Navigating the food environment: lived experiences of managing type 2 diabetes mellitus through dietary change

This thesis portfolio aimed to understand the lived experiences of individuals with T2DM who make changes to their diet and lifestyle, to lose weight as a way to manage their T2DM condition. The first chapter is a systematic review, using a thematic synthesis methodology to explore individual’s experiences of proposed dietary modifications with a weight loss focus. Four themes were identified that helped us to understand the commonalities and differences in people’s experiences of this approach. We learned that providing tailored nutritional information that is comprehensible and culturally appropriate needed to be prioritised. We also identified a number of additional avenues for research exploration, and consideration from a policy perspective, given the variability in guidance offered for individuals. The second chapter built upon what was learned from this review, and specifically focused on one weight loss focused intervention delivered in NHS Lothian, Scotland. An interpretive phenomenological approach was employed, which allowed the researchers to explore patients' experiences on a case-by-case basis, and in depth. The research provides two vantage perspectives by participants of the programme showcasing the experience of those beginning and ending the weight management intervention. The findings allow a greater depth of understanding of the emotional voyage of being diagnosed with T2DM and undertaking this programme to make health behaviour change. There are a number of insights that provide scope for future research avenues and clinical considerations

Essential healthcare services provided to conflict-affected internally displaced populations in low and middle-income countries: A systematic review

Background: Conflict and violent crises have resulted in over 40 million of internally displaced persons (IDPs). Most affected regions lack access to basic health resources and generally rely on humanitarian support. The objective of this review was to appraise primary health service interventions among conflict-induced internally displaced populations in low and middle income countries between 2000 and 2019. Methods: A systematic review of literature in the following databases: Embase, MEDLINE, PsyArticles, PsycINFO, Scopus, Web of Science, LILAC and CAB Articles, was performed to identify interventions implemented in conflict IDP settings.Results: Initial searches yielded 4578 papers and 30 studies met the inclusion criteria. Descriptive synthesis analysis was used, and the final selections were assessed using a customized Critical Appraisal Skills Programme (CASP) checklist. Included papers were from Sub-Saharan Africa, South Asia and the Middle East regions. Most studies were on prevention interventions, especially water treatment and maternal health. Treatment interventions mostly focused on on malaria and mental health. Only one food and nutrition study with outcome data was identified, indicating limitations in IDP health-related intervention publications. Reported interventions were conducted between one week to five years, and the study qualities were moderate. The most effective interventions were integrated programmes and common challenges were weak study methodology and data reporting. Conclusion: Regardless of the intervention types and durations, the services offered were beneficial to the IDPs. More intervention evidence are, however required as shown in gaps around food and nutrition, health education and disease surveillance

Work value as a moderator of the value congruence-employee attitude relationship

Researchers have identified the extent to which an individual values work as a potentially key component in the relationship between on-the-job experiences and employee attitudes. In a replication and extension of Amos and Weathington (2008), this study examined the moderating effects of work value on the relationship between employee-organization value congruence and attitudinal outcomes (i.e., satisfaction, commitment, and turnover intent). It was hypothesized that value congruence would positively correlate to affective and cognitive job satisfaction, organizational satisfaction, and organizational commitment, yet negatively correlate to employee turnover intent. It was also hypothesized that these relationships would be moderated by the employee’s degree of work value. Regression analyses and correlations were used to analyze the data. Results support a relationship between value congruence and employee attitudes. Results also support work value as a moderator of several value congruence-attitude relationships, specifically, affective and cognitive satisfaction, turnover intentions, normative commitment, and continuance commitment

Promotion of breastfeeding by dental teams: A survey of early career dentists

Breastfeeding provides a range of positive health benefits for both mother and baby. Due to maternal exemption of dental charges, dentists have the access and opportunity to provide information to expectant and nursing mothers, and are in an optimal position to positively influence breastfeeding behaviour. A cross-sectional survey of early career dentists in the East Midlands was conducted. The survey questionnaire assessed levels of confidence, knowledge and practice regarding breastfeeding. Barriers identified in supporting and encouraging breastfeeding were lack of knowledge (81%; n=57), lack of confidence (63%; n=44) and lack of time (52%; n=36). Approximately two thirds reported they had never received training and a majority felt they would benefit from this (86%; n=60). Early career dentists in the East Midlands reported limited knowledge and a lack of confidence in the delivery of breastfeeding advice. Wider incorporation of training into undergraduate and postgraduate programmes could be considered, which may improve breastfeeding rates

A content analysis of tobacco content in season 1 of ‘And Just Like That’

Aim: ‘Sex and the City’ regularly featured smoking as a plot device, often linked with sexuality and female empowerment. Eighteen years later, the follow up ‘And Just Like That’ was released. The aim of this paper was to explore the amount of tobacco content in the first series of ‘And Just Like That’. Subject and Methods: A 1-minute content analysis of the 10 episodes from season1 of ‘And Just Like That’. Results: The 10 episodes included 394 one-minute intervals of content, with individual episodes ranging from 35-44 minutes. Tobacco content occurred in 45 intervals (11% of the total) across all 10 episodes. Conclusion: This study demonstrates that, despite the 18-year age gap between the end of the ‘Sex and the City’ TV series and the start of ‘And just like that’, and the declining smoking rates during that time, tobacco content is still regularly featured in these programmes. Whilst viewing figures are not available for this series, we know that this was HBO Max’s most streamed show of all time and was highly popular, it is, therefore, likely that large numbers of people were exposed to tobacco content through this programme

Patients' and healthcare professionals' views on a specialist smoking cessation service delivered in a United Kingdom hospital: a qualitative study

BACKGROUND: Hospital admission provides a powerful opportunity to promote smoking cessation. We explored patients' and healthcare professionals' (HCP) views of a specialist smoking cessation service comprising systematic smoking ascertainment, default provision of pharmacotherapy and behavioural counselling at the bedside, and post-discharge follow-up, in a clinical trial in a United Kingdom teaching hospital. METHODS: Semi-structured interviews with 30 patients who were offered the intervention, and 27 HCPs working on intervention wards, were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: The shock of being admitted, and awareness that smoking may have contributed to the need for hospital admission, caused many patients to reassess their quit intentions. Most patients felt the service was too good an opportunity to pass up, because having long-term support and progress monitored was more likely to result in abstinence than trying alone. Had they not been approached, many patients reported that they would have attempted to quit alone, though some would have been discouraged from doing so by pharmacotherapy costs. Service delivery by a specialist advisor was favoured by patients and HCPs, largely because HCPs lacked time and expertise to intervene. HCPs reported that in usual practice, discussions about smoking were usually limited to ascertainment of smoking status. Timing of service delivery and improved co-ordination between service staff and inpatient ward staff were matters to address. CONCLUSIONS: A hospital-based specialist smoking cessation service designed to identify smokers and initiate cessation support at the bedside was deemed appropriate by patients and HCPs. TRIAL REGISTRATION: Trial registration: ISRCTN25441641

The Men’s Safer Sex Trial: a feasibility randomised controlled trial of an interactive digital intervention to increase condom use in men

OBJECTIVE: We aimed to determine the feasibility of an online randomised controlled trial (RCT) of the Men’s Safer Sex website, measuring condom use and sexually transmitted infection (STI). METHODS: For this study 159 men aged ≥16 with female sexual partners and recent condomless sex or suspected STI were recruited from three UK sexual health clinics. Participants were randomised to the intervention website plus usual clinic care (n = 84), or usual clinic care only (n = 75). Online outcome data were solicited at 3, 6, and 12 months. RESULTS: Men were enrolled via tablet computers in clinic waiting rooms. Software errors and clinic Wi-Fi access presented significant challenges, and online questionnaire response rates were poor (36% at 3 months with a £10 voucher; 50% at 12 months with £30). Clinical records (for STI diagnoses) were located for 94% of participants. Some 37% of the intervention group did not see the intervention website (n = 31/84), and (as expected) there was no detectable difference in condomless sex with female partners (IRR = 1.01, 95% CI 0.52 to 1.96). New acute STI diagnoses were recorded for 8.8% (7/80) of the intervention group, and 13.0% (9/69) of the control group over 12 months (IRR = 0.75, 95% CI 0.29 to 1.90). CONCLUSIONS: It is likely to be feasible to conduct a future large-scale RCT to assess the impact of an online intervention using clinic STI diagnoses as a primary outcome. However, practical and technical challenges need to be addressed before the potential of digital media interventions can be realised in sexual health settings

Recurrent Hemarthrosis Secondary to Erosive Patellofemoral Arthritis Treated with Arthroplasty: A Report of 3 Cases

Background: Spontaneous hemarthrosis of the knee joint in the elderly population is a rare phenomenon and is mostly seen in those with osteoarthritis. The identified causes of spontaneous hemarthrosis in this demographic include subchondral bone bleeding, meniscal tear, genicular artery bleeding, and the use of anticoagulants. Hemarthrosis caused by isolated patellofemoral bleeding, as in this case series, has been rarely documented and poorly described. Case: Three patients presented with recurrent hemarthrosis secondary to erosive patellofemoral arthritis. Recurrent hemarthrosis from the eroded patellofemoral subchondral bone has not been well described. Each patient presented with symptoms secondary to painful effusions that were identified by aspiration. Each patient was successfully treated with patellofemoral or total knee arthroplasty Conclusion: Spontaneous or recurrent effusions in the setting of erosivepatellofemoral arthritis should prompt orthopaedic surgeons to consider hemarthrosis as the cause of such effusions. Patellofemoral or total knee arthroplasty is effective in resolving the hemarthroses, resolving pain, and restoring function in these patients

A survey of tobacco dependence treatment services in 121 countries

Aims To report progress among Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in developing tobacco dependence treatment systems in accordance with FCTC Article 14 and the Article 14 guidelines recommendations. Design: Cross-sectional study. Setting: Electronic survey from December 2011 to August 2012. Participants: One hundred and sixty-three of the 174 Parties to the FCTC at the time of our survey. Measurements The 51-item questionnaire contained 21 items specifically on treatment systems. Questions covered the availability of basic treatment infrastructure and national cessation support systems. Findings: We received responses from 121 (73%) of the 166 countries surveyed. Fewer than half of the countries had national treatment guidelines (n = 53, 44%), a government official responsible for tobacco dependence treatment (n = 49, 41%), an official national treatment strategy (n = 53, 44%) or provided tobacco cessation support for health workers (n = 55, 46%). More than half encouraged brief advice in existing health care services (n = 68, 56%), while only 44 (36%) had quitlines and only 20 (17%) had a network of treatment support covering the whole country. Low- and middle-income countries had less tobacco dependence treatment provision than high-income countries. Conclusion: Most countries, especially low- and middle-income countries, have not yet implemented the recommendations of FCTC Article 14 or the FCTC Article 14 guidelines