Healthy eating in UK minority ethnic households : influences and way forward

Many minority ethnic groups living in the UK experience health inequalities in the form of higher rates of mortality and morbidity as compared to the white population (Liu, et al., 2015; Liu et al., 2012; Ghouri, 2005; Nazroo, 2003; Bhopal, 2002). It has been argued that health inequalities experienced by minority ethnic populations will in part be affected by food differences (Ludwig, Cox and Ellahi, 2011; Ludvigsen and Scott, 2009). However, there is limited evidence on the food choices and eating practices of minority ethnic populations due to small sample sizes, difficulties in collecting information and small scale contradictory findings. It is therefore not a surprise that policies and practices informed by limited and contradictory evidence have not been able to tackle the issues of healthy diet and obesity. This paper draws on the findings from academic and grey literature, alongside the outcomes from a qualitative study conducted in three cities in the North of England which explored the influences on food choices among minority ethnic populations. Where possible, UK literature has been used. Because South Asian minorities are the most populous in the UK and there is a larger existing literature on their dietary practices, it has been easier to provide examples from these communities. UK based examples from other minority ethnic populations have been used where possible, but in some instances the findings from other Western countries have been used instead. It must not be assumed that minority ethnic groups have homogenous food practices. Keywords: health inequality; health inequalities; minority ethnic; healthy eating; foo

Parkinson's impact on quality of life and cost of care on people with condition and their families in the UK: A review of literature*

The literature review aimed to gather evidence on the impact of Parkinson’s on the socio-economic life of individuals with the condition, their families and society based on prior research undertaken in the UK. The review also sought to enable a better understanding of the key medical and non-medical cost components directly associated with Parkinson's management and care, with an understanding of where public resources are currently directed. The literature has been synthesised using a comprehensive and transparent literature review process. 50 Papers meeting the inclusion criteria were read and data extracted using a standardised extraction form encompassing: author ⁄ date, the focus of the study, research design and sample size. The evidence was grouped into five themes: (a) Parkinson's incidence differentials by socio-economic status, (b) Parkinson's management and care, (c) Impact on quality of life (QoL) and wellbeing of people with Parkinson's (PwP), carers and family members, (d) Cost of healthcare use, and (e) Societal cost of Parkinson’s

Measures of upper limb function for people with neck pain: A systematic review of measurement and practical properties (protocol)

Background Upper limb disability is a common musculoskeletal condition frequently associated with neck pain. Recent literature has reported the need to utilise validated upper limb outcome measures in the assessment and management of patients with neck pain. However, there is a lack of clear guidance about the suitability of available measures, which may impede utilisation. This review will identify all available measures of upper limb function developed for use in neck pain patients and evaluate their measurement and practical properties in order to identify those measures that are most appropriate for use in clinical practice and research. Methods/design This review will be performed in two phases. Phase one will identify all measures used to assess upper limb function for patients with neck pain. Phase two will identify all available studies of the measurement and practical properties of identified instrument. The COnsensusbased Standards for selection of health Measurement INstrument (COSMIN) will be used to evaluate the methodological quality of the included studies. To ensure methodological rigour, the findings of this review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline.Discussion Optimal management of patients with neck pain should incorporate upper limb rehabilitation. The findings of this study will assist clinicians who seek to utilise suitable and accurate measures to assess upper limb function for a patient with neck pain. In addition, the findings of this study may suggest new research directions to support the development of upper limb outcome measures for patients with neck pain

A systematic review of ethnic minority women’s experiences of perinatal mental health conditions and services in Europe

Background Women from ethnic minority groups are at greater risk of developing mental health problems. Poor perinatal mental health impacts on maternal morbidity and mortality and can have a devastating impact on child and family wellbeing. It is important to ensure that services are designed to meet the unique needs of women from diverse backgrounds. Aim The aim of the review was to explore ethnic minority women's experiences of perinatal mental ill health, help-seeking and perinatal mental health services in Europe. Data sources Searches included CINAHL, Maternity and Infant Care, MEDLINE and PsycINFO with no language or date restrictions. Additional literature was identified by searching reference lists of relevant studies. Design This was a mixed method systematic review. Study selection, appraisal and data extraction were conducted by two researchers independently. A convergent approach was adopted for the analysis and the data were synthesised thematically. Results The 15 eligible studies included women from a range of minority ethnic backgrounds and were all undertaken in the United Kingdom (UK). Seven overarching themes were identified; awareness and beliefs about mental health, isolation and seeking support, influence of culture, symptoms and coping strategies, accessing mental health services, experiences of mental health services and what women want. Conclusion Lack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on ethnic minority women's ability to receive adequate perinatal mental health support in the UK. Future research should focus on in-depth exploration of the experiences of these women across multiple European settings and interventions to reduce health inequalities among vulnerable mothers and families affected by perinatal mental ill health

Reviewing art therapy research : a constructive critique

The literature search that informed our review initially yielded 12,122 papers of potential interest, derived from seven databases. After applying a series of filters we arrived at 92 papers on which we base our findings, thoughts and recommendations for future work. Our methodological approach was informed by the systematic review guidance published by the Centre for Reviews and Dissemination (2009), and the Arts Council definition of ‘arts activities’. Hence we considered papers reporting therapeutic arts interventions conducted on 'patients' which included some measurement of a health state. After excluding any research on people less than age 18, we selected studies where participants had active (as opposed to passive) engagement with the therapy/treatment/medium. Only study types which were quantitative were included in this review. Rather than simply criticise the execution of the research we applied our own expertise to the process. It was immediately evident that definitions and categories would pose some difficulties as there is much variety in the language used to describe the arts, therapies and treatment. This is a problem of indexing, causing the literature search and initial screening to be a laborious process. The most commonly reported art activities were: writing, music, art and dance. The most numerous health condition studied was mental health followed by cognitive function, stress and cancer. Most research was carried out in the US and the UK. As a discipline, psychology featured regularly. When arts therapists were involved in the research the descriptions and possible effects of the art medium tended to be better elucidated. Future research into the use of art therapy in healthcare will benefit from a synthesis of approaches that can retain the more robust aspects of, for example, RCTs with the insights that can be derived from qualitative methods

Measures of upper limb function for people with neck pain. A systematic review of measurement and practical properties

There is a strong relationship between neck pain (NP) and upper limb disability (ULD). Optimal management of NP should incorporate upper limb rehabilitation and therefore include the use of an ULD measure in the assessment and management process. Clear guidance regarding the suitability of available measures does not exist. The aim of this study was to identify all available measures of ULD for populations with NP, critically evaluate their measurement properties and finally recommend a list of suitable measures. This two-phase systematic review is reported in accordance with the PRISMA statement. Phase one identified clearly reproducible measures of ULD for patients with NP. Phase two identified evidence of their measurement properties. In total, 11 papers evaluating the measurement properties of five instruments were included in this review. The instruments identified were the DASH questionnaire, the QuickDASH questionnaire, the NULI questionnaire, the SFA and the SAMP test. There was limited positive evidence of validity of the DASH, QuickDASH, NULI, SFA and SAMP. There was limited positive evidence of reliability of the NULI, SFA and SAMP. There was unknown evidence of responsiveness of the DASH and QuickDASH. Although all measures are supported by a limited amount of low quality evidence, the DASH, QuickDASH, NULI questionnaires, and the SAMP test are promising measures, but they require further robust evaluation

The effects of physical exercise on cardiometabolic outcomes in women with polycystic ovary syndrome not taking the oral contraceptive pill: a systematic review and meta-analysis

Purpose: Women with polycystic ovary syndrome (PCOS) exhibit many metabolic abnormalities that are associated with an increased cardiovascular disease risk. Exercise may promote improvements in lipid profile and insulin sensitivity in women with PCOS. There is however, a knowledge gap on the optimal dose of exercise, regarding duration, intensity, type, and frequency of exercise. The aim of this systematic review and meta-analysis was to define effective types of exercise to improve cardiometabolic profile in PCOS. Methods: We included randomised controlled trials (RCT), quasi-RCT, and controlled clinical trials focusing on reproductive-aged women diagnosed with PCOS. Eligible interventions included those with at least two weeks of supervised exercise sessions. Primary outcomes were blood lipids, blood glucose, blood pressure, measures of abdominal adiposity, and inflammation markers. Secondary outcomes were total and free testosterone, sex hormone binding globulin, and measures of insulin resistance. Nine electronic databases were searched from inception to present for English language publications. The Cochrane Risk Assessment tool was used to assess bias in the included studies. Outcomes were quantitatively synthesised and a meta- analysis was performed. Pooled effect estimates and 95% confidence intervals were presented. Results: This systematic review identified three trials, including 231 participants with PCOS that examined the effect of structured, supervised exercise on cardiometabolic outcomes. Analysis of pooled data indicated statistical favourable effects of exercise on total cholesterol, fasting glucose, waist circumference and waist-to-hip ratio, systolic blood pressure, C-reactive protein, total testosterone, and sex hormone binding globulin using post-intervention scores. Conclusions: Moderate aerobic exercise interventions ≥3 months in duration, with a frequency of 3/week for at least 30-minutes, may have favourable effects on various cardiometabolic risk factors in women with PCOS. However, results should be interpreted with caution. Many of the outcomes were based on studies with serious methodological limitations, and only one "gold-standard" RCT was identified

The role of Allied Health Professions and Nursing Research Internships in developing a research culture: a mixed-methods exploration of stakeholder perspectives

Background: Developing research capability and capacity within the healthcare professions is a challenge throughout diverse international settings. Within England, the National Institute for Health Research aimed to address these challenges through the Integrated Clinical Academic (ICA) research careers escalator for nurses, midwives and allied health professionals. Poor academic progression has been identified in the advanced stages of the pathway, though progression from the earlier entry point (Internship) has not previously been investigated. A national evaluation of four completed Internship cohorts was undertaken to explore stakeholder perspectives and progression beyond the Internship programme. Methods A mixed methods project used sequential qualitative and quantitative data collection phases commencing with two stakeholder focus groups (n = 10); the findings informed the development of an online survey distributed to previous cohorts of interns (n = 104), their managers (n = 12) and academic mentors (n = 36). Eight semi-structured interviews subsequently explored the challenges and opportunities afforded by the internships. Thematic analysis was used to review qualitative data from focus groups and interviews, with survey data analysed and displayed using descriptive statistics. Synthesis of data from each phase is displayed within the four level evaluation framework outlined within the New World Kirkpatrick® Training Evaluation Model. Results Important regional differences exist yet the internships are highly valued by all stakeholders. Representation varied between different professions, with nursing and some service-based professions poorly represented. All interns successfully completed the programme (n = 104), with evidence of positive impacts on interns, colleagues and patient care. Balancing research commitments with clinical activity was challenging; middle managers were seen as gatekeepers to programme success. Progression to the next stage of the ICA pathway is highly competitive and was achieved by only a quarter of interns; access to mentors outside of the funded programme is vital for a successful transition. Conclusions The Internship programme succeeds in providing a range of important early experiences in research, though progression beyond the programme is challenging due, in part, to a widening gap between Internship and the next level of the ICA framework. Vital mentorship support to bridge this gap is threatened by a lack of time and funding; therefore, the pursuit of a clinical-academic career will continue to be elusive for many nurses and allied health professionals. A partnership approach to clinical academic support at institutional level is needed with several international models offering alternative strategies for consideration