Contraceptive patterns across the lifecourse in the SLAN populations

Little information is available on contraceptive practices of the Irish population. This study analyses data from the Surveys of Lifestyle, Attitudes and Nutrition (SLAN) 1998 and 2002, which sampled representative cross-sections of the Irish adult population. Both surveys reported 70.7% of respondents as sexually active. Marital status and age influence sexual activity and show no change over time. A small increase in the percentage using contraception was noted. At least 12% of sexually active single people report never using contraception. Condoms were the preferred contraceptive method for males, 66.2% and females, 34.1%. 88.6% of the sexually active report they belong to a religion (93.9% Catholic). There is no relationship between religiosity and sexual activity, or religiosity and use of contraception. We conclude that contraceptive practices have remained stable over time with religious affiliation having no effect.     

Temporal trends in misclassification patterns of measured and self-report based body mass index categories - findings from three population surveys in Ireland

Background  

As the use of self-reported data to classify obesity continues, the temporal change in the accuracy of self-report measurement when compared to clinical measurement remains unclear. The objective of this study was to examine temporal trends in misclassification patterns, as well as sensitivity and specificity, of clinically measured versus self-report based body mass index (BMI) from three national lifestyle surveys over a 10-year period.     

Barriers and facilitators to initial and continued attendance at community‐based lifestyle programmes among families of overweight and obese children: a systematic review

The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community‐based lifestyle programmes among families of overweight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed‐method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.     

Drivers for inappropriate fever management in children: a systematic review

Background Fever is one of the most common childhood symptoms and accounts for numerous consultations with healthcare practitioners. It causes much anxiety amongst parents as many struggle with managing a feverish child and find it difficult to assess fever severity. Over- and under-dosing of antipyretics has been reported. Aim of the review The aim of this review was to synthesise qualitative and quantitative evidence on the knowledge, attitudes and beliefs of parents regarding fever and febrile illness in children. Method A systematic search was conducted in ten bibliographic databases from database inception to June 2014. Citation lists of studies and consultation with experts were used as secondary sources to identify further relevant studies. Titles and abstracts were screened for inclusion according to pre-defined inclusion and exclusion criteria. Quantitative studies using a questionnaire were analysed using narrative synthesis. Qualitative studies with a semi-structured interview or focus group methodology were analysed thematically. Results Of the 1565 studies which were screened for inclusion in the review, the final review comprised of 14 studies (three qualitative and 11 quantitative). Three categories emerged from the narrative synthesis of quantitative studies: (i) parental practices; (ii) knowledge; (iii) expectations and information seeking. A further three analytical themes emerged from the qualitative studies: (i) control; (ii) impact on family; (iii) experiences. Conclusion Our review identifies the multifaceted nature of the factors which impact on how parents manage fever and febrile illness in children. A coherent approach to the management of fever and febrile illness needs to be implemented so a consistent message is communicated to parents. Healthcare professionals including pharmacists regularly advise parents on fever management. Information given to parents needs to be timely, consistent and accurate so that inappropriate fever management is reduced or eliminated. This review is a necessary foundation for further research in this area.     

A qualitative process evaluation of the introduction of procalcitonin testing as an antimicrobial stewardship intervention

Background Successful antimicrobial stewardship interventions are imperative in today’s environment of antimicrobial resistance. New antimicrobial stewardship interventions should include qualitative analysis such as a process evaluation to determine which elements within an intervention are effective and provide insight into the context in which the intervention is introduced. Objective To assess the implementation process and explore the contextual factors which influenced implementation. Setting An academic teaching hospital in Cork, Ireland. Methods A process evaluation was conducted on completion of a feasibility study of the introduction of a procalcitonin antimicrobial stewardship intervention. The process evaluation consisted of semi-structured face-to-face interviews of key stakeholders including participating (senior) doctors (5), medical laboratory scientists (3) and a hospital administrator. The Consolidated Framework for Implementation Research was used to guide data collection, analysis, and interpretation. Main outcome measures Qualitative assessment of the intervention implementation process, the contextual factors which influenced implementation and identification of improvements to the intervention and its implementation and determine if proceeding to a randomised controlled trial would be appropriate. Results Analysis of the interviews identified three main themes. (1) The procalcitonin intervention and implementation process was viewed positively to support prescribing decisions. Participants identified modifications to procalcitonin processing and availability to improve implementation and allow procalcitonin to be “more of a clinical influence”. (2) In the antimicrobial stewardship context the concept of fear of missing an infection and risks of potentially serious outcomes for patients emerged. (3) The hospital context consisted of barriers such as available resources and facilitators including the hospital culture of quality improvement. Conclusion This process evaluation provides a detailed analysis of the implementation of procalcitonin testing as an antimicrobial stewardship intervention. The positive findings of this process evaluation and feasibility study should be built upon and a full randomised controlled trial and economic evaluation should be conducted in a variety of hospital settings to confirm the effectiveness of procalcitonin as an antimicrobial stewardship intervention.

     

Alcohol consumption among university students: A latent class analysis

Alcohol consumption is the number one public health concern in the university student population. The heterogeneous nature of university students’ consumption has recently been highlighted. Thus, the aim of the current research was to use latent class analysis to employ a person centred approach to describe alcohol consumption among university students with particular reference to gender. Questionnaires were distributed to students attending lectures in randomly selected degrees in one university. A total of 2332 self-completed questionnaires were obtained, yielding a response rate of 84%. Latent class analysis was conducted. In total, 830 men and 1367 women were analysed separately to uncover latent class structures. Harms, attitudes and consumption patterns were included in a model totalling to 26 variables. A 3-class structure best described men, while a 4-class structure best described women. Both men and women reported a class of “Guarded Drinkers”, “Responsible Conformers” and “Realistic Hedonists”. The remaining class of women was described as “Peer-influenced drinkers”. Identifying consumption typologies provides those working on tackling excessive alcohol consumption with profiles to implement tailored health promotion strategies. Additional research is required to confirm these results, develop screening tools and tailor motivational interventions which incorporate these profiles.     

Correlates of increased risk of eating disorders in Irish school children

Currently there are no large-scale data on the prevalence of disordered eating behaviours in Irish children and adolescents. We examined the 2002 Health Behaviour in School Aged Children (HBSC) study to estimate those Irish children who are potentially at risk of developing an eating disorder. Body Mass Index (BMI) data, based on self-reported height and weight were available for 2,469 pupils (29% of all participants). This analysis showed that 32.2% of adolescents were underweight (BMI < 18.5 kg m(-2)) and 10.7% of this group 'thought they were too fat'. These latter (n-86) were identified as the 'risk' group and compared with group 2 (n = 717) who reported they were underweight and had indeed a low BMI and group 3, (n = 856) those with a normal range BMI (18.5-25Kg/m2). Those at risk were significantly more likely to choose a large silhouette, be unhappy, poorly satisfied with life and perceive themselves as not good looking, to have diet concerns, be bullied at least twice per month and feel they were average/below average in their academic work (all p < 0.001). These data indicate psycho-social associations with an important potentially pathological population sub-group of at risk children.     

Predictors of self-reported poor mental health at area level in Ireland: a multilevel analysis of deprivation and social capital indicators

The 2002 National Survey of Lifestyle Attitudes and Nutrition (SLAN) data on self-reported mental health for 5992 adults living in 328 Electoral Divisions across Ireland. The aim of this analysis was to determine if there was significant variance in self-reported mental health at Electoral Division (ED) level, and to determine whether this could be explained by social capital and sociodemographic factors at individual or ED level. 25.0% of respondents reported poor mental health. There was significant variability at ED level (variance 0.123 SE 0.034). Controlling for individual-level social and demographic variables did not affect the variability at ED level (variance 0.131, SE 0.050). People living in rural areas were less likely to report poor mental health and were more likely to report high levels of trust, which independently reduced the risk of reporting poor mental health and significantly reduced the variability at ED level (variance 0.046 SE 0.043). Indicators of social capital may reflect well-preserved community networks and support but are not necessarily related to material or social disadvantage.