Background: The HIV/AIDS epidemic has contributed to a drastic increase in the number of orphans and vulnerable children in sub-Saharan Africa. However, little is known about the mental health of these children in low prevalence areas such as Ghana. The thesis investigated the relationship between orphanhood, parental HIV/AIDS status and mental health. It further examined the mediating effects of identified risk and protective factors on the relationship between orphanhood/parental HIV/AIDS status and psychological difficulties. Finally, the thesis identified pathways through which HIV/AIDS impacts children by exploring the interactive and cumulative effects of the various risk and protective factors on psychological difficulties. Method: The thesis employed cross-sectional, quantitative interviews that involved 291 children aged 10-18 years and their caregivers that compared children who have lost their parents to AIDS, those who have lost their parents to other causes, those who are living with HIV/AIDS-infected caregivers and children from intact families in the Manya Krobo district in Ghana. ANOVAs, T-tests, General Linear Models, Log-linear Analyses, Chi-Squares and Bivariate Correlations were used to analyze the data that were obtained from both the children and their caregivers. Results After controlling for relevant socio-demographic factors, both children and informants’ reports showed that children orphaned by AIDS and those living with infected parents showed higher delinquency (p <.01), peer problems (p <.001), hyperactivity (p <.01) and lower self esteem (p <.001) than other orphans and children from intact families. AIDS orphans, other orphans and those living with HIV/AIDS-infected parents all reported significantly more depression (p <.001) and relationship problems (p <.001) than those for intact families. Conduct problems as indicated by informants’ reports were generally, significantly higher for orphans and vulnerable children compared to children from intact families. Over 70% of both AIDS orphans and children living with infected parents showed internalising symptoms that were above clinical cut-offs for abnormality. AIDS orphans and children living with infected parents reported more stigma, abuse, child labour and lower levels of SES and lower perceived social support. These factors independently, strongly mediated the relationship between orphanhood, parental HIV/AIDS status and mental health. The interactive and cumulative effect of engagement in child labour and being physically abused heightened the risks for depressive symptoms from 38% to 66%. Neglect and psychological abuse increased the risks for symptoms of Reactive Attachment Disorder from 26.6% to 67.3%. The cumulative effect of stigma and either child labour or physical abuse substantially increased the likelihood of delinquency symptoms to approximately 67%. Conclusion: The findings demonstrated that both AIDS orphans and children living with HIV/AIDS-infected parents showed heightened psychosocial symptoms. The present evidence also highlighted the interactive, cumulative, co-occurrence of contextual factors and HIV/AIDS unique exposures to create heightened vulnerabilities for psychological difficulties among children. The findings call for a comprehensive intervention programme that addresses factors specific to HIV/AIDS and contextual variables.

Background and Aims: Judicial antibiotic prescribing and appropriate use of healthcare resources are public health priorities. Preschool-aged children that attend day care frequently consult general practitioners (GPs) and receive antibiotics, despite experiencing mainly self-limiting and/or viral infections. North-American surveys indicate that day care providers unnecessarily exclude children with infections, and make exceptions to exclusion on the basis of antibiotic treatment. Commentators suggest that this may lead to unnecessary consultations and inappropriate antibiotic requests. This study’s main aim was to explore whether UK-based day care providers’ management of infections encourages parents to unnecessarily consult GPs, and inappropriately seek antibiotics. A secondary aim was to describe the content and nature of written day care sickness exclusion policies. Questionnaire Methods and Results: Questionnaires were distributed to 329 day care providers in three socio-demographically contrasting areas of South-East Wales, to gather descriptive data regarding sickness exclusion policies. 216 (66%) responses were received. Policies were mostly self-written, diverse in content and detail, and often non-evidence-based. Qualitative Methods and Results: Day care providers’ management of infections, and the influence this had on parents’ consulting and antibiotic-seeking behaviours, were explored through semi-structured interviews with 24 purposefully selected day care providers, and 28 opportunistically-selected parents that used their services. Interviews underwent inductive thematic analysis. All day care providers encouraged parents to consult GPs for self-limiting infections, and often inappropriately advised antibiotic treatment through written policies and verbal communication. Some parents felt that day care attendance increased their tendency to consult for symptoms they would usually manage themselves. The purpose of consultation was often to expedite return to day care, rather than alleviate concern. Parents understood that antibiotics were unlikely to be beneficial, but still sought and received treatment in order to appease day care providers’ requirements. Conclusion: Day care providers’ inappropriate advice to parents, together with non-evidence-based exclusion policies, contribute to unnecessary GP consultations and inappropriate antibiotic-seeking behaviour.

The high-resolution molecular characterisation of the Cryptosporidium species and subtypes biquitous in environmental samples can provide important information regarding their potential public health significance. The purpose of this study was to develop, evaluate and apply sensitive screening and DNA recovery methods to environmental Cryptosporidium for molecular characterisation. A systemic literature review as undertaken to identify methods of subtyping Cryptosporidium species recovered from environmental samples. Prior to molecular characterisation, the recovery and detection of oocysts from water is by immunomagnetic separation and immunofluorescence microscopy. However, this method is not currently suited for screening large numbers of faecal samples. A commercially available faecal parasite concentrator protocol was modified and evaluated for the enhanced detection of Cryptosporidium oocysts. Once recovered from samples, DNA must be released from the oocyst bound sporozoites before molecular methods can be applied. Commonly used oocyst disruption methods were identified and using samples containing high numbers of oocysts, evaluated by microscopy and a SYBR Green real-time polymerase chain reaction (PCR) developed from the internal stage of a previously published nested small subunit ribosomal DNA PCR. The eight best methods were then evaluated with low numbers of oocysts in the presence of immunomagnetic beads to replicate field samples, using the published nested PCR and SYBR Green real-time PCR. The enhanced screening and optimal DAN recovery combined with microsatellite multilocus fragment analysis was applied in a study investigating the species and subtypes of Cryptosporidium recovered from water, non-clinical farmed and wild animal faeces as well as clinical human and cattle samples from within a single water catchment. Several human pathogenic Cryptosporidium subtypes were identified in addition to the unprecedented finding of Cryptosporidium as the predominant species in the catchment surface water. This study demonstrated the potential application of the developed methodology in the public health investigation of environmental Cryptosporidium.

Despite structured enforcement of food safety requirements known to prevent foodborne disease outbreaks, catering businesses continue to be the most common setting for outbreaks in England and Wales. Limited published evidence suggests that the way catering businesses are managed and operated may contribute to food safety control failures which in turn can result in an outbreak. The purpose of this study, funded by the Food Standards Agency1,2 was to identify the underlying management factors that may contribute to or prevent outbreaks in the catering industry. A matched case control study compared the management and operational practices of 148 catering businesses associated with foodborne outbreaks with 148 control catering businesses. High response rates were achieved: case businesses 90%, and control businesses 93%. To minimise false inferences from chance associations analysis followed a predefined hypothesised causal pathway. Hazard analysis critical control point systems and formal food hygiene training were found not to be protective and food hygiene inspection scores were not useful in predicting which businesses were likely to be associated with outbreaks. Larger small medium sized (SME) businesses were more likely to be associated with outbreaks compared to micro SME businesses. Operational and management practices did not differ significantly between case and control businesses when adjusted for SME size. SME size was not explained by other staff employment and management variables. However, businesses associated with Salmonella outbreaks were significantly more likely to use regional egg suppliers, the only significantly independent operational practice associated with Salmonella outbreaks. Regional egg suppliers were also more likely to supply businesses associated with outbreaks that were attributed to food vehicles containing eggs. Businesses associated with egg outbreaks were less likely to use eggs produced under an approved quality assurance scheme suggesting that the underlying risk associated with using regional suppliers may relate to the use of contaminated eggs.

Certain mould genera were found to predominate and built form was observed to be associated with mould concentration. PIV reduced the indoor humidity and it reduced the likelihood of mould reoccurring in the intervention homes.

No description available.

irgarzon@ugr.es / This paper addresses the question of how construction workers perceive occupational risks. It is a question that has not been addressed in scientific research. Specifically, we answer the following research questions: what is the perception of risk of construction workers?; what aspects of risk significantly influence the formation of the overall perception of risk?; are there sociodemographic variables that help to understand the perception of risk of construction workers? and if this were the case, then what are these variables and how do they influence them?. Ultimately, it examines the profile of perceived risk, its relation to the delay of consequences and the influence of socio-demographic variables. Respondents filled out a questionnaire in the presence of the survey-taker. The questionnaire was based on the psychometric paradigm, and was comprised of: (a) nine questions, each exploring a perceived risk attribute or dimension rated on a Likert 7-point scale, (b) a question on global risk perception, and (c) categorical questions about socio-demographic issues. The survey was conducted in the city of Granada (Spain). A profile of the construction workers’ perceived risk was obtained. Answers to each attribute were above the neutral line (scores above four). The profile shows the risk dimension with the highest score was the delayed consequences of exposure to risk conditions, a dimension that can be related to ergonomics and occupational hygiene. This is a new outcome since traditionally this dimension was given a lower score in the worker’s perception. A simple linear regression showed global risk may be explained in terms of the delayed consequences dimension (R2=0.29). Finally, a variance analysis (ANOVA) and several t-tests explored the relationship between this dimension and the sample’s socio-demographic variables. To conclude, the delay of consequences is the risk dimension workers perceived as the most critical in their daily chores. In addition, this risk dimension is decisive in creating a high global risk perception. Parenthood, a higher worker category and training are the only socio-demographic variables having an impact on this dimension of perceived risk. Hence, there is a direct relationship between these two variables.

Background Public health interventions need to both improve health and reduce health inequalities, whilst using limited health care resources efficiently. Well-established ethnic differences in cardiovascular disease (CVD) raise the possibility that CVD prevention policies may not work equally well across ethnic groups. The aim of this thesis was to explore whether there are ethnic differences in the potential impact of two CVD prevention policy choices – the choice between mass and targeted screening for high cardiovascular risk, including the use of area deprivation measures to target screening, and the choice between population and high-risk approaches. Methods Cross-sectional data from the Health Survey for England 2003 and 2004 were used. Three sets of analyses were carried out – first, calculation of ethnic differences in the utility of area deprivation measures to identify individual socioeconomic deprivation; second, investigation of ethnic differences in the cost-effectiveness of mass and targeted screening for high cardiovascular risk; third, analysis of ethnic differences in the potential impact of population and high-risk approaches to CVD prevention. Results Area deprivation measures worked relatively effectively and efficiently at identifying individual socioeconomic deprivation in ethnic minority groups compared to the white group. In ethnic groups at high risk of CVD, cardiovascular risk screening programmes were a relatively cost-effective option, screening programmes targeted at deprived areas were particularly cost-effective, and population approaches were found to be an effective and equitable way of preventing CVD despite potential underestimation of their impact. Discussion This thesis found that ethnic minority groups in the UK are unlikely to be systematically disadvantaged by a range of CVD prevention policies that have been proposed, or implemented, for the general population. Additional CVD prevention policies, in particular those based on the population approach, should be implemented.

Older people are often portrayed as a disadvantaged and silent group in society, whose views have been largely ignored. Demographic studies suggest the number of people over 75 years of age, as a percentageo f the population in coming years is likely to substantially increase, which will place greater demands on healthcare services. In the last two decades, health policy has focused on delivering high quality services based on individuals' needs, with a greater emphasis placed on individuals being involved in decisions about their care. This policy direction has facilitated a change in power relationships between patients and professionals and will require providers of healthcare to focus on delivering 'patient-centred' care at times and places that meet individual's needs and expectations. The aim of this researchw as to evaluatet he current medical model provision of NHS podiatry with the biopsychosocial model which claims to provide 'holistic', patient-centredc are. An important aim of this research was to provide a greater and more informed understandingo f what older people communicate about their 'lived' experiences, the significance of those experiences on care-seeking and their expectations of appropriate podiatry care. The research was undertaken with older people living in east Gloucestershire, who were 75 years old or over, and had requested NHS podiatry. The study was underpinned by a qualitative methodology, strengthened by a desire to change current clinical practice and inform health policy. The research methodology included involvement of participants in an innovative reminiscence technique, and as a consequence the 'podiatry patient career' was constructed. The texts generated from the participants were examined using an interpretative phenomenological analysis to ensure a 'person-centred' focus because it was imperative to hear the voices of the 'Participants' and not just the medical model 'patients' narrative. A portrait was revealed of older people who were conscious of their position in the life course and their own mortality, together with the effect this had on how they conducted their lives. The participants' raised consciousness of their 'self' affected their expectations, feelings, and interaction with others. For many of the participants there appeared a vicious circle of impending frailty that led to a diminishing circle of contacts which had an effect on their wider social activities and relationships. At this stage, participants perceived a resolution of their foot-care needs to be of great value and importance in maintaining their well-being which, assisted by the podiatrist, resulted in a handing over of the responsibility for their care. The conclusion is that neither model delivers 'person-centred' care to meet participants' expectations and foot-care needs. A new model is presented where differing and changing priorities, at different times of the participant's lived world will be relevant to meet their expectations and needs. The research concluded that the requirement for podiatry care can be taken as an early indicator of failing independence. The importance of the participant podiatrist relationship was also identified as cental to the delivery of 'person-centred' podiatry. The research findings depict older people who want to be involved in their care rather thm being 'a burden to the state. Recognition is also given to the changing nature of caring relationships in the next decade, and how NHS podiatry services will have to profoundly transform if they are to deliver a holistic, person-centred service in the future.

Progression of chronic kidney disease (CKD) in diabetes can be slowed by strict blood pressure and blood sugar control, prescription of medicines that modify the renin-angiotensin system and lifestyle changes, such as smoking cessation. Because of the large numbers of people with diabetes whose condition progresses (and eventually require dialysis or transplantation), it is possible that the management of their diabetes remains sub-optimal. The overall purpose of this thesis is to develop, test and evaluate an educational package to help people self-manage their risk of CKD progression. This thesis contains a case study, a critical review of literature, the main research study and an artefact (the self-management package). The case study developed from a three-month observation period in six general practitioner (GP) practices. The literature review evaluates the effect of patient education and selfmanagement on diabetes control and outcomes. The research project develops and evaluates the self-management package. Development of the package was informed by the findings of the case study and literature review, and also through interviews with 15 people at high risk of CKD progression. The resulting self-management package comprises written information; a 20-minute DVD filmed with patients; a fridge magnet (with key messages); a monitoring diary; and a blood pressure machine if required. Testing of the package was undertaken in the same six practices mentioned above, with one additional control practice. Patients with Type 1 or Type 2 diabetes at risk of kidney disease were included. Data on renal function (serum creatinine, eGFR and proteinuria), systolic and diastolic blood pressure (BP), glycated haemoglobin (HbA1c), body mass index (BMI) and smoking status were collected at six time points, before, during and after the intervention. Outcomes in patients in the participating surgeries who did receive a pack (n=116) were compared with patients in the control group (n=61). At time point 4 mean systolic BP in the intervention group was 129.2 ± 19.2 mmHg vs. 134.6 ± 15.0 mmHg in the control group (p=0.057). At time point 5 there was mild significance (p=0.053) in mean diastolic BP. At the end of the study (time point 6) the intervention group had a mean systolic BP of 132.1 ± 14.2 mmHg vs. 136.2 ± 16.4 mmHg and mean diastolic BP of 74.9 ± 8.5 mmHg vs. 77.6 ± 9.1mmHg in the control group (p=ns). There were no significant differences in HbA1c and BMI at any time period. The results of the research project have shown the importance of self-management techniques to control blood pressure, which in turn can slow the rate of CKD progression and reduce cardio-vascular risk. Following evaluation by patients, the self-management package has been amended and strategies for local and national dissemination of the package have been put in place.