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Search Results: 1 - 10 of 4223 matches for " Denise Howel "
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Waist Circumference and Abdominal Obesity among Older Adults: Patterns, Prevalence and Trends
Denise Howel
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0048528
Abstract: Objectives To describe the patterns and trends in waist circumference and abdominal obesity for those aged 70–89 contrasting the standard and new age-related cut-points, and to investigate how they vary with time, age and educational level. Methods The subjects were 7129 men and 9244 women aged 70–89 years who participated in the Health Survey for England during 1993–2010. The outcome measures were the percentiles of waist circumference and standard and new indicators of abdominal obesity based on waist circumference. Binomial and quantile regression were used to investigate the relationship with key explanatory variables. Results The distribution of waist circumference among community-dwelling older adults in England has shifted upwards since 1993 (an increase in median of 4.5 cm in men and 5.1 cm in women). The prevalence of abdominal obesity has increased, while those in the low-risk group have decreased. Abdominal obesity was higher in those aged 70–79 compared to 80–89, and in those who left education earlier. The prevalence of abdominal obesity varies considerably with new and standard cut-points, which makes it impractical to use the new ones on a population that includes subjects across the adult age range. Conclusions Obesity is increasing among the elderly, but more work is needed on devising age-appropriate indicators of high risk based on waist circumference.
A systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings
Jean Adams, Martin White, Suzanne Moffatt, Denise Howel, Joan Mackintosh
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-81
Abstract: Published and unpublished literature was accessed through searches of electronic databases, websites and an internet search engine; hand searches of journals; suggestions from experts; and reference lists of relevant publications. Data on the intervention delivered, evaluation performed, and outcome data on health, social and economic measures were abstracted and assessed by pairs of independent reviewers. Results are reported in narrative form.55 studies were included in the review. Only seven studies included a comparison or control group. There was evidence that welfare rights advice delivered in healthcare settings results in financial benefits. There was little evidence that the advice resulted in measurable health or social benefits. This is primarily due to lack of good quality evidence, rather than evidence of an absence of effect.There are good theoretical reasons why income supplementation should improve health, but currently little evidence of adequate robustness and quality to indicate that the impact goes beyond increasing income.Socio-economic variations in health, including variations in health according to wealth and income, have been widely reported [1-4]. However, interventions to overcome socio-economic variations in health have achieved little success[5,6]. One potential method of improving the health of the most deprived groups is to increase their income. Despite a number of income supplementation experiments – particularly in the USA in the 1960s and 1970s – little investigation of the impact of these experiments on health has been performed[7].State funded welfare programmes of financial benefits and benefits in kind for, amongst others, the unemployed, the elderly and the sick are common in developed countries. However, there is evidence of widespread under claiming of welfare benefits by those eligible for them, with take up of income related benefits in the UK around 80% in 2002[8]. Take up rates in the rest of Europe are around 40–80% wit
The acceptability and impact of a randomised controlled trial of welfare rights advice accessed via primary health care: qualitative study
Suzanne Moffatt, Joan Mackintosh, Martin White, Denise Howel, Adam Sandell
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-163
Abstract: 25 men and women aged 60 years or over were recruited from four general practices in Newcastle upon Tyne (UK), a sub-sample of those who consented to be contacted (n = 96) during the RCT baseline interview. Semi-structured interviews were undertaken and analysed using the Framework Method.Participants viewed the trial positively although, despite agreeing that the information leaflet was clear, some had agreed to participate without being fully aware of what was involved. Some participants were unaware of the implications of randomisation. Most thought it fair, but a few concerns were raised about the control condition. The intervention was acceptable and made participants feel confident about applying for benefit entitlements. 14 out of 25 participants received some financial award; median weekly income gain was £57 (€84, $101). The perceived impact of additional finances was considerable and included: increased affordability of necessities and occasional expenses; increased capacity to deal with emergencies; and a reduction in stress related to financial worries. Overall, perceived independence and ability to participate in society increased. Most participants perceived benefits to their mental well-being, but no-one reported an improvement in physical health. The RCT showed little or no effect on a wide range of outcome measures.Participation in the trial and the intervention was acceptable to participants. Welfare rights advice targeted at people aged 60 years or over and accessed via primary care had a positive impact on quality of life and resulted in increased social participation. The divergence of qualitative and quantitative findings suggests that both methods make important contributions to the evaluation of complex social interventions.Qualitative research is increasingly used alongside randomised controlled trials (RCTs) to study factors such as recruitment[1], participants' experiences[2], lay understandings of randomisation[3] and informed consent[4],
Using quantitative and qualitative data in health services research – what happens when mixed method findings conflict? [ISRCTN61522618]
Suzanne Moffatt, Martin White, Joan Mackintosh, Denise Howel
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-28
Abstract: Quantitative and qualitative data were collected contemporaneously. Quantitative data were collected from 126 men and women aged over 60 within a randomised controlled trial. Participants received a full welfare benefits assessment which successfully identified additional financial and non-financial resources for 60% of them. A range of demographic, health and social outcome measures were assessed at baseline, 6, 12 and 24 month follow up. Qualitative data were collected from a sub-sample of 25 participants purposively selected to take part in individual interviews to examine the perceived impact of welfare rights advice.Separate analysis of the quantitative and qualitative data revealed discrepant findings. The quantitative data showed little evidence of significant differences of a size that would be of practical or clinical interest, suggesting that the intervention had no impact on these outcome measures. The qualitative data suggested wide-ranging impacts, indicating that the intervention had a positive effect. Six ways of further exploring these data were considered: (i) treating the methods as fundamentally different; (ii) exploring the methodological rigour of each component; (iii) exploring dataset comparability; (iv) collecting further data and making further comparisons; (v) exploring the process of the intervention; and (vi) exploring whether the outcomes of the two components match.The study demonstrates how using mixed methods can lead to different and sometimes conflicting accounts and, using this six step approach, how such discrepancies can be harnessed to interrogate each dataset more fully. Not only does this enhance the robustness of the study, it may lead to different conclusions from those that would have been drawn through relying on one method alone and demonstrates the value of collecting both types of data within a single study. More widespread use of mixed methods in trials of complex interventions is likely to enhance the overall quality
Randomised controlled trial of welfare rights advice accessed via primary health care: pilot study [ISRCTN61522618]
Joan Mackintosh, Martin White, Denise Howel, Tom Chadwick, Suzanne Moffatt, Mark Deverill, Adam Sandell
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-162
Abstract: The main objectives of this study were to assess the feasibility and acceptability of a randomised controlled trial of welfare rights advice in a community setting and identify appropriate health and social outcome measures in order to plan a definitive trial.This was a single blind, community-based, pilot randomised controlled trial. 126 men and women aged 60 years and over, recruited from 4 general practices in Newcastle upon Tyne, UK, participated. The intervention comprised a structured welfare rights assessment followed by active assistance with welfare benefit claims over the following 24 months. The control group received the intervention after a six month delay. A range of socio-economic, health, behavioural and psycho-social outcomes were measured.126 out of 400 people invited agreed to participate and 109 were followed up at 24 months. Both the intervention and research procedures were feasible and acceptable to participants and professionals involved. 68 (58%) of all participants received a welfare benefit award (31 financial, 16 non-financial and 21 both). Median time to receipt of benefits from initial assessment was 14 (range 1 to 78) weeks and median financial award was £55 (€81, $98) per household per week. There was little evidence of health-related differences between groups or over time, which could be due to limitations of the study design.Modification of the study design, including selection of study participants, timing of interventions and length of follow up are recommended for a definitive trial. More appropriate health and psycho-social outcome measures relevant to the elderly population should be sought, particularly focussing on those issues highlighted in the accompanying qualitative study.Major inequalities in health result from differences in socio-economic position between individuals, families and population groups[1]. Whilst the link between resources and health is well established[1-4], there has been little conclusive research eva
Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): study protocol for a pilot randomised controlled trial
Lisa Shaw, Christopher Price, Sally McLure, Denise Howel, Elaine McColl, Gary A Ford
Trials , 2011, DOI: 10.1186/1745-6215-12-152
Abstract: Trial Design: Double blind parallel group external pilot randomised controlled trial.Setting: Participant recruitment and initial treatment by North East Ambulance Service research trained paramedics responding to the emergency call. Continued treatment in three study hospitals.Participants: Target is recruitment of 60 adults with acute arm weakness due to suspected stroke (within 3 hours of symptom onset) and hypertension (systolic BP>160 mmHg).Intervention: Lisinopril 5-10 mg (intervention group), matched placebo (control group), daily for 7 days.Randomisation: Study medication contained within identical pre-randomised "trial packs" carried by research trained paramedics.Outcomes: Study feasibility (recruitment rate, compliance with data collection) and clinical data to inform the design of a definitive randomised controlled trial (blood pressure monitoring, National Institute of Health Stroke Scale, Barthel ADL Index, Modified Rankin Scale, renal function).This pilot study is assessing the feasibility of a randomised controlled trial of paramedic initiated lisinopril for hypertension early after the onset of acute stroke. The results will inform the design of a definitive RCT to evaluate the effects of very early blood pressure lowering in acute stroke.EudraCT: 2010-019180-10ClinicalTrials.gov: NCT01066572ISRCTN: 54540667Systemic hypertension occurs commonly during acute stroke and is associated with increased neurological impairment, poor functional outcome and death [1,2]. Due to the simultaneous disruption of cerebral vascular autoregulation that occurs in acute stroke, systemic hypertension has a greater effect on cerebral blood flow than normal [3]. This can lead to excessive cerebral oedema during ischaemic stroke or haematoma expansion after haemorrhage, both of which are associated with greater neurological injury [4]. Low levels of blood pressure may also be harmful, however, probably because of cerebral hypoperfusion [5]. Observational data supports a U
Are Social Inequalities Widening in Generalised and Abdominal Obesity and Overweight among English Adults?
Denise Howel, Elaine Stamp, Thomas J. Chadwick, Ashley J. Adamson, Martin White
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079027
Abstract: Background Obesity is now more common in lower socioeconomic groups in developed nations, but the socio-economic patterning of obesity has changed over time. This study examines the time trends in the socioeconomic patterning of generalised and abdominal obesity and overweight in English adults. Methods Data were from core annual samples of the Health Survey for England 1993–2008, including 155 661 participants aged 18–75 years. The prevalence of generalised and abdominal obesity and overweight was reported as crude and age-adjusted estimates. Binomial regression was used to model measures of obesity and overweight with age, sex, survey years, and two indicators of socioeconomic position: Registrar General’s Social Class (manual and non-manual occupational groups) and relative length of full time education. Trends in socioeconomic patterning were assessed by formal tests for interactions between socioeconomic position measures and survey periods in these models. Results The prevalence of generalised and abdominal overweight and obesity increased consistently between 1993 and 2008. There were significant differences in the four outcomes between the two socioeconomic position (SEP) groups in men and women, except for generalised and abdominal overweight with social class in men. The prevalence of obesity and overweight across the whole period was higher in subgroups with lower SEP (differences of 0.2% to 9.5%). There was no significant widening of the socioeconomic gradient of most indicators of greater body fat since the early 1990s, except for educational gradient in generalised obesity in men and women (P = 0.001). Conclusions Substantial social class and education gradients in obesity and overweight are still present in both sexes. However, there is limited evidence that these socioeconomic inequalities have changed since 1993.
Surface Temperatures Determination with Influencing Convective and Radiative Thermal Resistance Parameters of Combustor of Gas Turbine  [PDF]
Ebene Ufot, Ibiba Emmanuel Douglas, Howel Iberefata Hart
Engineering (ENG) , 2014, DOI: 10.4236/eng.2014.69056

Surface temperatures were determined with due consideration of the influencing thermal conditions of conductive, convective and radiative heat. A general condition of heat influx to a point was formulated with the end effect of such influx to the receiving point. It was noted that the heat flow will cause a rate of change of internal energy of the point. Based on the theory of the rate of change of internal energy, a combustor model of cylindrical cross-section was used to generate out the timely temperature equation. Further work was done on this model equation to convert it to non-dimensional. The conversion of this equation was very essential in summing up the parameters that can influence the timely generation of the temperatures. Interestingly, it is noted that when a material withstands temperatures, it will equally withstand the thermal stresses that inherently will be developed in it. From the results, the work came up with a table showing the range of these slope figures of equations, a point was also found for a vital recommendation for further studies, where such figures can be used to check the suitability for thermal stress levels and the lifetime of combustor of such thickness.

INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?): study protocol for a mixed methods study to assess the feasibility of a future randomised controlled trial of the clinical utility of invasive urodynamic testing
Megan Murdoch, Elaine McColl, Denise Howel, Mark Deverill, Brian S Buckley, Malcolm Lucas, Christopher R Chapple, Douglas G Tincello, Natalie Armstrong, Cath Brennand, Jing Shen, Luke Vale, Paul Hilton
Trials , 2011, DOI: 10.1186/1745-6215-12-169
Abstract: The aim of this pilot study is to test the feasibility of a future definitive randomised control trial that would address whether IUT alters treatment decisions and treatment outcome in these women and would test its clinical and cost effectiveness.This is a mixed methods pragmatic multicentre feasibility pilot study with four components:-(a) A multicentre, external pilot randomised trial comparing basic clinical assessment with non-invasive tests and IUT. The outcome measures are rates of recruitment, randomisation and data completion. Data will be used to estimate sample size necessary for the definitive trial.(b) Qualitative interviews of a purposively sampled sub-set of women eligible for the pilot trial will explore willingness to participate, be randomised and their overall trial experience.(c) A national survey of clinicians to determine their views of IUT in this context, the main outcome being their willingness to randomise patients into the definitive trial.(d) Qualitative interviews of a purposively sampled group of these clinicians will explore whether and how they use IUT to inform their decisions.The pilot trial will provide evidence of feasibility and acceptability and therefore inform the decision whether to proceed to the definitive trial. Results will inform the design and conduct of the definitive trial and ensure its effectiveness in achieving its research aim.Current Controlled Trials ISRCTN71327395 assigned 7th June 2010.Urinary incontinence (UI) can dramatically influence the physical, psychological and social wellbeing of affected individuals, their families and carers and has considerable resource implications for the health service. The estimated prevalence of UI in general population studies varies from 5% to 69% with most estimates between 25% and 45%. In middle aged and older women daily incontinence estimates vary from 5% to 15% [1]. The majority of these women have stress urinary incontinence (SUI), 50%, or mixed urinary incontinence (
The U.S.-Israeli Strategic Alliance: How the United States Is Contributing to a “Disappearing” Palestine  [PDF]
Denise De Garmo
Open Journal of Political Science (OJPS) , 2016, DOI: 10.4236/ojps.2016.61004
Abstract: This paper examines the implications of the U.S.-Israeli strategic alliance on the proposed “two state solution”. This alliance has its roots in common values and mutuality of national interests, interests that have produced intelligence sharing, technology transfer, and military assistance between the U.S. and Israel. These exchanges have led to extensive U.S. support of Israel’s militarization in the Jordan Valley. It is also this strategic alliance that serves to support the continued annexation of the West Bank while diminishing future attempts at reaching a proposed “two state solution”.
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