ABSTRACT
African and Caribbean populations are at higher risk of developing obesity and more likely than the average United Kingdom national to suffer from type 2 diabetes, cardiovascular disease and now COVID-19. Despite limited progress to date, we now see a growing political commitment to address the high rates of overweight and obesity in the UK. A clear understanding of what works for these populations is warranted in order to support their needs and develop effective interventions. A culturally tailored diet and lifestyle intervention was delivered for African and Caribbean people residing in Manchester to modify lifestyles and promote healthy eating. This paper presents insight from a reflection and qualitative process evaluation of the intervention. Participants received tailored nutrition and health education and participated in healthy cooking lessons/demonstrations every Tuesday for 90 minutes over 24 weeks (November 2021-March 2022). On a daily basis, 107 participants interacted by sharing photos of their meals, asking questions and sharing experiences of dietary changes on a social media platform. Participants also participated in daily 10,000 steps challenge as part of the intervention package, which was monitored using a fitness mobile application. The weekly group discussions (n = 24) involving 20-35 participants helped to explore the views of participants regarding the enablers, facilitators and challenges guided by a semi structured interview guide. All session were conducted via zoom and recorded. Thematic analysis was used to analyse the findings. Five main themes emerged: 1. motivation (e.g., chronic illness of participant or a close relation, or the desire to maintain a healthy weight);2. goal setting that was reviewed periodically;3. the regular contact with nutritionists and dietitians through social media platform;4. shared practices which was encouraged through a competitive edge;4. the unexpected advantage of reducing food expenditure;5. the use of an all African delivery team. Culturally tailored dietary interventions are beneficial and could potentially help African and Caribbean populations to adapt healthy dietary and lifestyle practices if it is co- produced and the implementation is led by people from African and/or Caribbean ancestry.
ABSTRACT
Introduction: With the increase in number of the people receiving COVID-19 vaccination, different adverse effects associated with vaccine are being described. While vocal fold paresis (VFP) after both COVID-19 disease and COVID-19 vaccination has been rarely reported, data on this entity in dialysis population is still lacking. We present a case of VFP in a hemodialysis patient following the administration of Pfizer-BioNTech COVID-19 vaccine. Case Description: 45-year-old West Indian female with DM, HTN and End Stage Kidney Disease 2/2 Focal Segmental Glomerulosclerosis s/p kidney transplant that failed after 16 years (on low dose tacrolimus) requiring to start hemodialysis presented to the ED with complaints of voice hoarseness with dysarthria and throat itching that started ~30- 45 minutes after having received the first dose of Pfizer-BioNTech COVID-19 vaccine. She underwent Fiberoptic Indirect Laryngoscopy that showed widely patent airway with mobile vocal cords bilaterally. Symptoms were thought to be secondary to a reaction to the vaccine vs mild GERD. She received steroids and was discharged home within 24 hours after symptomatic improvement on steroid therapy. Her voice normalized within a week. Six months later, she received the second dose of Pfizer-BioNTech vaccine, ~30 minutes after which again developed dysphonia and dysarthria. This time, she was found to have bilateral VFP with incomplete closure. Steroid therapy was reinitiated and is slowly being tapered. Her dysarthria has improved;however, she continues to have hoarseness of voice even after 9 months of having received 2nd dose of vaccine. She has not received the booster dose of vaccine. Discussion(s): Current guidelines recommend booster doses of COVID-19 vaccine for immunocompromised individuals including those on dialysis. The benefits of vaccination markedly outweigh the risk of very rarely reported development of VFP after vaccination. Further research is needed to determine the prevalence of this complication in dialysis patients and to elucidate the underlying mechanisms leading to it.