Diabetes is a progressive multi-factorial metabolic syndrome with serious short and long term complications affecting many of organs with high increasing prevalence in the world. Using herbs and their derivatives for treating diabetes has a long history in many traditional cultures across the world. Molecules and compounds were isolated from herbs are the basis of many therapeutics which we are using in medicine for treating a variety of health conditions. The seeds of fenugreek, Trigonella foenum graecum, commonly used as a spice in Middle Eastern countries and widely used in South Asia and Europe, are known to have anti-diabetic properties. In 1979, Hardman identified an unusual amino acid (2S, 3R, 4S) 4-hydroxyisoleucine (4HO-Ile) in a fenugreek seed extract as an active compound in fenugreek seed. It was so far found only in fenugreek seed, which is responsible for its anti-diabetic properties. Studies on 4-hydroxyisoleucine effects on type 2 diabetes and insulin resistant animal models revealed that it has anti-diabetic properties of enhancing insulin secretion under hyperglycaemic conditions, and increasing insulin sensitivity. Unfortunately, the available published researches for 4-hydroxyisoleucine are limited and its mechanism of actions is not clear. Here we describe for the first time the anti-diabetic activity of 4-hydroxyisoleucine in a model of type 1 diabetes as all the previous works focused on 4-hydroxyisoleucine activity in type 2 diabetes and insulin resistant condition. Treatment of streptozotocin-treated type 1 diabetes rats, where levels of insulin are much reduced, by 65%, compared to normal animals, with daily doses of 4-hydroxyisoleucine at 50 mg/kg/day for four weeks could reduce plasma glucose in the diabetic group. Moreover the high levels of lipids (cholesterol, HDL, III LDL and triglyceride) and uric acid in the diabetic rats, could be restored to levels found in non-diabetic controls by the treatment with 4-hydroxyisoleucine. These results demonstrate that 4-hydroxyisoleucine has significant anti-diabetic activities in type 1 diabetes as well as previously studied type 2 diabetes and insulin resistance model that are independent of insulin. The findings suggest the potential of 4HO-Ile as an adjunct to diabetes treatment and for type 1 as well as type 2 diabetes. To investigate the insulin-independent effects of 4-hydroxyisoleucine further, the cell based experiments were designed to assess the effect of 4-hydroxyisoleucine on cellular glucose uptake and ATP content after one day incubation. Isoleucine was added to the experiment as a positive control because firstly it has some level of anti-diabetic properties according to previously published studies and secondly it has similar molecular backbone as 4-hydroxyisoleucine. BRIN-BD 11, a functional and glucose responsive pancreatic beta cell, was selected as a cell model which is not insulin-responsive and dependent on the insulin signalling pathway for glucose uptake. Use of the model provides the opportunity to study the mechanisms of action of both 4-hydroxyisoleucine and isoleucine independently. We adopted a unique approach using inhibitors to target suggested pathway and molecules within the cell which may be involved in both 4-hydroxyisoleucine and isoleucine mechanism of actions. The results revealed that 4- hydroxyisoleucine and isoleucine could increase glucose uptake in BRIN-BD 11 cells, but as previously suggested, 4-hydroxyisoleucine activity is in direct correlation with glucose concentration. 4-hydroxyisoleucine has higher activity in higher concentrations of glucose. 4-hydroxyisoleucine increased the glucose uptake much greater than isoleucine at 11mM and 22mM concentration of glucose in IV cell culture medium. Endpoint measurements of ATP content of the BRIN-BD11 cells did not show any significant changes between 4-hydroxyisoleucine and isoleucine groups and control as well as an insulin level measurement in culture medium after 24 hours. The results showed that there are substantial differences between isoleucine and 4-hydroxyisoleucine mechanisms of action unlike their similar glucose uptake stimulatory effect which is greater in 4-hydroxyisoleucine. 4-hydroxyisoleucine activity strongly dependent on new protein synthesis and GLUT 1 activity. GLUT 1 is widely available in most of the cells and it controls the basal glucose uptake independent of insulin. The connection between GLUT 1 and 4-hydroxyisoleucine effect in cellular level, supports the idea that 4-hydroxyisoleucine utilises the glucose basal consumption and uptake of cells. Mitochondrial calcium channel signalling inhibition affects 4-hydroxyisoleucine and isoleucine functionality as well as inhibition of mitochondria pyruvate carrier. Real time monitoring of cell metabolism by Seahorse XF-24 autoanalyser after 24 hours incubation with 4-hydroxyisoleucine and isoleucine revealed that both 4-hydroxyisoleucine and isoleucine activities are strongly dependent on mitochondrial respiration but 4-hydroxyisoleucine significantly up-regulates glycolysis which is not affected by isoleucine. The connection between mitochondria calcium signalling and contradictory behaviour of 4-hydroxyisoleucine and isoleucine support the very important role of mitochondria in their mechanisms of action.

The recent development of biological therapies has revolutionized medical treatment for psoriatic arthritis. To date, research studies have focused on the treatment effects of biologics from a quantitative perspective using generic quality of life measures. An understanding of how treatment with biologics is experienced in the lives of psoriatic patients themselves therefore remains lacking. This study investigated the lived experience of psoriatic arthritis patients receiving biological therapy by employing Interpretative Phenomenological Analysis (IPA) to access this experience. Analysis of the data highlighted that receiving biologics for psoriatic arthritis was experienced as life-changing, but also required participants to make sense of the many unknowns surrounding treatment in regard to future effectiveness and long-term side effects of biologics. Participants experienced a biomedical focus on disease and treatment effects alone as not taking into account the significant psychological impact that having psoriatic arthritis and being treated with biologics can have on sufferers’ lives. Three master themes were identified: new lease of life, living with the fear of the unknown, and the importance of seeing the disease and the person. It is argued that this research extends the current knowledge base in counselling psychology on the psychological aspects of skin conditions such as psoriasis to what it is like to have both psoriasis and arthritis, whilst also being relevant to counselling psychologists working with psychological aspects of medical conditions, which is proposed to hold a promising future for the field.

Multiple sclerosis is an inflammatory and demyelinating multifactorial disease that results from the interplay between environmental factors and a susceptible genetic background. Omega (ω)-3/ω-6 polyunsaturated fatty acids (PUFAs) and some vitamins have been shown to reduce the number and severity of relapses and the overall progression of disability in multiple sclerosis patients, however clinical trials remain inconclusive due to a plethora of reasons. In this randomized, double blinded, placebo controlled trial aiming to provide concrete conclusions for the role of PUFAs and vitamins A and E (both gamma (γ) and alpha (α)) in multiple sclerosis. By measuring the incorporation and changes of the lipid composition in red blood cell (RBC) membranes before and after the dietary intervention, and by correlating the efficacy of the different interventions with disease progression, it was shown that supplementation with these specific molecules (that can either act on their own or synergistically) could probably cause the decrease of arachidonic acid (AA) and linoleic acid (LA) from the RBC membranes and the subsequent substitution by eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These events parallel the clinical observations where this can be correlated with the increased number of relapse activity occurring in the first six months of treatment and later with a prolonged period of remission. Supplementation with the mixture of PUFAs (both ω3 and ω6), vitamin E as gamma tocopherol significantly reduced the annualised relapse rate (ARR) and the risk of sustained disability progression without any reported serious adverse events.

Irritable Bowel Syndrome (IBS) is a common functional bowel disorder thought to effect between 10-20% of the UK population. IBS places much demand on the NHS to fund and treat. It is twice as common for IBS to be found in women compared to men. IBS gender findings are limited. Little is known about how IBS is experienced by men. A qualitative approach examined in-depth subjective accounts of six men who had IBS via semi-structured interviews. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Findings were interpreted against existing IBS research and literature and using a biopsychosocial framework. Participants experienced IBS as psychologically debilitating which often restricted activities, threatened relational identities and was isolating. Enduring experience of IBS seemed to compromise sense of self, constructs of masculinity and could foster despondency and helplessness with IBS. IBS symptoms frequently seemed unpredictable and illogical to cope with. Participants often conveyed ambivalence about seeking help for IBS. Many participants struggled to get their needs recognised and met in treatment with health professionals. Men had difficulties comprehending the ambiguities of IBS and need to accept and adapt to IBS. Disclosing IBS to others presented risk for incurring poor understanding, stigma and shame. Counselling psychologists could adapt therapeutic styles to build containing, collaborative relationships that better engage men in treatment. Therapeutic interventions could be adapted to better empower men and more adequately respond to their needs with IBS. Subjective differences in IBS presentation and experience implied need to individualise therapeutic treatments. Counselling Psychologists could help men accept the given aspects of IBS and nurture awareness of management responsibilities and abilities to influence IBS. Therapeutic efforts could challenge any stigma or shame about having IBS. Counselling Psychologists could facilitate efforts to maintain a valued sense of self and promote psychological well-being rather than specifically seeking a cure.

Background: The traditional Omani diet of dates, milk, rice, brown bread, fish and vegetables has undergone considerable change, now resembling a Western diet that is high in calories, high glycaemic index carbohydrates, total fat and saturated, trans and omega 6 fatty acids, and low in omega-3 fatty acids and essential micronutrients. The available data on daily food intake and its impact on micro- and macro-nutrients are scanty in the Arab world. Obtaining these data is especially important in light of the growing prevalence of non-communicable diseases (NCDs) - cardiovascular diseases, diabetes, cancer and respiratory diseases - which now account for more than 60% of the global disease burden and mortality, and contribute to more than 50% of annual deaths in Arabian countries, including Oman. Moreover, obesity, an antecedent of NCDs, has reached epidemic proportions in the region. Since NCDs develop gradually during the course of the lifespan, various national and international committees on NCDs have recommended that children and young adults be the primary focus of any action plan that aims to prevent and control non-communicable diseases. Specific aims: The aims of the study are: a) To assess the nutrient intake, body composition, blood lipids, blood pressure, blood glucose and cognitive behaviour of Omani school children; b) To assess the level of Vitamin A, D, E, and Beta Carotene among the Omani school children c) To assess the level of red blood cell fatty acids of Omani school children d) To investigate the effect of fish consumption on red blood cell omega-3 fatty acids and plasma fat-soluble vitamins; e) To investigate the impact of omega-3 fatty acids obtained from fish oil capsule on the red blood cell omega-3 fatty acids and plasma fat-soluble vitamins. Methods: Children ages 9 and 10 years (n = 314) were recruited from three randomly selected schools in the Muscat Governorate. The schools were assigned to a fish, fish oil, or control group and the children were accordingly provided a lightly grilled oily fish, a re-esterified triacylglycerol fish oil capsule, or no fish for 12 weeks. Baseline body weight, height and body mass index were assessed and a non-fasting blood sample collected at baseline and after 12 weeks of intervention. Data on food intake were gathered using a 24-hour recall questionnaire; also collected were data on weight, height, blood pressure, triglycerides and fasting glucose. In addition, teachers completed the National Initiative for Children’s Health Quality Vanderbilt Assessment Scales-Teacher Assessment Scale to assess the prevalence and sub-types of ADHD. Results: At baseline, a significant number of the children had low levels of vitamin D, and omega-3 fatty acids. The low levels of vitamin D and omega-3 fatty acids were ameliorated significantly by fish consumption and fish oil supplementation. In terms of weight, the prevalence of overweight or obesity for the total sample was 28.2% (10%, 46%) and 22.6% (8%, 38%). That is, about one fourth of the study subjects were overweight or obese. With regards to ADHD, the prevalence rate of PIS, PHIS and ADHDCIH among Omani school children was 7.3%, 3% and 8.8%, respectively. After 12 weeks intervention, the children who received fish oil (54.1±17.5 nmol/L; p < 0.001) and fish (49.2±17.4 nmol/L; p < 0.05) had elevated levels of vitamin D than those who did not (42.3±17.5 nmol/L). The fish oil (1.2±0.70 μmol/L) and fish (1.20±0.7 μmol/L) groups also had higher concentrations of beta carotene than the placebo group (0.85±0.43 μmol/L; p < 0.0001). Systolic and diastolic blood pressure (p=0.0001) and plasma triglycerides (p < 0.05) but not HDL, LDL and total cholesterol (p > 0.05) were lower in the fish oil group compared with those who were fed oily fish. Conclusions: This study provides important and underreported data on nutrient intake levels by school children in Arab world. For the first time, these data will be available as a benchmark for future research and health programs in the region. A large number of boys and girls had diets that failed to provide the recommended levels of daily nutrients. This study also indicates that ADHD is relatively common among Omani school children; additional studies are needed to assess the generalisability of these findings. Vitamin D deficiency is prevalent in Omani school children, but can be mitigated with omega-3 fatty acid supplementation. This study also provides evidence that Omani pre-adolescents have a low level n-3 fatty acid index that can be ameliorated by fish oil supplementation or consumption of oily fish. Hence, there is a need for a child-focused program of food fortification, school feeding programmes, targeted intervention with n-3 fatty acid enriched food products, family nutrition education and outdoor activities to alleviate the problem.

"Medically unexplained symptoms" or "MUS" has been constructed as a term to describe persistent physical symptoms for which no medical aetiology can be found. "MUS" account for at least 20 per cent of UK medical consultations, yet fit uneasily within a biomedical discourse where illness is legitimised by medical diagnosis. "MUS" supposedly operates as a neutral category, yet critical review of the literature problematises this so-called neutrality: it fails to be neutral whilst avoiding depicting the situation as it is. There is widespread conflict about terminology and aetiology, which results in the subjective creation of legitimacy criteria; disavowal of a psychological dimension; and patients receiving costly and ineffective treatment. This research, motivated by the need within this conflict to better understand the implications of how we talk about “MUS”, explores how practitioners are constructing “MUS”. Four semi-structured interviews with GPs and counselling psychologists were undertaken and analysed using Foucauldian Discourse Analysis. Alongside underlying biomedical discourses, discourses of separation, mindbody dualism, psychology and holism were identified. These contributed to various constructions of "MUS", including "MUS-as-choice", "MUS-as-challenge", "MUS-as-unreal", "MUS-as-placeless" and "MUS-as-untold-story". This research problematises the separation of illness into categories, the psychologisation of "MUS" and the lack of availability of an acceptable holistic discourse with which to construct illness. It emphasises the performative nature of our talk about "MUS" and the importance of discourse awareness for deepening our understanding of social and cultural influences on how we see the world and act within it. Exclusive biomedical and psychological constructions of illness displace "MUS" as legitimate illness and limit opportunities for constructive dialogue. As practitioners, we need to resist getting caught up in these frameworks. Suggestions are made for how practical disturbances of current working practices might be achieved.

Psoriasis is a chronic autoimmune skin condition that can impair psychological, social, and physical functioning. The psychological implications of psoriasis can be highly disturbing and a significant number of patients with psoriasis live with considerable and enduring psychological distress. An accumulating body of evidence suggests that Cognitive Behavioural Therapy (CBT) may be the most effective in ameliorating the psychological distress resulting from living with psoriasis. CBT has been effective in reducing the emotional distress, the quality of life impairment associated with psoriasis and as a result the clinical severity of it. The mechanisms behind these changes are not known, however. Outcome studies in CBT have shown that common factors (i.e., therapeutic relationship) and/or technical ones (i.e., CBT techniques) account for therapeutic change. The aim of this study is to identify the factors that influence the treatment process and the outcome of CBT for individuals with psoriasis and develop a model of it. This study adopted a constructivist Grounded Theory approach. In-depth semi-structured interviews were conducted with nine patients who had completed a course of CBT within the Psychodermatology Clinic of a hospital in England. From the analysis emerged the model of “Guided Therapeutic Growth” which was the core conceptual framework that subsumed the factors that influence the patients’ experiences of their therapeutic processes in CBT. These factors were: (a) “feeling engaged with the therapeutic process”; (b) “establishing a trusting therapeutic relationship”; (c) “legitimising the expression of distress associated with psoriasis”; and (d) “guided cognitive restructuring of the meanings attached to psoriasis”. The integration of these four interrelated factors forms a tentative model that was found to impact the therapeutic growth by reducing distress, alleviating emotional pain and helping individuals with psoriasis to become more self-compassionate, all of which were found to motivate and empower them to move forward and achieve positive changes in their adjustment to their psoriasis. Conversely, the absence of these factors or the presence of certain hindering conditions could compromise the therapeutic experience of CBT and jeopardise progress. In this context, the following hindering conditions were reported: (a) negative preconceived notions about homework; (b) too much or too little directiveness by the therapist; and (c) externalisation process of emotional release experienced by the patient as too revealing.

Rationale: There is accumulating evidence supporting the effectiveness of Acceptance and Commitment Therapy (ACT) in a group context for individuals with depression and/or anxiety. However, there is limited qualitative research in this area. Aim: This thesis aimed to address this gap by exploring individuals’ experiences of an ACT group for depression and/or anxiety. This may provide an insight into how individuals understand ACT processes and the mechanisms for therapeutic change within ACT. Method: Semi-structured interviews were conducted with six participants. Transcripts were analysed using Interpretative Phenomenological Analysis. Findings: Three master superordinate themes emerged; Group Dynamics; The Journey of Therapy; Usefulness of Therapy. A description of these superordinate themes and the seven related subordinate themes are discussed. The findings highlighted the benefits and challenges of ACT tools and concepts as well as the group context. Recommendations for clinical practice and future research are outlined.

Objective: Expanding the original scope of the study, which was to explore the decision-making process of pregnant women in the uptake of invasive diagnostic tests - amniocentesis and Chorionic Villus Sampling (CVS) – and taking into account the latest emergence of a Noninvasive Prenatal Testing, NIPT, the primary goal of this study was to explore factors that influence women’s decision to have an invasive, a non-invasive or no further testing at all. Design and sample: The Prenatal Decision Making Questionnaire (PDMQ) developed for the purposes of this study. Following a pilot test and factor analysis, it was distributed to a population of pregnant women (N=421) prior to them receiving their combined screening results. The total sample was divided into three sub-groups according to their risk status (low-intermediate-high) for the analysis. Results. Logistic regression analysis using the R version 3.0.3 revealed that none of the PDMQ factors had a significant impact on women’s decision to have an invasive test (CVS), whereas the following three factors had a significant impact on the decision to have a non-invasive test (NIPT): negative attitude to doctors and an internal locus of control were associated with the uptake of NIPT, whereas a negative attitude to medicine was associated with rejection of NIPT When risk status was included in the model it was found that uptake of NIPT was predicted by the presence of some level of risk for T21 or T13/T18. On the contrary, uptake of CVS was only predicted by an increased risk for T21. Conclusion(s): Women’s decision making process in prenatal diagnosis is affected by several factors with personalised risk being one of the key determinants. The findings of this study can be used by healthcare professionals in providing the appropriate support and information and facilitating an informed decision during this stage of pregnancy.

Research suggests that adoptees are seen in therapeutic settings in a greater proportion than their prevalence in the general population (Kennedy Porch, 2007). Few studies concentrate on adult adoptees, and those that do mainly focus on adjustment and the search for/reunion with the birth family rather than on therapy research. In particular, there seems to be a lack of empirical and theoretical understanding of the complexities of the therapeutic relationship when working with adults who were adopted. Early experiences can affect an adult's ability to form trusting relationships with others, including with a therapist. Counselling psychology, as a discipline, has a particular interest and skill base in understanding the therapeutic relationship and is therefore in the position to offer a valuable contribution to research on the therapeutic relationship with an individual who has been adopted as an infant. Through six semi-structured interviews, adoption counsellors currently working with adult adoptees were asked to share their experiences and understanding of the nature and the role of the therapeutic relationship. A qualitative methodology guided by Interpretative Phenomenological Analysis (IPA) enabled detailed exploration of the adoption counsellors' perspective. Three master themes were identified in the analysis: An awareness of the early rejection in all stages of the therapeutic process; a personal commitment to provide a corrective emotional experience; and the psychological consequences of working with adult adopted clients for therapists. The analysis highlighted the challenges that participants perceived in terms of establishing, maintaining and ending the therapeutic relationship with adoptees. The findings of this study extend the pre-existing research base by emphasising the interconnectedness of the personal and professional experiences of adoption counsellors and the need for flexibility in their practice in each phase of the therapeutic process, predominantly with regard to therapeutic boundaries and engaging in a different ending experience. The themes are discussed in relation to existing literature with an emphasis on attachment theory. The discussion also highlights practical implications, particularly the importance of familiarisation with aspects of adoption due to their likely influence on the therapeutic relationship and the need for reflective practice.