International Festival of Public Health

LT 5 - Prevention and Screening Abstracts

Oral health prevention in children

Luca Carlo Sala, Maurizio Bacchi, Anna Musso, Dania Brioschi, Alberto Dal Molin, L.Trisoglio, C.Gariazzo, E.Crestani, G.C.Motta, P.Pichetto, P.Lesca, M.Ferrari

The project allows an oral health free control for all the children attending the third year of primary school (8 years old) of Biella County. Teachers and educators are updated about the importance of basic prevention action (teeth woshing after dinner, oral hygiene, adequate consumption of food and drinks ecc.) the main target of the project is to reach children living in needy families and to offer them appropriate second and third level support.During the first level control we recorded (student of BAN nursing)the health situation of each child (more then 1.000 for year) to detect and valuete the general situation and the hope improvement. The project in collaboration with the 80 Municipality of Biella County will hold up at least for three years.

The Pathway to Success

Prasheena Naran

Breast cancer was the most common cancer in females in 2008-2010, accounting for 31% of all cancers diagnosed in females in the UK. It was the second most common cause of death from cancer over this period, being only second to lung cancer. For this reason, patient-focused, clinically driven evidence based services for breast cancer care is extremely relevant, and improving management on a national scale is of high importance.

Management of breast cancer is correlated directly to tumour type, but also to tumour size and nodal involvement. Most often, curative surgery is required, including sentinel node biopsy/ axillary lymph node clearance to evaluate evidence of metastasis; 80% of spread is through lymphatic system to the axillary nodes, and from there to body organs. Improving the management of such a common disease is imperative, and steps towards improved care have been demonstrated through the 24h Care Pathway.

The aim of this presentation is to explain what the 24h care pathway is and why it is effective, using case examples to put the pathway into context. In addition, I will provide an insight into aspirations for the future of the breast cancer patient pathway by exploring new potential techniques to improve hospital care.

The impact of using trained volunteers in community health settings

Elizabeth Marginson, Nigel Barrett

The Eat Well Staffordshire project will evidence whether trained volunteers can make a positive impact with the nutrition, health and wellbeing of older people in community settings and whether this new volunteer role adds value to the volunteering infrastructure.The three year project, funded through the Department of Health's Health and Social Care Fund recruits and trains volunteers from within the local community, under the supervision of a registered Dietitian. The volunteer provides a nutritional assessment (the MUST Test) together with a social prescription based on continuing support in the home. The project also engages with the voluntary, community and professional sectors in order to raise awareness and build capacity for preventative interventions,.

To date the project has trained 42 volunteers, supporting over 100 clients from South Staffordshire. In addition to the MUST Test, the project offers dietary advice, cookery support, signposting and social support. .There is verified evidence to demonstrate that volunteer interventions have resulted in six clients at risk from or suffering from under-nutrition improving their nutritional status (with a change to the MUST Score) and strong impact in the physical and mental wellbeing of the other clients across a number of measures. With the ongoing support of our partners and collaboration within the public, private and voluntary sectors, we are confident of the project's ability to further evidence the value of the volunteer role in health and social care pathways and associated community impact.

The Look to Die For? - reducing sunbed use in Liverpool

Emma Page

Half of girls aged 15-17 in Liverpool have used a sunbed compared to 11% nationally. In July 2013 the Public Health Department in Liverpool City Council launched 'The Look to Die For?' social marketing campaign to reduce the number of teenage girls using sunbeds in the city. The campaign was supported by the NHS, Cancer Research UK and fake tan brand St Moriz in order to bring together the expertise required for the target audience to perceive it as a credible campaign they would engage with.

The campaign led with a powerful creative to make girls aware of their own personal risk of skin cancer from using sunbeds (needed to focus attention) whilst associating these risks with the 'look' that was driving their behaviours (addressing barriers). The campaign encouraged girls to #binthebeds (local language) A range of channels were used to educate girls how to get 'the look' without the health risk by increasing their confidence and skills using fake tan (offering an alternative behaviour) including events, advertising, PR, social media and education in schools.

Additional activity was developed to target older girls and mothers to encourage them to change their behaviours, influencing the wider sunbed culture that was driving teenage sunbed use. A lobbying campaign asked for improved legislation to license sunbed salons to change the environment that was driving behaviours. The three month campaign has had a significant impact on knowledge, attitudes and behaviours towards sunbeds amongst girls and women of all ages in the city.

Multiple risk behaviours and central adiposity in mid-adulthood in the 1958 British birth cohort

Karin van Veldhoven, Snehal Pinto Pereira, Leah Li, Chris Power

Causes of obesity are multifactorial and include modifiable risk behaviours (e.g. physical inactivity, unhealthy diet). Such behaviours tend to cluster, but clustering effects on waist circumference (WC) are not well understood. In the 1958 birth cohort, we aimed to establish the extent of risk behaviour clustering over two adult ages in association with WC.Risk behaviours assessed at 33y and 42y were: physical inactivity (<1/week), low dietary fibre (<1/day), and heavy alcohol consumption (≥22(women)/36(men) units/week). The prevalence of combinations of risk behaviours and their associations with 45y WC were assessed (4,458 men, 4541 women).

All behaviours, except heavy drinking among men, were associated with WC. At 33y, the percentage with 0, 1, 2+ risk behaviours was 40.9%, 41.1%, 18% respectively for men and 48.9%, 37.4%, 13.7% for women; at 42y, the percentages were 35.7%, 40.9%, 23.4% for men and 43.6%, 39.4%, 17% for women. The most common combination was low dietary fibre with inactivity (~11% for both ages and genders) and observed/expected ratios indicated clustering for this combination. Compared to those with no risk behaviours, those with low fibre consumption and who were inactive had higher mean WC: 2.2cm (men) and 3.0cm (women) at 33y and 3.0cm (men) and 4.3cm (women) at 42y. For women, the combination of low fibre and inactivity accumulated across ages.

Whilst clustering of risk factors has been established for disorders such as cardiovascular diseases, identification of behaviour clustering for central adiposity is likely to reveal differing patterns, potentially informative for intervention strategies.

Socio-economic differences in Pre-natal HIV screening uptake in Uganda:a multilevel analysis

Olatunde Aremu

Background: Globally, pre-natal HIV testing remains the most effective means of reducing the risk of mother- to-child-transmission (PMTCT) of new HIV infection. However, in resources limited settings access to care is through out-of-pocket expenses; and utilization of preventive obstetric care such as pre-natal HIV screening in the absence of donor agencies led free testing modalities may prove difficult. Uganda, like few other countries in SSA carries the greatest HIV-AIDs burden in LMICs. As part of the Ugandan National HIV-AIDs Control strategy, pre-natal HIV- screening continue to be the most widely accepted preventive measure. While several studies have been conducted to characterize screening uptake at, none has examined socioeconomic gradients in uptake for the whole of Uganda. Thorough understanding of such is needed to help Ugandan policy makers better appropriate its resources to achieve effective coverage of HIV screening services.

Objectives: To explore socioeconomic disparities in prenatal HIV screening uptake among a nationally representative sample of Ugandan women . Methods. A multilevel regression model was applied to the individual and area levels data of 3,603 women aged 15-49 years from 555 communities who were part of the participants for the most recent Ugandan DHS.

Results: Of the 3,0603 women included in the analysis, about 78% reported being screened for HIV during the antenatal visit. Screening was lower among rural dewellers and those from economic deprived neighbourhoods. Household wealth, being educated and living in affluent neighbourhoods were associated with prenatal HIV screening uptake.

Conclusion: Uptake of prenatal HIV screening in Uganda is marked with economic inequities.

Is there a relationship between alcohol outlet density and alcohol consumption in early and middle adolescence? - A systematic review

Rakeeb Patel, Arsa Syed

Introduction: Adolescent drinking is a growing public health threat; it is associated with a variety of physical, mental, and social health problems. One determinant of adolescent alcohol consumption is the density of alcohol outlets within the specified geographical area. Previous studies have noted that outlet density may impact drinking behavior in older adolescents; however, the impact of alcohol outlet density on early and middle adolescence is still unclear.

Methods: A review of the literature was conducted to identify studies that compared outlet density to alcohol consumption in 11-16 year olds. This was conducted applying a free-text strategy with a set of terms. Following the search, studies were included and excluded based on a set of inclusion and exclusion criteria.

Results: Of the five studies included, three were cross-sectional, and two were longitudinal. Three of the five studies noted that outlet density impacts adolescent drinking behavior. 'Off-premise outlets' is the major commercial source of alcohol for adolescents. The impact of outlet density on adolescent drinking seems to be moderate by age.

Conclusions: Future studies investigating the impact of outlet density on specific age groups will allow a better understanding of age-specific impacts. Interventions aimed at 'off-premise' outlets to encourage safer business practices are likely to be beneficial. The evidence that outlet density may impact early adolescent alcohol use outlines the need for earlier interventions. Thus, this review outlines a potentially modifiable factor that may predict and influence early and middle adolescence alcohol use.

Flu vaccination uptake in the prison population

Ali Hashmi

Objective: To identify the flu vaccination uptake rates in the prison population. Also, to assess the effects of drivers and barriers for flu vaccination uptake in clinical risk groups in a prison population.

Design: I identified when the flu vaccines were given, what the percentage uptake was, who they were given to, who was excluded and why. Moreover, I explored what health promotion interventions were implemented during the flu vaccination season and any other elements of good practice associated with this. Finally, I identified any barriers to flu vaccination uptake. The study was conducted in four prisons in the northwest of England. It involved interviewing the chief medical officer, the pharmacist, the GP and the nurses. The information was recorded on a pre-prepared questionnaire and the questions were asked in the same order in each prison.

Setting: The medical health center in two prisons in the northwest of England: HMP Forest bank and HMP Manchester. As well as email correspondence with healthcare staff at HMP Buckley Hall. The interviews were conducted towards the end of the flu vaccination season between January 2014 and February 2014.

Main outcome measures: Influenza vaccination uptake, the demographic that is offered the vaccine, health promotion during flu vaccination season and barriers to flu vaccination uptake.

Results: Flu vaccination uptake rates in three prisons in the northwest of England are significantly below the current recommended 75%. Some prisons offer the vaccines to all prisoners, which is currently not recommended. Health promotion is limited in the prison population and several successful interventions have been discussed. Various barriers to flu vaccination uptake have also been identified and discussed.

To Screen or Not to Screen?

Prasheena Naran

Lung cancer is the second most common cancer after breast cancer and kills more people than any other cancer. Tobacco smoking is the main cause of lung cancer and about 80-90% of lung cancers can be attributed to it. The mortality rate of lung cancer is steadily decreasing in males; remaining around the same in females. Early stage lung cancer is associated with a lower mortality than more advanced disease, hence early detection, and ensuing treatment, could be beneficial in helping to lower mortality rates further.

Low-dose CT has been established for many years as a useful tool in the early detection of cancer, but it is questionable as to whether screening with low-dose CT actually reduces lung cancer mortality. The National Lung Screening Trial (NLST) recently compared two screening methods; low-dose helical CT with a conventional screening method, chest radiography (CXR), looking specifically at the different mortality rates between these two techniques. The primary outcome of the NLST was a 20 percent reduction in deaths from lung cancer among current or former heavy smokers who were screened with low-dose helical computed tomography (CT), versus those screened by chest X-ray. However, since the publication of this trial, many other studies have argued otherwise, and debated the usefulness of this technique.

This presentation aims to provide an overview of the current research into the impact of low-dose CT on lung cancer mortality, comparing the findings of many studies worldwide to try to answer the question 'To Screen or Not to Screen', and whether we should be screening more people using this method in the UK.​