From breathless to failure:symptom onset and diagnostic meaning in patients with heart failure - a qualitative study

Objectives: To explore 2 key points in the heart failure diagnostic pathway-symptom onset and diagnostic meaning-from the patient perspective. Design: Qualitative interview study. Setting: Participants were recruited from a secondary care clinic in central England following referral from primary care. Participants: Over age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care. Methods: Semistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audiorecorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method. Results: Participants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term 'heart failure' was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time. Conclusions: Greater public awareness of symptoms and adequate explanation of 'heart failure' as a diagnostic label, or reconsideration of its use, are potential areas of service improvement

Methodological challenges of cross-language qualitative research with South Asian communities living in the UK

Objective: We investigate (1) the influence of ethnic, gender, and age concordance with interviewers and (2) how expression of qualitative data varies between interviews delivered in English and community languages (Punjabi/Urdu) with monolingual and bilingual participants across three generations of the Indian Sikh and Pakistani Muslim communities living in the UK. Methods: We analyzed and interpreted semi-structured interview transcripts that were designed to collect data about lifestyles, disease management, community practices/beliefs, and social networks. First, qualitative content analysis was applied to transcripts. Second, a framework was applied as a guide to identify cross-language illustrations where responses varied in length, expression and depth. Results: Participant responses differed by language and topic. First-generation migrants when discussing religion, culture, or family practice were far likelier to use group or community narratives and give a longer response, indicating familiarity with or importance of such issues. Ethnic and gender concordance generated greater rapport between researchers and participants centered on community values and practices. Further, open-ended questions that were less direct were better suited for first-generation migrants. Conclusion: Community-based researchers need more time to complete interviews in second languages, need to acknowledge that narratives can be contextualized in both personal and community views, and reframe questions that may lead to greater expression. Furthermore, we detail a number of recommendations with regard to validating the translation of interviews from community languages to English as well as measures for testing language proficiency

Long-term conditions, self-management and systems of support::An exploration of health beliefs and practices within the Sikh community, Birmingham, UK

Objective. The global prevalence of non-communicable diseases (NCDs), such as diabetes mellitus and coronary heart disease, continues to rise. Internationally, people of South Asian origin (i.e. by birth or heritage) are much more likely to develop and live with NCDs compared to the general population. The South Asian diaspora population is highly heterogeneous, varying by socioeconomic status, migration history, religion and ethnicity. This article reports the findings of a study to explore the types of support accessed by Punjabi Sikhs living in Birmingham and the Black Country, UK, who were living with NCDs. Design. The study sought to develop a greater understanding of past experiences of accessing support and the importance of relationships in the mobilisation of resources for self-management. It was nested within a larger programme of research which explored attitudes to prevention of chronic diseases in local communities in the region. Seventeen Punjabi Sikh men and women were recruited through purposive sampling. Narrative interviews were conducted and analysed by the research team. Sociological theories on systems of support and social relations were consulted to inform the interpretation of data. Results. The study findings suggest that participants interpreted chronic disease self-management in relation to four primary systems of support: health services for disease management; multiple sources of care, including traditional Indian medicines and the Internet, for symptom management; community groups for lifestyle management; and the family for emotional and physical care. Within these systems of support, participants identified barriers and facilitators to the maintenance of a healthy lifestyle. We focus on intra-group diversity; exploring the intersection of views and experiences by age, gender, generation and caste. Conclusion. The findings have implications for the design and delivery of primary care and community services which support the prevention and management of NCDs in an increasingly diverse population

Language development, delay and intervention-the views of parents from communities that speech and language therapy managers in England consider to be under-served

Evidence-based practice includes research evidence, clinical expertise and stakeholder perspectives. Stakeholder perspectives are important and include parental ethno-theories, which embrace views about many aspects of speech, language and communication, language development, and interventions. The Developmental Niche Framework provides a useful theory to understand parental beliefs. Ethnotheories, including those about language development, delay and interventions, may vary cross culturally and are less well understood in relation to families who may be considered ‘under-served’ or ‘hard-to-reach’ by speech and language therapy services. Who is considered to be under-served and the reasons why some families are under-served are complex

The effect of tryptophan analogs on the induced synthesis of maltase and protein synthesis in yeast

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32528/1/0000628.pd

Exploring variations in childhood stunting in Nigeria using league table, control chart and spatial analysis

Background: Stunting, linear growth retardation is the best measure of child health inequalities as it captures multiple dimensions of children’s health, development and environment where they live. The developmental priorities and socially acceptable health norms and practices in various regions and states within Nigeria remains disaggregated and with this, comes the challenge of being able to ascertain which of the regions and states identifies with either high or low childhood stunting to further investigate the risk factors and make recommendations for action oriented policy decisions. Methods: We used data from the birth histories included in the 2008 Nigeria Demographic and Health Survey (DHS) to estimate childhood stunting. Stunting was defined as height for age below minus two standard deviations from the median height for age of the standard World Health Organization reference population. We plotted control charts of the proportion of childhood stunting for the 37 states (including federal capital, Abuja) in Nigeria. The Local Indicators of Spatial Association (LISA) were used as a measure of the overall clustering and is assessed by a test of a null hypothesis. Results: Childhood stunting is high in Nigeria with an average of about 39%. The percentage of children with stunting ranged from 11.5% in Anambra state to as high as 60% in Kebbi State. Ranking of states with respect to childhood stunting is as follows: Anambra and Lagos states had the least numbers with 11.5% and 16.8% respectively while Yobe, Zamfara, Katsina, Plateau and Kebbi had the highest (with more than 50% of their underfives having stunted growth). Conclusions: Childhood stunting is high in Nigeria and varied significantly across the states. The northern states have a higher proportion than the southern states. There is an urgent need for studies to explore factors that may be responsible for these special cause variations in childhood stunting in Nigeria