Diabetes and tuberculosis : how strong is the association and what is the public health impact?

PhD ThesisIntroduction : Recent research has generated discussion upon the historically noted association between tuberculosis (TB) and diabetes mellitus (DM). However, evidence on the direction of the association, its magnitude, specificity and impact remains sparse. The primary aim of this thesis was to identify whether rates of TB (all sub-types, pulmonary (PTB) and extra pulmonary (EPTB)) are raised amongst those with DM (all sub-types, type 1 (T1DM) and type 2 (T2DM)), or the converse. Further to this, to estimate the magnitude and direction of any such associations. A secondary aim of the thesis was to investigate whether key TB outcomes differ amongst those with co-morbid DM and TB comparative to those with TB disease alone. Methods : The Oxford Record Linkage Study (ORLS) is a database containing records of all hospital admissions and all deaths (regardless of where they occurred), in defined populations within the former Oxford National Health Service Region. ORLS1 covers the years 1963 to 1998 and ORLS2 covers the years 1999 to 2008, the two databases are not linkable. The Health Improvement Network (THIN) is a database containing electronic medical records collected at General Practice clinics throughout the United Kingdom (UK). Retrospective cohort analyses were carried out using data from ORLS1, ORLS2 and THIN. All patients in the datasets were classified as exposed to (having had) or unexposed to (not having had) TB (all sub-types, PTB or EPTB) and exposed or unexposed to DM (all sub-types, T1DM or T2DM). In the ORLS1 and ORLS2 datasets, standardised rate ratios (RR) and corresponding 95% confidence intervals (95% CI) were calculated and compared for DM (all sub- types, T1DM and T2DM) in individuals who have had and have not had TB (all sub- types, PTB or EPTB). Similarly, RR and 95% CI were calculated and compared for TB (all sub-types, PTB or EPTB) in patients with and without DM (all sub-types, T1DM and T2DM). Within THIN datasets, the incidence rate ratio (IRR) and 95% CI of DM (all sub-types, T1DM and T2DM) were calculated using negative binomial regression, with TB (all sub-types, PTB or EPTB) as an explanatory variable. Similarly, the IRR and 95% CI for TB (all sub-types, PTB or EPTB) were calculated using negative binomial regression, with DM (all sub-types, T1DM or T2DM) as an explanatory variable. Systematic searching was performed to identify studies comparing TB outcomes amongst those with and without DM. Data from these studies were utilised to inform meta-analyses that assessed all cause mortality, bacterial clearance rate and TB relapse or recurrence rate amongst individuals with DM and co-morbid TB comparative to those with TB alone. Results Significant increases in TB rates (all sub-types) and pulmonary tuberculosis (PTB) rates were identified amongst individuals with DM comparative to those without DM within the Oxford Record Linkage Study datasets. The RR of TB (all sub-types) was increased amongst individuals with DM (all sub- types) compared to those without in ORLS1 (RR 1.77 (95% CI 1.45-2.15), P-value <0.001) and ORLS2 (RR 2.56 (95% CI 1.78-3.69), P-value <0.001). The RR of PTB was also increased amongst individuals with DM (all sub-types) compared to those without in ORLS1 (RR 1.72 (95% CI 1.22-2.37), P-value <0.001) and ORLS2 (RR 3.33 (95% CI 1.51-6.62), P-value 0.001). There was a statistically significant elevation of risk for TB amongst those with T2DM compared to those without in ORLS1 (RR 1.58 (95%CI1.15-2.14), P-value 0.003) and ORLS2 (RR 3.33 (95% CI 1.51-6.62), P-value 0.001). There was no significant association between the rates of TB amongst those with T1DM compared to those without in ORLS1. The ORLS 2 dataset was too small to complete this analysis. No significant association was found between the rate of EPTB amongst those with DM comparative to those without in either ORLS1 or ORLS2. There was also no significant association between having had TB (all sub-types, PTB or EPTB) and subsequent risk of DM (all sub-types, T1DM or T2DM) in either ORLS1 or ORLS2. In THIN dataset the risk of TB (all sub-types) was found to be increased amongst individuals with DM (all sub-types), T1DM and T2DM when compared to those without. Thus, the IRR of TB (all sub-types) were significantly increased amongst individuals with DM (all sub-types) (IRR 1.50 (95%CI 1.27-1.76) P-value <0.001), T1DM (IRR 1.46 (95%CI 1.10-1.92) P-value 0.008) and T2DM (IRR 1.54 (95%CI 1.30-1.82) P-value < 0.001) compared to those without DM. The rate of PTB amongst individuals with DM (all sub-types), T1DM, or T2DM compared to those without were not significantly raised within THIN. The rate of EPTB was raised amongst those with T1DM (IRR 2.09 (95%CI 1.19-3.66), P-value 0.010) but was not raised amongst those with DM (all sub-types) (IRR 1.43 (95% CI 0.99-2.07), P-value 0.055) or those with T2DM (IRR 1.39 (95%CI 0.93-2.06), P-value 0.11) when compared to those without DM. In THIN dataset the rates of DM (all sub-types), T1DM and T2DM were found to be raised amongst individuals who have had TB (all sub-types), PTB and EPTB when compared to those who have not. The rate of DM (all sub-types) was increased amongst those who have had TB (all sub-types) (IRR 5.65 (95% CI 5.19-6.16) P-value <0.001), PTB (IRR 5.74 (95% CI 5.08-6.50) P-value <0.001) and EPTB (IRR 4.66 (95% CI 3.94-5.51) P-value <0.001) when compared to those who have not had TB. The rate of T1DM was increased amongst those who have had TB (all sub-types) (IRR 5.49 (95% CI 5.02-6.02) P-value <0.001), EPTB (IRR 0.84 (95% CI 0.35-2.03) P-value <0.001) but not amongst those who have had PTB (IRR 1.09 (95% CI 0.62-1.93) P-value 0.77) when compared to those who have not had TB. The rate of T2DM was increased amongst those who have had TB (all sub-types) (IRR 2.21 (95% CI 1.68-2.91) P-value <0.001), PTB (IRR 5.38 (95% CI 4.73-6.12) P-value <0.001) and EPTB (IRR 4.36 (95% CI 3.65-5.22) P-value <0.001) when compared to those who have not had TB. However, within THIN dataset these estimates of association were being promoted by a significant age by TB interaction effect. Utilising systematic review techniques, twenty five studies were identified which reported upon TB outcomes amongst those with compared to without DM. Meta- analyses showed individuals with co-morbid TB and DM had no significant difference in bacterial clearance rate after 2-3 months of treatment (1,675 participants, 6 trials, Relative Risk (RR) 1.38 (95% CI 0.97-1.97)), no significant difference in risk of TB recurrence & relapse (1,225 participants, 4 trials RR 1.20 (95% CI 0.93-1.54)), but a statistically significant increased risk of all cause mortality (12,128 participants, 18 trials, RR 1.97 (95% CI 1.53-2.55)) comparative to those with TB in isolation. Discussion TB risk is increased in those with compared to those without DM within a UK setting. However, it remains unclear if risk of PTB and EPTB are raised amongst those with DM comparative to those without. It also remains unclear as to whether risk of DM is increased amongst those who have had TB comparative to those who have never had TB. Individuals with co-morbid disease are at a greater risk of mortality during active TB disease than those with TB alone, however risk of TB relapse and recurrence are the same. Consideration of the association between DM and TB may become more important for improving TB control and TB treatment as DM prevalence rises in the UK and globally. In areas where TB is endemic TB screening amongst those with DM and TB prophylaxis may be needed to reduce or stabilise numbers developing active disease. Also, the increasing numbers suffering from co-morbid TB and DM will need heightened clinical attention in order to improve TB mortality outcomes.Medical Research Counci

Sure Start Blacon reach report, April 2004 - March 2005

This project report discusses Sure Start computerised records (covering personal details of all registrations within the Sure Start programme and records of each serivce and which service users have accessed them) which allow the 'reach' of the local programme across Blacon to be established between 1 April 2004 and 31 March 2005

Making Education Work: The Effects of Welfare Reform on the Educational Goals and Experiences of TANF Participants

After U.S. welfare was reformed in 1996, many states eliminated their educational programs and replaced them with work-first options. This study uses in-depth interviews and content analysis of current and proposed welfare legislation to examine how these policy changes have shaped the experiences of postsecondary students participating in the Temporary Assistance for Needy Families (TANF) program and to determine whether or not proposed policy changes in TANF reauthorization legislation meet the needs of students. To fulfill the first objective of this study, I conducted interviews with 20 TANF participants who were using enrollment in a postsecondary institution as a means of satisfying their TANF work requirements and 10 TANF case managers who were familiar with the program\u27s policies and procedures. The interviews were conducted in Georgia, one of 13 states that until 2003 explicitly allowed participants to use postsecondary education as a means of meeting work activity requirements. To fulfill the second objective of this study, I analyzed the content of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) and current legislative proposals reauthorizing the act. I find that a variety of internal and external forces -- including one\u27s beliefs regarding education and parenting, one\u27s familial obligations and support systems, and one\u27s receipt of academic and financial aid -- collectively shape students\u27 experiences and likelihood of educational success in various ways. I also determine that the TANF program itself, in particular the emphasis on increasing participation rates and restrictive definitions of acceptable work activities, prevent students from succeeding. These findings are relevant for researchers and policymakers intent on more fully understanding the effects of contemporary U.S. welfare reform and reveal the limitations of current welfare reauthorization acts that seek to further limit educational opportunities of economically-poor women

The experiences, attitudes, and motivations of those within circles of support and accountability

This thesis examines the nature of attitudes held by students, members of the public, and volunteers towards individuals who have been convicted of a sexual offence, and considers the importance of better understanding these attitudes. This is explored within a group of individuals who volunteer within a community-based initiative providing support to those who have committed a sexual offence, along with their motivations for initially choosing to volunteer in such a programme. The experiences of those individuals within the programme who have been convicted of a sexual offence (Core Members) are also reviewed. Chapter 1 presents a general introduction to the concepts of sexual offending, Circles of Support and Accountability (CoSA), and attitudes. Chapter 2 consists of a literature review regarding the experiences of Core Members (CMs) participating in a CoSA. Chapter 3 then presents a critique of a scale designed to measure attitudes towards individuals who have been convicted of a sexual offence and examines its validity, reliability, and the way in which it has been used within research. Chapter 4 presents an empirical research study regarding volunteers within CoSA. Their attitudes towards people who have committed a sexual offence are assessed and compared to both undergraduate students and members of the wider public. Their perceptions are also measured following exposure to vignettes depicting different types of sexual offences. Volunteers’ motivations for joining the programme are also considered through Thematic Analysis. Additional reliability data regarding the attitudinal measure, the Attitudes towards Sexual Offenders scale (ATS; Hogue, 1993), is then presented within this chapter. Finally, Chapter 5 presents an overall summary of the thesis. The implications of the main findings are discussed, as well as potential directions for future research

An assessment of self-reported physical activity instruments in young people for population surveillance: Project ALPHA

<p>Abstract</p> <p>Background</p> <p>The assessment of physical activity is an essential part of understanding patterns and influences of behaviour, designing interventions, and undertaking population surveillance and monitoring, but it is particularly problematic when using self-report instruments with young people. This study reviewed available self-report physical activity instruments developed for use with children and adolescents to assess their suitability and feasibility for use in population surveillance systems, particularly in Europe.</p> <p>Methods</p> <p>Systematic searches and review, supplemented by expert panel assessment.</p> <p>Results</p> <p>Papers (n = 437) were assessed as potentially relevant; 89 physical activity measures were identified with 20 activity-based measures receiving detailed assessment. Three received support from the majority of the expert group: Physical Activity Questionnaire for Children/Adolescents (PAQ-C/PAQ-A), Youth Risk Behaviour Surveillance Survey (YRBS), and the Teen Health Survey.</p> <p>Conclusions</p> <p>Population surveillance of youth physical activity is strongly recommended and those involved in developing and undertaking this task should consider the three identified shortlisted instruments and evaluate their appropriateness for application within their national context. Further development and testing of measures suitable for population surveillance with young people is required.</p

“Like A Dance”: Working creatively with healthcare practitioners to explore mobility and osteoporosis

Anthony Schrag - ORCID 0000-0001-8660-7572 https://orcid.org/0000-0001-8660-7572Margaret Smith - ORCID 0000-0003-2944-5348 https://orcid.org/0000-0003-2944-5348Related eResearch output available at: https://eresearch.qmu.ac.uk/handle/20.500.12289/10487AM replaced with VoR 2020-04-03Collaborations between health sciences and creative arts can generate insights into complex health phenomena. This article describes a creative workshop derived from an action research project that aimed to raise awareness of fracture risk in health practitioners supporting people with Osteoporosis. The creative workshop aimed to provide opportunities for practitioners within the action research community to create new knowledge as well as share their practice insights. The article considers the notion of creative arts as a physical, embodied process that can facilitate learning by enabling tacit knowledge to be made explicit. Rather than applying an instrumental approach to arts within healthcare, the workshop became a mechanism for the convergence of ideas, disciplines and support structures and provided a learning environment where old beliefs could be challenged, practice insights shared and new knowledge constructed. We discuss the workshop development and outputs and suggest the utility of this approach for collaborative learning.https://doi.org/10.1386/jaah_00003_11010pubpub

Population level variation in reproductive development and output in the golden kelp Laminaria ochroleuca under marine heat wave scenarios

Thermal tolerance is often interpreted as a species-wide thermal niche in the absence of studies focusing on the adaptive potential of populations to exhibit differential thermal tolerance. Thus, considering intraspecific thermal plasticity, local adaptation or both between populations along distributional gradients when interpreting and predicting species responses to warming is imperative. Removing the effect of environmental histories by raising kelp gametophyte generations in vitro under common garden conditions allows unbiased comparison between population-specific adaptive variation under different environmental conditions. Following this approach, this study aims to detect (potentially) adaptive differentiation in microscopic life-stages (gametophytes) between populations of a temperate forest forming kelp, Laminaria ochroleuca from locations with distinct thermal conditions. Gametophytes from four geographically distinct populations were subjected to different temperature treatments (17, marine heat waves of 23, 25 and 27 degrees C) and gametophyte survival during thermal stress as well as reproductive success and photosynthetic responses during recovery were investigated. Intraspecific variation in resilience and reproductive output to thermal stress was found in L. ochroleuca; gametophytes from the most northern population (Brittany, France) were the most thermally sensitive, with mortality onset at 23 degrees C, whereas mortality in the remaining populations was only apparent at 27 degrees C. Gametophytes from northern Spain and Morocco exhibited very low reproductive success during recovery from 23 and 25 degrees C. However, when recovering from the highest thermal treatment (27 degrees C) the reproductive development and sporophyte output was higher than in the gametophytes from France and Italy (Mediterranean). The population-specific responses of gametophyte resilience and reproductive success to temperature stress suggest genetic differentiation in response to variation in local thermal regimes.info:eu-repo/semantics/publishedVersio

Aphantasia, dysikonesia, anauralia: call for a single term for the lack of mental imagery – Commentary on Dance et al. (2021) and Hinwar and Lambert (2021)

Recently, the term ‘aphantasia’ has become current in scientific and public discourse to denote the absence of mental imagery. However, new terms for aphantasia or its subgroups have recently been proposed, e.g. ‘dysikonesia’ or ‘anauralia’, which complicates the literature, research communication and understanding for the general public. Before further terms emerge, we advocate the consistent use of the term ‘aphantasia’ as it can be used flexibly and precisely, and is already widely known in the scientific community and among the general public