The main aims and objectives of this study was to determine if plant essential oils (PEOs) and polyphenol-rich fruit extracts (PRFEs) could reduce the viability of Giardia duodenalis trophozoites, Trypanosoma cruzi epimastigotes and Cryptospordium parvum oocysts in vitro. All PEOs tested reduced epimastigote and trophozoite viability at a concentration of 0.02% v/v, with titrations of the PEOs showing a concentration dependant decrease in viability. The minimum inhibitory concentrations (MICs) of PEOs demonstrated that myrtle and elemi oil were the most active PEOs (trophozoites = 0.005% v/v; epimastigotes = 0.00125% v/v) with the terpenes, α-pinene and limonene, constituents of these oils, being responsible for their action. Incubation of palmarosa oil and its terpene, geraniol, with C. parvum oocysts caused the almost complete excystation of oocysts (in the presence of increased temperature and time), with geranium oil and its terpene, citronellol, being nearly as effective. PRFEs reduce trophozoite viability, with 4 members of the Rosaceae Family causing complete reduction at 167 μg ml-1, possibly through their ellagitannin content. Cloudberry extract was found to have an MIC comparable to the drug metronidazole (67 μg ml-1). The historical use of blueberries for the treatment of diarrhoeal diseases was demonstrated by the ability of blueberry PRFE, pressed juice and drink to kill trophozoites. Protein expression was both inhibited and upregulated in several proteins in whole cell lysates of PEO treated trophozoites, indicating a supplemental intracellular mode of action. Both PEOs and PRFEs cause morphological changes to epimastigotes and trophozoites through flagellar truncation and internalisation, swelling and rounding of the cell body, cytoplasmic condensation and the formation of large membrane protrusions. These indicate an action on the membrane itself with possible changes in osmoregulation. Both PEOs and PRFEs can be considered to be candidates for novel drug discovery for the treatments of cryptosporidiosis, giardiasis and American trypanosomiasis.

Objective: During feeding there is an integrated 'whole body' response which endeavours to maintain energy homeostasis. The integrated response consists of sensory, postingestive, postabsorptive and cognitive feedback which exerts control over ingestive behaviour. It is accepted that when an imbalance in this integrated response occurs and may promote an increased fat mass and ultimately can lead to obesity which is known to play an important role in the development of IGT and type 2 diabetes. This study investigated the integrated responses of a test meal to determine any differences between IGT, type 2 diabetics and controls in their integrated response mechanisms. This knowledge may be important in both predicting the onset of these diseases and in the treatment of them. Research Design and Methods: IGT and type 2 diabetics with a BMI greater than 30 were recruited together with a group of healthy controls. The study assessed habitual energy intakes and energy expenditure in all groups. All participants' height, weight, BMI and WHR were measured. A taste test assessed the sensory component of food intake. The metabolic response and parallel changes in appetite to the meal were recorded at baseline and at 15, 30, 60, 90 and 120 minutes. Results: Control participants had significantly lower weight (p<0.01), BMI (p<0.01), waist (p<0.01) and hip (p<0.01) measurements compared to IGT and the type 2 diabetic groups. Habitual diet diaries indicated a lower sugar intake in the type 2 diabetic group compared with IGT and control groups. Percentage protein intake was significantly lower in control participants (14.4%, p<0.05) compared to IGT (17.2%) and type 2 diabetics (18.5%). Activity diaries highlighted an indication of increased strenuous/physical activity in the control participants compared to IGT participants however, this was not statistically significant. The control group showed greater sensitivity to PROP followed by type 2 diabetics and then IGT participants (p<0.05). Throughout the study the control participants rated themselves the most hungry compared to IGT (p<0.05) and type 2 diabetics (p<0.01) respectively and controls were also the least satiated (p<0.05). There was no difference in fullness ratings. Control participants rated prospective consumption the highest compared to IGT and then type 2 diabetics (p<0.05) respectively. The differences in EE measured by calorimetry when normalised for body weight indicated that IGT (p<0.01) and type 2 diabetic participants (p<0.01) had significantly lower EE than control participants. CHO oxidation rates were significantly lower in IGT and type 2 diabetics (p<0.05). Investigating the blood parameters showed no differences in plasma ghrelin responses, that IGT participants had the highest overall plasma glucose (p<0.01) and insulin (p<0.05) responses. Conclusions: It is clear that there are subtle differences in the pathways of energy balance in IGT and type 2 diabetics compared to controls; including sensitivity to taste, subjective feelings of appetite, EE, oxidation rates and differing blood parameters. Taste appears to be an important contributor to the sensory control of food intake and is associated with an increased sugar intake. Furthermore, differences between IGT and type 2 diabetics demonstrate that the degree of management of the disease can influence the effectiveness of the metabolic pathways controlling food intake. It is not clear which component is the most influential in the control of food intake and it is likely that the synergistic effects are what potentiate the diseases and make them difficult to combat.

Traditionally, quantifiable research into homeopathy has largely focused on its effectiveness compared to forms of mainstream medicine. The effect of such comparisons is that homeopathy is commonly constructed as not being demonstrably effective. It becomes discredited, demarcated and downgraded as an alternative ‘type’ of practice, subsequently marginalised in terms of mainstream acceptance. Qualitative studies concerned with homeopathy and focusing on notions of personal credibility, demarcation and the marginal are primarily concerned with practitioners’ perspectives, where views are taken for granted and regarded as representative of accurate events. Thus, no study has focused on and investigated social constructions of homeopathic practice derived from practitioners, and their patients, in the semi-structured interview and in the context of the homeopathic consultation. Here, I identify and fill a gap in the literature which is currently under-represented. The corpus of twenty practitioners, seventeen patients and five homeopathic consultations drawn from interview and consultation contexts were recorded and subsequently transcribed verbatim. The innovative analytical framework is informed by discursive psychology perspectives that focus on accounts as action. Discourse analysis (DA) led to new, original and significant findings about how interpersonal experiences in relation to homeopathic practice are contingently formulated and constituted in interaction and configured over broader discourses. The analytical chapters show how talk about homeopathy is presented via four discursive strategies: by using the communicative competencies and descriptions they do, the participants’ factual accounts function to enhance their own individual credibility and that of their practices, defend their practices and attend to the notion of personal accountability as a discursive practice. For those advocates for homeopathy, managing their personal credibility is accomplished only through sensitive ways of accounting. This reflects the way in which homeopathic practice is located in a culture of scepticism, as an alternative, contested and controversial ‘type’ of practice positioned on the fringe of the modern medical market. Demonstrating an understanding of homeopathy and their expectations of it as a form of treatment, participants draw upon dichotomised categories attributed to notions of mainstream medicine and homeopathy, combined with various discursive devices to add persuasiveness to their descriptions. Overall, the originality of the research lies in the application of the innovative interactional DA framework, its broad range of participants and unique findings from within the field of homeopathy. With several implications, it forms a unique interdisciplinary, theoretical, and methodological contribution to the DA literature. It has practical implications for future policy makers, in the education and training of practitioners, and offers ways to approach future research in homeopathic encounters and in parallel health-related encounters such as other CAM therapies, Myalgic Encephalomyelitis or Chronic Fatigue Syndrome and Attention-Deficit Hyperactivity Disorder. Notably, the transferability of the findings has wider implications for the understanding of other contested, controversial and new medical practices in the ways that mainstream medicine is the taken-for-granted, accepted yardstick for practice. In making this distinction, the paradoxical boundaries of what is and what is not acceptable is seen as a central issue to members’ mutually intelligible sense-making practices in everyday medical encounters.

Introduction: The amino acid homocysteine has been identified as a risk factor for cardiovascular disease (CVD), as elevated levels induce atherosclerosis, through a direct effect on arterial tissue. In alcohol dependent individuals an association between plasma homocysteine levels and alcohol consumption has been found (Bleich et al. 2000d). However this link has not been explored in individuals who have a range of nondependent alcohol drinking patterns. This fact has informed the design of the present work. Material and Methods: A convenience sample of abstainers (N=7), non-dependent drinkers (N=28) and alcohol dependent individuals (N=18) was recruited. Alcohol consumption was recorded using questionnaires and diaries. All study participants’ biological samples were analysed for the following biomarkers: plasma homocysteine (HPLC); serum folate and vitamin B12 (competitive immunoassay); serum Carbohydrate Deficient Transferrin (N-Latex immunoassay); urinary creatinine (colorimetric assay) and the methylenetetrahydrofolate (MTHFRC677T) polymorphism (Real-Time Polymerase Chain Reaction (PCR)). Results: There was no association between alcohol consumption during drinking days and plasma homocysteine levels in non-dependent drinkers. However when this group was categorised according to pattern of consumption, plasma homocysteine levels were found to be lower in abstainers (median 5.60 μmol/l), but higher in sessional drinkers (median 7.15 μmol/l) and alcohol-dependent individuals (median 7.89 μmol/). The mutant MTHFR(C677T) polymorphism when present was associated with an increase in plasma homocysteine levels, which correlated with alcohol consumption (R=0.975). CDT levels were found to be elevated in both sessional and alcohol-dependent individuals at baseline (median 2.68% and 5.95% respectively) compared with abstainers (2.16%). Additionally there was a linear relationship between the number of drinking days in a week and a positive CDT result, in a sample of sessional drinkers (R=0.98). Discussion: The work undertaken has shown that sessional drinking and alcohol dependence does increase homocysteine levels in comparison to abstainers. This may have important implications in relation to CVD risk. Additionally new evidence of the utility of CDT as a biomarker of alcohol consumption within a sample of sessional drinkers, has been identified.

Nutrition is a major concern in paediatric cancer, increasing the risk of co-morbidities, affecting tolerance of therapies and influencing survival. Despite this, very few studies have aimed to identify the nutritional risks of children treated for cancer in the western world. A unique retrospective study was therefore proposed to assess the degree of nutritional risk in paediatric cancer using the need for nutrition support (NS) as a proxy for high nutritional risk. Of 168 patients, seventy four (44%) required NS of whom 50 (67%) and 24 (33%) had solid and haematological malignancies. These findings underline the common need for NS in this childhood cancer cohort. A prospective study was consequently designed to assess the effect of cancer and its treatment on nutritional status, using commonly used assessment techniques. Measurements were taken regularly at six time points over a period of up to 18 months. 26 patients, 18 (69%) male and 8 (31%) female (median age 5.1; IQR 2.3, 7.9) volunteered for the study. At recruitment and during the first three months of treatment, those with solid tumour demonstrated nutritional deprivation, low BMI (median 25.5, IQR 5.5-60.5; median 18.0, IQR 7.5-54.2 respectively), low fat mass %(median 76.3, IQR 48.5-99.1; median 70.8, IQR 62.6-124.8 respectively), low energy intake (median kcal/d 1200, IQR 866-1970; median 1305 kcal/d, IQR 901-1488) and a high need for NS. In contrast, those with haematological cancer demonstrated an excess BMI (median 66.0, IQR 41.5-82.2; median 79.5; IQR 70- 94.2 respectively), high fat mass % (median 102.0, IQR 78.6- 153.0; median 129.4, IQR 96.5-202.6,respectively) and excessive energy intake (median kcal/d 2076; IQR 1453-2525, median kcal/d 1078, IQR 919-1206 respectively) These results suggest that children undergoing cancer therapy are at high risk of both undernutrition and obesity and they indicate apparent differences in nutritional risk according to diagnosis and treatment.

Polyphenols are phytochemicals widely available in plants. Dark chocolate (DC) is a high source of polyphenols, particularly flavanols. Studies previously reported a beneficial effect of polyphenol-rich dark chocolate (PRDC) on insulin sensitivity and oxidative stress, while its effects on blood pressure, serum lipid levels and inflammation remain unclear. In addition, a research area regarding the effect of PRDC on body weight control emerged recently. Two investigations were carried out. Study I (61 participants) looked at the effect of PRDC on insulin sensitivity in normal weight and overweight adults, while Study II (14 participants) investigated the effect of PRDC on body weight in overweight individuals. Volunteers received 20g of either PRDC (500mg of polyphenols) or placebo DC (low in polyphenols) daily for 4 weeks (Study I) or 12 weeks (Study II). Anthropometric measures and blood, saliva and urine samples were taken. Results showed that 4 weeks of PRDC supplementation decreased insulin levels (p<0.001) and HOMA-IR (p=0.003), and increased QUICKI (p<0.001), but had no significant impact on glucose levels (p=0.16). However, participants administered placebo DC showed an increase in insulin (p=0.014), HOMA-IR (p=0.003), TG (p= 0.008), glucose (p=0.041) and BMI (p=0.007) levels and a decrease in QUICKI (p=0.013). No significant changes in blood pressure, other serum lipid levels or glucocorticoid hormones were noted in both groups. In study II, there was an increase in BMI in the whole study population (p=0.046) with no significant difference between groups. Results indicate a potential implication of PRDC in the prevention of risk factors for cardiovascular diseases. Findings also highlight the detrimental effects of placebo DC, and propose the analysis of polyphenol content of different DC brands in the market. The increase in BMI and other markers only in the placebo group after four weeks, suggests that PRDC may counteract the adverse effects of fat and energy in the diet. However, the increase in BMI in both groups after 12 weeks implies further investigations to test the counteracting effect of PRDC over the long term.

Introduction: Scotland has an ageing population which has significant implications for health and social care services. Encouraging older people to engage in healthy lifestyle behaviours has the potential to maintain a person’s functional ability, increase healthy life years and thus has the potential to enable older people to live at home independently for longer. Recommendations for levels of activity have been produced for older adults but whether these are being achieved is currently unknown. Levels of activity are influenced by many factors including nutritional and functional status, dietary intake and fatigue but as yet the relationship between these parameters and habitual activity has not been established. Therefore the aims of this study were 1) to determine the relationship between levels of habitual activity and nutritional status, functional ability, dietary intake, and levels of fatigue in older adults and 2) to inform physical activity targets for the aging population. Methods: Older adults were recruited from a range of social and leisure facilities across central Scotland. Habitual activity was measured continuously for seven consecutive days using an activPALTM accelerometer. Nutritional status (BMI, waist circumference (WC), tricep skinfold and mid arm muscle circumference) was measured using ISAK methodology. Functional status (handgrip dynamometry, sit to stand (STS), six minute walk (6MW) and gait speed (m/s)) was measured along with dietary intake using a seven day unweighed diet diary. In addition levels of fatigue were measured using the Multi-dimensional Fatigue Inventory. Pearson’s correlation coefficient analysis was utilised to establish relationships between levels of habitual activity and markers of nutritional status, functional status and dietary intake. Spearman’s rho correlation analysis was utilised to establish the relationship between levels of habitual activity and levels of fatigue. Partial correlation analysis was used to establish the influence of age and gender on these relationships. Results: Forty four (21m, 23f) healthy older adults were recruited and completed the study. Participants were found to spend a mean±sd 551 ± 88 min in sedentary behaviour daily which equates to 61±10% awake time being sedentary. They took 8721 ± 3585 steps daily and spent 108±38 min stepping, 253±78 min standing and 1080±103 min sitting or lying each day. Percent time in sedentary behaviour was positively associated with BMI (r=.302, p=.049), WC (cm) (r=.302, p=.049), percent energy intake from fat (r=.535, p<.001) and saturated fat (r=.381, p=.011) and was negatively associated with 6MW (m) (r=-.445, p=.002) and % energy from non-milk extrinsic sugar (r=-.314, p=.038). Total weekly time in moderate intensity activity accumulated in blocks of at least 10 minutes was positively associated with 6MW (r=0.321, p=.041), daily protein intake (g) (r=.350, p=.025) and mean daily vitamin D intake (μg) (r=.404, p=.009) and was negatively associated with STS (r=-.321, p=.041). Age but not gender influenced the relationships. Conclusion: This is the first study to report objectively measured levels of sedentary behaviour where habitual activity was measured continuously over seven days and sedentary behaviour was considered during waking hours only in a Scottish older adult population. Recommendations for physical activity were not consistently met and there is therefore some indication that current recommendations for sedentary behaviour and physical activity should be reviewed. However activity cannot be considered in isolation as many factors influence this including nutritional status, functional status, dietary intake and levels of fatigue.

Good nutrition is essential for optimal growth and functional development in children. Research indicates that the preschool years are essential for encouraging children to develop a taste for healthy food. Scotland’s obesity rates are amongst the highest in the world, and in areas of low socio-economic status, obesity and related conditions are considered to be most prevalent. It is also widely reported that areas of deprivation are related to poor dietary intake. In 2004, Edinburgh Community Food Initiative (ECFI) was responsible for initiatives that were based on ECFI’s ‘provide and promote’ philosophy, combining health promotion activities with the provision of fresh fruit and vegetables to schools, child and family centres and community centres in the most disadvantaged communities of Edinburgh. Funding was acquired from the Big Lottery Fund to initiate a citywide health initiative in the nursery school setting called ‘the Pip Project’. The aim of this research was to identify dietary intake at baseline in pre-school children and their parents from council sector nurseries, and to observe changes in dietary intake and behaviour over a period of 20 months, comparing dietary intake of children and their parents from areas of lower socio-economic status who received the Pip project interventions to those from areas of higher socio-economic status, who did not. Dietary intake was recorded using a 5 day diet diary at three time points; prior to nursery school attendance (August 2005), at completion of year one (June 2006), and two months prior to leaving nursery (April 2007). A questionnaire was also completed to determine knowledge and dietary behaviour at baseline (August 2005) and at the end of the research period (April 2007). Baseline intake was compared to the National Diet and Nutrition Surveys for adults and for children aged 1.5 to 4.5 years, the Payne and Belton Edinburgh preschool dietary survey, the Food Standards Agency Low Income Diet and Nutrition Survey, and the standards devised by UK Scientific Advisory Committee for Nutrition (SACN). Results at baseline were comparable to results from other national surveys. Research indicated that all adults were aware of the 5 a day message and 80 % thought that 400 g was ‘just right’ or ‘not enough’. Adults, and particularly those from the lower SES group, had clear knowledge of what constituted one portion of fruit or vegetables and did not report any barriers to healthy eating, however at baseline fruit and vegetable intake was 260 g/d, which was significantly lower (p = < 0.05) than the recommended 400 g/d and intakes were significantly less (p = < 0.05) in the lower SES group (219.5 g/d compared with 297.5 g/d in the higher SES group). Minimal increase was seen in fruit and vegetable intake of adults from the lower SES group, who consumed significantly less (p = < 0.05) than adults from the higher SES group by the end of the 20 month research period; children from the lower SES increased their intake by 1 portion (82 g) per day but still consumed less than the children from the higher SES group by stage 3 (203 g/d compared to 253 g/d). At baseline, the diet was balanced for adults and children in terms of % energy from CHO and fat, but mean intakes of both NME sugar and saturated fat were greater than the recommended maximum intake of 11 % total food energy. Mean intake NME sugar in children was 17.9 %; intakes were greater in the higher SES group (19.5 % compared to 16.6 %). Mean intakes were also significantly greater (p = < 0.05) in the parents from the higher SES group (15.2 % compared to 11 %). Mean intakes of NME sugar in parents decreased in both groups over the 18-month duration of the study but mean intakes in children remained high throughout the research period. Saturated fat intakes increased in adults from both SES groups, but were higher in the lower SES group at all stages. There was no change in mean saturated fat intake over time in children from the higher SES group, but mean intake decreased in children from the lower SES group (from 16.2 % to 14.1 %). Mean intake of NSP increased in both parents and children, but remained below the recommended 18 g/d throughout the study. With the exception of iron, mean intakes of all micronutrients for parents were greater than the RNI in both groups. Iron intake was lower than the RNI (14.8 mg/d) at all stages. At baseline intakes were lowest in the lower SES group (9.3 mg/d compared to 11.4 mg/d); 11 participants consumed less than the LRNI (8 mg/d), eight of whom from the lower SES group (73 % of participants). Mean intakes increased in the lower SES group by 3.7 mg/d over the duration of the study but neither group reached the RNI at any stage. At baseline, children met the RNI for all micronutrients, and there were no significant differences between groups. Overall the diet of children, particularly from the lower SES group, improved over the duration of the study, although salt and NME sugar intake did not decrease over time. Further research is required to investigate the best methods to improve diet in families with young children, with particular emphasis on reducing % energy from NME sugar and saturated fat, reducing salt intake and increasing fruit, vegetable and NSP intake.

The purpose of this study is to investigate the effectiveness of homeopathy in improving perceived health and well being in the 55+ age group. Homeopathy is defined as a complex intervention including the homeopathic remedy, the therapeutic relationship and participant choices about self care. The literature on health care for the 55+ age group suggests growing concern about the need to find ways of improving the health and quality of life of older people. Smallwood (2005) suggests that homeopathy and Complementary and Alternative Medicine (CAM) may contribute to improvement in the health and well being of older people in our society. Research has been carried out into the use of homeopathy to improve health and well being, but has not focused on homeopathy as a complex intervention or its use for the 55+ age group. A mixed methodology was chosen for this research study based on a pragmatic approach. An embedded design was used, with qualitative measures as the primary source of data and quantitative measures as the secondary source. Twenty participants were recruited and received homeopathic treatment. Their response to treatment was recorded in interview transcripts, case notes, the practitioner‟s reflective journal, and results from Measure Your Own Medical Outcomes Profile (MYMOP) and SF-36 questionnaires. The practitioner was also the researcher. The participants in this study clearly identified the outcomes and the nature of the experience. 18 out of 20 participants noted a definite or limited improvement in their health which they associated with homeopathic treatment. Additionally, participants valued the opportunity to review life experiences, to make connections between life events and health issues and the resulting increase in self awareness. They reported benefits that were consistent with classical homeopathic philosophy and practice, and other research studies into homeopathic treatment. Their evidence confirmed that homeopathy provided a healing experience both physically and emotionally which met the complex needs of participants in the study, and potentially future health care needs of this age group.

Breakfast has been shown to increase the supply of glucose to the brain which improves short-term memory. On waking hepatic glycogenolysis is the major buffer against short-term (12-18 hrs) fasting. The higher ratio of brain weight to liver weight in the child (1.4 - 1.6 versus 0.73 for the adult) and the 50% greater metabolic rate per unit brain weight in the child, places a greater demand on the child's glycogenic stores during a short fast as compared to the adult. Few school breakfast studies have examined the effect of different breakfasts on cognitive performance. This study investigated the nutritional differences of a habitual breakfast consumed at hom (NBC) and breakfast served at a breakfast club in (BC) school and the effect of these breakfasts on cognitive performance. Subjects were primary school children aged 7-11 years old in Scotland. When baseline cognitive performance scores were compared to scored at data collections 2,3 and 4 there were more significantly pronounced improvements for the NBC group than the BC group (p < 0.001). There were significantly greater numbers of children eating a cooked breakfast in the BC group and significantly higher numbers of children eating a cereal breakfast in the NBC group. As a result breakfasts of the BC group were higher in fat (MUFA and PUFA) (p < 0.01) and lower in percentage energy from carbohydrate than the NBC group. Positive correlations existed between percentage energy from carbohydrate and percentage energy from starch and cognitive test performance (p < 0.01). This suggests that a breakfast higher in % energy from carbohydrate such as a cereal breakfast benefits short-term memory, by supplying the brain with readily available supply of glucose it's primary and preferred fuel. This results of this research provide evidence for the requirement of guidelines to ensure that breakfasts served at school will both assist learning in morning lessons and be in-line with healthy eating recommendations.