bluuebunny/crossref_metadata_2025 huggingface dataset:
OP89 The Association of Parental Fatal and Non-Fatal Suicidal Behaviour with Offspring Suicidalbehaviourand Depression: A Systematic Review and Meta-Analysis
Authors: Geulayov G , Gunnell DJ , Holmen TL , Metcalfe C
Published: September 2012

Background

Children whose parents die by, or attempt, suicide are believed to be at greater risk of suicidal behaviours and affective disorders. We systematically reviewed the literature on the association of parental fatal and non-fatal suicidal behaviours with offspring suicidal behaviour and depression and, using meta-analysis, estimated the strength of these associations. We further investigated the role of parental and offspring gender, and offspring age at exposure as potential effect modifiers.

Methods

We carried out a comprehensive literature search using Medline (1950-April 2011), PsycINFO (1876-April 2011), EMBASE (1980-April 2011) and Web of Science. Twenty eight articles met our inclusion criteria, 14 of which contributed to the meta-analysis. Crude odds ratio (OR) and adjusted odds ratio (AOR) were pooled using fixed-effects models.

Results

Controlling for relevant confounders, offspring whose parents died by suicide were more likely than offspring of two living parents to die by suicide [AOR 1.94, 95% confidence interval (CI) 1.54–2.45] but there were heterogeneous findings in the two studies investigating the impact of parental suicide on offspring suicide attempt (AOR 1.31, 95% CI 0.73–2.35). Children whose parents attempted suicide were more likely than unexposed children to attempt suicide (AOR 1.95, 95% CI 1.48–2.57). However, compared with offspring of parents who died by other causes, the risk of suicidal behaviour was only slightly elevated for offspring of suicide decedents (suicide: OR 1. 81, 95% CI 1.56–2.10; suicide attempt: OR 1.73, 95% CI 1.63–1.83); no adjusted analyses were available. Limited published research indicated that offspring exposure to parental death by suicide is associated with subsequent increased risk of affective disorders compared to offspring of two living parents. Maternal suicidal behaviour was associated with larger effect estimates compared to paternal suicidal behaviours. There was some evidence that younger age at exposure to parental suicidal behaviours was associated with greater risk than exposure in later childhood/adolescence. There was no evidence that the association differed in sons versus daughters.

Conclusion

Parental suicidal behaviour is associated with increased risk of offspring suicidal behaviour, above and beyond the risk associated with a loss of a parent to a cause other than suicide. Findings suggest that maternal suicidal behaviour is a more potent risk factor than paternal suicidal behaviour. Limited evidence suggests that children are more vulnerable than adolescents and adults. However, there is no evidence of a stronger association in either male or female offspring.
OP90 Evaluating Mental Wellbeing in Children with Health Related Barriers to Learning: Results of a Quasi-Experimental before and after Intervention
Authors: Putz RE , Clarke A
Published: September 2012

Background

Clear associations have been demonstrated between poor mental health, behavioural problems and low educational attainment in secondary school children while negative self-perceptions are associated with truancy and classroom disruption at secondary school level. The majority of research in this field focuses and measures outcomes in terms of mental illness. Fewer interventions have been evaluated using positive mental health/mental wellbeing measures, though the body of evidence is growing.

We aimed to evaluate the effect of targeted school counselling or ‘Wellbeing Mentorship’ on mental wellbeing in children with health related barriers to learning at risk of low educational attainment and attendance. Health related barriers to learning included medical issues, mental health, sexual health, bullying, family challenges and emotional and behavioural barriers.

Methods

The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) was used to evaluate mental wellbeing in pupils seen by Wellbeing Mentors. WEMWBS is validated for use in populations aged 13+. Gender, age, school deprivation, attainment and attendance were measured. Mentors at eight diverse schools collected data from April 2011 to February 2012. A power analysis was conducted. Given the risk of high attrition, pupils were sampled within a designated time frame wherein Mentors evaluated every eligible pupil. Pupils completed WEMWBS at the beginning, end, and 6–10 weeks after their last mentoring session. Interventions comprised 6 sessions of weekly one-to-one health and wellbeing support.

Results

Ninety-six eligible pupils undertook and completed WEMWBS, out of 160 estimated mentoring referrals. Using paired t-tests and ANOVA, we assessed changes in WEMWBS scores between time points. Pupils’ mental wellbeing significantly improved (95% Confidence) from baseline to completion. Girls’ baseline mean WEMWBS score (43.3) increased by 7.4 points to 50.7 at completion; boys baseline mean (44.2) increased by 6.2 to 50.4. These changes were sustained at follow up. Boys and girls results demonstrate statistically and clinically meaningful change. We compared our results with WEMWBS data collected in 2008 from two of the same and one similar school (n=753). The comparator mean for girls (47.4) and boys (49.8) indicate that mentored pupils improved their mental wellbeing to a similar level (boys) or a significantly higher level (girls).

Cooperation, process measures, attainment and attendance reporting varied greatly between schools; these data are still being collected.

Conclusion

Both before and after and population controls suggest that mentoring is a worthwhile intervention for improving mental wellbeing in secondary school pupils identified with health related barriers to learning.
OP92 The Impact of Military Deployment, Combat Experiences and Post-Deployment Mental Health Problems on Violent Behaviour among UK Military Personnel
Authors: MacManus D , Dean K , Jones M , Rona R , Hull L , Greenberg N , Fahy T , Wessely S , Fear N
Published: September 2012

Background

There is considerable media, political and public interest on both sides of the Atlantic in an alleged rise in violence among military personnel returned from conflicts in Iraq and Afghanistan. This study explores violence among a large sample of UK military personnel, a proportion of whom had been deployed to Iraq/Afghanistan. The aims were to estimate the prevalence of self-reported violence, examine the impact of deployment and combat experiences on subsequent violence and the association with post-deployment mental health problems and alcohol misuse.

Methods

This study formed part of a questionnaire-based cohort study established to explore the impact of deployment on mental health among UK military personnel. The sample was randomly selected from all military personnel serving in the UK Armed Forces between 2003 and 2007. A total of 9986 participants from all Services were included, some had been deployed and some had been trained but not deployed. Special Forces were excluded. Data, collected by questionnaire, included information on deployment experiences, socio-demographic and military characteristics, pre-enlistment antisocial behaviour, and post-deployment health outcomes. The main violence outcomes were self –report measures of interpersonal violence.

Results

6.2% of the sample reported interpersonal violence in the last month. Deployment showed a stronger association with subsequent violence among reservists (OR=2.98 (1.50–5.93),P=0.002) than among regulars (OR=1.26 (0.96–1.67),P=0.098) when compared to their non-deployed counterparts. Performing a combat role whilst deployed was associated with a significantly increased likelihood of violence among regulars (OR=1.90 (1.38–2.75), P<0.001) and the risk of violence increased with the number of traumatic events experienced (P<0.001)). Violence on homecoming was also associated with mental health problems such as PTSD (OR=4.8 (3.2–7.2) P<0.001) and alcohol misuse (OR=3.1 (2.5–3.9) P<0.001).

Conclusion

Military deployment, in particular combat exposure, increased the risk of subsequent violence among military personnel and the risk of violence increased with increasing number of traumatic events experienced on deployment. Valuable information on risk factors for violence among military personnel is provided, especially regarding increased risk among deployed reservists and among personnel who report post-deployment mental health problems and alcohol misuse.
OP96 Survey of use and Application of test Accuracy Measures for Decision Making in Primary Care
Authors: Davenport CF , Hyde CJ
Published: September 2012

Background

Increase in test use over recent decades has occurred despite disappointing results from test accuracy evaluations. Difficulties with understanding and application of test accuracy information are purported to be important contributors to this observed evidence ‘gap’. Empirical research to date is based on the premise that formal probability revision is a necessary pre-requisite for informed diagnostic decison making and is characterised by self selected samples with recent experience or expertise in test evaluation. The survey aims were to describe how clinicians apply existing test accuracy metrics for diagnostic decision making.

Methods

An incentivised, electronic survey was used. Informed application of test accuracy information was evaluated by asking respondents to indicate their management decision following presentation of nine different representations of the same test accuracy information to a common hypothetical scenario. Quantitative and qualitative synthesis was employed based on closed and open responses to management decisions.

Results

A total of 204 General Practitioners (response rate 95%) did not appear to be self-selected on the basis of academic position, involvement in policy or experience in test evaluation. Sensitivity and specificity, the annotated 2x2 diagnostic table and predictive values were reported to be familiar metrics by the most respondents. Likelihood ratios the DOR and AUC were familiar to less than 1/3 of respondents. Application of test accuracy metrics resulted in marked variation in responses to both positive and negative test results although greater inconsistency and management uncertainty was observed following presentation of a negative test result. Formal probability revision was not a feature of the diagnostic decision making process. Test errors (false negatives and false positives) were prominent as part of the translational pathway from quantitative summary estimates of test accuracy to management decisions. Summary measures that separate the two dimensions of test accuracy in the absence of prevalence information (for example sensitivity and specificity) appeared to result in a misplaced emphasis on one or other of false positive or false negative test errors. Presenting test accuracy data using the 2x2 diagnostic table or a pictograph attenuated this effect.

Conclusion

Choice of test accuracy metric appears to have a profound effect on diagnostic decision making. Understanding, contextual factors and motivational biases are likely to be contributing factors to the observed variability. It is unclear to what extent any advantage of test accuracy metric for informed decision making is based on familiarity as opposed to their intuitive nature. Simultaneous illustration of both dimensions of test accuracy in order to facilitate informed diagnostic decision making requires further exploration.
PL02 Breastfeeding and Social Mobility: Neurological Development or Stress Mechanisms?
Authors: Sacker A , Kelly Y , Bartley M , Iacovou M
Published: September 2012

Background

Breastfeeding has been associated with higher cognitive scores, better test results and fewer socio-emotional problems in childhood. These outcomes in turn predict social mobility. This study examines the effect of breastfeeding on inter-generational social mobility and the role of two biologically plausible mechanisms: via improved neurological development due to the long-chain polyunsaturated fatty acids in breast milk and via hypothalamic-pituitary-adrenal (HPA) axis functioning due to growth hormones in breast milk.

Methods

We use data from two birth cohorts (the 1958 National Child Development Study and the 1970 British Birth Cohort) to examine breastfeeding’s relationship with social mobility. Social class at 10/11 years was based on father’s class. Both class of origin and own social class in adulthood (age 33/34) were measured by the Registrar General’s social class (RGSC). Neurological development was assessed using cognitive tests and assessments of fine motor function. HPA functioning was assessed using socio-emotional behaviour scales and a physical symptoms of stress score.

Results

Rates of breastfeeding were higher in the 1958 cohort than the 1970 cohort (43% vs. 21% breastfed 1+ months). Breastfeeding was more socially patterned by 1970, with advantaged mothers being more likely to breastfeed. A propensity score approach matched breastfed and non-breastfed children on a large number of characteristics before estimating the effect of breastfeeding on social mobility. We modelled the odds of upward and downward social mobility conditional on being breastfed for 1 month or more and social class of origin. Results show that breastfeeding increased the odds of upward mobility (1958 cohort: OR 1.25 95% CI 1.13, 1.37; 1970 cohort: OR 1.14 95% CI 1.00, 1.31), and reduced the odds of downward mobility (1958 cohort: OR 0.81 95% CI 0.74, 0.90; 1970 cohort OR 0.79 95% CI 0.69, 0.91). Controlling for the measures of neurological development and stress functioning attenuated the effect of breastfeeding to marginal or non significance. Gender differences in these findings will be discussed.

Conclusion

Breastfeeding promotes upward social mobility and protects against downward mobility. The effects appear to operate through enhanced neurological development and more effective stress processes.
PL03 Socio-Economic Inequalities in Lung Cancer Treatment: A Systematic Review and Meta-Analysis
Authors: Forrest LF , Adams JM , Wareham H , Rubin G , White M
Published: September 2012

Background

Intervention-generated inequalities in health result from the way that health interventions are organised and delivered. There is some evidence that socio-economic inequalities in care may occur for some common cancers and treatment inequalities may contribute to socio-economic differences in survival. Although the incidence and outcome of lung cancer varies with socio-economic status (SES), it is not known whether socio-economic inequalities in treatment occur. We conducted a systematic review and meta-analysis of existing research on socio-economic inequalities in receipt of treatment for lung cancer.

Methods

Systematic methods were used to identify relevant studies, assess study eligibility for inclusion and evaluate study quality. Cohort studies of adults with a primary diagnosis of lung cancer, published in peer-reviewed English language journals up to 2011, were examined. All studies reporting rates of receipt of any treatment for lung cancer according to a measure of SES were included in the review. Studies that reported odds ratios for receipt of treatment, adjusted for at least age and sex, were included in the meta-analysis. Subgroup analyses by healthcare system (universal healthcare system or insurance-based system), histology and stage were conducted.

Results

From the initial 1345 studies identified, 46 studies were included in the review and 29 in the meta-analysis.

Socio-economic inequalities in receipt of lung cancer treatment were observed. Low SES was associated with a reduced likelihood of receiving any treatment (OR=0.79, CI (0.74 to 0.84) p<0.001), surgery (OR=0.71 (CI 0.65 to 0.77), p<0.001) and chemotherapy (OR=0.81 (CI 0.73 to 0.91), p<0.001), but not radiotherapy (OR=0.95 (CI 0.84 to 1.07), p=0.41), for lung cancer. The association was found in both insurance-based and universal healthcare systems and remained when stage and histology were taken into account for receipt of surgery.

Conclusion

This systematic review and meta-analysis found that lung cancer patients living in more socio-economically deprived circumstances were less likely to receive any type of treatment, surgery and chemotherapy. These inequalities cannot be accounted for by socio-economic differences in stage at presentation or by type of healthcare system. Further investigation is required into the patient, clinician and system factors that may contribute to socio-economic inequalities in receipt of lung cancer care and how these inequalities may impact on survival, and also into how to reduce such inequalities.
PS10 The Appropriateness of, and Compliance with, Telephone Triage Decisions
Authors: Blank L , Coster J , Cathain A , Knowles E , Tosh J , Turner J , Nicholl J
Published: September 2012

Background

Telephone triage plays an important role in managing demand for healthcare. In recent years there has been an increasing use of telephone triage in managing demand for unscheduled health care for general health problems. Policy makers, service providers and service evaluators are interested in the appropriateness of triage decisions in the context of offering an effective and safe service. In 2009 the Department of Health in England announced the establishment of a small number of pilot sites to test a new telephone triage service called ‘NHS 111’. The service offers telephone triage to members of the general population calling about urgent but non-emergency health problems. Calls are triaged by trained non-clinical call advisors and directed to a range of services such as an emergency department, or a general practitioner.

Methods

As part of an evaluation of these pilots, in order to provide context for understanding the findings, a rapid evidence assessment was undertaken of the appropriateness of, and compliance with, telephone triage to synthesise the evidence on the percentage of telephone triage decisions assessed as appropriate and the percentage which callers complied with. The aim of this paper is to report on a systematic review of the literature on appropriateness of, and compliance with, telephone triage decisions. The study focused on telephone triage services directing patients to an appropriate health care provider. The principles of rapid evidence assessment were followed.

Results

We identified 54 relevant papers; 26 papers reported appropriateness of triage decision, 26 papers reported compliance with triage decision and 2 papers reported both. Nurses triaged calls in most of the studies (n=49). Triage decisions rated as appropriate varied between 44% and 98% (median 75); compliance ranged from 56% to 98% (median 77%). Variation could not be explained by type of service or method of assessing appropriateness. However, inconsistent definitions of appropriateness may explain some variation. Triage decisions to contact primary care (median 66%, range 25%-91%) may have lower compliance than decisions to contact emergency services (median 75%, range 29%-100%) or self care (median 77%, range 26%-100%).

Conclusion

Telephone triage services can offer appropriate decisions, and decisions that callers comply with. However the association between the appropriateness of a decision and subsequent compliance requires further investigation and further consideration needs to be given to the minority of calls which are inappropriately managed. We suggest that a definition of appropriateness incorporating both accuracy and adequacy of triage decision should be encouraged.
PS11 Does Contact with a Podiatrist Prevent The Occurrence of a Lower Extremity Amputation in people with Diabetes? A Systematic Review and Meta-Analysis
Authors: Buckley CM , Kearney PM , Perry IJ , Bradley CP
Published: September 2012

Background

Diabetes is associated with a significant risk of LEA (lower extremity amputation). LEA rates vary between communities, 46–9,600 per 105people with diabetes, for many reasons. The effects of clinical and socio-demographic risk factors on the occurrence of a LEA have been well documented in people with diabetes. However, the effect of patient contact with a podiatrist on the prevention of LEA in people with diabetes is less well explored. The objective of this study was to determine if contact with a podiatrist prevents the occurrence of lower extremity amputation in people with diabetes.

Methods

We conducted a systematic review of available published literature on the effect of contact with a podiatrist on the prevention of lower extremity amputation in people with diabetes. Eligible studies were identified through searches of PUBMED, CINAHL, EMBASE (Excerpta Medica), and Cochrane databases. Reference lists of all relevant papers were reviewed for additional eligible articles. Randomised and non-randomised studies of the effect of contact with a podiatrist on risk of LEAs in people with diabetes (type 1 or 2) were included. Two reviewers independently assessed titles, abstracts, and full articles to identify eligible studies. Meta-analysis was performed separately for randomised and non-randomised studies.

Results

Four hundred and ninety-nine titles were retrieved from searches of electronic databases. Duplicates (138) were removed and 361 titles/abstracts were reviewed. Nineteen papers were considered for review after initial screening of titles and abstracts. Three further studies were identified as potentially eligible from reference checking. After reviewing the full text articles, 6 studies met the inclusion criteria. The identified studies were heterogeneous in design (2 RCTs and 4 cohort studies) and included people with diabetes at both low and high risk of amputation. In a meta-analysis of available data from RCTs, the pooled RR of LEA was 1.4 (95% CI 0.2–9.3). The pooled RR from available cohort studies suggested a protective effect of podiatry but the estimate was unreliable, RR of 0.7 (95% CI 0.09–5.68).

Conclusion

There is very limited data available on the effect of contact with a podiatrist on risk of LEA in people with diabetes. Further research in this area is warranted. An adequately powered RCT with a reasonably homogenous population regarding risk profiles would be the ideal way to answer this question if possible. A systematic review looking at the effect of podiatry as part of a multidisciplinary foot team on the risk of LEA in people with diabetes would also be prudent.
PS13 Equity of access to Health Care and Treatment of Non-Communicable Diseases in Scotland and Hong Kong
Authors: Elwell-Sutton TM , Schooling CM
Published: September 2012

Background

Providing equitable access to health care is a goal for most health systems. The long-term and costly nature of treating non-communicable diseases may present particular challenges for equity of access (equal treatment for equal need), though few previous studies have considered this. This study compares equity of access to health care in Scotland and Hong Kong, with a particular focus on treatment for non-communicable diseases (NCDs). Since Scotland’s health care is largely tax-funded, while Hong Kong has a mixed medical economy (shared between public and private sectors) we expected to see greater equity of access to health care in Scotland, particularly for treatment of NCDs.

Methods

In two large, population-representative household surveys - the Scottish Health Survey (2008–9) and Hong Kong’s Thematic Household Survey (2010) - we assessed associations between health care utilisation (GP consultations, specialist consultations, admissions to hospital, and utilisation specifically for NCDs) and socioeconomic position (income, occupation and education) using multi-variable logistic regression. We also controlled for ‘need for health care’ (age, sex, self-rated health and chronic conditions).

Results

After controlling for need, in Scotland: utilisation of GP consultations and GP consultations for cardiovascular disease (CVD) were not associated with any measure of SEP; utilisation of specialist care, however, was positively associated with income (OR 1.27 for highest versus lowest income quintile, 95% CI 1.08 – 1.50), though this was attenuated by additionally adjusting for education, and the association was even stronger for specialist CVD consultations (OR 1.68, 95% CI 1.12 – 2.54); and hospital admissions were negatively associated with income (OR 0.73, 95% CI 0.57 – 0.94). In Hong Kong, utilisation of all types of health care was positively associated with income and occupation, except for care for chronic conditions; most associations were attenuated after additionally controlling for health insurance cover.

Conclusion

Taking utilisation rates as a proxy for access to health care, our results suggest that in Scotland, access to primary care is highly equitable, but that people on low incomes or with poor education may have restricted access to specialist treatment, especially for CVD. This could be due to GP referrals giving preference to higher SEP patients. Surprisingly, we found that, whilst access to care in Hong Kong was generally better for people with high SEP, treatment of chronic conditions was more equitable than in Scotland, showing that fully tax-funded health systems do not necessarily provide more equitable access to all forms of care than systems of mixed funding.
PS18 Analysis of Emergency 30-Day Readmissions in England Using Routine Hospital Data 2004-2010. Is there Scope for Reduction?
Authors: Clarke A , Blunt I , Bardsley M
Published: September 2012

Background

A number of health systems including the NHS have recently introduced arrangements to deny payment if a patient is readmitted to hospital as an emergency soon after a period of care. These approaches assume that emergency admissions are a reflection of poor quality of care and of errors or failure in the original care episode. Our objectives were to assess the extent and types of readmission within 30 days and possible causes and scope for reduction.

Methods

Retrospective analysis of 83 million routinely-collected national hospital episode statistics (HES) records covering NHS hospitals in England for a 6 year period (2004–10). Records were linked at the individual level using an annonymised person level identifier. Numbers of 30-day readmissions were calculated. We categorised readmissions using pre-defined discharge-admission diagnostic pairs, overall admission patterns and the “Bridges to Health” patient group categories.

Results

There were 7,166,304 emergency 30-day readmissions over a six year period equivalent to 8.7% of all hospital discharges. Readmissions were grouped into six categories:

Potentially preventable (probable or possible suboptimal care during index admission): 1,988,967 (27.8%);

Approach to care (anticipated but unpredictable hospital care): 1,503,282 (21.0%);

Preference of patients or staff in admission or discharge timing: 56,514 (0.8%);

Artefact in data collection: 139,508(2%);

Accident or Coincidence: 1,473,583 (20.6%);

No obvious cause: 2,107,339 (29.4%)

Conclusion

Very large numbers of emergency readmissions fell into potentially preventable categories and to categories amenable to immediate reduction by hospitals. Denial of payment for emergency readmission has the potential to improve quality of care by improving data systems and reducing error. Action to address the majority of emergency readmissions requires assessment of care delivery across health and social care providers for those with complex, chronic or terminal conditions. In conclusion, new systems of denial of payment will be dangerous if they invoke perverse incentives which reduce access to necessary hospital care for patients.
PS21 Evaluation of Maternity Care Intervention in Rural Nepal: Can a Health Promotion Exercise Improve Maternal Health and Service uptake in Rural Nepal?
Authors: Sharma S , Sicuri E , Belizan J , Teijlingen E van , Simkhada P , Stephens J
Published: September 2012

Background

In developing countries, where the majority of the world’s maternal deaths occur it is recognised that to target maternal mortality within limited resources, safe motherhood strategies need to be targeted to rural areas and to the poor in order to increase access to antenatal care and delivery care. In these populations, a lack of understanding of local beliefs and practices, and the reasons for them, can hinder the development of appropriate interventions.

The Green Tara Nepal intervention, Pharping, Nepal, aims to improve the uptake of maternal care practices in rural Nepal via health promotion activities in the community. The expectation is that the measured aspect of health-seeking behaviour should improve in the intervention area relative to the control.

Methods

In 2008, Green Tara Nepal (GTN), a Nepalese Non-Governmental Organisation implemented a 5 year health promotion intervention to improve maternal and neonatal health in 2 rural village development communities (VDC) in Pharping, Nepal. The GTN programme works with midwives and community health workers to target fertile women, in health promotion groups and on a one-to-one basis. During this interaction, women receive advice on health behaviours and care-seeking practice.

Two surveys were conducted a baseline (2008) and a midline (2010) on the intervention communities and in 2 control communities.; 833 women of childbearing age with their last child of less than 2 years old, were interviewed in this controlled before and after, cross-sectional study.

Results

After the intervention the proportion of women, during their last pregnancy, attending antenatal care, at least once, increased by from 84.6% to 96.8% (p=0.00). The proportion of women who had their first prenatal visit in the first trimester was increased from 39.9% to 58.1% (p=0.00). Women attending more than 4 visits increased from 37.1% to 42.6% (p=0.28).

Conclusion

This ongoing community intervention providing health promotion shows an improvement on women’s attendance of antenatal care.
PS22 Life Course Socio-Economic Position and Quality of Life in Adulthood: A Systematic Review of Life Course Models
Authors: Niedzwiedz C , Katikireddi SV , Pell J , Mitchell R
Published: September 2012

Background

Measurement and determinants of quality of life are of increasing interest to researchers and policymakers. A relationship between current socio-economic position and subjective quality of life has been demonstrated, using wellbeing, life and needs satisfaction approaches. Less is known regarding the influence of different socio-economic trajectories across the life course and their subsequent effect on quality of life. Several conceptual models have been proposed to help explain potential life course effects on health, including accumulation, latent, pathway and social mobility models. This systematic review aimed to apply these models to studies investigating life course socio-economic effects on quality of life, in order to assess which model(s) best described any relationship.

Methods

A review protocol was developed detailing explicit inclusion and exclusion criteria, search terms, data extraction items and quality appraisal procedures. Literature searches were performed in 12 electronic databases during January 2012 and the references and citations of included articles were checked for additional relevant articles. Narrative synthesis was used to analyse the results and studies were categorised into groups based on the life course design implemented.

Results

After screening 7,566 records, 12 studies met the eligibility criteria. The included articles used data from 10 different datasets and five countries. Study quality varied and heterogeneity was high. Five studies assessed the latent model, two assessed the pathway model and three tested the accumulation model. Seven studies assessed social mobility models (inter-generational mobility in three, intra-generational mobility in five and one included both types). More evidence was found to support the latent model among women (but results were contradictory) and mixed evidence was found for intra-generational mobility and pathway effects. Associations also tended to vary by gender. Few studies were identified for accumulation and inter-generational mobility effects and heterogeneity of these studies resulted in limited synthesis.

Conclusion

A lack of available and comparable evidence prevented the identification of the optimal life course model(s). Different target populations, outcomes and methodologies used between studies likely contributed to the mix of results. To improve the potential for synthesis in this area, future studies should aim to increase study comparability. Recommendations include testing all life course models within studies and the use of multiple measures of socio-economic position and quality of life. To enable investigation of between-country differences, the increased collection, harmonisation and utilisation of comparable cross-national data would be beneficial.
PS24 Nutritional Status in Relation to Caries Experience Among Primary School Iraqi Children in the Middle Region of Iraq
Authors: Diab Ban S , Samarrai SK El , Al-Alousi WS , Al-Radha ASD
Published: September 2012

Background

Malnutrition when occurs during development period may cause irreversible effect on developing dental tissues leading to dental caries. The aims of the present study were to evaluate the nutritional status of primary school children and its influence on dental caries.

Methods

This study was conducted among primary school children (6–10 years old) in the middle region of Iraq (five governorates). The total sample composed of 4,089 children randomly selected. The assessment of nutritional status was performed using height for age indicator for chronic malnutrition (stunted), the values were compared with the international reference values defined by the National Center for Health Statistics (NCHS) and classify them into mild, moderate, and sever stunted. The nutrient analysis was done through the dietary assessment using semi-quantitative food frequency questionnaires the assessment was converted to nutrient data (according to nutrient composition of Iraqi food) which was performed using software program especially designed for this study. Diagnosis and recording of dental caries was conducted according to World Health Organization criteria in 1997 using dmfs and DMFs indices for primary and permanent teeth respectively. Statistical analyses were performed using Analysis of Variance and Least Significant Different tests.

Results

The prevalence of stunted, was found to be 49%, where the mild grade was the most prevalent (29%). The data presented in the study showed that there is a significant difference in mean of caries experience between different grades of nutritional status (P<0.01). The well-nourished children had significantly lower dmfs values (11.76±0.95) than mild (10.44±0.61) and sever stunted (16.32±1.07). Concerning caries experience of permanent dentition, apposite figure were found, well-nourished children had higher DMFS values (2.11±0.93) than mild (1.39±0.07), moderate (1.56±0.10), and sever stunted (1.14±0.18). However all these differences were statistically not significant (P>0.05).

The daily nutrients intake for the well-nourished children were recorded to be for protein 52.0±0.62grams, calcium 0.63±0.01 grams, phosphorus 1.01±0.01grams, calcium/phosphate ratio 0.61±0.004, iron 0.01±0.0002 milligrams, vitamin A 6981±84.04 I.U and vitamin C 0.10±0.002 milligrams. These amounts tended to be decreased significantly with increased severity of malnutrition. Multiple linear regressions showed correlation between nutrients and dmfs, DMFs with R² value 0.7%, 0.5% respectively.

Conclusion

The oral cavity is considered a mirror of nutritional status of the body. Stunted children with inadequate nutrients intake during growth and development had a significant effect on tooth development and subsequent caries initiation and progression.
PS33 Health-Seeking Behaviour in the Era of Free Healthcare in Urban Slums in Sierra Leone
Authors: Nathaniel-Wurie L , Martin G , Cooper G , Bernier G-L De , Ajayi T , Martineau F , Cridford B , Lako S
Published: September 2012

Background

Sierra Leone has child health statistics which are amongst the worst in the world. In April 2010, the Government of Sierra Leone launched a Free Health Care Initiative (FHCI), eliminating user fees in government facilities for children under the age of five, as well as pregnant and lactating women. Data from Ola During Children’s Hospital (ODCH), the country’s only government-run tertiary paediatric hospital, suggests that the FHCI has increased service utilisation. However, mortality rates remain high and delayed presentation is a major factor contributing to poor outcomes. This study sought to understand health-seeking behaviour in the era of Free Health Care, as a means of addressing barriers to the delivery of timely paediatric care for the urban poor.

Methods

Data was collected via focus group discussions and key informant interviews in Freetown. Men and women with at least one child below the age of five under their care were included. Participants were selected from neighbourhoods in Freetown where Ola During Children’s Hospital (ODCH) represented the nearest secondary care facility to their usual place of residence. Focus groups were facilitated in Krio, the national language, guided by a pre-designed survey tool. Discussions were audio-recoded, transcribed and translated into English. Data analysis was conducted by the research team using a thematic framework.

Results

Preliminary analysis reveals several factors contributing to delays in accessing appropriate care for sick children:

Indirect costs: Transportation, child-minding, lost income, cost of prescribed medicines and unsanctioned charges for care that continue to be levied.

The negative perceptions of ODCH staff and facilities: Perceived disrespectful, discriminatory or unfair treatment within the health facility.

Numerous healthcare options more easily accessible: Private pharmacies, self-treatment at home using traditional (herbal) or allopathic remedies.

Poor insight into disease: Deficiencies in caregivers’ ability to recognise at what time during illness progression seeking healthcare would result in the highest cost benefit ratio.

Non caregiver factors: Long queues, perceived complicated referral process between FHC facilities, and reduced opening hours.

Conclusion

User fees represent a major barrier to accessing timely and appropriate care for poor children. However, the elimination of official charges for paediatric care in Sierra Leone has brought to the surface several critical factors, beyond direct costs, which also impact upon healthcare utilisation. Understanding the processes and determinants which modulate health seeking behaviour is fundamental to efforts to improve health outcomes for the most vulnerable children.
PS44 What is the Nature and Extent of Alcohol Advertising on Facebook?
Authors: Page B , Cole K
Published: September 2012

Background

There is a growing evidence base that alcohol advertising increases consumption, particularly amongst young people. Alcohol companies are increasingly using social media, such as Facebook, as a critical part of their marketing campaigns. The Advertising Standards Agency (ASA) states that alcohol advertising must not link alcohol with social success. However, by using a platform which is inherently social, alcohol companies can implicitly link their brand with these concepts. This study aimed to describe the nature and extent of alcohol advertising on Facebook.

Methods

A quantitative descriptive analysis of UK Facebook brand pages of the highest volume sales brand for spirits, beer and cider (Smirnoff GB, Carling and Strongbow respectively) amongst the key Facebook user demographics (18–25 year olds). We collected all status updates for each brand page over a month. These appeared on the Newsfeed of those who Like the brand. The status updates were coded using concepts expressed in the ASA standards, the Committee of Advertising Practice (CAP) Code and the alcohol marketing literature. The frequencies of the identified categories were then calculated for each brand and for all three brands. The numbers of likes and comments of each status was also recorded.

Results

85 status updates were collected. The average number of status updates each day was 0.94 overall. The number of people receiving these updates at the time of writing is in total 881,398. The total number of likes and comments is 12,984 and 4,780 respectively. The most frequently occurring code was a reference to the Carling Cup. The codes used that refer to enhanced social or sexual success (which is in contravention of the ASA rules) were references to ‘dating’ and ‘partying’. These occurred less often. All the brands encouraged user interaction by asking users a question (32 updates, 37.6% of all posts) and ‘fill in the gap’ statuses.

Conclusion

This initial research suggests that the alcohol industry is using Facebook to engage with a large number of young consumers through frequent status updates. There is some evidence that the content on the pages is in contravention of ASA regulations. Further research needs to be conducted in this area in order to determine the effect that alcohol marketing via social media is having on levels of consumption of alcohol and initiation of consumption by young people in order to provide strong evidence for tightening ASA standards that reflect the advancement of alcohol advertising using Facebook.
PS46 The Complex Association Between Blood Glucose Concentration and Birth Weight in Women with Pre-Gestational Diabetes
Authors: Tennant PWG , Glinianaia SV , Bilous RW , Rankin J , Bell R
Published: September 2012

Background

Large fetal size (macrosomia) is a frequent pregnancy complication in women with diabetes. High blood glucose during pregnancy is hypothesised to explain much of the association, but previous investigations have presented equivocal results. This could be due to inadequate adjustment for confounding factors or a non-uniform association between blood glucose concentration and birth weight.

This study investigated the association between blood glucose concentrations during early and late pregnancy and birth weight in women with pre-gestational diabetes, whilst accounting for a range of potentially relevant clinical and socio-demographic factors.

Methods

All singleton births in women with pre-gestational diabetes delivered during 1996–2008 were identified from the Northern Diabetes in Pregnancy, a population-based survey of all pregnancies occurring in women with pre-gestational diabetes in the North of England. Cases of congenital anomaly (identified from the Northern Congenital Abnormality Survey) were excluded.

Three measures of glycated haemoglobin concentration (HbA1c) were obtained, to estimate the blood glucose concentration around conception, and during the second and third trimesters. The associations between HbA1c at these time points, a range of other clinical and socio-demographic variables, and birth weight were examined by multiple linear regression. The total and indirect associations were further examined by path-analysis. Gestational age was modelled as a three-order polynomial.

Results

Increasing peri-conceptional HbA1c was associated with reduction in birth weight (adjusted regression coefficient, b=-50.4 grams per 1%, 95% CI: -71.1 to -29.6), while increasing third-trimester HbA1c was associated with increase in birth weight (b=171.9 grams per 1%, 95% CI: 132.1–211.7). There was no association between birth weight and second-trimester HbA1c.

Of the other variables in the adjusted model; male sex, increasing maternal height, increasing maternal BMI, multiparity, and later gestational age at delivery were all significantly associated with larger birth weight, while increasing maternal age, later gestational age at booking, maternal smoking, history of pre-pregnancy nephropathy or retinopathy were all significantly associated with smaller birth weight.

Maternal socio-economic status (estimated from maternal postcode at birth) was associated with a range of birth weight modifiers (maternal height, BMI, age, parity, smoking status, and periconceptional HbA1c), but as these acted in opposite directions, the overall effect on birth weight was negligible.

Conclusion

Maternal blood glucose concentrations are associated with birth weight, but the association is complex, reversing as pregnancy progresses. For women with pre-gestational diabetes, maintaining good glucose control throughout pregnancy is likely to be associated with the lowest risk of pathological fetal size.
PS50 The Development Of Minimum Unit Pricing Of Alcohol In Scotland: A Policy Case Study
Authors: Katikireddi SV , Hilton S , Bond L
Published: September 2012

Background

Awareness of alcohol as a public health issue has increased in the UK and elsewhere over recent years. Evidence exists to support the use of price mechanisms to address alcohol harms. While various Canadian provinces have used reference pricing to control off-license alcohol prices in state-run monopolies, no country has implemented a uniform minimum unit price (MUP) that applies to all alcohol sales. This policy is being actively considered in Scotland, with legislation likely to be passed this year. Studying developments in Scotland may therefore help those working in public health to improve their engagement with policymakers as well as being of use to other countries seeking to introduce MUP in the future.

Methods

Political science theories can be used to identify potential explanations for the development of policy. We draw on a number of theories to allow a range of explanations to be identified (a ‘multiple-lenses’ approach). Punctuated-Equilibrium Theory (PET) suggests policymakers use their limited time to address a few issues in detail (which can experience major policy change), while paying little attention to most other policy areas. Alternatively, multi-level governance highlights the diversity of actors seeking to influence policy within different governmental levels (venues). The same policy issue can therefore be considered at European Union, Westminster Parliament or Scottish Parliament, for example. We utilise political science theories to provide explanations for the development of minimum unit pricing for alcohol as a public health policy in Scotland.

Results

PET highlights the importance of redefining the policy problem so that it becomes a focus for policymaking. This therefore suggests reframing of alcohol as a public health problem amenable to a population-based solution has been instrumental in bringing about consideration of MUP. A multi-level governance framework suggests that the devolution of health (but not trade or taxation policy) to Scottish Parliament illustrates how public health advocates were able to ‘venue shop’ from Westminster to the Scottish Parliament. We also provide a necessary description of the process through which MUP has emerged.

Conclusion

Political science theories are useful for understanding public health policy developments and could be more widely used by the public health community to inform advocacy or engagement with policymakers. This case study illustrates their value as well as providing more generalisable lessons for public health advocates (such as to seek opportunities for ‘venue shopping’ and an appreciation of the importance of framing of policy issues).