• Prevalence of Human Immunodeficiency Virus among pregnant women in Nigeria

      Ozim, C.; Mahendran, Rahini; Amalan, Mahendran; Puthussery, Shuby (Oxford University Press, 2020-09-30)
      Background Human Immunodeficiency Virus (HIV) infection among pregnant women has been associated with a number of adverse maternal and infant outcomes. Nigeria accounts for about 10% of the HIV/AIDS burden worldwide and has the second highest incidence of new HIV infections among women globally. This study estimated the overall prevalence of HIV among pregnant women in Nigeria and examined variations across the geo-political zones of the country. Methods We conducted a systematic review and meta-analysis. A comprehensive search was conducted using eight electronic databases and grey sources for studies published from 1·1·2008 to 31·8·2019. Primary studies reporting prevalence estimates of HIV among pregnant women diagnosed using a diagnostic/ screening test were identified, screened and appraised using a two-stage process. A meta-analysis was conducted with the primary outcome measure as proportion (%) of pregnant women identified as having HIV infection. Results Twenty three eligible studies involving 72,728 pregnant women were included in the meta-analysis. The overall pooled prevalence of HIV among pregnant women was 7·22% (95% CI: 5·64, 9·21). A high degree of heterogeneity (I2=97·2%) and publication bias (p = 0.728) was reported. Prevalence rate for South-East geo-political zone (17·04%, 95% CI: 9·01, 29·86) was higher compared to the overall prevalence. Conclusions Findings imply that 7 out of every 100 pregnant women in Nigeria are likely to have HIV infection. The magnitude of the issue highlight the need for targeted efforts at local, national and international levels towards prevention, diagnosis and treatment.
    • Negotiating difference and belonging in families from mixed racial, ethnic and faith backgrounds in Britain: Implications for mental health

      Puthussery, Shuby; Caballero, Chamion; Edwards, Rosalind (Oxford University Press, 2008-09-30)
      Poster presentations: abstracts Key points * Mixed-parent couples in Britain were often in sustained relationships, and a high proportion were middle class. * The couples interviewed used three typical approaches to instil a sense of belonging in their children; particular approaches were not associated with particular racial or faith combinations: o Individual: children's sense of belonging was not seen as rooted in their mixed background. o Mix: children's mixed background was understood as a factual part of their identity; all aspects were emphasised. o Single: one aspect of children's mixed background was stressed. * Couples whose approach differed in giving their children a sense of belonging were not necessarily in conflict. For some, divergent approaches were complementary. Others saw difficulties between them as humanistic, political or personality choices. * Parents identified supportive or constraining resources and relationships in creating a sense of belonging, including neighbourhoods, schools, travel, languages, grandparents and children themselves. What some regarded as supportive, others saw as drawbacks. * Mixed-parent couples can be more concerned with other issues, such as children's safety and health, unity over discipline and financial security. * The researchers conclude that it is important that family support, health, education and social services do not make assumptions about mixed families. Families who seem to share a form of mixing can differ from each other. 'Mixedness' may be insignificant for some, compared to other issues. Mixed families would benefit from policies and practice that further tackle prejudice based on race and faith.
    • Born in the UK: Maternity and postnatal care needs of UK-born ethnic minority women

      Puthussery, Shuby; Twamley, Katherine; Mirsky, Judith; Macfarlane, Alison; Harding, Seeromanie; Baron, Maurina (Radcliffe Publishing Ltd, 2009-09-30)
    • Acceptability and effectiveness of multi-media delivery of an exercise programme among postpartum women with lumbo pelvic pain in Taiwan

      Tseng, Pei-Ching; Puthussery, Shuby; Pappas, Yannis; University of Bedfordshire (2016-03-02)
      Registration of study Background and study aims Lumbo Pelvic Pain (LPP) is a common problem among pregnant women and those that have given birth within the last year (postnatal). LPP may lead to sleep problems, depression, fatigue and anxiety, and a general inability to carry out activities that involve carrying or lifting. Various treatments have been used to reduce LPP in general including physical exercise although the effect of exercise programmes in treating back pain is yet to be fully understood among postnatal women. In any case, new mothers in many Asian countries, such as Taiwan, tend to reduce physical activity after birth in accordance with traditional practices. Mothers in Taiwan receive verbal advice on exercise to be followed in the postnatal period by health care professionals before their discharge from hospital. Most of the hospitals also provide the women with a leaflet containing details of an exercise programme to manage postpartum LPP commonly referred to as back pain. However, very little is known about the uptake of this exercise programme or its benefits for postnatal women. Technology has been increasingly used in health care to deliver various treatments and technology based delivery can improve the uptake of exercise among certain groups. How acceptable different methods of teaching the exercises, using digital or print media are and how they might affect how many postnatal women take up the exercise, adhere to it and complete an exercise programme has yet to be understood. Taiwan has a world-leading position in technology with 80% of all households owning personal computers and around 84% households with high speed internet connection. This study assesses the effectiveness of an exercise programme (the intervention) designed to strengthen abdominal and global muscles delivered using Digital Versatile Disc (DVD), Internet or leaflet, on LPP among postnatal women in Taiwan, and to compare exercise uptake, adherence and completion rates.
    • Effectiveness of nutrition interventions in low-and middle-income countries: a meta-review

      Rana, Ritu; Menon, Kavitha; Puthussery, Shuby; Ravalia, Anal; Panchal, Pooja; Vaze, Gauri; Tseng, Pei-Ching; Mavalankar, Dileep; ; Indian Institute of Public Health Gandhinagar; et al. (World Public Health Nutrition Association, 2020-03-24)
      Background: Undernutrition remains an unfinished agenda for a majority of low- and middle-income countries (LMICs). Numerous nutrition interventions have been implemented in LMICs and various indicators have been used to measure the impact of these interventions. The aim of this meta-review was to summarise the findings on the effectiveness of various nutrition interventions that have been implemented in LMICs on the WHO global nutrition targets-related outcomes. The six outcomes are- reducing stunting, wasting, anemia among women of reproductive age, low birthweight, childhood overweight, and improving exclusive breastfeeding. This study presents the results for one of the outcomes (stunting). Methods: We conducted a comprehensive search on 21 electronic databases, including six regional and four systematic reviews (SRs) specific databases. Two researchers independently screened identified records against the inclusion criteria. Quality of included SRs were assessed using the AMSTAR tool. Extracted data were narratively synthesised examining the direction of impact. The review protocol was registered with the EPPI-Centre. Results: Of 6,597 SRs initially identified, 28 SRs that assessed outcomes of WHO global nutrition targets-related outcomes were eligible for inclusion. We found 12 SRs that assessed stunting outcomes, these SRs synthesised 68 quantitative primary studies, from 29 LMICs. All included SRs were of high quality. Eight nutrition interventions were reported in the included SRs- five nutrition-specific (n=9) and three nutrition-sensitive (n=3). Among all interventions, two nutrition-specific (complementary feeding: n=1; dietary supplementation: n=2) interventions showed a positive effect. Conclusion: This meta-review identified, two interventions, complementary feeding and dietary supplementation, with most frequently reported evidence of positive impact on stunting. In LMICs, public health policymakers should consider these two interventions for scaling-up.
    • How young, disadvantaged fathers are affected by socioeconomic and relational barriers: a UK-based qualitative study

      Donald, Louisa; Davidson, Rosemary; Murphy, Suzanne; Hadley, Alison; Puthussery, Shuby; Randhawa, Gurch; ; University of Bedfordshire (2021-11-05)
      This article is based on the interviews of nine young, socially disadvantaged fathers from the UK. Young fathers are more likely to experience socioeconomic deprivation and disrupted pathways towards parenthood, which affect their participation in socially accepted trajectories of ‘father involvement’. Whilst this has received some attention in research, studies have largely neglected to examine the lived experiences of such fathers directly. The current article aims to address this gap, building upon the limited body of research that exists exploring the impact of socioeconomic and relational barriers on father involvement. In this study, three interrelated themes demonstrate the cyclical nature of generational disadvantage, reduced socioeconomic circumstances and disrupted relationships, providing a different perspective on the decreased levels of involvement exhibited by young fathers in prior research. The findings also enlighten our understanding of how these fathers can be better supported in policy and practice, thereby contributing to current academic debate.
    • Effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering

      Rana, Ritu; Kirubakaran, Richard; Puthussery, Shuby; Lelijveld, Natasha; Kerac, Marko; Sirwani, Barkha; Choudhury, Prativa (PROSPERO International prospective register of systematic reviews, 2021-09-29)
      Protocol for an ongoing systematic review focussed on the following review question: What is the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering?
    • Barriers and facilitators to genetic testing amongst Black African women in the UK

      Kabeya, Valencia; Puthussery, Shuby; Furmanski, Anna L. (Oxford University Press, 2021-10-20)
      Background Black African women have the lowest attendance of genetic testing services and the highest mortality rate of breast and ovarian cancer amongst women from ethnic minority groups in the UK. Therefore, this study aimed to identify the barriers and facilitators to genetic testing to enable these women to make informed choices if found eligible. Methods A qualitative approach was used to explore the perceptions surrounding genetic testing amongst Twenty-four women aged 23-57 Black African women in Luton. Purposive sampling combined with snowballing sampling was used as a recruitment technique. Results The findings revealed that most of the participants had no awareness or knowledge of genetic testing and limited knowledge of their family medical history for eligibility to attend genetic testing services. Facilitators including family member's health, funding by the National Health services and accessibility and awareness and education on genetic testing were identified. Conclusions This study sought to explore the perceptions of Black African women on barriers and facilitators to genetic testing to enable researchers to implement efficient intervention that would increase genetic testing attendance whilst addressing the other barriers and facilitators to alter Black African's women health seeking behaviours.
    • First-time mothers’ experiences of foetal reduction in pregnancy following assisted reproductive technology treatment in Taiwan: a qualitative study

      Huang, Mei-Zen; Sun, Yi-Chin; Gau, Meei-Ling; Puthussery, Shuby; Kao, Chien-Huei; ; National Taipei University of Nursing and Health Sciences; University of Bedfordshire (Biomed Central, 2021-11-02)
      Background Foetal reduction—removal of one or more foetuses to reduce the number of foetuses in multiple conceptions—is a procedure used for improving pregnancy outcomes following assisted reproductive technology (ART) treatment. While there is a recognition of the importance of understanding the experiences of women who undergo foetal reduction to offer appropriate help and support, studies that provide relevant insights are sparse. Our aim was to gain an in-depth understanding about first-time mothers’ experiences of foetal reduction following ART treatment in Taiwan. Methods We adopted a qualitative design based on a phenomenological approach for this study. In-depth semi-structured interviews were conducted with seven first-time mothers who underwent foetal reduction following ART treatment at a fertility centre in Taipei, Taiwan. All interviews were recorded, transcribed and analysed using the Colaizzi strategy. Results The views and experiences relating to foetal reduction reflected five key themes: hesitation, ambivalence and distress; the guilt of knowingly terminating a life; rituals and ceremonies to ease the sense of guilt; persuading oneself to consider the ‘big picture’; and wishing for a reunion in next pregnancy. Mothers often regretted that they took clinical advice to implant multiple embryos and then having had to resort to foetal reduction. There was a sense of hesitation, ambivalence and distress reflected in the views from all participants. They believed that they ended the fetuses’ lives knowingly and expressed strong feelings of guilt. Mothers often tried to persuade themselves to look at foetal reduction within the ‘big picture’ of the overall pregnancy outcome. Losing their unborn babies was as an unforgettable incident for most mothers, and they wished for a reunion with the lost baby in the next pregnancy. Conclusion Findings indicate the need for ART providers to undertake a more sensitive approach that involves detailed discussions with women and their families to tailor the embryo transfer processes to suit individual needs. Women who undergo foetal reduction should be provided with tailored interventions towards enhancing their coping strategies before and after foetal reduction taking into account the cultural and religious context.
    • Racial and ethnic differences in falls among older adults: a systematic review and meta‑analysis

      Wehner‑Hewson, Natasha; Watts, Paul; Buscombe, Richard; Bourne, Nicholas; Hewson, David; (Springer Nature, 2021-11-16)
      The aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.
    • Ethnic minority women’s experiences of accessing antenatal care in high income European countries: a meta-synthesis of qualitative studies

      Sharma, Esther; Tseng, Pei-Ching; Puthussery, Shuby; Li, Leah; Harden, Angela; Griffiths, Malcolm; Bamfo, Jacqueline (2021-02-22)
      Protocol for an ongoing systematic review focussed on the following review question: What are the key themes reflected in ethnic minority women’s experiences of accessing antenatal care in European countries?
    • Connecting health, health-related behaviours and place through the work of community gardening

      Church, Andrew; Ellaway, A.; Mitchell, R.; Moore, Niamh; Ravenscroft, Neil; AHRC (Connected Communities Cross Council Programme, 2012-01-01)
    • Ethnic minority women’s interactions with antenatal care providers in Europe

      Sharma, Esther; Puthussery, Shuby; Tseng, Pei-Ching; Li, Leah; Harden, Angela; Griffiths, Malcolm; Bamfo, Jacqueline (Oxford University Press, 2021-10-20)
    • Grieving a disrupted biography: an interpretative phenomenological analysis exploring barriers to the use of mindfulness after neurological injury or impairment

      Finlay, K. A.; Hearn, J.H.; Chater, Angel M.; University of Reading; Manchester Metropolitan University; University of Bedfordshire (Biomed Central, 2021-08-24)
      Mindfulness has demonstrated strong utility for enhancing self-management and health outcomes in chronic illness. However, sensation-focused mindfulness techniques may not be appropriate for clinical populations with neurological injury. This study aimed to identify how expert mindfulness teachers with sensory loss/impairment naturalistically adapt and experience mindfulness. We aimed to highlight the rationale for and barriers to mindfulness practice when living with sensory loss. A qualitative, semi-structured interview design was used, analysed via Interpretative Phenomenological Analysis (IPA). Eight (5 females, 3 males) mindfulness teachers with neurological injury were recruited via a national registry of Mindfulness for Health teachers. Interviews (range: 50-93 min) were completed, transcribed verbatim and analysed idiographically for descriptive, linguistic and conceptual themes, before a cross-case analysis was completed. Two superordinate themes were identified: (1) Overcoming a disrupted biography; and (2) Proactive self-management. These themes considered the challenge of reconciling, through grief, a past health status with the present reality of living with sensory loss due to Spinal Cord Injury, Multiple Sclerosis or Functional Neurological Disorder. Mindfulness was experienced as a method by which proactive choices could be made to maintain control and autonomy in health, reducing perceptions of suffering, psychological distress, cognitive reactivity and rumination. Mindfulness was found to support the self-management of health after neurological injury/impairment. Mindfulness meditation presented an initial challenge as trauma and grief processes were (re-)activated during mindfulness sessions. However, mindfulness was found to support the resolution of these grief processes and encourage adaptive approach-based coping and acceptance of health and neurological impairment/injury.
    • Factors that facilitate or hinder whole system integrated care for obesity and mental health: a scoping review protocol

      Liapi, Fani; Chater, Angel M.; Randhawa, Gurch; Pappas, Yannis; University of Bedfordshire (BMJ, 2021-08-10)
      Integrated care aims to improve population health. Obesity and mental health are major health issues worldwide. The complexity of the multifactorial drivers of these public health problems has led to the adoption of a whole system approach. This review aims to highlight factors that influence the planning, implementation and evaluation of whole system integrated care for these conditions. Using the framework of Arksey and O' Malley, we will perform a comprehensive search in the following databases: MEDLINE, CINAHL, PsychINFO, PubMed, British Nursing Database, Web of Science, Health Systems Evidence, Cochrane Library and University of York Centre for Reviews and Dissemination. Further hand-search of reference lists and the grey literature will be conducted. The search will be restricted to articles published from 2000 to 2020. The review is expected to be completed by August 2021. Full texts of the potential studies will be screened for the inclusion criteria. Quality of studies will be appraised. Narrative synthesis will be completed using data extracted from the included studies. A favourable ethics opinion for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC937). This review expects to identify information relating to factors that facilitate or hinder whole system integrated care for obesity and mental health. The finding from this review will be widely disseminated to stakeholders to inform implementation of whole system integrated care initiatives.
    • How the integration of telehealth and coordinated care approaches impact health care service organization structure and ethos: mixed methods study

      Davidson, Rosemary; Barrett, David Ian; Rixon, Lorna; Newman, Stanton; ; ACT Program; University of Bedfordshire; University of Hull; City University of London (JMIR Publications, 2020-10-09)
      Coordinated care and telehealth services have the potential to deliver quality care to chronically ill patients. They can both reduce the economic burden of chronic care and maximize the delivery of clinical services. Such services require new behaviors, routines, and ways of working to improve health outcomes, administrative efficiency, cost-effectiveness, and user (patient and health professional) experience. The aim of this study was to assess how health care organization setup influences the perceptions and experience of service managers and frontline staff during the development and deployment of integrated care with and without telehealth. As part of a multinational project exploring the use of coordinated care and telehealth, questionnaires were sent to service managers and frontline practitioners. These questionnaires gathered quantitative and qualitative data related to organizational issues in the implementation of coordinated care and telehealth. Three analytical stages were followed: (1) preliminary analysis for a direct comparison of the responses of service managers and frontline staff to a range of organizational issues, (2) secondary analysis to establish statistically significant relationships between baseline and follow-up questionnaires, and (3) thematic analysis of free-text responses of service managers and frontline staff. Both frontline practitioners and managers highlighted that training, tailored to the needs of different professional groups and staff grades, was a crucial element in the successful implementation of new services. Frontline staff were markedly less positive than managers in their views regarding the responsiveness of their organization and the pace of change. The data provide evidence that the setup of health care services is positively associated with outcomes in several areas, particularly tailored staff training, rewards for good service, staff satisfaction, and patient involvement.
    • The impact of the Luton social prescribing programme on mental well-being: a quantitative before-and-after study

      Pescheny, Julia Vera; Gunn, Laura H.; Pappas, Yannis; Randhawa, Gurch; (Oxford University Press, 2019-12-27)
      Background Social prescribing programmes expand the range of options available to primary care health professionals to address patients’ psychosocial needs, impacting on their health and well-being. The objective of this study was to assess the change in the mental well-being of service users after participation in the Luton social prescribing programme. Methods Skew-normal (SN) regression was applied to analyse the change in mental well-being post-intervention (N = 63). The short Warwick–Edinburgh mental well-being scale was used as the outcome measure. Results The SN regression found a statistically significant change (P < 0.0001) in the average difference score between baseline and post-intervention measures. However, the observed change does not appear to be of clinical relevance. No significant associations in mental well-being scores by gender, age or working status were found. Conclusion Findings of this study indicate that social prescribing may have the potential to improve the mental well-being of service users. The study findings contribute to the sparse evidence base on social prescribing outcomes by socio-demographic characteristics of participants and highlight the importance of considering subgroup analysis in future research.
    • Gestational diabetes mellitus (GDM) and adverse pregnancy outcome in South Asia: a systematic review

      Mistry, Sabuj Kanti; Das Gupta, Rajat; Alam, Sabiha; Kaur, Kuljeet; Shamim, Abu Ahmed; Puthussery, Shuby; BRAC University, Dhaka; University of New South Wales; University of Dhaka; University of Bedfordshire (Wiley, 2021-07-03)
      Introduction The prevalence of gestational diabetes mellitus (GDM) is increasing in developing countries including the South Asian Nations. The current study aimed to examine the association of GDM with adverse pregnancy outcomes from foetal and maternal perspectives in South Asia. Methods A systematic review was conducted including primary studies published since January 2020 from South Asian countries. Following electronic databases were searched to locate the articles: MEDLINE, EMBASE and EMCARE. Data were extracted using a customized extraction tool and methodological quality of the included studies was assessed using modified Effective Public Health Practice Project (EPHPP) quality assessment tool. Narrative synthesis was performed as statistical pooling was not possible due to the heterogeneous nature of the studies. Results Eight studies were included in the review. Overall, the review found a positive correlation between GDM and adverse foetal outcomes such as macrosomia, neonatal hyperglycaemia, intrauterine growth retardation (IUGR), stillbirths and low birthweight (LBW), but the findings were not conclusive. GDM was also positively associated with preeclampsia but the association between GDM and C-section delivery was not conclusive. Conclusion Policymakers, public health practitioners and researchers in South Asia should take in to account the link between GDM and adverse pregnancy outcomes while designing interventions to promote maternal health in South Asia. Researchers should focus on conducting longitudinal studies in future to clearly understand the epidemiology and pathobiology of this issue.
    • Understanding the disproportionate effects of COVID-19 on nurses from ethnic minority backgrounds

      Qureshi, Irtiza; Garcia, Rebecca; Ali, Nasreen; Randhawa, Gurch; University of Bedfordshire; Open University (RCN Publishing, 2021-07-12)
      People from ethnic minority backgrounds in the UK have been disproportionately affected by coronavirus disease 2019 (COVID-19), with higher death rates and suboptimal health outcomes compared with those from white ethnic backgrounds. This trend is reflected in healthcare staff from ethnic minority backgrounds, including nurses, who are disproportionately affected by COVID-19 and have higher death rates from the disease. The theory of intersectionality contends that social categorisations such as gender, race and class can contribute to discrimination and result in disadvantages. In this article, the authors outline several intersecting factors that could be contributing to the disproportionate effects of COVID-19 among nurses from ethnic minority backgrounds, as well as making recommendations for further research in this area.