Assessing the impact of the Covid-19 pandemic on student wellbeing at universities in the UK: a conceptual analysis

Transitioning into the university environment can be both exciting and stressful for new and returning students alike. The pressure to perform well academically in an increasingly competitive environment, coupled with a vast array of lifestyle changes, can contribute to suboptimal wellbeing. Over recent years, uptake to wellbeing services within universities in the United Kingdom has grown given the concurrent rise in mental health difficulties reported. Higher education students now have to contend with a drastically altered learning landscape, owing to the discovery of novel coronavirus, Sars-Cov-2, otherwise referred to as COVID-19. In the United Kingdom, universities have moved to close their campuses to both students and non-essential staff in an effort to protect them from contracting the virus. The repercussions of these decisions have been monumental for the delivery of teaching, relationships and, importantly, the provision of student services. Ambiguity remains as to how teaching will be delivered for the forthcoming academic year. The uncertainty caused by the pandemic has yet to be considered in terms of student wellbeing and the new, mostly online, environments that students will be expected to navigate without their typical support networks. For the purpose of this paper, the concept of student wellbeing, a population level term concerned with positive emotions rather than diagnosed mental health conditions, will be considered in relation to the COVID-19 outbreak. The current paper performs a conceptual analysis on student wellbeing in United Kingdom universities with a specific lens on the psychosocial impact of the global COVID-19 outbreak. Given the unprecedented world that students now learn in, considering the impact of the pandemic on psychosocial outcomes delineates the novel challenges that researchers and practitioners must consider when implementing student wellbeing initiatives moving forward

Understanding health across different settings: a nursing journey

Introduction and Background This thesis presents ten published papers linked by the need to come to a better understanding of health across different settings and contexts. Central to the concept of health is the principle that settings play a pivotal role in shaping positive health outcomes for people and populations. The introduction of the concept of a settings approach to better health is usually attributed to the World Health Organisation (WHO), since its first mention in the Ottawa Charter (1986). I have used the concept of a settings approach (WHO 1986) to understanding health in order to draw the papers in this thesis together. Helping Nurses Understand Health to Promote Health in Practice. The idea that nurses are well placed to contribute to positive health in practice settings is well versed within the literature and it is in this context that the first published papers (1-5) and two book chapters are presented. As the publications in this thesis around nursing and its role in promoting health took shape, public health policy drivers from Government and from nursing’s professional body continued to emerge (e.g. DoH 1999, 2000, 2004, 2006, 2010, HEE 2015, NMC 2010, RCN, 2012). The papers in this section of the thesis demonstrate the challenge for nurse educators, in particular responding to an ever-changing NHS and the demands and expectations from those we nurse. Health in University Settings My work within the UK Healthy Universities Network led to external work for Papers 6 and 7. These focus on student health in universities, and the wider needs of students in such settings. It presents universities as settings for health, which can support students (and staff) using a whole systems approach. This section of the thesis provides the reader with glimpses of how health and, what creates health, is intrinsically linked across different settings and, how nurses can use settings such as universities to explore health and what creates health. Health in Work Place Settings Health and wellbeing in the workplace is a concept that is understood as a fundamental business case for a productive, happy, and healthy workforce. The workplace is also a setting by which knowledge and skills about health can be disseminated to assist people, in improving their health and wellbeing. The final paper in this thesis (paper 8), explores the main health and wellbeing needs of a sample of Small and Medium sized Enterprises (SMEs) across Greater Manchester. This work resulted in some unanticipated findings in terms of what creates health for people in SMEs, in particular that of quick fix public health interventions. It provides the reader with, an alternative lens in which to view health and health needs in the workplace. Summary The papers within this thesis and the contribution of the work that enabled their development, is intrinsically linked by the ideology of settings as places where people experience health and, what creates health for them in those settings. Being a nurse is at the heart of this thesis, it is where it begins, and this is where the thesis returns to at the end. Within this thesis, I have explored health in different settings through a research lens. From this, I am able to propose that by taking a settings approach to understanding health through the undergraduate nursing curriculum, alongside the use of non-traditional settings (e.g. universities and workplaces) for student nursing placements, nurses may then truly understand health and what creates health, for those they work with and care for. The papers, and subsequent work that has resulted from them, have enabled me to be at the cutting edge of nurse education. I have represented these within the thesis as a timeline linked to how these changes influenced my work and, my contribution to nurse education, workplace health, and health within universities

DISTRIBUTED BROKERAGE OFFICES THROUGH INFORMATION TECHNOLOGY

This paper describes some novel ways in which Edward D. Jones and Co., a successful brokerage firm with 1650 offices nationwide, uses information technology to pursue a unique market niche: single-broker offices in communities too small to support a traditional, typically much larger, brokerage branch office. The paper focuses on the use of mainframes with "dumb" CRT terminals, rather than workstations or personal computers, to coordinate distributed operational work on a day-to-day basis.Information Systems Working Papers Serie

Whole system approaches to health in higher education

Purpose - This paper reports on an evaluation of the UK Healthy Universities Network, which: explored engagement of Network members; identified what members value about the Network; examined facilitators and barriers to engagement; and informed the Network’s future development. Design/methodology/approach - The study was a two phase mixed-method study, with participants being staff from Higher Education institutions. Phase 1 involved a documentary review and an online 14-question survey (n=32). Phase 2 comprised follow-up semi-structured interviews and focus groups, conducted using Skype (n=11). These were audio recorded and transcripts were thematically analysed in a two-stage process. Findings – A number of key themes emerged from the thematic analysis: value of network meetings and events; popularity of the Network website; increased communication and collaboration; sense of leadership offered by the Network; Interest and inclusion of an international perspective; importance of institutional support. Research limitations/implications – Only six Universities who are involved in the network took part in Phase 2. Although a range of organisations were chosen purposively, it is possible that additional key issues at other universities were excluded. Originality/value – The UK Healthy Universities Network is valued by its membership, particularly its biannual meetings, online presence, leadership, ethos and communication methods. Key barriers include capacity of staff to attend meetings and contribute to the Network, influenced by a lack of institutional commitment and prioritisation. Findings from the evaluation have informed a ‘refresh’ of the Network’s website and a revision of its membership structure, as well as guiding its positioning to achieve greater strategic influence

Whole system approaches to health in higher education: an evaluation of the UK Healthy Universities Network

Purpose - This paper reports on an evaluation of the UK Healthy Universities Network, which: explored engagement of Network members; identified what members value about the Network; examined facilitators and barriers to engagement; and informed the Network’s future development. Design/methodology/approach - The study was a two phase mixed-method study, with participants being staff from Higher Education institutions. Phase 1 involved a documentary review and an online 14-question survey (n=32). Phase 2 comprised follow-up semi-structured interviews and focus groups, conducted using Skype (n=11). These were audio recorded and transcripts were thematically analysed in a two-stage process. Findings – A number of key themes emerged from the thematic analysis: value of network meetings and events; popularity of the Network website; increased communication and collaboration; sense of leadership offered by the Network; Interest and inclusion of an international perspective; importance of institutional support. Research limitations/implications – Only six Universities who are involved in the network took part in Phase 2. Although a range of organisations were chosen purposively, it is possible that additional key issues at other universities were excluded. Originality/value – The UK Healthy Universities Network is valued by its membership, particularly its biannual meetings, online presence, leadership, ethos and communication methods. Key barriers include capacity of staff to attend meetings and contribute to the Network, influenced by a lack of institutional commitment and prioritisation. Findings from the evaluation have informed a ‘refresh’ of the Network’s website and a revision of its membership structure, as well as guiding its positioning to achieve greater strategic influence

Exploring Trends and Differences in Health Behaviours of Health Sciences University Students from Germany and England: Findings from the "SuSy" Project.

OBJECTIVES: This research aimed to explore the health behaviours of health sciences students over time and across different settings. METHODS: A health behaviour surveillance system has been implemented in Hamburg and Manchester among under- and postgraduate health sciences students. Trends among the Hamburg sample were described. In a cross-sectional assessment, health behaviours across both universities were examined using multivariate regression analysis. RESULTS: Between 2014 and 2018, increasing trends in physical activity and cannabis and alcohol consumption were observed in Hamburg (n = 1,366). While fruit and vegetable intake was constantly low, tobacco smoking decreased. No clear trend was observed for stress perception. The comparison (n = 474) revealed that Manchester students had higher odds of smoking, excessive alcohol consumption, and fruit and vegetable consumption; and lower odds of being physically active, and consuming cannabis. No difference in stress perception was observed. CONCLUSIONS: Varying trends and potential areas of intervention were identified for health behaviours in Hamburg. The comparison with Manchester students revealed differences in behaviours, which could be further explored to help inform health promotion strategies in both settings

Qualitative Analysis of Factors Influencing Patient Persistence and Adherence to Prescribed Overactive Bladder Medication in UK Primary Care

Introduction Pharmacotherapy for overactive bladder (OAB) is generally associated with low rates of persistence and adherence. This study was conducted to explore the patient journey in a UK primary care setting (experiences, perceptions, attitudes, and levels of engagement and expectations) and identify self-reported reasons for patient non-adherence and/or non-persistence to medications for OAB. Methods This was a qualitative, non-interventional study involving one-to-one semi-structured, face-to-face or phone interviews with individuals aged 40–80 years, diagnosed with OAB, and currently taking, or having taken, either antimuscarinic or β3-adrenoceptor agonist medications within the last 12 months. Thematic analyses of interview transcripts identified themes surrounding the participants’ experiences with OAB. Results A total of 20 interviews were conducted (face-to-face, n = 13; telephone, n = 7). Interviews from five men and 13 women (mean age 70 years) were included in the final analysis. The most common OAB symptoms reported included urgency, frequency, incontinence and nocturia. Several key themes of factors influencing persistence and/or adherence to prescribed OAB medication were identified: patients’ attitude and condition adaptation behaviour; support with treatment; unmet efficacy/tolerability expectations; drug/condition hierarchy. Non-adherence and/or non-persistence to OAB medication was largely intentional, with patients balancing side effects against perceived clinical benefits. Perceived lack of efficacy was the primary reason for discontinuing treatment. Other factors cited included side effects of medication (either experienced or a fear of future effects), a general aversion to long-term medication taking, drug/condition hierarchy relative to other comorbidities, and limited healthcare professional (HCP) support/engagement. Patients expressed condition adaptation behaviours to help self-manage their condition. Conclusion Persistence and adherence to OAB medication may be suboptimal. HCPs might be able to improve persistence and adherence by fostering realistic treatment expectations and scheduling regular medication reviews. These measures may help optimise patient care and support more adherent behaviours, thus minimising the impact of undertreated OAB on patient quality of life

Healthy Universities: a guiding framework for universities to examine the distinctive health needs of its own student population.

The underlying principle of settings for health is that investments in health are made within social systems in which health is not necessarily the main remit. In order to understand the health needs of its own community, a growing movement of Healthy Universities is interested in applying the approach within the higher education sector. This study examined the student health behaviours of one university so that future initiatives can be tailored to its own student population.Quantitative data were gathered from 3,683 students studying at a UK urban university. A 60-question online student questionnaire focusing on seven key topic areas was used to gather data and simple descriptive statistics are used to present key findings.The study has identified a need for considering alternative ways of engaging students with appropriate health services throughout the academic year. A focus for university initiatives around healthy eating options, how to cook healthy food and the importance of keeping hydrated is highlighted as a common need. Risky behaviour involving alcohol, drug and substance use and sexual activity suggests a strong argument for not separating university sexual health and alcohol interventions.Underpinned by the Healthy Universities settings concept, this study examined the health and wellbeing behaviours of one university's own student population. It highlights behaviours within the university that are similar to national averages, and some that are not. This understanding can inform the planning of future health promoting university initiatives to meet the distinctive needs of its own students

Evolution and transmission of antibiotic resistance is driven by Beijing lineage Mycobacterium tuberculosis in Vietnam

A previous investigation has elucidated the landscape of Mtb genomic diversity and transmission dynamics in Ho Chi Minh City, Vietnam. Here, we expand the scope of this survey by adding a substantial number of additional genomes (total sample size: 2,542) and phenotypic drug susceptibility data for the majority of isolates. We aim to explore the prevalence and evolutionary dynamics of drug resistance and our ability to predict drug resistance from sequencing data. Among isolates tested phenotypically against first-line drugs, we observed high rates of streptomycin [STR, 37.7% ( N = 573/1,520)] and isoniazid resistance [INH, 25.7% ( N = 459/1,786)] and lower rates of resistance to rifampicin [RIF, 4.9% ( N = 87/1,786)] and ethambutol [EMB, 4.2% ( N = 75/1,785)]. Relative to global benchmarks, resistance to STR and INH was predicted accurately when applying the TB-Profiler algorithm to whole genome sequencing data (sensitivities of 0.81 and 0.87, respectively), while resistance to RIF and EMB was predicted relatively poorly (sensitivities of 0.70 and 0.44, respectively). Exploring the evolution of drug resistance revealed the main phylogenetic lineages to display differing dynamics and tendencies to evolve resistance via mutations in certain genes. The Beijing sublineage L2.2.1 was found to acquire de novo resistance mutations more frequently than isolates from other lineages and to suffer no apparent fitness cost acting to impede the transmission of resistance. Mutations conferring resistance to INH and STR arose earlier, on average, than those conferring resistance to RIF and are now more widespread across the phylogeny. The high prevalence of “background” INH resistance, combined with high rates of RIF mono-resistance (20.7%, N = 18/87), suggests that rapid assays for INH resistance will be valuable in this setting. These tests will allow the detection of INH mono-resistance and will allow multi-drug-resistant isolates to be distinguished from isolates with RIF mono-resistance. IMPORTANCE Drug-resistant tuberculosis (TB) infection is a growing and potent concern, and combating it will be necessary to achieve the WHO’s goal of a 95% reduction in TB deaths by 2035. While prior studies have explored the evolution and spread of drug resistance, we still lack a clear understanding of the fitness costs (if any) imposed by resistance-conferring mutations and the role that Mtb genetic lineage plays in determining the likelihood of resistance evolution. This study offers insight into these questions by assessing the dynamics of resistance evolution in a high-burden Southeast Asian setting with a diverse lineage composition. It demonstrates that there are clear lineage-specific differences in the dynamics of resistance acquisition and transmission and shows that different lineages evolve resistance via characteristic mutational pathways

The 2021 WHO catalogue of Mycobacterium tuberculosis complex mutations associated with drug resistance: a genotypic analysis.

Background: Molecular diagnostics are considered the most promising route to achievement of rapid, universal drug susceptibility testing for Mycobacterium tuberculosis complex (MTBC). We aimed to generate a WHO-endorsed catalogue of mutations to serve as a global standard for interpreting molecular information for drug resistance prediction. Methods: In this systematic analysis, we used a candidate gene approach to identify mutations associated with resistance or consistent with susceptibility for 13 WHO-endorsed antituberculosis drugs. We collected existing worldwide MTBC whole-genome sequencing data and phenotypic data from academic groups and consortia, reference laboratories, public health organisations, and published literature. We categorised phenotypes as follows: methods and critical concentrations currently endorsed by WHO (category 1); critical concentrations previously endorsed by WHO for those methods (category 2); methods or critical concentrations not currently endorsed by WHO (category 3). For each mutation, we used a contingency table of binary phenotypes and presence or absence of the mutation to compute positive predictive value, and we used Fisher's exact tests to generate odds ratios and Benjamini-Hochberg corrected p values. Mutations were graded as associated with resistance if present in at least five isolates, if the odds ratio was more than 1 with a statistically significant corrected p value, and if the lower bound of the 95% CI on the positive predictive value for phenotypic resistance was greater than 25%. A series of expert rules were applied for final confidence grading of each mutation. Findings: We analysed 41 137 MTBC isolates with phenotypic and whole-genome sequencing data from 45 countries. 38 215 MTBC isolates passed quality control steps and were included in the final analysis. 15 667 associations were computed for 13 211 unique mutations linked to one or more drugs. 1149 (7·3%) of 15 667 mutations were classified as associated with phenotypic resistance and 107 (0·7%) were deemed consistent with susceptibility. For rifampicin, isoniazid, ethambutol, fluoroquinolones, and streptomycin, the mutations' pooled sensitivity was more than 80%. Specificity was over 95% for all drugs except ethionamide (91·4%), moxifloxacin (91·6%) and ethambutol (93·3%). Only two resistance mutations were identified for bedaquiline, delamanid, clofazimine, and linezolid as prevalence of phenotypic resistance was low for these drugs. Interpretation: We present the first WHO-endorsed catalogue of molecular targets for MTBC drug susceptibility testing, which is intended to provide a global standard for resistance interpretation. The existence of this catalogue should encourage the implementation of molecular diagnostics by national tuberculosis programmes. Funding: Unitaid, Wellcome Trust, UK Medical Research Council, and Bill and Melinda Gates Foundation