• Household and market survey on availability of adequately iodized salt in the Volta region, Ghana

      Agbozo, Faith; Der, Joyce B.; Glover, Nutifafa J.; Ellahi, Basma; University of Health and Allied Sciences, Ho, Ghana; Volta Regional Health Directorate, Ghana Health Service; University of Chester (Taylor and Francis, 2016-10-27)
      Consumption of adequately iodized salt (AIS) ≥15ppm is one of the criteria for measuring progress towards universal salt iodization (USI) and sustainable elimination of iodine deficiency disorders. After series of health promotion activities, this survey was conducted to evaluate the extent to which USI was achieved. Cross-sectional survey was conducted in 1,961 households and 350 markets to estimate the iodine levels of salt consumed or sold. Three degrees of iodization were estimated from fine, coarse and granular texture salt using MBI rapid field test kits. Differences in iodization levels were determined using Bonferroni test in STATA. Determinants for household utilization of AIS were identified using regression analysis and reported as odds ratio (OR). Availability of AIS in households (24.5%) and markets (30.9%) was far below the 90% recommendation. No differences where observed in urban (26.8%) and rural (24.1%) households. Households that used fine-texture salt (OR: 40.13; CI: 30.1-53.4) or stored salt in original packs (OR: 8.02; CI: 6.01-10.70) were more likely to consume AIS. Across districts, highest household availability of AIS was 51.7% while the least was 7.5%. The district with the highest market availability of AIS was 85.7% while the least was 8.3%. Almost 32% of the traders were aware that selling non-iodized salt was unauthorized but out of this, only 12% sold AIS. Public education should emphasis appropriate handling and storage of salt throughout the supply chain. To ensure adequate salt fortification with iodine, improved surveillance of factories and mining sites is recommended.
    • How Do I Look? Body Image Perceptions among University Students from England and Denmark

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

      Khan, Nahim; University of Chester (2016-06-08)
      This is a small case study on the appropriateness of mefloquine in a patient with a co-existing psychiatric disorder. It also includes a question on prescribing advice and other methods of reducing mosquito bites.
    • How to encourage a woman to remain active in labour

      Steen, Mary; University of Chester (Redactive, 2012-03)
      This article gives an insight into how to encourage a woman to remain active in labour. There is substantial evidence that demonstrates being active during labour is beneficial and a range of different positions can be adopted. Good preparation during pregnancy is essential as this will assist women to become confident and believe in their ability to be active during labour. Ideally, upright positions in first and second stage should be encouraged and the use of props such as a chair, bean bag or birth ball. The impact of water immersion during labour should also be highlighted as an effective birthing option.
    • ‘How you keep going’: Voluntary sector practitioners’ story-lines as emotion work

      Quinn, Kaitlyn; Tomczak, Philippa; Buck, Gillian; University of Toronto; University of Nottingham; University of Chester (Wiley, 2022-01-16)
      The voluntary sector acts as the last line of defense for some of the most marginalized people in societies around the world, yet its capacities are significantly reduced by chronic resource shortages and dynamic political obstacles. Existing research has scarcely examined what it is like for voluntary sector practitioners working amidst these conditions. In this paper, we explore how penal voluntary sector practitioners across England and Scotland marshaled their personal and professional resources to “keep going” amidst significant challenges. Our analysis combines symbolic interactionism with the concept of story- lines. We illuminate the narratives that practitioners mobilized to understand and motivate their efforts amidst the significant barriers, chronic limitations, and difficult emotions brought forth by their work. We position practitioners' story- lines as a form of emotion work that mitigated their experiences of anger, frustration, overwhelm, sadness, and disappointment, enabling them to move forward and continue to support criminalized individuals. Our analysis details three story- lines— resignation, strategy, and refuge—and examines their consequences for practitioners and their capacities to intervene in wicked social problems.
    • Humanist learning theories

      McIntosh, Annette; University of Chester (SAGE, 2010-10-29)
      This book chapter discusses humanist learning theories and the education of healthcare professionals.
    • 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.
    • Including public health considerations in trade and investment agreements

      Thow, A; Garde, A; Mabhala, M; Smith, R; Kingston, P; Manning, P; Hunter, D; Winters, L A; Lincoln, P; Parish, R (Oxford University Press (OUP), 2020-09-30)
      Abstract There is widespread recognition that trade and investment agreements (TIAs) can affect health services, access to medicines, NCD prevention (particularly related to tobacco, alcohol and unhealthy food) and health systems structures. In addition, these binding international economic agreements can constrain the policy space available for innovative, evidence-based health policymaking. Although TIAs can have positive outcomes for employment and economic growth, these benefits are only likely to accrue when governments are pro-active in implementing complementary policies to mitigate impacts on other sectors and to address potential inequalities arising. The aim of this panel session is to examine the ways in which TIAs can be designed to achieve economic goals while also protecting public health, and identify complementary policy measures that may be needed as well as strategies for strategic policy engagement. This panel will be hosted by the UK-PRP PETRA Network (Prevention of noncommunicable disease using trade agreements). The UK will be negotiating a range of new TIAs over the coming years, representing a window of opportunity for strategic engagement with policymakers regarding how public health can be protected and promoted within these agreements. There is an emerging global body of evidence regarding how consideration of health can be integrated into TIAs, both textually and through strategic engagement with policymakers before and during the negotiation phase. Experience to date indicates common global challenges and opportunities for health and trade, as well as significant potential for cross country learning regarding trade and health. The panel discussion will use the UK experience as a springboard to address these global issues.
    • 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.