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"Brown, Heather"
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Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews
by
Brown, Heather
,
Heslehurst, Nicola
,
Rankin, Judith
in
Access to care
,
Asylum seeker
,
At risk populations
2018
Background
Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status.
Methods
Twelve electronic database, reference list and citation searches (1 January 2007–July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively.
Results
Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women’s experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare.
Conclusions
This review identified adverse pregnancy outcomes among asylum seeker and refugee women, representing a double burden of inequality for one of the most globally vulnerable groups of women. Improvements in the provision of perinatal healthcare could reduce inequalities in adverse outcomes and improve women’s experiences of care. Strategies to overcome barriers to accessing care require immediate attention. The systematic review evidence base is limited by combining heterogeneous migrant, asylum seeker and refugee populations, inconsistent use of definitions and limited data on some perinatal outcomes and risk factors. Future research needs to overcome these limitations to improve data quality and address inequalities.
Systematic registration
Systematic review registration number: PROSPERO
CRD42017073315
.
Journal Article
Socioeconomic risks of food insecurity during the Covid-19 pandemic in the UK: findings from the Understanding Society Covid Survey
2022
Background
We estimated socioeconomic factors associated with food insecurity during the first year of the Covid pandemic in the UK and explored potential mechanisms explaining these associations.
Methods
Data were from the April, July, and September 2020 waves of the UK Understanding Society Covid Survey. Food insecurity was measured as ‘not having access to healthy and nutritious food’ and ‘reporting being hungry but not eating’. Logistic regression estimated the relationship between socioeconomic factors and food insecurity. A decomposition approach explored if financial vulnerability and having Covid-19 explained associations between socioeconomics factors and food insecurity.
Results
Single parents and young people aged 16–30 years had a higher odds of reporting both measures of food insecurity. Financial insecurity explained 5% to 25% of the likelihood of reporting being food insecure for young people and single parents depending on the food insecurity measure used. Experiencing Covid-19 symptoms explained less than 5% of the likelihood of being food insecure for single parents but approximately 30% of not having access to healthy and nutritious food for young people.
Conclusion
Policies providing additional financial support may help to reduce the impact of Covid-19 on food insecurity in the UK.
Journal Article
Frequency of eating home cooked meals and potential benefits for diet and health: cross-sectional analysis of a population-based cohort study
2017
Background
Reported associations between preparing and eating home cooked food, and both diet and health, are inconsistent. Most previous research has focused on preparing, rather than eating, home cooked food; used small, non-population based samples; and studied markers of nutrient intake, rather than overall diet quality or health. We aimed to assess whether frequency of consuming home cooked meals was cross-sectionally associated with diet quality and cardio-metabolic health.
Methods
We used baseline data from a United Kingdom population-based cohort study of adults aged 29 to 64 years (
n
= 11,396). Participants self-reported frequency of consuming home cooked main meals. Diet quality was assessed using the Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH) score, fruit and vegetable intake calculated from a 130-item food frequency questionnaire, and plasma vitamin C. Markers of cardio-metabolic health were researcher-measured body mass index (BMI), percentage body fat, haemoglobin A
1c
(HbA
1c
), cholesterol and hypertension. Differences across the three exposure categories were assessed using linear regression (diet variables) and logistic regression (health variables).
Results
Eating home cooked meals more frequently was associated with greater adherence to DASH and Mediterranean diets, greater fruit and vegetable intakes and higher plasma vitamin C, in adjusted models. Those eating home cooked meals more than five times, compared with less than three times per week, consumed 62.3 g more fruit (99% CI 43.2 to 81.5) and 97.8 g more vegetables (99% CI 84.4 to 111.2) daily. More frequent consumption of home cooked meals was associated with greater likelihood of having normal range BMI and normal percentage body fat. Associations with HbA
1c
, cholesterol and hypertension were not significant in adjusted models. Those consuming home cooked meals more than five times, compared with less than three times per week, were 28% less likely to have overweight BMI (99% CI 8 to 43%), and 24% less likely to have excess percentage body fat (99% CI 5 to 40%).
Conclusions
In a large population-based cohort study, eating home cooked meals more frequently was associated with better dietary quality and lower adiposity. Further prospective research is required to identify whether consumption of home cooked meals has causal effects on diet and health.
Journal Article
Metal Chlorides in Ionic Liquid Solvents Convert Sugars to 5-Hydroxymethylfurfural
2007
Replacing petroleum feedstocks by biomass requires efficient methods to convert carbohydrates to a variety of chemical compounds. We report the catalytic conversion of sugars giving high yield to 5-hydroxymethylfurfural (HMF), a versatile intermediate. Metal halides in 1-alkyl-3-methylimidazolium chloride are catalysts, among which chromium (II) chloride is found to be uniquely effective, leading to the conversion of glucose to HMF with a yield near 70%. A wide range of metal halides is found to catalyze the conversion of fructose to HMF. Only a negligible amount of levulinic acid is formed in these reactions.
Journal Article
Colonization by B. infantis EVC001 modulates enteric inflammation in exclusively breastfed infants
by
Henrick, Bethany M
,
Brown, Heather K
,
Smilowitz, Jennifer T
in
Baby foods
,
Breastfeeding & lactation
,
Cytokines
2019
BackgroundInfant gut dysbiosis, often associated with low abundance of bifidobacteria, is linked to impaired immune development and inflammation—a risk factor for increased incidence of several childhood diseases. We investigated the impact of B. infantis EVC001 colonization on enteric inflammation in a subset of exclusively breastfed term infants from a larger clinical study.MethodsStool samples (n = 120) were collected from infants randomly selected to receive either 1.8 × 1010 CFU B. infantis EVC001 daily for 21 days (EVC001) or breast milk alone (controls), starting at day 7 postnatal. The fecal microbiome was analyzed using 16S ribosomal RNA, proinflammatory cytokines using multiplexed immunoassay, and fecal calprotectin using ELISA at three time points: days 6 (Baseline), 40, and 60 postnatal.ResultsFecal calprotectin concentration negatively correlated with Bifidobacterium abundance (P < 0.0001; ρ = −0.72), and proinflammatory cytokines correlated with Clostridiaceae and Enterobacteriaceae, yet negatively correlated with Bifidobacteriaceae abundance. Proinflammatory cytokines were significantly lower in EVC001-fed infants on days 40 and 60 postnatally compared to baseline and compared to control infants.ConclusionOur findings indicate that gut dysbiosis (absence of B. infantis) is associated with increased intestinal inflammation. Early addition of EVC001 to diet represents a novel strategy to prevent enteric inflammation during a critical developmental phase.
Journal Article
A Meta-Analysis of the Reading Comprehension Skills of Individuals on the Autism Spectrum
by
Brown, Heather M.
,
Oram-Cardy, Janis
,
Johnson, Andrew
in
Ability
,
Autism
,
Autism Spectrum Disorders
2013
This meta-analysis examined 36 studies comparing autism spectrum disorder (ASD) and control groups in reading comprehension. Three moderators (semantic knowledge, decoding skill, PIQ) and two text types (high vs. low social knowledge) were examined as predictors of reading comprehension in ASD. The overall standardized mean difference for reading comprehension was g = −0.7 SD. The strongest individual predictors of reading comprehension were semantic knowledge (explaining 57 % of variance) and decoding skill (explaining 55 % of variance). Individuals with ASD were significantly worse at comprehending highly social than less social texts. Having ASD alone does not predict reading comprehension deficits. Instead, individual skills, especially language ability, must be considered before one can accurately predict whether a given individual with ASD will experience difficulties in reading comprehension.
Journal Article
Understanding the role of policy on inequalities in the intergenerational correlation in health and wages: Evidence from the UK from 1991–2017
2020
Social mobility is high on the policy agenda and is an important component of reducing inequalities. Estimating the relationship across generations of multiple dimensions of mobility such as health and wages can be used to understand the current state of mobility. However, there has been little research on how policy impacts on the relationship of multiple outcomes across generations and how that may be contributing to health inequalities and long-term mobility. In this paper, we use the UK as a case study to evaluate the impact of three distinct policy periods: 1991-1998 (Increasing neo-liberalism); 1998-2009 (English Health Inequalities Strategy); 2010-2017 (Austerity) on the relationship across generations in health (self-assessed health (SAH) and mental health measured by General Health Questionnaire 12 (GHQ-12)) and hourly wages. We employ fixed effects models on data from the British Household Panel Survey (1991-2008) and its successor the Understanding Society Survey (2009-2017). To investigate the role of policy on inequalities, sub-group analysis is performed by parental socioeconomic status measured by parental educational attainment, parental occupation, and if a single parent household. Results show that for the population on average, a changing policy focus has no impact on the strength of the relationship across generations in both health and wages. However, when looking at sub-groups the strength of the relationship in SAH and wages is increasing for parents with basic and higher qualifications and their young adult children. Whereas the influence of parents on their young adult children's SAH, mental health, and wages has remained fairly constant over the period 1991-2017 for parents with manual occupations and professional occupations. There has been a slight weakening in the influence of parents on their young adult children's SAH and wages for single parent families from 2010.
Journal Article
Time series analysis of COVID-19's impact on physician and dentist visits in Iran
2024
This study aimed to assess the impact of the COVID-19 pandemic on general practitioner (GP), specialist, and dentist visits among 40 million Iranians covered by the Social Security Organization (SSO). A monthly interrupted time series analysis was conducted over a period of 72 months, including—47 months before the pandemic and 25 months after its onset. The outcomes variables were monthly number of GP, specialist, and dentist visits per 1000 SSO-insured individuals. The analysis was performed by total visits, visits to the SSO direct sector, and visits to the indirect sectors. The study found that in the first month of the pandemic, the number of visits per 1000 insured individuals significantly decreased for visits to GPs (by 51.12, 95% CI −64.42 to −37.88), visits to specialists (by 39.11, 95% CI −51.61 to −26.62), and visits to dentists (by 6.67, 95% CI −8.55 to −4.78). However, during the subsequent months of the pandemic, there was a significant increase in the number of monthly visits for all three categories, with GPs experiencing the highest increase (1.78 visits per 1000 insured), followed by specialists (1.32 visits per 1000 insured), and dentists (0.05 visits per 1000 insured). Furthermore, prior to the pandemic, the number of monthly GP visits per 1000 insured individuals was statistically significantly lower in the indirect sector compared to the direct sector (45.79, 95% CI −52.69 to −38.89). Conversely, the direct sector exhibited lower rates of specialist visits (25.84 visits per 1000 insured individuals, 95% CI 22.87 to 28.82) and dentist visits (0.75 visits per 1000 insured individuals, 95% CI 0.12 to 1.36) compared to the indirect sector. Additionally, the study found that in the first month of the pandemic, the monthly number of GP visits in the indirect sector significantly increased by 34.44 times (95% CI 24.81 to 44.08) compared to the direct sector. For specialist visits and dentist visits, the increase was 3.41 (95% CI −5.87 to 12.69) and 5.01 (95% CI 3.48 to 6.53) per 1000 insured individuals, respectively. Overall, the findings of this study demonstrate statistically significant disruptions in GP, specialist, and dentist visits during the COVID-19 pandemic, although some recovery was observed. Both the direct and indirect sectors experienced decreased visits.
Journal Article