Public Health and Healthcare Delivery and Practice

PI: Professor Helen Steed

This study is funded by Crohn’s & Colitis UK to explore the experience and feelings related to fertility and family planning of women with IBD and their partners. Objectives include understanding what IBD-related factors may be perceived by women with IBD as affecting their decisions on family planning and pregnancy anticipated outcomes and identify the needs and expectations that women with IBD have in relation to family planning, pregnancy and postpartum.  

To date a literature review has been undertaken and published in APT and an abstract presented at the European Crohn’s and Colitis meeting.  

In the second phase a qualitative study has been conducted and is currently being analysed. Key themes have been identified that impact on IBD women as they progress through reproductive choices and phases. 

In addition, we have initiated a collaborative project with artists in the School of Art to give voice to the lived experiences of the women from the research study. Three artists (1 animator and 2 graphic designers) have been recruited and are in the final phase of developing their work, with a plan to launch them later in the year nationally, their progress is being documented by a documentary maker. This project was discussed at an online webinar hosted by the University. We will be measuring and researching the impact of their representations and documenting the method of using art represent research results to the public. 

Collaborators include those from within the university; Professor Matthew Brookes, Maggie Ayliffe, Dr Satvinder Purewal and colleagues from other NHS sites or universities, Dr Christian Selinger (Leeds), Ms Wladzia Czucher-Dochan (Kings College London), Dr Sarah Chapman (Bath). 

PIs: Dr Hana Morrissey and Professor Patrick Ball 

Increasingly, patients are discharged with parenteral (injectable) therapy to continue at home for specified period of time or life-long. Home parenteral therapy (HPT) can vary in its complexity, from e.g. subcutaneous (SC) injections to complex technology of home parenteral nutrition (HPN) administration that requires expertise in managing aseptic techniques, central venous catheter (CVC) care and infusion technology equipment. When patients are allowed to be treated at home, significant medical decisions are delegated to non-medical individuals. New home care patients are often overwhelmed during the first few days following discharge home. Patients reported changes in their physical, psychological and social function that negatively affect their perceived Quality of Life (QoL). Early studies focused on the clinical outcomes and complications of the treatment rather than patient experience. HPT effect on QoL has been studied globally in the United States of America, Australia, Canada and Japan but not in the United Kingdom (UK). 

The aim of the study is to explore if patient immediate-, short- and long-term experience with self-management and home parenteral therapy matches the expectation of the healthcare professionals (HCPs) who requested it, with the intention to develop a guideline for service development in the UK. The study involves questionnaires and quantitative data analysis as well as qualitative interviews and patient education sessions with patients on various HCT. 

This research project is being conducted by PhD student Marko Puzovic at the Shrewsbury and Telford NHS Hospital Trust under the supervision of Dr Hana Morrissey and Professor Patrick Ball. 

For further details, please contact, Marko Puzovic  M.Puzovic@wlv.ac.uk 

PIs: Dr Hana Morrissey and Professor Patrick Ball 

Mental ill-health service efficiency has become one of the main areas of public health concerns locally and globally. Medications to support mental ill-health are increasingly being dispensed by pharmacies with many patients taking long-term antipsychotic and anti-depressant drugs.  As such, pharmacists have great role to play in the early identification of people who are likely to experience mental health problems and support them in managing their illness. 

The objectives of this research are to: 

1. Determine logistically sustainable length of time for pharmacist and their team to carry out the medication adherence mental health screening and memory health screening within a maximum of 30 minutes of patient time. The responses can be reviewed in the patient’s absence and a consultation booked later on as part of the minor aliment services to discuss the results. 
2. Establish the possible patient uptake rate and acceptance of the community pharmacy screening concept and approach. 
3. Through participants feedback, understand the impact of the study on increasing the community awareness about the importance of good medication adherence, good mental health and good cognitive health. 
4. Empower the pharmacy workforce to support people living with memory or mental health conditions through training. 

We have recruited and carried out interventions on 175 patients to date, including the indicative case study below: 

Condition: COPD, GORD, Dyslipidaemia, Depression, Angina, Hypothyroid, incontinence, pain 

Number of medication: 14 

At baseline: referred to GP for anxiety investigation 

Adherence low: 3.75 (i3,u0.75) 

CUDOS: 26  

CUXOS: 38 

At 6-month follow up 

Adherence high: 6.75 (i3, u3.75)  

CUDOS: 10  

CUXOS: 13  

Citalopram 20mg added to medication by GP 

Patients comment: Patient feels better. Was made very comfortable, pharmacist very helpful. 

This research is being conducted by PhD student Olutayo Arikawe and funded by the Harold and Marjorie Moss Charitable Trust Fund and the Health Equalities Framework. 

Relevant Publications

• Arikawe, O., Morrissey, H., Paul, P., Sandhu, M., Sadique, Z., Ball, P.A. Long term conditions and mental health: an audit of local data. International Journal of Current Pharmaceutical Research 2021;13(2):32-38. DOI: https://dx.doi.org/10.22159/ijcpr.2021v13i2.51552 (Q4) 

For further details, please contact, Olutayo Arikawe Olutayo.arikawe@nhs.net 

PI - Professor Tilly Pillay

The STORK Programme is an interactive programme for parents, carers and families of new-born babies.

STORK is an acronym for Supportive Training, Offering Reassurance and Knowledge to parents, carers and families.  The Programme provides information and training on aspects relating to reducing risks for infant mortality (baby death) in the region, using a mobile application, computer aids, an interactive quiz, and a manikin (baby doll).  It usually takes place within a health care support team in 1:1 or small group sessions.

The STORK Programme provides information around:

• recognising the signs of illness in baby
• breast feeding support
• safe sleeping and reducing the risk for Sudden Infant Death
• basic life support
• how to deal with the choking child (for older children)
• the harmful effects of smoking in pregnancy, and thereafter
• local signposting to health lifestyles support 

It is designed as an informative guide for parents, carers and families on what can be done by the public to keep young babies safe in the first few months of life, and to augment health care provision in families. It is not a certified resuscitation training course. For access to our free mobile app click here. 

The STORK Collaborative is a network of interested health care teams working towards reducing risks for newborn and infant mortality though parent, carer and family education and empowerment, using the STORK Programme, in the West Midlands.

PI: Dr Opelou Ojo

Increasing evidence shows that type 2 diabetes mellitus disproportionately affects different ethnicities, with people from South East Asia and Sub-Saharan Africa identified as particularly predisposed to the development of type 2 diabetes. Genetic predisposition and changing behaviours/lifestyles are two major factors implicated in this regard. However, the complex interplay between genetics and lifestyle characteristics in the development of type 2 diabetes and related complications, particularly within the African population is not fully understood. In this project, we are studying genome-wide changes and mutations associated with the development of type 2 diabetes among people from African origin. In addition, we are seeking to understand the contribution of migration, diet acculturation, increasing westernization, and other yet-to-be-identified factors to the development of T2DM among people from sub-Saharan Africa.

Ongoing studies include:

1. Investigation of factors predisposing migrants from sub-Saharan Africa in the UK to the development of type 2 diabetes
2. Understanding of environmental and psychological determinants of diabetes remission in people living with type 2 diabetes in West Midlands
3. Type 2 diabetes self-management education in West Midlands: A critical analysis of associated challenges and new approaches to encourage uptake

These studies are conducted in collaboration with Professor Baldev Singh of the University of Wolverhampton/The Royal Wolverhampton NHS Trust; Dr Segun Fatumo of London School of Hygiene and Tropical Medicine; The Nigerian Institute of Medical Research, the Bioscience Research Education and Advisory Centre, Nigeria.

Recent Publications:

• Engwa, G.A., Nwalo, F.N., Chiezey, V.O., Unachukwu, M.N., Ojo, O.O. and Ubi, B.E., 2018. Assessment of the Pro12Ala Polymorphism in the PPAR-γ2 Gene among Type 2 Diabetes Patients in a Nigerian Population. Journal of clinical medicine, 7(4), p.69.
• Engwa, G.A., Nwalo, F.N., Chikezie, C.C., Onyia, C.O., Ojo, O.O., Mbacham, W.F. and Ubi, B.E., 2018. Possible association between ABCC8 C49620T polymorphism and type 2 diabetes in a Nigerian population. BMC medical genetics, 19(1), pp.1-7.

PI: Dr Simon J Dunmore

Analysis of epidemiological and public health data following the onset of the COVID-19 pandemic has highlighted the role of a number of important factors including diabetes and obesity as well as ethnicity, vitamin D deficiency and deprivation on morbidity and mortality of the disease. Our analysis of data in the Black Country (part of the West Midlands, UK) has demonstrated the importance of understanding local factors to obtain a nuanced assessment of disease risk relating to COVID-19 (and similar infectious diseases).

Our project further aims to investigate the following:

• Impact of diabetes and metabolic diseases on risk of SARS-CoV2 infection and on severity of COVID-19: We are continuing to accumulate data from the Royal Wolverhampton NHS Trust and feeder GP-practices as the COVID-19 pandemic progresses and we will analyse the outcomes in relation to identified risk factors and specific geographical and demographic characteristics of the local population.
• Potential role of COVID-19 as a precipitating factor in the onset of diabetes: There is increasing evidence that SARS-CoV2 can infect cells in the endocrine pancreas and may act as a precipitating factor in the onset of diabetes. We are investigating the potential beta-cell specific mechanisms which may underlie this.

Project staff: Dr Simon J Dunmore; Professor Baldev M Singh (co-PI);  Professor Mark Livingston (UW and RWT)

Collaborators: Dr James Bateman (Co-PI, Consultant Rheumatologist RWT); Dr Ananth Viswanath (Consultant in Endocrinology and Diabetes, RWT)

Recent Publications:

• Singh BM, Bateman J, Viswanath A, Klaire V, Mahmud S, Nevill A, Dunmore SJ (2021) Risk of COVID-19 hospital admission and COVID-19 mortality during the first COVID-19 wave with a special emphasis on ethnic minorities: an observational study of a single, deprived, multiethnic UK health economy. BMJ Open. 11(2):e046556. doi: 10.1136/bmjopen-2020-046556.
• Livingston M, Plant A, Dunmore S, et al. (2021) Detectable respiratory SARS-CoV-2 RNA is associated with low vitamin D levels and high social deprivation [published online ahead of print, 2021 Apr 2]. Int J Clin Pract. 2021;e14166. doi:10.1111/ijcp.14166