Maximal short-term power output was determined in adults and children and its variability under different physiological conditions was examined.

Thrombocytopenia, occurring sometimes in conjunction with disseminated intravascular coagulation, has been reported sporadically in both human and animal trypanosomiases. The extent of the thrombocytopenia and its relationship to the anaemia and parasitaemia has been investigated in experimental infections of Trypanosoma brucei brucei and Trypanosoma congolense in rabbits, and of Trypanosoma vivax in calves. Studies of platelet size, structure, function and survival have been undertaken in an attempt to ellucidate the mechanism for the thrombocytopenia. A significant decrease in platelet number is associated with the early parasitaemia of the infection. A parasite-mediated mechanism, either immune or toxic, leads to in vivo platelet clumping, marked platelet ultrastructural changes and functional inhibition of the circulating platelets. The potential ischaemic action of the resultant microthrombi and the haemostatic problems of poorly functioning platelets may contribute significantly to the pathology of the disease. Platelet destruction, precipitated by the parasite, occurs in the spleen resulting in a reduced platelet lifespan. Experiments in asplenic animals show that other organs can take over the splenic role in this respect. Thrombocytopenic stimulation of platelet production from the increased megakaryocytic mass in the bone marrow only partially compensates for the platelet loss which continues late in the infection by a mechanism unrelated to parasite number. Evidence is provided suggesting that the expanded mononuclear phagocytic ability of the reticular endothelial system actively or passively continues the platelet destruction at this time. Support for two different mechanisms of platelet destruction, active at different stages of the disease, is also provided by experiments involving different strains of trypanosome and limited immunity experiments. The pattern of platelet destruction is similar to that suggested for red cells of an early haemolytic anaemia with a non-haemolytic anaemia active in the later stages.

A collection of Lancefield group C and group G streptococci was examined for biochemical or serological properties that could provide the basis for their subdivision beyond species and serological group.

This thesis explores the techniques employed for monitoring human exposure to airborne trace elements in urban atmospheres using trace metal analysis of human hair.

The proportion of maximum force (% PF max) utilised during cycling exercise was determined within a group of trained and untrained subjects. Maximum forces were determined isokinetically and submaximum forces were measured during continuous progressive exercise tests.

Rationale: The reported incidence of postpartum depression and anxiety for women in the first year after birth in the UK ranges from 15 to 20 per cent. Research suggests that as many as 58 per cent of women with symptoms of postpartum depression do not seek professional help, indicating that the incidence of postpartum emotional difficulties may be much higher. Attempts to understand the help-seeking behaviours of women with symptoms of postnatal depression have identified stigma as one of the reasons for avoiding treatment. Although the relationship between stigma and help-seeking has been explored in the context of mental health in general, at the time of writing it does not appear to have been a primary research question for the specific population of women in the postpartum period. Aim: This thesis seeks to examine how women understand the role of stigma in the context of seeking help for postpartum emotional difficulties. Method: Constructivist grounded theory was selected due to its ability to accommodate a heterogeneous sample of women, representing a spectrum of emotional well-being and help-seeking behaviours. Initially, four first-time mothers were interviewed. Purposive sampling followed, recruiting two additional participants as well as conducting a follow-up interview with one of the original interviewees as part of data validation. In total, seven interviews were conducted with six women. Findings: Analysis highlighted five emergent themes: experiencing a difference between expectations and reality; re-evaluating a sense of self; seeking and trusting the help available; “saying it how it is” and the role of breastfeeding in stigma and help-seeking. A Grounded Theory Model was created to demonstrate the relationship between these themes. It appears that the absence and avoidance of ‘open and honest’ conversations about the difficult elements of mothering at a public, inter- and intra-personal level might perpetuate the stigmatisation of postpartum emotional difficulties. In addition, aspects of the way that professional support services are designed, which may indirectly amplify stigma and inhibit help-seeking, are explored. Implications for further research and the role that Counselling Psychologists can play in advancing multi-disciplinary practice to reduce stigma related to postpartum emotional difficulties are proposed.

"Medically unexplained symptoms" or "MUS" is a term used to reference a poorly understood phenomenon in which patients experience subjectively compelling and distressing somatic symptoms which are not explained by underlying physical pathology. The literature on MUS is replete with controversy regarding the diagnosis and classification of this problem. A dualistic diagnostic system that seeks to classify disorders as either “physical” or “mental” disenfranchises patients with MUS who are so firmly at the intersection, causing problems that reverberate throughout the system. Effective treatment of MUS has been impeded by a complex array of barriers, including structural problems in the health system, lack of consensus over MUS aetiology, lack of effective therapies, and a shortage of suitably trained therapists. A pluralistic review of the clinical literature highlights that no single, universally accepted, and empirically supported model of MUS currently prevails. Furthermore, issues with patient engagement have been consistently highlighted as a problem. Despite this, few exploratory studies on treatment have been conducted so at present, relatively little is understood about either therapists’ or patients’ experiences of therapy for MUS. This research has used a constructivist grounded theory approach to explore the process of therapeutic engagement based on depth interviews with specialist clinicians who work with the most complex patients with MUS in primary care. Through a process of constant comparison the analysis identified how multiple interacting layers of disconnections (systemic, interpersonal and intra-psychic) impede engagement. The research introduces a new theoretical framework “negotiating disconnection” that conceptualises the process of engagement in terms of a series of stages: “drawing in” (negotiating systemic disconnection), “meeting patients where they’re at” (connecting in the disconnection) and “nudging forward” (cultivating new connections), and illustrates how the different stages of engagement are negotiated by clinicians. The model shows that it is critical for mental health clinicians to engage the medical system and collaborate closely with GPs in order to engage these patients. However, it also points to some of the challenges that may be encountered doing this, reflecting the complexities of organisational and cultural change. At a clinical practitioner level, the model illustrates the importance of adopting a flexible, pluralistic and integrative approach that is person and process-led. The model emphasises the importance of clinicians and doctors, who must both embrace a holistic (biopsychosocial) stance towards MUS and to be sensitively attuned to its complex phenomenology. Implications for service structure, psychological therapy provision, training and future research are discussed, as well as implications for Counselling Psychology.

Whilst counselling psychology has established itself as recognised profession in both the NHS and the independent sector, studies and anecdotal evidence have shown that counselling psychology positions itself in opposition to the prevalent medical discourse and is not as well understood an known as its cousin clinical psychology. At the same time, the Increased Access to Psychological Therapies services translate principles of evidence-based practice and clinical governance into a model of psychological therapies delivery, which creates areas of tension between counselling psychology identity and IAPT’s identity. Research conducted in the US and UK as well as anecdotal evidence suggests that this conflict can lead to unclear professional identities for counselling psychologists practising in this setting, contributing to burn-out, disillusionment and job dissatisfaction. Semi-structures interviews were conducted with six counselling psychologists with experience of working in IAPT services, which were analysed using interpretative phenomenological analysis. Their experience of professional identity whilst working in IAPT highlighted an ambivalent relationship with their professional identity, which was attributed to the tension between organisational and professional identities. The consequences were signs of burn-out, disillusionment, disconnection from the profession as well as a negative selfimage of clinical skills. The mediating factor of stages of professional development is discussed.

Background: Black Africans in developed countries have a higher prevalence of diet-related chronic diseases. However, dietary and anthropometry data is limited, particularly on sub-groups such as Ghanaians in the UK. Objectives: To determine the habitual diet and body composition of first generation Ghanaian migrants, to validate a food frequency questionnaire specific for Ghanaians, find the ideal body image of Ghanaians and the body size most attractive to Ghanaian males and to conduct a nutrition intervention programme using the Black Churches as a setting. Methodology: Cross-sectional survey. Participants were volunteers and first generation Ghanaian migrant who were congregants of Black Churches in London (n=288). Information on dietary intake was obtained from multiple repeated 24-hour recalls in a sub-sample (n=68) of the survey participants. The food frequency questionnaire was developed using the most commonly reported foods and portion sizes, field tested, shortened and then validated with multiple 24hr recalls (n=68). Information was also collected on height, weight, waist circumference, waist to hip ratio and percentage body fat which was measured using a portable bioelectric impedance analyzer (n=212). Participants from London (n=45) and Ghana (n=79) completed questionnaires to collect information on their ideal size and other body-shape related questions using the Figure Rating Scale (FRS). The nutrition intervention programme (n=76) was developed with input from participants through focus groups and the Obesity Clinic at the London Metropolitan University. Participants were assigned to either the intervention or control group and information on socio-demography, dietary intake and anthropometric measurements were taken at baseline, 6 weeks and at 3 months to evaluate the effectiveness of the intervention programme. Results: Energy and the percentage energy from fat intake of Ghanaian migrants (1987 kcal, fat 35.3%) was similar to that of the host population (1972kcal, fat 35.4%) but carbohydrate and fibre intake was different (carbohydrate 50.1%, fibre 16.4g vs 48.1%, 13.9g) for migrant Ghanaians and host population respectively. Energy under-reporting was 31% for this survey and was associated with gender and body mass index. The food frequency questionnaire performed well relative to 7 multiple 24-hour recalls with correlations increasing after adjusting for energy (protein r= 0.71, fat r=0.69, carbohydrate r=0.54, fibre r=0.69). Participants were correctly classified in the same (34%) or adjacent quartile (54%) for most nutrients with only 3% to 9% of participants mis-classified into opposite quartiles. Bland-Altman plots were within limits of agreement for all the macro-nutrients. The prevalence of overweight and obesity was higher in female migrant Ghanaians using body mass index (67%) compared to the host population (58%) but prevalence was lower when percentage body fat was used (female 40%). There was a cultural shift in acceptability of overweight and obese body sizes and shapes among Ghanaians with 60% of Ghanaian males preferring Ghanaian females with a normal body size. The nutrition intervention programme was conducted over 6 weeks and changes were observed in energy (intervention - 250kcal vs -135kcal (NS)) and fat intake (intervention -3.8g (p=0.04) vs control -2.1g (NS). Waist circumference decreased by 2.2cm (p=0.05) for the intervention group after 6 weeks. After 3 months fat intake decreased by 7.3g (p=0.000) for the intervention group and 10.4g (p=0.04) for the control group. Changes in anthropometry still persisted after 3 months for body weight (-2.3kg, p=0.001), body mass index (-1.4kg/m², p=0.001) waist circumference (-3.3cm, p=0.04) and % body fat (-2.0%, p=0.01) for the intervention group. Changes in anthropometry were also observed in the control group for weight (-0.9kg, p=0.05), waist circumference (-1.9cm, p=0.006) and waist-hip ratio (-0.1, p=0.03). Conclusion: The dietary intake of Ghanaian migrants in the UK is similar to the host population. The food frequency questionnaire developed specifically for this population is an adequate dietary assessment tool. Ghanaian males preferred females with normal body sizes. The prevalence of overweight and obesity is higher in female migrant Ghanaians compared to the host population and the Black Churches are an effective setting for the delivery of nutrition intervention programmes.

Atopic dermatitis (eczema) is a psychosomatic chronic skin condition. Onset of the condition usually occurs in early life. Some people however, do develop it much later. Even though studies have demonstrated high levels of psychological disturbance and maladjustment among most people with AD, some others still do not, suggesting that a certain level of variability exists in the way people adjust to their skin condition. The goal of the present study was to identify the factors that determine adjustment to AD and account for this variability. Existing studies on this topic have considered factors such as: age of onset of the condition, demographic characteristics, disease severity and visibility, cognitive representations of illness and condition appraisals. Most of these studies however are limited in the explanations that they offer. Drawing upon the schema theory model of personality development and psychopathology, the present study proposes that adjustment to AD is mediated by personality-level structures (self-schemas) that have their origins in early experiences. Design: A cross-sectional design was employed with three groups: a) patients with an early onset of atopic dermatitis (n = 130), b) patients with a late onset (n = 76) and c) people with no chronic medical condition (n = 74). Method: All groups completed the Young Parenting Inventory- Revised, and the Young Schema Questionnaire-Short Form 3. The two atopic dermatitis groups also completed the Adjustment to Chronic Skin Disease Questionnaire. Results suggest that: a) people with an early and a late onset of atopic dermatitis were presented with a certain schematic profile that differentiated them from participants in the control groups; b) a certain pattern of early parenting experiences was linked to the development of this schematic profile and c) this schematic profile predicted high levels of dysfunctional coping and difficulties in adjustment. Findings have a clear relevance to the practice of Counselling Psychology. Limitations of the study and clinical implications are discussed.