Industrial restructuring and physical activity in England

In recent decades, the prevalence of physical activity has declined considerably in many high-income countries, and this has been linked to rising levels of obesity and several weight-related medical conditions such as coronary heart disease, diabetes and cancer. There is some evidence that areas experiencing the lowest levels of physical activity tend to be those which have undergone a particularly strong transition away from employment in physically demanding occupations. It is proposed that such processes of industrial restructuring may be causally linked to unexplained geographical variations in activity patterns. Although the socio-cultural correlates of activity behaviours have been well studied, none have explicitly attempted to identify components of industrial change that may impact physical activity. This thesis addresses the gap in knowledge surrounding the socio-cultural context of industrial restructuring by investigating where, how and why dimensions of industrial change may impact current levels of physical activity in England. The research applies a mixed methods approach using GIS techniques, multilevel modelling and qualitative research interviewing. Firstly, the current literature on socio-cultural correlates of health behaviours is reviewed to present a novel conceptual framework that hypothesises how processes between physical activity and industrial restructuring may be linked in context. Subsequently, measures of industrial restructuring as well as physical activity are developed to analyse spatial variations in activity patterns across England. The analyses focus on how employment decline in physically demanding occupations may affect current levels of physical activity across different activity domains and relevant macroeconomic time periods. Finally, this research aims to get an insight in the mechanisms underlying the relationship between physical activity and industrial restructuring. Results from this research showed geographical variations with distinctive urban-rural disparities in levels of predominantly recreational physical activity across England. Processes of industrial restructuring appeared to be associated with patterns of physical activity, although the nature of the association differed across areas, time periods and employment types. The results also highlighted the plausible impact of inherited cultures and regional identities on health-related behaviours. Socio-cultural factors relevant in the context of industrial restructuring are likely to provide valuable context in activityrelated research

A Study of the Effectiveness of Risk Assessment and Extension Supports for Irish Farmers to Improve Farm Safety and Health Management

Doctoral thesisThe agricultural sector workforce in Ireland and Internationally has a poor occupational safety and health (OSH) record. Given this situation, identifying approaches to improve OSH adoption on farms are urgently required, yet limited research has been conducted on this topic. In Ireland, legislation introduced in 2005 permitted the development of a Code of Practice (COP) in association with a Risk Assessment Document (RAD) for specific sectors to assist owners of small-scale enterprises and the self-employed to manage OSH. Two state agencies, the Health and Safety Authority and Teagasc – Agriculture and Food Development Authority, formed an alliance to undertake a Prevention Initiative to develop the COP and RAD for the agriculture sector and to assist farmers to use these documents to manage farm OSH and to assess the utility of the approach adopted. The Prevention Initiative firstly developed the RAD on a pilot basis and assessed its value in assisting farmers with OSH management in association with provision of short halfday training and follow-up extension. This was followed by circulation of COP documents, including the RAD, to farmers nationally and making available half-day training based on the RAD and associated OSH extension. A mixed-method research approach was implemented to assess the RAD utility and effectiveness while triangulation of data from different sources was undertaken to maximise the knowledge gained. Questionnaires were used among farmer participants (n=1,206) and Teagasc staff (n=54), who facilitated the training, to gain opinions of the RAD and of the training provided. RAD’s were assembled (n=475) and assessed for their completion levels and nature of controls specified for action by farmers. Farm audits were undertaken (n=94) to assess implementation of farm OSH controls in association with RAD use. A nationally representative survey of farmers (n=891) was used to establish levels of COP and RAD usage and farm accident levels. Farmers reported having a positive attitude to farm OSH. They rated the RAD developed on a pilot basis as the most helpful to them in assisting with OSH management when compared with other legal documents developed in Ireland for this purpose. Farmers perceptions of the causes of serious accidents were found to be at variance with objective data and it was concluded that use of the RAD was an effective means of accurate communications. The COP and RAD documents were used to a limited extent among the farming population and it was concluded that greater utility of these documents requires further support through training. Participation in training on RAD completion in the project pilot phase was motivated by farmers’ desire to improve farm OSH and to gain assistance in completing the legally required documents. Among training approaches used, participants rated using accident victim testimonials and visual approaches to show OSH controls most useful while the provision of information on farmers’ health and level of discussion during training as least useful. Most participants were willing to engage in further OSH farm-based extension including participation in further training and attending farm demonstrations. Following RAD completion, most farmers (78%) planned to make OSH changes for which farm resources were mainly available, but just over half (55%) implemented the changes they planned and these were identified as having a prior record of OSH adoption. Farmers identified a limited number of controls in the RAD for action and those who attended training specified a higher level , while controls specified were mainly physical in nature such as machinery and farm facilities improvement. RAD facilitators were satisfied with the content and structure of farmer RAD training and the majority (80%) were also satisfied with the training they received to provide RAD farmer training while those dissatisfied mainly felt that the training provided was too short. Advisors who facilitated RAD training when compared to those not allocated this role, subsequently reported providing higher levels of OSH advice. Farmers’ completion of the RAD with or without training (half-day) was not associated with reduced farm accident levels. Farm accident level was associated with farms where the farmer and spouse had off farm work, which were comparatively larger in scale. Being a Teagasc client or having received agricultural education was not associated with reduced farm accident levels. Overall the study indicates that farmers’ knowledge is not the limiting factor to OSH implementation as use of the RAD and training did not lead to OSH change among prior non-adopters. The study recommends further assessment of extension approaches which can motivate OSH adoption such as use of farmer discussion groups which have been shown to improve farm management and technology adoption

Guidelines for fostering hand hygiene compliance and infection control among healthcare workers at Mutoko and Mudzi districts in Zimbabwe

Background: Healthcare workers’ hand hygiene remains a key pillar because it prevents and controls healthcare associated infections. Healthcare Workers’ hand hygiene compliance is suboptimal. Aim: The study developed contextualised guidelines for Healthcare Workers’ hand hygiene and infection control in patient care. Methods: The Precede-Proceed model with Theory of Planned Behaviour guided the study. The study was conducted following the mixed methodology approach, observational survey, exploratory, descriptive and contextual in nature study with mixed thematic analyses in a research wheel process. Data were collected through direct participant observation of hand hygiene opportunities through observing (n=95 Healthcare Workers; n=570 practices). Self-administered questionnaires were used to collect data from Healthcare workers (n=189) regarding challenges they faced in achieving hand hygiene. Structured interviews were conducted with patients (n=574). Retrospective reviews of healthcare associated infections and their associated mortalities were carried out from mortality records. Data were analysed retrospectively. Partly the data were statistically and mixed thematically analysed. Guidelines were developed using intervention alignment throughout, mapping, matching, pooling, patching and validation corroborated with Precede-Proceed models’ best practices. The study was ethically reviewed and approved by University of South Africa and the Medical Research Council of Zimbabwe project numbers, 6067662 and MRCZ/B/208. Results: Hand hygiene non-compliances were mostly found in the following contexts, after touching patients’ surroundings, and before doing an aseptic procedure. A non-hand hygiene compliance of Healthcare workers 167(29.3%) and compliance 403(70.7%) in context was suboptimal with sad patients and challenges faced by Healthcare workers. Conclusion: Healthcare Workers had gaps in hand hygiene compliance and availability of required resources. Gaps were also noted in ongoing hand hygiene promotion educational strategies and guidelines to comply and prevent. Guidelines to enhance hand hygiene included, attend to hand hygiene strictly after touching patient surroundings, bed linen, lockers and curtains to prevent gastroenteritis; follow standard precautions against HCAIs from spreading to patients' environments; and comply with hand hygiene guidelines, policies and regulations for best practice with patients. The study contributes generalisable knowledge.Health StudiesD. Litt et Phil. (Health Studies

Predictors of uptake of screening mammography

BACKGROUND Policymakers believe mammography uptake is declining; whether there is a decrease, and in whom is not known. There is a wealth of research focussed on single predictors of uptake in mammography such as socioeconomic status or ethnicity. However, there are limited papers investigating global predictors, particularly with an international focus. AIM The thesis aims to: identify predictors of (1) mammography uptake worldwide and (2) in South-West London; ascertain if patterns of attendance have changed and if so, in whom, and; commence questionnaire development to determine influencers of uptake. METHODS A systematic search was conducted on six databases in 2016. Two reviewers independently examined the articles using pre-defined inclusion criteria. Random-effects meta-analyses and sub-group meta-analyses were conducted. Mixed-effects logistic models analysed dichotomised cohort data. The questionnaire was developed with a patient and public representative prior to testing. Thirteen cognitive interviews were conducted and analysed using thematic and content analysis. RESULTS Data from 91 studies met the systematic review inclusion criteria. Marital status, smoking status, insurance status and number of chronic conditions or primary care visits were found to be statistically associated with uptake. Ethnicity, age, socioeconomic status, income, education, housing tenure and obesity were not significantly associated. The database provided attendance information from 406,015 women. Overall, older women had lower odds of attending mammography than younger women. Odds of attending appeared to increase with affluence, disability or a previous recall and were lower in minority ethnic women compared with White women. Few concerns were identified with the questionnaire items. Minor alterations to questions were made in response to data where appropriate. CONCLUSION Many variable factors influence uptake. The generalisability of the results to a UK population needs establishing. The questionnaire needs further development to establish validity before establishing which women make informed decisions. Future research should evaluate if personalised information, in line with risk status and other known factors associated with uptake, would be beneficial for screening programmes

Mammography

In this volume, the topics are constructed from a variety of contents: the bases of mammography systems, optimization of screening mammography with reference to evidence-based research, new technologies of image acquisition and its surrounding systems, and case reports with reference to up-to-date multimodality images of breast cancer. Mammography has been lagged in the transition to digital imaging systems because of the necessity of high resolution for diagnosis. However, in the past ten years, technical improvement has resolved the difficulties and boosted new diagnostic systems. We hope that the reader will learn the essentials of mammography and will be forward-looking for the new technologies. We want to express our sincere gratitude and appreciation?to all the co-authors who have contributed their work to this volume

Social Public Health System and Sustainability

This edited volume contains 18 articles published in Sustainability from late 2018 to early 2021. During that time, the world faced the fatal and widespread health crisis, COVID-19, which had threatened the social and public health systems at every corner for quite some time.As the Guest-Editors and also a contributing authors, we are glad that the academic contents from the Special Issue will now be put together in this volume, making the authors' hard work and efforts accessible to the larger audience

Active Commuting and Active Transportation

This book focuses on active transport as a way to increase physical activity levels. Active commuting and active transportation on foot or by bicycle create opportunities for physical activity, provide transportation options for those without a car, encourage social cohesion, and reduce contributions to air pollution