During pregnancy and breastfeeding, women are concerned about the health and safety of themselves and their baby. They undertake many activities in order to maintain good health, manage minor ailments and improve their lifestyle, including seeking help and advice from pharmacies. Community pharmacists have an important role in selecting appropriate medicines and encouraging good health behaviours. The Thai population can purchase medicines from pharmacies without a prescription, and self-treatment or self-medication is commonly used and important to the health status of Thai people. In addition, culture, family and relatives have an influence on health behaviours in Thailand. There have been very few previous studies about self-care behaviours including self-medication in Thailand focused on healthy women during pregnancy and breastfeeding, and the views of community pharmacists in self-medication and self-care during pregnancy and breastfeeding. In addition, the modern lifestyle and accessible health information might be affected by the current attitudes and behaviours of women during pregnancy and breastfeeding. Therefore, an investigation of self-care behaviours in pregnant and breastfeeding women was needed to explore their recent behaviours in terms of maintaining health and well-being as well as managing minor ailments. Views and experiences of community pharmacists about self-care in pregnancy and breastfeeding were also explored. This study contributes to the understanding of self-care behaviours and indicates the actual situation in community pharmacies regarding self-care and self-medication in pregnancy and breastfeeding. Two in-depth interviews in the Thai language were held with 43 women in Chiangmai about their self-care experiences and behaviours during pregnancy (>34-weeks gestation) and 35 out of the 43 women in the breastfeeding period (>four weeks following birth). Audio-taped interviews were transcribed, translated and analysed by using interpretative analysis. In addition, a postal questionnaire survey was used to collect data from 198 full-time community pharmacists in Chiangmai province. The first mailing was sent in April 2006 and a reminder was posted in June 2006. The completed questionnaires were returned from 110 pharmacists and the response rate was 56%. The majority of pregnant women tended to change their habits and adopt activities that they thought could make them and their babies healthy. They tried to consult their doctor rather than self-medicating. The traditional beliefs still had a very strong influence on most women interviewed during both pregnancy and postnatal period. The majority of pharmacists strongly agreed that self-care is important for both pregnant and breastfeeding women and they believed they provided good support for these women. Some pharmacists, however, still lacked the confidence to provide appropriate advice for these women and appeared to need more support with up-to-date information. Regarding the implications of this study, some self-care activities are harmful to women and their babies, so their dangers should be widely advertised in appropriate places. Furthermore, health professionals should consider a balance between safe traditional beliefs and modern health systems to ensure the best self-care practices for both women and their babies. In addition, continuing education and up-to-date information will help to increase the pharmacists’ confidence in providing appropriate advice to pregnant and breastfeeding women.

This study is an empirical exploration of Foucault's theoretical ideas on resistance, through a case study of cervical cancer screening and women's responses to the official discourse surrounding it. In England, this form of screening is organised through a national programme and consistently achieves coverage of over 80%. Given this high attendance it may appear that any resistance is negligible. However, this thesis argues that such a focus on attendance, or behaviour, is misguided and that, by focusing attention on the level at which the official discourse on screening is interpreted, understood and made sense of by individual women, it is possible to identify instances of thought and talk based resistance. Using qualitative interviews with a sample structured to include a range of ethnic backgrounds and ages, the thesis identifies three key forms of resistance. Firstly, women may resist the general subject position suggested within the official discourse and make sense of screening in ways that are meaningful to them as individuals. Secondly, many women resist the general 'at risk' status suggested and negotiate their own position drawing on a range of risk factors that do not always fit well with those medically recognised. Thirdly, in making sense of the information they receive, women frequently attempt to create a rational framework of knowledge and understanding which can lead to them interpreting issues such as risk factors or disease development in different ways. Based upon these, the thesis argues for conceptualising power and resistance in terms of a complex network of possibilities with multiple points of potential difference or divergence that can lead to individuals adopting very different subject positions. Although the majority of resistance detailed is thought and talk based, this is nevertheless important as it provides the means for challenges to the official discourse and constitutes a necessary prerequisite for further behavioural resistance.

This thesis seeks to determine the macro-economic impacts of changes in health care provision, whilst recognising the simultaneous effects of consequent changes in health on effective labour supplies and the resource claims made by the health care sector. The resource allocation issues have been explored in theory, by developing an extension of the standard Rybczynski theorem from a low-dimension Heckscher-Ohlin framework, and empirically, by developing a Computable General Equilibrium model, calibrated to a purpose-built dataset for the UK. The theory predicts that, if the government is solely concerned with improving per capita income, a morally questionable policy of targeting health care provision towards skilled workers performs best. Furthermore, the impact of an expanding health sector on the outputs of non-health sectors is shown to depend on the sign and magnitude of a scale effect of increased effective labour supplies and a factor-bias effect of changes in the ratio of skilled to unskilled labour, although the latter effect dominates if effective labour supplies are relatively inelastic with respect to health care provision. The theoretical predictions are not generally validated by the applied model due to added real-life complexities. The main findings are that a rise in NHS expenditures, the employment of foreign health care-specific skilled workers, and costless factor-neutral and skill-biased technical change in the UK health sector have a positive impact upon overall welfare via direct improvements in population well-being and indirect benefits from increased worker incomes. The study indicates that if an expansion of the health sector is financed from a reduction in state benefits, the non-working households and pensioners may require some compensation since they rely relatively heavily on these as a source of income. The presence of health care-specific factors and rising pharmaceutical prices impact negatively upon the health sector and overall welfare, suggesting the importance of tackling rising input costs and structural rigidities. This may be achieved by the immigration policy, although since effects on domestic workers if their wages are not sustained, and on countries of origin faced by a 'brain-drain', are negative, in the long-term increasing the number of medical school places may be more desirable. Another suitable policy response is to purchase a more effective pharmaceutical product. Fairly small productivity gains in health care were shown to generate overall welfare gains. Finally, factor-neutral and skill-biased technical improvements yield significant welfare gains and cost-savings in the health sector. Such technical improvements may come in the form of improved medical procedures, which have been developed abroad yet are freely available or have been funded by charitable institutions, but also may reflect domestic policy which aims at reducing administrative overheads so that more resources can be devoted to front-line staff. The sensitivity of the results to the elasticity of the waiting lists with respect to health care indicates the importance of ensuring that additional resources are effectively employed, attainable by the technical and administrative improvements in health care.

Complex social problems (the continued rise in chronic disease; resource depletion, inequality etc.) call for new social marketing frameworks to accommodate midstream and upstream action which requires collaborations with multiple actors (government, public and private sector). Service-dominant logic (SDL) (Vargo and Lusch, 2004) theoretical developments (systems thinking, value creation, networks etc.) suggest a good compatibility with the collaborative approaches required by midstream and upstream social change (Russell-Bennett, Wood and Previte, 2013). This thesis interrogates the applicability of SDL concepts (value creation and actor engagement) to social marketing. This study focuses on examining the factors influencing engagement, actor motivation and perceived value in a health social marketing context. The study adopts a case study approach and draws upon interviews, observation and document analysis to examine a Smokefree homes and cars programme (‘Smokefree’) in a city in England. Key findings of this research indicate that adopting a service orientation facilitates contextualising social marketing programmes, building capacity at the community level and adopting a long-term approach which suits better the realities of individuals. However, it also reflects that understanding and addressing contextual factors means considering the fluidity of individuals’ goals and the subjective dimension of value which might challenge pre-set programme objectives. The study indicates that a collaborative approach to value creation poses challenges in addition to the benefits. This study is one of the few (Domegan et al., 2013; Lefebvre, 2012; Russell-Bennett, Wood and Previte, 2013) to contribute to the efforts to examine the implications of a service perspective for extending social marketing theory. One of the main contributions of this study is illustrated by the articulation of service dominant benchmarks for social change programmes. A key implication for policy is that building collaborations with community services is essential to understanding individuals in context, customising offerings and supporting skill development.

No description available.

Despite major advances in the diagnosis of infections for many pathogenic organisms, there is still a problem obtaining an accurate immunodiagnosis of Echinococcus infection due to its serological cross-reactivity with other species of taeniid cestodes or at higher taxonomic levels. For this reason, there are ongoing efforts to develop a better method for diagnosis of echinococcosis, especially when the parasite has a crucial role in hypersensitivity reactions. Like other helminthic infections, one of the immunological hallmarks is an elevated serum concentration of parasite-specific IgE. Our aim was to assess the use of IgE reporter system as a possible new method for diagnosis Echinococcus spp infection, using RS-ATL8 NFAT Reporter System, which is a humanised rat basophilic leukaemia (RBL) cell line that can be used to detect the presence of specific human IgE directed against Echinococcus allergens and cross-link their receptors, depending on luciferase generation as an indication of presence of parasite-specific IgE, pointing to infection. Towards this goal, we first optimised the use of the humanised RS-ATL8 Reporter System. This was achieved by optimisation of experimental conditions, such as cell density, stimulation time, optimum conditions for sensitising factors and stimulant optimum concentration. Once a robust standard operating procedure had been elaborated, the second goal was to choose a few Echinococcus antigens for the investigation into their immunogenic properties and potential diagnostic value and to express them recombinantly for testing through the RS-ATL8 NFAT Reporter System. The chosen antigens were EF1-alpha, EgAg5, AgB2, Cyclophilin, Eg19, EgTeg, and EgTPx.

This thesis explores the impact of lifestyle factors on the development of metabolic syndrome (MS) in Saudi Arabian women. A survey of a snowball sample was used to recruit 258 female and explored factors influencing physical activity (PA) and food intake and their effects on BMI in women living in the KSA and the UK. Participants completed a self-reporting questionnaire relating to knowledge, attitudes, barriers and levels of PA, sedentary activity and eating habits. Excessive energy intake, physical inactivity and sedentary lifestyle were all prevalent in Saudi women, resulting in 80%, over the age of 35y, being overweight or obese. BMI was associated with both energy intake and PA, though the relationship with the former was stronger. The most common barriers to regular exercise were transportation and lack of time. Findings were generally similar between women living in Saudi Arabia and the UK. The efficacy of reducing energy intake, with or without increased PA, on risk factors associated with MS in overweight Saudi women was investigated in a pilot study. After a four-week program, incorporating dietary modification alone (D) or in combination with regular vigorous aerobic exercise (D+E), improvements were seen in body composition and a range of metabolic risk factors. Both groups lost weight, but, paradoxically, those in D lost significantly more than those in D+E (5.3 vs. 3.3%, p=0.016). Moreover, significant reductions were also found in blood pressure, plasma triacylglycerol, insulin, total and LDL cholesterol, with no significant differences between the two groups. Plasma glucose and HDL cholesterol remained unaltered. Overall, these changes led to a decline in the prevalence of MS from 20% to 5% and 21% to 7% for the D and D+E groups, respectively. Thus, reducing energy intake appears, at least in the short term, more important than increasing PA in reducing body weight and associated metabolic risk factors. These studies confirm that excessive dietary intake and physical inactivity both contribute to overweight and obesity in Saudi Arabian women. With appropriate support, it is possible to both reduce energy intake and increase PA, although, in the short -term, the former appears to be most important. It remains to be established whether longer-term improvements in PA would further improve metabolic health.

The rise in population together with industrialisation in the first half of the nineteenth century presented central government and local authorities with new challenges. Large numbers of people crowded together in poorly constructed homes with very limited sanitation facilities and created the perfect breeding ground for infectious diseases. The endemic nature of many of these diseases affected the most vulnerable members of society and the reduction in the high death-rates was an important consideration for the authorities. The Public Health Act 1848 was the first serious attempt by Westminster to tackle the problems of urban health which had been identified in several reports published in the 1840s. During the second half of the century public health policy was hesitantly developed and concentrated on cleaning up the environment in the expectation of bringing about a reduction in deaths. At the same time, rising living standards and improved food supplies to the towns brought about slight improvements in the dietary levels of the urban poor. A combination of factors brought about a rapid decline in death-rates by the end of the nineteenth century, and a further fall mainly attributable to changes in the pattern of infant mortality in the early period of the twentieth century. This thesis tests the general pattern of change in the context of Nottingham, one of Britain's largest provincial cities. It assesses the relative roles played by improvements in the areas of public health and housing and their contribution to the reduction in deaths. It then examines the issue of the improvements in food and nutrition, particularly at the beginning of the twentieth century, by assessing how accessible a more balanced and nutritional diet was available to the working-classes. It then assesses the changes in health during the period 1850-1939 and concludes that the improvements in the environment were minimal until 1920 and had little to do with the reduction in the death rate. The suggestion is that a better diet together with gradual improvements in the environment brought about the decline in deaths from certain diseases.

ABSTRACT MORPHINE BIOTRANSFORMATIONS BY MICROBIAL PHENOL OXIDASES Erdural Korkmaz, Beril M.S., Department of Chemical Engineering Supervisor: Prof. Dr. Ufuk Bakir Co-Supervisor: Prof. Dr. Ayhan S. Demir January 2006, 96 pages The objective of this study is to perform morphine biotransformation by using phenol oxidases. Syctalidium thermophilum, Thermomyces lanuginosus and Phanerochaete chrysosporium cells and culture fluid were used as microbial intracellular and extracellular phenol oxidases. Besides the phenol oxidases produced in laboratory, commercial pure phenol oxidases, A. bisporus tyrosinase and laccase, T. versicolor laccase and horseradish peroxidase, were also used in the morphine biotransformation reactions. Morphine biotransformation to pseudo-morphine was achieved by using pure T. versicolor laccase, A.bisporous tyrosinase and laccase. Before utilization of phenol oxidases in morphine biotransformations, the time course of microbial phenol oxidase productions were followed. Maximum phenol oxidase activity of S. thermophilum were detected on the 5th day of cultivation as 0.17 U/ml and the 4th day of cultivation as 0.072 U/ml, respectively. On the other hand, maximum laccase activity of P. chrysosporium was detected on the 8th day of cultivation as 78.5 U/ml. Although phenol oxidases which were obtained from S. thermophilum or T. lanuginosus could not catalyze morphine biotransformation, phenol oxidases including a peroxidase of P. chrysosporium transformed morphine to pseudo-morphine and an unknown product.

The severity of the outbreak of an infectious disease is highly dependent upon the structure of the population through which it spreads. This thesis considers the stochastic SIR (susceptible → infective → removed) household epidemic model, in which individuals mix with other individuals in their household at a far higher rate than with any other member of the population. This model gives a more realistic view of dynamics for the transmission of many diseases than the traditional model, in which all individuals in a population mix homogeneously, but retains mathematical tractability, allowing us to draw inferences from disease data. This thesis considers inference from epidemics using data which has been acquired after an outbreak has finished and whilst it is still in its early, `emerging' phase. An asymptotically unbiased method for estimating within household infectious contact rate(s) from emerging epidemic data is developed as well as hypothesis testing based on final size epidemic data. Finally, we investigate the use of both emerging and final size epidemic data to estimate the vaccination coverage required to prevent a large scale epidemic from occurring. Throughout the thesis we also consider the exact form of the households epidemic model which should be used. Specifically, we consider models in which the level of infectious contact between two individuals in the same household varies according to the size of their household.