Genetic and environmental factors determining heterogeneity in preservation stress resistance of Aspergillus niger conidia

Fungal food spoilage often starts with a contamination with spores. Experimental data strongly indicate the existence of subpopulations of spores with different levels of resistance to preservation methods. In this thesis, the extent of this heterogeneity and the underlying mechanisms using fungal model systems is studied. The role of the genetic background, environmental conditions and the developmental state of the spores were studied, using quantitative imaging, genome and RNA/protein sequencing as well as functional gene analysis. The role of transcription factors in weak acid stress resistance of Aspergillus niger is described. Next, heat resistance of fungal spores of three food spoilage species was quantified and compared. The genomes of Aspergillus niger strains were sequenced and compared revealing the existence of a possible sexual cycle. Melanin of fungal spores impacts UV-C resistance, but not heat resistance and a functional CRISPR/Cas9 genome editing system for Paecilomyces variotii and Penicillium roqueforti is described. Older spores are more heat resistant than younger spores, which can be contributed to differences in compatible solute composition. Additionally, a high cultivation temperature results in fungal spores with high heat resistance, possibly due to heat shock proteins.This work was performed within the framework of TIFN, financed by Agri & Food: AF-15507 | Heterogeneity in spores of food spoilage fungiMicrobial Biotechnolog

Examining patient distress and unmet need for support across UK renal units with varying models of psychosocial care delivery : a cross-sectional survey study

Objective: To examine in-centre haemodialysis patients’ emotional distress and need for support across UK renal units with varying models of psychosocial service provision. Design: The study used a cross-sectional survey design. Logistic regression analysis was used to examine patient distress, as captured by the Distress Thermometer, and need for support, across different renal units. Setting: Seven renal units across England, Wales and Scotland. The units were purposively selected so that varying workforce models of renal psychosocial services were represented. Participants: In total, 752 patients were on dialysis in the participating centres on the days of data collection. All adult patients, who could understand English, and with capacity (as determined by the nurse in charge), were eligible to participate in the study. The questionnaire was completed by 509 patients, resulting in an overall response rate of 67.7%. Outcome measures: The prevalence of distress and patient-reported need for support. Results: The results showed that 48.9% (95% CI 44.5 to 53.4) of respondents experienced distress. A significant association between distress and models of renal psychosocial service provision was found (χ2(6)=15.05, p=0.019). Multivariable logistic regression showed that patients in units with higher total psychosocial staffing ratios (OR 0.65 (95% CI 0.47 to 0.89); p=0.008) and specifically higher social work ratios (OR 0.49 (95% CI 0.33 to 0.74); p=0.001) were less likely to experience distress, even after controlling for demographic variables. In addition, a higher patient-reported unmet need for support was found in units where psychosocial staffing numbers are low or non-existent (χ2(6)=37.80, p<0.001). Conclusions: The novel findings emphasise a need for increased incorporation of dedicated renal psychosocial staff into the renal care pathway. Importantly, these members of staff should be able to offer support for psychological as well as practical and social care-related issues

An examination of how the ‘Household Model' of care can contribute to positive ageing for residents in the ‘Fourth Age’

Background: Promoting a good quality of life for the oldest members of society has become a top priority as evidenced in UK policy. The ‘household’ model is a departure from traditional approaches to care provision since it offers person-centred support - combining health and social care - to older people in specially-designed, small, homelike environments. Having gained increasing popularity in care homes across developed countries, the impact of this model of service delivery on residents’ quality of life and its contribution to positive ageing is of increasing interest. Belong is a not-for-profit, UK care organisation currently operating several villages under the household model. The villages comprise independent living apartments (bought or rented) and residential/nursing care households offering 24 hours personalised, on-site care for residents. In each village there is a range of facilities open to the public (including a Bistro, hairdressers and gym facilities) and a domiciliary community service. Methods: In this paper we present new data generated from qualitative interviews with a sample of household residents in the ‘Fourth Age’ and relatives across two villages in the North West of England, UK. Results: We examine how the household model as operated at Belong facilitates the maintenance of autonomy and independence - which underpins positive ageing and quality of life in the fourth age - among residents. Conclusion: We show how the household model contributes to positive ageing and quality of life as defined by residents

Investigating UK renal psychosocial service provision

Background: Internationally, emerging evidence of psychosocial problems in patients with end-stage renal disease has led to increasing calls for collaborative renal care models that include psychosocial services. In the UK, there is a dearth of empirical studies and clear policies to guide the implementation of these services. Methods: This thesis used a critical realist, mixed-methods approach to examine processes and outcomes of psychosocial service delivery, specifically focusing on the renal social worker role. First, an audit of the UK renal psychosocial workforce was completed. Then, a cross-sectional survey (n=869) captured and compared distress, psychosocial issues and need for services of in-centre haemodialysis patients across seven units. Focus groups (n=4) and in-depth interviews (n=6) with health professionals added a deeper understanding of processes of service delivery. In addition, diaries (n=15), questionnaires completed before and after social worker involvement (n=161), and a focus group brought insight into the renal social worker role. Results: Findings highlighted variation in psychosocial staffing patterns, with recommended benchmarks significantly exceeded. Overall, almost 50% of patients experienced distress. Multivariable logistic regression analysis showed that patients in units with better psychosocial staffing ratios [odds ratio (OR) 0.33 (95% CI 0.14-0.77); p= .01] and specifically better renal social work ratios [OR 0.15 (95% CI 0.05-0.45; p= .001) were less likely to experience distress, even after controlling for demographic variables. Nurses were found to play an important part in the process of psychosocial service delivery, yet experienced barriers in their ability to fulfil this role. Differences were found in funding arrangements and in the degree to which services were proactive and process oriented. The role of renal social worker was found to be poorly defined; and problems with their integration into renal teams and threats for the future of the role from Local Authorities were exposed. Discussion: The novel findings implicate a need for an increase in the renal psychosocial workforce. To ensure equitable access across the country, renal policy documents should make dedicated psychosocial care an unambiguous requirement and offer clear standards of practice and staffing recommendations. Renal units should explore processes, such as psychosocial education for clinical staff and distress screening, that can be put in place to ensure that a focus on psychosocial wellbeing is a standard part of renal care. To guide practice and further research, this thesis proposes a stepped-care model, putting renal social work at the heart of psychosocial service provision

Opportunities and challenges for improving antimicrobial stewardship in low and middle income countries ; lessons learnt from the maternal sepsis intervention in Western Uganda

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and Surgical Site Infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary ‘huddles’ form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers’ ability to exercise their knowledge and skill for the benefit of their patients. This escalates healthcare costs and contributes to Anti-Microbial Resistance

Exploring the role of the UK renal social worker: the nexus between health and social care for renal patients

Introduction Patients living with progressive chronic kidney disease may face a variety of ongoing physical, emotional, financial and/or social challenges along the disease pathway. In most UK renal units, psychosocial support has traditionally been provided by a renal social worker. However, in recent years, the numbers of renal social workers have been declining. The specialised role is poorly understood and there is no UK research about the profession. To inform future research and guide workforce planning, this study presents the first-ever exploration of the UK renal social worker role. It aimed to map the profession’s activities and reasons for involvement in patient care, as well as providing an initial evaluation of that involvement on patient wellbeing. Methods and analysis This mixed-method study recruited adult renal social workers (n = 14), who completed diaries over a 4-month period, participated in a focus group, and provided secondary data (caseload data and audit files where available) to give insight into their role. The evaluation of social work involvement on patient wellbeing used a pre-post intervention design. It measured distress, anxiety and depression levels as captured by the Distress Thermometer and Emotional Thermometers. A total of 161 patients completed the pre-involvement questionnaire, and 87 (55%) returned the post-involvement questionnaire. Results and conclusion The renal social worker role is creative, broad and fluid, with variations in roles linked to differences in employment and funding arrangements, configurations of the wider multidisciplinary renal team, level of standardisation of psychosocial care, availability of community services, and staff-to-patient ratios. Renal social work is different from statutory social work, and renal social workers are generally able to offer continuous rather than episodic care and support patients that would not meet strict local authority eligibility criteria. The findings showed that this support leads to significantly reduced distress and anxiety

Promotive, preventive, and treatment interventions for adolescent mental health in sub-Saharan Africa: A protocol for two scoping reviews including systematic analyses of intervention effectiveness

Introduction: The increasing prevalence of mental health difficulties amongst adolescents is a worldwide concern. Poor mental health in adolescence is associated with a range of mental, physical and social problems in later life. In sub-Saharan Africa, limited data suggests that mental disorders amongst adolescents are common. It is important that interventions to address this are rooted in an understanding of the unique local context and culture. Yet, the current use, development, and effectiveness of adolescent mental health interventions in sub-Saharan Africa is unclear. In response, this paper presents a protocol for two scoping reviews that together will examine the available evidence on promotive, preventive, and treatment interventions for adolescent mental health in sub-Saharan Africa. Methods and analysis: The scoping reviews will follow the five-step methodological framework proposed by Arksey and O’Malley, with further recommendations from the Joanna Briggs Institute. They will review scientific and grey literature published between 2000 and 2021, without restrictions in language or study type. A wide range of sources, including MEDLINE, CINAHL, Global Health, PsychINFO, Cochrane and Google Scholar will be searched. Eligibility screening and data extraction will be done by two independent reviewers, and disagreements resolved by a third reviewer. Data will be summarised in two phases. A narrative synthesis will provide a descriptive profile of all studies included and will explore key concepts related to intervention types, target populations and adaptations to local context. A systematic review element will collate evidence of intervention effectiveness from (cluster) Randomised Controlled Trials. Discussion and dissemination: To the best of our knowledge, these scoping reviews are the first to synthesise a wide range of available evidence on promotive, preventive and treatment interventions for adolescent mental health in sub-Saharan Africa. The results will be published in peer-reviewed publications and will be presented as an evidence base for future intervention development and implementation

Promotive and preventive interventions for adolescent mental health in Sub-Saharan Africa: a combined scoping and systematic review

Introduction: Poor mental health in adolescence is associated with mental, physical and social problems in later life. Adolescence is, therefore, a critical time for promoting mental well-being and preventing mental illness, particularly in sub-Saharan Africa, where adolescents are exposed to a multitude of risk factors for poor mental health. This review aimed to map the current use, effectiveness and cultural sensitivity of promotive/preventive adolescent mental health interventions in the region. Methods: A combined scoping and systematic review was conducted using the Arksey and O’Malley framework through searches in MEDLINE, CINAHL, Global Health, PsycINFO and the Cochrane Database of Systematic Reviews, covering January 2000 to December 2021. Results: This review identified 79 papers, related to 61 unique interventions. Only five universal, school-based programmes were identified; most studies targeted orphans or HIV positive adolescents. Psychosocial interventions—aimed at strengthening knowledge, expression and psychosocial skills—produced mixed results. Structural interventions were often community-based and had limited psychosocial programming. Those that focused on HIV prevention, gender equity and parenting also produced mixed results; evidence was strongest for economic-livelihood programmes. Few studies described cultural sensitivity in detail. Some explained how the intervention aligned with local worldviews/values; had context-specific content; were based on explorations of relevant concepts; or integrated spiritual/cultural practices. Conclusion: Preventive/promotive interventions for adolescent mental health in sub-Saharan Africa are limited in terms of geographical spread, but broad in terms of intervention types. Targeted approaches reflect realities that adolescents in the region face in relation to socioeconomic deprivation, family disruption and poor physical health. Yet, universal interventions that focus on general well-being are limited and lack a consideration of contemporary developments in the region such as increased social media use, suicide and obesity. Economic livelihood interventions showed most consistent evidence of effectiveness. Future studies could do more to consider/report cultural sensitivity

Measuring alcohol use among adolescents in Africa: A systematic scoping review of consumption, screening and assessment tools

Issues: Globally, adolescent drinking is a major public health concern. Alcohol measurements are influenced by local consumption practices, patterns and perceptions of alcohol‐related harm. This is the first review to examine what tools are used to measure alcohol consumption, or screen for or assess harmful use in African adolescents, and how these tools take into account the local context. Approach: A systematic scoping review was conducted in line with the Arksey and O'Malley framework. A search in MEDLINE, CINAHL, Global Health and the Cochrane Database covered the period of 2000–2020. Key Findings: The search identified 121 papers across 25 African countries. A range of single‐ and multi‐item tools were identified. Very few adaptations of existing questions were specified, and this search identified no tools developed by local researchers that were fundamentally different from established tools often designed in the USA or Europe. Inconsistencies were found in the use of cut‐off scores; many studies used adult cut‐off scores. Implications and Conclusion: The possible impact of African drinking practices and culture on the accuracy of alcohol screening tools is currently unknown, but is also not taken into account by most research. This, in combination with a limited geographical distribution of alcohol‐related research across the continent and inconsistent use of age‐ and gender‐specific cut‐off scores, points towards probable inaccuracies in current data on adolescent alcohol use in Africa