Protecting the well-being of parents and children during a pandemic

BackgroundThe UK was severely affected by the COVID-19 pandemic. Over the course of three years, the disease claimed the lives of over 220,000 people in the UK. To try to control the spread of COVID-19, the UK Government implemented a range of compulsory and recommended non-pharmaceutical interventions to reduce disease transmission. Between 23 March and 1 June 2020, the guidance that was in place was commonly referred to as “lockdown” or “stay-at-home” guidance, because of the stringent restrictions. For example: non-essential shops were closed, people who could had to work from home, only leave the home to shop as infrequently as possible, and to not meet anyone from another household. If people were to go outside of their home, they were advised to keep two meters away from people from other households. One particularly controversial intervention was the closure of schools. However, schools were not fully closed. They were kept open for children who had a parent that was critical to the COVID-19 response and for children who were vulnerable. Schools closing placed a particular strain on families, as parents were required to home-school their children and there were common concerns about children’s education and about the well-being of children and parents as a result of the restrictions.Non-pharmaceutical interventions are not only used for pandemic-related interventions. There are also everyday non-pharmaceutical interventions that are used to reduce disease transmission, one of which is a schools’ sickness policy. It is a legal requirement for schools to have a policy that guides parents, children, and school staff about the procedure to follow if a child is too ill to attend school or becomes ill at school. It is important that this guidance is adhered to, as children can be particularly susceptible to many diseases and are often in close contact with many other children. Nonetheless, it is common for children to attend school whilst they are unwell and “presenteeism,” specifically “school-based presenteeism,” has been used to describe this behaviour. Understanding school-based presenteeism is important to prevent the spread of disease and outbreaks within schools. School-based presenteeism is relatively understudied. However, previous research suggests that the reasons and risk factors for presenteeism are related to perceptions about an illness, attitudes about presenteeism, the financial consequences of staying at home when ill and organisational pressures. Exploration of the connection between presenteeism and perceptions about illness may also be important in relation to adherence to COVID-19 guidance. For about two years during the pandemic, the public were required to self-isolate immediately and seek a COVID-19 test via NHS Test and Trace if they identified any of the Government’s listed symptoms of COVID-19.In this thesis, I investigated the factors that affect (a) the well-being of parents and children during a pandemic and (b) adherence to measures intended to mitigate the spread of disease between families, both in school and during school closures. These aims were investigated under broad objectives, relating to the factors associated with; children attending school whilst unwell; adherence to public health guidance in families; the well-being of children and parents and children’s education during a pandemic; and adherence to NHS Test and Trace guidance in families.MethodsA combination of quantitative and qualitative study designs were used to investigate the thesis’ aims. Study A was a systematic review that was conducted on the 11 July 2022, which included 18 studies concerning factors associated with school-based presenteeism. Study B consisted of one-to-one interviews (n = 5) and two focus groups (n = 5 and n = 7) with a total of 17 parents, that took place between 26 February and 24 March 2020 and asked about parents’ attitudes about presenteeism. Study C was a qualitative study using telephone interviews with parents (n = 30) between 16 and 21 April 2020, which explored families’ experiences of lockdown and about their adherence to the COVID-19 guidance. Study D was a cross-sectional survey (n = 2,010) of a sample of parents in England (8 and 11 June 2020), which assessed the factors associated with children’s school attendance, families’ well-being and children’s non-adherent physical interactions while schools were closed to most children. Study E was a qualitative study with parents (n = 18) interviews were conducted between 30 November and 11 December 2020, which asked about families’ experiences of using and attitudes about NHS Test and Trace. Study F was a cross-sectional survey (n = 941) with UK parents that was conducted between 19 November and 18 December 2021. This final study investigated the risk factors associated with children who continued to socialise and engage in activities when they had signs and symptoms of an infectious disease.ResultsI found that in June 2020, 26% of children and 19% of parents included in my study reported low well-being. Several factors affected the well-being of parents and children. Primarily, responses to the COVID-19 guidance, such as the reduced in-person interactions with non-household members, home-schooling, and concerns about loved ones becoming seriously ill adversely affected family well-being. Moreover, I found that children who had educational difficulties, families with limited resources or a psychological or physical health problems before the pandemic were particularly at risk of low well-being. In contrast, I found that family well-being could be protected by physical exercise, social support, and positive motivations.I found that 15% of children had non-household family interactions in June 2020, in contravention of Government guidance and that, when schools had re-opened, 33% of children attended school, engaged in other activities, or socialised with others when they had symptoms of an infectious disease that should have led them to remain at home. Across multiple studies, I found several risk factors linked with families’ adherence to public health guidance in general, which included national COVID-19 guidance and schools’ sickness policies. These factors included perceptions about the illness; communications about the guidance; and contextual factors, such as financial resources, organisation pressures, social networks, low well-being in children and parents and having special educational needs.ConclusionsOverall, I found surprisingly high numbers of families who reported low well-being and who were non-adherent to the guidance that was in place to prevent disease transmission. I found that adherence was associated with themes about the clarity of the guidance, perceptions about COVID-19, a family’s motivation and attitudes about adherence and other environmental factors that may prevent or encourage adherence. These themes are also relevant to adherence to polices that are used to prevent disease outbreaks in schools outside of a pandemic. Notably, children with special educational needs, families that had fewer resources and parents or children with health problems were at an increased risk of (a) having low family well-being and (b) non-adherence to health guidance. Families that engaged in physical activity, stayed connected with family and friends and had positive motivations were better able to cope with the pandemic. Policymakers need to consider these factors when designing and implementing public health guidance to protect families’ well-being and improve adherence to local and national health guidance.<br/

A framework for preferred practices in conducting culturally competent health research in a multicultural society

Background: Improving the health and well-being of the whole population requires that health inequities be addressed. In an era of unprecedented international migration, meeting the health care needs of growing multicultural or multiethnic societies presents major challenges for health care systems and for health researchers. Considerable literature exists on the methodological and ethical difficulties of conducting research in a cross-cultural context; however, there is a need for a framework to guide health research in multicultural societies. Methods: The framework was informed by “research on research” that we have undertaken in community and primary health care settings in Sydney, Australia. Case studies are presented as illustrative examples. Results: We present a framework for preferred practices in conducting health research that is culturally informed, high-quality, safe, and actionable. Conclusions: The framework is not intended to be universal, however many of its aspects will have relevance for health research generally. Application of the framework for preferred practices could potentially make health research more culturally competent, thus enabling enhanced policies, programmes and practices to better meet population health needs. The framework needs to be further tested and refined in different contexts

Promoting mental health and wellbeing in multicultural Australia : a collaborative regional approach

Migrant communities are often under-served by mental health services. Lack of community engagement results in missed opportunities for mental health promotion and early intervention, delayed care, and high rates of untreated psychological distress. Bilingual clinicians and others who work with these communities lack linguistically and culturally appropriate resources. This article reports on the implementation and evaluation of a community-based group mindfulness program delivered to Arabic and Bangla-speaking communities in Sydney, Australia, including modifications made to the content and format in response to the COVID-19 pandemic. The program was positioned within a stepped-care model for primary mental health care and adopted a collaborative regional approach. In addition to improved mental health outcomes for face-to-face and online program participants, we have documented numerous referrals to specialist services and extensive diffusion of mindfulness skills, mostly to family members, within each community. Community partnerships were critical to community engagement. Training workshops to build the skills of the bilingual health and community workforce increased the program’s reach. In immigrant nations such as Australia, mainstream mental health promotion must be complemented by activities that target specific population groups. Scaled up, and with appropriate adaptation, the group mindfulness program offers a low-intensity in-language intervention for under-served communities

"It is definitely a good program for everyone from every community" : a qualitative study of community partner perspectives on the culturally and linguistically diverse (CALD) mindfulness program

Meeting the health needs of migrant and refugee communities is crucial to successful settlement and integration. These communities are often under-served by mental health services. Previous research has demonstrated the effectiveness of a group mindfulness-based intervention tailored for Arabic and Bangla speakers living in Sydney, Australia. This study aimed to explore community partner perspectives on the program’s impact, contributing factors and sustainability, and to elicit suggestions for future development. Data were collected via semi-structured telephone interviews with a purposively selected sample of 16 informants. Thematic analysis was conducted using the Rigorous and Accelerated Data Reduction (RADaR) technique. Community partners welcomed the emphasis on promoting wellbeing and reported that the community-based in-language intervention, in both face-to-face and online formats, overcame many of the barriers to timely mental health care for culturally and linguistically diverse (CALD) communities, with a beneficial impact on group participants, program providers, partner organisations and the broader community. Positive outcomes led to stronger community engagement and demand for more programs. For group mental health programs, both trust and safety are necessary. Relationships must be nurtured, diversity within CALD communities recognised, and projects adequately resourced to ensure partner organisations are not overburdened

Effectiveness of a community-based group mindfulness program tailored for Arabic and Bangla-speaking migrants

Background: Migrant communities are often underserved by mainstream mental health services resulting in high rates of untreated psychological distress. This collaborative study built on evidence that mindfulness-based interventions delivered in-language and culturally tailored were acceptable and clinically effective for Arabic speakers in Australia. It aimed to establish whether a group mindfulness program produced expected outcomes under normal operational conditions, and to test its scalability and its transferability to Bangla speakers. Methods: A 5-week mindfulness program was delivered to 15 Arabic-speaking and 8 Bangla-speaking groups in community settings. The mixed-methods evaluation incorporated a pre-post study. Descriptive statistics were used to summarise the socio-demographic data, group attendance and home practice. Differences in DASS 21 and K10 scores from pre to post-intervention were tested using the nonparametric sign test for paired samples (two-sided). Multiple linear regression analysis was performed to determine the effects of selected sociodemographic variables, group attendance and home practice on clinical outcomes, based on intention to treat. Content analysis was used to examine the qualitative data. Results: The program attracted 168 Arabic speakers and 103 Bangla speakers aged 16 years and over, mostly women. Cultural acceptability was evident in the overall 80% completion rate, with 78% of Arabic speakers and 84% of Bangla speakers retained. Both language groups showed clinically and statistically significant improvements in mental health outcomes on the DASS21 and K10. Thirty new referrals were made to mental health services. Participant feedback emphasised the benefits for their everyday lives. All but one participant reported sharing the mindfulness skills with others. Conclusions: Across multiple and diverse groups of Arabic and Bangla speakers in Sydney, the community-based group mindfulness program was shown to have high levels of cultural acceptability and relevance. It resulted in clinically and statistically significant improvements in mental health outcomes, facilitated access to mental health care and boosted mental health literacy. This innovative, low-intensity, in-language mental health intervention that was originally developed for Arabic speakers is scalable. It is also transferable—with cultural tailoring—to Bangla speakers

A Scoping Review of the Evidence on Health Promotion Interventions for Reducing Waterpipe Smoking: Implications for Practice

Background: Waterpipe tobacco smoking is a traditional method of tobacco use, especially in the Eastern Mediterranean Region (EMR), but its prevalence is growing worldwide, especially among young people. Although often perceived as less harmful than other methods of tobacco use because the smoke passes through water, accumulating evidence shows harmful effects and that some smokers become addicted. Interventions that deglamourise and denormalise use have been recommended but little is known about the range and impact of different health prevention and promotion interventions.Methods: A scoping review of literature was undertaken to explore the breadth of literature and assess the range and impact of community based health promotion interventions for waterpipe smoking. Searches were conducted in Medline, Embase, CINAHL, Psychinfo, and the Cochrane database of systematic reviews. Interventions were classified using a health promotion framework and data extracted on the aspects of prevention/promotion addressed; key strategies employed, evidence of effectiveness or impact on behavior change as well as barriers to implementation and perceived success factors.Results: Ten studies were included in the review. They include brief interventions to increase quit rates; community campaigns to raise awareness and increase knowledge; web based health education and skill development to increase perceived risks and intention to quit; as well as studies that evaluated product labeling and opportunities for policy interventions to create healthy environments.Conclusions: The evidence base is small but growing. Brief interventions for waterpipe users, community campaigns, and web based tailored information can modify perceptions of addiction and increase intentions to quit. Product labeling may be an effective policy tool to curb waterpipe smoking. A range of policy interventions have been identified but not evaluated

Inflammatory chemokine receptors regulate CD8+ T cell contraction and memory generation following infection

CD8+ T cells lacking CXCR3 and CCR5 expression have impaired contraction and generate an increased number of memory cells after virus infection

The role of the kidney in human toxicology, p-glycoprotein-mediated drug interactions and intrarenal drug metabolism

grantor: University of TorontoThe prime role of the kidney in drug elimination makes it a target for drug-induced toxicity. Using a renal tubular cell culture model that allows separation of the apical and basolateral compartments, I studied the renal tubular handling of substrates of the P-glycoprotein drug transporter. This thesis will highlight the importance of renal tubular drug interactions to systemic toxicity. The cardiac glycoside digoxin was used as an example drug because its low therapeutic index necessitates an understanding of its renal elimination in the presence of interacting drugs. The 'in vitro' model allowed me to characterize known digoxin-drug interactions with propafenone and verapamil and to identify potential digoxin-drug interactions with mifepristone and itraconazole. Metabolites of propafenone and verapamil were found to contribute to the interactions with digoxin. Moreover, the renal tubular cells were capable of biotransforming propafenone and verapamil to their major metabolites. The importance of renal drug biotransformation to human toxicity is illustrated with the chemotherapeutic agent ifosfamide. Nephrotoxicity is often a limiting factor in the use of ifosfamide in children. Despite the co-administration of the uroprotective agent mesna (sodium 2-mercaptoethane sulfonate), ifosfamide chemotherapy is associated with nephropathy characterized by glomerular and tubular toxicity consistent with the Fanconi syndrome. This is in distinction to cyclophosphamide, an analogue which differs solely by the position of a chloroethyl group, that is not associated with nephrotoxicity. The major nephrotoxic metabolites of ifosfamide have short half-lives and it is difficult to model renal damage caused by them after production by the liver. I hypothesized that ifosfamide is metabolized by CYP enzymes located in the renal tubular cell to the toxic metabolite chloroacetaldehyde. My results show that porcine and human kidney microsomes are capable of biotransforming ifosfamide to dechloroethylifosfamide metabolites, indicating that local production of chloroacetaldehyde in the renal tubular cell is a possible mechanism for nephrotoxicity.Ph.D