International Festival of Public Health

Posters

An Audit on Antipsychotic use in Dementia and Alzheimer's disease in a Bury Practice

Winifred Garr, University of Manchester

Impact of the Cancer Awareness Roadshow on attitudes, awareness and health behaviour

Sophie Tring on behalf of Megan Shirley, Cancer Research UK

Helen, Emily Power, Elizabeth Potinger, Kirstie Osborne

Is burnout among community midwives just a problem of high-income countries? Cross-sectional study from Sri Lanka

Indika Pathiraja, Department of Primary care Health Sciences, University of Oxford

Pushpa Fonseka, David Mant

Cancer epidemiology: what's being studied and how do we keep on top of it?

Casey Dunlop, Cancer Research UK

Katrina Brown, Cheryl Livings

Human Trafficking is Modern Day Slavery

Vishal Chandra, University of Northampton

Seasonal Influenza - Supporting the Programme in Greater Manchester

Sue Perry-White, Public Health England

Prevention of Dental Caries: A systematic review on the effectiveness of community water fluoridation

Zipporah Iheozor-Ejiofor, University of Manchester

Glenny A-M, O’Malley LA, Alam R, Worthington HV, Macey R, Walsh T

An Audit on Antipsychotic use in Dementia and Alzheimer's disease in a Bury Practice

Winifred Garr, University of Manchester

With an increasingly ageing UK population, 13% of patients at the practice are over 60 years of age. Dementia incidence increases with age, and thus appropriate management is vital.Anti-psychotics are often used to ease the behavioural and psychological symptoms of dementia; despite a potential risk of cerebrovascular events. Previously addressed at the practice, this completes the audit cycle.

Criteria selection - based on guidance from the National Institute for Health and Clinical Excellence and Bury PCT - focussed on the need for a clearly documented indication for each antipsychotic drug prescribed; documentation of changes in target symptoms; in addition to the documentation of any consequent change in drug dose, in accordance with recent guidance. A standard of 100% was set for the 3 criteria. All dementia patients at the practice in receipt of a prescription for one or more antipsychotic drugs in the last 12 months were selected. The practice failed to meet the standard for all 3 criteria. On closer inspection it became apparent the failings were largely a consequence of insufficient record keeping. Clearer documentation in patients' notes, in addition to regular reviews of patients and their medication, has been recommended. With an increase in both dementia incidence and prevalence, appropriate patient management is more important now than ever. In a patient group such as this, with likely co-morbidities, the potential for cerebrovascular events with these antipsychotic drugs only reinforces the need for good patient monitoring and clear documentation - both key parts of good clinical practice.

Impact of the Cancer Awareness Roadshow on attitudes, awareness and health behaviour

Sophie Tring on behalf of Megan Shirley, Cancer Research UK

Helen, Emily Power, Elizabeth Potinger, Kirstie Osborne

Cancer Research UK's Cancer Awareness Roadshow aims to engage people face-to-face and encourage them to make positive health behaviour changes. It focuses on those who live in deprived areas, BME groups, the elderly and men. We aimed to assess how the Roadshow impacts on visitors' awareness of cancer and their intentions to change behaviour.Between July and September 2013, we interviewed 511 people immediately prior to visiting the Roadshow. A different group of 685 visitors were interviewed immediately after their visit and asked to take part in two and seven month follow-up interviews (ongoing). Pre and post interviews were conducted concurrently and the samples were predominantly demographically similar.

The most common topics visitors discussed were signs and symptoms (75%), weight (49%), going to the GP (46%), smoking (45%) and diet (43%). The Roadshow had a significant impact on people's awareness of several cancer risk factors. While there was little change in visitors' intentions to do more physical activity or eat more fruit and vegetables, intention to quit smoking was significantly higher in the post sample (54% vs. 69%; p<0.01).

The number of barriers to visiting a GP was significantly lower in the post sample (0.4 vs. 0.5; p<0.01), with fewer visitors worried about what the doctor might find (38% vs. 28%; p<0.01) or not feeling confident to discuss their symptoms (18% vs. 13%; p<0.01).The results from the two and seven month follow-up will help identify whether intentions translate into behaviour change and to what extent this is sustained.

Is burnout among community midwives just a problem of high-income countries? Cross-sectional study from Sri Lanka

Indika Pathiraja, Department of Primary care Health Sciences, University of Oxford

Pushpa Fonseka, David Mant

Objective: To establish whether community midwives in Sri Lanka suffer from the problem of occupational burnout described in high-income countries

Design: Cross-sectional survey Setting: Western Province of Sri LankaParticipants: 556 (98.6%) of a random sample of 564 community midwives

Measurements: Copenhagen Burnout Inventory - Sinhala version (CBI-S)Results: Burnout was a much bigger problem in younger than older midwives. In those with 5-9 years service, 26.1% (95% CI 14.3 to 41.1%) scored >50 (the threshold which others have suggested indicates a significant problem). Personal burnout (mean score in all age groups 44.5, 95%CI 43.0 to 46.1) was a significantly bigger problem than client or work related burnout (mean scores 21.2 and 26.4 respectively). As in Europe, high workload was a risk factor but lack of a supportive work environment was equally important. The most important personal factor was housework burden.

Key conclusions: Burnout among community midwives, particularly junior midwives, is not a problem restricted to high-income countries. It undermines care quality and threatens the sustainability of the service. Despite country-specific cultural differences, the underlying causes and solutions are almost certainly the same.Implications for practice: Resource constraints make it difficult to reduce workload but providing better recognition and professional support for younger midwives working in isolated community settings is not resource-intensive and likely to impact substantially on sustainability and future service quality.

Cancer epidemiology: what's being studied – and how do we keep on top of it?

Casey Dunlop, Cancer Research UK

Katrina Brown, Cheryl Livings

Background:Cancer epidemiology is a fast-moving, vast and complex field, leaving researchers, clinicians, media and the public potentially inundated with material. Trusted health information providers are crucial in disseminating accurate evidence - but with the enormous quantity of research produced, this is quite an undertaking. Cancer Research UK (CRUK) is a leading provider of epidemiological information that is arguably unique in its breadth and depth in the UK, covering dozens of risk factors across around 30 cancer sites. Our method for searching, selecting, appraising and adding new evidence is presented, as well as a summary of the shape and size of cancer epidemiology research in 2013/2014.

Method: Weekly systematic PubMed searches were conducted over a six-month period in 2013/2014 using a sensitive and specific search algorithm. For retrieved studies meeting predefined inclusion/exclusion criteria, key study attributes were extracted, and quality and relevance were appraised. Then where suitable, results were summarised and information added to the CRUK website.

Results:Around 7,000 articles were retrieved: 500 studies had key attributes extracted; and 200 CRUK website additions were made. Cohort studies on medical conditions and treatments in relation to the risk of breast and bowel cancers were most frequently retrieved.

Conclusion:Keeping on top of the cancer epidemiology evidence is a huge task. A systematic process for searching, selecting, appraising and adding new evidence enables timely provision of quality information. CRUK welcomes collaborative working to improve the information landscape by sharing expertise and resources.

Human Trafficking is Modern Day Slavery

Vishal Chandra, University of Northampton

Human trafficking remains a public health and political issue all around the globe for the past decade (Lee, 2007). It comprises the recruitment, sale and movement of people, unfair treatment in a number of sexual ways, forced labour, services towards a degree of slavery and organ removal (United Nations Office on Drugs and Crime, 2012; Lee, 2007). Dovydaitis (2010) suggest that women and children are most vulnerable and make up 80% of human trafficking victims annually.

Victims suffer numerous medical problems and are rarely cared for by their traffickers or captors (Dovydaitis, 2010). Females, as the higher percentage, suffer multiple unhygienic abortions, STDs, infected bruises, insomnia, stress, poor nutrition, communicable diseases and live in filthy overcrowded spaces (APHA, 2008). Traffickers fear that the seeking of treatment for their victims, presents likely exposure of the issue. As a result they do not pursue these options (Oram et al., 2012)

According to UNGIFT, 2012, about 2.5 million people at any moment of time are in forced labour or/and sexual exploitation. Furthermore, in 2006, there were only 5,808 prosecutions and 3,160 convictions throughout the world, which means that for every 800 people trafficked, only one person was convicted in 2006 (Belser, 2005).

There is need to identify potential victims before they are trafficked or acquire ability to spot victims under captivity (UNICEF, 2012). Though different governments have instigated various policies in support of the victims, no appropriate laws have been created for the control of this disgraceful crime. Considerable sensitization and awareness raising is key to the provision of the safe and appropriate care of victims of human trafficking.

Seasonal Influenza - Supporting the Programme in Greater Manchester

Sue Perry-White, Public Health England

Seasonal Influenza Vaccination - “ Supporting the Programme in Greater ManchesterIntroductionInfluenza is a highly infectious respiratory viral illness. Typically sudden onset, symptoms include pyrexia, headache, aching muscles, cough, runny nose, sore throat & feeling very unwell generally. All age groups are affected. Lasts between 2-7 days, sometimes longer and can lead to complications such as bronchitis & pneumonia, requiring hospital admission. Deaths occur every year that are attributed to influenza. The elderly and people with underlying medical conditions are more at risk of developing complications from influenza.

The Vaccination ProgrammeInfluenza activity peaks between late December and early March. Vaccinations should be given before or at beginning of each influenza season to ensure protection before increase in incidence. The vaccination programme is targeted to certain age groups and at risk groups to give some protection directly to the individual but also reduce the incidence in the population and therefore reduce the circulating rates of influenza. Eligible people need to be vaccinated each year because the influenza strains can change (known as drift and shift).

The Public Health SystemThere are many stakeholders involved in the influenza vaccination programme. All these organisations and systems need to work together to ensure vaccinations are delivered to eligible groups. This mean Public Health England, NHS England, Department of Health, CCG's, Local Authority Public Health Departments, GP's, Community and Acute Trusts and other providers such as Pharmacies. The poster depicts how some of this has worked in Greater Manchester.

Prevention of Dental Caries: An updated systematic review on the effectiveness of community water fluoridation

Zipporah Iheozor-Ejiofor, University of Manchester

LA O'Malley

Background There has been a decline in dental caries over the years,1 and community water fluoridation (CWF) is thought to have played a major role in this. Despite the evidence of its effectiveness,2 CWF has remained controversial due to ethical concerns and adverse effects of excess fluoride intake.

Aim To evaluate the effect of community water fluoridation for the prevention of dental caries and its effect on dental fluorosis.

Method Six databases were searched for studies published from January 1999 to November 2012. The literature search was followed by the screening of abstracts for relevant studies and data extraction from the included studies. Included studies were critically appraised and quality assessed depending on the number of limitations. The primary outcome of dental caries prevalence was reported as a percentage or dmft/DMFT (decayed missing or filled primary/secondary teeth). The association of water fluoride level with the prevalence of dental fluorosis was evaluated by regression analysis using STATA 12.

Results Of the 4936 potentially relevant articles identified by the literature search, 47 studies met the inclusion criteria. The eligible studies were subjected to quality assessments after which 29 studies were found to be of good/fair quality and 18 studies were limited.

OUTCOME	MEASURE	RESULT
Caries	Change in % caries free (mean difference) Fluoride initiation	Median 25.1%; range 19.8 to 31.6%
	Change in DMFS* (mean difference) Fluoride discontinuation**	8 year olds: 0.13 (95% CI: -0.07 to 0.33) 14 year olds: 0.47, 95% CI: -0.05 to 0.99)
Disparities in caries	% caries reduction	Inconsistent results
Dental fluorosis (0.7ppm)	% fluorosis prevalence	38 % (95% CI: 28 to 46%)

*DMFS – Decayed, Missing or Filled Surfaces in permanent teeth; ** For discontinuation studies, a positive value indicates caries rates decreased following cessation; a negative value indicates an increase in rates of caries following cessation.

Conclusions There is strong evidence that community water fluoridation reduces dental caries in communities. The fluorosis data showed a clear dose response relationship with fluoride in drinking water. The majority of these cases are mild and not considered to be of aesthetic concern. There is need for more research to establish the effect of CWF on disparities in dental caries.