International Health Conference
St Hugh’s College
Oxford
BOOK OF ABSTRACTS
25th-27th June, 2015
ORAL PRESENTATIONS
Sessions starting Friday 10.20
Health Policy and Systems
0127
A systematic review of the standards of clinical audits in UK hospitals.
Eunkyung Lee1, Conrad Lee2, Michael George3, 1Brighton and Sussex Medical
School, Brighton, UK, 2Brighton and Sussex University Hospital NHS Trust,
Brighton, UK, 3Portsmouth Hospitals NHS Trust, Portsmouth, UK
Clinical audits are an important part of quality improvement process in the NHS.
Poorly conducted audit cycles can be detrimental to its success. We conducted a
systematic review to look at the completeness of clinical audits in UK hospitals
within the past two decades, and found out of the 877 audit projects reviewed in 12
publications, only 17% were completed with a complete cycle. Low completion rate
is a major concern for the effectiveness of clinical audits across NHS hospitals.
Evaluation of local clinical audit practice is therefore highly recommended in
consideration of improving local audit monitoring and support process
.
0111
Staff Making Sense of Patient Complaints about Care
Mary Adams1, Jill Maben1, 1King's College London, London, UK
Drawing on sociological studies of regulation by audit, we examine the effects of
increasing management attention to patient complaint (events and data) on
clinicians.
Analysis of in-depth qualitiative data (73 clinician interviews and 140hrs.
ethnographic observation) from 8 NHS clinical services with significantly high or low
staff wellbeing was undertaken.
40%+ clinicians independently described patient complaint management as
stressful and time-consuming and felt most issues of complaint beyond their
control. Negative effects on general clinical relationships were reported and
observed. The effect of patient complaint management without effective staff voice
is noted.
0186
Developing policy to support cross-cultural communication in primary care:
Learning from RESTORE
Kate O'Donnell1, Nicola Burns1, France Mair1, Chris Dowrick2, Christos Lionis3,
Maria Van den Muisenbergh4, Evelyn Van Weel-Baumgarten4, Anne
MacFarlane5, 1University of Glasgow, Glasgow, UK, 2University of Liverpool,
Liverpool, UK, 3University of Crete, Heraklion, Greece, 4Radboud University
Nijmegen, Nijmegen, The Netherlands, 5University of Limerick, Limerick, Ireland
Migration to and across Europe means that primary care has to met the needs of an
increasingly diverse population. RESTORE is an EU funded project exploring the
implementation of guidelines and training to support cross-cultural communication in
European primary care.
Here, we show how primary care systems, migration history and health care policy
can combine to support or hinder cross-cultural communication. Drawing on
Normalisation Process Theory, we have developed a set of propositions which can
alert policy-makers attention to those issues which need to be considered when
developing migrant-friendly health care systems.
Public Health and Care
0118
Contribution of physical activity as measured by pedometer
questionnaire to waist circumference and BMI in men and women
Terence Dwyer1, 1Oxford University, Oxfordshire, UK
and
Inconsistent associations have been found between physical activity (PA),
measured by questionnaire, and body fatness. We examined the association using
both pedometers and questionnaires.
A population based sample of 1126 Tasmanian adult subjects wore pedometers for
two week days, completed questionnaires on PA and other lifestyle factors, and
were measured for waist circumference and height and weight.
Pedometers were more significantly associated with waist circumference than the
questionnaire measures. Also, a larger effect was obserced for an increase in steps
for men than women - 1.7 cm (0.77-2.56) reduction vs 1.3 cm (0.82-1.79), for a
50% increase in steps.
0122
Gaps in reported and functional capacity to provide care at health facilities:
evidence and policy implications for sub-Saharan Africa
Nancy Fullman1, Alexandra Wollum 1, Caroline Kisia3, Felix Masiye2,1, Jane Achan4,
Herbert Duber1, Emmanuela Gakidou1, 1Institute for Health Metrics and Evaluation,
Seattle, USA, 2University of Zambia, Lusaka, Zambia, 3Action Africa HelpInternational, Nairobi, Kenya, 4Infectious Diseases Research Collaboration,
Kampala, Uganda
To deliver optimal medical care, health facilities need the functional equipment and
supplies to provide specific services. Based on nationally-representative health
facility data collected and analyzed through the Access, Bottlenecks, Costs, and
Equity (ABCE) project, a substantial service capacity gap emerged across levels of
care in sub-Saharan Africa. In Uganda, for example, 78% of facilities reported
providing antenatal care (ANC), but due to factors such as poor availability of
ultrasound and blood testing, only 13% of faciliies had full capacity for ANC. These
results help to identify targeted policy and investment opportunities for improving
health systems in sub-Saharan Africa.
0097
Internet-Based Smoking Cessation Program Development and Effectiveness
Evaluation
Ayse Koyun1, Kafiye Eroglu2, 1Afyon Kocatepe University, Afyonkarahisar, Turkey,
2Koç University, Istanbul, Turkey
This project is aimed to development and evaluation of the effectiveness of an
internet-based smoking cessation program (www.sbp.aku.edu.tr) on smoking
university students. This study intends to fight against smoking with online stagedbased program. This project is supported by TUBİTAK with 114S130 project number
between 15.07.2014 and 15.07.2015. The study consists of four phases: studies to
determine needs; website content development and graphic design; implementation;
and evaluation. The first two phases completed and the third phase is currently
underway. 401 smoker students were reached by website. It can be expected that
progress stages of the sample, increase self-efficacy and decision-making.
Health Economics
0029
Geographic variation in potentially avoidable hospitalizations in France
Gregoire Mercier1,2, Vera Georgescu1, Jean Bousquet1, 1CHRU de Montpellier,
Montpellier, France, 2Université Montpellier 1, Montpellier, France
Potentially avoidable hospitalizations (PAH) are used as an indirect measure of
access to primary care. Understanding their determinants can contribute to improve
the quality and equity of health care delivery. So far no studies have tackled this
issue at the national level in France. We assessed the disparities in PAH in France
in 2012 and their determinants. Increased PAH was associated with higher
mortality, a lower density of acute care beds and ambulatory care nurses, a lower
median income and education level. This work unveils considerable variation in PAH
rates in spite of a publicly funded health insurance scheme.
0165
“The academic and the real world don’t match”: the challenges of adopting
health economics approaches to public health decision-making
Silvia Scalabrini1, 1Durham University, Stockton on Tees, UK
This paper explores how local authorities think about public health spending
following the relocation of public health responsibilities from the NHS to local
government in England. Drawing on an ongoing action-oriented project involving 3
local authorities, we discuss challenges related to the adoption of priority-setting
tools in public health spending decisions. Interviewees highlighted the importance of
examining the wider context of local government in order to avoid a mechanical
adoption of tools that fails to consider the political priorities and ‘real world’
constraints. The findings have implications for the practical issues that stakeholders
encounter in their day-to-day work.
0092
Cost Effectiveness of Vascular Surgery: A UK Perspective
Mahim I Qureshi1, Rishi Mandavia1, Brahman Dharmarajah1,
Davies1, 1Imperial College London, London, UK
Alun
H
Background: In this economic climate, provision of cost-effective quality healthcare
is paramount.
Aim: To determine the influence of cost-effectiveness on UK healthcare policy in key
domains of vascular surgery: carotid endarterectomy, superficial venous intervention
and AAA repair.
Methods: Systematic review adherent to PRISMA guidelines. Quality of inclusions
was assessed using Evers checklist, and strength of evidence determined by the
quality and number of studies.
Results: There was insufficient evidence to determine cost-effectiveness of
symptomatic CEA. In remaining domains, healthcare policy contradicted high-quality
evidence regarding cost-effective management.
Conclusion: Cost-effectiveness does not appear to influence UK healthcare policy in
vascular surgery.
Mental Health
0131
The evaluation of the conflict management program delivered to the
adolescents in the orphanages
Pinar Çiçekoglu1, Gül Ünsal Barlas Ünsal Barlas 2, Semra Karaca2, 1Çankiri
Karatekin Universi, School of Healthty, Çankiri, Turkey, 2Marmara University,
Faculty of Health Sciences, Istanbul, Turkey
Objective: To evaluate the impact of conflict management training delivered to the
adolescents in the orphanages on conflict resolution behaviors of the adolescents.
Material and Method: Our study was realized with 80 adolescents who are living in
the orphanages. In experimental group, adolescence had been carried out conflict
management program for 10 week.
Findings: Following the implemented training program, the pre-test aggression
average of the adolescents in the experimental group is significantly higher than the
post-test average (p˂0. 05). The post-test problem solving average of the
adolescents in the experimental group is significantly higher than the pre-test
average (p˂0. 05).
0178
Violence exposure and mental health among Indonesian urban adolescents
Sherly Turnip1, Arina Isyalhana1, 1Universitas Indonesia, Jakarta, Indonesia
Previous studies indicated that high rates of child and adolescent exposure to
violence both as witnesses and victims, have lead to an increase of adolescents
mental health problems such as internalizing and externalizing behaviors. This cross
sectional study examined the relationships between violence exposure and mental
health in a sample of 497 students from 5 urban high schools in Indonesia. Results
showed that there were significant correlations between violence exposure and
internalizing and externalizing behaviors. This findings suggest that violence
exposure has a detrimental effect on adolescents’ mental health and therefore need
to be addressed.
0116
Prevalence and factors associated with depression among antenatal women
in an urban health centre of Delhi
Urvi Sharma1, Ritesh Bansal1, Jugal Kishore1, 1Maulana Azad Medical College,
New Delhi, India
Theory: Detection of depression during pregnancy has been a much neglected
component of antenatal care.
Aim: To find out the prevalence and factors associated with depression among
antenatal women in a urban health centre in Delhi.
Methods: A total of 220 antenatal care attendees from July to December 2014 were
screened for depression using the Edinburgh Postnatal Depression Scale.
Results: An EDPS score of ≥10 was found in 47 (21.4%). Nulliparity, gestational
age (<20 years) and intimate partner violence were associated factors.
Primary Workforce Training
0045
Primary Care Transformation: Multi-dimensional Training for Office Staff
Bruce Block2,1, 1University of Pittsburgh School of Medicine, Pittsburgh,
Pennsylvania, USA, 2Pittsburgh Regional Health Initiative, Pittsburgh, Pennsylvania,
USA
Improvement in patient outcomes and reduction of costs depends upon
implementing evidence-based guidelines, adopting electronic health records, and
instituting coordinated patient-centred care.
Since 2010, the Pittsburgh Regional Health Initiative (PRHI) conducted a series of
overlapping initiatives aimed at enhancing primary care practice transformation in
western Pennsylvania.
PRHI provided collaborative learning sessions and workflow-associated training to
over 100 practices focused upon Medical Home change concepts, elevation of
clinical assistant roles, behavioural health integration and development of a quality
improvement culture.
Multi-disciplinary training and coaching for office staff can effectively assist primary
care practices to implement transformational care elements.
0034
Increasing the value of healthcare education using behavioural science
Lucie Byrne-Davis1, Jo Hart1, Marie Johnston2, Chris Armitage1, Ged
Byrne3, 1University of Manchester, Manchester, UK, 2University of Aberdeen,
Aberdeen, UK, 3Health Education England, Manchester, UK
THEORY: Education is a major ‘intervention’ to change healthcare practice. Despite
high investment (Health Education England over £4 billion pa) evalutions of
behaviour are rare. Behavioural science theory and methods can evaluate impact of
education on behaviour/determinants.
METHODS: Questionnaires identifying behaviours and assessing determinants
were piloted in 2 UK and 2 Ugandan courses (total N = 214).
RESULTS: Questionnaires were feasible and acceptable. We extracted data for
analyses of large datasets.
CONCLUSION: Educators were engaged. Data will be examined to
identify potential increase in the value of education from changing educators’ focus
to behaviour.
0027
Improving health workforce performance in Uganda: linking research and
practice through action research
Joanna Raven1, Sebastian Olikira Baine2, Saul Kamukama2, Alvaro AlonsoGarbayo1, Tim Martineau1, 1Liverpool School of Tropical Medicine, Liverpool, UK,
2School of Public Health, Makerere University, Kampala, Uganda
The district is key to developing and sustaining resilient and effective health systems
for providing universal health coverage. The PERFORM project used action
research with district management teams in Uganda to improve health workforce
performance. Problem analysis techniques helped teams to reflect on challenges
and opportunities they face, find solutions and integrate them into district plans.
Solutions included improving staff appraisal, reducing absenteeism and
strengthening supervision. Action research bridges research and practice; supports
sustainability and ownership through solving problems at district level; enables
sharing of practices between districts; and can promote a culture of partnership and
inspire innovation.
Mixed – Global Perspectives
0136
Noncommunicable Disease Prevention and Control in Mongolia: A Policy
Analysis
Oyun
Chimeddamba1,2,
Anna
Peeters3,
Helen
Walls4,5,
Catherine
1
1
Joyce , Department of Epidemiology and Preventive Medicine, School of Public
Health and Preventive Medicine, Monash University, Melbourne, Australia,
2Mongolian Association of Family Medicine Specialists, Ulaanbaatar, Mongolia,
3Obesity & Population Health | Baker IDI Heart and Diabetes Institute, Melbourne,
Australia, 4Leverhulme Centre for Integrative Research on Agriculture and
Health,London School of Hygiene and Tropical Medicine, London, UK, 5Australian
National University, Canberra, Australia
This paper aimed to evaluate the extent to which non-communicable disease (NCD)
related policies introduced in Mongolia align with the WHO 2008-2013 Action Plan
for the Global Strategy for the Prevention and Control of NCDs. We conducted a
qualitative review of policy documents. The Mongolian Government response to the
burden of NCDs is a population-based public health approach which includes a
national multisectoral framework and integration of NCD prevention and control into
national health policies. Our findings suggested gaps in addressing chronic
respiratory disease, physical activity guidelines, specific food policy actions, and a
lack of funding supporting NCD research.
0037
Unintentional poisoning in young children: knowledge of poisons, preventive
practices and the management practices among caregivers in western Nigeria.
Taofeeq Elias1, Ifeoma Okafor1, 1College of Medicine, University of Lagos, IdiArabia, Lagos, Nigeria
This study assessed the knowledge of unintentional poisoning, its preventive
measures and management practices in young children among care-givers in
Western Nigeria. A descriptive cross-sectional design was used. Interview
administered questionnaires were used to collect data from 304 adult respondents
using a multi stage sampling technique. The most common substance known to be
harmful was rat poison and 91.8% knew it leads to death. The most common
symptom known by respondents was abdominal pain. Among respondents with a
positive history, 52.6% gave palm oil as the first course of action. More awareness
should be made to improve their knowledge.
0156
Equity of Maternal Health Care in Post-conflict and Non-conflict Uganda: A
Comparative Mixed Methods study
Andrew Alyao Ocero1,2, Sally Theobald1,3, Tim Martineau1,3, 1Liverpool School of
Tropical Medicine, Liverpool, Merseyside, UK, 2Commonwealth Scholarship
Commission, London, England, UK, 3ReBuild Consortium, Liverpool, Merseyside,
UK
Background: Northern Uganda, a post-conflict region, has poor maternal health
(MH) indicators. This study compares equity in government MH policy and financing
in post-conflict and non-conflict Uganda.
Methods: Documentary review, qualitative interviews with key stakeholders and a
costing study were conducted to determine patterns in MH funding.
Findings: Northern Uganda lost out on critical resources and benefit incidence, but
gained comparatively good health infrastructure and commitment to social justice.
Conclusion: Inequity in maternal health financing contributed to poor MH outcomes
in Northern Uganda.
Sessions starting Friday 11.40
Service Use and Organisation
0210
Health service utilization after terrorism - a longitudinal study of survivors of
the 2011 Utøya attack in Norway
Lise Eilin Stene1, Grete Dyb1,2, 1Norwegian Centre for Violence and Traumatic
Stress Studies, NKVTS, Oslo, Norway, 2Institute of Clinical Medicine, Faculty of
Medicine, University of Oslo, Oslo, Norway
Terrorism is a major challenge due to its unforeseen and devastating effects. To
improve public health preparedness, it is essential to estimate post-terrorism health
service utilization. We assessed the prevalence of health service utilization and
factors associated with mental health service (MHS) utilization among the Utøya
shooting survivors. After 5-15 months, 267(95%) reported health service utilization:
254(90%) primary care and 192(68%) MHS. After multivariable adjustments, MHS
utilization remained associated with early symptoms of anxiety/depression and
concurrent somatic symptoms. The results underscore the importance of allocating
sufficient resources to meet the service demands and of addressing somatic
symptoms in MHS users.
0174
Health service delivery, public health and ethnicity: from theoretical debates
to sustainable interventions
Rosalie Aroni1, 1Monash University, Melbourne, Victoria, Australia
Research into ethnicity and health continues to raise ethical, theoretical and
methodological issues notwithstanding promulgation of the Leeds Principles for
Research on Ethnicity and Health in 2012. Similarly, while there is recognition in the
health intervention literature on ethnicity that "one size does not fit all," it seems
there is rarely sufficient funding available to conduct appropriate research or
implement sustainable programs. Three case studies are presented to illuminate the
key issues. Potential solutions are suggested for conducting ethical, rigorous
research on ethnicity and health and producing sustainable interventions in health
service delivery, public health, illness prevention and health promotion.
0229
A Comparison of Organizational Cultures around Promoting Equity in Public
(NHS) and Hybrid (Social Enterprise) Healthcare Organizations
Ashok Patnaik1, 1University of Huddersfield, Huddersfield, UK
Theory: To promote competition, UK governments have encouraged community
healthcare services within the NHS to spin out and become private ‘social
enterprises'. Service provision by social enterprises may be less equitable than by
the NHS.
Hypothesis: Organizational cultures of social enterprises differ from those of the
NHS in their supportiveness for equity.
Methods:
a) Online survey to compare equity-supportiveness of organizational cultures in the
NHS and social enterprises
b) Interviews to investigate cultural change in social enterprises and the impact on
equity in service provision
Conclusions: Social enterprises are promoting equity to an equal or greater degree
than the NHS.
Health Policy and Systems
0069
Changing Issues in Healthcare Policy in The U.S. and The Role of Research
Stuart Altman1, 1Heller School, Brandeis Univeristy, Waltham, MA, USA
The presentation traces changing issues that shaped US government policy and
research from the 1960s until now, and changing players. Early central issues,
expanding health insurance and controlling spending growth, brought to the
ascendency individuals with expertise in how the U.S. system was organized and
financed – mostly non physicians/healthcare professionals. As new issues
have been added to the national debate, (1) quality and safety (2) differential
health status of groups and why they occur, and (3) types of allowable health
professionals, the obvious need to engage physicians and healthcare professionals
in health policy formulation and research activities has emerged.
0185
Impact of contextual factors on the effect of interventions to improve health
worker performance in sub-Saharan Africa: review of published trials
Claire Blacklock1, Daniela Goncalves Bradley1, Sharon Mickan1,2, Merlin Willcox1,
Nia Roberts1, Anna Bergstrom3,4, David Mant1, 1Oxford University, Oxford, UK,
2Griffith University, Queensland, Australia, 3University College London, London, UK,
4Uppsala University, Uppsala, Sweden
Variation in health worker performance compromises quality of care. We sought to
identify interventions implemented in sub-Saharan African to improve health worker
performance, including contextual factors likely to influence local effectiveness. A
systematic search for trials was undertaken. Interventions were defined by EPOC
category. Within-study variability in effect was extracted. Reported contextual
factors likely to have modified effect were subjected to thematic analysis.
Range of effect between centres within trials varied substantially. Nine contextual
themes were identified as effect modifiers.
Policy makers must address contextual factors causing differences in local effect of
interventions. These need to be reported by researchers.
0198
Translating research into practice - using an evidence based approach
to Acupuncture within the UK health system
Nick Pahl1, 1British Acupuncture Council, London, UK
Introduction: Acupuncture has substantial Evidence Based Medicine support from
NICE, RCTs etc. Acupuncture has been shown to be of value to patients, with over
4 million treatments a year in the UK. The UK Govt has recognised Acupuncture via
the UK Professional Standards Authority.
Discussion: To review the evidence base for acupuncture, and opportunities and
challenges for implementation within health systems. To provide a global overview
of health policy towards acupuncture in the light of the 2014 WHO strategy for
traditional medicine (at
http://www.who.int/medicines/publications/traditional/trm_strategy14_23/en/). To
reflect on UK policy response to acupuncture
Conclusion: Acupuncture provides a positive example of how policy makers have
managed a traditional medicine and issues related to evidence, safety, risk and
professionalism.
Health Psychology
0091
Exploring the barriers and enablers to the implementation of a falls prevention
intervention - development of an implementation protocol for the 6-PACK RCT
Anna Barker1, Fiona Landgren2, Jeanette Kamar1, Renata Morello1, Caroline
Brand1, Darshini Ayton1, 1Monash University, Melbourne, Australia, 2Project Health,
Melbourne, Australia, 3Northern Health, Melbourne, Australia
The Theoretical Domain Framework (TDF), which details the processes involved in
behavior change of healthcare professionals, was used to assess the barriers and
enablers of effective falls prevention in acute hospitals. Data was obtained from six
Australia hospitals via medical records, practice audits (n=37,737); focus groups
(n=12 with 96 nurses); interviews (n=24); and surveys (n=421). Barriers included a
lack of time, skills, and resources, patient complexity, and a belief that falls were
inevitable. Enablers were face-to-face education; leadership; use of audits,
reminders and feedback. An implementation protocol for the 6-PACK program
addressing these factors was developed and will be discussed.
0193
Effectiveness of intensive healthcare waste management training model
among health professionals at teaching hospitals of Pakistan: A quasiexperimental study
Ramesh Kumar1,2, Ratana Somrongthong1, Babar Tasneem Shaikh2, Rapat
Eknithiset1, 1College of Public Health Sciences, Chulalongkorn University, Bangkok,
Thailand, 2Health Services Academy, Islamabad, Pakistan
Infectious waste management has always remained a neglected public health
problem in the developing countries, resulting in high burden of environmental
pollution affecting general masses. Quasi-experimental pre and post design with
control and intervention groups was conducted on 275 health care workers, 138
assigned for intervention group for 3 months trainings, hands-on practicum and
reminders on infectious waste management; whereas 137 workers were assigned to
the control hospital. Multivariate analysis, independent, paired /unpaired t-test, chisquare with p values, and mean of the responses were calculated. Response rate
was 92% at the end of intervention. Intervention has found statistically significance
effect.
0233
Generalised anxiety disorder (GAD) and health service use in a large British
community cohort: findings from the EPIC-Norfolk study
Olivia Remes1, Louise Lafortune1, Robert Luben1, Nick Wainwright1, Paul Surtees1,
Amit Bhaniani1, Carol Brayne1, Kay-Tee Khaw1, 1University of Cambridge,
Cambridge, UK
Generalised anxiety disorder (GAD) is one of the most common, impairing anxiety
disorders in the general population. We used data from the population-based EPICNorfolk to study the association between DSM-IV GAD and health service use in
18,393 participants ages 40-79 years between 1996-99 and 2012.
Sociodemographics, medical histories and disability were assessed using
questionnaires, and hospital service use through record linkage with East
Norfolk Primary Health Care trust databases.
In multivariate models, GAD was significantly associated with hospital admissions
(RR=1.13, 1.07-1.19) and hospital stay greater than 3 days (OR=1.51, 1.211.87). These novel findings highlight the need to diagnose and treat GAD to
prevent the associated health service system burden.
Older Age
0001
A stepped care approach to frailty screening among community dwelling
older people aged 65 years and over using the FRAIL score
Jean Woo1, Ruby Yu1, Martin Wong1, Moses Wong1, 1The Chinese University of
Hong Kong, Shatin, Hong Kong
The FRAIL score consists of five questions without the need for any measurements.
When applied to 816 older people, 52 % were classified as pre-frail, and 12.5% frail.
In a subgroup of 255 people, compared with the pre-frail group, the frail group had
higher prevalence of sarcopenia, mild cognitive impairment, poorer self-rated health,
higher number of falls, greater number of chronic diseases, medications, ADL and
IADL impairments. The findings suggest that a simple tool that can be applied by
trained staff may be a useful community screening test, followed suitable referrals
for further management.
0017
Community Geriatric Assessment Team: a model for supporting care home
residents in Hong Kong
Elsie Hui1,2, Jean Woo1, 1The Chinese University of Hong Kong, Shatin, Hong
Kong, 2Community Outreach Service Team, Shatin, Hong Kong
It is increasingly recognised that quality care for nursing homes involve collaboration
between general practitioners and Geriatricians. In Hong Kong, the majority of older
people rely on the public healthcare system. Primary care is under-developed and
patients tend to rely heavily on hospital-based services. To deal with the increasing
demand, especially from frail care home patients with multiple, complex medical
problems, the Hospital Authority of Hong Kong established Community Geriatric
Asessment Teams (CGATs) in 1994. These teams provide multi-disciplinary care to
nursing home residents with the aim of minimizing transfers and promoting good
practice, such as end of life care.
0231
Informal and formal care provision in the UK: Results from a quasi-natural
experiment
Emmanouil Mentzakis1, 1University of Southampton, Southampton, UK
Ageing populations and increasing health care demands on strained budgets
suggest reliance on informal care as a way to maintain care provision and contain
care expenditure. However, with ageing carers and changes in family structure,
future supply of informal care is uncertain. If policies are to promote informal care,
identification of the relationship between formal and informal care is vital. Taking
advantage of a 2002 Scottish law providing free personal care to those +65,
differences-in-differences estimations provide evidence of substitutional patterns
with Scotland experiencing a drop in free formal care and an increase in informal
care provision in response.
Nursing and Care
0169
Control and co-operation: delivering ‘harm-free care' in the community setting
Liz
Brewster1,
Natalie
Armstrong1,
Carolyn
Tarrant1,
Mary
Dixon1
1
Woods , University of Leicester, Leicester, UK
Collecting data to improve the quality of healthcare presents different challenges in
community settings to those encountered in the acute sector. Based on interview
data and ethnographic observations, this paper presents reflections on
implementing a data collection tool - the NHS Safety Thermometer - in community
nursing. This point of care instrument aims to enable a ‘temperature check' of harm
across the NHS. However, the design of tools for use in similar improvement
strategies needs to take into account the particular difficulties of preventing harm in
an environment where healthcare staff have little opportunity to monitor and
influence patient action.
0228
Development and validation of the Culture of Care Barometer.
Anne Marie Rafferty1, Julia Philippou1, Joanne Fitzpatrick 1, Jane Ball2, 1King's
College London, London, UK, 2University of Southampton, Southampton, UK
The purpose of the Culture of Care Barometer is to prompt reflections and
conversations on the underlying issues involved in creating a culture of care. The
literature associated with organisational culture, culture of compassion and safety
highlights the centrality of culture to the provision of health care and post Francis
healthcare delivery. We propose an instrument with which to gauge the different
attributes of environments in which care is delivered. The operationalization of the
Culture of Care Barometer provides a theoretical foundation for future research and
a tool to assist organisations in developing an environment that supports a caring
culture.
0093
Suami Siaga, the Father Participation in Maternal Health
Anna Kurniati1,2, Ching-Min Chen1, Ferry Efendi1,3, 1National Cheng Kung
University, Tainan City, Taiwan, 2Ministry of Health, the Republic of Indonesia, DKI
Jakarta, Indonesia, 3Airlangga University, Surabaya, Indonesia
Suami Siaga (the alert husband) is a nationwide community empowerment program
to improve maternal health in Indonesia. This study aims to identify the prevalence
of Suami Siaga and the associated factors using data from the 2012 IDHS with an
eligible sample of 1,314 married men. Bivariate and logistic regression analysis
were performed to test the hypotheses. We assumed that father characteristics,
control over income, child-wish factors have significant associations with Suami
Siaga elements. Our study found that urban residents and earning higher income
were more likely to discuss the delivery place and transportation. Father
participation could contribute to maternal health.
Mixed Session
0199
Genomic Breakthroughs - Promises and Challenges
Dodie Roskies1, 1Jewish Healthcare Foundation, Pittsburgh , PA, USA
Breakthroughs in genomic sequencing come with a new set of ethical, familial,
financial, health and legal issues and challenges. Genetic education and preconception screening raise the potential for preventing the birth of babies with
serious disabilities and genetic defects and can introduce a host of interventions to
prevent the birth of predictably "damaged" newborns. How families deal with the
knowledge and available choices also offers a rich research agenda. This talk will
describe how one community addressed this delicate issue in a series of bold
anticipatory education, counseling and screening sessions, leading to fruitful and
unanswered research questions.
0175
Translational research in an Academic Health System (AHS):Establishing the
research infrastructure for a knowledge eceonomy in Qatar
Edward Hillhouse1, Sadaf Lynes1, Ibrahim Janahi1, Hanan Al-Kuwari1, Kristen
Mrus1, 1Hamad Medical Corporation, Doha, Qatar
The Qatar AHS is a partnership of 9 clinical, academic and research organizations
developing an integrated model transforming patient care as part of Qatar National
Vision 2030. This is the first attempt by any nation to assemble all academic and
health-care providers to work towards a shared vision and strategic plan.
In a healthcare model that has predominantly been service delivery focused, the
transformation to one that embraces the translational research continuum has
required strong leadership with focus on infrastructure, governance, capacity and
capability building. This is being achieved with partnerships that break traditional
boundaries creating an interprofessional care model.
0166
State-building and human resources for health in fragile and conflict-affected
states: exploring the linkages
Sophie Witter1, Jean-Benoit Falisse2, Maria Bertone3, Alonso Garbayo4, João
Martins5, Salehi Ahmed6, Enrico Pavignani7, Tim Martineau4, 1Queen Margaret
University, Edinburgh, UK, 2St Antony's College, Oxford, UK, 3London School of
Hygiene and Tropical Medicine, London, UK, 4Liverpool School of Tropical Medicine,
Liverpool, UK, 5Universidade Nacional Timor Lorosa’e, Dili, Timor-Leste, 6Ministry of
Public Health, Kabul, Afghanistan, 7University of Queensland, Brisbane, Australia
Human resources for health are critical to running a health service and system.
There is however a wider set of social issues which are more rarely considered.
One area which is hinted at in literature, particularly on fragile and conflict-affected
states, but rarely examined in detail is the contribution which health staff may or do
play in relation to the wider state-building processes. This presentation explores that
relationship, developing a conceptual framework to understand what linkages might
exist and looking for empirical evidence from different bodies of literature as well as
three case studies to support or refute those linkages.
Sessions starting Friday 14.40
Health Policy and Systems
0221
Evidence Informed Decision Making: Innovative Approaches through
Researcher-Patient Partnerships
Vasanthi Srinivasan1, Mark Roseman1, 1Ontario SPOR SUPPORT Unit, Toronto,
Ontario, Canada
In 2014, Canada embarked on an ambitious research agenda entitled Strategy for
Patient-Oriented Research (SPOR). The Province of Ontario has actively embraced
SPOR, committing significant resources to engage leading research centres,
patients, clinicians, policy makers, industry and other health system professionals.
Key features include the value-add to the $50+ billion provincial health system, and
the alignment of patient partnered research activities to public policy imperatives.
Objectives will be achieved in part through research networks focusing on mental
health, primary and continuing care, and chronic disease prevention and
management, and scalable demonstration projects that offer knowledge to health
system users.
0225
What is the patient's role in medicines reconciliation?
Rachel Urban1,2, Gerry Armitage1, Alison Blenkinsopp1, Julie Morgan1, 1University
of Bradford, Bradford, UK, 2Bradford Teaching Hospitals NHS Foundation Trust,
Bradford, UK
Decreasing the scale of medicines reconciliation related error is an international
priority. There is insufficient evidence on the roles of those involved in medicines
reconciliation, especially the patient. This study observed staff interacting with
patients during medicines reconciliation across multiple secondary care centres
using an evidence-informed framework. We identified the patient as the constant
throughout the medicines reconciliation process, adding information which could not
be gained elsewhere. Despite this, patients were not routinely involved in
information-seeking discussions about their medication and were unlikely to be
given medicines information, including changes to their prescription.
0183
Understanding emergency hospital admissions of older people
Raphael Wittenberg1, Luke Sharpin1, Barry McCormick1, Jeremy Hurst1, 1Centre for
Health Service Economics & Organisation (CHSEO), Nuffield Department of
Primary Health Care Sciences, University of Oxford, Oxford, UK
Aim is improved understanding of the rise in emergency hospital admissions for
older people, 2001/02 to 2012/13.
Methods: Analysis of Hospital Episode Statistics, including age, cohort period
(APC) analysis.
Results: The emergency admissions rate increased by 25% over the period, but
the bed day rate fell by 25%. APC analysis shows: emergency admission rate rose
monotonically with age from 40; each successive cohort experienced lower
emergency admission rates; period effects have been increasing since 1999.
Conclusions: Cohort effects suggest demand pressures may prove more limited
than expected from population projections, but period effects seem inconsistent with
emergency admissions falling soon.
Nursing and Leadership
0075
The role of coaching in the development of nurse managers
Liz Westcote1, 1Oxford Brookes Univeristy, Oxford, UK
This presentation will share the results of empirical research undertaken into the
role that coaching is playing in the development of nurse managers. Nurse
managers are the first line managers of a team of nurses within any health
sector. The mixed methods research used a pragmatist paradigm and gathered
data from a quantitative survey and qualitative interviews. Thematic analysis and
pattern coding was the framework used for data interrogation. The key findings of
the survey and interviews will be shared including development of self, resilience,
leadership, the team and the value of a coaching culture in health care settings.
0159
Silent work: the interactional coordination of critical, collaborative care in ICU
Andreas Xyrichis1, Anne Marie Rafferty1, 1King's College London, London, UK
This paper examines how nurses in three intensive care units (ICUs) in England
accomplished the organisation and delivery of safe care to critically ill patients;
based on qualitative analysis of ethnographically derived observational and
interview data collected over 2009-2010. We show how ICU care was accomplished
dynamically, through a system characterised by mutual support and a shared sense
of protection and concern for other nurses; and reveal tacit processes and skills that
nurses exercised in accomplishing their day-to-day work. We draw from
these findings to raise implications for policy and the organisation of safety work in
specialist hospital settings.
0121
Best evidence for best practice: how can we help nurses engage with
research?
Sarah Chapman1, 1UK Cochrane Centre, Oxford, UK
Framework: Cochrane produces reliable evidence for better health. The UK
Cochrane Centre uses social media to disseminate evidence and encourage
engagement with it.
Methods: A Cochrane review found no reliable evidence to support an established
nursing practice. We used blogs and tweetchats to engage nurses in debate about
the evidence and implications for practice.
Results: Individual nurses and representative bodies participated in online
discussion. Reasons were given for continuing the practice in question other than its
intended purpose.
Conclusions: Through social media we successfully disseminated evidence,
promoted reflective practice and established relationships within the nursing
community, leading to collaborative working.
Public Health
0236
Estimating the prevalence of female genital mutilation in England and Wales
Alison Macfarlane0, 1City University London, London, UK
Background: Estimates of the prevalence of female genital mutilation are needed to
plan the provision of care for affected women and protection for their daughters
Methods: Data from surveys in countries where female genital mutilation is practised
were applied to data from census data about numbers of women born in these
countries resident in each local authority in England and Wales and birth registration
data about births to these women
Results: Despite concentration in a relatively small number of urban areas some
women born in these countries were resident in most areas, but women who
migrated may be atypical.
0187
The effect of self-efficacy learnig programme on teenage pregnanacy
prevention in female students, u-thong district, suphanburi province, Thailand
Chawthip Boromtanarat1, 1Sukhothai Thammathirat Open University, Nonthaburi
Province, Thailand
The objectives of this quasi-experimental research were to study the effect of selfefficacy learning programme on teenage pregnancy prevention in female students in
U-thong district of Suphanburi province. The two experimental groups pre-post test
design were 31 students from U-thong Suksalai school and 31 students from
Srayaysome School with received self-efficacy learning programme on teenage
pregnancy prevention. Data were collected by self-administered questionnaires and
analysed by paired t-test.
The results showed that the mean score of knowledge, self-efficacy and
the efficacy expectation on teenage pregnancy prevention in both experimental
groups were a significant difference between pre-test and post test.
0123
Low income women’s experience of delivering in public facilities:
Discriminatory attitudes, degrading treatment and dehumanizing care
Nalini Visvanathan1, Monika Walia2, 1Independent Researcher, Washington DC,
USA, 2National AIDS Control Organization (NACO), New Delhi, India
Why are low income Indian women still resistant to delivering in no-cost public
facilities when financial incentives now cover transportation and incidental
expenses? A survey of community outreach workers (n=105), the ASHAs,
illuminated fears and reservations among pregnant clients. A follow-up qualitative
study used in-depth interviews (n=42) to assess quality of care (QoC) with the
ASHAs’ post-partum clients who described their facility-based experiences. A
protocol based on Hulton et al. (2000) QoC framework for maternity services elicited
a mixed response. Dominant themes included denial of care, untimely referrals,
verbal and physical abuses, predatory practices and discrimination against higher
parity women.
Health Finance Economics
0234
Prospective payment system and medical practices : Cesarean sections in
France
Saad Zbiri1,3, Carine Milcent1,2, 1French National Center for Scientific Research
(PSE, CEFC), Paris, France, 2French National Authority for Health (CEESP, IFAQ),
Saint-Denis La Plaine, France, 3University of Versailles Saint-Quentin, Versailles,
France
The use of C-sections varies across regions and providers. This variation is
worrisome because of the increased cost and clinical risk of the C-section.
French data (103,207 deliveries, 2008-2013) and multilevel logit models with fixed
hospital effect clustered at the residence level were used to examine the effect of
each determinant factor, after activity-based pricing (T2A) came into effect.
The probability of C-section increases in precarious patients, on working days, in the
private sector. Moreover, this probability differs depending on the number of
midwives and the place of residence. Finally, T2A doesn't seem to affect practices
across sectors.
0148
Decision-based Evidence-Making: When Research Informs Decisions in Care
Delivery and Financing
Sophia Chang1,2, 1California HealthCare Foundation, Oakland, CA, USA,
2University of California, San Francisco, San Francisco, CA, USA
The translation of research into practice is driven by payment, especially the
adoption of new medical treatments. Peer-reviewed published research is a primary
means of validating new interventions with the expectation that payment policies will
follow in the US. When evaluating service interventions or approaches, however, the
delay in measurable clinical outcomes and the lack of relevance to business and
funding decisions leave standard health services research approaches poorly
positioned to support adoption. Rapid-cycle evaluations focused on the return on
investment are being conducted in California to spread adoption of palliative care
and virtual services such as telemedicine and e-consults.
Community / GP Care
0024
Health-care seeking behavior and use of traditional medicine in persons
with diabetes in Uganda.
Katarina Hjelm1, 1Department of social and welfare studies, Linköping University,
Norrköping, Sweden
Healthcare seeking behaviour is important as it determines acceptance of
healthcare and outcomes of chronic conditions but has been investigated to a
limited extent in persons with diabetes in developing countries.
Qualitative study. Focus-group interviews.
Reasons for seeking help from traditional healers were diabetes symptoms and
failure of effect from western medicine. Help had been sought from different health
facilities with the help of relatives and friends.
Conclusion: A switch between healthcare providers influenced by popular and folk
sectors was found. Despite beliefs of using different healthcare providers searching
for complementary medicine, participants still experienced health problems related
to diabetes.
0160
Telegeriatrics in the Nursing Home- The Singapore Experience
James Alvin Low1,2, Joanne Chia1,2, Hui Jin Toh1,2, 1Khoo Teck Puat Hospital,
Singapore, Singapore, 2Alexandrahealth Service, Singapore, Singapore
We studied a telemedicine programme between the Geriatrics Department of an
acute hospital and several nursing homes. This descriptive study was conducted
from 2010 to 2014, recruiting 667 residents: 60% were women, mean age was 76years, most were widowed (27%). The reasons for consultation were: behavioral
issues (32%), medication/management review (25%), rash (6%), fever (4%),
breathlessness (3%). Commonest diagnoses were dementia with BPSD, skin
lesions and infections. We also looked at the management plan, follow-up and
hospital transfers of the cohort. We conclude that telegeriatrics is feasible and
effective in providing care in nursing homes in an urban and densely-populated
setting such as Singapore.
0055
Liberating the change? A bottom up approach to improving general practice
Robin Miller1, 1University of Birmingham, Birmingham, UK
Improvement in English general practice was sought through a top-down approach
in which purchasers would direct interventions and pathways through specifications,
quality frameworks and financial incentives. Using qualitative methodologies this
action research project explores an emergent approach in which GPs are given
upfront funding and autonomy to create new models to achieve better standards
and divert activity from acute hospital. Drawing on OD and readiness to change
theory it will reflect the extent to which initial assumptions are realised in practice
and consider the enablers and barriers to positive change being achieved.
Industry and Health
0141
Autogenic Training in high risk industries: an effective neuropsychophysiological tool for the occupational health and performance of
NASA Astronauts and Australian Police
Helen Gibbons1,2, 1Autogenic Training Institute of Australia, Sydney, NSW,
Australia, 2International Institute of Autogenic Training and Autogenic
Psychotherapy, Madrid, Spain, 3Australian Psychological Society, Melbourne,
Victoria, Australia, 4The International Society of Behavioural Medicine, Marburg,
Germany
Police are exposed to high stress work environments. Exposure to extreme
stressors causes mind-body dysregulation that affects health and workplace
performance. Autogenic Training (AT) is an evidence-based neuropsychophysiological tool that mobilizes brain-directed self-regulatory mechanisms to
recover from mind-body dysregulation brought on by stress. Research highlighting
AT’s effectiveness for OH&S will be examined with a special emphasis on the
benefits of AT for NASA Astronauts and Australian Police who received Autogenic
Training from me as part of an Employee Assistance Programme for the prevention
and treatment of stress related conditions such as Post-Traumatic Stress Disorder,
Depression, substance abuse and insomnia.
0144
The effect of environmental and social sensitivities on corporate reputation
Özlem Tuna1, İbrahim Kılıç1, 1Afyon Kocatepe University, Afyonkarahisar, Turkey
Environmental and social attempts lead to the protection of social image of
organizations, the increase of their reputation, and the decrease of their reputation
risks. Corporate reputation is a part of the communication between the
organizations and their stakeholders. In this regard, in the study, determining the
effect of sensitivity on corporate reputation is aimed by evaluating the sensitivity of
public hospitals operating in Afyonkarahisar on environmental and social issues with
the eye of stakeholders who are for the corporate reputation. For the data obtained
with the survey, descriptive and relationship analysis methods are used.
Sessions starting Friday 16.00
Mental Health and ICT
0211
Internet-based Cognitive Behavioural Therapy for Adults with Post Traumatic
Stress Disorder: A Systematic Review
Julie Fricke1, David Humphreys1, Oluchukwu Onyimadu2, 1University of Oxford,
Oxford, UK, 2Brunel University, London, London, UK
Background: Dissemination and effective delivery of short-term, evidence-based
treatments for PTSD is an urgent priority to address this growing public health
problem.
Aims: Systematically review the effectiveness of internet-based cognitive
behavioural therapy interventions for adults with PTSD.
Methods: A systematic search for relevant studies was conducted
Results: Nine RCTs were included (n=626), and six were meta-analysed (n=501). A
separate analysis was conducted for each of the subscales of the IES-R to obtain
the average mean differences (intrusion (n=501, -6.4 [-8.5-4.2]), avoidance (n=501,
-7.0 [-9.4-4.7]), and hyper-arousal (n=389, -4.7 [-6.1-3.3]), and sizeable reductions
of symptoms in the experimental group are found.
0056
Harnessing the power of mental-health risk assessment expertise to create a
seamless, evolving partnership between research and the delivery of advice at
the point of care.
Christopher Buckingham 1, Ann Adams2, 1Aston University, Birmingham, UK,
2University of Warwick, Coventry, UK
Predicting precisely when people will try to kill themselves is not possible. This can
be used as a reason for eschewing risk assessments despite their clinical
importance: managing risk requires knowledge of what raises it. GRiST is a decision
support system that overcomes resistance by modelling clinicians' natural thinking
and reasoning about risk and evolving it alongside clinical requirements. In
particular, the GRiST database of accumulating risk judgements fuels machine
learning research that captures expert consensus and helps reduce assessment
errors. This is a perfect example of clinical input directly influencing research, which
then feeds straight back into practice.
0090
MindExpressTM: An online risk factor-based tailored depression prevention for
young adults with a familial risk of major depressive disorder
Alex Wilde1, Alexis E Whitton1, Rhoshel Lenroot2,3, Lyndal Trevena4, Peter R
Schofield2,5, Philip B Mitchell1,6, 1School of Psychiatry, University of New South
Wales, Sydney, Australia, 2Neuroscience Research Australia, Sydney, Australia,
3South East Sydney and Illawarra Area Health Service, Sydney, Australia, 4School
of Public Health, University of Sydney, Sydney, Australia, 5School of Medical
Sciences, University of New South Wales, Sydney, Australia, 6Black Dog Institute,
Sydney, Australia
Theory/framework: Pilot study of a new online prevention program, MindExpress TM,
based on the Transtheoretical Model of Behavioural Change, to facilitate cognitive
and behavioural change thereby reducing depression risk factors in at-risk young
people.
Methods/hypotheses: Risk factor-based interactive educational and cognitive
behavioural modules tailored to individual risk status.
Results: The ‘Coping Styles’ module produced a significant mean behavioural
change with large effect size (Cohen’s d=0.88, n=17). Mean depression scores
decreased from mild at baseline to minimal at endpoint.
Conclusions: MindExpressTM holds promise as an online tailored risk factor-based
model for reducing susceptibility to depression in young people.
Health Systems and Primary Care
0022
Implementing and Evaluating Evidence-Based Mental and Physical Health
Care Management in General Practice
Robert Ferguson1,2, 1Jewish Healthcare Foundation, Pittsburgh, PA, USA,
2Pittsburgh Regional Health Initiative, Pittsburgh, PA, USA
Framework: Eight U.S. partners (18 medical groups) are implementing evidencebased care management programs for primary care patients with depression plus
diabetes or cardiovascular disease. If these CMS-CMMI Awards reduce costs, the
Affordable Care Act authorizes CMMI to change policies.
Methods: Each regional partner is responsible for recruitment, implementation,
quality improvement, and data submission (July 2012--June 2015). The evaluation
is assessing disease control rates, healthcare costs, and satisfaction. The collection
and use of data are part of the practice model. Results: Preliminary results show
improvements in disease control rates.
Conclusions: The uptake of research-based healthcare delivery models requires
system requirements.
0102
Commercial Health Plan management of Unwarranted Variation in Practice to
Improve Quality and Affordability
Donald Fischer1, 1Highmark, Inc., Pittsburgh, PA, USA
Unwarranted variation in practice has been well documented as a marker of poor
quality and waste in the American health care system. A U.S. commercial
insurer with 4.5 million members uses claims data to demonstrate opportunities for
reducing unwarranted overutilization and increasing use of effective therapies where
underutilization is prevalent. Partnerships among employers, providers and the
health plan are effective in decreasing variation, improving quality, and lowering
cost. Key success factors are sharing actionable data, facilitating process
improvement, and providing financial incentives for patient centered medical homes
and hospitals to better manage health. Similarly, lifestyle behaviors that contribute
to poor health can be modified by member rewards programs.
0153
Did higher NHS spending growth, 2001/2-2009/10, buy capacity or higher
relative wages?
Barry McCormick1, Adam Millican-Slater1, 1Centre for Health Service Economics &
Organisation, London, UK
There is concern that Labour Government policy to expand health spending in GDP
was dissipated in NHS wage growth, and failed to benefit patients. We analyse
hospital sector cost increases, in particular whether higher relative NHS wages
significantly diminished the intended real increase in capacity. Additional funding is
found to modestly increase relative hospital sector wage growth, and accounts for
10% of the additional real funding, 2001/2-9/10. Labour policy to increase NHS
wages immediately prior to funding growth, also absorbed 8% of the additional real
funding, 2001/2-9/10. However, over 80% of the increase in real funding purchased
greater NHS capacity, disproportionately employment.
India & China
0163
The Effects of Mobile Phone Use on Healthcare-Seeking Trajectories in Rural
India and China
Marco Haenssgen1,2, 1Oxford Department of International Development, Oxford,
UK, 2Hertford College, Oxford, UK
Rapid mobile phone diffusion offers new opportunities for rural dwellers in low- and
middle-income countries where healthcare challenges are pressing. Yet not all
forms of mobile phone use are equally beneficial for people's health. This paper
analyses how mobile phone use is linked to different healthcare behaviours. Original
data from 800 rural dwellers in Rajasthan (India) and Gansu (China) shows that
mobile phone use is positively linked to accessing formal and informal health
providers (rather than not receiving any care). However, among people who seek
care, phone use is often associated to delays in access to formal health providers.
0120
The Relationship between Economic Freedom and Health Indicators across
India
Saleema Razvi1, Debashis Chakravarty1, 1Indian Institute of Foreign Trade, New
Delhi, India
Framework: Deficiencies in health systems can be overcome by significant reforms.
Partnership with the private sector is a new avenue of growth. Existing literature
looks at impact of economic freedom on trade deficits, FDI but impact on health
indicators is missing.
Hypothesis: There is an significant relationship between economic freedom and
health indicators in Indian states.
Methods: Data for 20 states of India from 2004 to 2012 used. Regression analysis
evaluates impact of economic freedom on health expenditures, health infrastructure
and health indicators across the Indian states.
Results: A definite correlation between economic freedom and health expenditures
in Indian States.
0205
Where are women? Justice and Health Care in India today
Arunima Deka1, 1OKD Institute of Social Change and Development, Guwahati,
Assam, India
Despite recent improvements in the maternal health scenario in rural India, the
country still remains challenged with very high maternal deaths. Institutional
delivery, antenatal care, and postnatal care have been actively promoted by the
State to deal with the situation. However, State policies are still incongruously
geared towards addressing the issue without taking sufficient note of the various
sociocultural impediments in the way of maternal health care. While the Right based
approach towards health care fails to be widely accepted, can we move towards a
Justice based approach to address the malice of public health in the country?
Cancer and Female Health
0066
Association between use of the urgent cancer referral pathway and cancer
survival: national cohort study
Henrik Moller1, 1King's College London, London, UK
The overall survival impact of the urgent referral mechanism for patients with
suspected cancer is not known. We estimated hazard ratios for death in 215,284
cancer patients in relation to their GP practice's propensity to use urgent referral.
Use of the urgent referral mechanism was associated with reduced mortality. The
27% of cancer patients from GP practices with low use had a significant excess
mortality (hazard ratio: 1.07; 95% CI: 1.05-1.08). The GP practices that currently
have low propensity to use urgent referral could increase their use of it and hereby
plausibly increase the survival of their cancer patients.
0098
Pregnancy termination for fetal abnormality: Health professionals'
perceptions of women's coping processes
Caroline Lafarge1, Kathryn Mitchell1, Pauline Fox1, 1University of West London,
London, UK
Background: Understanding women's coping with pregnancy termination for fetal
abnormality (TFA) is important for health professionals to deliver appropriate care.
This study examined health professionals' perceptions of women's coping with TFA,
and compared them with women's accounts of their coping processes.
Methods: Fifteen interviews with health professionals were analysed using Thematic
Analysis.
Results: Themes common between the datasets included: support, acceptance,
problem-solving, avoidance, meaning-making and another pregnancy. Insights into
long-term coping were lacking.
Conclusions: Health professionals have a good understanding of women's shortterm coping. However, the limited insight into women's long-term coping may have
clinical implications.
0099
Comparison of Effects of Plyometric and Isokinetic Exercises on Trunk
Muscles in Premenopausal Women
Kubra Alpay1, Safinaz Albayrak Yildiz2, Turker Sahinkaya2, 1Bezmialem Vakif
University, Istanbul, Turkey, 2Istanbul University, Istanbul, Turkey
Objective: To compare the effects of plyometric and isokinetic exercises on trunk
muscles in premenopausal women.
Methods: Eighteen premenopausal women were included in this study and
assigned into two groups: Plyometric Exercise Group, (n=10) and Isokinetic
Exercise Group (n=8). Subjects performed exercise protocols for 6 weeks. Muscle
strength was measured using isokinetic dynamometer.
Results : Muscle strength increased significantly at both groups. Comparisons of
differences before and after interventions showed that IG had significantly
improvement for trunk extensor (p<0.05).
Conclusion: Due to increase in strength, plyometric exercises can be added to
premenopausal women's exercise program as a preventive approach.
Patient Care
0048
Access to primary health care in Ontario: patient prespectives on barriers and
reasons for use of walk in clinics and emergency rooms.
Michael Green1,2, Liisa Jaakimainen2,4, Graham Reid5, Eliot Frymire1, Simone
Dahrouge3,2, Karen Hall-Barber1, Rick Glazier2,4, 1Queen's University, Kingston,
Ontario, Canada, 2Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada, 3University of Ottawa, Ottawa, Ontario, Canada, 4University of Toronto,
Toronto, Ontario, Canada, 5University of Western Ontario, London, Ontario, Canada
From the past decade there have been major reforms to the delivery of primary
healthcare in Ontario, Canada. Despite this crude measures of access such as the
proportion of patients reporting same or next day access have not changed
significantly. This paper will present results from 18 waves of the Primary Care
access survey - a random dial survey of 2000 adults in Ontario quarterly from 20062010. Reported difficulties with accessing care, use of walk in clinics and
emergency rooms will be reported as will patient reported reasons for use of these
services.
0115
The Well Visit Planner: Implementing A Patient-Centered Pediatric Quality
Improvement Tool in Provider and Community Settings
Christina Bethell1, Michele Solloway1, Judith Shaw2, John Kilty3, Heather
Fitzpatrick4, Samantha Simmons1, Katherine Cox1, 1The Child and Adolescent
Health Measurement Initiative, The Johns Hopkins University, School of Public
Health, Baltimore, MD, USA, 2University of Vermont, Burlington, VT, USA, 3Oregon
Health & Sciences University, Portland, OR, USA, 4American Academy of
Pediatrics, Elk Grove Village, IL, USA
Framework: The US recommends 18 well child visits between ages 0-6. These
visits are short and often fall short of participants' expectations. Methods: The
CAHMI created and implemented a free family-centered tool to engage parents in
their child's healthcare and improve the quality and efficiency of health supervision
visits. Results: We successfully implemented and tested the WVP in healthcare and
community settings. Over 85% of parents reported that the WVP added value to
their visit, helped prioritize their issues and would recommend the tool to others.
Conclusion: The WVP is an effective tool for improving health supervision in the
US.
0032
Developing systems to identify patient deterioration: recent work
Jim Briggs1, Caroline Kovacs1, David Prytherch1,2, Paul Schmidt2, Paul Meredith2,
Gary Smith3, 1University of Portsmouth, Portsmouth, UK, 2Portsmouth Hospitals
NHS Trust, Portsmouth, UK, 3Bournemouth University, Bournemouth, UK
We will describe our recent research to validate/improve the UK's National Early
Warning Score (NEWS), developed by the Royal College of Physicians. This work
includes:
• an early warning score (EWS) devised from blood test results
• how decision tree data mining techniques can be used to develop new EWS
systems quickly
• how aggregate EWS values are more important than high scores for a single vital
signs parameter for discriminating the risk of adverse outcomes
• whether observation selection methods are important when comparing EWS
performance
• EWS performance in admissions to surgery
UK Research
0212
Discriminatory practices faced by undocumented migrants in accessing
health care in the UK and the NHS reform
Michael Mavrommatis1, 1University Campus Suffolk, Ipswich, UK
This paper investigates the barriers undocumented migrants face in accessing
health care in the UK. Under the theoretical framework of social representations it
studies the role of the media in creating an anti-immigrant sentiment reflected in
exclusionary practices in GP surgeries. The study argues that that the NHS reform
is in significant ways an apologist to pre-existing discrimination.
Methodology: Interviews with GPs publishing on migrants' access to health care, the
Advocacy and Outreach Officer of the Doctors of the World, and a journalist
reporting on health care; content analysis in the relevant literature and issues from
high-circulation newspapers.
0208
Public policy and evidence-building: UK residential care for older people
Pauline McGovern1, Elizabeth West1, 1University of Greenwich, London, UK
The UK has an ageing population with increasing demands for social care and such
an important area of public policy should be underpinned by high-quality evidence.
We present a systematic review of academic studies of the quality of life of elderly
residents of UK care homes. We used 1,169 citations from eight databases.
We find that there are few academic studies of UK residential care. Also, although
Coalition policy has emphasised the importance of social enterprises as providers of
public welfare services, we find no studies that contrast UK for-profit and not-forprofit providers of social care for the elderly.
0110
Disparity in training provision for healthcare assistants across NHS Trusts in
England.
Clare Aldus1, Marcus Barker2, Sophie Sarre3, Heather Wharrad2, Jill Maben3,
Antony Arthur1, 1University of East Anglia, Norwich, UK, 2University of Nottingham,
Nottingham, UK, 3King's College, London, London, UK
There is increasing recognition of problems with hospital care of older people across
the NHS, including relational care (kindness, respect). Healthcare assistants (HCAs)
provide much of that care yet training provision for HCAs is unregulated and underresearched.
A semi-structured telephone survey of English NHS Trusts was carried out (MarchOctober 2014) to identify training provision for HCAs, including training in relational
care of older people.
Trust responses (109/163(68%)) showed that training, mentorship and ongoing
support is heterogeneous within and between Trusts.
High standards of care are expected NHS-wide but HCA training lacks the
necessary resource, standardisation and quality control.
Sessions starting Saturday 9.00
Research and Care Improvement
0068
Integrating Research, Training and Clinical Care: Experiences from Sydney,
Australia
Mary
MacLennan1,
Wendy
Lipworth2,1,
Julie
Johnson3,
Terence
1
1
Campbell , University of New South Wales, Sydney, Australia, 2University of
Sydney, Sydney, Australia, 3Northwestern University, Chicago, USA
Background: The University of New South Wales recently established four
Academic Health Science Centres as part of the larger "Sydney Alliance for
Healthcare, Research and Teaching" (SAHRT).
Method: In-depth interviews were conducted with involved senior academics and
clinicians.
Results: Overall, interviewees were optimistic about the potential of SAHRT as a
vehicle to create a portfolio of collaborative research and funding and, to a much
lesser extent collaborative teaching and clinical care.
Discussion/conclusion: The results point to the importance of considering
entrenched cultural norms and values, power relationships and structural
considerations when establishing new alliances in settings where these are not wellknown.
0008
Improving pre-operative assessment in ear, nose and throat surgery - A full
cycle quality improment project
Manuela Cresswell2, Rosie Cresner3, Donald McFerran1, 1Colchester Hospital
University NHS Trust, Colchester, UK, 2Broomfield Hospital NHS Trust, Chelmsford,
UK, 3Alder Hey Children's Hospital, Liverpool, UK
Theory/Framework: Clear preoperative testing guidelines were published by NICE
and ENTUK. Aim of this study is to assess compliance and improve it.
Methods and hypotheses: Two-cycle audit with prospective data collection from
case records. Findings of first cycle were presented to doctors ans nurses and
poster with guidelines was displayed in the pre-assessment room.
Results: 50 patients were included. 86% had American association of anaesthetists
(ASA) grade I or II. 23 patients did not have formal pre-assessment. Compliance
with guidelines improved from 52% to 60%.
Conclusions: Low attendance to pre-assessment clinics may relate to the low
compliance with guidelines.
0143
Examining Patient Reported Outcome Measures (PROMs) in varicose veins
procedures
Sarah Onida1, Joseph Shalhoub1, Hayley Moore1, Karen Head1, Tristan Lane1, Alun
Davies1, 1Imperial College London, London, UK
Background: Procedural satisfaction and quality of life are assessed by PROMs
questionnaires distributed to individuals undergoing varicose vein intervention in
England.
Methods: PROMs data from June 2009-July 2011 were extracted from the online
Hospital Episode Statistics data warehouse.
Results: 35,093 patient episodes were identified. Quality of life scores improved
with intervention(p<0.001). Self-reported anxiety of depression was prevalent in
24.1% of our cohort. Pre-operative scores relating to anxiety and depression were
associated with post-operative success and satisfaction(p<0.001).
Conclusions: Pre-operative depression and anxiety levels and quality of life scores
impact on patients’ perception of post-operative success and satisfaction following
varicose vein intervention.
Public Health and Health Policy
0025
Doing health policy in European Union. The analysis of contextual
determinants of cooperation between Poland and EU
Kinga Zdunek1, Teresa B. Kulik1, 1Medical University of Lublin. Faculty of Nursing
and Health Sciences. Public Health Department, Lublin, Poland
Despite the fact that the cooperation between Poland and EU is strongly formalized,
important role is played by sociocultural factors. Based on the analysis, which used
grounded theory approach and was supplemented by secondary research, we
observed that in the process of Europeanisation the contextual determinants were of
systemic and sociocultural character. The former group consists: legal and
organisational factors, while the latter concerns elements such as: informal
relationships, stakeholders actions, media impacts as well as patients and
consumers attitudes. The network of informal relationships significantly affects the
effectiveness of cooperation while individual patients and consumers had least
noticeable impact.
0031
Priorities for self-management of long-term conditions in England: a
qualitative investigation of commissioners' views
Emma Boger1, Jaimie Ellis1, Anne Kennedy1, Sue Latter1, Fiona Jones2, Claire
Foster1, Ian Kellar3, Claire Reidy1, Sara Demain1, 1University of Southampton,
Southampton, UK, 2St Georges University of London and Kingston University,
London, UK, 3University of Leeds, Leeds, UK
NHS commissioners are required to be proactive in supporting long-term condition
(LTC) management (Imison et al., 2011). How commissioners prioritise this and
which outcomes of support are valued is unknown.
Purpose: To understand how commissioners conceptualise and prioritise LTC selfmanagement and which outcomes of self-management support are valued.
Methods: Semi-structured interviews with commissioners (n=23).
Results Self-management was conceptualised as increased patient responsibility
for health. Self-management support services competed with other commissioning
priorities. Outcomes of services were process-focused (e.g. admissions reduction).
Conclusions Commissioners aim for population-focused services, a focus upon
process may detract from outcomes which are meaningful to patients.
0033
Activated Patients Improve Outcomes and Lower Costs
Karen Wolk Feinstein1,2, 1Jewish Healthcare Foundation, Pittsburgh, PA, USA,
2Pittsburgh Regional Health Initiative, Pittsburgh, PA, USA
The digitization of health information has enabled a new type of patient. We call
them the activated patient. They have the motivation, knowledge, skills, and
confidence to become engaged in their health care. Studies show that patients with
high activation levels have improved outcomes and lower healthcare costs than
those with low activation levels. This presentation will discuss the new patientprovider paradigm, its impact in flattening the traditional hierarchical patient-provider
relationship, and ways we can support patients and providers in embracing the shift
as a way to achieve better health outcomes at lower cost.
Big Data eHealth and Economics
0004
Greater excess risk of all-cause mortality and vascular events in women than
in men with type 1 diabetes: a systematic review with meta-analysis
Rachel Huxley2, Sanne Peters1, Gita Mishra2, Mark Woodward1, 1University of
Oxford, Oxford, UK, 2University of Queensland, Herston, Australia
Background Studies have suggested that the mortality rate associated with type 1
diabetes differs between women and men. We performed a meta-analysis to
provide the most reliable estimates of any sex differences in the effect of type 1
diabetes on risk of all-cause and cause-specific mortality.
Methods PubMed MEDLINE was systematically searched for all studies published
between January 1, 1966 and March 24, 2014. Eligible studies had to have reported
sex-specific estimates of the standardized mortality ratio (SMR) associated with type
1 diabetes either for all-cause mortality or cause-specific mortality. Random effects
meta-analyses with inverse variance weighting were used to obtain sex-specific
SMR and their pooled ratio (women:men) for all-cause mortality, and mortality due
to coronary heart disease, stroke, cardiovascular disease, renal disease, cancer,
and accident and suicide associated with type 1 diabetes.
Findings Data from 23 studies including 93,846 individuals and 6,434 events were
included. The pooled ratio of the women: men SMR for all-cause mortality was 1.43
(95% CI: 1.19-1.72), for incident stroke 1.37 (1.03-1.81) and for renal disease 1.44
(1.02-2.05). For coronary heart disease events the sex difference was more
extreme; the pooled ratio of SMR was 2.54 (95% CI: 1.80–3.60). There was no
significant evidence of a sex difference for mortality associated with type 1 diabetes
from cancer, or from accident and suicide.
0207
Societal costs of diabetes mellitus in denmark according to gender, age and
complication state in 2011- a register based study of all centrally available
diabetes data.
Camilla Sortsoe1,3, Anders Green1,2, Peter Bjoernholt Jensen2, Martha
Emneus1, 1Institute of Applied Economics and Health Research (ApEHR),,
Copenhagen, Denmark, 2Odense Patient data Explorative Network (OPEN), Odense
University Hospital and University of Southern Denmark, Odense, Denmark, 3Centre
of Health Economics Research (COHERE), Department of Business and
Economics, University of Southern Denmark, Odense, Denmark
Diabetes attributable costs (DAC) by age, gender, education, complication
progression are presented for RWE health, pharmaceuticals, nursing, productivity
costs. All diabetes register person data were linked to cost data from 5 health/social
registers. Complication groups were defined through National Hospital Register
data. DAC reached 31.8 billion DKK in 2011 (107,000 DKK per PYRS). Steep
increasing costs with increasing complications are evidenced across all components
(health care 12 and nursing 33 times). The 25% of persons with complications
consume 60% of resources pointing to secondary prevention. RWE helps evaluating
cost-effectiveness of future efforts and burdens, and targeting specific groups.
0112
Usual blood pressure and risk of new onset diabetes: evidence from 4.1
million adults and a meta-analysis of prospective studies
Connor Emdin1, Simon Anderson1, Kazem Rahimi1, 1The George Institute for
Global Health, Oxford, UK
Background: The relationship between systolic blood pressure (SBP) and risk of
new onset diabetes is unclear.
Methods: A cohort of 4.1 million adults was assembled from linked electronic health
records. Cox models were used to examine the relationship between usual blood
pressure and diabetes.
Results: A 20 mm Hg higher SBP was associated with a 58% higher risk of new
onset diabetes (hazard ratio 1.58 95% confidence interval 1.56, 1.59). No evidence
of a nadir was observed. The strength of the association declined with increasing
BMI.
Conclusions: Elevated blood pressure is associated with an increased risk of new
onset diabetes.
Female Health
0043
Women's Attitudes towards the Medicalization of Childbirth
Yael Benyamini1, Heidi Preis1, Uzi Dan2, Miri Gozlan2, 1Tel Aviv University, Tel
Aviv, Israel, 2Maccabi Health Services, Rishon LeZion, Israel
Framework - women today can choose birth modes, from homebirth to cesarean
delivery.
Methods and hypotheses - a 16-item measure of women's attitudes towards the
medicalization of childbirth was developed and tested with data from 836 pregnant
and 129 non-pregnant women.
Results - Attitudes towards the medicalization of childbirth did not differ between
pregnant and non-pregnant and between primiparas and multiparas; they changed
only along the first pregnancy. These attitudes were significantly associated with
fear of birth, birth plans, and actual birth modes.
Conclusions - understanding women's views of the medicalization of childbirth may
be a key to understanding their choices.
0062
Knowledge, Attitude and Practice of Preconception Care Among Women of
Reproductive Age in Alimosho Local Government Area, Lagos State.
Yusuf Shittu1, Kofo Odeyemi1, 1College of Medicine, University of Lagos, Lagos,
Nigeria
Theory: This study examines the knowledge, attitude and practice of preconception
care among women of reproductive age in Alimosho area of Lagos, Nigeria.
Methods/Hypotheses: A cross-section of 400 women of reproductive age was
coopted for interview using multi-stage sampling technique.
Results: Only 30.5% of the women had heard of preconception care, even
less(21.4%) defined it correctly. Most respondents demonstrated a good attitude
despite poor practice(84.4%). Also, increase in knowledge resulted in significant
increase in positive attitude and practice. [p<0.05]
Conclusion: This study demonstrated the poor level of awareness and practice of
preconception care amongst the participants despite their positive attitude.
0003
Down with Masculinity: the need to rethink the social determinants of men's
health
John Macdonald1, 1University of Western Sydney, Penrith, NAW, Australia
Until recently "men's health" has concerned itself with male-specific clinical
pathologies like prostate cancer or social pathologies of men- their reluctance to
attend the doctor, their diffidence in talking about problems etc. The sad incidences
of male violence have ensured that this phenomenon is almost the starting point for
reflection and action on men's health. "Masculinity", hegemonic or otherwise, is
seen to be at the root of much male ill-health and of course, that of women also.
At the same time, the scholarship on the social determinants of populations has
grown apace. WHO has contributed a lot to this broadening of the bio-medical
perspective to include the importance of contexts like the social gradient and social
inclusion/exclusion in understanding health in general.
This perspective has not often been applied to men and we remain, globally, with
medical preoccupations (important in themselves) and a Western exported
understanding of men and their health based on a deficiency model born from
western feminism thinking and practice.
The time has come to challenge this paradigm by simply applying a social
determinants of health approach to boys' and men's health. Otherwise the shocking
revelation by WHO that there is a difference of over 20 years in terms of life
expectancy for men in one suburb of Glasgow, Scotland and those in another is
going to be attributed to "masculinity". The irrationality of this calls for a rethink of
the social determinants of men's health. Based on an Australian experience, this
paper will take a global perspective.
Sessions starting Saturday 10.20
Health Economics / Older Age
0014
On Death and Dying: Changing Expectations and Outcomes for Care at End of
Life
Nancy Zionts1, 1Jewish Healthcare Foundation, Pittsburgh, PA, USA, 2Colaition for
Quality and End of Life, Pittsburgh , PA, USA
In the U.S., 32% of Medicare spending is on patients in their last two years of life.
While 70% would prefer to die at home, only 25% actually do. The healthcare
system too often fails families and patients at end-of life, presenting emotional,
physical and financial burdens. But other realities are possible. This session will
explore how Closure -- a model of enhanced health professions training (medical,
legal, social, cultural-familial and spiritual aspects of death and dying), advanced
care planning, and frank discussions about death and options (e.g., hospice and
palliative care) can change practice, patient experience and costs.
0150
Health Care Expenditure in the Last Year of Life
Worawan Chandoevwit1,2, Tirnud Paichayontvijit2, 1Khon Kaen University, Khon
Kaen, Thailand, 2Thailand Development Research Institute, Bangkok, Thailand
The elderly in Thailand are under either the Civil Servant scheme (CS) or the
Universal Coverage scheme (UC). Both schemes pay inpatient care using the DRG
system. The rate of payment per one adjusted RW is lower for the UC.
Hypothesis: Elderly under the CS scheme have higher health care expenditure
(HCE).
Data include 336,537 elderly who were admitted between 2007 and 2011. The
elderly in the UC scheme have a shorter life. Using log-linear regression, the results
show that HCE in the last year of life among CS elderly are 13 percent higher than
UC elderly.
0142
Labor supply decision and mental health: Does retirement matter?
Ruozhi Xu1, 1Hong Kong University of Science and Technology, Hong Kong, Hong
Kong
Retirement is one of the main life course shocks that faced by individuals and
households. Studying impacts of retirement is important for labor force participation
and policy maker. Using CHARLS 2011 and 2013 wave data, the study adopts fuzzy
regression discontinuity (RD) design and an instrumental variable (IV) "eligible for
mandatory retirement age" to establish causal effects of retirement on multiple
mental health outcomes among Chinese elderly. Preliminary results indicate that, for
subjective outcomes, retirement has significant negative effects on life satisfaction
among men. For cognitive abilities, retirement has delay negative effects on
episodic memory for women.
Mental Health and HIV
0044
Rethinking our understanding and application of autonomy and human
dignity in the context of demented patients' care-taking - a Multicultural
Perspective.
Miriam Bentwich1, Amitai Oberman2,1, Nomy Dickman1, 1Faculty of Medicine, BarIlan University, Safed, Israel, 2Padeh Medical Center, Poriya, Israel
Treating patients with dementia triggers questions regarding the extent to which
their autonomy and human dignity can be respected. However, much of the
literature in this area represents a Western-liberal perspective. We present the
results of a mixed-methods study, based on interviews and questionnaires
administered to nurses, social workers and other professional caretakers from three
main cultural groups in Israel: Arabs, Jews born in Israel and migrants from Russia.
Our results show differences between these groups in interpreting human dignity
and autonomy, while suggesting significant possible extensions to the application of
both concepts in the care-taking of demented patients.
0218
The International AIDS Vaccine Initiative's capacity building activities in East
Africa
Gavin Cochrane1, Enora Robin1, Joanna Chataway1, 1RAND Europe, Cambridge,
UK
The International AIDS Vaccine Initiative is a Product Development Partnership
created to bridge the gap between scientific potential and the health needs of
populations in low and middle income countries. Its capacity building activities aim
to strengthen the ability to conduct clinical trials, spanning scientific and
technological capacity but also organisational, advocacy and broader development
capabilities to encourage research use in HIV policy. Our study used a multi-method
approach, combining desk-based research and fieldwork in Kenya, Rwanda and
Uganda to understand the impact of IAVI's capacity building activities on HIV
research uptake in policy at a national and regional level.
0101
The costs of HIV care using layworker support in in sub-Saharan Africa: a
case-study from Tanzania
Godfather Kimaro1,3, Victoria Simms2, Sokoine Kivuyo1, Jaffar Shabbar2, Godfrey
Mfinanga1, Amos Kahwa1, Lorna Guinness3, 1National Institute for Medical
Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania,
2Department of Infectious Disease Epidemiology, London School of Hygiene and
Tropical Medicine, London, UK, 3Department of Global Health and Development,
London School of Hygiene and Tropical Medicine, London, UK
We evaluated the cost implications of adding community-based layworker support to
the first weeks of HIV care in order to reduce the high mortality rate evident in this
period. We used an ingredients approach to cost HIV services at the individual level.
The mean annual per patient cost was US$ 519 (95%CI, 498 - 541) with layworker
support costing $42.46/ patient (95%CI 38.49 - 46.47). These data fill an important
gap in the evidence of the costs of the HIV programmes.
Information and Public Health
0019
Willingness of future A/H7N9 influenza vaccine uptake, Hong Kong
Calvin KY Cheng1, Greta Tam1, Zhe Huang1, Poyi Lee1, Emily YY Chan1, 1Chinese
University, Hong Kong, Hong Kong
We conducted a cross-sectional population-based telephone survey between 15
and 28 February 2014 in Hong Kong during the second wave of influenza A/H7N9
outbreak to delineate the willingness of future A/H7N9 vaccine uptake and factors
affecting their choices. We found half of the respondents were willing, which was
independent of demographic factors. High anxiety level and a vaccine history were
associated with willingness to uptake future A/H7N9 vaccine. Understanding the
willingness of A/H7N9 influenza vaccine uptake in the community help policy
makers to decide suitable strategies to control the re-emerging of this influenza
virus.
0084
Managing Fearbola - a public relations perspective on Canada's travel VISA
restriction in response to the Ebola outbreak
Yun-Ju Song1, Alexandre Sevigny1, 1McMaster University, Hamilton, Ontario,
Canada
Canada imposed a travel VISA ban to 3 Ebola stricken countries in November of
2014. The ban is a direct violation of the International Health Regulation. This
multiple case study research explores public relations paradigms to managing
Ebola. By promoting dialogical communication, PR are crucial to relationship
building, reputation maintenance, and crisis response in public health. This research
can be used to critically appraise past responses towards SARS, H1N1, and other
infectious diseases in terms of its appropriateness to issues management. It also
highlights PRs contribution to building better diplomatic relations in an increasingly
collaborative environment of global private-public partnerships.
0061
Frameworks of Patient Empowerment- A review
Aisha Umar Akeel1, Darren Mundy1, 1University of Hull, Scarborough, UK
The presence and increase of challenges to ehealth in today’s society have begun
to generate doubts about the capability of patient empowerment especially with the
frameworks. Through the review of existing frameworks and articulation of patient
demands, weaknesses in current structures to support empowerment are explored,
and key constituents of a framework for patient empowerment are determined. This
paper argues that existing frameworks for patient empowerment in the healthcare
system, although well intentioned, are insufficiently constituted, as they are
fragmented. System theory concepts such as holism and iteration are considered
vital in improving patient empowerment framework.
Research and Incentives
0095
The COHRED Fairness Index for ethical and equitable research collaborations
to address health needs in low and middle-income countries.
Najia Musolino1, Carel IJsselmuiden1, Janis Lazdins1, Jacintha Toohey2, 1Council
on Health Research for Development, Geneva, Switzerland, 2Council on Health
Research for Development, KwaZulu Natal, South Africa
Global support for health in low middle-income countries has resulted in many
improved products and services, but has not substantially improved the systems
that countries need to conduct or partner research and to translate results into
effective policy and practice. The COHRED Fairness Index developed through a
multi-sector consultation involving a Technical Working Group proposes a
certification scheme for best practices in international collaborative partnerships in
research for health. The added values of its implementation will be to improve the
alignment of interests of all partners in global health research, to reduce inequity in
health and ultimately stimulate socio-economic development.
0094
Contextual factors associated with the utilization of rapid response
mechanisms for urgent decision-making research evidence needs
Rhona Mijumbi1, Nelson Sewankambo1, 1Makerere University, Kampala, Uganda
There is a drive to scale up rapid response mechanisms in low and middle income
countries, following pilots that have shown the feasibility of this innovative strategy
aimed at meeting urgent research evidence needs for policy and decision-making.
Using process evaluation methods informed by the theory of planned behavior, we
determined the contextual factors associated with the utilization of such
mechanisms. The mechanism’s objectives, operational procedures, target clientele
and products are some of the categories under which we identified associated
factors.
0067
Do user fee exemption policies for maternal health services work? Studying
the impact of Free Delivery and Caesarean Policy in Senegal.
Divya Parmar1, 1City University London, London, UK
This study investigates the impact of a user fees exemption policy (Free Delivery
and Caesarean Policy, FDCP), introduced in 2005-06 in Senegal. We study the
impact of FDCP on facility-based deliveries, caesarean births and antenatal care.
Using household surveys covering a period from 2003 to 2009, multivariate logistic
regressions are conducted to study the impact of FDCP across different groups
based on their socio-economic status, place of residence, ethnicity and mother's
education. Although FDCP substantially increased utilisation of maternal healthcare
services; this increase was not equitable. Efforts to improve access among the most
vulnerable groups need to be strengthened.
Children and Public Health
0040
Breastfeeding Experiences among a group of Thai adolescent under 16 year
old mothers in Suphanburi province, Thailand
Wilawan Dhanawan1, 1Boromarajonani College of Nursing Suphanburi, Thailand.,
Suphanburi, Thailand
The adolescent mothers maybe had stressful events, that are challenging for
health care providers. This study was to explore breastfeeding experiences in a
group of Thai adolescent under 16 year old mothers. A Qualitative Study was used.
The purposive of 14 adolescent mothers who had had experiences of breastfeeding
participated. Individual perspective by adolescent mothers and breastfeeding
supporting are two mains themes with three categories emerged from the text. The
adolescent mothers consider great and more self esteem when they had
breastfeeding to the babies. Positive support from family and nurses can be
encouraged adolescent mothers to successful in breastfeeding.
0085
Three-wheeler motor van (Mom's Van) for emergency transporation for women
with obstetric complications in rural Bangladesh.
Nazmul Alam1, 1Université de Montréal, Montreal, Quebec, Canada
Poor transportation directly and indirectly contributes to high maternal mortality and
morbidity in low and middle-income countries by limiting access to care for maternal
emergencies. We have conducted a feasibility study of three-wheeler motor
ambulance (Moms van) intervention in rural Bangladesh. We have collected data
from survey, key informant interviews, focus group discussions and chart
abstraction of log books. Poor transportation and related cost were reported as key
barriers to seek care during pregnancy and delivery. Mom's van intervention created
huge positive response in the community and its business model of limited income
generation was found to be financially feasible.
0226
The development of the Economic impacts of Smoking in Pregnancy (ESIP)
model for measuring the impacts of smoking and smoking cessation during
pregnancy
Matthew Jones1, Sarah Lewis1, Steve Parrot2, Murray Smith1, Tim
Coleman1, 1University of Nottingham, Nottingham, UK, 2University of York, York, UK
Smoking in pregnancy a major cause of morbidity and mortality, and a significant
cost burden to the NHS. However, at least 12% of all mothers report smoking
throughout pregnancy. While interventions have demonstrated effectiveness, the
economic literature on cessation during pregnancy is underdeveloped, failing to take
into account both the within-pregnancy effects of smoking and the long term impacts
for both the mother and her child. ESIP captures both the within-pregnancy for
mother and child, with extensions for the remaining life of the mother and the
infant's childhood, hence producing better estimates of the cost-effectiveness of the
cessation interventions.
Sessions starting Saturday 11.20
Care and Patients
0238
Improving the safety and continuity of medicines management at care
transitions
Gerry Armitage1, 1University of Bradford, Bradford, UK, 2University of Leeds, Leeds,
UK
As part of our ‘Improving safety and continuity of medicines management at care
transitions’ (ISCOMAT) programme, we updated a systematic review of the
effectiveness of interventions to reduce discontinuity. We identified 13 RCTs
published in the three years since the original review. Rigorously evaluated trials
were uncommon, but in those with a measurable impact on health outcomes,
interventions were multifaceted. They involved multiple points in the patient journey,
repeated contact with health professionals, and structured communication. This
paper considers the implications of these findings for patient involvement and
evaluation of existing systems as part of a novel research design
0167
“The moment you come out of hospital you’re on your own.” Cardiology
patients' social networks for medicines management.
Beth Fylan Gwynn1, Gerry Armitage1, Alison Blenkinsopp1, Deirdre
Naylor0, 1University of Bradford, Bradford, UK
Medicines management is a system that supports patients’ medicines use. Patients
experience greater risk from their medicines when their care is transferred following
hospitalisation, often due to poor medicines management. Using phase 1 of a Social
Network Analysis (SNA), sixty semi-structured interviews explored professional and
lay medicines management functions. Transcribed interview data were analysed
thematically. Network functions were identified as: supporting medicines use;
medicines orientation; and health condition management. Patients experienced
safety incidents as a function of their networks through communication failures and
supply errors. SNA can reveal valuable insights into the quality and safety of primary
care medicines management.
Ethnicity and Migrants
0173
Ethnicity, health service delivery and engagement
Sabrina Gupta1,2, Rosalie Aroni1, Helena Teede1, 1Monash University, Melbourne,
Victoria, Australia, 2La Trobe Unversity, Melbourne, Victoria, Australia
A cultural competence framework underpinned this study.
Aim: to explore views of South Asians (SA) and Anglo-Australians with type 2
diabetes and/or cardiovascular disease (CVD) of their relationships with health
professionals and the Australian health care system.
Methods: Audio recorded in-depth interviews were conducted with SAs and AngloAustralians with type 2 diabetes and/or CVD in Australia. Thematic analyses were
performed.
Conclusions: SA participants perceived a lack of cultural competence, knowledge
and understanding amongst their treating clinicians producing disillusionment and
disengagement with their health practitioners and the health system. This contrasts
with the perceived engagement of the host population.
0240
Thematic Study on cost-analysis of health care provisions to migrants and
ethnic minorities - Preliminary results
Anna-Theresa Renner, Ursula Trummer, Sonja Novak Zezula, Ina Wilczewksa1
1Center for Health and Migration, Vienna, Austria
Access to health care in most countries is connected to certain preconditions like
insurance or citizenship. Ongoing debates argue that exclusion may cause "forced
emergencies" resulting in higher costs than timely treatment. In this thematic study,
commissioned by the International Organization for Migration, the costs of providing
primary care versus hospital care to irregular migrants in four European countries
were investigated using a vignette approach. The preliminary results of the microcosting exercise from three perspectives (patient, third party payer, society) depict
that particularly the third party payer could benefit from inclusion of irregular
migrants in the health care system.
Distance and Travel
0202
Health-Related Constraints to Travel among Older Adults
Bob Lee1, 1Bowling Green State University, Bowling Green, Oh, USA
As baby boomers grow into advanced age, it drives a large portion of older
population to express their leisure on the road. Older adults rated travel as the
number one choice of retirement activities. However, to be able to travel for
pleasure, many of them must negotiate health-related constraints.
The purpose of this study is to identify health conditions that may intervene seniors’
travel. Data was collected through interviewing 206 older adults during the years of
2012-2013. The respondents’ health status was measured and analyzed within
SPSS. Result identified key variables that may help to explain why seniors not
travel.
0184
The effect of home to hospital travel time on 30day mortality after PCI in
STEMI patients in the Lazio region (Italy)
Riccardo Di Domenicantonio1, Giovanna Cappai1, Valeria Belleudi1, Paolo
Sciattella1, Francesca Mataloni1, Mariangela D'Ovidio1, Mirko Di Martino1, Roberto
Ricci2, Carlo Alberto Perucci2, Marina Davoli1, Danilo Fusco1, 1Department of
Epidemiology of the Regional Health Service , Rome, Lazio, Italy, 2Local health
authority Roma E, Rome, Lazio, Italy
OBJECTIVES: To evaluate the relationship between travel time from home to
hospital and 30¬day mortality after percutaneous coronary intervention (PCI) among
patients with STEMI. METHODS: A cohort of STEMI patients who underwent PCI in
the Lazio Region were selected using administrative data. Travel time from census
block to hospitals were calculated using geographic information system. RESULTS:
Travel time of 20 or more minutes versus travel time equal to 0¬19 minutes was
associated with mortality in 0¬89 minutes cohort (OR=2.29; IC: 1.07¬4.90).
CONCLUSIONS:Travel time affects 30¬day survival, its utilization could contribute
to better estimate patient's mortality risk in hospitals outcome evaluation.
Mixed - Pain and Intervention
0200
Inequalities, Blind Spots and Lack of Evidence: Rethinking Interventions to
understand a Public Health of Disability
Maria Berghs1, 1University of York, York, UK
We no longer perceive disability as a distinct category but understand it as more
encompassing, affecting anyone, including those with pre-existing chronic
conditions and mental health problems. This is why current international
understandings are moving away from a strictly medical definition to one more in
tune with how people experience disability in their day-to-day life. Public health
research has been slow to accommodate these shifts. The use of inappropriate
definitions and measurement tools-with disability represented in terms of cost, risk
or burden-along with a more general struggle to accommodate diverse social
experiences, make it difficult to provide evidence on successful interventions.
0214
Describing the characteristics, treatment pathways, outcomes and costs of
people with chronic non-cancer pain managed by community pain clinics in
Nottingham and generating an indicative estimate of cost-effectiveness
Saja Almazrou1, Shiekha Alaujan1, Roger Knaggs1, Rachel Elliott1, 1University of
Nottingham, Nottingham, UK
Community pain clinics (CPC) are considered to be a rational option to manage
musculoskeletal pain (MP). Knowing that these services are resource intensive,
evidence is needed to demonstrate their cost effectiveness (CE). This study aims to
describe the management of patients with musculoskeletal pain in Nottingham CPC
to derive an indicative estimate of CE.
We will collect data from eligible patients on health outcomes and resource
utilization at baseline, three and six months later. Resource use collected by costing
diaries will be compared with electronic records. Finally data derived from the
previous stages will be integrated in a decision model.
Diabetes
0035
Type 2 diabetes diet as a determinant of the quality of life. A Polish
perspective
Renata Bogusz1, 1Independent Medical University of Lublin, Lublin, Poland
Quality of life as sociomedical indicator of health reflects the treatment results and
patients expectations. Type 2 diabetes which is becoming epidemic of 21st century
requires both: treatment and radical changes in lifestyle. The goal of the study was
to analyse the relationship between type 2 diabetes diet and the quality of life. An
opinion poll was conducted and an original standardized questionnaire was used in
the group of 127 patients. Although respondents were aware of the need of
appropriate diet they did not adhere it. The highest level of quality of life was directly
proportional to adhering strict diet.
Sessions starting Saturday 14.20
Care and Death
0016
Dying for Change: An Examination of the affects of Hopice Programs in the
US Penal System
Kori Novak1, 1The Mellivora Group, Lititz, PA, USA
The number of individuals living their lives within the U.S. penal system has
increased substantially. Convicted offenders are receiving longer sentences and
being sent to correctional facilities at older ages. This has created issues specifically
healthcare issues and healthcare costs for aging offenders. This study employed
qualitative measures through case studies to examine how end-of-life programs
affect prison cultur. The researcher hypothesized there would be a significant affect
on prisons with hospice units. While the effects are more difficult to ascertain in
inmate populations, it was determined a culture shift occurred within the
administration in conjunction with a hospice program.
0151
Grief experiences of older and young workers: Implications for workplace
bereavement policy
Frank Eyetsemitan1, 1Roger Williams UNiversity, Bristol Rhode Island, USA
Levels of attachment to the deceased and employers' reaction to loss experience
were explored for older and young workers. 145 volunteers participated; 35 were
forty years and over while 109 were thirty-nine years and under. Ages ranged from
18-65 years (M=30.95)--67% females and 33% males. "Relationship of Community"
type of loss was experienced mostly by young employees while "Relationship of
Attachment" type of loss mostly by older employees. No difference however for both
groups, in number of paid days given off work for mourning. Workplace
bereavement policies should consider employees' age and attachment types in
developing workplace bereavement policies.
Mental Health, Alternative Medicine
0058
Why people believe in alternative medicine
Helena Matute1, Fernando Blanco1, Ion Yarritu1, 1Deusto University, Bilbao, Spain
Framework: People preferring alternative medicine over evidence-based medicine
are increasing. This is a public health problem. We propose this requires
understanding how people attribute causes to effects.
Method: Students estimated the effectiveness of a drug that was administered to
fictitious patients. Most patients recovered, regardless of whether they took the
drug. Variables that might affect the illusion that it was working were tested.
Results: An illusion that the pill was effective was observed. In addition, some
strategies were found that reduced this illusion.
Conclussion: These strategies could be used in campaigns to reduce the illusion
that alternative treatments are effective.
0089
Self-Balancing Sanctuarying: A Classical Glaserian Grounded Theory of
Relaxation and Autogenic Training for Generalized Anxiety
Ruth T Naylor1, Sue Holttum2,1, 1British Autogenic Society, London, UK,
2Canterbury Christ Church University, Canterbury, UK
Aims: elucidate how Relaxation and Autogenic Training work; develop clinical
practice recommendations; influence access to relaxation therapies throughout the
NHS.
Data: forty-six interviews, thirty-four diaries; non-anxious community volunteers and
moderate-severe anxious clients of AT therapists. Classical Glaserian grounded
theory analysis methodology determined participants' main concern (self-balancing)
and how this concern was resolved (sanctuarying).
Theory: 3 switching strategies; restorative benefits enable and maintain allostatic
balance, integrate/strengthen the core self, connect people to community, expand
self-discovery, and develop character.
Adds: a grounded perspective to the spiritual well-being debate; theoretically
situates and/or challenges extant descriptive/conceptual models of Relaxation and
AT.
Care Trajectories, Psychology
0206
Exploring Healthcare Trajectories and Their Analytical Value in Assessing
Effects of Healthcare Interventions and Development Processes
Proochista Ariana1, Marco Haenssgen2,3, 1University of Oxford, Nuffield Department
of Medicine, Oxford, UK, 2University of Oxford, Department of International
Development, Oxford, UK, 3Hertford College, Oxford, UK
It is widely accepted that health-seeking behaviour is neither limited to nor
terminated by access to one single healthcare provider. However, interventions
aiming at promoting healthcare access tend to focus on a narrow range of mutually
exclusive behaviours, potentially disregarding the complexity of people's healthcareseeking trajectories. Using a simple survey instrument, descriptive statistics, and
sequence analysis, we explore 119 unique healthcare trajectories among 637
respondents in rural India and China. The emerging patterns do not only reveal
locational and socio-demographic healthcare idiosyncrasies, but also yield deeper
insights into development processes than a conventional emphasis on "access to
formal healthcare" would.
0109
Review of evidence about occupational health in palliative medicine
Asta Medisauskaite1, Caroline Kamau1, 1Birkbeck, University of London, London,
UK
Theory: There are risks to the occupational health of doctors who work in palliative
medicine because of the regular experience of patient death and grieving families.
Methods: We use PRISMA guidelines to systematically review quantitative articles.
To date, the systematic review is at the end of the first search stage and will be
completed for discussion.
Results: The presentation will discuss the data extraction and synthesis, identifying
the most frequent occupational health outcomes of working in the end-of-life care.
Conclusion: Understanding the occupational health problems caused by working in
palliative medicine will help us plan and deliver appropriate intervention
programmes.
Patient Outcomes
0190
Short Generic Patient-Reported Quality Measures
Tim Benson1,2, 1R-Outcomes Ltd, Newbury, UK, 2UCL, London, UK
Current regulatory and governance processes fail to assure quality. We do not
routinely track and provide feedback on changes in patients’ health status,
engagement and experience.
We have developed and tested a new generation of short generic patient-reported
measures, howRu (health status), howRwe (experience) and HCS (health
confidence score measuring engagement). These have proven effectiveness across
health and social care using a range of collection and reporting methods.
The challenge now is to collect this type of outcome measure at scale in routine
care, and to provide feedback dashboards for patients, commissioners, providers
and professionals.
0080
The anchoring vignette approach: can survey design improve response
consistency and vignette equivalence?
Rachel Knott1, Mark Harris2, Nigel Rice3, Bruce Hollingsworth4, Paula
Lorgelly1, 1Monash University, Melbourne, Victoria, Australia, 2Curtin University,
Perth, WA, Australia, 3University of York, York, UK, 4Lancaster University,
Lancaster, UK
The anchoring vignette approach is used as a method to identify systematic
differences in the use of categorical response scales (differential item functioning,
DIF) in self-assessments of health. This study contributes to the design and validity
of the approach by examining whether survey design can enhance adherence to the
assumptions required for the method to adequately identify DIF. Using online
survey responses (N=1782) we find that 'priming' respondents by switching the
usual order of the survey such that the vignette evaluations are undertaken before
self-assessments increases assumption adherence, while the degree of vignette
complexity does not appear to influence assumptions.
POSTER PRESENTATIONS
0020 Searching Cost-Effectiveness of Laboratory Processing on Infectious Diseases Sector
in Crete Area
Eliona Gkika1, Anna Psaroulaki1, Yannis Tselendis1, 1University of Crete, Faculty of Medicine,
Heraklion, Crete, Greece
The study is associated with laboratory cost and especially with managing infectious diseases
analysis procedures. It aims toward control of cost with respect to hospitalized patients who are
under treatment for infectious diseases. Can we reduce hospital expenditures offering at the
same time high quality health services to “infected” patients?
Focused on a list of 31 syndrome based pathogens, laboratory data from 8 public Hospitals of
Crete region were analyzed for a period of 3 years. Application of multiple criteria approaches
on both quantitative and qualitative data, high correlation between samples analyzing process,
patient therapy and hospital expenses was achieved.
0028 Self-rated health and its relation to marital breakup and relationship-status in later
adulthood
Bina Knöpfli1, Stéphane Cullati2, Delphine Courvoisier2, Claudine Burton-Jeangros2,
Pasqualina Perrig-Chiello1, 1University of Bern, Bern, Switzerland, 2University of Geneva,
Geneva, Switzerland
This research examines the impact of relationship-status and marital breakup on self-rated
health (SRH) by taking into account intrapersonal and social resources. Data stem from a
Swiss-based survey of 1355 participants aged 40-65 years. Three groups are compared:
continuously married (n=399), single divorcees (n=532) and repartnered divorcees (n=424).
Results underline the positive effect of an intimate relationship on SRH. Our results suggest
further that personality traits and social resources are significant predictors of SRH, whereas
age and duration of ex-partnership were not related to SRH.
0030 The road to defining preference-sensitive care
Judit Zsuga1, Klára Bíró1, Gábor Bányai1, 1University of Debrecen, Hungary
Preference-sensitive care refers to care scenarios in which there are significant tradeoffs
among the available options, therefore the rate at which they are delivered is sensitive to, or in
part depends upon the patient or the provider's preference. In the era of evidence based
medicine however health professionals are inclined to base treatment decisions on the
recommendations of practice guidelines. As these guidelines are based solely on the clinical
evidences acquired in clinical trials they lack information on possible trade-offs. Based on the
accumulated literature, methodological aspects for defining preference sensitive care will be
overviewed.
0038 Translating Evidence into Safer Practice: Review of Codeine Use in Paediatrics in a
Tertiary Hospital in Singapore
Kae Shin Lim1, Jamie Stephanie1,
Singapore
1KK
Women's and Children's Hospital, Singapore,
Reports of fatal respiratory depression in children taking codeine preparations triggered safety
concerns on its use. The Pharmacy and Therapeutics (P & T) committee of KK Women's and
Children's Hospital (KKH), Singapore evaluated safety data on codeine in children, including
pharmacokinetic data and recommendations from various healthcare agencies. Consequently,
codeine was contraindicated in those below 12 years old, with an alert set in the system to
discourage prescribing in this population. Since then, there have been no codeine prescriptions
or orders for this age group. This initiative details the implementation of a hospital policy based
on evidence.
0042 Psychophysical adaptation of emergency patients 30 days after admission
Lukas Faessler1, Philipp Shuetz1, Beat Mueller1, Pasqualina Perrig-Chiello2,
1University
Department of Internal Medicine, Aarau, Switzerland,
Switzerland
2Institute
of Psychology, Berne,
Framework: Little is known about how patients adapt psychophysically after being admitted to
an emergency department. This study aims at identifying classes of adaptation in terms of
psychophysical outcomes in emergency patients 30 days after admission.
Method: Data of a representative sample of adult emergency patients (N=1575) with acute
medical conditions are presented. Exploratory latent class analyses based on psychophysical
variables (e.g. psychological distress, subjective health) are used to explore different patient
profiles. Between-class differences are estimated on covariates (e.g. diagnosis, adverse
medical outcomes).
Conclusion: Results are discussed referring to design prevention and intervention strategies.
0107 Nursing Students' the Causes of Profession Selection and Perceptions of Nursing: A
Quantitative And Qualitative Analysis
Dilek Öcalan1, Ayşe Koyun1, 1Afyon Kocatepe University, Afyonkarahisar, Turkey
The purpose of this research is to examine student's opinion about the nursing profession and
the reasons for choosing. Both quantitative and qualitative research methods were used. This
study was conducted at Afyon Kocatepe University, Nursing Department between 01.03.2014
and 30.03.2014. The 250 students participated in the quantitative research and 24 students
participated in the qualitative research. The focus group interviews were conducted with four
groups. Reasons for choosing the profession of nursing students are easy to find work and love
the profession. Female students' views on nursing are more positive. Projects should be
increased for nursing education and promotion.
0114 Knowledge and attitude towards breastfeeding during Ramadan among women in
Najran, Saudi Arabia
Hatem Mohamed1,2, Stephen Handsley1, Eid Brima3, Abdullah Shawl2, Parvez Haris1, 1De
Montfort University Leicester, Leicester, UK, 2Najran University, Najran, Saudi Arabia, 3King
Khalid University, Abha, Saudi Arabia
The objective of this study was to assess the attitude of women in Najran City surrounding
breastfeeding during the month of Ramadan. We tested the hypothesis as to if women
consider breastfeeding whilst fasting during Ramadan is acceptable. A questionnaire was
completed by 169 women. The majority of the women showed positive attitudes towards
breastfeeding. They were more likely to breastfeed during the month of Ramadan although
some were unsure. Most women disagree that fasting can alter the composition of breast
milk. Health care providers need to provide support and advice to women regarding
breastfeeding during the month of Ramadan.
0157 Experience of life in patients with heart failure
Gulcan Bakan1, Asiye Durmaz Akyol1, 1Pamukkale University, Denizli, Turkey
Framework: To explore beliefs, behaviors, experiences of dealing with the condition, and
adaptive strategies of patients with heart failure
Methods: Individual Diagnostic Form and semi-configured Interview Form were used to collect
data from 21 patients. All interviews with patients were done face-to-face by using the in-depth
interviewing technique.
Results: Three main themes and fifteen sub-themes were created that related to the life
experience. Poor points to cope with the diseases were found.
Conclusions: When the nurses received a patient’s report with information on the patient’s
mental, physical and social status, nurses could contribute to creating a safe and secure
environment.
0177 Enhancing health resilience in the built-environment for the elderly
Ripin Kalra1, 1University of Westminster, London, UK
The paper will focus on the particular needs of the elderly and the infirm within the builtenvironment (our public spaces and buildings) The elderly are most vulnerable in the context of
chronic stresses in the built-environment such as environmental pollution, thermal stress,
energy shortages, location and condition of health services, climate variability.
The paper will explore to what extent health and care sector frameworks commonly applied
within the health-care services are also adaptable as a design tool for the built-environment in
promoting healthy living and quality of life for the elderly and infirm.
0204 Papillary Thyroid Cancer. Hashimoto's Thyroiditis, Adenomatoid Hyperplasia. Do They
Have Any Connection?
Mariam Khachatryan1, Levon Mkhitaryan1, 1Yerevan State Medical University, Erebuni Medical
Center, Yerevan, Armenia, Armenia
During the period of 2010-2014, 183 patients were operated on with papillary thyroid cancer
(pathohistologically diagnosed too) in the clinic of general and endocrine surgery of "Erebuni"
MC. 34 of the mentioned patients (18.6%) were diagnosed with Hashimoto's thyroiditis as a
premorbid status, another 51 (27.9%) had adenomatoid hyperplasia as a premorbid status
while for the 98 of the patients (53.5%) papillary thyroid cancer was identified de novo.
74 (40.4%) of the patients were below 40 years old while 109 (59.6) were under 40.
0209 Challenges and Enablers of using Cluster-Randomised Stepped Wedge Research
Designs in a Domiciliary Aged Care Context
Mohammadreza Mohebbi1,2, Goetz Ottmann1,2, 1Deakin University, Melbourne, Australia, 2The
Encouraging Best Practice in Residential Aged Care Program (Australian Government
Department of Social Services), Victoria, Australia
Objectives: To evaluate a CDC model to suit the needs of older people in CALD communities
in Victoria.
Background: Cluster-Randomised Stepped Wedge (CRSW) designs are a relatively novel
feature in the field of domiciliary aged care. Yet CRSW designs can create considerable
challenges in terms of methodological integration, implementation, and analysis and
practitioners should be aware of these in order to take the necessary steps to deal with them
should they occur.
Methods: While CRSW designs present the opportunity for a full integration of qualitative
methods, there is a gap in the current research literature as to how to achieve this in a
methodologically robust manner. Methodological questions regarding how the staggered nature
of the CRSW can be integrated with previous or subsequent qualitative methods (that may not
be staggered) need to be explored in greater detail.
Conclusion: CRSW designs can be successfully used within a domiciliary aged care context
and can be integrated into mixed method design. However, careful planning is required to
accommodate methodological, analytical, and practical challenges.
0220 A method for the screening of residual solvents in pharmaceutical control.
Francesca Pettinau1, Barbara Pittau1, 1Consiglio Nazionale delle Ricerche, Istituto di
Farmacologia Traslazionale UOS Cagliari, Pula (Ca), Italy
To determine the quality of medicinal products a GC/MS method for the screening of residual
solvents (class 1, 2) has been developed. These solvents permit an initial screening of
pharmaceuticals in tablets involved in equivalence assessment. The proposed method uses a
generic capillary column (utilized for the other assays involved in the equivalent assessment
between pharmaceutics), and a cheap headspace sampling preparation. Moreover the analysis
time has been optimized using fast temperature ramping. This application permits to achieve a
considerable gain in laboratory productivity and a reduction in time and money.
This work has been supported by grant L.R. 7/2007 RAS.
0232 Health outcomes of fathering involvement
Ligia Santis1, Elizabeth Barham 1,
Paulo, Brazil
1Universidade
Federal de São Carlos, São Carlos, São
Father involvement is important for family wellbeing. We present a systematic literature review,
conducted in Brazil, using the following databases: APA, PsycNET, Bireme, PEPSIC and Web
of Science, and the following keywords: "envolvimento", "paterno", "avaliação" and
"instrumento", in Portuguese, and "involvement", "father", "measure" "instrument", "scale" and
"tool", in English. Of the 85 articles retrieved, many studies provided information about the
effects of father involvement on measures of health and wellbeing. This information can
contribute to the development of intervention programs for fathers, designed to prevent health
problems among the fathers, the mothers and the children.
0237 Local Reminiscence Therapy
Sharifah Rose Ee1, Rachel Lim1, Sue-Ann Tan1, Chun Ying Foo1, Iris Quah1,
Polytechnic, Singapore
1Temasek
Research have shown reminiscence activities to slow down the progression of dementia
Conducted at Senior Activity Centres at selected neighbourhood., issue is not mainly the long
waiting list to be enrolled in these centres, but the professionals who were employed to conduct
them, many of whom from neighbouring countries. As Singapore progresses as a nation,
the communication between generations widens, as culture does. This project customises
reminiscence therapies for the locals as well as a skill-based tool for any Singaporeans to
communicate with PWD reducing verbal communication. Favourable results were yielded,
including unexpected positive feedback such as the confidence level in caring for PWD.