Zoe A. Sheppard

Poor numeracy skills are associated with glycaemic control in Type 1 diabetes

Diabet. Med. 29, 662–669 (2012)

A national survey of obstetric early warning systems in the United Kingdom: five years on

The Confidential Enquiries into Maternal Deaths in the UK have recommended obstetric early warning systems for early identification of clinical deterioration to reduce maternal morbidity and mortality. This survey explored early warning systems currently used by maternity units in the UK. An electronic questionnaire was sent to all 205 lead obstetric anaesthetists under the auspices of the Obstetric Anaesthetists’ Association, generating 130 (63%) responses. All respondents reported use of an obstetric early warning system, compared with 19% in a similar survey in 2007. Respondents agreed that the six most important physiological parameters to record were respiratory rate, heart rate, temperature, systolic and diastolic blood pressure and oxygen saturation. One hundred and eighteen (91%) lead anaesthetists agreed that early warning systems helped to prevent obstetric morbidity. Staffing pressures were perceived as the greatest barrier to their use, and improved audit, education and training for healthcare professionals were identified as priority areas.

Approaches for assessing the role of household socioeconomic status on child anthropometric measures in urban South Africa.

The objectives of this article were to compare the variance explained in anthropometric outcomes when using individual measures of socioeconomic status (SES) versus different approaches to create SES indices within the urban African context, and to examine the influence of SES measured during infancy on child anthropometric outcomes at 7/8 years. Data from the 1990 Birth‐to‐Twenty cohort study set in Johannesburg‐Soweto, South Africa, were used (n = 888). Linear regression models were used to investigate the association between SES (individual and index measures) during infancy and anthropometric measures at age 7/8 years, controlling for sex, age, and population group. Both individual and index measures of SES explained similar proportions of the variance for each anthropometric outcome. SES measured during infancy influenced weight more than height at age 7/8 years in Johannesburg‐Soweto. Positive associations were found between SES and the anthropometric measures––ownership of a car, telephone, and having an inside flush toilet were the most significant SES variables. The similarities observed in the variance explained relating to the anthropometric outcomes suggest that researchers who want to adjust for SES in analyses could use an SES index to make statistical models more parsimonious. However, using such indices loses information relating to the specific socioeconomic factors that are important for explaining child anthropometrics. If the purpose of the research is to make policy recommendations for the improvement of child growth, individual SES variables would provide more specific information to target interventions. Am. J. Hum. Biol., 2009.

A service evaluation of the Eczema Education Programme: an analysis of child, parent and service impact outcomes

The systematic support of parents of children with eczema is essential in effective disease management. The few existing support models have a limited evidence base. This paper reports the outcome‐orientated service evaluation of an original, extensive, social learning‐theory based, nurse‐led Eczema Education Programme (EEP).

Current Socio‐Economic Measures, and Not Those Measured During Infancy, Affect Bone Mass in Poor Urban South African Children

Understanding the impact of socio‐economic status (SES) on physical development in children is important, especially in developing countries where considerable inequalities persist. This is the first study to examine the association between SES on bone development at the whole body, femoral neck, and lumbar spine in black children living in Soweto and Johannesburg, South Africa. Linear regression models were used to study associations between SES during infancy and current SES, anthropometric, and DXA‐derived bone mass in 9/10‐yr‐old children (n = 309). Findings suggest that current SES measures, rather than SES during infancy, are stronger predictors of current whole body bone area (BA) and whole body BMC after adjusting for body size, pubertal development, physical activity, habitual dietary calcium intake, and body composition. SES had no significant effect on either hip or spine bone mass. Caregivers marital/cohabiting status (indicator of social support) and whether there was a television in the home (indicator of greater income) at age 9/10 yr were the most important socio‐economic determinants of whole body BA and BMC. SES has a significant independent effect on whole body BMC through its impact on BA. This suggests that poverty alleviation policies in South Africa could have a positive effect on bone health.

ASSOCIATIONS BETWEEN HOUSEHOLD AND NEIGHBOURHOOD SOCIOECONOMIC STATUS AND SYSTOLIC BLOOD PRESSURE AMONG URBAN SOUTH AFRICAN ADOLESCENTS

Factors resulting in high risk for cardiovascular disease have been well studied in high income countries, but have been less well researched in low/middle income countries. This is despite robust theoretical evidence of environmental transitions in such countries which could result in biological adaptations that lead to increased hypertension and cardiovascular disease risk. Data from the South African Birth to Twenty cohort, Bone Health sub-sample (n = 358, 47% female), were used to model associations between household socioeconomic status (SES) in infancy, household/neighbourhood SES at age 16 years, and systolic blood pressure (multivariate linear regression) and risk for systolic pre-hypertension (binary logistic regression). Bivariate analyses revealed household/neighbourhood SES measures that were significantly associated with increased systolic blood pressure. These significant associations included improved household sanitation in infancy/16 years, caregiver owning the house in infancy and being in a higher tertile (higher SES) of indices measuring school problems/environment or neighbourhood services/problems/crime at 16 years of age. Multivariate analyses adjusted for sex, maternal age, birth weight, parity, smoking, term birth, height/body mass index at 16 years. In adjusted analyses, only one SES variable remained significant for females: those in the middle tertile of the crime prevention index had higher systolic blood pressure (β = 3.52, SE = 1.61) compared with the highest tertile (i.e. those with the highest crime prevention). In adjusted analyses, no SES variables were significantly associated with the systolic blood pressure of boys, or with the risk of systolic pre-hypertension in either sex. The lack of association between SES and systolic blood pressure/systolic pre-hypertension at age 16 years is consistent with other studies showing an equalization of adolescent health inequalities. Further testing of the association between SES and systolic blood pressure would be recommended in adulthood to see whether the lack of association persists.

Clinical risk factors for underlying gastrointestinal malignancy in iron deficiency anaemia: the IDIOM study

Objective Ten percent of adults presenting with iron deficiency anaemia (IDA) have underlying cancer. This analysis – the Iron Deficiency as an Indicator Of Malignancy (IDIOM) study – was undertaken to assess whether five simple clinical parameters can usefully predict the likelihood of gastrointestinal (GI) malignancy on subsequent investigation of patients with IDA. Design Retrospective observational study, with multivariable analysis of the predictive value of sex, age, haemoglobin concentration (Hb), mean red cell volume (MCV) and iron studies for the risk of underlying GI malignancy. Setting District General Hospital IDA clinic. Patients 720 adults with confirmed IDA. Results Sex, age and Hb were strongly associated with the risk of GI malignancy—the parsimonious model including only these variables yielded ORs of 4.0 (95% CI 2.3 to 7.0) for males compared with females; 3.3 (95% CI 1.7 to 6.4) for age >70 years compared with ≤70 years; and 5.3 (95% CI 2.4 to 11.7) for a Hb of ≤91.4 g/L compared with ≥111.5 g/L. Combining these risk factors identified a subgroup (12% of the study population) at particularly low risk (<2% likelihood), and a second subgroup (16% of the study population) at especially high risk (>20% likelihood) of underlying GI malignancy. Conclusions Three simple and objective clinical parameters can be combined to provide a clinically useful cancer risk stratification model for subjects with IDA. This may assist with patient counselling and the prioritisation of investigational resources.

Health and well-being of Nepalese migrant workers abroad

Purpose Although South Asia is a growing supplier of migrant labour, there is a paucity of research on the health and well-being of male Nepalese migrant workers. The purpose of this paper is to assess the health and mental well-being of Nepalese construction and factory workers employed in Malaysia, Qatar and Saudi Arabia. Design/methodology/approach A structured questionnaire administered, in and around Nepal’s international airport, to 403 migrants who had worked for over six months in their host countries. Logistic regression was used to investigate factors associated with self-reported health status and mental health symptoms. Findings Over 13 per cent reported poor or very poor health and nearly a quarter reported mental health issues. Whilst age and exercise were significantly associated with health status, poor work environments and perceived health risks were associated with both mental health issues and health status. Research limitations/implications The study is limited to males only and those working in the factories and the construction industry. To improve migrant health and mental well-being, Nepalese and host governments should consider mandatory health insurance and a range of pre-departure and arrival education around general literacy, mental health assessments and workplace health and safety. Originality/value There have been no known studies on the health and well-being of Nepalese migrant construction and factory workers in the Middle East and Malaysia. The strong association between self-reported poor health and perceived work environment is an important issue that policy makers in Nepal and destination countries should address.

Factors related to choice of place of birth in a district in Nepal

OBJECTIVE In Nepal, both percentage of women giving birth at health facility and proportion of birth assisted by skilled birth attendant is very low. The purpose of this research was to identify predictors for choice of place of birth: either at home, primary health care facility (including birthing centres) or at tertiary health care facilites (hospitals and clinics). METHODS A cross-sectional household survey was conducted in seven village development committee of a district lying in plain area of Nepal: Nawalparasi. A structured interview questionnaire was developed and administered face-to-face. Descriptive analysis along with chi-square test and multinomial logistic regression was used to identify the predictors of giving birth at a health care facility. RESULTS Women were significantly more likely to give birth at health care facilities compared to home if the distance was less than one hour, belonged to advantaged caste, had radio, television and motorbike/scooter, decision maker for place of birth was husband, reported their frequency of antenatal (ANC) visits at 4 or more and belonged to age group 15-19. CONCLUSION The analysis indicates that husbands of women giving birth influence the choice of place of birth. The findings highlight importance of having four or more ANC visits to the health institutions and that it should be located within one-hour walking distance. Inequity in utilisation of childbirth services at health institutions exists as showed by low utilisation of such services by disadvantaged caste.

Stress at work: factors associated with cognitive disorganisation among private sector professionals

This study explores psychological and psychological variables associated with perceived stress at work. A total of 100 international participants consented to donating a hair sample and completing a work-related stress survey. Logistic regression was used to investigate associations with low/high cognitive disorganisation using data collected from hair cortisol analysis and self-report questionnaires. High cognitive disorganisation scores were associated with high cardiopulmonary and anger scores. Low perceived self-efficacy was associated with high cognitive disorganisation. An association was found between low cortisol and low perceived self-efficacy. The relationship between high cognitive disorganisation and low self-efficacy endorses previous claims linking performance to perceived high self-efficacy.