Weight monitoring during pregnancy could help save lives

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Hazel Flight, Edge Hill University

There are times in a person’s life when specific events can have long-term implications on their future health. Pregnancy is one of those times – when major and dramatic changes occur within a woman’s body composition in a short period of time.

A key element of a healthy pregnancy is appropriate weight gain. Maternal obesity is thought to be one of the most common factors in high-risk pregnancies. It can cause short and long-term health risks to both mother and child, an increased birth weight and problems with delivery.

It is thought that 20% of pregnant women in the UK are obese, and due to the current obesogenic environment it is likely that this proportion will increase.

Obesity in pregnancy can cause infants to be predisposed to develop childhood obesity, metabolic syndrome and diabetes. For the mother there is also the risk of pre-eclampsia, miscarriage and gestational diabetes.

To combat this, there have been calls for women’s weight to be monitored throughout the course of their pregnancy. This is something which has not been carried out consistently in the UK since the 1990s (when there was a lack of clinical evidence to suggest it was worthwhile).

But we know now that body composition measurements can help predict maternal health and pregnancy outcomes. This monitoring throughout pregnancy may also have an influence on the birth weight of the baby, which in turn is a key determinant of short and long-term health conditions.

Midwives have a unique opportunity to provide advice regarding appropriate nutrition to the women in their care, and health promotion and education are considered among the most important activities they perform. However studies in the UK, Sweden and Australia conclude that many struggle to provide this advice.

One reason for this is that midwives do not have clear guidelines regarding what weight a woman should gain throughout her pregnancy. The National Institute of Health and Care Excellence (NICE) are currently considering a target of 16kg for women of a normal weight and 9kg for those who are obese.

Eating for how many?

It is important to remember that weight gain during pregnancy is not the sole issue with regard to the future health of the baby. If a baby has low weight gain following birth the risk of chronic disease later in life is increased and the child can also be undernourished and suffer stunted growth.

And while the focus is often on obesity and excessive weight gain, there are also serious issues at the other end of the spectrum. Women who do not gain enough weight and are not consuming enough calories are more at risk of giving birth preterm to children with a low birth weight. Babies born under 2.5kg are less likely to survive, and those that do also have an increased risk of long-term health conditions.

The current dietary reference value for a pregnant woman is an extra 200 Kcal per day in the third trimester only. This is all that should be required in order to maintain the healthy development of the foetus.

Counting 200 calories. Shutterstock

The myth that pregnant women are “eating for two” encourages them to feel they can eat whatever they want. The right information about how much and what they should eat during pregnancy is still not reaching many women – potentially putting their health, and that of their unborn babies, at risk.

So who should be providing this information? The weight loss organisation Slimming World has been commended for supporting women to eat healthily and monitor weight increase in pregnancy.

But there also needs to be advice provided to how to increase weight for those who are underweight. Alongside information regarding adequate and appropriate nutritional intake, there is a need for specialist support and education within this area. This could be a valuable role for a nutritionist as part of the care provided to women during their pregnancy.

Management of a healthy weight and subsequent weight gain in pregnancy is becoming increasingly difficult to maintain within modern society. The current advice from NICE is that weight and height are measured at the pregnant woman’s first appointment – but not regularly throughout the pregnancy.

Yet pregnancy is a time when women often have an increased nutritional awareness and the motivation to do what is right for themselves and their baby. Regular weight monitoring would be an effective way of helping them achieve this – while they are hungry for information on how to be as healthy as they can be.The Conversation

Hazel Flight, Programme Lead Nutrition and Health, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Child obesity is linked to deprivation, so why do poor parents still cop the blame?

World Obesity Federation., CC BY

Robert Noonan, Edge Hill University

Childhood obesity has risen ten-fold over the past 40 years. In the UK, roughly 30% of children are overweight or obese. Obesity rates are much higher among children living in deprived communities. In England, there is a clear trend: the wealthier a child’s family is, the more likely the child is to be a healthy weight. And those who are a healthy weight during childhood are much more likely to be a healthy weight in adolescence.

In 2006, then Labour leader and prime minister Tony Blair argued that many public health problems, including obesity, can be solved by getting people to change their lifestyles. But strong evidence from behavioural economics research and weight-loss trials shows that advocating personal responsibility is destined to fail in the long-term.

The fact remains that behavioural interventions alone – such as the NHS five a day and Change4Life campaigns – do little to address child obesity across society, because healthy food is not always easily accessible. In fact, these types of approaches widen socioeconomic health inequalities. Findings from my latest research drive this home: childhood obesity rates in Liverpool – one of England’s most deprived cities – increased by up to 3% between 2006 and 2012.

Lessons from Liverpool

For our study, we analysed data from the National Child Measurement Program (NCMP), which measures the height and weight of children within state schools across England. We examined the data of 25,905 children aged four to five years and 24,220 children aged ten to 11 years, recorded between 2006 and 2012, in order to track changes in childhood obesity and socioeconomic health inequalities over time.

Liverpool is the sixth largest city in England, and up until 2016 it was ranked as the nation’s most deprived, with over 90% of Liverpool’s 470,000 population living in areas of high deprivation. Across the six-year duration of the study, children who lived in deprived communities became overweight or obese at a greater rate than children living in less deprived communities.

As public health and other services across England continue to have their funding cut by central government, it’s more important than ever that the nation takes a new approach to tackling child obesity, and reduce inequalities linked with poor health.

A better way

For too long, behavioural interventions have been used to prompt people – especially parents – to take responsibility for individual instances of child obesity. For example, the national social marketing campaign Change4Life aims to prevent child obesity, by educating and informing families about the benefits of being physically active and eating healthily. And the NCMP informs parents if their child is overweight by means of a letter, reinforcing the idea that it’s the parent’s responsibility to address their child’s weight.

Meanwhile, little attention is paid to the policies or the social and environmental conditions which also shape healthy (or unhealthy) behaviours. Research points to inequality as a primary factor which prevents people from making healthy choices. For example, many deprived communities are “food deserts”, where affordable or high-quality fresh food is hard to come by.

Deprived communities also have few opportunities for physical activity, and typically live in areas where there are lots of fast food outlets. If we take Liverpool as an example, the city now houses over 600 fast food outlets – a figure which has risen by roughly 10% since 2014.

Too great a temptation. Shutterstock.

There is quite a lot of evidence showing that children are more likely to be overweight or obese if there are fast food outlets near their home or school. To reduce access and remove temptation, some councils in England have suggested banning fast food outlets within 400 m etres of schools. But councils’ hands are tied, as they dont’t have the powers to stop new takeaway outlets being built.

People are the product of their environment, and in modern society, the default choice for many people is the unhealthy choice – and for some, the only choice as eating healthy has been shown to be more expensive. To address this major problem, government policies need to address public health priorities. The healthy choice needs to be just as easy as the unhealthy choice, and there needs to be a level playing field, in terms of the accessibility and pricing of decent food.

Placing the responsibility on children and families, without changing their economic and physical environment, will do little to tackle health inequality and reduce weight-related health problems in society. Instead, the government needs to step in and, through policy, create communities which promote and enhance healthy choices and lifestyles. Only this will ensure that the default choice for most people is the healthy choice.The Conversation

Robert Noonan, Senior Lecturer in Physical Education and Children’s Physical Activity, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Knife crime: how former offenders can make great mentors for at-risk teens

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Sean Creaney, Edge Hill University

It’s widely reported that there’s been an increase in street violence, particularly in London – with the number of knife and gun crimes rising. While the causes are complex and multifaceted, victims and perpetrators of serious youth violence often lack a relationship with a trusted adult.

One way to help reduce crime is to use ex-offenders as peer mentors. Those who have overcome adversity and stopped offending can act as positive role models for their peers – especially teenagers who are at risk of committing crime or being drawn into gang activity.

My research found that young people on court orders really value building empathetic and collaborative relationships with professionals who are ex-offenders, and have first-hand experience with the criminal justice system.

When carefully selected, provided with extensive training and given tailored support, former young offenders can be uniquely well-equipped to help their peers in need of support. And they can encourage young people on court orders to engage with criminal justice services and make positive changes in their lives.

Positive peers

Peer mentors can offer advice and support to young people who are experiencing personal, social or emotional difficulties, because they have first-hand experience overcoming such problems themselves. Projects operating around the world offer proof that this can work in practice.

One approach in the US is to recruit ex-offenders as credible messengers who can build trust and inspire change among young people. These mentors, who have transformed their lives, are viewed as assets who can help motivate young people – who are often marginalised and disadvantaged – to make better decisions and desist from crime. The project has been shown to reduce re-offending and improve young people’s self-esteem.

Similarly, the St Giles Trust, based in London, works with young people exposed to or at risk of violence. Their SOS project carefully recruits ex-offenders to engage young people.

The effectiveness of this approach was borne out in my research: in 2016 and 2017, I spoke with 20 young people and 20 professionals from a youth offending service in England, which works with young people who get into trouble with the law. One young person in my study said:

…unless you’ve experienced that, you cannot tell them…you cannot relate to them. Unless it’s happened to you, or someone that you know, there’s no way you can fully understand how they’re feeling.

Teenagers who are at risk of committing crime or being drawn into gang activity may be reluctant to talk to authority figures. But if the person they’re speaking to is an ex-offender themselves, they may be more forthcoming. For example, another of my participants, Anthony (aged 17), spoke passionately about a trusting relationship he had built with one of his workers, who had experience in the care and criminal justice systems.

Anthony said his worker was non judgemental and able to empathise and offer guidance when he was in a difficult situation. He described how he has contacted his worker on many occasions in a state of panic and valued receiving emotional and practical assistance. Anthony described his worker as inspirational, and was keen to follow in his footsteps in the future, by securing a job which involves caring for others.

Another of my participants – Zain, aged 17 – was also inspired by his mentor:

I’d love to do his job. He sort of inspired me. Cos I know about his past, he knows about mine. And it’s pretty similar, do you know what I mean? Grew up on a bad estate, got into drugs.

The right choice

Yet within the justice system there is still some scepticm about whether ex-offenders can steer their peers away from crime.

There are challenges: young people may lack the ability to offer emotional and practical assistance to their peers who are experiencing mental health problems. For this reason, it’s crucial to provide ex-offenders with appropriate training and ongoing support.

What’s more, they may have their own unresolved traumas, which could make it more difficult for them to form constructive relationships with both their peers and professionals. And this is why it’s important for authorities to screen and select the right people.

Yet peer mentoring can be an antidote to the disconnected, unhearing and technocratic criminal justice process. And the young people who engage in mentoring can discover that they have talents and abilities they didn’t know they had.

Because they’re seen as role models, rather than authority figures, young people who are ex-offenders can forge positive and meaningful connections with their peers, to the benefit of both parties. Above all, mentoring gives young people who have overcome their own hardships a chance to help others do the same.The Conversation

Sean Creaney, Lecturer in Psychosocial Analysis of Offending Behaviour, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why you shouldn’t take antibiotics for colds and flu

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And don’t infect everyone else in the office either. Shutterstock

Carol Kelly, Edge Hill University

Winter is well and truly on its way. For many, this conjures up images of log fires, mistletoe and festive feasts. But it can also mean cold, damp mornings, short hours of daylight and the dreaded cold and flu season.

Tickly throats, headaches, fevers and generally feeling rotten are the warning signs that many of us fear. Pressures of work and personal commitments often lead people to seek a quick fix from their GP or other healthcare professional. This usually takes the form of antibiotics.

Evidence suggests the use of antibiotics is on the increase, which is a cause for concern as the overuse of antibiotics has been linked to antimicrobial resistance. This is the ability of microorganisms – such as bacteria and viruses – to evolve so that antimicrobials (antibiotics and antivirals) become less effective at killing or working against them.

Antibiotic resistance results in standard treatments – such as many of the commonly prescribed antibiotics – becoming ineffective. And this leaves people who need antibiotics for serious infections vulnerable.

This issue has been recognised as a problem on a global scale in a UK government commissioned review. These findings led to the National Institute of Clinical Excellence (NICE) publishing quality standards to help clinicians when prescribing antibiotics to slow the rise in antimicrobial resistance.

Antibiotic expectations

The Cochrane review, on which I worked, found that many vulnerable patients have an increased risk of developing microbial resistance. This includes people with chronic respiratory illness – many of whom have “rescue packs” which include antibiotics at home. These repeat prescriptions are often issued without enough education to support their use or highlight their drawbacks – so unnecessary prescribing practices continue.

Beliefs and expectations by patients, healthcare professionals and society have been found to be the main drivers of the overuse of antibiotics. From a patient’s perspective, the desire to get better is often more important than any external considerations such as publicity campaigns. And for healthcare professionals, the greater good of society occurs outside the immediate consultation and is therefore often overlookedalong with existing evidence. This breeds a cycle of expectation and self-interest which serves both clinician and patient but neglects wider societal issues.

It is possible, then, that much antibiotic prescribing, particularly in the flu season, is driven by these expectations – from both patients and healthcare professionals. But this is not unique to antibiotic prescribing. Our previous research found similar behaviours with oxygen therapy. Despite emerging evidence and guidelines, poor prescribing and administration of oxygen therapy persists – and it is often given routinely for breathlessness to patients.

A medical priority

A UK parliamentary health and social care committee report on antimicrobial resistance has called for the issue to be regarded as “top five policy priority” for government – stressing the need to support the pharmaceutical industry to develop new antibiotics.

How Brexit will affect this investment and commitment is unclear. But there remains an urgent need to promote responsible and appropriate prescribing through education, research, guidelines and campaigns.

Current UK prescribing levels are reported as double that of other countries such as Sweden, Netherlands and the Baltic States. This presents a challenge for primary care and hospitals who need to reduce both the number of antibiotics prescribed and the length of time that they are administered.

Antibiotic efficacy

A recent government report has called for the use of rapid diagnostic testing to inform all antibiotic prescriptions. This approach should take the guesswork out of prescribing antibiotics by testing for blood markers that signify the presence of infection. Findings from a large trial based in the UK are expected soon.

Sometimes though, the prescribing of general use antibiotics is not only expected, but cheaper and easier. So it will require a concerted effort to promote responsible prescribing and educate all healthcare professionals, patients and the public to refrain from using antibiotics.

So as winter approaches, rather than rushing out to your doctors at the first sign of a sniffle, try and ride it out. Get lots of sleep, keep stress to a minimum and up your fluid intake – all of which have been shown to help in the treatment and staving off of colds and flu. It’s also worth being extra vigilant with hand washing to help keep those germs at bay and stop them from developing into something more nasty in the first place.The Conversation

Carol Kelly, Reader Respiratory Care, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Winter pressures and the NHS Ambulance Services: ‘Doing more with less’ is not an option

ambulances queuing outside A&E at a North West hospital

Paresh Wankhade, Professor of Leadership and Management and Emergency Services Management Expert discusses the issues the Ambulance Service faces as winter approaches in his latest Comment blog:

With each passing year, the winter crisis puts a massive strain on the NHS ambulance resources with huge bottlenecks in the transfer of patients into the hospital Accident and Emergency (A&E) wards. In 2017, media carried several reports which highlighted delays on the part of ambulance crews arriving at the scene, including deaths of the patient waiting for an ambulance. Some of these arguments have been well rehearsed and have also prompted emotional debates and the cries of “52 weeks of the year crisis” in the Parliament.  I have highlighted four issues which in my view are the key flash points for ambulance services to deal with such recurrent crisis.

Address the funding-demand gap

The sustainability of an underfunded and overstretched ambulance services is though well recognised, but remains unresolved. The National Audit Office reported that between 2009-10 and 2015-16, the number of ambulance calls and NHS 111 transfers increased from 7.9 million to 10.7 million (average year-on-year increase of 5.2 per cent), and income for NHS ambulance trusts’ urgent and emergency care activity increased by 16 per cent from £1.53bn to £1.78bn between 2011-12 and 2015-16, but ambulance activity over this period (NHS ambulance calls and NHS 111 transfers) rose by a massive 30 per cent. This is accompanied by significant shifts in the demand with only 10 per cent of 999 callers having a life threatening emergency despite the average annual increase of five to six per cent in ambulance demand.  Doing even ‘same with less’ is proving difficult for ambulance trusts, something I have argued in my recent piece.

 

Move away from response time targets

Response time targets have been historically used to measure ambulance performance. Since July 2017, performance of NHS ambulance trusts is being benchmarked against four new national standards, based upon patient’s condition, now enshrined in the NHS Constitution.  However, during May-September 2018, ambulance services in England failed to meet  all the standards. A recent Parliamentary Report concluded that ‘ambulance trusts have organised themselves to meet response-time targets, at the expense of providing the most appropriate response for patients’ (p.5).  Another view that ‘commissioners, regulators and providers still place too much focus on meeting response times” reported in the National Audit Report (p.8) is deeply worrying.

Our research points to similar conclusions. We have systematically documented a range of unintended consequences  of response time targets used by the ambulance services.  We have also explored the relationship between cultures, performance measures, and organisational change to understand how organisational culture is perpetuated and found the targets to be a significant factor impeding the process of change. Ambulance services have embarked on the drive for ‘professionalisation’ but our latest research suggests that as ambulance work continues to intensify, ‘issues around dignity, staff retention and the meaning of work are becoming ever more challenging’.

 

Introduce fines/penalty for hospital delays

Ambulance handover delays to hospital A&E departments can have serious implications for patient safety and reduce available ambulance resources. The 30 minute cycle (handover and readiness for next call) is proving difficult to resolve. NAO  figures suggest that in 2015-16, only 58 per cent of hospital transfers met the 15-minute expectation in 58 per cent of cases as against 80 per cent in 2010-11, and only 65 per cent of ambulance crews were then ready for another call within 15 minutes. There are inconsistencies on the part of commissioners to penalise hospitals that do not adhere to the guidance of 15-minute transfers in absence of a fining regime. A quality indicator for measuring hospital performance in meeting the transfer-time target has not yet materialised, notwithstanding the recommendations of the Committee of Public Accounts.

Improve efficiency and productivity

The Carter Efficiency Review, published last month, highlighted concerns about huge variations in the delivery of ambulance services. It suggested potential savings of £300m a year by cutting unnecessary ambulance transfers, along with further £200m through use of more efficient models of operations and procurement.  But the review also raised fundamental questions over the need for significant investment in the ambulance sector. The shortage and retention  of paramedic staff coupled with high sickness absence rates continue to be a problem, an issue highlighted in the draft NHS Workforce Strategy. However, the review raises the clear need for investment since one of the recommendations to reduce high conveyance rates is likely to have cost implications. This will also require high quality staff engagement.

 

Conclusion

There are no easy fixes and addressing the winter pressures will necessitate strong and visionary leadership by ambulance chiefs and cooperation from other health care partners, in a political climate dominated by Brexit. A ‘whole systems’ approach is crucial to deal with this crisis. The Dalton Review called for successful leaders to act as a ‘systems architect’ to use their entrepreneur skills to explore innovative organisational models, as set out under the NHS Five Year Forward View. The Carter Review necessitates ambulance leaders to make right business and spending decisions which will impact the NHS. Devising an effective public education campaign to minimise misuse of ambulance resources and managing public expectation, will be a good starting point.

County lines: the dark realities of life for teenage drug runners

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Jon Tyson/Unsplash., CC BY

Grace Robinson, Edge Hill University; James Densley, Metropolitan State University , and Robert McLean, Northumbria University, Newcastle

“County lines” is a term used by the police to describe a growing practice among criminal gangs: when demand for drugs fails to meet the supply in major cities, gangs travel to remote rural areas, market towns or coastal locations in search of new customers.

The process – referred to as “going cunch” (country) or “going OT” (out there) by those involved – has initiated ugly forms of exploitation. Children as young as 12 are hired as “runners” to transport and sell illicit drugs, while the homes of vulnerable adults are occupied without permission to create a base to sell from – a practice also known as “cuckooing”.

Tackling county lines is now a national priority: the government has launched a new £3.6m National County Lines Coordination Centre, made up of experts from the National Crime Agency. The centre aims to measure the threat of county lines, focus resources on the most serious offenders and work closely with partners in health, welfare and education to reduce the harms associated with the practice.

For our latest research, published in the International Journal of Offender Therapy and Comparative Criminology, we spoke with members of organised crime groups, police, staff on youth offending teams and young people aged between 14 and 17 involved in drugs gangs in Glasgow, Scotland and Merseyside, England, to find out what leads them to get involved in this practice, and how it affects their lives.

Working the lines

Before gangs started using the county lines model, class A drugs such as heroin and crack cocaine were typically supplied in remote areas by user-dealers who would sell to locals from their own supply. Competition in these areas was low, and violence was kept to a minimum.




Read more:
Not all drug dealers are the same – it’s time to ditch outdated stereotypes


But in recent years, gangs have been using experience gained in the big cities to enter into smaller, satellite areas with high demand, good profit margins and low police presence. They are leveraging violent reputations earned in the big cities to intimidate and dominate existing players in the illegal drugs market. Police in picturesque county towns such as Shrewsbury (a town of about 70,000 people close to the Welsh border in Western England) are now dealing with turf wars and homicides.

A costly mistake. Shutterstock.

During our research, we found that one of the root causes of this problem is how normal it is among teenagers to use cannabis – and the monetary cost of this. Young people in our study began smoking weed recreationally with their friends as young as 13. Perhaps more significant than the psychological and physical effects of cannabis use, which are heightened around the time of puberty, was the fact that weed cost money that these adolescents did not have.

The majority of county lines workers we interviewed in Merseyside owed money to a drug dealer. They accrued debt by having their drugs “on tick” – a slang term for a “buy now, pay later” scheme. When they failed to pay, the indebted were forced into working for their dealers. Working the lines meant being deployed anywhere at any time, answering the phone without delay when their masters (or clients) called, and leaving their post only to meet paying customers.

Debt bondage wasn’t the only way people ended up working the lines. Some of our interviewees in Glasgow entered the trade by their own volition. They were willing to travel and simply asked known drug dealers for a job. Owing to boredom, poverty and a sense of hopelessness about their legitimate job prospects, these young people felt they had no choice but to sell drugs.

The experiences of young people who had made a choice (albeit a constrained one) to “go country” didn’t fully concur with the horror stories about the practice portrayed by the media. During their interviews, some young people recalled their experiences as “funny”, especially when they spoke of the exploitative relationships they had formed with vulnerable drug users.

A user-dealer’s flat is taken over by teenage drug runners. Source, Author provided
Young interviewees in both cities recounted how drug users would be “terrored” or intimidated to pass the time between waiting for the phone to ring and completing drug sales. Young people would entertain themselves by getting users to perform sex acts, eat from ashtrays and “shit off the floor” or undergo “challenges” in exchange for “free” drugs.

Removing root causes

Our findings expose a paradox at the heart of county lines – the exploited and the exploiters are often one and the same. Drug dealers, drug runners and drug users form a hierarchical structure, with the most vulnerable – the users – at the bottom. Drug runners look down on drug addicts to make themselves feel better about their own station.

County lines expose that drug prohibition is not working: current laws neither effectively prevent young people from selling drugs, nor protect the most vulnerable in society from consuming them. Positive initiatives such as the National County Lines Coordination Centre are necessary for sharing intelligence between police and social service providers, but constrained by the folly of existing drug policy.

Our research highlights that a criminal justice approach based on tough enforcement and recovering the proceeds of crime is not enough to dissuade dealers from dealing. Unless we tackle demand for illicit drugs, and the root causes of gang culture – namely social and economic marginalisation – county lines will continue to be drawn.The Conversation

Grace Robinson, PhD Candidate and Graduate Teaching Assistant, Edge Hill University; James Densley, Associate Professor of Criminal Justice, Metropolitan State University , and Robert McLean, Lecturer in Criminology, Northumbria University, Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Crime and nourishment – the link between food and offending behaviour

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tiverylucky/shutterstock

Hazel Flight, Edge Hill University; John Marsden, Edge Hill University, and Sean Creaney, Edge Hill University

It is well known that eating a balanced diet is of vital importance for maintaining good health and well-being. It is also one of the great social pleasures of life. Yet, far too many young people in prisons are consuming a poor diet, lacking in nutrition.

Alarmingly, research suggests over half of food items available for purchase in some prisons in the UK and the US are “high in fat or sugar”. It has also been suggested that in the US, prison food has been described as “scant, joyless, and unsavoury”. But it doesn’t have to be like this. Sant’angelo dei lombardi in Italy is said to have one of the best fed prisons in the world, where prisoners work to produce organic fruit and vegetables and leave healthier than when admitted.

Poor nutrition can impact on concentration and learning and may result in episodes of violent or aggressive behaviour. In prison, a bad diet can also contribute to increased rates of poor mental and physical health compared with the general population.

To tackle this problem, a new UK government strategy aims to provide young people with healthy eating advice on arrival in prison. Inmates up to the age of 21 will be provided with nutritional guidance so they can make “informed choices” about their diets.




Read more:
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Poor diet, aggression and impulsivity

The amount and nutritional value of food available in prisons and the dietary choices prisoners make has a significant influence on the quality of a prisoner’s life. Consuming highly processed and sugary foods can lead to sudden peaks and troughs in the amount of glucose in a person’s blood. This can cause fatigue, irritability, dizziness, insomnia and is even a risk factor for depression – particularly in men. It has been shown that a diet of whole foods can offer protection against depression.

Deficiencies in vitamins and minerals can lead to a number of issues. For example, low levels of iron, magnesium and zinc can lead to increased anxiety, low mood and poor concentration, leading to attention deficits and sleep disturbance. Omega 3 is required to improve cognitive functioning.

Recent government policies have recognised the problem of additives and the high sugar content of food, with the introduction of the sugar tax and moves to address the use of colourings, which have been found to have a negative effect on behaviour and hyperactivity. A recent example of the UK government’s willingness to intervene in the purchasing decisions of young people is the outlawing of energy drink sales to under-16s.

The types of problems associated with a poor diet, such as aggression, attention deficits and hyperactivity can make impulsive behaviour more likely. Studies have shown that “high levels of impulsivity are connected with high and stable levels of offending”.

Addressing the problem

Lucy Vincent – a freelance journalist with a background in both food and fashion – has started a campaign to address the need for better food in UK prisons. She believes that decent nutrition has the power to positively impact self-esteem, health, learning and development. Young people in prison are likely to have struggled with these issues and providing a better diet is an important step in improving their emotional health and well-being.

But there are obvious difficulties in improving the diets of young offenders. For example, Public Health England suggests that providing a balanced diet costs £5.99 per person, per day. Yet some prisons have food budgets as low as £1.87 per person, per day. There are obvious economies of scale to take into account, but providing a balanced diet for young offenders would still be a costly exercise – at a time when other parts of the prison service are starved of funds.

With experienced prison officers leaving the service and their remaining colleagues protesting over unacceptable levels of violence, improving the diet of young people in prison will be difficult to achieve.

But if the UK is to come close to breaking the cycle of reoffending, it needs to meet the basic needs of young people in prison and respect the basic human right of adequate nutrition. Government advice for young inmates is one thing, but those in prison need to have healthy food to choose from if they are to have any hope of staying healthy in jail.The Conversation

Hazel Flight, Programme Lead Nutrition and Health, Edge Hill University; John Marsden, Senior Lecturer in Counselling and Psychotherapy, Edge Hill University, and Sean Creaney, Lecturer in Psychosocial Analysis of Offending Behaviour, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What Labour’s Brexit motion means in practice

Paula Keaveney, Edge Hill University

As Labour delegates gathered in Liverpool, it was impossible to avoid mentions of Brexit. There are 25 separate fringe meetings listed on the conference agenda and there are certain to be more meetings arranged on the fly.

The challenge Labour faces, whether at conference or immediately afterwards, is that it is simply impossible to satisfy all the strands of opinion among members and Labour-leaning voters. While the party’s position has been made clear on some policies (with rail renationalisation an obvious example), Brexit is one of those areas where it is all a bit vague.

This has not necessarily been a problem to date. With doubt surrounding the government’s Chequers proposal, it would be difficult to have a hard and fast position that is not total opposition or total support. Of course Labour can do neither. It has instead drawn up a list of six tests it says the final deal must pass in order to be acceptable. But these are carefully drafted to be general enough not to frighten the horses.

But conferences have a habit of throwing a spotlight on what is missing on party platforms, and there has been a build up of pressure on Labour to be more precise and to commit to a stronger statement of opposition.

Ahead of conference, more than 100 motions on Brexit had been proposed for debate. Under Labour’s processes, this meant a lot of stitching together and compromising had to happen to produce one motion to put to a vote at conference. Late on Sunday night the wording emerged ready for a debate on the Tuesday (September 25).

The words agreed won’t please everybody. But they do move Labour in the direction of supporting a people’s vote – a referendum on the final Brexit deal. The key phrase, which campaigners will fix on is “if we cannot get a general election Labour must support all options remaining on the table, including campaigning for a public vote.”

This immediately raises two questions. First, how likely is another early general election? It is good campaigning fare for Labour to keep calling for it, but under the Fixed Term Parliaments Act (2011) there either has to be a large House of Commons vote in favour (which is what happened last time) or a successful motion of no confidence in the government, which is not then reversed by a second vote. At the moment there is no parliamentary arithmetic showing such a vote can be won. An early election is simply not in the interests of either the Conservatives or the DUP, so crucial votes are not available to make it happen.

The second question is about the logistics of another referendum. The UK is due to leave the EU on March 29 2019. Referendums don’t just happen. Parliament has to agree to one, the wording has to be sorted out, there have to be official campaigns designated, expense limits need to be agreed and there has to be a campaign period. Some argue that there simply isn’t time. However the roadmap published by the People’s Vote campaign argues that the logistics can work. The Article 50 letter can be withdrawn, the campaign argues, to make this possible.

The motion also includes the line “conference believes we need a relationship with the EU that guarantees full participation in the single market”. Shadow Brexit minister Keir Starmer had in fact already highlighted this aspiration by proposing in 2017 a lengthy transition period with single market membership. This could also be a reference to future membership of the European Economic Area, something that is controversial in Labour circles.

The question of a question

This is only part of the story for Labour however. There is ambiguity among anti-Brexit campaigners (or pro-second vote campaigners) both inside and outside the party about what form of words a public vote would use.

Some believe it should offer the option of remaining in the EU. Others say it should simply be about accepting the government’s deal or not. It is not even clear if it would be a binary choice. Some, including the Conservative’s Justine Greening, are advocating a three choice ballot, which would presumably offer the choice of accepting the deal, rejecting it and remaining in the EU or rejecting it and leaving without a deal. (A linked problem arises here over the form of vote. A first past the post approach to the three options would cause an almightly row.) Of course some of this ambiguity is deliberate. Campaigns wanting to establish the principle of something need to avoid too many early details as that usually derails momentum.

The task for Labour, as an opposition party wanting to get into government, is to adopt a position which is clearer than it has been while not offering up hostages to fortune by being overly specific. The position also needs to be maintainable during those tense weeks between the return of parliament on October 9 and the vote on the government’s deal. No small task.The Conversation

Paula Keaveney, Senior Lecturer in Public Relations and Politics, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why conditional offers are better for students

Students in lecture theatre

As we enter the new application cycle, a fresh cohort of prospective students will again be confronted with unconditional offers (not based on their final exam results) or other incentivised offers to persuade them to choose a particular university. As this practice becomes increasingly common, key figures in education are questioning whether it really benefits students – or the university sector as a whole.

In their recent report on the subject, UCAS stated that the number of unconditional offers made to 18 year old students from England, Northern Ireland, and Wales has risen significantly over the past five years – from 2,985 in 2013, to 67,915 in 2018. In the most recent application cycle, 22.9% of this group of students received at least one unconditional offer, an increase of 29% on the previous year.

The Government has been critical of this sharp rise in unconditional offers. Universities Minister, Sam Gyimah, has criticised the practice as “completely irresponsible” stating that it “undermines the credibility of the university system”. Gyimah says that “unconditional offers risk distracting students from the final year of their schooling, and swaying their decisions does them a disservice – universities must act in the interest of students, not in filling spaces.” His comments have been echoed by Robert Halfon, Chair of the Commons Education Select Committee, who claims that the practice is putting “funding” before “standards”. Gyimah has promised to closely monitor the number of unconditional offers being issued and has empowered the Office for Students to take appropriate action if necessary.

Head of Student Recruitment, Simon Jenkins, said: “At Edge Hill, we believe that going to university is a rewarding, life-changing decision and that choosing the right university is vital. Students should select where they are going to spend the next three years on the basis of which university and course is right for them, rather than which university is prepared to make an offer unconditional if a student chooses them.”

Geoff Barton, General Secretary of the Association of School and College Leaders, highlights the long-term dangers of unconditional offers saying that they “can lead to students making less effort in their A-Levels because their place is assured. That can then hamper their job prospects later down the line if potential employers take into account their A-Level grades.”

Edge Hill has always had a policy of not making unconditional offers to applicants who are sitting their A-Level, BTEC or equivalent qualifications for this reason.

“We are very conscious that exam grades are not just about getting into university,” said Simon. “We set what we believe are stretching entry requirements and we encourage applicants to work hard to achieve the very best grades that they can.

“We have strong academic standards as a university and we want students who are passionate about their subject and who want to be part of an exciting and dynamic community of lecturers and like-minded students. We also want students who are committed to their own success. For that reason, we will not compromise our standards by making unconditional offers to applicants in order to encourage them to come to us regardless of the grades they achieve.”

Third year Geography student Max Beaton turned down two unconditional offers from other universities to take up a place at Edge Hill. He said: “I chose Edge Hill as my firm choice as I could see myself studying and living here. The unconditional offers didn’t really sway my choice – visiting Edge Hill on open days and applicant days definitely sold the University to me and allowed me to talk to students and staff and get a real feel for the place.

“I do think I made the right choice. Being a student here and being a member of the Edge Hill community actually exceeded my initial expectations.”

Max advises students starting off on their application journey to choose the university that is best for them.

He added: “Unconditional offers do look great and very encouraging and the university might really want you to choose them, but if it’s not the right choice for you, no matter what they are offering, you have to do what is best for you.”

Kazia Cannon, a 3rd year Drama student, also received two unconditional offers before deciding on Edge Hill. She said: “Edge Hill was just a lot more suited to my needs both academically and in terms of student support.

“When you’re visiting universities, you have to think ‘is this somewhere I can imagine myself in three years?’ That’s what I did every time I went to an open day and that’s how I made my decision in the end.”

 

Potatoes are out of favour – but they have strong roots in a healthy lifestyle

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shutterstock.

Hazel Flight, Edge Hill University

Potatoes are apparently far from being flavour of the month. Rejected by young people and “clean eaters”, sales are plummeting. But what has the potato done to deserve being treated so distastefully?

Reports claim that millennials prefer rice and noodles, and think that potatoes will make them fat. According to The Grocer magazine potato sales have decreased by 5.4% in the last four years, while sales of rice and noodles have risen by 30%.

But the potato has a proud history. One of the most common and versatile root vegetables, it was first cultivated by the Inca Indians in Peru over 7,000 years ago. Brought to Europe in the 16th century, potatoes have been associated with population surges and increased global urbanisation. There are now as many as 2,000 different varieties being grown in over 160 countries.

Yet today it seems we crave the quick and easy, avoiding anything that requires time or preparation. Potatoes are apparently seen as neither exotic, convenient or healthy.

So why did a once favoured food find itself pushed aside? Well let’s examine the evidence before it is judged guilty. In its defence the potato has all the requirements to form part of a healthy balanced diet.

In 100g of steamed potatoes, you’ll find just 100 calories, no fat, no sodium, no cholesterol, and no gluten. Instead, you’ll get nearly half your daily dose of vitamin C, more potassium than in a banana and plenty of vitamin B6, fibre, magnesium and antioxidants.

Yes, there is starch, which can increase insulin sensitivity – but it can also improve blood sugar control, digestive health, nutrient absorption and satiety (fullness), help curb inflammation in the body, boost immunity and improve blood circulation.

The case against potatoes often seems to rest on accusations of high calorific value. But it is not the actual potatoes which bring the calories, it is the method of cooking.

And yes, potatoes are high in carbohydrates, but these are necessary for long term energy. Many do not know the difference between simple and complex carbohydrates. Potatoes are complex carbohydrates which are a necessary part of our everyday diet.

People often listen to the latest diet information and react by thinking that certain food groups are not good for you. In fact, a person requires foods from each nutrient group in order to maintain optimal health. Eating potatoes cooked appropriately in moderation is simply not harmful.

Potatoes are also classified as a high glycemic food, but if eaten as part of a diet which includes high fibre foods such as lentils, beans, nuts and other vegetables, the sugar spike can be counteracted.

Hot stuff. Shutterstock

A lot of the potato’s PR problem may simply be about portion control. It seems that once we start to eat a bowl of chips or crisps, we find it impossible to stop until they are gone, and all of their salty calories have been consumed. Boiled or baked potatoes on the other hand are very rarely eaten to excess.

When the chips are down

But with rises in obesity, we become obsessed with following the latest diet craze – where usually at least one of the main nutrient groups are significantly decreased or eliminated. As part of this, potatoes have become taboo.

In the 1970’s potatoes formed a staple part of the everyday diet. In the decades since, according to the National Obesity Forum, which compared the habits of 4,000 UK households from 1980 to 2012, eating habits and diets have been getting steadily worse.

This has been mainly due to the introduction of processed foods and ready meals and falls in line with the commencement of the obesity crisis in children. Another reason may be due to more exotic lifestyles. With foods from around the world more readily available, alongside the increasing number of takeaways, the potato has lost some favour. But in our desire to save time and money we may actually be forgetting a key aspect – our overall health and longevity?<!– Below is The Conversation's page counter tag. Please DO NOT REMOVE. –>The Conversation

Potatoes deserve to be given another chance. People need to consider the way that they have been cooking and consuming this wonderful vegetable. There is no reason to cast them aside. For a nutritious vegetable which will power up your performance – look no further than the humble spud.

Hazel Flight, Programme Lead Nutrition and Health, Edge Hill University

This article was originally published on The Conversation. Read the original article.