6th European Public Health Conference: Friday 15 November, 10:30–12:00
Results Some population-based interventions have reduced fall-related injuries in independent living elderly by 6 to 33%. In a nursing home study in Sweden, a 36-week multifactorial intervention reduced falls by 40% and hip fractures by 75% compared to a control group. Regulation in the traffic area (seat belts, alcohol limit, etc.) and in the fire area (smoke alarms) has reduced fatalities for the entire population, included elderly people. Some driving courses for elderly people showed that those attending the courses had fewer accidents than those not attending courses. Conclusions Infrastructures for injury prevention should be established. Few countries in Europe have established concrete targets for prevention of injuries in elderly people and even fewer evaluate whether their targets are met. Most of them are rather vague or non-existant. A list of recommendations will be presented. The ageing population: ethical challenges for contemporary society Els Maeckelberghe ELM Maeckelberghe University Medical Center Groningen/Institute for Medical Education, Groningen, The Netherlands Contact:
[email protected]
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Background In 1986 Daniel Callahan wrote in ‘Setting Limits: Medical Goals in An Aging Society’ that "a good society ought to help young people become old people, but is under no obligation to help the old become indefinitely older". He warned future generations that: "Our society can not, and should not, promise open-ended, progress-driven medical care that is indifferent to costs. In that respect, age does matter, and that reality should not be evaded." Setting the debate More than half a century later, the debate about how society ought to deal with an aging population has not been decided yet. Questions that need to be addressed are: are experiences of decline and increasing dependence compatible with normative ideals of independence and self-care? What is well being and quality of life in the context of an aging body? Furthermore, the aging population puts pressure on society as a whole. Callahan suggest that we will have to consider "the likely unpleasant solutions to see if we can come up with those that might do the most good and the least harm". We need to look at this from the perspective of intergenerational solidarity. Ethical framework We will present an ethical framework that elaborates the concepts of: 1. vulnerability of the elderly 2. intergenerational solidarity.
P.3. Inequalities 2 Prevalence and determinants of prenatal depression symptoms in a Romanian sample of pregnant women: a comparative analysis across socioeconomic groups Alexandra Brinzaniuc A Brinzaniuc1, OM Pop1, IA Rus1, RM Chereches1, AB Wallis1,2 School of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University Cluj-Napoca, Romania 2 Department of Epidemiology, College of Public Health, University of Iowa, Des Moines, United States Contact:
[email protected]
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Background Socioeconomic status is significantly associated with depressive symptoms (DS) during pregnancy. Limited evidence is available on the differentiated psychosocial determinants of DS across the socioeconomic gradient of pregnant women. The current study aims to comparatively assess the prevalence and determinants of prenatal DS across education and income groups of pregnant women, in a Romanian sample. Methods Data were collected in 2012-2013, in five clinics in Romania. We report preliminary findings on 546 pregnant women, seeking prenatal care. A self-administered questionnaire assessed DS (through the Edinburgh Perinatal Depression Scale), perceived stress, available social support, parity, income, education, employment status, living arrangements. Univariate statistics were used to describe DS prevalence. Logistic multivariate regression models were employed to explore predictors of positive perinatal depression screens, across education and income groups. Results Preliminary results suggest significant differences in DS prevalence among educational (p = .000) and income groups (p = .000). Women with high-school education or less had a higher prevalence of DS (28%) as compared to university graduates (15,1%). Similarly, participants reporting a low family income had a 29.8% prevalence, whilst the medium and high income groups had a 16.7% respectively 12.1% prevalence rate. When controlling for all other factors, across educational and income groups, stress was a significant determinant of DS (p < .05). Having a been diagnosed with a pregnancy health
problem was a significant determinant in the lower educated group (p = .010). Social network extension was significant in the lower educated (p = .006) and medium income (p = .009) groups. Not having a partner was significant in the lower educated and low income groups (p = .036 and p = .020). Not working at the time of the interview was a significant determinant in the higher education (p = .020) and medium income (p = .046) groups. Conclusions This study suggests a socioeconomic gradient in the presence or absence of depression symptoms in a large sample of pregnant women in Romania. It brings evidence for developing tailored, prenatal depression prevention programs, to adequately respond to the needs of all pregnant women. Key message Important group differences in the prevalence and determinants of prenatal depression symptoms were measured, emphasizing the need for tailored prevention strategies across the socioeconomic gradient. Missing women? The health inequalities impact of low control and gender discrimination: a theory-led systematic review of observational studies Andy Pennington A Pennington1, L Orton1, M Whitehead1, A Ring1, D Fox2, M Petticrew3, M White4, A Sowden2 1 Public Health and Policy, University of Liverpool, Liverpool, United Kingdom 2 Centre for Reviews and Dissemination, University of York, York, United Kingdom 3 Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom 4 Institute of Health & Society, Newcastle University, Newcastle, United Kingdom Contact:
[email protected]
Background Increasing control and empowerment are considered central to efforts to reduce health inequalities. From our critical review of theory, low control emerged as a potentially fundamental mechanism underlying social inequalities in health. Amartya Sen’s theories of ‘‘freedom’’ and ‘‘capabilities’’ to live a long and healthy life focused attention on the health consequences
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European Journal of Public Health, Vol. 23, Supplement 1, 2013
of a lack of freedom for women in contexts with pervasive gender discrimination. We conducted a systematic review to address the question: what is the empirical evidence of the relationship between control in the living environment and health inequalities. Findings on gender inequalities are presented here. Methods Logic models were used to guide our search strategy. Studies were identified by searching seven bibliographic databases, screening reference lists, consulting key informants and searching websites. Observational studies that addressed our review question were included. Data extraction and quality appraisal were carried out by two reviewers, with disagreements brought to the wider team, followed by a narrative synthesis. Results We identified 40 studies that reported findings on the healthrelated outcomes of low control/discrimination against women, 35 were set in low and middle-income countries. There is evidence that women with low control have reduced freedom of movement and control over determinants of health such as access to food, household resources, healthcare, education, employment and reproductive rights. Low control was associated with increased anxiety, stress and depression, increased childhood malnutrition and mortality, higher fertility, poorer reproductive health and increased violence. Son preference, in societies characterised by low female control and discrimination, is associated with reduced survival of girls; resulting in the phenomenon of ‘‘missing women’’. The effects of gender discrimination on survival begin before birth through selective abortion of female foetuses, leading to distorted demographics. Conclusions There is empirical evidence of an adverse impact on the health of girls and women living in societies in which they suffer low control and gender discrimination. Measures to improve the economic, social and political position of women are advocated. Key messages From our critical review of theory, low control or powerlessness emerged as a potentially fundamental mechanism underlying social inequalities in health. Our systematic review found evidence that low female control and discrimination at the societal level was associated with reduced survival and other adverse health outcomes for girls and women. Can we predict pregnancies requiring intervention based on the area in which a woman lives? Erin Mercer E Mercer, DOC Anumba University of Sheffield, Sheffield, United Kingdom Contact:
[email protected]
Background Research has shown that women from more deprived socioeconomic backgrounds have a greater risk of poorer maternal and fetal outcomes and are more likely to struggle to engage with antenatal services. This would suggest that there exists a subset of these women who require more support and pointed intervention strategies in order to prevent these disparities in pregnancy outcomes. We aimed to assess if there was a relationship between Index of Multiple Deprivation (IMD) score of the area in which a woman lived and the fetal outcomes of her pregnancy and the week of gestation at which she first engaged with antenatal services in order to establish if these scores could be used to pinpoint women at most risk and to guide future interventions. Methods This was a retrospective database analysis of 59,487 maternity records at the Jessop Wing, Sheffield, between January 2002 to December 2010. Binary logistic regressions were performed
upon the data to assess the impact of IMD score on week of gestation at which the first antenatal appointment was initiated and the outcomes mentioned previously. Results IMD score was a statistically significant (p = 0.031) predictor for booking appointment. A woman from an area with a high IMD score was 9.2% more likely to book late for treatment than a woman from an area with a low IMD score (OR: 1.092, 95% CI: 1.008 to 1.182). Women with a high IMD score were 1.7 times more likely to have a baby with a birth weight less than 2500g compared to women with a low IMD score (OR: 1.664, 95% CI: 1.307 to 2.119). Women in the high IMD score bracket were 34% more likely to have a newborn before 37 weeks than women with a low IMD score (OR: 1.338, 95% CI: 1.055 to 1.698) Conclusions The findings of this study cement the conclusions of prior research regarding the importance of factors of social exclusion on poor fetal outcomes. It showed that IMD score can be used to predict women who are most likely to present late to the antenatal programme. We have shown a relationship between IMD score and late booking for antenatal appointments. IMD score is a cheap and easily accessible means of directing interventions to women most at need and this could be explored in the future. Key messages Poor fetal outcomes can impact on long term health of individuals. Using IMD score to detect those women most at risk could help guide early intervention and prevent such long-term health risks. IMD score is an easily obtainable means of assessing socioeconomic deprivation of a woman even prior to her becoming pregnant so that interventions can be guided to those women most in need. The influence of family and school on adult social position: findings from the Aberdeen Children of the 1950s study Ruth Dundas R Dundas, CA Davies, MJ Green, AH Leyland MRC/CSO Social & Public Health Sciences, University Of Glasgow, Glasgow, United Kingdom Contact:
[email protected]
Background The relationship between adult social position and health is well documented. People with less education for example have higher mortality than those with more education and low income has been shown to be associated with poor health, even in affluent societies. It is therefore important to understand the determinants of adult social position. Some evidence suggests that early family and school environments may be influential but their relative contributions to adult social position are unclear. Methods We examined the long-term influence of family and school on adult income and education attainment. A total of 6806 children in 5685 families clustered in 21 schools aged 5-12 in 1962 were followed-up at mean age 47 years. Cross-classified multilevel logistic regression was used to estimate the contribution of family, primary school and secondary school to adult income (earning >£30,000 per year) and obtaining degree level education, adjusting for childhood social position (measured by parental social class) and IQ. Results The number of people who left school with no qualifications was 1497 (22%); 1303 (19%) were educated to degree level and 1566 (23%) had an income >£30,000 per year. The Median Odds Ratios (MOR) for the variances, adjusted for childhood social position and IQ, show family to be more important than primary or secondary school for obtaining a degree; MOR family: 5.32 (3.38 to 9.07); MOR primary school: 1.22 (1.03 to
