Perspectives in Public Health

To compare levels of health engagement between adolescents, young adults and older adults and to investigate the association between health engagement and key health outcomes at different ages.

Using the Healthy Foundations study (2008), the responses to three previously validated questions on health engagement were analysed by age group; adolescents (12-15 years; N=452), young adults (16-24 years; N=785) and older adults (25-74 years; N=4136). Logistic regression was used to calculate the odds ratio of poor health outcomes among participants with low versus high health engagement.

Feeling in control of one’s own health decreased from adolescence (mean score 79.3 (95% CI 77.6,81.0)), through young adulthood (74.6 (73.1,76.1)) into older adulthood (72.2 (71.5,72.9)). In contrast, perceived involvement in health showed a U-shaped trajectory: (adolescents 72.0 (70.2,73.7), young adults 68.6 (67.1,70.1), older adults 73.8(73.1,74.5)), as did perceived importance of health (adolescents 75.0 (73.1,76.9), young adults 62.9 (61.0,64.8), older adults 77.1 (76.4,77.8)). Not feeling involved in health was more strongly associated with poor general health among adolescents (OR 1.81 (1.41,2.32)) than older adults (OR 1.19 (1.11,1.28)). Not feeling in control of health was only associated with poorer general health among young adults (OR 2.33 (1.93,2.83)) and older adults (OR 2.26 (2.10,2.44)). In contrast, lack of control over health was most strongly associated with physical inactivity among adolescents (OR 1.99 (1.49,2.66)) but this was also significant in young adults (OR 1.25 (1.06,1.48)) and older adults (OR 1.11 (1.04,1.19)).

Young adults feel less involved in their health and rate health a less important priority than adolescents and older adults. Involvement is more strongly linked to key health behaviours among under 25s than older adults.

Children’s health suffers disproportionately from the effects of poverty. The inverse care law states that those who need care the most are the least likely to receive it. Community paediatricians are well placed to address health inequalities in children.

To explore, using routinely collected data, whether we address health inequalities and the inverse care law, particularly for certain conditions targeted by our specialty.

Five years of data were analysed, during which health equity audits have led to service changes in order to tackle inequities. The data include postcodes, allowing each child to be assigned to a deprivation quintile, and a range of diagnoses, including five sentinel conditions: attention deficit hyperactivity disorder (ADHD) on medication, autistic spectrum disorder (ASD), epilepsy, cerebral palsy and Down’s syndrome. This allowed analysis of the caseload by deprivation index for these conditions, comparison with the background population and exploration of time trends.

The number of children on the caseload and their distribution across the quintiles remained stable. The proportion of deprived children (i.e. in the lowest two quintiles) on the caseload over the last five years taken together is 56%, compared to 44% in the background population. The numbers of children with ADHD on medication has almost quadrupled in deprived quintiles and doubled in the least deprived quintile, while the numbers of children with this diagnosis in the most deprived is four times that in the least deprived. Numbers of children with ASD have also increased in each quintile. In contrast, the number of children with epilepsy and cerebral palsy did not show much variation, but those from deprived quintiles made up a greater proportion of the caseload.

Routine data collection demonstrates that inequalities are addressed using all four quality domains of service provision and sentinel conditions more likely to affect deprived children are targeted. We believe it is possible for all services to collect and analyse data thus with minimal effort, thereby providing a foundation from which to address the inverse care law.

Accident and Emergency attendances continue to rise. Infants are disproportionately represented. This study examines the clinical reasons infants attend UK Accident and Emergency departments.

A retrospective review of 6,667 infants aged less than one year attending Accident and Emergency at two district general hospitals in London from 1^st April 2009 to 30^th March 2010. All infants had been assigned to a diagnostic category by the medical coding department according to National Health Service (NHS) data guidelines, based on the clinical diagnoses stated in the medical records. The Accident and Emergency case notes of a random subsample of 10% of infants in each of the top five recorded diagnostic categories (n = 535) were reviewed in detail and audited against the standard national NHS data set.

The top 5 clinical diagnoses were ‘infectious diseases’, ‘gastrointestinal’, ‘respiratory’, ‘unclassifiable’ and ‘no abnormality detected’ (NAD). A third of infants were originally given a diagnosis of unclassifiable (21.5%) or NAD (11.5%). After detailed case-note review, we were able to reduce this to 9.7% (95% confidence interval (CI): 9.0, 10.4) and 8.8% (95% CI: 8.1, 9.5), respectively.

This study demonstrates the importance of providing a clear clinical diagnosis and coding system for Accident and Emergency attendances and understanding that system fully. This would allow for better informed health service evaluation, planning and research as each of these relies on the interpretation of routine health-care data. Furthermore, the relatively high proportion (10%) of infants attending with no discernible underlying medical abnormality suggests the health needs of a significant proportion of infants attending Accident and Emergency departments may be better addressed by alternative service provision and/or improved education and support to parents.

This paper focuses on an innovative intersection between education, health and arts. Taking a broad definition of health it examines some social and psychological well-being impacts of extended collaborations between a theatre company and children with communication difficulties. It seeks to test aspects of Fredrickson’s¹ broaden-and-build theory of positive emotions in a primary school curriculum context.

The researcher participated in a project called Speech Bubbles. The programme was devised by theatre practitioners and aimed at six- and seven-year-olds with difficulties in speech, language and communication. Sessions were observed, videoed and analysed for levels of child well-being using an established scale. In addition, responses regarding perceived improvements in speech, language and communication were gathered from school records and teachers, teaching assistants, practitioners and parents. Data were captured using still images and videos, children’s recorded commentaries, conversations, written feedback and observation. Using grounded research methods, themes and categories arose directly from the collected data.

Fluency, vocabulary, inventiveness and concentration were enhanced in the large majority of referred children. The research also found significant positive developments in motivation and confidence. Teachers and their assistants credited the drama intervention with notable improvements in attitude, behaviour and relationships over the year. Aspects of many children’s psychological well-being also showed marked signs of progress when measured against original reasons for referral and normal expectations over a year. An unexpected outcome was evidence of heightened well-being of the teaching assistants involved.

Findings compared well with expectations based upon Fredrickson’s theory and also the theatre company’s view that theatre-making promotes emotional awareness and empathy. Improvements in both children’s well-being and communication were at least in part related to the sustained and playful emphases on the processes and practice of drama, clear values and an inclusive environment.

School food in many countries has become the object of change and innovation processes, not only in relation to policies for healthier eating but also in relation to policies for more sustainable food consumption and procurement. The purpose of this study was to examine the possible influence that organic food sourcing policies in Danish school meal systems may have on the development of healthier school food environments.

The study was a cross-sectional analysis undertaken among 179 school food coordinators (SFCs) through a web-based questionnaire (WBQ) in a sample of Danish public primary schools. The ‘organic’ schools were compared to ‘non-organic’ schools. The questionnaire explored the attitudes, intentions/policies and actions in relation to organic and healthy foods served in the schools.

Data indicates that 20 ‘organic’ schools were associated with the indicators of healthier school environments, including adopting a Food and Nutrition Policy (FNP) in the school (p = .032), recommending children to eat healthily (p = .004).

The study suggests that organic food policies in schools may have potential to support a healthier school food environment.