PhD

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A cross-linguistic study of affective prosody production by monolingual and bilingual children
(Queen Margaret University College, 2006-09) Grichkovtsova, Ioulia; This work would also not have been possible without funding. Financial assistance
The main objective of the research reported in the dissertation was to investigate the production of affective speech by monolingual and simultaneous bilingual children in Scottish English and French. The study was designed to address several important issues with respect to affective speech. First, possibility of identifying and compar- ing acoustic correlates of affective speech in productions of monolingual children was explored in a cross-linguistic perspective. Second, affective speech of bilingual chil- dren was examined in their two languages and compared to that of their monolingual peers. Third, vocal emotions encoded by monolingual and bilingual children were tested through the identification by French and Scottish monolingual adults. Five bilingual and twelve monolingual children were recorded for a cross-linguistically comparable corpus of affective speech. Children played four emotions (anger, fear, sadness and happiness) on one token utterance with the help of visual materials, which served as the reference of the expressed emotions, and as an affect inducing material. A large number of child speakers brings better understanding of cross- language and within-language variability in vocal affective expressions. The corpus was acoustically analysed and used in a cross-linguistic perception test with Scottish and French monolingual adults. The results of the perception test support the existing view in the cross-cultural research on emotions: even if people from different cultural groups could identify each others' emotions, an in-group advantage was generally present. Another im- portant finding was that some affective states were more successfully identified in one of the languages by the two groups of listeners. Specifically, French anger, as expressed by bilingual and monolingual children, was identified more successfully by both French and Scottish listeners than anger, encoded by bilinguals and mono- linguals in Scottish English, thus suggesting that children showed some emotions more in one of the languages. The joint analysis of production and perception data confirmed the association of the studied acoustic correlates with affective states, but x also showed the variability of different strategies in their usage. While some speak- ers used all the measured acoustic correlates to a significantly large extent, other speakers used only some of them. Apparently, the usage of all the possible acoustic correlates is not obligatory for successful identification. Moreover, one of the studied affective states (fear) was characterised by more variable usage of acoustic correlates than others. Cross-linguistic differences were attested in the usage of some acoustic correlates and in the preferred strategies for the realisation of affective states. Simultaneous bilingual children could encode affective states in their two lan- guages; moreover, on average, their affective states are identified even better than those of monolingual children. This ability to successfully encode vocal emotions can be interpreted as a signal of high social competence in bilingual children. Produc- tion results show that all bilingual children realise some cross-linguistic differences in their affective speech. Nevertheless, interaction between the languages in the affec- tive speech was discovered both in the production and perception data for bilinguals. This finding comes in support of other studies which call language interaction as a characteristic feature of bilingual phonetic acquisition. The specific pattern of the affective speech realisation is individual for each bilingual child, depending on the affective state and on the used language. In this context, the theory of integrated continuum, developed by Cook (2003), is discussed for its possibility to describe the paralinguistic organisation in the bilingual mind. This thesis thus contributes to a better understanding of phonetic learning by monolingual and bilingual children in the context of affective speech. It also gives a detailed analysis of cross-language and within-language variability present in affec- tive speech. This new data will be of interest to the researchers working in speech sciences, psycholinguistics, developmental and cross-cultural psychology.
A randomised controlled trial investigating the influences of food form and energy density on appetite, satiation and satiety in healthy adults
(Queen Margaret University, Edinburgh, 2014) Carroll, Sarah
Background: Texture and energy density are two physical properties of foods known to impact on eating behaviour. For those with mastication and/or deglutition disorders; diets which have their texture altered are prescribed. Further these texture modified diets may be energy enriched in an effort to optimise the opportunity for individuals prescribed them to meet their required energy intakes. However there is insufficient evidence supporting this strategy. No well controlled studies have been conducted evaluating these alterations (made in line with clinical guidelines), which specifically investigates their impact on eating behaviour. As such despite their intention to facilitate food and energy intakes it is unknown if these diets are in fact fit for purpose. Objective: To investigate the effect of texture modification, and/or energy enrichment of a standard meal developed to meet current recommendations for meal provision in hospitals on appetite parameters and food and energy intakes at a single eating occasion, in healthy adults. Design: A single blind, randomised crossover within-subjects design, where on four occasions 33 healthy adults consumed a test meal at lunch until satiation (i.e. meal termination) was reached whilst rating their appetite parameters. The meal had its texture and/or energy density altered to compare the effects of food form and energy density on appetite and satiation. The quantity of meal consumed was calculated using a plate wastage method. Subsequent intakes were recorded in a food diary to determine the effect of the treatments on satiety and identify any evidence of energy compensation. Food (g) and energy intakes (kcal) consumed during the feeding session were analysed using repeated measures ANOVA. Results: Test meal energy intakes (kcal) were significantly higher with energy enrichment of both meals (standard texture (ST); 315 kcal and texture modified (TM); 303 kcal (p=0.001)). Area under the curve (AUC) did not differ between meals for hunger, fullness, or desire to eat however palatability was significantly reduced with texture modification. Regardless of the composition and quantity consumed at the test meal, post-meal energy and macronutrient intakes remained the same across all days. Evidence of partial energy compensation was revealed (15 % (ST) and 22% (TM)) thus energy intakes remained higher over the day for both (260 kcal and 225 kcal respectively) (p<0.05). Conclusions: Enriching a meal, suitable for provision in a hospital setting results in significantly greater energy content without impacting on rated palatability. In a well-controlled, healthy sample, this enriched meal was sufficient to increase energy intakes (kcal) at an individual eating occasion for both ST and TM meals without affecting absolute food intake (g) or appetite responses (between meals) at the testing session. Incomplete subsequent energy compensation resulted in daily energy intakes remaining significantly higher with consumption of the enriched meals. Thus energy enrichment at a single meal, appropriate for provision for patients requiring a “Texture C” diet appears to be a suitable method to optimise short term energy intakes, in a healthy sample not confounded by disease state. Further investigation into enrichment of these meals in a clinical setting is justified.
A single blinded randomised controlled trial, to investigate the clinical effectiveness of pre-formed semi-rigid foot orthoses, on pain, quality of life and the dynamics of gait of patients diagnosed with juvenile idiopathic arthritis (JIA)”.
(Queen Margaret University, 2013) Coda, Andrea
Introduction - Currently there is limited evidence supporting podiatric treatment of children with JIA. The foot orthoses (FOs) prescribed to JIA children so far appeared to be very expensive and required long time to manufacture before the fitting. This randomised controlled trial (RCT) aimed to determine whether pre-formed FOs that can be prescribed at chair side, impacted on pain, quality of life (primary outcomes) and/or gait-parameters (secondary outcomes) in children affected by JIA. Methods - The study took place at the Gait Analysis laboratory at Queen Margaret University – Edinburgh and at the TORT Centre, Ninewells Hospital-Dundee. Children with JIA were diagnosed according to the ILAR criteria. Intervention was blinded to the patients. The trial group received Slimflex-plus FOs, with the addition of chair side corrections and the control FOs supplied were made with leather board (1mm thick) only. Both FOs had the same black EVA top cover. Primary outcomes were investigated using validated questionnaires (VAS, CHAQ and PedsQL). Tekscan™ equipment (F-Scan™ and HR Walkway®) measured secondary outcomes in-shoe pressure and force data with and without FOs intervention. Multiple foot strikes and repetitive gait patterns were compared pre and post-treatment. Primary and secondary outcome measures were recorded at baseline, 3rd and 6th month’s period. Results - Sixty children were recruited; 48.3% (n=29) control and 51.7% (n=31) active treatment group. Within the control group 20.7% (n=6) of patients were male. Within the active treatment group, 29% (n=9) subjects were male. Age ranged between 5 to 18 years, median age for the control group was 11 (range=12.90) and for the trial group were 11.50 (range=12.11). In order to attribute any effect solely on the FOs intervention, details of changes of medication and/or new joint injections were recorded during the trial. In the control group 65.5% (n=19) were considered to be prescribed with stable medications. Similarly, amongst children receiving active treatment 74.2% (n=23) were deemed to be taking stable medications. Overall, 99.4% (n=179/180) appointments were completed, only one subject did not attend the 6 month session. Significant improvement was identified in the primary outcomes favouring active treatment with regards to pain and quality of life measures: VAS (p<0.05); CHAQ (p<0.05); PedsQL paediatric-generic (p<0.05) Peds paediatric rheumatology (p<0.05); PedsQL parent-generic (p<0.05); PedsQL parent-rheumatology (p<0.05). In all these quality of life tools where p<0.05, clinical significance was also obtained. Significant differences were also identified between the groups for gait time, stance time, total plantar surface, heel contact, midfoot, 5th metatarsal head and distal phalanx. Discussion - The results strongly suggest that FOs are effective in improving pain, quality of life and most gait parameters in JIA children. FOs can be customised at chair-side so JIA children can receive immediate podiatric benefit from the same day of the biomechanical assessment. Compliancy rate proved to be extremely high confirming that the podiatric treatment is well accepted by JIA children. Conclusion - Primary and secondary outcome’s results, strongly support the use of FOs in the treatment of JIA children, which highlights the important role of the podiatrists within the multidisciplinary team in paediatric rheumatology.
A study of a home exercise programme for community dwelling people with late stage stroke
(Queen Margaret University, 2011) Baer, Gill
BACKGROUND Many people living with chronic stroke are not involved in any form of ongoing rehabilitation, despite having ongoing impairments and limitations in activity and participation. The approach to structuring practice of functional tasks, as part of ongoing rehabilitation, can incorporate diverse techniques. Current texts advocate that physiotherapists construct stroke rehabilitation programmes that incorporate Motor Learning principles, however the evidence to support this is limited. No evidence related to stroke exists as to whether functional tasks should be practised in their entirety (whole practice) or in component parts (part practice). The primary aim of the work reported in this thesis was to investigate the effects of a home exercise programme based on Motor Learning principles of part practice (PP) or whole practice (WP) of selected functional tasks for people at least six months after a stroke. METHODOLOGY A single blind, randomised controlled trial was undertaken, with participants allocated to either a part practice experimental group (PP), a whole practice experimental group (WP) or a control (Con) group. Both experimental groups followed a four week exercise intervention programme of functional tasks based on PP or WP. Outcome measures were undertaken at baseline, at the end of a four week intervention (wk 4), at short-term follow-up (wk 4.5) and at long-term follow-up (wk 16). Outcome measures utilised were the Barthel Index (BI), Motor Assessment Scale (MAS), Timed Up and Go over 2 metres (TUG2m), Step Test, Frenchay Arm Test (FAT), Hospital Anxiety and Depression Scale (HADS), Frenchay Activities Index (FAI)and the Stroke Impact Scale (SIS). Differences between the groups at each measurement point were examined using a Kruskal Wallis test. Differences within each group over time were analysed using a Friedman's Anova, followed up by a Wilcoxon's Signed Ranks test using a Bonferroni correction where a significant difference was found. RESULTS Sixty four people with late-stage stroke were recruited and provided informed consent. Data were available for analysis for 60 participants (median time since stroke 21 months). No statistically significant differences were found between the three groups at any point for any of the dependent outcome variables. A number of statistically significant within group changes were found in all groups. Most statistically significant changes were demonstrated by PP including on the BI from baseline to wk 4.5; on the MAS from baseline to weeks 4, 4.5 and 16; on the Step Test from baseline to weeks 4, 4.5 and 16 and on the FAT from baseline to week 4. On more global measures the PP group reported statistically significant improvements on the SIS in the domains of strength, mood and mobility from baseline to wk 4; and in the SIS participation domain from baseline to wk 16; as well as a statistically significant within group improvements on FAI from baseline to wk 4. CONCLUSIONS People with late-stage stroke demonstrated capacity for improvements in a number of measures of impairment, activity, participation and mood. The PP group demonstrated improvements, over time, in more of the outcome measures relating to physical ability than either WP or Con groups. Implications for clinical practice and further research are discussed.
A Study To Investigate Any Potential Effects On The Foot Of A Commonly Prescribed Off-The-Shelf Foot Orthosis In Patients With Early Diagnosed Rheumatoid Arthritis (RA)
(Queen Margaret University, 2010) Cameron, Victoria
Rheumatoid Arthritis (RA) frequently affects the foot. Custom moulded foot orthoses are effective in the management of the foot in RA; however the process of manufacture is lengthy, resulting in a delay of treatment for the patient. Offthe- shelf foot orthoses can be dispensed at the chairside on the day of diagnosis, so the patient receives treatment immediately. This is particularly crucial in RA, as early intervention is thought to improve patient outcomes in the long term. Anecdotal evidence suggests that Podiatrists do prescribe off-the-shelf foot orthoses for the management of the foot in RA; however no clinical studies exist to support this practice. The aim of this study was to investigate any potential effects on the foot of one commonly prescribed off-the-shelf foot orthosis, in patients with early RA. The type of off-the-shelf foot orthosis used was the Slimflex™ Plastic which has been shown to be a commonly used off-the-shelf foot orthosis by Podiatrists in the management of patients with RA in Scotland (Cameron et al. 2009). A total of 35 patients diagnosed with RA, with a mean age of 52.4 years (SD 13.3 years) and median disease duration of 0.5 years (IQR 1.8 years) were included. Local ethical approval was obtained. The study used a repeated measures design, with data collected at baseline, three months, and six months when patients were barefoot, shod, and with foot orthoses, to investigate any effects over time and between conditions. The primary objective was to investigate any potential effects of the Slimflex™ Plastic off-the-shelf foot orthosis on foot health related quality of life (QOL) using the Leeds Foot Impact Scale (LFIS) and foot pain using the Visual Analogue Scale (VAS). Plantar foot pressure measurement, walking speed, foot stability during walking and foot kinematics were then investigated to provide a rationale as to why foot health related QOL and foot pain may be affected with the foot orthosis. Data was analysed using SPSS version 16.0. Due to the known potential effects of medication, data was analysed for the total patient group (n=35) and subanalyses were then carried out on the group of patients who presented with stable medication throughout the study (n=12). This enabled any changes to be attributed to the foot orthosis alone and not because of any effects of medication. The LFIS and VAS for foot pain were significantly lower with the use of the foot orthosis over six months (p<0.05). Peak plantar pressure at the forefoot increased between barefoot and shod, and barefoot and foot orthosis (p<0.05), but decreased between shod and foot orthosis (p<0.05). Pressure time integral at the forefoot reduced with the foot orthosis (p<0.05). There was an increase in contact area at the midfoot and in hallux and lesser toe contact area, with the orthosis (p<0.05). Walking speed also increased over the six months (p<0.05). Preliminary findings indicated that the orthosis may affect foot stability during walking, and a case study implied that the foot orthosis positively affects foot kinematics. This study suggests that the Slimflex™ Plastic off-the-shelf foot orthosis is effective in the management of the foot in early RA, according to the measured variables in this study.
Accelerometry measurement of physical activity and sedentary behaviour in pre-school children
(Queen MArgaret Univrsity, 2013) Hislop, Jane
This thesis is based on six studies which address questions around the use of accelerometers to measure physical activity and sedentary behaviour of pre-school children: are shorter epochs more accurate? Which epochs are most accurate? Are there advantages to using triaxial accelerometers? Which cut-points are most accurate? Are different generations of Actigraph accelerometers comparable? What is the recommended wear time to provide a reliable estimate of habitual physical activity and sedentary behaviour? Analysis of 7-10 day accelerometry data, collected from 31 pre-school children (mean (SD) age 5.9 (0.7) y), suggests that shorter epochs (15 s) result in significantly greater estimates of time spent in moderate-to-vigorous physical activity (MVPA) in comparison to 60-s epochs (p <0.05). When compared against a direct observation method, Children's Activity Rating Scale (CARS), with 32 pre-school children (4.4 (0.8) y) during 1 hour of free-play, 15-s epochs were more accurate than 60-s epochs. Comparison of the triaxial RT3 against a uniaxial accelerometer, suggests no advantage of the RT3 accelerometer. The Puyau et al. (2002) cut-points had the 'best' agreement with estimates of sedentary behaviour, light intensity and MVPA against the CARS. Different generations of accelerometers were not comparable, however, application of a correction factor to the GT1M data (7164 = GT1M/0.91) may improve comparability of total physical activity. Finally, analysis of 7 day accelerometry data from 112 pre-school children (3.7 (0.7) y) suggests that 3 days of 7 hours provides a reliable estimate of habitual physical activity and that inclusion of weekend days is not necessary. This thesis highlights the implications that methodological decisions can have over apparent estimates of physical activity and sedentary behaviour and has made recommendations for accelerometry use. Ideally, there needs to be a move towards consensus, as, only by adopting standardised approaches to accelerometry use, will comparison between study outcomes become meaningful.
ACOUSTIC SPEECH MARKERS FOR TRACKING CHANGES IN HYPOKINETIC DYSARTHRIA ASSOCIATED WITH PARKINSON’S DISEASE
(Queen Margaret University, Edinburgh, 2023-06-28) Murali, Mridhula
Previous research has identified certain overarching features of hypokinetic dysarthria associated with Parkinson’s Disease and found it manifests differently between individuals. Acoustic analysis has often been used to find correlates of perceptual features for differential diagnosis. However, acoustic parameters that are robust for differential diagnosis may not be sensitive to tracking speech changes. Previous longitudinal studies have had limited sample sizes or variable lengths between data collection. This study focused on using acoustic correlates of perceptual features to identify acoustic markers able to track speech changes in people with Parkinson’s Disease (PwPD) over six months. The thesis presents how this study has addressed limitations of previous studies to make a novel contribution to current knowledge. Speech data was collected from 63 PwPD and 47 control speakers using an online podcast software at two time points, six months apart (T1 and T2). Recordings of a standard reading passage, minimal pairs, sustained phonation, and spontaneous speech were collected. Perceptual severity ratings were given by two speech and language therapists for T1 and T2, and acoustic parameters of voice, articulation and prosody were investigated. Two analyses were conducted: a) to identify which acoustic parameters can track perceptual speech changes over time and b) to identify which acoustic parameters can track changes in speech intelligibility over time. An additional attempt was made to identify if these parameters showed group differences for differential diagnosis between PwPD and control speakers at T1 and T2. Results showed that specific acoustic parameters in voice quality, articulation and prosody could differentiate between PwPD and controls, or detect speech changes between T1 and T2, but not both factors. However, specific acoustic parameters within articulation could detect significant group and speech change differences across T1 and T2. The thesis discusses these results, their implications, and the potential for future studies.
Addressing Non-Communicable Diseases in Fragile Lebanon: A Mixed-Methods Research Study
(Queen Margaret University, Edinburgh, 2023-06-28) Bou-Orm, Ibrahim
Introduction: Lebanon has faced a substantial increase in the burden of NonCommunicable Diseases (NCD) over the last decade. There is a dearth of research focusing on health systems and policy responses to NCD. This PhD thesis analyses how the NCD burden is addressed in the context of fragile Lebanon and identifies policy-, health system- and community-related factors affecting NCD prevention and control. Methodology: This thesis adopts a pragmatic paradigm and incorporates: 1. a political economy analysis of NCD, based on a literature review; 2. a system analysis of NCD prevention and control, based on semi-structured interviews and group-model building workshops with 79 health providers and community members in urban Greater Beirut; 3. a survey with 941 persons living with NCDs to identify the magnitude of key factors affecting NCD control in Greater Beirut. Findings: The political economy analysis revealed an unbalanced power relationship between NCD policy promoters (e.g. civil society) and blockers(e.g. private entities). This has led to a gap in the prevention policy landscape. Care is provided under the auspices of a highly privatized hospital-centric model where services are offered for commercial gain rather than public good. The systems analysis validated these insights, with health provider and community participants linking the challenging socio-political environment to lacking prevention policy/action. This increases NCD incidence and creates barriers in accessing care. Experiences with NCD care were noted to be varied and influenced by perceptions of service quality and trust in providers. The survey confirmed that inequities in access to care exist in Greater Beirut and highlighted that service delivery patterns differ by provider. Communities evaluated different dimensions of trust in healthcare and identified gaps in the reliability, fairness and fidelity of the current system. Conclusions: The thesis concludes with an overview of how to strengthen Lebanon’s response to NCDs.
Adjustment to a brain tumour diagnosis: A mixed methods investigation
(Queen Margaret University, Edinburgh, 2021) Trejnowska, Anna
A primary brain tumour diagnosis is known to elicit higher distress compared to other forms of cancer, and is related to high depressive symptomatology. It poses unique challenges in the process of psychosocial adjustment, with social networks and roles often being disrupted. Despite emerging evidence regarding the importance of social support in maintaining well-being when living with a chronic condition, literature on adjustment to living with a brain tumour rarely focuses on social relationships. The current mixed methods project was therefore designed to address an overarching research question: How do people cope with a brain tumour diagnosis in the context of their social relationships? The aim of the first study was to examine the associations between insecure attachment dimensions and coping strategies, with a proposed mediating role of perceived availability of social support. In this cross-sectional study, participants diagnosed with primary brain tumours (N = 480) were recruited online. Multiple regression analyses revealed significant positive associations between both attachment anxiety and avoidance and helplessness/hopelessness. Attachment anxiety was found to be significantly related to anxious preoccupation, while attachment avoidance was associated with fighting spirit and fatalism. Mediation analyses indicated that perceived social support mediated the relationships between both attachment dimensions and helplessness/hopelessness and fatalism. The findings indicate that individuals higher on insecure attachment dimensions seem to respond with a more maladaptive coping repertoire when adjusting to a diagnosis. The second study sought to gain an in-depth understanding of the lived experience of being diagnosed with a brain tumour, with a focus on exploring participants’ understandings of the meaning of social support. Twelve individuals took part in semi-structured interviews, which were analysed using Interpretative Phenomenological Analysis framework. Five inter-related themes were identified: (1) Making sense of the diagnosis, (2) Working it out in the family, (3) Giving and receiving support, (4) Feeling appreciative, and (5) Negotiating a new normal. The results emphasise that the diagnosis does not affect only the individual but a whole network of closest relationships, often with a price or negotiation that needs to take place within these relationships. Collectively, the results of the project highlight that coping is never an individual task. Both studies were integrated and interpreted jointly through narrative and joint display methods. Overall, the project portrays a complex interplay between family dynamics and individual coping and concludes by proposing that coping is deeply socially embedded. Implications of the findings are discussed. Keywords: Coping, adjustment, brain tumour, adult attachment, social support, mixed methods
Adult attachment, anger regulation and aggression: individual differences in the experience and expression of anger
(Queen Margaret University, Edinburgh, 2016) Brodie, Zara
Attachment theory has increasingly been applied to the understanding of individual differences in emotion regulation, however application of the attachment framework to anger is underspecified. The present thesis describes three studies reporting relationships between attachment insecurity and anger expression, taking into account attachment-related differences in anger regulation. Using multiple regression analyses, the results of Study 1a indicated that attachment anxiety was a significant independent predictor of trait anger, while attachment avoidance and self-esteem were not. Study 1b extended these findings by examining whether the use of specific anger regulation strategies mediated the relationship between attachment insecurity and dispositional aggression (physical aggression, verbal aggression and hostility). Attachment anxiety was indirectly related to physical aggression and hostility, through the use of maladaptive regulation techniques and a lack of anger control; while attachment avoidance had an indirect relationship with hostility through anger suppression. Study 2 utilised an anger induction procedure to investigate the relationship between attachment insecurity, self-reported and physiological responses, and subsequent aggressive behaviour. Neither attachment dimension was significantly associated with physiological reactivity to the anger induction, however attachment avoidance was negatively associated with changes in self-reported anger. Attachment avoidance was once again a significant predictor of anger suppression, while attachment anxiety significantly predicted variance in aggression. Overall, the findings indicate that attachment anxiety is a predictor of dispositional anger and aggression, whilst attachment avoidance predicts the use of suppression to regulate anger, reduced self-reported anger responsivity and increased hostility. Implications for both theory and practice are discussed with suggestions for attachment and emotion regulation-based anger management interventions.
Agency and wellbeing in the context of early marriage: A qualitative inquiry into the northern Nigerian context
(Queen Margaret University, Edinburgh, 2018) Zasha, Doosuur
According to the literature, early marriage remains a problem due to the limitations it places on the educational and economic opportunities of the young girls involved, as well as the variety of health complications they suffer as a result of this. Although early marriage is prevalent in Nigeria, regional differences indicate the northern part of the country as having a higher percentage of girls who marry before the age of 18 compared to the south. Most research and advocacy efforts, as well as related programmes and policies, rightfully focus on the prevention of early marriage but neglect the adolescent girls who are already married. This study focuses on the lives of young married girls, highlighting the process through which they get married as told from their own perspective, and explores their accounts of life after marriage particularly illuminating their health needs and overall wellbeing. Using semi-structured interviews, focus group discussions participatory techniques, and participant observations, 24 young married girls between the ages of 15-25 from Nasarawa state in Nigeria, were recruited for this study, adopting a mixture of principles borrowed from ethnography and grounded theory. The analysis highlights the personal agency exercised by some of the girls in their decisions to get married but also demonstrates how said agency is constrained by the context in which it is exercised. Analysis further reveals the underlying influences behind the constructions of health and illness held by young girls and explores ways in which they primarily seek to address their health and wellbeing. The accounts of these girls also point to strong associations between their wellbeing, economic factors, relationships and experiencing self-worth. This dissertation will contribute to knowledge around early marriage in Nigeria and Sub-Saharan Africa and highlight nuances around the decision-making process at the time of marriage. It also offers insights as to how young girls construct wellbeing in the context of marriage hereby contributing to knowledge around wellbeing in poorer populations in Nigeria and arguably, similar African contexts.
Alleviating psychosocial suffering: an analysis of approaches to coping with war-related distress in Angola.
(Queen Margaret University, 2001) Eyber, Carola
This study investigates the role that the notions of trauma and culture play in relation to the alleviation of distress within an war-affected population. It analyses how local, cultural conceptions of distress and those held by psychological service providers relate to one another, and how they contribute to improving the well-being of the displaced. Fieldwork was conducted with urban and rural displaced populations in the south-eastern province of Huila in Angola. Ethnographic, psychometric and participatory methods were used to examine issues of health, illness and distress amongst the displaced. Local idioms of distress in the form of pensamentos, mutima, madness and high and low blood pressure are common ways of expressing suffering related to war. The different explanatory models held about these illnesses and the various resources available in the popular, folk and professionals sectors of the health care system were explored. The religious and spiritual domains were found to be influential in the treatment of distress-related illnesses. The psychological services available in the war-displaced communities were examined in terms of their common theoretical and practical elements. These were then analysed in relation to the conceptualisations held by local populations, and points of similarity and difference were noted. Specifically, the conceptualisation of suffering as trauma and the cultural misunderstandings that arise as a result of this, and the representation of the displaced as traumatised and therefore dependent and passive people, are discussed. A particular subgroup in the community, the adolescents, was identified and participatory methods were employed to investigate the strategies and resources this group uses for coping with war-related distress. The youths predominantly make use of distraction, conselho, religious and cultural resources. The application of a PTSD scale, the EARAT, suggests that 71% of the adolescents had symptoms of trauma consistent with a diagnosis of PTSD. It is argued that for the vast majority such a conceptualisation does not reflect the adolescents' abilities to function on social, vocational, educational and physical levels. The implications of these findings for research and practice in the field of psychosocial work are discussed.
An action research study of Palliative Care for people with A Dementia and their carers
(Queen Margaret University, 2009) Smith, Stephen D M.
The objectives of this participatory action research were to: identify the palliative care needs of PWAD and their carers in West Lothian; analyse two dementia care services as they develop practice in the assessment and management of distress for PWAD, and supporting carers; determine implications for practice development and service delivery. Multiple data collection methods were used including; focus groups, interviews, participant observation, reflective accounts, case studies, documentation review, action learning and notes recorded from meetings with staff. The first phase was a dementia palliative care needs assessment. Eight PWAD, 25 carers and 63 service providers participated in interviews and focus groups. Overall findings were that a palliative care approach provided a useful and appropriate framework to understand the needs of PWAD. Recognition of and support for family carers should take a high priority when considering a model for dementia palliative care. More specific needs were identified, these included: the need to develop person centred approaches; enhance the management of pain and distress and enhance individual support for carers. Two services participated in the action phase; a day centre and a hospital ward. Eleven people with a dementia, 28 carers and 86 service providers participated. Services focused on carer support or assessing pain / distress. Carer support findings: implementing an assessment tool enhanced staffs understanding of carers needs; carers preferred flexible and individual support interventions; family carers experienced cumulative factors that restricted access to support. Assessment of distress findings: assessing distress from the behaviour of PWAD was complex. The implementation of the Disability Distress Assessment Tool (DisDAT) identified new evidence that it provided a person centred assessment suitable for PWAD. It was identified that the theoretical concept of relationship centred care, could provide a way of working, that complemented the adoption of a palliative care approach for PWAD, whilst enhancing carer support and assessment of distress practices.
An assessment of neuromuscular performance, functional range of motion and quality of life characteristics in children diagnosed with hypermobility syndrome
(Queen Margaret University, 2008-06) Fatoye, Francis A.
Introduction: Hypermobility syndrome (HMS) is a common cause of morbidity in children, with the knee most frequently affected by its symptoms. Impaired joint proprioception has been reported in adults with HMS. Muscle weakness, problems with school activities and abnormal gait patterns have been observed in children with this condition. It has also been suggested that activities of daily living and physical and sporting activities may be limited in children with HMS due to pain. To date, the factors associated with HMS in children have not been well reported. The relationships between impairments, function and quality of life (QoL) have not been investigated in children with this condition. The purpose of this study was to identify the range of neuromuscular performance, functional range of motion (ROM) and QoL indices, and investigate the relationships between these features in children with HMS. A purpose-built motorised device was developed and validated for the assessment of knee joint proprioception as an integral part of the research programme. The test-retest repeatability of various outcome measures used for the present study was also investigated in healthy children and those with HMS. Methods: A cross-sectional study was conducted. Twenty nine children with HMS and 37 healthy children (aged 8 – 15 years) were investigated for neuromuscular indices, functional ROM and QoL. Knee joint kinaesthesia (JK) and position sense (JPS) were examined using a motorised device, muscle torque was tested with a digital myometer, passive ROM was measured with a universal goniometer and functional ROM was assessed using the VICON camera system. Pain intensity and QoL were measured using the Coloured Analogue Scale and the Paediatric Quality of life Inventory respectively. Mann-Whitney U tests and independent t-tests were performed to determine the differences between the two groups. The relationships between pain and each of the following: neuromuscular impairments, functional ROM and QoL were examined in children with HMS. The correlation between Beighton scores and each outcome was also evaluated in children with HMS. Results: Knee JK and JPS were significantly poorer (both p < 0.001) in children with HMS compared with the controls. Significantly reduced (p < 0.001) knee muscle torque was also observed in children with HMS. Pain intensity and passive knee ROM were significantly higher (both p < 0.001) in children with HMS. They also demonstrated significantly increased knee extension, reduced knee flexion in loading response and during maximal knee flexion of walking (all p <0.001). Moreover, the overall QoL perception and all the domains were significantly poorer (p range < 0.001 to 0.008) in children with HMS than the controls. No relationship (r range = -0.065 to 0.271; p range = 0.106 to 0.985) was found between pain, neuromuscular impairments and functional ROM in children with HMS. However, a significantly strong negative relationship (r = -0.65; p = <0.001) was established between pain and QoL in children with HMS. In addition, no relationship (r range = -0.014 to 0.315; p range = 0.112 to 0.895) was observed between Beighton scores and neuromuscular impairments, functional ROM and QoL in children with HMS. Conclusions: Children with HMS, compared with their healthy counterparts had knee joint proprioception and knee muscle torque deficits, increased passive knee ROM and pain intensity. Abnormal walking patterns (increased knee extension, reduced knee flexion in both mid stance and maximum knee flexion in swing phase during walking) were also found in children with HMS. They also presented with poorer QoL in comparison with the controls. Clinicians are to be aware of these identified features and should develop appropriate treatment intervention programmes for children with this condition.
An assessment of the capacity of faculty-based youth friendly reproductive health services to promote sexual and reproductive health among unmarried adolescents: evidence from rural Malawi
(Queen Margaret University, 2009) Jimmy-Gama, Dixon
Despite the recognition of the influence of cultural norms on adolescent sexual behaviours in most societies (Kaler 2004; Chege 2005), less attention has been paid to the link between social norms and effectiveness of health facilities to promote adolescent sexual and reproductive health (ASRH). This thesis therefore examines the capacity of facilitybased youth-friendly reproductive health services (YFRHS) to promote ASRH in rural Malawian societies where culture strongly influences adolescent sexual behaviours. The study employs a social constructionist epistemology and a social interactionism theory to understand the capacity of YFRHS in ASRH promotion in rural Malawi. Qualitative and quantitative data were collected using a sequential exploratory design. Semi-structured in-depth interviews, participant observations, client exit interviews, survey, focus group discussions and review of health strategic and service utilisation documents/records were conducted. The results were generated by triangulating both qualitative and quantitative data. The findings of the study illuminate how social norms related to social identities influence adolescent sexual behaviours and ASRH promotion. An exploration of the cultural context reveals a major disjuncture between an ideal norm - no premarital sex - and a modelled norm where unmarried adolescents are expected to engage in unsafe sex. It also shows the conflicts between the cultural and scientific models of ASRH promotion. Structural gender asymmetry that emphasises subservience in females and hegemonic masculinity also reduces adolescents' rights and agency in SRH promotion. The health providers are cultural agents. They manage diverse roles both as 'moral guardians' and as 'health promoters' in a way that limits their effectiveness as health promoters. The thesis concludes that the way facility-based YFRHS is implemented has limited impact on SRH promotion among unmarried adolescents of rural Malawi. The study recommends that appropriate health promotion interventions based on conscientisationoriented empowerment theories directed at adolescents, community and health workers should be used in ASRH promotion in societies with strong cultural influence on sexual behaviours.
An economic analysis Of retail pharmaceutical market In Nigeria: towards access expansion and policy
(Queen Margaret University, 2014) Usar, Joseph Iornumbe
Rural areas in much of sub-Saharan Africa access needed health care from untrained and often poorly regulated drug vendor shops with concerns over the quality of products and services provided and their public health implications. The thesis undertook to understand market relationships in a rural retail drug market in the light of the structure-conduct-performance paradigm and isolate opportunities for potential policy interventions for improved access to quality and safer medicines. Data was collected from a sample of patent medicine vendors and drug purchasers in Katsina-Ala Local Government Area of Benue State, north central Nigeria, over 9 months in 2012. Information from drug vendors and drug consumers was generated through semi-structured questionnaires, in-depth interviews and systematic business transaction observations. Key state and national drug regulatory officials were also interviewed in-depth and related documentary data collected and evaluated. Data analysis focussed mainly on the relationships between market structure, provider conduct, consumer behaviour and the nature of regulation, with the aim of understanding market performance in relation to access to medicines and their rational use. The study established that patent medicine vendors were an important source of medicines for inhabitants of the local government for ambulatory primary health care. Drug retailers were said to be a reliable source of a wide range of drugs provided at relatively more affordable prices and in a convenient way that satisfied consumer expectations. However, a number of market failures existed: low quality of treatment due to poor provider knowledge of diseases and drugs and therefore inappropriate prescription and dispensing practices. Ineffective regulation was also demonstrated by way of inappropriate and inadequate regulatory regime, occasioned by wide spread regulatory infractions. To attain the desirable public health objective of sustained improvement in the quality of products and services obtainable at patent medicine vendor outlets, regulatory strategies must be contextually relevant, providers must be trained and offered financial and business incentives and consumers must be empowered by accessible and timely health information for informed choices against the backdrop of strengthened and better incentivized inspectorate unit in a systematically intertwined approach.
An enquiry into the potential of a Co-operative approach to sustainable Rural tourism development in India. A stakeholder perspective
(Queen Margaret University, Edinburgh, 2015) Gladwell, Cecilia
Sustainable tourism and rural development are much examined research areas. Within these, the importance of community-centric approaches is becoming more and more recognised; however, specific research upon which community-centric development strategies could be built seems to be lacking. This thesis addresses this research gap with the aim to explore the nature of co-operative tourism and its potential towards sustainable rural tourism development in India from a stakeholder perspective. A literature review demonstrated the benefits of co-operatives as a sustainable business model, particularly for poor communities of developing countries; however, a clear gap emerged with regard to investigating tourism and co-operatives in the same context. This research contributes to filling this gap in knowledge and outlines the clear theoretical benefits of adopting a co-operative business model as a community-centric approach to tourism in the context of rural India, while also pointing out considerable challenges in its practical implementation, such as possible limitations to the ability for self-help. Fifty qualitative semi-structured interviews were carried out with stakeholders of a co-operative tourism project in two states of India: Uttarakhand and West Bengal. Twenty-six of these were conducted with farmers who are members of the tourism co-operatives presented in this study, ten with members of the wider community in which the project took place and fourteen with tourism professional and academics local to the areas. Focus was put on in-depth exploration of participants' experiences, implying qualitative methods and a phenomenological research approach. The findings revealed a clear theoretical advantage of a co-operative approach to tourism development, which has potential to address and alleviate many of the challenges associated with tourism and host communities, and which is intensified in poor peripheral areas. However, there are significant practical challenges, which need to be addressed in order for this comparative advantage to translate into practice. These challenges are manifested in a sense of dormancy in the participants, a lack of skills and significant language difficulties. A limit to the principle of self-help, which is inherent to co-operative activities, was identified as creating effective marketing links and hence, requiring ongoing external support. This research study makes an interdisciplinary contribution to the literature on sustainable tourism, rural development and co-operative studies. In addition, it provides a starting point for further empirical research on the co-operative business model as an approach, which has not yet been sufficiently conceptualised for tourism. Furthermore, it contributes to the wider debate on sustainable rural development through tourism. Future research could usefully investigate how the challenges identified in this study, such as limitations to the principle of self-help, lack of initiative in participants and creating marketing linkages could be addressed.
An evaluation of the impact of introducing a breakfast club on nutritional status and cognitive function in lower social class primary school children
(Queen Margaret University, 2005) Mehrotra, S.
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.
An exploratory study to determine the relationship between levels of habitual activity and nutritional status, functional status, dietary intake and fatigue in older adults.
(Queen Margaret University, Edinburgh, 2015) Jones, Jacklyn
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.
An inquiry into the relationship between the visual arts and psychotherapy in post revolutionary Cuba
(Queen Margaret University College, 2006-03) Hills de Zárate, Margaret
This thesis focuses on the relationship between the visual arts and psychotherapy in post Revolutionary Cuba. The material on which it is based was collected over a fourteen month period and three visits to Cuba between April 1999 and August 2001. The study opens with the presentation of two brief histories, that of Cuban Art and Art Education and that of Cuban Mental Health Care. In this context the Revolution is taken as a useful reference point in terms of thinking about change and historical developments in both fields. Naturalistic Inquiry and Grounded Theory respectively were used to collect and analyse the data presented. These approaches allowed the researcher the degree of flexibility necessary to undertake research in a potentially delicate situation full of unknowns and to be able to modify and develop the course of inquiry as new evidence emerged. The main descriptive themes emerging from an analysis of the data pertain to the relationship between artists and mental health care professionals. These are (1) therapeutic work undertaken by artists, (2) artists working collaboratively with mental health professionals and (3) psychologists working with art as a therapy. The story which emerges pertains to a series of largely unrecorded histories spanning a forty year period. It begins with the work of Antonia Eiriz, who emerges as a key figure in the early development of art as a therapy and concludes with the work of the psychologist, Aurora García Morey, who takes centre stage in its continued development. This snapshot of Cuban art therapy is specific and unique and demonstrates the development of a very particular Cuban practice. However an analysis of the analytic themes which emerge from the data suggests that certain concepts such as responsiveness and pragmatism resound within a wider picture. These themes are discussed in chapters 7 and 8 with reference to the wider international context and specifically to the development of the profession in the United Kingdom. In my conclusions I suggest that these themes may be applicable to other areas of research and practice outwith and beyond Cuba and that while the concept of art therapy cannot be narrowly defined when it is applied to understanding practices in other, social, economic and cultural contexts, there are common factors which can be identified.