• Preparing to write

      Chapman, Hazel M.; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      This chapter explores the psychology of writing, how to reduce stress and anxiety, why writing is important for learning and why you want to write well. The chapter also addresses getting started and finishing well.
    • Preparing to write

      Chapman, Hazel M.; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      This chapter explores the following topics: • The psychology of writing • How to reduce stress and anxiety • Why writing is important for learning • Why do you want to write well? • A space of one’s own • Getting started and finishing well • Reading for writing – and other learning resources • Using feedback and accessing support This chapter begins by looking at how your thoughts and feelings about writing, especially writing for assessment, can affect your behaviour. Through understanding what makes you write or prevents you from writing, you can gain control over your writing behaviours, the behaviours that are key to your ultimate performance. This chapter shows the small, simple steps you can take in order to achieve your writing potential. By exploring how to break down the barriers to writing, such as stress and anxiety, this chapter shows how writing can eventually become just another activity, and even an enjoyable habit. We discuss the reasons why writing is important for helping you to learn, and help you to explore your own reasons for wanting to write. This will help you to keep writing, even when you are finding it challenging. The environment you work in is important for developing good writing habits and enabling you to write well, so the chapter discusses how you can create your own writing den and find your favourite writing haunts. Practical tips, such as where to find your ideas from, how to start writing, how to finish your writing session, and how to plan writing for assessment are included. Suggestions on using different sources of information and inspiration for your writing, how to use feedback to improve your writing, and how to get the most from university student support services are given. Writing is an important part of your life when you are studying in health and social care. This chapter helps you to put it into perspective alongside the rest of your life, so that you can approach the act of writing without fear, and develop your writing skills to achieve your full potential in your chosen field within health and social care.
    • Prescribing in mental health practice - the balancing act

      Green, Ben; University of Chester (SAGE, 2013-01-15)
      This book chapter aims to discuss the potential impact of psychiatric pharmacology on the physical health of people with mental health problems; discuss the potential impact of medical prescibing on those with mental health problems; and reflect on the role of the mental health practitioner in medication management.
    • The presentation of depression in the British Army

      Finnegan, Alan; Finnegan, Sara; Thomas, Mike; Deahl, Martin; Simpson, Robin; Ashford, Robert; University of Chester (Elsevier, 2013-03-26)
      Background The British Army is predominately composed of young men, often from disadvantaged backgrounds, in which Depression is a common mental health disorder. Objectives To construct a predictive model detailing the presentation of depression in the army that could be utilised as an educational and clinical guideline for Army clinical personnel. Method and Participants Utilising a Constructivist Grounded Theory, phase 1 consisted of 19 interviews with experienced Army mental health clinicians. Phase 2 was a validation exercise conducted with 3 general practitioners. Results Depression in the Army correlates poorly with civilian definitions, and has a unique interpretation. Conclusion Young soldiers presented with symptoms not in the International Classification of Disorders and older soldiers who feared being medically downgraded, sought help outside the Army Medical Services. Women found it easier to seek support, but many were inappropriately labelled as depressed. Implications include a need to address the poor understanding of military stressors; their relationships to depressive symptoms and raise higher awareness of gender imbalances with regard to access and treatment. The results have international implications for other Armed forces, and those employed in Young Men's Mental Health. The results are presented as a simple predictive model and aide memoire that can be utilised as an educational and clinical guideline. There is scope to adapt this model to international civilian healthcare practice
    • Presenting your writing in different formats

      Ridgway, Victoria; Keeling, June J.; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      This chapter explores the following topics: essays, oral presentations/examinations, poster presentation, dissertation structuring and writing, portfolio development and finally writing for publication. With key tips for each, the chapter address these concepts in detail.
    • Prevalence of treatment resistance and clozapine use in early intervention services.

      Stokes, Imogen; Griffiths, Siân Lowri; orcid: 0000-0003-0031-7174; Jones, Rowena; Everard, Linda; Jones, Peter B; Fowler, David; Hodgekins, Joanne; Amos, Tim; Freemantle, Nick; Sharma, Vimal; et al. (2020-09-17)
      Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics. This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services. Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points. A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine. Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.
    • Problem Joints and Their Clinical and Humanistic Burden in Children and Adults with Moderate and Severe Hemophilia a: CHESS Paediatrics and CHESS II

      McLaughlin, Paul; Hermans, Cedric; Asghar, Sohaib; Burke, Tom; Nissen, Francis; Aizenas, Martynas; Meier, Oliver; Dhillon, Harpal; O'Hara, Jamie (American Society of Hematology, 2020-11-05)
      Introduction Severe hemophilia A (SHA) is characterized by spontaneous (non-trauma related) bleeding episodes into the joint space and muscle tissue, leading to progressive joint deterioration and chronic pain. Chronic joint damage is most often associated with severe hemophilia, however more recent research has illustrated that people with moderate hemophilia A (MHA) also experience hemophilic arthropathy and functional impairment. The need to measure joint health in children as well as adults, is underscored by findings from the Joint Outcome Continuation Study, which found that FVIII prophylaxis was insufficient to protect joints from damage, from childhood through adolescence in severe HA (Warren et al., 2020). The objective of this analysis is to gain a more patient-centric understanding of the clinical, economic and humanistic burden associated with 'Problem Joints', a measure of joint morbidity developed in consultation with an expert panel to overcome limitations with existing measures, in people with MHA and SHA. Methods A descriptive cohort analysis was conducted, utilizing retrospective, cross-sectional real-world data from the 'Cost of Haemophilia in Europe: a Socioeconomic Survey' (CHESS Paeds and CHESS II), studies of adult and pediatric persons with hemophilia. The analysis population is comprised of children (17 and below) with MHA or SHA in CHESS Paeds, and adults aged 20 and over with MHA or SHA in CHESS II. To account for the possibility that persons aged 18 or 19 in CHESS II may have participated in CHESS Paeds, these individuals were excluded from the analysis. Physician-reported clinical outcome data and patient/caregiver-reported quality of life were analyzed. A problem joint (PJ) is defined as having chronic joint pain and/or limited range of movement due to compromised joint integrity (i.e. chronic synovitis and/or hemophilic arthropathy). Analyses were stratified by number of PJs: none, 1 PJ, and 2+ PJs. We report retrospective data of the 12 months prior to study enrollment, on annualized bleeding rate (ABR), prevalence of target joints (TJ), as defined by the International Society on Thrombosis and Haemostasis, and EQ-5D-/5L/Y/Proxy score. Results are presented as mean (standard deviation) or N (%). Results Among 785 participants (N = 464 SHA; N = 321 MHA) in CHESS Paeds, mean age and BMI were 10.33 (4.63) and 22.50 (17.07), respectively. Of 493 participants (aged 20 and above) in CHESS II (N = 298 SHA; N = 195 MHA), the mean age and BMI were 38.61 (14.06) and 24.55 (2.92), respectively. Current inhibitor to FVIII replacement was more prevalent in children than in adults (10% vs. 5%). In CHESS II, approximately 40% of people with MHA and 49% with SHA had one or more PJs, respectively [1 PJ (23% vs. 28%); 2+ PJs (16% vs. 21%)]. In CHESS Paeds, approximately 14% of children with MHA and 18% with SHA had at least one PJ, respectively [1 PJ (9% vs. 14%); 2+ PJs (5% vs. 3%)]. TJs were less prevalent with MHA in comparison to SHA, in both adults (24% vs. 45%) and children (13% vs. 22%). Clinical burden was higher among both children and adults with PJs compared to those with no PJs. ABR correlates with the number of PJs, in those with MHA and SHA in CHESS II (Figure 1). Similarly, PJs were associated with higher ABR across MHA and SHA in CHESS Paeds (Figure 2). Hemophilia-related hospitalizations were higher in both adult and pediatric participants with PJs. In CHESS II, MHA with no PJs had fewer [0.73 (1.23)] hospitalizations compared to having those with 1 PJ [1.38 (1.11)] or 2+ PJs [1.28 (1.25)]. Similarly, children with MHA with 2+ PJs had 1.60 (1.92) hemophilia-related hospitalizations, compared to 1.38 (1.92) with 1 PJ and 0.71 (1.14) with no PJs. PJs were associated with impaired quality of life. In CHESS II, MHA and SHA EQ-5D-5L values in persons with no PJs were 0.81 (0.19) and 0.79 (0.18), respectively, compared to 0.65 (0.16) and 0.62 (0.23) with 1 PJ, and 0.65 (0.14) and 0.51 (0.33) in with 2+ PJs. A similar trend was observed in EQ-5D-Y and EQ-5D-proxy scores in CHESS Paeds. Conclusions Data from CHESS Paeds and CHESS II demonstrate an association between chronic joint damage, as measured by the 'problem joint' definition, and worsening clinical and quality of life outcomes, across both MHA and SHA. Further analyses will seek to expand upon the initial results presented here, to investigate the wider elements of burden associated with compromised long-term joint health. Disclosures McLaughlin: BioMarin: Consultancy; Novo Nordisk: Consultancy, Speakers Bureau; Sobi: Consultancy, Speakers Bureau; Roche/Chugai: Speakers Bureau; Takeda: Speakers Bureau. Hermans:Novo Nordisk: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; Sobi: Consultancy, Research Funding, Speakers Bureau; Biogen: Consultancy, Speakers Bureau; CAF-DCF: Consultancy, Speakers Bureau; CSL Behring: Consultancy, Speakers Bureau; Shire, a Takeda company: Consultancy, Research Funding, Speakers Bureau; Pfizer: Consultancy, Research Funding, Speakers Bureau; Bayer: Consultancy, Research Funding, Speakers Bureau; WFH: Other; EAHAD: Other; Octapharma: Consultancy, Speakers Bureau; Kedrion: Speakers Bureau; LFB: Consultancy, Speakers Bureau. Asghar:HCD Economics: Current Employment. Burke:HCD Economics: Current Employment; University of Chester: Current Employment; F. Hoffmann-La Roche Ltd: Consultancy. Nissen:GSK: Research Funding; Novartis: Research Funding; Actelion: Consultancy; F. Hoffmann-La Roche Ltd: Current Employment. Aizenas:F. Hoffmann-La Roche Ltd: Current Employment, Current equity holder in publicly-traded company. Meier:F. Hoffmann-La Roche Ltd: Current Employment, Current equity holder in publicly-traded company. Dhillon:HCD Economics: Current Employment; F. Hoffmann-La Roche Ltd: Other: All authors received editorial support for this abstract, furnished by Scott Battle, funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland. . O'Hara:F. Hoffmann-La Roche Ltd: Consultancy; HCD Economics: Current Employment, Current equity holder in private company.
    • Problem solving

      Quigley, Jane; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses the actual and the percieved problem and problem solving strategies.
    • Problem-based learning

      Mannix, Jean; McIntosh, Annette; University of Chester (SAGE, 2010-10-29)
      This book chapter discusses problem-based learning as a way in which students can take control of their own learning and develop critical thinking, analysis, reflection, teamworking, and collaboration.
    • Product focus: Postnatal breast and perineal pain

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (MA Publishers, 2003-05-01)
      Painful breasts and perineum are a very common phenomenon in the early postnatal period. Both types will cause acute pain and may cause considerable distress and discomfort for many mothers. Assessing pain before offering advice on how best to alleviate the pain is an important issue. Midwives will, therefore, need to routinely assess the intensity and quality of the pain by asking mothers to self-report. It is generally accepted that acute pain is managed inadequately by the use of systemic analgesics alone. Localized pain relief, however, can assist to alleviate acute pain and hot and cold therapy throughout the centuries has been used effectively to achieve this. This product focus describes the benefits of two cooling devices (Mom's Breast Soother and the feme Pad) manufactured by Florri-Feme Pharmaceuticals Ltd, that will assist newly delivered mothers to achieve breast and perineal pain relief.
    • Professional development

      Harlow, Elizabeth; University of Chester (SAGE, 2012-11-30)
    • Professional development

      Wilkins, Maureen; McIntosh, Annette; University of Chester (SAGE, 2008-03-17)
      This book chapter discusses continuing professional development in nursing
    • Promoting a healthy diet in young adults: The role of nutrition labelling

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

      Steen, Mary; University of Chester (Scutari Projects, 2013-09-04)
      Continence in women during pregnancy and following childbirth is an important issue that needs to be managed appropriately. Urinary and bowel problems can have numerous negative physical and psychological consequences, and women may be too embarrassed to seek help. Healthcare professionals need to encourage and support women to identify any changes in their normal bowel and bladder habits. They also need to have knowledge of the anatomy and physiology of the urinary, reproductive and digestive systems to understand how continence may be affected during pregnancy and following childbirth.
    • Prophylactic Treatment in People with Severe Hemophilia B in the US: An Analysis of Real-World Healthcare System Costs and Clinical Outcomes

      Noone, Declan; Pedra, Gabriel; Asghar, Sohaib; O'Hara, Jamie; Sawyer, Eileen K; Li, Nanxin (Nick) (American Society of Hematology, 2019-11-13)
      Introduction The treatment paradigm for people with severe hemophilia B in the US typically involves prophylaxis with factor IX (FIX) replacement therapy, the primary aim of which is to provide sufficient FIX levels to reduce the frequency of bleeding events. The clinical benefits of FIX prophylaxis are well understood, however the cost of FIX products as well as costs associated with healthcare resource utilization present a significant burden to the healthcare system. Substantive costs may also accrue in patients who continue to bleed while on prophylaxis, due to the impact on both short and long-term joint-related outcomes. In the absence of existing data in the US, the 'Cost of Hemophilia Across the USA: a Socioeconomic Survey' (CHESS US) study was conducted to establish a population-based estimate of the real-world US healthcare system burden associated with severe hemophilia. Using data drawn from the CHESS US study, this analysis examines the real-world healthcare system costs and clinical outcomes of people with severe hemophilia B on FIX prophylaxis. Methods CHESS US, a retrospective, cross-sectional dataset of adults with severe hemophilia in the USA, gathered information on patient cost via a patient record form. Data on the following parameters are included in this analysis: FIX consumption, annualized bleeding rate (ABR), the presence of one or more chronically damaged joints ("problem joint"), as well as costs associated with annual (prophylactic) factor consumption and hospitalizations (i.e., number of admissions, number of day cases, total inpatient days, and total intensive care unit [ICU] days). All variables report retrospective data of the 12 months prior to enrolment in the study. Results are presented as mean (± standard deviation) or N (%). Results In total, 132 of 576 patients profiled in the CHESS US study had severe hemophilia B. Among them, 77 patients were on FIX prophylaxis, of whom 44 patients reported FIX dosing regimen and were included in the current analyses. Among them, 20 patients were treated with conventional FIX and 24 patients with extended half-life (EHL) FIX products. The cohort has a mean age of 27.64 (± 11.05) and mean weight (kg) of 75.71 (± 13.41). In the last 12 months, the mean number of international units (IU) prescribed for FIX prophylaxis across the full cohort was 257,216 IU (± 213,591), with an associated annual cost of $610,966 (± $495,869). Among patients treated with conventional FIX, mean prescribed FIX was 287,141 IU (± 264,906) at an annual cost of $397,491 (± $359,788), while patients treated with EHL FIX reported a mean prescribed FIX of 232,278 IU (± 160,914) at an annual cost of $788,861 (± $529,258). The cohort reported a mean ABR of 1.73 (± 1.39); 8 (18%) were reported to have a target joint meeting the International Society on Thrombosis and Haemostasis (ISTH) definition; and 11% were reported to have had at least one chronically damaged joint (i.e., problem joint). Healthcare resource utilization associated with bleed events were reported as follows: hospital admissions days [0.18 (± 0.62)]; inpatient days [0.34 (± 1.22)]; and ICU days [0.23 (± 0.86)]. The direct medical cost to the healthcare system was $2,885 (± $7,857; excluding FIX cost) and $614,886 (± $498,839; including FIX cost). Discussion Data from the CHESS US study showed substantial costs and resource utilization among patients with severe hemophilia B receiving FIX prophylaxis, of which the cost of FIX replacement therapy constituted most of the total cost to healthcare system. Although the ABR observed in the analysis population was low, bleed-related hospitalizations comprised a significant non-drug cost to the healthcare system. A proportion of patients also still experienced joint arthropathy. Such substantial clinical and economic burden highlights that unmet needs remain in patients with severe hemophilia B on FIX prophylaxis in the US. Disclosures Noone: HCD Economics: Employment. Pedra:HCD Economics: Employment. Asghar:HCD Economics: Employment. O'Hara:HCD Economics: Employment, Equity Ownership. Sawyer:uniQure Inc.: Employment. Li:uniQure Inc.: Employment.
    • Psychiatric morbidity in medically ill patients using Spanish version of GMHAT/PC

      Tejada, Paola A.; Jaramillo, Luís Eduardo; Polo, Gilberto; Sharma, Vimal; University of Chester (Taylor and Francis, 2016-12-14)
      The study aimed to assess psychiatric morbidity in medically ill patients and to examine the use of GMHAT/PC Spanish version in a general health setting. We recruited patients who were hospitalized at the services of Internal Medicine, Surgery and G/O during a period of 1 month for each service. The diagnosis of a medical illness was supported by specialists in each service. A trained GP conducted a psychiatric assessment of all the participants using GMHAT/PC. The interview was carried out at patients’ bedside. Of 455 medically ill patients, 4.8% had a mental illness identified by GMHAT/PC interview. Anxiety, depression and organic disorders were the most frequently identified mental disorders in internal medicine and surgery. Cancer had a significantly higher prevalence of comorbid mental illness. In this study the proportion of medically ill with mental disorders was less compared to other studies. The GMHAT/PC is more close to identifying clinical cases of mental illness and also patients who need help. The GMHAT is more a diagnostic instrument than a screening instrument. Physicians and practitioners can be trained to identify mental illness using computer-assisted tools such as GMHAT/PC. A holistic approach of providing care to such patients may improve their overall outcome and quality of life.
    • The psychological distress in healthcare workers: Current perspectives and challenges

      Mitchell, Andrew E.P.; University of Chester
      Aims and objectives. The review presents evidenced-based literature on psychological distress amongst health care professionals; the work is not a systematic review but covers a wide selection of contemporary literature and covers the COVID-19 pandemic. The review discusses several reasons why psychological distress within health care professionals requires separate consideration and strategies to support resilience and access to support. Background. Health care workers report high workplace stress levels, burnout, psychological distress, and an increased risk of mental health problems. This is when the World Health Organisation recommends supporting health care professionals’ mental health and social aspects. It is also accepted that the physical and mental ill-health in health care workers can impact operational effectiveness and delivery of patient outcomes. Literature review. The integrative review utilized keywords to undertake a search of the literature. The following key terms ‘healthcare worker,’ ‘health professional,’ ‘mental health,’ ‘resilience,’ ‘support,’ ‘social risk factors,’ ‘physical risk factors’ and ‘Intervention.’ The PsycINFO, CINAHL and Embase and the Cochrane library were searched to find contemporary research articles. Conclusions. The review has collated the available evidence and recommendations for supporting healthcare workers. It is recognized that stressors can increase the prevalence of psychological distress and lead to recruitment and retention issues. Stressors for psychological distress in health care professionals are the impact of patient-specific situations, interprofessional working relationships and perceived workload burden.
    • Psychological distress in student nurses undertaking an educational programme with professional registration as a nurse: their perceived barriers and facilitators in seeking psychological support

      Mitchell, Andrew E. P.; University of Chester (Wiley, 2018-03-06)
      Introduction. The present study adds to the existing international evidence on psychological distress in the student population by focusing on student nurses. It quantitatively assesses psychological distress with comparative norms and investigates service uptake in in a single study. Aim. Investigate the level of psychological distress in students and compare this with population norms and highlight potential facilitators and barriers to help seeking. Methods. This study recruited N=121 student nurses from one university in a cross sectional design. Data were analysed using descriptive statistics, independent t-tests and one-way ANOVA’s. Findings. The key findings show high levels of psychological distress which is above levels seen in the general population. The main barriers to seeking support was fear of disclosure and the perceived impact on their suitability as a student nurse. Discussion. The study highlights that high levels of distress identified in the literature are seen in student nurses and that fear of disclosure may account for some not seeking support. Relevance. The fear of disclosure and low levels of seeking support suggest there is a need for mental health nurses and academics to play a key role in mental health literacy and evidence-based interventions such as mindfulness to combat these issues.
    • Public acceptability of public health policy to improve population health: A population‐based survey

      Bellis, Mark A.; Hughes, Karen; Di Lemma, Lisa; Public Health Collaborating Unit, School of Health Sciences, Bangor University, Wrexham; Public Health Wales; University of Chester
      Background: For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate. Objective: To explore public acceptance of public health statements and examine differences in acceptability across socio-demographics, health behaviours (physical activity, diet, binge drinking and smoking), health status and well-being. Method: A cross-sectional survey was conducted with a nationally representative sample (N = 1001) using a random stratified sampling method. Face-to-face interviews were conducted at homes of residents in Wales aged 16+ years. Individuals reported whether they agreed, had no opinion, or disagreed with 12 public health statements. Results: More than half of the sample were supportive of 10 out of 12 statements. The three statements with the greatest support (>80% agreement) reflected the importance of: a safe and loving childhood to becoming a healthy adult, schools teaching about health, and healthier foods costing less. Individuals who engaged in unhealthy behaviours were less likely to agree with some of the statements (eg 39.8% of binge drinkers agreed alcohol adverts should be banned compared to 57.6% of those who never binge drink; P < .001). Conclusions: Findings show an appetite for public health policies among the majority of the public. The relationship between supporting policies and engaging in healthy behaviours suggests a feedback loop that is potentially capable of shifting both public opinion and the opportunities for policy intervention. If a nation becomes healthier, this could illicit greater support for stronger policies which could encourage more people to move in a healthier direction.
    • Public health and adults

      Phillips, Sue; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses the range of activities and professions involved in public health.