• Associations of polyunsaturated fatty acids with residual depression or anxiety in older people with major depression

      Jadoon, Ayesha; Chiu, Chih-Chiang; McDermott, Lindsay C.; Cunningham, Phil; Frangou, Sophia; Chang, Ching-Jui; Sun, I-Wen; Liu, Shen-Ing; Lu, Mong-Liang; Su, Kuan-Pin; et al. (Elsevier, 2012-02-28)
      BACKGROUNDS: Depression in late life often follows a chronic course with residual depressive and anxiety symptoms. Levels of omega-3 polyunsaturated fatty acids (PUFAs) have been found to be depleted in people with major depression in the acute stage. Additionally, lower omega-3 PUFA levels have been suggested to be associated with anxiety. The aim of this study was to investigate whether PUFAs levels (omega-3 or omega-6) are correlated with residual depressive or anxiety symptoms in older people with previous depression. METHODS: Participants aged 60 years or over with previous major depression in remission were enrolled from outpatient psychiatric services of four hospitals. Participants with residual depressive symptoms were defined as the Hamilton Depression Rating Scale (HDRS) scores>5, and those with anxiety were defined as sum of scores for the two anxiety subscale of HDRS≧2. The levels of fatty acids in erythrocyte membranes and in plasma were measured separately by gas chromatography. RESULTS: One hundred and thirty two older people with previous major depression (mean age of 68 years, range 60-86 years) were analyzed. Erythrocyte membrane linoleic acid levels had a curvilinear association with depressive symptoms and anxiety symptoms. Plasma linoleic acid levels were found to have a negative linear relationship with depressive symptoms. No significant associations were found between any omega-3 fatty acid level and depressive or anxiety symptoms. CONCLUSION: Linoleic acid levels may be a possible biomarker for residual depression and anxiety in older people with previous depression. Possible clinical applications need further investigation.
    • Bereaved donor families' experiences of organ and tissue donation, and perceived influences on their decision making

      Sque, Magi; Walker, Wendy; Long-Sutehall, Tracy; Morgan, Myfanwy; Randhawa, Gurch; Rodney, Amanda; University of Wolverhampton; University of Southampton; King's College London; University of Bedfordshire (Elsevier, 2018-01-16)
      To elicit bereaved families' experiences of organ and tissue donation. A specific objective was to determine families' perceptions of how their experiences influenced donation decision-making. Retrospective, qualitative interviews were undertaken with 43 participants of 31 donor families to generate rich, informative data. Participant recruitment was via 10 National Health Service Trusts, representative of five regional organ donation services in the UK. Twelve families agreed to DBD, 18 agreed to DCD, 1 unknown. Participants' responses were contextualised using a temporal framework of 'The Past', which represented families' prior knowledge, experience, attitudes, beliefs, and intentions toward organ donation; 'The Present', which incorporated the moment in time when families experienced the potential for donation; and 'The Future', which corresponded to expectations and outcomes arising from the donation decision. Temporally interwoven experiences appeared to influence families' decisions to donate the organs of their deceased relative for transplantation. The influence of temporality on donation-decision making is worthy of consideration in the planning of future education, policy, practice, and research for improved rates of family consent to donation. PURPOSE METHODS RESULTS CONCLUSIONS
    • Characterisation of hepcidin response to holotransferrin treatment in CHO TRVb-1 cells

      Mehta, Kosha; Greenwell, Pamela; Renshaw, Derek; Busbridge, Mark; Garcia, Mitla; Farnaud, Sébastien; Patel, Vinood B.; University of Westminster; Coventry University; Imperial College Healthcare NHS Trust; et al. (Elsevier, 2015-08-28)
      Iron overload coupled with low hepcidin levels are characteristics of hereditary haemochromatosis. To understand the role of transferrin receptor (TFR) and intracellular iron in hepcidin secretion, Chinese hamster ovary transferrin receptor variant (CHO TRVb-1) cells were used that express iron-response-element-depleted human TFRC mRNA (TFRC∆IRE). Results showed that CHO TRVb-1 cells expressed higher basal levels of cell-surface TFR1 than HepG2 cells (2.2-fold; p < 0.01) and following 5 g/L holotransferrin treatment maintained constitutive over-expression at 24h and 48 h, contrasting the HepG2 cells where the receptor levels significantly declined. Despite this, the intracellular iron content was neither higher than HepG2 cells nor increased over time under basal or holotransferrin-treated conditions. Interestingly, hepcidin secretion in CHO TRVb-1 cells exceeded basal levels at all time-points (p < 0.02) and matched levels in HepG2 cells following treatment. While TFRC mRNA expression showed expected elevation (2h, p < 0.03; 4h; p < 0.05), slc40a1 mRNA expression was also elevated (2 h, p < 0.05; 4 h, p < 0.03), unlike the HepG2 cells. In conclusion, the CHO TRVb-1 cells prevented cellular iron-overload by elevating slc40a1 expression, thereby highlighting its significance in the absence of iron-regulated TFRC mRNA. Furthermore, hepcidin response to holotransferrin treatment was similar to HepG2 cells and resembled the human physiological response.
    • Community pharmacists' views on providing a reproductive health service to women receiving opioid substitution treatment: a qualitative study using the TDF and COM-B

      Alhusein, Nour; Scott, Jenny; Neale, Jo; Chater, Angel M.; Family, Hannah; University of Bristol; University of Bath; King's College London; University of New South Wales; University of Bedfordshire (Elsevier, 2021-09-21)
      Background The absence of menstruation is common in women who use drugs. This can give a belief that conception is unlikely. When stabilised on Opioid Substitution Treatment (OST), fertility often returns, initially without realisation as ovulation precedes menstruation. This leaves women vulnerable to unplanned pregnancies. Community pharmacists (CPs) are frequently in contact with this patient group through the Supervised Consumption of OST service. This provides a timely opportunity to provide reproductive health (RH) advice. The aim of this study was to investigate pharmacists' views on providing a RH service to women receiving OST. Methods Twenty semi-structured interviews based on the Capability-Opportunity-Motivation to Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) were conducted between 2016 and 2017. Data analysis involved deductive coding using the TDF domains. The TDF domains were mapped onto the elements of the COM-B and used in the second step to create the framework and chart the data. The third step involved re-reading and clustering the codes, and inductive themes were generated to explain the data in depth. Results Nine of the 14 TDF domains, mapped into five elements of the COM-B, were identified. Five inductive themes were generated: 1) The pharmacists' experience and knowledge of reproductive health (RH) needs of women receiving OST, 2) The pharmacists' approach to providing advice, 3) The pharmacists' perception of the relationship with women receiving OST, 4) Social influences, and 5) Environmental factors. Community pharmacists feared causing offense to women receiving OST and described requiring cues as to when the service was needed. Pharmacists' highlighted a power imbalance in the relationship with women receiving OST. This could influence how receptive this patient group would be to pharmacy RH interventions. Conclusions CPs' concerns of providing RH service could hinder a proactive service provision. Supporting good rapport and providing a structured consultation would increase the accessibility of such a service.
    • Culture and health

      Napier, A David; Ancarno, Clyde; Butler, Beverley; Calabrese, Joseph; Chater, Angel M.; Chaterjee, Helen; Guesnet, Francois; Horne, Robert; Jacyna, Stephen; Jadhav, Sushrut; et al. (Elsevier: Lancet, 2014-10-28)
    • The impact of COVID-19 on health behaviour, well-being, and long-term physical health.

      McBride, Emily; Arden, Madelynne A.; Chater, Angel M.; Chilcot, Joseph; ; University College London; Sheffield Hallam University; University of Bedfordshire; King's College London (Wiley, 2021-03-31)
      Editorial
    • Parents' expectations and experiences of the 6-week baby check: a qualitative study in primary care

      Gilworth, Gill; Milton, Sarah; Chater, Angel M.; Nazareth, Irwin; Roposch, Andreas; Green, Judith; King's College London; University of Bedfordshire; University College London (Royal College of General Practitioners, 2020-11-18)
      Background: The Newborn and Infant Physical Examination (NIPE) programme requires all babies to have a comprehensive health check at 6-8 weeks of age. These are typically completed by GPs. Although person-centred care has achieved prominence in maternity care policy in recent years, there is limited empirical evidence on what parents and/or carers expect from the check, and how far experiences meet their needs. Aim: To explore the expectations and experiences of parents attending their GP for a baby check. Design &amp; setting: A qualitative study was undertaken in primary care in London. Method: Content analysis was undertaken of transcripts of semi-structured interviews. Interviews were conducted with a total of 16 participants (14 mothers and two fathers) who had recently attended for a 6-week check for their baby. Results: Despite the availability of plentiful sources of general advice on infants' health and development, a thorough check by a trusted GP was an important milestone for most parents. They had few specific expectations of the check in terms of what examinations were undertaken, but even experienced parents anticipated reassurance about their baby's normal development. Many also hoped for reassurance about their own parenting. Parents appreciated GPs who explained what they were doing during the examination; space to raise any concerns; and combined mother and baby checks. Referrals to secondary care were generally experienced as reassuring rather than a source of anxiety. Conclusion: The baby check meets needs beyond those of the NIPE screening programme. Protecting the time for a thorough consultation is important for parents at what can be a vulnerable time.
    • Parents’ expectations and experiences of the 6-week baby check: a qualitative study in primary care

      Gilworth, Gill; Milton, Sarah; Chater, Angel M.; Nazareth, Irwin; Roposch, Andreas; Green, Judith; King's College London; University of Bedfordshire; University College London (Royal College of General Practitioners, 2020-11-18)
      Background The Newborn and Infant Physical Examination (NIPE) programme requires all babies to have a comprehensive health check at 6–8 weeks of age. These are typically completed by GPs. Although person-centred care has achieved prominence in maternity care policy in recent years, there is limited empirical evidence on what parents and/or carers expect from the check, and how far experiences meet their needs. Aim  To explore the expectations and experiences of parents attending their GP for a baby check. Design &amp; setting A qualitative study was undertaken in primary care in London. Method Content analysis was undertaken of transcripts of semi-structured interviews. Interviews were conducted with a total of 16 participants (14 mothers and two fathers) who had recently attended for a 6-week check for their baby. Results Despite the availability of plentiful sources of general advice on infants’ health and development, a thorough check by a trusted GP was an important milestone for most parents. They had few specific expectations of the check in terms of what examinations were undertaken, but even experienced parents anticipated reassurance about their baby’s normal development. Many also hoped for reassurance about their own parenting. Parents appreciated GPs who explained what they were doing during the examination; space to raise any concerns; and combined mother and baby checks. Referrals to secondary care were generally experienced as reassuring rather than a source of anxiety. Conclusion The baby check meets needs beyond those of the NIPE screening programme. Protecting the time for a thorough consultation is important for parents at what can be a vulnerable time.
    • Perceptions of professional drug treatment staff in England about client barriers to Narcotics Anonymous attendance

      Day, Ed; Wall, Rosemary; Chohan, Gagandeep; Seddon, Jennifer L.; King's College London; University of Birmingham (Taylor & Francis, 2015-11-04)
      A growing body of research evidence shows that Twelve Step Group (TSG) attendance confers a consistent moderate beneficial effect on substance use. Clinicians potentially represent a major referral pathway to TSG. This qualitative study aimed to explore staff perceptions of the barriers to Narcotics Anonymous (NA) group attendance in a population receiving drug treatment, and potential strategies to increase attendance. A cross-sectional survey of substance misuse treatment professionals was conducted between January and April 2012 in Birmingham, England. Fifty-eight members of staff working within statutory community drug treatment teams were interviewed using qualitative research methods. The overarching themes within the staff accounts are described and the importance of these themes explored. Perceived objections to core elements of the 12 step programme (religious nature of the programme, powerlessness, surrender, desire to stop using drugs) were major obstacles to recommending NA attendance. However, a perception that the client would object to any form of group process, and concerns about risk both to the client and the TSG members were also important. Increased education about TSG practices and procedures was a commonly cited strategy for increasing levels of TSG referral, and in particular ensuring that clinicians attend open meetings themselves. An increased understanding and familiarity with the process and principles of TSGs may be necessary to increase promotion of TSG within drug treatment services in line with recent national policy promoting recovery from drug use.
    • Self-stigma experiences among older adults with mental health problems residing in long term care facilities: a qualitative study

      Tzouvara, Vasiliki; Papadopoulos, Chris; Randhawa, Gurch; King's College London; University of Bedfordshire (Taylor & Francis, 2017-12-29)
      Self-stigma is linked with a variety of deleterious consequences for the stigmatised individual. Much of the past research on self-stigma focuses on younger adults; however, little is known about the self-stigma experience among institutionalised older adults with mental health problems. This study aims to explore experiences of self-stigma among older adults with mental health problems in long-term care facilities. Ten semi-structured interviews were conducted. Insight into mental illness was identified as having a key influence upon the self-stigma experiences among this group. Participants shared common understandings, views, and behavioural reactions towards mental health problems. Lacking control, public stigma, sympathy, disinterest, avoidance, and fear were key themes among them. Re-conceptualising self-stigma theories and implementing interventions that aim at reducing stigmatising attitudes among this group are essential.
    • Should the family have a role in deceased organ donation decision-making? a systematic review of public knowledge and attitudes towards organ procurement policies in Europe

      Molina-Pérez, Alberto; Delgado, Janet; Frunza, Mihaela; Morgan, Myfanwy; Randhawa, Gurch; Reiger-Van de Wijdeven, Jeantine; Schicktanz, Silke; Schiks, Eline; Wöhlke, Sabine; Rodríguez-Arias, David; et al. (Elsevier, 2021-11-26)
      Goal: To assess public knowledge and attitudes towards the family's role in deceased organ donation in Europe. Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection were performed by two or more independent reviewers for each record. Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. Conclusions: Public views on the authority of the family in organ donation decision-making requiere further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation.
    • Strong and weak zinc binding sites in human zinc-α2-glycoprotein

      Kumar, Aditya Arun; Hati, Debolina; Thaker, Thana'a Mohajer; Miah, Layeque; Cunningham, Phil; Domene, Carmen; Bui, Tam T. T.; Drake, Alex F.; McDermott, Lindsay C.; King's College London (Wiley, 2013-11-01)
      Zinc-α2-glycoprotein (ZAG) is an adipokine with an MHC class I-like protein fold. Even though zinc causes ZAG to precipitate from plasma during protein purification, no zinc binding has been identified to date. Using mass spectrometry, we demonstrated that ZAG contains one strongly bound zinc ion, predicted to lie close to the α1 and α2 helical groove. UV, CD and fluorescence spectroscopies detected weak zinc binding to holo-ZAG, which can bind up to 15 zinc ions. Zinc binding to 11-(dansylamino) undecanoic acid was enhanced by holo-ZAG. Zinc binding may be important for ZAG binding to fatty acids and the β-adrenergic receptor.
    • Structural and functional analysis of fatty acid-binding proteins

      Storch, Judith; McDermott, Lindsay C.; Rutgers University; King's College London (American Society for Biochemistry and Molecular Biology, 2009-04-30)
      The mammalian FA-binding proteins (FABPs) bind long-chain FA with high affinity. The large number of FABP types is suggestive of distinct functions in specific tissues. Multiple experimental approaches have shown that individual FABPs possess both unique and overlapping functions, some of which are based on specific elements in the protein structure. Although FA binding affinities for all FABPs tend to correlate directly with FA hydrophobicity, structure-function studies indicate that subtle three-dimensional changes that occur upon ligand binding may promote specific protein-protein or protein-membrane interactions that ultimately determine the function of each FABP. The conformational changes are focused in the FABP helical/portal domain, a region that was identified by in vitro studies to be vital for the FA transport properties of the FABPs. Thus, the FABPs modulate intracellular lipid homeostasis by regulating FA transport in the nuclear and extra-nuclear compartments of the cell; in so doing, they also impact systemic energy homeostasis.
    • Understanding physician behaviour in the 6-8 weeks hip check in primary care: a qualitative study using the COM-B

      Chater, Angel M.; Milton, Sarah; Green, Judith; Gilworth, Gill; Roposch, Andreas; ; University of Bedfordshire; King's College London; University College London; Great Ormond Street Hospital for Children (BMJ Publishing Group, 2021-03-19)
      A compulsory hip check is performed on an infant at 6-8 weeks in primary care for the detection of developmental dysplasia of the hip (DDH). Missed diagnoses and infants incorrectly labelled with DDH remain an important problem. The nature of physician behaviour as a likely source of this problem has not been explored. The aims of this study were to make a behavioural diagnosis of general practitioners (GPs) who perform these hip checks, and identify potential behavioural change techniques that could make the hip checks more effective. Qualitative study with in-depth semistructured interviews of 6-8 weeks checks. We used the Capability, Opportunity, Motivation and Behaviour model in making a behavioural diagnosis and elicited factors that can be linked to improving the assessment. Primary care. 17 GPs (15 female) who had between 5 and 34 years of work experience were interviewed. Capability related to knowledge of evidence-based criteria and skill to identify DDH were important behavioural factors. Both physical (clinic time and space) and social (practice norms), opportunity were essential for optimal behaviour. Furthermore, motivation related to the importance of the 6-8 weeks check and confidence to perform the check and refer appropriately were identified in the behavioural diagnosis. Aspects of capability, opportunity and motivation affect GPs' diagnosis and referral behaviours in relation to DDH. The findings from this work extend current knowledge and will inform the development of an intervention aimed at improving the diagnosis of DDH.
    • Using Twitter™ to drive research impact: a discussion of strategies, opportunities and challenges

      Schnitzler, Katy; Davies, Nigel; Ross, Fiona; Harris, Ruth; ; Kingston University; University of Bedfordshire; St George's, University of London; Leadership Foundation for Higher Education; King's College London (Elsevier Ltd, 2016-02-16)
      Researchers have always recognised the importance of disseminating the findings of their work, however, recently the need to proactively plan and drive the impact of those findings on the wider society has become a necessity. Firstly, this is because funders require evidence of return from investment and secondly and crucially because national research assessments are becoming powerful determinants of future funding. In research studies associated with nursing, impact needs to be demonstrated by showing the effect on a range of stakeholders including service users, patients, carers, the nursing workforce and commissioners. Engaging these groups is a well-known challenge influenced by lack of access to academic journals, lack of time to read long complex research papers and lack of opportunities to interact directly with the researchers. This needs to be addressed urgently to enable nursing research to increase the impact that it has on health delivery and the work of clinical practitioners. Social media is potentially a novel way of enabling research teams to both communicate about research as studies progress and to disseminate findings and research funders are increasingly using it to publicise information about research programmes and studies they fund. A search of the healthcare literature reveals that advice and guidance on the use of social media for research studies is not well understood or exploited by the research community. This paper, therefore, explores how using social networking platforms, notably Twitter™ offers potential new ways for communicating research findings, accessing diverse and traditionally hard-to-reach audiences, knowledge exchange at an exponential rate, and enabling new means of capturing and demonstrating research impact. The paper discusses approaches to initiate the setup of social networking platforms in research projects and considers the practical challenges of using Twitter™ in nursing and healthcare research. The discussion is illuminated with examples from our current research. In summary, we suggest that the use of social media micro-blogging platforms is a contemporary, fast, easy and cost effective way to augment existing ways of disseminating research which helps drive impact.
    • What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol

      Harris, Ruth; Sims, Sarah; Levenson, Ros; Gourlay, Stephen; Ross, Fiona; Davies, Nigel; Brearley, Sally; Favato, Giampiero; Grant, Robert; King's College London; et al. (BMJ Publishing Group, 2017-01-09)
      Intentional rounding (IR) is a structured process whereby nurses in hospitals carry out regular checks, usually hourly, with individual patients using a standardised protocol to address issues of positioning, pain, personal needs and placement of items. The widespread implementation of IR across the UK has been driven by the recommendations of the Francis Inquiry although empirical evidence of its effectiveness is poor. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. The study will be conducted in four phases. Phase 1: theory development using realist synthesis to generate hypotheses about what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure which will be tested in subsequent phases of the study. Phase 2: a national survey of all NHS acute trusts to explore how IR is implemented and supported across England. Phase 3: case studies to explore how IR is implemented 'on the ground', including individual interviews with patients, family members and staff, non-participant observation, retrieval of routinely collected patient outcomes and cost analysis. Phase 4: accumulative data analysis across the phases to scrutinise data for patterns of congruence and discordance and develop an overall evaluation of what aspects of IR work, for whom and in what circumstances. The study has been approved by NHS South East Coast-Surrey Research Ethics Committee. Findings will be published in a wide range of outputs targeted at key audiences, including patient and carer organisations, nursing staff and healthcare managers. INTRODUCTION METHODS AND ANALYSIS ETHICS AND DISSEMINATION
    • Zinc-induced oligomerisation of zinc α2 glycoprotein reveals multiple fatty acid binding sites

      Zahid, Henna; Miah, Layeque; Lau, Andy M.; Brochard, Lea; Hati, Debolina; Bui, Tam T. T.; Drake, Alex F.; Gor, Jayesh; Perkins, Stephen J.; McDermott, Lindsay C.; et al. (Portland Press, 2015-12-09)
      Zinc α2 glycoprotein (ZAG) is an adipokine with a class I major histocompatibility complex protein fold and is associated with obesity and diabetes. Although its intrinsic ligand remains unknown, ZAG binds the dansylated C11 fatty acid, DAUDA, in the groove between the α1 and α2 domains. The surface of ZAG has about 15 weak zinc binding sites deemed responsible for precipitation from human plasma. Here the functional significance of these metal sites was investigated. Analytical ultracentrifugation and circular dichroism showed that zinc, but not other divalent metals, cause ZAG to oligomerise in solution. Thus ZAG dimers and trimers were observed in the presence of 1 mM and 2 mM zinc. Molecular modelling of X-ray scattering curves and sedimentation coefficients indicated a progressive stacking of ZAG monomers, suggesting the ZAG groove may be occluded in these. Using fluorescence-detected sedimentation velocity, these ZAG-zinc oligomers were again observed in the presence of the fluorescent boron dipyrromethene fatty acid C16-BODIPY. Fluorescence spectroscopy confirmed that ZAG binds C16-BODIPY. ZAG binding to C16-BODIPY, but not to DAUDA, was reduced by increased zinc concentrations. We conclude that the lipid binding groove in ZAG contains at least two distinct fatty acid binding sites for DAUDA and C16-BODIPY, similar to the multiple lipid binding seen in the structurally-related immune protein Cd1c. In addition, because high concentrations of zinc occur in the pancreas, the perturbation of these multiple lipid binding sites by zinc may be significant in Type 2 diabetes where dysregulation of ZAG and zinc homeostasis occurs.