Good nutrition and eating well are an important part of public health and can help stave off a number of age-related illnesses. Over the last twenty years, Bournemouth University’s Professor Heather Hartwell has been carrying out research into nutrition in the context of developing large-scale interventions to improve public health. Her work has taken her from prisons to hospitals to workplace canteens.

When Professor Hartwell began her research career in nutrition, much of the health policy focus was on one-to-one support for people who were struggling with associated health conditions. The idea that large scale interventions might be successful was only beginning to be recognised.

“One of the first projects I was involved in at Bournemouth University was a commission from the National Audit Office, exploring nutrition in prisons,” says Professor Hartwell, “We found that while prisoners did have healthy eating options, the catering on offer tended to over-rely on processed foods – bread, sausages and pasties, for example. This meant they were eating more salt than the general population, which can lead to high blood pressure and the risk of heart disease. Among other things, we recommended that they used the prison gardens to grow fresh produce, as it was a low-cost way of adding more vegetables to the food on offer.”

“Around the same time, we were also looking at nutrition in hospital catering. In this setting, we found that there were much fewer healthy food options on offer and that meal production and delivery were overseen by a number of different teams – caterers, porters and ward staff. This meant that there was no real consistency and making it easier for miscommunication to take place.”

“It was quite eye-opening working in two very different public sector contexts,” continues Professor Hartwell, “As researchers, it’s important to go into every situation with humility because until you’re fully immersed in the context in which you’re working, you can’t fully appreciate the barriers that staff might be facing. In the NHS, for example, catering managers are often providing three meals per day, drinks and snacks on a very low budget, which limits what they’re able to do. You can’t achieve perfection in any situation, but co-created research can significantly improve what was there before.”

Working in public sector settings and seeing the difference that larger scale interventions could make on people’s health then led Professor Hartwell to consider the difference that healthier eating options could make in workplace canteen environments.

“These settings are really important because they’re where people eat on a regular basis, not just one-off celebratory meals. If people are continually being offered unhealthy food choices, then it can have long-term implications for their health. We’re given very little information about what’s in our food when we eat out, so my starting point was to improve that.”

Over the last few years, Professor Hartwell has been working on a major European grant, FoodSMART, which has been addressing exactly that issue. The grant enabled Professor Hartwell and her team to develop an App, which uses data provided by catering companies to help consumers to make more informed choices about their meals.

“We wanted to create an IT solution for the contract catering industry which would both better inform their consumers and also give the companies an edge when competing for new contracts,” explains Professor Hartwell, “It was slightly ahead of its time when we first created it, but is gaining much more interest now as workplaces are increasingly concerned about employee wellbeing.  Nutrition can help contribute to better health, which helps to reduce sickness rates and can improve productivity too.”

Alongside FoodSMART, Professor Hartwell and her team were also leading on another European grant, which was looking at increasing our protein intake through vegetables. In the context of an increasing global population, it is important for the agricultural and catering sectors to consider more sustainable sources of food.

“The project was about encouraging people to get their protein through vegetables, rather than meat, which uses far more resources than arable farming,” says Professor Hartwell, “It’s a healthier way of meeting our protein requirements as vegetables contain less fat and are much more sustainable in the long run.”

Partly inspired by the issues of sustainability raised in this project, Professor Hartwell and her team have recently started working on a new research grant with partners in Brazil to consider how to improve our long term food security.

More information about VeggiEAT can be found here: www.bournemouth.ac.uk/veggieat 

More information about FoodSMART can be found here: www.bournemouth.ac.uk/foodsmart

This article was featured in the 2018 Bournemouth Research Chronicle. To see the magazine in full, click here or pick up a copy in Poole House or Studland House reception.

‘Blood’ loss after childbirth is a normal occurrence for women, due to the separation of the placenta. Excessive blood loss within the first 24 hours is known as primary post-partum haemorrhaging, while excessive blood loss after this period is known as secondary post-partum haemorrhage. Research undertaken by former Bournemouth University staff explores the prevention and early detection of the latter, which can result in chronic ill health and even the need for emergency medical care.

The ‘blood’ loss, known as lochia, gradually changes colour and reduces in volume over several weeks. Observations of the lochia and the gradual reduction in size of the uterus in the first few weeks after childbirth have long been a standard part of midwifery care. These observations are an essential part of monitoring for warning signs of secondary post-partum haemorrhaging.

Dr Sally Marchant and Emeritus Professor Jo Alexander were the lead researchers behind the project, which was partly inspired by Dr Marchant’s earlier career as a practicing midwife.

“I was a Ward Sister for around ten years, specialising in postnatal care,” explains Dr Marchant, “During that time, I noticed that there were some inconsistencies in practice. Midwives were taking very different approaches to the same task, as a lack of evidence meant it was unclear which method was best.”

A review of guidance for midwives in textbooks showed that while certain postnatal practices were advocated as being correct care, there was very little evidence to underpin them. Having established the gaps in knowledge, the next stage of the research was for Dr Marchant to carry out a longitudinal survey of postnatal women to see how their lochia changed over time and what advice they were being given.

“The second stage of the research was quite revealing, as it showed us that there was a huge lack of knowledge among new mothers about why they were being asked to monitor their ‘blood’ loss”, explains Dr Marchant, “Women were aware of what to look for, but not why it was important or why a change might be significant and could be something to be concerned about.”

“For midwives, it seemed to be perceived as just another test which needed to be conducted as part of their routine checks. We also found that the way notes were written up was quite inconsistent. The terms and language midwives used to describe the postnatal uterus varied hugely, so there was sometimes miscommunication about the normality of a woman’s health.”

As a result of their research, the team were able to make a number of evidence-based recommendations which still underpin the advice in midwifery textbooks today. These recommendations also inform World Health Organization (WHO) guidance on this aspect of postnatal health.

The final stage of the research was a case control study in which Dr Marchant compared retrospective data of 530 women who had not experienced secondary postpartum bleeding against 265 women who had. The aim was to establish predictive factors, which might help to identify at-risk women.

“Among other things, Dr Marchant found that if women had a previous history of the condition then they were at higher risk of it happening again,” says Professor Alexander, “We also found that smoking during pregnancy was a risk factor, which wasn’t an obvious connection.”

“In addition, we looked at the extent to which midwives’ observations were predictive of the likelihood of secondary post-partum haemorrhaging. We found that they were significantly predictive, which was reassuring!”

The project took place as part of the work of a wider group of researchers who were exploring a number of different avenues related to the health of women, babies and their families. This included considerable work in the area of post-natal care and breastfeeding which, among other successes, resulted in a module about breastfeeding for the website HealthTalk. This site brings together video clips of women recounting their experiences, with best quality evidence in order to help others to gain a better understanding of any health challenges they may be facing and to feel less isolated.

For more information about BU’s research in the area of maternal health, visit the website of the Centre for Midwifery, Maternal and Perinatal Health: www.bournemouth.ac.uk/cmmph

This article was featured in the 2018 Bournemouth Research Chronicle. To see the magazine in full, click here or pick up a copy in Poole House or Studland House reception.

Around 1 in 50 people are thought to be affected by prosopagnosia or face blindness. The condition can have a significant effect on people’s personal and professional lives, but has only relatively recently begun to gain public attention. Bournemouth University’s Dr Sarah Bate has spent much of her career researching people affected by the condition, and more recently those at the other end of the spectrum: so-called ‘super-recognisers’.

Prosopagnosia affects people’s ability to recognise even the most familiar of faces. People are largely born with the condition, although in rare cases they may develop it in later life, following a head injury or illness. Until recently, it was thought that only a small number of people had prosopagnosia, but research led by Dr Bate has proved otherwise.

“My interest in the area stemmed from my undergraduate studies at the University of Exeter, where I first heard about the condition,” says Dr Bate, “My lecturer was in touch with one person with prosopagnosia and offered me the chance to work with that person for my final year project. It was a unique opportunity at the time, as not many people were thought to have prosopagnosia.”

“I continued researching face blindness for both my Master’s and PhD studies, but still with quite a limited pool of people as the condition was believed to be rare. It wasn’t until I’d completed my PhD and moved to Bournemouth University (BU) to set up my own research lab that I discovered this was quite far from the truth!”

“Not long after I moved to BU, my research gained considerable media coverage, which was probably one of the first times that face blindness had gained much public attention. It also coincided with people beginning to rely more on using the internet to better understand their symptoms. The combination of the two meant that suddenly I was being approached by thousands of people who thought they had the condition,” explains Dr Bate.

At the time, very few GPs and medical staff knew about prosopagnosia, so for many people, talking to Dr Bate was the first time they’d been able to fully understand their symptoms. In due course, the increased need to acknowledge people’s symptoms, combined with Dr Bate’s extensive research into diagnosis of prosopagnosia led to the National Institute for Health and Care Excellence (NICE) recognising it as an official health condition in 2014.

Since then, much of Dr Bate’s research has moved on to focused on how to diagnose the condition in children. The tests used to diagnose prosopagnosia in adults do not work particularly well with children, so Dr Bate’s team have developed new methods involving eye-tracking technology to help with diagnostics.

“The tests we use with adults aren’t very suitable for children, as they tend not to have the concentration needed to make them work,” says Dr Bate, “We use state-of-the-art eye tracking technology, which enables us to pinpoint which parts of the face children are looking at. This is important because our research shows that typical people tend to spend more       time looking at the eyes, whereas those with prosopagnosia look at other areas of the face.”

“The main aim of developing better diagnostic tools for children is so that we can improve early intervention treatments for them. As with many conditions, the earlier interventions can be made, the more likely they are to succeed,” continues Dr Bate, “It’s harder to treat adults, as many will have developed their own coping strategies and they don’t always want to try something new.”

At the other end of the spectrum are so-called ‘super-recognisers’, who have above average abilities when it comes to recognising faces. This is an area of research that Dr Bate has begun to explore more recently, in an attempt to understand if prosopagnosia is a developmental disorder or a sliding scale of ability.

“The idea was that if we have people who are at the bottom end of a normal range when it comes to facial recognition, then there must be people who are at the top range too,” explains Dr Bate, “We’ve developed research in this area, which is now beginning to help organisations such as the police and border control to identify which of their staff are best at recognising faces.”

“We found that different people are better at different aspects of facial recognition, so it’s not just about screening for the ‘best’ people. Computer software is a long way off being able to perform this function of policing and border control, so it was important for us to have rigorous research to back our theories.”

For more information about prosopagnosia and super-recognisers, visit the Centre for Face Processing Disorder’s web page: www.prosopagnosiaresearch.org

This article was featured in the 2018 Bournemouth Research Chronicle. To see the magazine in full, click here or pick up a copy in Poole House or Studland House reception.