• Patients treated for hyperthyroidism are at increased risk of becoming obese: findings from a large prospective secondary care cohort

      Torlinska, B.; Nichols, L.; Mohammed, Mohammed A.; McCabe, C.; Boelaert, K. (2019-10-15)
      Background: The most commonly reported symptom of hyperthyroidism is weight loss; successful treatment increases weight. Weight gain faced by patients with hyperthyroidism is widely considered a simple reaccumulation of premorbid weight, whereas many patients feel there is a significant weight “overshoot” attributable to the treatment. We aimed to establish if weight gain seen following treatment for hyperthyroidism represents replenishment of premorbid weight or “overshoot” beyond expected regain and, if there is excessive weight gain, whether this is associated with the applied treatment modality. Methods: We calculated the risk of becoming obese (body mass index [BMI] >30 kg/m2) following treatment for hyperthyroidism by comparing BMI of 1373 patients with overt hyperthyroidism seen in a secondary care setting with the age- and sex-matched background population (Health Survey for England, 2007–2009). Next, we investigated the effect of treatment with an antithyroid drug (ATD) alone in regard to ATD with radioactive iodine (131I) therapy. We modeled the longitudinal weight data in relation to the treatment pathway to thyroid function and the need for long-term thyroxine replacement. Results: During treatment of hyperthyroidism, men gained 8.0 kg (standard deviation ±7.5) and women 5.5 kg (±6.8). At discharge, there was a significantly increased risk of obesity in male (odds ratio = 1.7 [95% confidence interval 1.3–2.2], p < 0.001) and female (1.3, 1.2–1.5, p < 0.001) patients with hyperthyroidism compared with the background population. Treatment with 131I was associated with additional weight gain (0.6 kg, 0.4–0.8, p < 0.001), compared with ATD treatment alone. More weight gain was seen if serum thyrotropin (TSH) was markedly increased (TSH >10 mIU/L; 0.5 kg, 0.3–0.7, p < 0.001) or free thyroxine (fT4) was reduced (fT4 ≤ 10 pmol/L (0.8 ng/dL); 0.3 kg, 0.1–0.4, p < 0.001) during follow-up. Initiation of levothyroxine was associated with further weight gain (0.4 kg, 0.2–0.6, p < 0.001) and the predicted excess weight gain in 131I-induced hypothyroidism was 1.8 kg. Conclusions: Treatment for hyperthyroidism is associated with significant risks of becoming obese. 131I treatment and subsequent development of hypothyroidism were associated with small but significant amounts of excess weight gain compared with ATD alone. We advocate that the discussion over the weight “overshoot” risk forms part of the individualized treatment decision-making process.
    • Patients’ experiences with home parental nutrition: A grounded theory study

      Wong, C.; Lucas, Beverley J.; Wood, Diana (2018-04)
      Background & aims Parenteral nutrition (PN) provides nourishment and hydration as an intravenous infusion to patients with intestinal failure (IF). The aim of the study is to generate theory that explains the experiences of adult patients living with home parenteral nutrition (HPN) and complex medication regimens. Methods A grounded theory methodology was used to explore the experiences of twelve patients receiving HPN. A semi-structured interview was conducted and recorded in each participant's home setting. Each interview was transcribed verbatim. The simultaneous process of data collection and analysis was followed reflecting the principles of the constant comparative approach. Results A total of 15 patients gave written consent, with 12 of them agreeing to be interviewed. All the participants had previously undergone surgery as a result of chronic ill health or sudden illness. Analysis revealed two core categories: stoma and HPN, and these were supported by the subcategories: maintaining stoma output, access to toilets, managing dietary changes, maintaining the HPN infusion routine, access to technical help to set up an HPN infusion, mobility with HPN equipment and general health changes. The strategy of living with loss was demonstrated by all the participants, and this was supported by the action strategies of maintaining daily activities and social interactions. Conclusions This study generates new understanding and insight into the views and experiences of patients receiving HPN in the UK. The findings from these participants have been shown to resonate with the Kubler-Ross Model [1] of the five stages of grief. The theory of living with loss was generated by the use of a grounded theory methodology. This small scale exploratory study reveals opportunities for improvements in practice to be considered by the nutrition support team (NST) and other healthcare professionals involved in the patient's hospital stay prior to discharge on HPN.
    • Patients’ experiences with home parenteral nutrition: a literature review

      Wong, C.; Lucas, Beverley J.; Wood, Diana (2015)
      Aim The aim of this review is to summarise the literature relating to patients’ experiences with home parenteral nutrition (HPN). Method This literature review is based on searches of CINAHL, PubMed, Web of Knowledge and Web of Science for articles published between 1970 and 2013. Additional studies were included from Department of Health publications, NICE clinical guidance, UK patient support group with interests in HPN or intestinal failure (IF). Results Patients with severe IF have been successfully treated with HPN since the 1970s. Early published studies evaluated clinical outcomes such as catheter-related infections, metabolic complications, thrombosis of the catheterised vein and liver impairment. Since the 1980s questionnaire studies were used to evaluate the quality of life (QoL) of patients treated with HPN. These early studies used QoL assessment tools which were not validated for patients treated with HPN. Internationally, there were published qualitative research studies which explored the experiences of patients treated with HPN. Conclusions The long-term outcome of patients treated with HPN continues to attract research interest. The review of the literature did not identify any published qualitative studies on the experiences of patients treated with HPN in the UK, suggesting a gap in the research. The UK National Health Service advocates a patient-centred approach for service design and delivery in primary and secondary care. This literature review has highlighted opportunities for qualitative research into the experiences of patients living with HPN to achieve better understanding and awareness of the rehabilitation of these patients
    • A pedometer-based physically active learning intervention: The importance of using preintervention physical activity categories to assess effectiveness

      Morris, J.L.; Daly-Smith, Andrew; Defeyter, M.A.; McKenna, J.; Zwolinsky, S.; Lloyd, S.; Fothergill, M.; Graham, P.L. (2019-08)
      Purpose: To assess physical activity outcomes of a pedometer-based physically active learning (PAL) intervention in primary school children. Methods: Six paired schools were randomly allocated to either a 6-week teacher-led pedometer-based physically active learning intervention or a control (n = 154, female = 60%, age = 9.9 [0.3] y). Accelerometers assessed total daily sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Preintervention mean daily MVPA minutes grouped participants as Low Active (<45 min/d) and High Active (≥45 min/d). Results: From the final sample size, the intervention (n = 52) significantly improved LPA versus control (n = 31, P = .04), by reducing sedentary time. More intervention (+10%) than control (+3%) pupils met the 60 minutes per day guidelines. In both intervention subgroups, pupils spent less time in LPA (P < .05) versus control. The greatest nonsignificant increase was found in the Low Active pupils MVPA levels. Conclusions: Improvements in LPA were statistically significant in the intervention versus control group. In subgroup analysis, Low Active pupils in the intervention showed the greatest beneficial effects and the Most Active pupils may have replaced MVPA and sedentary time with LPA. The intervention group housed clusters of pupils showing variable responsiveness, justifying routine examination of subgroup variability in future studies.
    • People with dementia.

      Downs, Murna G. (c2011)
    • The perceived and objective availability of green and blue spaces and quality of life in people with dementia: results from the IDEAL programme

      Wu, Y.T.; Clare, L.; Jones, I.R.; Nelis, S.M.; Quinn, Catherine; Martyr, A.; Victor, C.R.; Lamont, R.A.; Rippon, I.; Matthews, F.E. (2021-09)
      The aim of this study was to investigate the associations between quality of life and both perceived and objective availability of local green and blue spaces in people with dementia, including potential variation across rural/urban settings and those with/without opportunities to go outdoors. This study was based on 1540 community-dwelling people with dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme. Quality of life was measured by the Quality of Life in Alzheimer’s Disease (QoL-AD) scale. A list of 12 types of green and blue spaces was used to measure perceived availability while objective availability was estimated using geographic information system data. Regression modelling was employed to investigate the associations of quality of life with perceived and objective availability of green and blue spaces, adjusting for individual factors and deprivation level. Interaction terms with rural/urban areas or opportunities to go outdoors were fitted to test whether the associations differed across these subgroups. Higher QoL-AD scores were associated with higher perceived availability of local green and blue spaces (0.82; 95%CI: 0.06, 1.58) but not objective availability. The positive association between perceived availability and quality of life was stronger for urban (1.50; 95%CI: 0.52, 2.48) than rural residents but did not differ between participants with and without opportunities to go outdoors Only perceived availability was related to quality of life in people with dementia. Future research may investigate how people with dementia utilise green and blue spaces and improve dementia-friendliness of these spaces.
    • Perceived Support as a Moderator of the Relationship between Stress and Organisational Citizenship Behaviours.

      Jain, A.K.; Giga, Sabir I.; Cooper, C.L. (2013)
      Purpose – The purpose of this paper is to identify the impact of organizational stressors on organizational citizenship behaviour (OCB) and how perceived organizational support (POS) will moderate in the relationship between stressors and citizenship behavior. Design/methodology/approach – The sample for this research involves operators from call center organizations located around the national capital of India. A questionnaire survey was carried out involving 402 operator level employees from five different organizations. Findings – The results highlight a significant negative relationship between organizational stressors and OCB, a significant positive relationship between POS and OCB, and confirmation that POS moderates in the relationship between organizational stressors and OCB. Research limitations/implications – This research has been carried out in an emerging economy and in a sector which is seen as an attractive area of work. However, as this study is limited to the BPO sector in India, these results may not be generalized to other areas such as the public and manufacturing sectors and in other national contexts. Future research in this area should also consider using different data collection approaches to maximize participation and enrich findings. Practical implications – The analysis suggests that change management initiatives in organizations may not be implemented as effectively as they can under high stressor conditions because employee extra‐role work behavior and commitment may not be at full capacity. Originality/value – There is limited research examining the relationship between organizational stressors and OCB in the presence of POS, especially within high demand environments such as the Indian BPO sector.
    • Perceptions of absolute versus relative differences between personal and comparison health risk

      Mason, Dan; Prevost, A.T.; Sutton, S. (2008)
      OBJECTIVE: To explain inconsistent results in previous attempts to determine whether, when presented with health risk information, people focus primarily on information about their own risk status or on a comparison with others. DESIGN: A randomized between-groups experiment in which participants were presented with hypothetical cardiac risk information. We examined whether affective responses were primarily sensitive to the relative difference between personal and comparison risk, rather than the absolute difference. MAIN OUTCOME MEASURES: Participants' negative affective response to the risk information. RESULTS: When relative differences were held constant, participants' responses were independently influenced by both personal risk and comparative standing, effects that were greatly attenuated when absolute differences were held constant. When maintaining constant absolute differences, personal and comparison risk information appeared to interact. CONCLUSION: Previous studies tended to maintain constant absolute risk differences and so may have underestimated the impact of personal risk information. Participants' responses were sensitive to the way the risk difference was constructed. Basing experimental design decisions on assumptions about the information participants will respond to can lead to misinterpretations of the basis of risk judgments.
    • Perceptions of dementia and use of services in minority ethnic communities: a scoping exercise.

      Parveen, Sahdia; Peltier, C.; Oyebode, Jan R. (2016)
      Despite the rapidly ageing population and a predicted sevenfold increase in the prevalence of dementia in minority ethnic communities, people from these communities remain under-represented in specialist dementia services. Leventhal’s Model of Self-Regulation suggests perceptions ofillness facilitate help-seeking behaviours such as the use of services. Thisscoping exercise makes use of the model to explore perceptions ofdementia in British Indian, African and Caribbean, and East and CentralEuropean communities in the United Kingdom. Between August 2013and April 2014, culturally specific dementia awareness roadshows wereattended by people living with dementia, carers and members of thepublic. During the roadshows, 62 British Indian, 50 African and Caribbean, and 63 East and Central European attenders participated indiscussion groups and a dementia knowledge quiz. Thematic andframework analysis were conducted on the discussion group data. Threemain themes are presented: Perceptions of dementia, awareness ofdementia in the wider family and community, and awareness and use ofservices. The findings suggest that although groups attributed a biologicalbasis for memory loss, a number of misconceptions prevailed regardingthe cause of dementia. Groups also made use of religion, as opposed tomedical healthcare services, as a form of personal and treatment control. Seeking help from healthcare services was hindered by lack of awarenessof services, and culturally specific barriers such as language. The findingshave a number of implications for policy and practice including thedevelopment of public health interventions and the need to focus further on reducing barriers to accessing services.
    • Perceptions of Dental Health Professionals (DHPs) on job satisfaction in Fiji: A qualitative study

      Kumar, S.; Mohammadnezhad, Masoud (2022-08-29)
      Reviewing factors that affect work challenges is crucial for any organization as it has an impact of organizational commitment for a better service delivery and job satisfaction. This study aimed to explore the perceptions of dental health professionals (DHPs) on work challenges and the impact it has on job satisfaction in Fiji. Materials and Methods: A descriptive, qualitative method approach (nationwide) was done commencing from August to November, 2021. DHPs who provide prosthetic services in Fiji were selected using purposive selection located at Nakasi Dental Clinic, Lautoka Dental Clinic, Labasa Dental Clinic, and Fiji National University. A total of 29 DHPs participated in the in-depth interview, and the responses were grouped into nine themes: working conditions, the location of practice, equipment and material, a lack of specialization, service delivery, organizational support, remuneration, career development, and promotions. A semi-structured open-ended questionnaire in the form of an interview via a virtual platform—Zoom was used for data collection. Thematic analysis was used to transcribe and analyze the audio recordings. Results: The findings from the study indicated that factors such as working conditions, the location of practice, equipment and material, a lack of specialization, service delivery, organizational support, remuneration, career development, and promotions were associated with work challenges. Conclusion: Gaps and areas for the improvement of work challenges and its impact on job satisfaction were identified for DHPs who provide prosthetic services in Fiji such as a need for more career and professional development pathways, improved infrastructure to support prosthetic service delivery, and better remuneration.
    • Perceptions of the Impact of Positive Action in EU and non-EU Countries

      Archibong, Uduak E.; Eferakorho, Jite; Darr, Aliya; Scally, Andy J.; Atkin, K.; Baxter, C.; Johnson, M.R.D.; Bell, M.; Waddington, L.; Wladasch, K.; et al. (2009)
      Abstract: Around the world, inequalities exist around boundaries of race, social class, gender, disability, religious beliefs and sexual orientation, often resulting from past and current discriminatory practices. Governments have taken certain measures, including enacting policies such as positive action, to remedy such discrimination. This paper provides a comparative analysis of perceptions of the impact of positive action in seven EU and three non-EU countries. The study adopted participatory methods including consensus workshops, interviews and policy analysis to obtain data from designers of positive action. Findings are discussed, conclusions drawn and wide-ranging recommendations are made at the EC, individual countries and organisational levels.
    • Performance of externally validated enhanced computer-aided versions of the National Early Warning Score in predicting mortality following an emergency admission to hospital in England: a cross-sectional study

      Faisal, Muhammad; Richardson, D.; Scally, Andy J.; Howes, R.; Beatson, K.; Mohammed, Mohammed A. (2019-11)
      OBJECTIVES: In the English National Health Service, the patient's vital signs are monitored and summarised into a National Early Warning Score (NEWS) to support clinical decision making, but it does not provide an estimate of the patient's risk of death. We examine the extent to which the accuracy of NEWS for predicting mortality could be improved by enhanced computer versions of NEWS (cNEWS). DESIGN: Logistic regression model development and external validation study. SETTING: Two acute hospitals (YH-York Hospital for model development; NH-Northern Lincolnshire and Goole Hospital for external model validation). PARTICIPANTS: Adult (≥16 years) medical admissions discharged over a 24-month period with electronic NEWS (eNEWS) recorded on admission are used to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) using the first electronically recorded NEWS (model M0) versus a cNEWS model which included age+sex (model M1) +subcomponents of NEWS (including diastolic blood pressure) (model M2). RESULTS: The risk of dying in-hospital following emergency medical admission was 5.8% (YH: 2080/35 807) and 5.4% (NH: 1900/35 161). The c-statistics for model M2 in YH for predicting mortality (in-hospital=0.82, 24 hours=0.91, 48 hours=0.88 and 72 hours=0.88) was higher than model M0 (in-hospital=0.74, 24 hours=0.89, 48 hours=0.86 and 72 hours=0.85) with higher Positive Predictive Value (PPVs) for in-hospital mortality (M2 19.3% and M0 16.6%). Similar findings were seen in NH. Model M2 performed better than M0 in almost all major disease subgroups. CONCLUSIONS: An externally validated enhanced computer-aided NEWS model (cNEWS) incrementally improves on the performance of a NEWS only model. Since cNEWS places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated to determine if it can improve care in hospitals that have eNEWS systems.
    • Perinatal depression: Factors affecting help-seeking behaviours in asylum seeking and refugee women. A systematic review

      Firth, A.; Haith-Cooper, Melanie; Dickerson, J.; Hart, Andrew (2022)
      Purpose Perinatal depression is one of the most commonly diagnosed mental health conditions in the general maternity population but whilst the prevalence is thought to be much higher in asylum seeking and refugee (AS&R) women, it is less frequently identified and diagnosed by health care professionals. Method A systematic review was undertaken to address ‘what factors influence help-seeking behaviours in asylum seeking and refugee women with symptoms of perinatal depression’. The review focussed on women accessing care in high income countries. 12 studies met the eligibility criteria and a narrative synthesis was undertaken resulting in two main themes: women's perceptions of depression and access to healthcare and support services. Results Findings indicated that many of the influences on help-seeking were also present in the general population and women from ethnic minority populations, with the exception of migration experiences; but that women from a AS&R background may experience more of these barriers, exacerbating inequality in access to and engagement with healthcare. Conclusion Further research is needed to provide more detailed insight into the experiences of asylum seeking and refugee women to identify ways that barriers in help-seeking can be addressed.
    • Person centred care.

      Downs, Murna G. (2011)
    • Person-Centered Dementia Care in the Community: A Perspective From the United Kingdom

      Downs, Murna G.; Lord, Kathryn (2017)
      Dementia is a global concern. Although effort is being put toward finding a cure, many advances have been made in ensuring excellence in dementia care. In the United Kingdom, the concept of person-centered dementia care has transformed what is expected for individuals with dementia. Now embraced in national policy in the United Kingdom, it was pioneered by Thomas Kitwood and Kathleen Bredin and driven by a con-cern for the quality of care for indi-viduals with dementia in care homes. The purpose of the current article is to describe key concepts of Kitwood’s pioneering work in person-centered dementia care and to use them to inform current community-based supports and services for individuals with dementia in their own homes, whether alone or with family carers.
    • Person-centred communication in dementia care

      Downs, Murna G.; Collins, L. (2015)
      Communication involves the exchange of information between at least two people, a giver and a receiver. If left unaddressed, communication difficulties may have a profound effect on quality of life and quality of care. Poor communication may result in high levels of anxiety and depression for the person living with dementia. Communication breakdown contributes to high rates of depression in spouses of people living with dementia and is a major problem for family and carers. Positive and supportive communication is essential to ensure good quality dementia care. A person-centred approach focuses on supporting a person to use and retain their skills and abilities. Person-centred communication involves a commitment to including the perspective of the person living with dementia, and an understanding of who the person is, their life history and preferences.
    • Person-centredness in direct care workers caring for residents with dementia: effects of a psycho-educational intervention

      Barbosa, Ana; Nolan, M.; Sousa, L.; Figueiredo, D. (2017-02-01)
      This study assessed the effects of a psycho-educational intervention on direct care workers' person-centredness during morning care to residents with dementia. A controlled pretest–posttest study was conducted in four aged-care facilities with 56 direct care workers (female, mean age 44.72 ± 9.02). Two experimental facilities received a psycho-educational intervention comprising person-centred care competences and stress management skills; control facilities received an education-only intervention, without stress support. In total, 112 video-recorded morning care sessions were coded using the Global Behaviour Scale. Both groups reported significantly higher scores on eight of 11 items of the Global Behaviour Scale and on the Global Behaviour Scale total score at posttest (F=10.59; p=0.02). Global Behaviour Scale total score improvements were higher for the experimental group, with values close to significance (F=3.90; p=0.054). The findings suggest that a psycho-educational intervention may increase care workers' person-centredness. Further research is needed to explore the long-term sustainability and extent of its benefits on workers and residents.
    • A personalized self-management rehabilitation system with an intelligent shoe for stroke survivors: a realist evaluation

      Mawson, S.; Nasr, N.; Parker, J.; Davies, R.; Zheng, H.; Mountain, Gail (2016)
      Background: In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology–enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an “intelligent shoe.”. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer. Objective: To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes. Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers. Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system. The study revealed that the system should also encourage independent use and the setting of personalized goals or activities. Conclusions: Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities.