learning

      McCarthy, Jill (2007-06-01)
      This presentation discusses problem based learning (PBL) which is a style of facilitating learning in which the problem acts as the context and driving force for the knowledge to be learnt. PBL varies from problem solving in that with problem solving the students gain the knowledge and then apply it to the problem given, whereas with PBL, the problems are encountered before all the relevant knowledge has been acquired. It is claimed that a PBL approach produces indepdent, motivated students, with a deeper understanding of the subject and with improvements in communication, team work and higher order cognitive skills such as problem solving, and critical analysis.
    • Investigation of the development of a 'career' of aggressive behaviour by people with learning disabilities

      Lovell, Andy; Skellern, Joanne; University of Chester (Kavanah, 2010)
      This paper aims to study the development of aggression over time in the lives of a group of individuals with learning difficulties.