An interview study of pregnant women who were provided with indoor air quality measurements of second hand smoke to help them quit smoking

Background:  Maternal smoking can cause health complications in pregnancy. Particulate matter (PM2.5) metrics applied to second hand smoke (SHS) concentrations provide indoor air quality (IAQ) measurements and have been used to promote smoking behaviour change among parents of young children. Here, we present the qualitative results from a study designed to use IAQ measurements to help pregnant women who smoke to quit smoking.  Methods:  We used IAQ measurements in two centres (Aberdeen and Coventry) using two interventions: 1. In Aberdeen, women made IAQ measurements in their homes following routine ultrasound scan; 2. In Coventry, IAQ measurements were added to a home-based Stop Smoking in Pregnancy Service. All women were invited to give a qualitative interview to explore acceptability and feasibility of IAQ measurements to help with smoking cessation. A case study approach using grounded theory was applied to develop a typology of pregnant women who smoke.  Results:  There were 39 women recruited (18 in Aberdeen and 21 in Coventry) and qualitative interviews were undertaken with nine of those women. Diverse accounts of smoking behaviours and experiences of participation were given. Many women reported changes to their smoking behaviours during pregnancy. Most women wanted to make further changes to their own behaviour, but could not commit or felt constrained by living with a partner or family members who smoked. Others could not envisage quitting. Using themes emerging from the interviews, we constructed a typology where women were classified as follows: 'champions for change'; 'keen, but not committed'; and 'can't quit, won't quit'. Three women reported quitting smoking alongside participation in our study.  Conclusions:  Pregnant women who smoke remain hard to engage,. Although providing IAQ measurements does not obviously improve quit rates, it can support changes in smoking behaviour in/around the home for some individuals. Our typology might offer a useful assessment tool for midwives

Piloting co-developed behaviour change interventions to reduce exposure to air pollution and improve self-reported asthma-related health

Background Exposure to air pollution can exacerbate asthma with immediate and long-term health consequences. Behaviour changes can reduce exposure to air pollution, yet its ‘invisible’ nature often leaves individuals unaware of their exposure, complicating the identification of appropriate behaviour modifications. Moreover, making health behaviour changes can be challenging, necessitating additional support from healthcare professionals. Objective This pilot study used personal exposure monitoring, data feedback, and co-developed behaviour change interventions with individuals with asthma, with the goal of reducing personal exposure to PM2.5 and subsequently improving asthma-related health. Methods Twenty-eight participants conducted baseline exposure monitoring for one-week, simultaneously keeping asthma symptom and medication diaries (previously published in McCarron et al., 2023). Participants were then randomised into control (n = 8) or intervention (n = 9) groups. Intervention participants received PM2.5 exposure feedback and worked with researchers to co-develop behaviour change interventions based on a health behaviour change programme which they implemented during the follow-up monitoring week. Control group participants received no feedback or intervention during the study. Results All interventions focused on the home environment. Intervention group participants reduced their at-home exposure by an average of 5.7 µg/m³ over the monitoring week (−23.0 to +3.2 µg/m³), whereas the control group had a reduction of 4.7 µg/m³ (−15.6 to +0.4 µg/m³). Furthermore, intervention group participants experienced a 4.6% decrease in participant-hours with reported asthma symptoms, while the control group saw a 0.5% increase. Similarly, the intervention group’s asthma-related quality of life improved compared to the control group. Impact statement This pilot study investigated a novel behaviour change intervention, utilising personal exposure monitoring, data feedback, and co-developed interventions guided by a health behaviour change programme. The study aimed to reduce personal exposure to fine particulate matter (PM2.5) and improve self-reported asthma-related health. Conducting a randomised controlled trial with 28 participants, co-developed intervention successfully targeted exposure peaks within participants’ home microenvironments, resulting in a reduction in at-home personal exposure to PM2.5 and improving self-reported asthma-related health. The study contributes valuable insights into the environmental exposure-health relationship and highlights the potential of the intervention for individual-level decision-making to protect human health

“I have to stay inside …”: experiences of air pollution for people with asthma

Asthma, characterized by airway inflammation, sensitization and constriction, and leading to symptoms including cough and dyspnoea, affects millions of people globally. Air pollution is a known asthma trigger, yet how it is experienced is understudied and how individuals with asthma interact with air quality information and manage exacerbation risks is unclear. This study aimed to explore how people living with asthma in Scotland, UK, experienced and managed their asthma in relation to air pollution. We explored these issues with 36 participants using semi-structured interviews. We found that self-protection measures were influenced by place and sense of control (with the home being a “safe space”), and that the perception of clean(er) air had a liberating effect on outdoor activities. We discuss how these insights could shape air quality-related health advice in future

Personal exposure to fine particulate matter (PM2.5) and self-reported asthma-related health

•PM2.5 (fine particulate matter ≤2.5 μm in diameter) is a key pollutant that can produce acute asthma exacerbations and longer-term deterioration of respiratory health. Individual exposure to PM2.5 is unique and varies across microenvironments. Low-cost sensors (LCS) can collect data at a spatiotemporal resolution previously unattainable, allowing the study of exposures across microenvironments. The aim of this study is to investigate the acute effects of personal exposure to PM2.5 on self-reported asthma-related health. •Twenty-eight non-smoking adults with asthma living in Scotland collected PM2.5 personal exposure data using LCS. Measurements were made at a 2-min time resolution for a period of 7 days as participants conducted their typical daily routines. Concurrently, participants were asked to keep a detailed time-activity diary, logging their activities and microenvironments, along with hourly information on their respiratory health and medication use. Health outcomes were modelled as a function of hourly PM2.5 concentration (plus 1- and 2-h lag) using generalized mixed-effects models adjusted for temperature and relative humidity. •Personal exposures to PM2.5 varied across microenvironments, with the largest average microenvironmental exposure observed in private residences (11.5 ± 48.6 μg/m3) and lowest in the work microenvironment (2.9 ± 11.3 μg/m3). The most frequently reported asthma symptoms, wheezing, chest tightness and cough, were reported on 3.4%, 1.6% and 1.6% of participant-hours, respectively. The odds of reporting asthma symptoms increased per interquartile range (IQR) in PM2.5 exposure (odds ratio (OR) 1.29, 95% CI 1.07–1.54) for same-hour exposure. Despite this, no association was observed between reliever inhaler use (non-routine, non-exercise related) and PM2.5 exposure (OR 1.02, 95% CI 0.71–1.48). •Current air quality monitoring practices are inadequate to detect acute asthma symptom prevalence resulting from PM2.5 exposure; to detect these requires high-resolution air quality data and health information collected in situ. Personal exposure monitoring could have significant implications for asthma self-management and clinical practice

Solid fuel users' perceptions of household solid fuel use in low- and middle-income countries: a scoping review

Almost half of the global population is exposed to household air pollution (HAP) from the burning of biomass fuels primarily for cooking, and this has been linked with considerable mortality and morbidity. While alternative cooking technologies exist, sustained adoption of these is piecemeal, indicating that there is insufficient knowledge of understandings of HAP within target communities. To identify potential gaps in the literature, a scoping review was conducted focused on solid fuel users' perceptions of HAP and solid fuel use in low- and middle-income countries. From the initial 14,877 search returns, 56 were included for final analysis. An international multi-disciplinary workshop was convened to develop the research question; six key domains: health; family and community life; home, space, place and roles; cooking and cultural practices, environment; and policy and practice development, were also identified using a Social Ecological Model framework. The review showed a series of disconnects across the domains which highlighted the limited research on perceptions of HAP in the literature. Reviewed studies showed that participants emphasized short-term health impacts of HAP as opposed to longer-term health benefits of interventions and prioritized household security over improved ventilation. There was also a socio-demographic gendered disconnect as although women and children generally have most exposure to HAP, their decision-making power about use of solid fuels is often limited. In the domain of policy and practice, the review identified the importance of community norms and cultural traditions (including taste). Research in this domain, and within the environment domain is however limited and merits further attention. We suggest that interventions need to be locally situated and community-led and a deeper understanding of perceptions of HAP could be obtained using participatory and innovative research methods. Bridging the disconnects and gaps identified in this review is essential if the global disease burden associated with HAP is to be reduced

White matter connectivity, cognition, symptoms and genetic risk factors in Schizophrenia

Schizophrenia is a highly heritable complex neuropsychiatric disorder with a lifetime prevalence of around 1%. It is often characterised by impaired white matter structural dysconnectivity. In vivo and post-mortem alterations in white matter microstructure have been reported, along with differences in the topology of the structural connectome; overall these suggest a reduced communication between distal brain regions. Schizophrenia is characterised by persistent cognitive impairments that predate the occurrence of symptoms and have been shown to have a neural foundation reflecting aberrant brain connectivity. So far, 179 independent genome-wide significant single nucleotide polymorphisms (SNPs) have been associated with a diagnosis of schizophrenia. The high heritability and polygenicity of schizophrenia, white matter parameters and cognitive functions provides a great opportunity to investigate the potential relationships between them due to the genetic overlap shared among these factors. This work investigates the psychopathology of schizophrenia from a neurobiological, psychological and genetic perspective. The datasets used here include data from the Scottish Family Mental Health (SFMH) study, the Lothian Birth Cohort 1936 (LBC1936) and UK Biobank. The main goal of this thesis was to study white matter microstructure in schizophrenia using diffusion MRI (dMRI) data. Our first aim was to examine whether processing speed mediated the association between white matter structure and general intelligence in patients diagnosed with schizophrenia in the SFMH study. Secondly, we investigated specific networks from the structural connectome and their topological properties in both healthy controls and patients diagnosed with schizophrenia in the SFMH study. These networks were studied alongside cognition, clinical symptoms and polygenic risk factor for schizophrenia (szPGRS). The third aim of this thesis was to study the effects of szPGRS on the longitudinal trajectories of white matter connectivity (measured using tractography and graph theory metrics) in the LBC1936 over a period of three-years. Finally, we derived the salience network which has been previously associated with schizophrenia and examined the effect of szPGRS on the grey matter nodes associated with this network and their connecting white matter tracts in UK Biobank. With regards to the first aim, we found that processing speed significantly mediates the association between a general factor of white matter structure and general intelligence in schizophrenia. These results suggest that, as in healthy controls, processing speed acts as a key cognitive resource facilitating higher order cognition by allowing multiple cognitive processes to be simultaneously available. Secondly, we found that several graph theory metrics were significantly impaired in patients diagnosed with schizophrenia compared with healthy controls. Moreover, these metrics were significantly associated with intelligence. There was a strong tendency towards significance for a correlation between intelligence and szPGRS that was significantly mediated by graph theory metrics in both healthy controls and schizophrenia patients of the SFMH study. These results are consistent with the hypothesis that intelligence deficits are associated with a genetic risk for schizophrenia, which is mediated via the disruption of distributed brain networks. In the LBC1936 we found that higher szPGRS showed significant associations with longitudinal increases in MD in several white matter tracts. Significant declines over time were observed in graph theory metrics. Overall these findings suggest that szPGRS confer risk for ageing-related degradation of some aspects of structural connectivity. Moreover, we found significant associations between higher szPGRS and decreases in cortical thickness, in particular, in a latent factor for cortical thickness of the salience network. Taken together, our findings suggest that white matter connectivity plays a significant role in the disorder and its psychopathology. The computation of the structural connectome has improved our understanding of the topological characteristics of the brain’s networks in schizophrenia and how it relates to the microstructural level. In particular, the data suggests that white matter structure provides a neuroanatomical substrate for cognition and that structural connectivity mediates the relationship between szPGRS and intelligence. Additionally, these results suggest that szPGRS may have a role in age-related changes in brain structural connectivity, even among individuals who are not diagnosed with schizophrenia. Further work will be required to validate these results and will hopefully examine additional risk factors and biomarkers, with the ultimate aims of improving scientific knowledge about schizophrenia and conceivably of improving clinical practice

Research is ‘a step into the unknown’: an exploration of pharmacists’ perceptions of factors impacting on research participation in the NHS

Objective This study explored National Health Service (NHS) pharmacists’ perceptions and experiences of pharmacist-led research in the workplace.  Design Semistructured, face-to-face discussions continued until distinct clusters of opinion characteristics formed. Verbatim transcripts of audio-recordings were subjected to framework analysis.  Setting Interviews were carried out with 54 pharmacists with diverse backgrounds and roles from general practices and secondary care in the UK's largest health authority.  Results The purpose and potential of health services research (HSR) was understood and acknowledged to be worthwhile by participants, but a combination of individual and system-related themes tended to make participation difficult, except when this was part of formal postgraduate education leading to a qualification. Lack of prioritisation was routinely cited as the greatest barrier, with motivation, confidence and competence as additional impediments. System-related themes included lack of practical support and pharmacy professional issues. A minority of highly motivated individuals managed to embed research participation into routine activity.  Conclusions Most pharmacists realised the desirability and necessity of research to underpin pharmacy service expansion, but a combination of individual and professional level changes is needed to increase activity. Our findings provide a starting point for better understanding the mindset of hospital-based and general practice-based pharmacists towards research, as well as their perceived barriers and supports

Cardiac Energetics Before, During, and After Anthracycline-Based Chemotherapy in Breast Cancer Patients Using 31 P Magnetic Resonance Spectroscopy: A Pilot Study

Purpose: To explore the utility of phosphorus magnetic resonance spectroscopy (31P MRS) in identifying anthracycline-induced cardiac toxicity in patients with breast cancer. Methods: Twenty patients with newly diagnosed breast cancer receiving anthracycline-based chemotherapy had cardiac magnetic resonance assessment of left ventricular ejection fraction (LVEF) and 31P MRS to determine myocardial Phosphocreatine/Adenosine Triphosphate Ratio (PCr/ATP) at three time points: pre-, mid-, and end-chemotherapy. Plasma high sensitivity cardiac troponin-I (cTn-I) tests and electrocardiograms were also performed at these same time points. Results: Phosphocreatine/Adenosine Triphosphate did not change significantly between pre- and mid-chemo (2.16 ± 0.46 vs. 2.00 ± 0.56, p = 0.80) and pre- and end-chemo (2.16 ± 0.46 vs. 2.17 ± 0.86, p = 0.99). Mean LVEF reduced significantly by 5.1% between pre- and end-chemo (61.4 ± 4.4 vs. 56.3 ± 8.1 %, p = 0.02). Change in PCr/ATP ratios from pre- to end-chemo correlated inversely with changes in LVEF over the same period (r = −0.65, p = 0.006). Plasma cTn-I increased progressively during chemotherapy from pre- to mid-chemo (1.35 ± 0.81 to 4.40 ± 2.64 ng/L; p = 0.01) and from mid- to end-chemo (4.40 ± 2.64 to 18.33 ± 13.23 ng/L; p = 0.001). Conclusions: In this small cohort pilot study, we did not observe a clear change in mean PCr/ATP values during chemotherapy despite evidence of increased plasma cardiac biomarkers and reduced LVEF. Future similar studies should be adequately powered to take account of patient drop-out and variable changes in PCr/ATP and could include T1 and T2 mapping

The role of pandemic planning in the management of COVID-19 in England from an infection prevention and control (IPC) perspective: results of a national survey

Objectives A national survey which aimed to explore how existing pandemic preparedness plans (PPP) accounted for the demands placed on infection prevention and control (IPC) services in acute and community settings in England during the first wave of the COVID-19 pandemic. Study design A cross-sectional survey of IPC leaders working within NHS Trusts or clinical commissioning groups/integrated care systems in England. Methods Survey questions related to organisational COVID-19 preparedness pre-pandemic and the response provided during the first wave of the pandemic (January to July 2020). The survey ran from September to November 2021 and participation was voluntary. Results In total, 50 organisations responded. 71% (n=34/48) reported having a current PPP in December 2019, with 81% (n=21/26) indicating their plan was updated within the previous three years. Around half of IPC teams were involved in previous testing of these plans via internal and multi-agency tabletop exercises. Successful aspects of pandemic planning were identified as command structures, clear channels of communication, COVID-19 testing, and patient pathways. Key deficiencies were lack of PPE, difficulties with fit testing, keeping up to date with guidance, and insufficient staffing. Conclusions Pandemic plans need to consider the capability and capacity of IPC services to ensure they can contribute their critical knowledge and expertise to the pandemic response. This survey provides a detailed evaluation of how IPC services were impacted during the first wave of the pandemic and identifies key areas which need to be included in future PPP to better manage the impact on IPC services

Partial Deletion of Chromosome 8 β-defensin Cluster Confers Sperm Dysfunction and Infertility in Male Mice

β-defensin peptides are a family of antimicrobial peptides present at mucosal surfaces, with the main site of expression under normal conditions in the male reproductive tract. Although they kill microbes in vitro and interact with immune cells, the precise role of these genes in vivo remains uncertain. We show here that homozygous deletion of a cluster of nine β-defensin genes (DefbΔ9) in the mouse results in male sterility. The sperm derived from the mutants have reduced motility and increased fragility. Epididymal sperm isolated from the cauda should require capacitation to induce the acrosome reaction but sperm from the mutants demonstrate precocious capacitation and increased spontaneous acrosome reaction compared to wild-types but have reduced ability to bind the zona pellucida of oocytes. Ultrastructural examination reveals a defect in microtubule structure of the axoneme with increased disintegration in mutant derived sperm present in the epididymis cauda region, but not in caput region or testes. Consistent with premature acrosome reaction, sperm from mutant animals have significantly increased intracellular calcium content. Thus we demonstrate in vivo that β-defensins are essential for successful sperm maturation, and their disruption leads to alteration in intracellular calcium, inappropriate spontaneous acrosome reaction and profound male infertility