International Festival of Public Health

S2 - Health Services Research

Muslim women's transition to motherhood

Presenter: Shaima M Hassan, Centre for Public Health at Liverpool John Moores University

Other authors: None

Ethnic differences in women's use of mental health services: do social networks play a role? Findings from a national community survey

Presenter: Dharmi Kapadia, the University of Manchester

Other author(s): James Nazroo, Mark Tranmer

Abstract Text:

Background: Ethnic differences in women's mental health service use are well documented. Explanations for these variations have focussed on individualistic reasons. The social aspect of help-seeking; the way in which decisions are influenced by people we know, are important but rarely focused on. The objectives of this study were to investigate the associations between (a) ethnic group and mental health service usage for women in England, (b) social networks and mental health service usage, and (c) whether the latter association varies between women of different ethnic groups.

Methods: We used logistic regression modelling of data from a nationally representative English survey, Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC), with ethnicity, mental illness and social networks as the main exposures. The sample consisted of 2260 women. The outcome variable was self-reported usage of mental health services in the past six months.

Results: Pakistani and Bangladeshi women were less likely than White women to have used mental health services (Pakistani OR=0.23, CI=0.08-0.65, p=0.005; Bangladeshi OR=0.25, CI=0.07-0.86, p=0.027). Frequent contact with relatives reduced odds of service use (OR=0.45, CI=0.23-“0.89, p=0.023). An increase in perceived inadequate support was associated with increased odds of using services (OR=1.91, CI=1.11-“3.27, p=0.019). The influence of social networks on service use did not differ between ethnic groups.

Conclusions: Pakistani and Bangladeshi women were the least likely to use mental health services. Two aspects of social networks were associated with service use, but the association did not vary between ethnic groups. After adjusting for many socio-demographic and health variables, ethnic differences in mental health service use remained.

A study of quality standards for Enoxaparin Prophylaxis in AICU patients

Presenter: Jiaqian Cui, Manchester Medical School

Other author(s): None

Abstract Text:

Background: Venous thromboembolism (VTE) is a frequent complication among patients in the Acute Intensive Care Unit (AICU), and is associated with increased morbidity and mortality. These patients have significantly greater risk factors for developing VTE, but are often asymptomatic and undiagnosed. National guidelines put in place for VTE prophylaxis have since lowered the incidence of AICU VTE events.

Aim: This review and audit focuses on the use of pharmacological prophylaxis, in particular Low Molecular Weight Heparin (LMWH): Enoxaparin (Clexane). It is often a complex issue in deciding whether 40mg of Enoxaparin should be given to or omitted in ACIU patients due to their numerous co-morbidities, requiring careful risk-benefit assessment. This study aims to assess the quality standards of VTE prophylaxis in an AICU, and to explore parameters involved in deciding whether Enoxaparin should be given, omitted or reduced in dose.

Methods: A prospective cohort study was conducted on all AICU patients admitted in a three-week period, in the University Hospital of South Manchester (UHSM). Patient data was collected on Enoxaparin administration, blood test results (INR, PT, APTT, Platelet Count), and degree of documentation. A survey was conducted to find out doctors' opinions on such decisions.

Results and Conclusion: High quality standards of VTE prophylaxis in accordance to national guidelines was apparent; and could possibly be enhanced by setting in place local guidelines with various parameter values and clinical contraindications, and by improving documentation in the unit. Future directions should involve more extensive studies across the country.

An Audit of Oxygen Prescription and Monitoring in the Acute Medical Assessment Unit at University Hospital of South Manchester (UHSM)

Presenter: Sarah Chua, University of Manchester

Other author(s): None

Abstract Text:

Background: While the ill-effects of the underuse of oxygen are well-established, the overuse of oxygen has now become a subject of safety concerns. The 2008 publication of the British Thoracic Society Guidelines for Emergency Oxygen Use in Adult Patients has led to an overall improvement of oxygen prescription. An audit was conducted in the University Hospital of South Manchester (UHSM) to evaluate how the hospital fared in comparison to the national standard.

Methods: The prescription and use of oxygen were audited in patients on the Acute Medical Assessment Unit (MAU) in UHSM. Data was collected from the patients' medical notes, drug charts and observation charts. The prescription and use of oxygen were measured against the BTS guidance and UHSM guidance. The audit findings were compared against the BTS Oxygen audits.

Results: The oxygen prescription and use records of 52 patients were audited manually. 40.7% (n=22) of the patients were administered oxygen at some point since admission. Of the 22 patients on oxygen, 45.4% (n=10) had no oxygen prescription, 18.2% (n=4) had a complete oxygen prescription while 36.4% (n=8) had an incomplete prescription.

Conclusion: The standard of oxygen prescription and use in UHSM need to be improved. Five recommendations for improvement have been made in hopes that re-audits will show better guideline adherence.

Physical Activity promotion for Cancer Survivors (PACS)

Presenter: Sadia Nafees, Bangor University

Other author(s): Nefyn Williams, Rhiannon Edwards, Clare Wilkinson and Maggie Hendry

Abstract Text: Background: The benefits of regular physical activity (PA) for cancer survivors are widely recognised but the levels of PA are low among this group. Interventions to promote PA are needed. The overall aim of this project was to develop a behaviour change intervention to encourage PA among cancer survivors. Methods: Systematic review to synthesise the evidence about the effectiveness of PA education materials for cancer survivors; focus groups to assess participants' views and perceptions about PA, focusing on behaviour change; survey to find out the knowledge and beliefs of health professionals about PA promotion for cancer survivors. Results: Review showed that the provision of PA education materials for cancer survivors resulted in a statistically significant increase in PA levels. Focus groups showed that cancer survivors prefer tailored PA advice, given in person as part of their standard care; should be consistent throughout their cancer journey; and be reinforced at the end of their treatment. Healthcare professionals' survey confirmed the findings of focus groups that PA advice is inconsistent during follow-up care of cancer survivors. Conclusion: This research concludes that there is a lack of standardisation in PA promotion for cancer survivors. The findings from this series of studies will provide further information for healthcare professionals when considering the follow-up care plans for cancer survivors at the end of their treatment. A developed three months PA motivational intervention may help adult cancer survivors to adopt physically active lifestyle, leading to improved quality of life.