International Health ConferenceSt Hugh’s College

Oxford

BOOK OF ABSTRACTS

25th-27th June, 2015

ORAL PRESENTATIONSSessions starting Friday 10.20Health Policy and Systems

0127 A systematic review of the standards of clinical audits in UK hospitals.Eunkyung Lee1, Conrad Lee2, Michael George3,  1Brighton and Sussex Medical School, Brighton, UK, 2Brighton and Sussex University Hospital NHS Trust, Brighton, UK, 3Portsmouth Hospitals NHS Trust, Portsmouth, UK

Clinical audits are an important part of quality improvement process in the NHS. Poorly conducted audit cycles can be detrimental to its success. We conducted a systematic review to look at the completeness of clinical audits in UK hospitals within the past two decades, and found out of the 877 audit projects reviewed in 12 publications, only 17% were completed with a complete cycle. Low completion rate is a major concern for the effectiveness of clinical audits across NHS hospitals. Evaluation of local clinical audit practice is therefore highly recommended in consideration of improving local audit monitoring and support process

.

0111 Staff Making Sense of Patient Complaints about CareMary Adams1, Jill Maben1,  1King's College London, London, UK

Drawing on sociological studies of regulation by audit, we examine the effects of increasing management attention to patient complaint (events and data) on clinicians.

Analysis of in-depth qualitiative data (73 clinician interviews and 140hrs. ethnographic observation) from 8 NHS clinical services with significantly high or low staff wellbeing was undertaken.

40%+ clinicians independently described patient complaint management as stressful and time-consuming and felt most issues of complaint beyond their control. Negative effects on general clinical relationships were reported and observed.  The effect of patient complaint management without effective staff voice is noted.

0186 Developing policy to support cross-cultural communication in primary care: Learning from RESTOREKate O'Donnell1, Nicola Burns1, France Mair1, Chris Dowrick2, Christos Lionis3, Maria Van den Muisenbergh4, Evelyn Van Weel-Baumgarten4, Anne MacFarlane5,  1University of Glasgow, Glasgow, UK, 2University of Liverpool, Liverpool, UK, 3University of Crete, Heraklion, Greece, 4Radboud University Nijmegen, Nijmegen, The Netherlands, 5University of Limerick, Limerick, Ireland

Migration to and across Europe means that primary care has to met the needs of an increasingly diverse population. RESTORE is an EU funded project exploring the implementation of guidelines and training to support cross-cultural communication in European primary care.

Here, we show how primary care systems, migration history and health care policy can combine to support or hinder cross-cultural communication. Drawing on Normalisation Process Theory, we have developed a set of propositions which can alert policy-makers attention to those issues which need to be considered when developing migrant-friendly health care systems.

Public Health and Care

0118 Contribution of physical activity as measured by pedometer and questionnaire to waist circumference and BMI in men and womenTerence Dwyer1,  1Oxford University, Oxfordshire, UK

Inconsistent associations have been found between physical activity (PA), measured by questionnaire, and body fatness.   We examined the association using both pedometers and questionnaires.

A population based sample of 1126 Tasmanian adult subjects wore pedometers for two week days, completed questionnaires on PA and other lifestyle factors, and were measured for waist circumference and height and weight.

Pedometers were more significantly associated with waist circumference than the questionnaire measures. Also, a larger effect was obserced for an increase in steps for men than women -  1.7 cm (0.77-2.56) reduction vs 1.3 cm (0.82-1.79), for a 50% increase in steps.

0122 Gaps in reported and functional capacity to provide care at health facilities: evidence and policy implications for sub-Saharan AfricaNancy Fullman1, Alexandra Wollum1, Caroline Kisia3, Felix Masiye2,1, Jane Achan4, Herbert Duber1, Emmanuela Gakidou1,  1Institute for Health Metrics and Evaluation, Seattle, USA, 2University of Zambia, Lusaka, Zambia, 3Action Africa Help-International, Nairobi, Kenya, 4Infectious Diseases Research Collaboration, Kampala, Uganda

To deliver optimal medical care, health facilities need the functional equipment and supplies to provide specific services. Based on nationally-representative health facility data collected and analyzed through the Access, Bottlenecks, Costs, and Equity (ABCE) project, a substantial service capacity gap emerged across levels of care in sub-Saharan Africa. In Uganda, for example, 78% of facilities reported providing antenatal care (ANC), but due to factors such as poor availability of ultrasound and blood testing, only 13% of faciliies had full capacity for ANC. These results help to identify targeted policy and investment opportunities for improving health systems in sub-Saharan Africa.

0097 Internet-Based Smoking Cessation Program Development and Effectiveness EvaluationAyse Koyun1, Kafiye Eroglu2, 1Afyon Kocatepe University, Afyonkarahisar, Turkey, 2Koç University, Istanbul, Turkey

This project is aimed to development and evaluation of the effectiveness of an internet-based smoking cessation program (www.sbp.aku.edu.tr) on smoking university students. This study intends to fight against smoking with online staged-based program. This project is supported by TUBİTAK with 114S130 project number between 15.07.2014 and 15.07.2015. The study consists of four phases: studies to determine needs; website content development and graphic design; implementation; and evaluation. The first two phases completed and the third phase is currently underway. 401 smoker students were reached by website. It can be expected that progress stages of the sample, increase self-efficacy and decision-making.

Health Economics

0029 Geographic variation in potentially avoidable hospitalizations in FranceGregoire Mercier1,2, Vera Georgescu1, Jean Bousquet1,  1CHRU de Montpellier, Montpellier, France, 2Université Montpellier 1, Montpellier, France

Potentially avoidable hospitalizations (PAH) are used as an indirect measure of access to primary care. Understanding their determinants can contribute to improve the quality and equity of health care delivery. So far no studies have tackled this issue at the national level in France. We assessed the disparities in PAH in France in 2012 and their determinants. Increased PAH was associated with higher mortality, a lower density of acute care beds and ambulatory care nurses, a lower median income and education level. This work unveils considerable variation in PAH rates in spite of a publicly funded health insurance scheme.

0165 “The academic and the real world don’t match”: the challenges of adopting health economics approaches to public health decision-makingSilvia Scalabrini1,  1Durham University, Stockton on Tees, UK

This paper explores how local authorities think about public health spending following the relocation of public health responsibilities from the NHS to local government in England. Drawing on an ongoing action-oriented project involving 3 local authorities, we discuss challenges related to the adoption of priority-setting tools in public health spending decisions. Interviewees highlighted the importance of examining the wider context of local government in order to avoid a mechanical adoption of tools that fails to consider the political priorities and ‘real world’ constraints. The findings have implications for the practical issues that stakeholders encounter in their day-to-day work.

0092 Cost Effectiveness of Vascular Surgery: A UK PerspectiveMahim I Qureshi1, Rishi Mandavia1, Brahman Dharmarajah1, Alun H Davies1,  1Imperial College London, London, UK

Background: In this economic climate, provision of cost-effective quality healthcare is paramount.

Aim: To determine the influence of cost-effectiveness on UK healthcare policy in key domains of vascular surgery: carotid endarterectomy, superficial venous intervention and AAA repair.

Methods: Systematic review adherent to PRISMA guidelines. Quality of inclusions was assessed using Evers checklist, and strength of evidence determined by the quality and number of studies.

Results: There was insufficient evidence to determine cost-effectiveness of symptomatic CEA. In remaining domains, healthcare policy contradicted high-quality evidence regarding cost-effective management.

Conclusion: Cost-effectiveness does not appear to influence UK healthcare policy in vascular surgery.

Mental Health

0131 The evaluation of the conflict management program delivered to the adolescents in the orphanagesPinar Çiçekoglu1, Gül Ünsal Barlas Ünsal Barlas2, Semra Karaca2,  1Çankiri Karatekin Universi, School of Healthty, Çankiri, Turkey, 2Marmara University, Faculty of Health Sciences, Istanbul, Turkey

Objective: To evaluate the impact of conflict management training delivered to the adolescents in the orphanages on conflict resolution behaviors of the adolescents.

Material and Method: Our study was realized with 80 adolescents who are living in the orphanages. In experimental group, adolescence had been carried out conflict management program for 10 week.

Findings: Following the implemented training program, the pre-test aggression average of the adolescents in the experimental group is significantly higher than the post-test average (p˂0. 05). The post-test problem solving average of the adolescents in the experimental group is significantly higher than the pre-test average (p˂0. 05).

0178 Violence exposure and mental health among Indonesian urban adolescentsSherly Turnip1, Arina Isyalhana1,  1Universitas Indonesia, Jakarta, Indonesia

Previous studies indicated that high rates of child and adolescent exposure to violence both as witnesses and victims, have lead to an increase of adolescents mental health problems such as internalizing and externalizing behaviors. This cross sectional study examined the relationships between violence exposure and  mental health in a sample of 497 students  from 5 urban high schools in Indonesia. Results showed that there were significant correlations between violence exposure and internalizing and externalizing behaviors. This findings suggest that violence exposure has a detrimental effect on adolescents’ mental health and therefore need to be addressed.

0116 Prevalence and factors associated with depression among antenatal women in an urban health centre of DelhiUrvi Sharma1, Ritesh Bansal1, Jugal Kishore1,  1Maulana Azad Medical College, New Delhi, India

Theory: Detection of depression during pregnancy has been a much neglected component of antenatal care.

Aim: To find out the prevalence and factors associated with depression among antenatal women in a urban health centre in Delhi.

Methods: A total of 220 antenatal care attendees from July to December 2014 were screened for depression using the Edinburgh Postnatal Depression Scale.

Results: An EDPS score of ≥10 was found in 47 (21.4%).  Nulliparity, gestational age (<20 years) and intimate partner violence were associated factors.

Primary Workforce Training

0045 Primary Care Transformation: Multi-dimensional Training for Office StaffBruce Block2,1,  1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA, 2Pittsburgh Regional Health Initiative, Pittsburgh, Pennsylvania, USA

Improvement in patient outcomes and reduction of costs depends upon implementing evidence-based guidelines, adopting electronic health records, and instituting coordinated patient-centred care. Since 2010, the Pittsburgh Regional Health Initiative (PRHI) conducted a series of overlapping initiatives aimed at enhancing primary care practice transformation in western Pennsylvania.PRHI provided collaborative learning sessions and workflow-associated training to over 100 practices focused upon Medical Home change concepts, elevation of clinical assistant roles, behavioural health integration and development of a quality improvement culture. Multi-disciplinary training and coaching for office staff can effectively assist primary care practices to implement transformational care elements.

0034 Increasing the value of healthcare education using behavioural scienceLucie Byrne-Davis1, Jo Hart1, Marie Johnston2, Chris Armitage1, Ged Byrne3,  1University of Manchester, Manchester, UK, 2University of Aberdeen, Aberdeen, UK, 3Health Education England, Manchester, UK

THEORY: Education is a major ‘intervention’ to change healthcare practice. Despite high investment (Health Education England over £4 billion pa) evalutions of behaviour are rare. Behavioural science theory and methods can evaluate impact of education on behaviour/determinants.

METHODS: Questionnaires identifying behaviours and assessing determinants were piloted in 2 UK and 2 Ugandan courses (total N = 214).

RESULTS: Questionnaires were feasible and acceptable. We extracted data for analyses of large datasets.

CONCLUSION: Educators were engaged.  Data will be examined to identify potential increase in the value of education from changing educators’ focus to behaviour.

0027 Improving health workforce performance in Uganda: linking research and practice through action researchJoanna Raven1, Sebastian Olikira Baine2, Saul Kamukama2, Alvaro Alonso-Garbayo1, Tim Martineau1,  1Liverpool School of Tropical Medicine, Liverpool, UK, 2School of Public Health, Makerere University, Kampala, Uganda

The district is key to developing and sustaining resilient and effective health systems for providing universal health coverage.  The PERFORM project used action research with district management teams in Uganda to improve health workforce performance. Problem analysis techniques helped teams to reflect on challenges and opportunities they face, find solutions and integrate them into district plans. Solutions included improving staff appraisal, reducing absenteeism and strengthening supervision. Action research bridges research and practice; supports sustainability and ownership through solving problems at district level; enables sharing of practices between districts; and can promote a culture of partnership and inspire innovation.

Mixed – Global Perspectives

0136 Noncommunicable Disease Prevention and Control in Mongolia: A Policy AnalysisOyun Chimeddamba1,2, Anna Peeters3, Helen Walls4,5, Catherine Joyce1,  1Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 2Mongolian Association of Family Medicine Specialists, Ulaanbaatar, Mongolia, 3Obesity & Population Health | Baker IDI Heart and Diabetes Institute, Melbourne, Australia, 4Leverhulme Centre for Integrative Research on Agriculture and Health,London School of Hygiene and Tropical Medicine, London, UK, 5Australian National University, Canberra, Australia

This paper aimed to evaluate the extent to which non-communicable disease (NCD) related policies introduced in Mongolia align with the WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs. We conducted a qualitative review of policy documents. The Mongolian Government response to the burden of NCDs is a population-based public health approach which includes a national multisectoral framework and integration of NCD prevention and control into national health policies. Our findings suggested gaps in addressing chronic respiratory disease, physical activity guidelines, specific food policy actions, and a lack of funding supporting NCD research.

0037 Unintentional poisoning in young children: knowledge of poisons, preventive practices and the management practices among caregivers in western Nigeria.Taofeeq Elias1, Ifeoma Okafor1,  1College of Medicine, University of Lagos, Idi-Arabia, Lagos, Nigeria

This study assessed the knowledge of unintentional poisoning, its preventive measures and management practices in young children among care-givers in Western Nigeria. A descriptive cross-sectional design was used. Interview administered questionnaires were used to collect data from 304 adult respondents using a multi stage sampling technique. The most common substance known to be harmful was rat poison and 91.8% knew it leads to death. The most common symptom known by respondents was abdominal pain. Among respondents with a positive history, 52.6% gave palm oil as the first course of action. More awareness should be made to improve their knowledge.

0156 Equity of Maternal Health Care in Post-conflict and Non-conflict Uganda: A Comparative Mixed Methods studyAndrew Alyao Ocero1,2, Sally Theobald1,3, Tim Martineau1,3,  1Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK, 2Commonwealth Scholarship Commission, London, England, UK, 3ReBuild Consortium, Liverpool, Merseyside, UK

Background: Northern Uganda, a post-conflict region, has poor maternal health (MH) indicators. This study compares equity in government MH policy and financing in post-conflict and non-conflict Uganda.

Methods: Documentary review, qualitative interviews with key stakeholders and a costing study were conducted to determine patterns in MH funding.

Findings: Northern Uganda lost out on critical resources and benefit incidence, but gained comparatively good health infrastructure and commitment to social justice.

Conclusion: Inequity in maternal health financing contributed to poor MH outcomes in Northern Uganda.

Sessions starting Friday 11.40Service Use and Organisation

0210 Health service utilization after terrorism - a longitudinal study of survivors of the 2011 Utøya attack in NorwayLise Eilin Stene1, Grete Dyb1,2,  1Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway, 2Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

Terrorism is a major challenge due to its unforeseen and devastating effects. To improve public health preparedness, it is essential to estimate post-terrorism health service utilization. We assessed the prevalence of health service utilization and factors associated with mental health service (MHS) utilization among the Utøya shooting survivors.  After 5-15 months, 267(95%) reported health service utilization: 254(90%) primary care and 192(68%) MHS. After multivariable adjustments, MHS utilization remained associated with early symptoms of anxiety/depression and concurrent somatic symptoms. The results underscore the importance of allocating sufficient resources to meet the service demands and of addressing somatic symptoms in MHS users.

0174 Health service delivery, public health and ethnicity: from theoretical debates to sustainable interventionsRosalie Aroni1,  1Monash University, Melbourne, Victoria, Australia

Research into ethnicity and health continues to raise ethical, theoretical and methodological issues notwithstanding promulgation of the Leeds Principles for Research on Ethnicity and Health in 2012. Similarly, while there is recognition in the health intervention literature on ethnicity that "one size does not fit all," it seems there is rarely sufficient funding available to conduct appropriate research or implement sustainable programs. Three case studies are presented to illuminate the key issues. Potential solutions are suggested for conducting ethical, rigorous research on ethnicity and health and producing sustainable interventions in health service delivery, public health, illness prevention and health promotion.

0229 A Comparison of Organizational Cultures around Promoting Equity in Public (NHS) and Hybrid (Social Enterprise) Healthcare OrganizationsAshok Patnaik1,  1University of Huddersfield, Huddersfield, UK

Theory: To promote competition, UK governments have encouraged community healthcare services within the NHS to spin out and become private ‘social enterprises'. Service provision by social enterprises may be less equitable than by the NHS.

Hypothesis: Organizational cultures of social enterprises differ from those of the NHS in their supportiveness for equity.

Methods: a) Online survey to compare equity-supportiveness of organizational cultures in the NHS and social enterprises b) Interviews to investigate cultural change in social enterprises and the impact on equity in service provision

Conclusions: Social enterprises are promoting equity to an equal or greater degree than the NHS.

Health Policy and Systems

0069 Changing Issues in Healthcare Policy in The U.S. and The Role of ResearchStuart Altman1,  1Heller School, Brandeis Univeristy, Waltham, MA, USA

The presentation traces changing issues that shaped US government policy and research from the 1960s until now, and changing players. Early central issues, expanding health insurance and controlling spending growth, brought to the ascendency individuals with expertise in how the U.S. system was organized and financed – mostly non physicians/healthcare professionals. As new issues have been added to the national debate, (1) quality and safety  (2) differential health status of groups and why they occur, and (3) types of allowable health professionals, the obvious need to engage physicians and healthcare professionals in health policy formulation and research activities has emerged.

0185 Impact of contextual factors on the effect of interventions to improve health worker performance in sub-Saharan Africa: review of published trialsClaire Blacklock1, Daniela Goncalves Bradley1, Sharon Mickan1,2, Merlin Willcox1, Nia Roberts1, Anna Bergstrom3,4, David Mant1,  1Oxford University, Oxford, UK, 2Griffith University, Queensland, Australia, 3University College London, London, UK, 4Uppsala University, Uppsala, Sweden

Variation in health worker performance compromises quality of care. We sought to identify interventions implemented in sub-Saharan African to improve health worker performance, including contextual factors likely to influence local effectiveness. A systematic search for trials was undertaken. Interventions were defined by EPOC category. Within-study variability in effect was extracted. Reported contextual factors likely to have modified effect were subjected to thematic analysis.

Range of effect between centres within trials varied substantially. Nine contextual themes were identified as effect modifiers.

Policy makers must address contextual factors causing differences in local effect of interventions. These need to be reported by researchers.

0198 Translating research into practice - using an evidence based approach to Acupuncture within the UK health systemNick Pahl1,  1British Acupuncture Council, London, UK

Introduction: Acupuncture has substantial Evidence Based Medicine support from NICE, RCTs etc.  Acupuncture has been shown to be of value to patients, with over 4 million treatments a year in the UK. The UK Govt has recognised Acupuncture via the UK Professional Standards Authority.

Discussion:  To review the evidence base for acupuncture, and opportunities and challenges for implementation within health systems. To provide a global overview of health policy towards acupuncture in the light of the 2014 WHO strategy for traditional medicine (at http://www.who.int/medicines/publications/traditional/trm_strategy14_23/en/). To reflect on UK policy response to acupuncture

Conclusion: Acupuncture provides a positive example of how policy makers have managed a traditional medicine and issues related to evidence, safety, risk and professionalism.

Health Psychology

0091 Exploring the barriers and enablers to the implementation of a falls prevention intervention - development of an implementation protocol for the 6-PACK RCTAnna Barker1, Fiona Landgren2, Jeanette Kamar1, Renata Morello1, Caroline Brand1, Darshini Ayton1,  1Monash University, Melbourne, Australia, 2Project Health, Melbourne, Australia, 3Northern Health, Melbourne, Australia

The Theoretical Domain Framework (TDF), which details the processes involved in behavior change of healthcare professionals, was used to assess the barriers and enablers of effective falls prevention in acute hospitals. Data was obtained from six Australia hospitals via medical records, practice audits (n=37,737); focus groups (n=12 with 96 nurses); interviews (n=24); and surveys (n=421). Barriers included a lack of time, skills, and resources, patient complexity, and a belief that falls were inevitable. Enablers were face-to-face education; leadership; use of audits, reminders and feedback. An implementation protocol for the 6-PACK program addressing these factors was developed and will be discussed.

0193 Effectiveness of intensive healthcare waste management training model among health professionals at teaching hospitals of Pakistan: A quasi-experimental studyRamesh Kumar1,2, Ratana Somrongthong1, Babar Tasneem Shaikh2, Rapat Eknithiset1,  1College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand, 2Health Services Academy, Islamabad, Pakistan

Infectious waste management has always remained a neglected public health problem in the developing countries, resulting in high burden of environmental pollution affecting general masses. Quasi-experimental pre and post design with control and intervention groups was conducted on 275 health care workers, 138 assigned for intervention group for 3 months trainings, hands-on practicum and reminders on infectious waste management; whereas 137 workers were assigned to the control hospital. Multivariate analysis, independent, paired /unpaired t-test, chi-square with p values, and mean of the responses were calculated. Response rate was 92% at the end of intervention. Intervention has found statistically significance effect.

0233 Generalised anxiety disorder (GAD) and health service use in a large British community cohort: findings from the EPIC-Norfolk studyOlivia Remes1, Louise Lafortune1, Robert Luben1, Nick Wainwright1, Paul Surtees1, Amit Bhaniani1, Carol Brayne1, Kay-Tee Khaw1,  1University of Cambridge, Cambridge, UK

Generalised anxiety disorder (GAD) is one of the most common, impairing anxiety disorders in the general population.  We used data from the population-based EPIC-Norfolk to study the association between DSM-IV GAD and health service use in 18,393 participants ages 40-79 years between 1996-99 and 2012.

Sociodemographics, medical histories and disability were assessed using questionnaires, and hospital service use through record linkage with East Norfolk Primary Health Care trust databases.

In multivariate models, GAD was significantly associated with hospital admissions (RR=1.13, 1.07-1.19) and hospital stay greater than 3 days (OR=1.51, 1.21-1.87). These novel findings highlight the need to diagnose and treat GAD to prevent the associated health service system burden.

Older Age

0001 A stepped care approach to frailty screening among community dwelling older people aged 65 years and over using the FRAIL scoreJean Woo1, Ruby Yu1, Martin Wong1, Moses Wong1,  1The Chinese University of Hong Kong, Shatin, Hong Kong

The FRAIL score consists of five questions without the need for any measurements. When applied to 816 older people, 52 % were classified as pre-frail, and 12.5% frail. In a subgroup of 255 people, compared with the pre-frail group, the frail group had higher prevalence of sarcopenia, mild cognitive impairment, poorer self-rated health, higher number of falls, greater number of chronic diseases, medications, ADL and IADL impairments. The findings suggest that a simple tool that can be applied by trained staff may be a useful community screening test, followed suitable referrals for further management.

0017 Community Geriatric Assessment Team: a model for supporting care home residents in Hong KongElsie Hui1,2, Jean Woo1,  1The Chinese University of Hong Kong, Shatin, Hong Kong, 2Community Outreach Service Team, Shatin, Hong Kong

It is increasingly recognised that quality care for nursing homes involve collaboration between general practitioners and Geriatricians. In Hong Kong, the majority of older people rely on the public healthcare system. Primary care is under-developed and patients tend to rely heavily on hospital-based services. To deal with the increasing demand, especially from frail care home patients with multiple, complex medical problems, the Hospital Authority of Hong Kong established Community Geriatric Asessment Teams (CGATs) in 1994. These teams provide multi-disciplinary care to nursing home residents with the aim of minimizing transfers and promoting good practice, such as end of life care.

0231 Informal and formal care provision in the UK: Results from a quasi-natural experimentEmmanouil Mentzakis1,  1University of Southampton, Southampton, UK

Ageing populations and increasing health care demands on strained budgets suggest reliance on informal care as a way to maintain care provision and contain care expenditure. However, with ageing carers and changes in family structure, future supply of informal care is uncertain. If policies are to promote informal care, identification of the relationship between formal and informal care is vital. Taking advantage of a 2002 Scottish law providing free personal care to those +65, differences-in-differences estimations provide evidence of substitutional patterns with Scotland experiencing a drop in free formal care and an increase in informal care provision in response.

Nursing and Care

0169 Control and co-operation: delivering ‘harm-free care' in the community settingLiz Brewster1, Natalie Armstrong1, Carolyn Tarrant1, Mary Dixon-Woods1,  1University of Leicester, Leicester, UK

Collecting data to improve the quality of healthcare presents different challenges in community settings to those encountered in the acute sector. Based on interview data and ethnographic observations, this paper presents reflections on implementing a data collection tool - the NHS Safety Thermometer - in community nursing. This point of care instrument aims to enable a ‘temperature check' of harm across the NHS. However, the design of tools for use in similar improvement strategies needs to take into account the particular difficulties of preventing harm in an environment where healthcare staff have little opportunity to monitor and influence patient action.

0228 Development and validation of the Culture of Care Barometer.Anne Marie Rafferty1, Julia Philippou1, Joanne Fitzpatrick1, Jane Ball2,  1King's College London, London, UK, 2University of Southampton, Southampton, UK

The purpose of the Culture of Care Barometer is to prompt reflections and conversations on the underlying issues involved in creating a culture of care. The literature associated with organisational culture, culture of compassion and safety highlights the centrality of culture to the provision of health care and post Francis healthcare delivery. We propose an instrument with which to gauge the different attributes of environments in which care is delivered. The operationalization of the Culture of Care Barometer provides a theoretical foundation for future research and a tool to assist organisations in developing an environment that supports a caring culture.

0093 Suami Siaga, the Father Participation in Maternal HealthAnna Kurniati1,2, Ching-Min Chen1, Ferry Efendi1,3,  1National Cheng Kung University, Tainan City, Taiwan, 2Ministry of Health, the Republic of Indonesia, DKI Jakarta, Indonesia, 3Airlangga University, Surabaya, Indonesia

Suami Siaga (the alert husband) is a nationwide community empowerment program to improve maternal health in Indonesia. This study aims to identify the prevalence of Suami Siaga and the associated factors using data from the 2012 IDHS with an eligible sample of 1,314 married men. Bivariate and logistic regression analysis were performed to test the hypotheses. We assumed that father characteristics, control over income, child-wish factors have significant associations with Suami Siaga elements. Our study found that urban residents and earning higher income were more likely to discuss the delivery place and transportation. Father participation could contribute to maternal health.

Mixed Session

0199 Genomic Breakthroughs - Promises and ChallengesDodie Roskies1,  1Jewish Healthcare Foundation, Pittsburgh , PA, USA

Breakthroughs in genomic sequencing come with a new set of ethical, familial, financial, health and legal issues and challenges. Genetic education and pre-conception screening raise the potential for preventing the birth of babies with serious disabilities and genetic defects and  can introduce a host of interventions to prevent the birth of predictably "damaged" newborns.  How families deal with the knowledge and available choices also offers a rich research agenda. This talk will describe how one community addressed this delicate issue in a series of bold anticipatory education, counseling and screening sessions, leading to fruitful and unanswered research questions.

0175 Translational research in an Academic Health System (AHS):Establishing the research infrastructure for a knowledge eceonomy in QatarEdward Hillhouse1, Sadaf Lynes1, Ibrahim Janahi1, Hanan Al-Kuwari1, Kristen Mrus1,  1Hamad Medical Corporation, Doha, Qatar

The Qatar AHS is a partnership of 9 clinical, academic and research organizations developing an integrated model transforming patient care as part of Qatar National Vision 2030. This is the first attempt by any nation to assemble all academic and health-care providers to work towards a shared vision and strategic plan.

In a healthcare model that has predominantly been service delivery focused, the transformation to one that embraces the translational research continuum has required strong leadership  with focus on infrastructure, governance, capacity and capability building. This is being achieved with partnerships that break traditional boundaries creating an interprofessional care model.

0166 State-building and human resources for health in fragile and conflict-affected states: exploring the linkagesSophie Witter1, Jean-Benoit Falisse2, Maria Bertone3, Alonso Garbayo4, João Martins5, Salehi Ahmed6, Enrico Pavignani7, Tim Martineau4,  1Queen Margaret University, Edinburgh, UK, 2St Antony's College, Oxford, UK, 3London School of Hygiene and Tropical Medicine, London, UK, 4Liverpool School of Tropical Medicine, Liverpool, UK, 5Universidade Nacional Timor Lorosa’e, Dili, Timor-Leste, 6Ministry of Public Health, Kabul, Afghanistan, 7University of Queensland, Brisbane, Australia

Human resources for health are critical to running a health service and system. There is however a wider set of social issues which are more rarely considered. One area which is hinted at in literature, particularly on fragile and conflict-affected states, but rarely examined in detail is the contribution which health staff may or do play in relation to the wider state-building processes. This presentation explores that relationship, developing a conceptual framework to understand what linkages might exist and looking for empirical evidence from different bodies of literature as well as three case studies to support or refute those linkages.

Sessions starting Friday 14.40

Health Policy and Systems

0221 Evidence Informed Decision Making: Innovative Approaches through Researcher-Patient PartnershipsVasanthi Srinivasan1, Mark Roseman1,  1Ontario SPOR SUPPORT Unit, Toronto, Ontario, Canada

In 2014, Canada embarked on an ambitious research agenda entitled Strategy for Patient-Oriented Research (SPOR). The Province of Ontario has actively embraced SPOR, committing significant resources to engage leading research centres, patients, clinicians, policy makers, industry and other health system professionals. Key features include the value-add to the $50+ billion provincial health system, and the alignment of patient partnered research activities to public policy imperatives. Objectives will be achieved in part through research networks focusing on mental health, primary and continuing care, and chronic disease prevention and management, and scalable demonstration projects that offer knowledge to health system users.

0225 What is the patient's role in medicines reconciliation?Rachel Urban1,2, Gerry Armitage1, Alison Blenkinsopp1, Julie Morgan1,  1University of Bradford, Bradford, UK, 2Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK

Decreasing the scale of medicines reconciliation related error is an international priority. There is insufficient evidence on the roles of those involved in medicines reconciliation, especially the patient. This study observed staff interacting with patients during medicines reconciliation across multiple secondary care centres using an evidence-informed framework. We identified the patient as the constant throughout the medicines reconciliation process, adding information which could not be gained elsewhere. Despite this, patients were not routinely involved in information-seeking discussions about their medication and were unlikely to be given medicines information, including changes to their prescription.

0183 Understanding emergency hospital admissions of older peopleRaphael Wittenberg1, Luke Sharpin1, Barry McCormick1, Jeremy Hurst1,  1Centre for Health Service Economics & Organisation (CHSEO), Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK

Aim is improved understanding of the rise in emergency hospital admissions for older people, 2001/02 to 2012/13.

Methods: Analysis of Hospital Episode Statistics, including age, cohort period (APC) analysis.

Results:  The emergency admissions rate increased by 25% over the period, but the bed day rate fell by 25%. APC analysis shows: emergency admission rate rose monotonically with age from 40; each successive cohort experienced lower emergency admission rates; period effects have been increasing since 1999.

Conclusions: Cohort effects suggest demand pressures may prove more limited than expected from population projections, but period effects seem inconsistent with emergency admissions falling soon.

Nursing and Leadership

0075 The role of coaching in the development of nurse managersLiz Westcote1,  1Oxford Brookes Univeristy, Oxford, UK

This presentation will share the results of empirical research undertaken into the role that coaching is playing in the development of nurse managers. Nurse managers are the first line managers of a team of nurses within any health sector.  The mixed methods research used a pragmatist paradigm and gathered data from a quantitative survey and qualitative interviews.  Thematic analysis and pattern coding was the framework used for data interrogation. The key findings of the survey and interviews will be shared including development of self, resilience, leadership, the team  and the value of a coaching culture in health care settings.

0159 Silent work: the interactional coordination of critical, collaborative care in ICUAndreas Xyrichis1, Anne Marie Rafferty1,  1King's College London, London, UK

This paper examines how nurses in three intensive care units (ICUs) in England accomplished the organisation and delivery of safe care to critically ill patients; based on qualitative analysis of ethnographically derived observational and interview data collected over 2009-2010. We show how ICU care was accomplished dynamically, through a system characterised by mutual support and a shared sense of protection and concern for other nurses; and reveal tacit processes and skills that nurses exercised in accomplishing their day-to-day work. We draw from these findings to raise implications for policy and the organisation of safety work in specialist hospital settings.

0121 Best evidence for best practice: how can we help nurses engage with research?Sarah Chapman1,  1UK Cochrane Centre, Oxford, UK

Framework: Cochrane produces reliable evidence for better health. The UK Cochrane Centre uses social media to disseminate evidence and encourage engagement with it.

Methods: A Cochrane review found no reliable evidence to support an established nursing practice. We used blogs and tweetchats to engage nurses in debate about the evidence and implications for practice.

Results: Individual nurses and representative bodies participated in online discussion. Reasons were given for continuing the practice in question other than its intended purpose.

Conclusions: Through social media we successfully disseminated evidence, promoted reflective practice and established relationships within the nursing community, leading to collaborative working.

Public Health

0236 Estimating the prevalence of female genital mutilation in England and WalesAlison Macfarlane0,  1City University London, London, UK

Background: Estimates of the prevalence of female genital mutilation are needed to plan the provision of care for affected women and protection for their daughters

Methods: Data from surveys in countries where female genital mutilation is practised were applied to data from census data about numbers of women born in these countries resident in each local authority in England and Wales and birth registration data about births to these women

Results: Despite concentration in a relatively small number of urban areas some women born in these countries were resident in most areas, but women who migrated may be atypical.

0187 The effect of self-efficacy learnig programme on  teenage  pregnanacy prevention in female students, u-thong district, suphanburi province, ThailandChawthip Boromtanarat1,  1Sukhothai Thammathirat Open University, Nonthaburi Province, Thailand

The objectives of this quasi-experimental research were to study the effect of self-efficacy learning programme on teenage pregnancy prevention in female students in U-thong district of Suphanburi province. The two experimental groups pre-post test design were 31 students from U-thong Suksalai school and 31   students from Srayaysome School with  received self-efficacy learning programme on teenage pregnancy prevention. Data were collected by self-administered questionnaires and analysed  by paired t-test.

The results showed that  the mean score of knowledge,  self-efficacy and the  efficacy  expectation  on teenage pregnancy prevention in both experimental groups were a significant  difference between pre-test and post test.

0123 Low income women’s experience of delivering in public facilities: Discriminatory attitudes, degrading treatment and dehumanizing careNalini Visvanathan1, Monika Walia2,  1Independent Researcher, Washington DC, USA, 2National AIDS Control Organization (NACO), New Delhi, India

Why are low income Indian women still resistant to delivering in no-cost public facilities when financial incentives now cover transportation and incidental expenses?  A survey of community outreach workers (n=105), the ASHAs, illuminated fears and reservations among pregnant clients. A follow-up qualitative study used in-depth interviews (n=42) to assess quality of care (QoC) with the ASHAs’ post-partum clients who described their facility-based experiences. A protocol based on Hulton et al. (2000) QoC framework for maternity services elicited a mixed response. Dominant themes included denial of care, untimely referrals, verbal and physical abuses, predatory practices and discrimination against higher parity women.

Health Finance Economics

0234 Prospective payment system and medical practices : Cesarean sections in FranceSaad Zbiri1,3, Carine Milcent1,2,  1French National Center for Scientific Research (PSE, CEFC), Paris, France, 2French National Authority for Health (CEESP, IFAQ), Saint-Denis La Plaine, France, 3University of Versailles Saint-Quentin, Versailles, France

The use of C-sections varies across regions and providers. This variation is worrisome because of the increased cost and clinical risk of the C-section.

French data (103,207 deliveries, 2008-2013) and multilevel logit models with fixed hospital effect clustered at the residence level were used to examine the effect of each determinant factor, after activity-based pricing (T2A) came into effect.

The probability of C-section increases in precarious patients, on working days, in the private sector. Moreover, this probability differs depending on the number of midwives and the place of residence. Finally, T2A doesn't seem to affect practices across sectors.

0148 Decision-based Evidence-Making: When Research Informs Decisions in Care Delivery and FinancingSophia Chang1,2,  1California HealthCare Foundation, Oakland, CA, USA, 2University of California, San Francisco, San Francisco, CA, USA

The translation of research into practice is driven by payment, especially the adoption of new medical treatments. Peer-reviewed published research is a primary means of validating new interventions with the expectation that payment policies will follow in the US. When evaluating service interventions or approaches, however, the delay in measurable clinical outcomes and the lack of relevance to business and funding decisions leave standard health services research approaches poorly positioned to support adoption. Rapid-cycle evaluations focused on the return on investment are being conducted in California to spread adoption of palliative care and virtual services such as telemedicine and e-consults.

Community / GP Care

0024 Health-care seeking behavior and use of traditional medicine in persons with diabetes in Uganda.Katarina Hjelm1,  1Department of social and welfare studies, Linköping University, Norrköping, Sweden

Healthcare seeking behaviour is important as it determines acceptance of healthcare and outcomes of chronic conditions but has been investigated to a limited extent in persons with diabetes in developing countries.

Qualitative study. Focus-group interviews.

Reasons for seeking help from traditional healers were diabetes symptoms and

failure of effect from western medicine. Help had been sought from different health facilities with the help of relatives and friends.

Conclusion: A switch between healthcare providers influenced by popular and folk sectors was found. Despite beliefs of using different healthcare providers searching for complementary medicine, participants still experienced health problems related to diabetes.

0160 Telegeriatrics in the Nursing Home- The Singapore ExperienceJames Alvin Low1,2, Joanne Chia1,2, Hui Jin Toh1,2,  1Khoo Teck Puat Hospital, Singapore, Singapore, 2Alexandrahealth Service, Singapore, Singapore

We studied a telemedicine programme between the Geriatrics Department of an acute hospital and several nursing homes. This descriptive study was conducted from 2010 to 2014, recruiting 667 residents: 60% were women, mean age was 76-years, most were widowed (27%).  The reasons for consultation were: behavioral issues (32%), medication/management review (25%), rash (6%), fever (4%), breathlessness (3%). Commonest diagnoses were dementia with BPSD, skin lesions and infections. We also looked at the management plan, follow-up  and hospital transfers of the cohort. We conclude that telegeriatrics is feasible and effective in providing care in nursing homes in an urban and densely-populated setting such as Singapore.

0055 Liberating the change? A bottom up approach to improving general practiceRobin Miller1,  1University of Birmingham, Birmingham, UK

Improvement in English general practice was sought through a top-down approach in which purchasers would direct interventions and pathways through specifications, quality frameworks and financial incentives. Using qualitative methodologies this action research project explores an emergent approach in which GPs are given upfront funding and autonomy to create new models to achieve better standards and divert activity from acute hospital. Drawing on OD and readiness to change theory it will reflect the extent to which initial assumptions are realised in practice and consider the enablers and barriers to positive change being achieved.

Industry and Health

0141 Autogenic Training in high risk industries: an effective neuro-psychophysiological tool for the occupational health and performance of NASA Astronauts and Australian PoliceHelen Gibbons1,2,  1Autogenic Training Institute of Australia, Sydney, NSW, Australia, 2International Institute of Autogenic Training and Autogenic Psychotherapy, Madrid, Spain, 3Australian Psychological Society, Melbourne, Victoria, Australia, 4The International Society of Behavioural Medicine, Marburg, Germany

Police are exposed to high stress work environments. Exposure to extreme stressors causes mind-body dysregulation that affects health and workplace performance. Autogenic Training (AT) is an evidence-based neuro-psychophysiological tool that mobilizes brain-directed self-regulatory mechanisms to

recover from mind-body dysregulation brought on by stress. Research highlighting AT’s effectiveness for OH&S will be examined with a special emphasis on the benefits of AT for NASA Astronauts and Australian Police who received Autogenic Training from me as part of an Employee Assistance Programme for the prevention and treatment of stress related conditions such as Post-Traumatic Stress Disorder, Depression, substance abuse and insomnia.

0144 The effect of environmental and social sensitivities on corporate reputationÖzlem Tuna1, İbrahim Kılıç1,  1Afyon Kocatepe University, Afyonkarahisar, Turkey

Environmental and social attempts lead to the protection of social image of organizations, the increase of their reputation, and the decrease of their reputation risks. Corporate reputation is a part of the communication between the organizations and their stakeholders. In this regard, in the study, determining the effect of sensitivity on corporate reputation is aimed by evaluating the sensitivity of public hospitals operating in Afyonkarahisar on environmental and social issues with the eye of stakeholders who are for the corporate reputation. For the data obtained with the survey, descriptive and relationship analysis methods are used.

Sessions starting Friday 16.00Mental Health and ICT

0211 Internet-based Cognitive Behavioural Therapy for Adults with Post Traumatic Stress Disorder: A Systematic ReviewJulie Fricke1, David Humphreys1, Oluchukwu Onyimadu2,  1University of Oxford, Oxford, UK, 2Brunel University, London, London, UK

Background: Dissemination and effective delivery of short-term, evidence-based treatments for PTSD is an urgent priority to address this growing public health

problem.

Aims: Systematically review the effectiveness of internet-based cognitive behavioural therapy interventions for adults with PTSD.

Methods: A systematic search for relevant studies was conducted

Results: Nine RCTs were included (n=626), and six were meta-analysed (n=501). A separate analysis was conducted for each of the subscales of the IES-R to obtain the average mean differences (intrusion (n=501, -6.4 [-8.5-4.2]), avoidance (n=501, -7.0 [-9.4-4.7]), and hyper-arousal (n=389, -4.7 [-6.1-3.3]), and sizeable reductions of symptoms in the experimental group are found.

0056 Harnessing the power of mental-health risk assessment expertise to create a seamless, evolving partnership between research and the delivery of advice at the point of care.Christopher Buckingham1, Ann Adams2,  1Aston University, Birmingham, UK, 2University of Warwick, Coventry, UK

Predicting precisely when people will try to kill themselves is not possible. This can be used as a reason for eschewing risk assessments despite their clinical importance: managing risk requires knowledge of what raises it. GRiST is a decision support system that overcomes resistance by modelling clinicians' natural thinking and reasoning about risk and evolving it alongside clinical requirements. In particular, the GRiST database of accumulating risk judgements fuels machine learning research that captures expert consensus and helps reduce assessment errors. This is a perfect example of clinical input directly influencing research, which then feeds straight back into practice.

0090 MindExpressTM: An online risk factor-based tailored depression prevention for young adults with a familial risk of major depressive disorderAlex Wilde1, Alexis E Whitton1, Rhoshel Lenroot2,3, Lyndal Trevena4, Peter R Schofield2,5, Philip B Mitchell1,6,  1School of Psychiatry, University of New South Wales, Sydney, Australia, 2Neuroscience Research Australia, Sydney, Australia, 3South East Sydney and Illawarra Area Health Service, Sydney, Australia, 4School of Public Health, University of Sydney, Sydney, Australia, 5School of Medical Sciences, University of New South Wales, Sydney, Australia, 6Black Dog Institute, Sydney, Australia

Theory/framework: Pilot study of a new online prevention program, MindExpressTM, based on the Transtheoretical Model of Behavioural Change, to facilitate cognitive and behavioural change thereby reducing depression risk factors in at-risk young people.Methods/hypotheses: Risk factor-based interactive educational and cognitive behavioural modules tailored to individual risk status.Results: The ‘Coping Styles’ module produced a significant mean behavioural change with large effect size (Cohen’s d=0.88, n=17). Mean depression scores decreased from mild at baseline to minimal at endpoint.Conclusions: MindExpressTM holds promise as an online tailored risk factor-based model for reducing susceptibility to depression in young people.

Health Systems and Primary Care

0022 Implementing and Evaluating Evidence-Based Mental and Physical Health Care Management in General PracticeRobert Ferguson1,2,  1Jewish Healthcare Foundation, Pittsburgh, PA, USA,

2Pittsburgh Regional Health Initiative, Pittsburgh, PA, USA

Framework: Eight U.S. partners (18 medical groups) are implementing evidence-based care management programs for primary care patients with depression plus diabetes or cardiovascular disease. If these CMS-CMMI Awards reduce costs, the Affordable Care Act authorizes CMMI to change policies.

Methods: Each regional partner is responsible for recruitment, implementation, quality improvement, and data submission (July 2012--June 2015). The evaluation is assessing disease control rates, healthcare costs, and satisfaction. The collection and use of data are part of the practice model. Results: Preliminary results show improvements in disease control rates.

Conclusions: The uptake of research-based healthcare delivery models requires system requirements.

0102 Commercial Health Plan management of Unwarranted Variation in Practice to Improve Quality and AffordabilityDonald Fischer1,  1Highmark, Inc., Pittsburgh, PA, USA

Unwarranted variation in practice has been well documented as a marker of poor quality and waste in the American health care system.  A U.S. commercial insurer with 4.5 million members uses claims data to demonstrate opportunities for reducing unwarranted overutilization and increasing use of effective therapies where underutilization is prevalent.  Partnerships among employers, providers and the health plan are effective in decreasing variation, improving quality, and lowering cost.  Key success factors are sharing actionable data, facilitating process improvement, and providing financial incentives for patient centered medical homes and hospitals to better manage health.  Similarly, lifestyle behaviors that contribute to poor health can be modified by member rewards programs.

0153 Did higher NHS spending growth, 2001/2-2009/10, buy capacity or higher relative wages?Barry McCormick1, Adam Millican-Slater1,  1Centre for Health Service Economics & Organisation, London, UK

There is concern that Labour Government policy to expand health spending in GDP was dissipated in NHS wage growth, and failed to benefit patients. We analyse hospital sector cost increases, in particular whether higher relative NHS wages significantly diminished the intended real increase in capacity. Additional funding is found to modestly increase relative hospital sector wage growth, and accounts for 10% of the additional real funding, 2001/2-9/10. Labour policy to increase NHS wages immediately prior to funding growth, also absorbed 8% of the additional real funding, 2001/2-9/10. However, over 80% of the increase in real funding purchased greater NHS capacity, disproportionately employment.

India & China

0163 The Effects of Mobile Phone Use on Healthcare-Seeking Trajectories in Rural India and ChinaMarco Haenssgen1,2,  1Oxford Department of International Development, Oxford, UK, 2Hertford College, Oxford, UK

Rapid mobile phone diffusion offers new opportunities for rural dwellers in low- and middle-income countries where healthcare challenges are pressing. Yet not all forms of mobile phone use are equally beneficial for people's health. This paper

analyses how mobile phone use is linked to different healthcare behaviours. Original data from 800 rural dwellers in Rajasthan (India) and Gansu (China) shows that mobile phone use is positively linked to accessing formal and informal health providers (rather than not receiving any care). However, among people who seek care, phone use is often associated to delays in access to formal health providers.

0120 The Relationship between Economic Freedom and Health Indicators across IndiaSaleema Razvi1, Debashis Chakravarty1,  1Indian Institute of Foreign Trade, New Delhi, India

Framework: Deficiencies in health systems can be overcome by significant reforms. Partnership with the private sector is a new avenue of growth. Existing literature looks at impact of economic freedom on trade deficits, FDI but impact on health indicators is missing.

Hypothesis: There is an significant relationship between economic freedom and health indicators in Indian states.

Methods: Data for 20 states of India from 2004 to 2012 used. Regression analysis evaluates impact of economic freedom on health expenditures, health infrastructure and health indicators across the Indian states.

Results: A definite correlation between economic freedom and health expenditures in Indian States.

0205 Where are women? Justice and Health Care in India todayArunima Deka1,  1OKD Institute of Social Change and Development, Guwahati, Assam, India

Despite recent improvements in the maternal health scenario in rural India, the country still remains challenged with very high maternal deaths. Institutional delivery, antenatal care, and postnatal care have been actively promoted by the State to deal with the situation. However, State policies are still incongruously geared towards addressing the issue without taking sufficient note of the various sociocultural impediments in the way of maternal health care. While the Right based approach towards health care fails to be widely accepted, can we move towards a Justice based approach to address the malice of public health in the country?

Cancer and Female Health

0066 Association between use of the urgent cancer referral pathway and cancer survival: national cohort studyHenrik Moller1,  1King's College London, London, UK

The overall survival impact of the urgent referral mechanism for patients with suspected cancer is not known. We estimated hazard ratios for death in 215,284 cancer patients in relation to their GP practice's propensity to use urgent referral. Use of the urgent referral mechanism was associated with reduced mortality. The

27% of cancer patients from GP practices with low use had a significant excess mortality (hazard ratio: 1.07; 95% CI: 1.05-1.08). The GP practices that currently have low propensity to use urgent referral could increase their use of it and hereby plausibly increase the survival of their cancer patients.

0098 Pregnancy termination for fetal abnormality: Health professionals' perceptions of women's coping processesCaroline Lafarge1, Kathryn Mitchell1, Pauline Fox1,  1University of West London, London, UK

Background: Understanding women's coping with pregnancy termination for fetal abnormality (TFA) is important for health professionals to deliver appropriate care. This study examined health professionals' perceptions of women's coping with TFA, and compared them with women's accounts of their coping processes.

Methods: Fifteen interviews with health professionals were analysed using Thematic Analysis.

Results: Themes common between the datasets included: support, acceptance, problem-solving, avoidance, meaning-making and another pregnancy. Insights into long-term coping were lacking.

Conclusions: Health professionals have a good understanding of women's short-term coping. However, the limited insight into women's long-term coping may have clinical implications.

0099 Comparison of  Effects of Plyometric and Isokinetic Exercises on Trunk Muscles in Premenopausal WomenKubra Alpay1, Safinaz Albayrak Yildiz2, Turker Sahinkaya2,  1Bezmialem Vakif University, Istanbul, Turkey, 2Istanbul University, Istanbul, Turkey

Objective: To compare the effects of plyometric and isokinetic exercises on trunk muscles in premenopausal women.

Methods:  Eighteen premenopausal women were included in this study and assigned into two groups: Plyometric Exercise Group, (n=10) and Isokinetic Exercise Group (n=8). Subjects performed exercise protocols  for 6 weeks. Muscle strength was measured using isokinetic dynamometer.

Results :  Muscle strength  increased significantly  at both groups.  Comparisons of differences before and after interventions showed that  IG had significantly improvement for trunk extensor (p<0.05).

Conclusion: Due to  increase in  strength, plyometric exercises  can be added to premenopausal women's exercise program as a preventive approach.

Patient Care

0048 Access to primary health care in Ontario: patient prespectives on barriers and reasons for use of walk in clinics and emergency rooms.Michael Green1,2, Liisa Jaakimainen2,4, Graham Reid5, Eliot Frymire1, Simone Dahrouge3,2, Karen Hall-Barber1, Rick Glazier2,4,  1Queen's University, Kingston, Ontario, Canada, 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, 3University of Ottawa, Ottawa, Ontario, Canada, 4University of Toronto,

Toronto, Ontario, Canada, 5University of Western Ontario, London, Ontario, Canada

From the past decade there have been major reforms to the delivery of primary healthcare in Ontario, Canada.    Despite this crude measures of access such as the proportion of patients reporting same or next day access have not changed significantly.  This paper will present results from 18 waves of the Primary Care access survey - a random dial survey of 2000 adults in Ontario quarterly from 2006-2010. Reported difficulties with accessing care,  use of walk in clinics and emergency rooms will be reported as will patient reported reasons for use of these services.

0115 The Well Visit Planner: Implementing A Patient-Centered Pediatric Quality Improvement Tool in Provider and Community SettingsChristina Bethell1, Michele Solloway1, Judith Shaw2, John Kilty3, Heather Fitzpatrick4, Samantha Simmons1, Katherine Cox1,  1The Child and Adolescent Health Measurement Initiative, The Johns Hopkins University, School of Public Health, Baltimore, MD, USA, 2University of Vermont, Burlington, VT, USA, 3Oregon Health & Sciences University, Portland, OR, USA, 4American Academy of Pediatrics, Elk Grove Village, IL, USA

Framework: The US recommends 18 well child visits between ages 0-6. These visits are short and often fall short of participants' expectations. Methods: The CAHMI created and implemented a free family-centered tool to engage parents in their child's healthcare and improve the quality and efficiency of health supervision visits. Results: We successfully implemented and tested the WVP in healthcare and community settings. Over 85% of parents reported that the WVP added value to their visit, helped prioritize their issues and would recommend the tool to others. Conclusion: The WVP is an effective tool for improving health supervision in the US.

0032 Developing systems to identify patient deterioration: recent workJim Briggs1, Caroline Kovacs1, David Prytherch1,2, Paul Schmidt2, Paul Meredith2, Gary Smith3,  1University of Portsmouth, Portsmouth, UK, 2Portsmouth Hospitals NHS Trust, Portsmouth, UK, 3Bournemouth University, Bournemouth, UK

We will describe our recent research to validate/improve the UK's National Early Warning Score (NEWS), developed by the Royal College of Physicians. This work includes:• an early warning score (EWS) devised from blood test results• how decision tree data mining techniques can be used to develop new EWS systems quickly • how aggregate EWS values are more important than high scores for a single vital signs parameter for discriminating the risk of adverse outcomes• whether observation selection methods are important when comparing EWS performance• EWS performance in admissions to surgery

UK Research

0212 Discriminatory practices faced by undocumented migrants in accessing health care in the UK and the NHS reformMichael Mavrommatis1,  1University Campus Suffolk, Ipswich, UK

This paper investigates the barriers undocumented migrants face in accessing

health care in the UK. Under the theoretical framework of social representations it studies the role of the media in creating an anti-immigrant sentiment reflected in exclusionary practices in GP surgeries. The study argues that that the NHS reform is in significant ways an apologist to pre-existing discrimination.

Methodology: Interviews with GPs publishing on migrants' access to health care, the Advocacy and Outreach Officer of the Doctors of the World, and a journalist reporting on health care; content analysis in the relevant literature and issues from high-circulation newspapers.

0208 Public policy and evidence-building: UK residential care for older peoplePauline McGovern1, Elizabeth West1,  1University of Greenwich, London, UK

The UK has an ageing population with increasing demands for social care and such an important area of public policy should be underpinned by high-quality evidence. We present a systematic review of academic studies of the quality of life of elderly residents of UK care homes. We used 1,169 citations from eight databases.

We find that there are few academic studies of UK residential care. Also, although Coalition policy has emphasised the importance of social enterprises as providers of public welfare services, we find no studies that contrast UK for-profit and not-for-profit providers of social care for the elderly.

0110 Disparity in training provision for healthcare assistants across NHS Trusts in England.Clare Aldus1, Marcus Barker2, Sophie Sarre3, Heather Wharrad2, Jill Maben3, Antony Arthur1,  1University of East Anglia, Norwich, UK, 2University of Nottingham, Nottingham, UK, 3King's College, London, London, UK

There is increasing recognition of problems with hospital care of older people across the NHS, including relational care (kindness, respect). Healthcare assistants (HCAs) provide much of that care yet training provision for HCAs is unregulated and under-researched.

A semi-structured telephone survey of English NHS Trusts was carried out (March-October 2014) to identify training provision for HCAs, including training in relational care of older people.

Trust responses (109/163(68%)) showed that training, mentorship and ongoing support is heterogeneous within and between Trusts.

High standards of care are expected NHS-wide but HCA training lacks the necessary resource, standardisation and quality control.

Sessions starting Saturday 9.00Research and Care Improvement

0068 Integrating Research, Training and Clinical Care: Experiences from Sydney, Australia

Mary MacLennan1, Wendy Lipworth2,1, Julie Johnson3, Terence Campbell1,  1University of New South Wales, Sydney, Australia, 2University of Sydney, Sydney, Australia, 3Northwestern University, Chicago, USABackground:  The University of New South Wales recently established four Academic Health Science Centres as part of the larger "Sydney Alliance for Healthcare, Research and Teaching" (SAHRT).Method: In-depth interviews were conducted with involved senior academics and clinicians.Results:  Overall, interviewees were optimistic about the potential of SAHRT as a vehicle to create a portfolio of collaborative research and funding and, to a much lesser extent collaborative teaching and clinical care.Discussion/conclusion: The results point to the importance of considering entrenched cultural norms and values, power relationships and structural considerations when establishing new alliances in settings where these are not well-known.

0008 Improving pre-operative assessment in ear, nose and throat surgery - A full cycle quality improment projectManuela Cresswell2, Rosie Cresner3, Donald McFerran1,  1Colchester Hospital University NHS Trust, Colchester, UK, 2Broomfield Hospital NHS Trust, Chelmsford, UK, 3Alder Hey Children's Hospital, Liverpool, UKTheory/Framework: Clear preoperative testing guidelines were published by NICE and ENTUK. Aim of this study is to assess compliance and improve it.Methods and hypotheses: Two-cycle audit with prospective data collection from case records. Findings of first cycle were presented to doctors ans nurses and poster with guidelines was displayed in the pre-assessment room.Results: 50 patients were included. 86% had American association of anaesthetists (ASA) grade I or II. 23 patients did not have formal pre-assessment.  Compliance with guidelines improved from 52% to 60%.Conclusions: Low attendance to pre-assessment clinics may relate to the low compliance with guidelines.

0143 Examining Patient Reported Outcome Measures (PROMs) in varicose veins proceduresSarah Onida1, Joseph Shalhoub1, Hayley Moore1, Karen Head1, Tristan Lane1, Alun Davies1,  1Imperial College London, London, UK

Background: Procedural satisfaction and quality of life are assessed by PROMs questionnaires distributed to individuals undergoing varicose vein intervention in England.

Methods: PROMs data from June 2009-July 2011 were extracted from the online Hospital Episode Statistics data warehouse.

Results: 35,093 patient episodes were identified. Quality of life scores improved with intervention(p<0.001). Self-reported anxiety of depression was prevalent in 24.1% of our cohort. Pre-operative scores relating to anxiety and depression were associated with post-operative success and satisfaction(p<0.001).

Conclusions: Pre-operative depression and anxiety levels and quality of life scores impact on patients’ perception of post-operative success and satisfaction following varicose vein intervention.

Public Health and Health Policy

0025 Doing health policy in European Union. The analysis of contextual determinants of cooperation between Poland and EUKinga Zdunek1, Teresa B. Kulik1,  1Medical University of Lublin. Faculty of Nursing

and Health Sciences. Public Health Department, Lublin, Poland

Despite the fact that the cooperation between Poland and EU is strongly formalized, important role is played by sociocultural factors. Based on the analysis, which used grounded theory approach and was supplemented by secondary research, we observed that in the process of Europeanisation the contextual determinants were of systemic and sociocultural character. The former group consists: legal and organisational factors, while the latter concerns elements such as: informal relationships, stakeholders actions, media impacts as well as patients and consumers attitudes. The network of informal relationships significantly affects the effectiveness of cooperation while individual patients and consumers had least noticeable impact.

0031 Priorities for self-management of long-term conditions in England: a qualitative investigation of commissioners' viewsEmma Boger1, Jaimie Ellis1, Anne Kennedy1, Sue Latter1, Fiona Jones2, Claire Foster1, Ian Kellar3, Claire Reidy1, Sara Demain1,  1University of Southampton, Southampton, UK, 2St Georges University of London and Kingston University, London, UK, 3University of Leeds, Leeds, UK

NHS commissioners are required to be proactive in supporting long-term condition (LTC) management (Imison et al., 2011). How commissioners prioritise this and which outcomes of support are valued is unknown.

Purpose: To understand how commissioners conceptualise and prioritise LTC self-management  and which outcomes of self-management support are valued.

Methods: Semi-structured interviews with commissioners (n=23).

Results Self-management was conceptualised as increased patient responsibility for health. Self-management support services competed with other commissioning priorities. Outcomes of services were process-focused (e.g. admissions reduction).

Conclusions Commissioners aim for population-focused services, a focus upon process may detract from outcomes which are meaningful to patients.

0033 Activated Patients Improve Outcomes and Lower CostsKaren Wolk Feinstein1,2,  1Jewish Healthcare Foundation, Pittsburgh, PA, USA, 2Pittsburgh Regional Health Initiative, Pittsburgh, PA, USA

The digitization of health information has enabled a new type of patient. We call them the activated patient. They have the motivation, knowledge, skills, and confidence to become engaged in their health care. Studies show that patients with high activation levels have improved outcomes and lower healthcare costs than those with low activation levels. This presentation will discuss the new patient-provider paradigm, its impact in flattening the traditional hierarchical patient-provider relationship, and ways we can support patients and providers in embracing the shift as a way to achieve better health outcomes at lower cost.

Big Data eHealth and Economics

0004 Greater excess risk of all-cause mortality and vascular events in women than in men with type 1 diabetes: a systematic review with meta-analysisRachel Huxley2, Sanne Peters1, Gita Mishra2, Mark Woodward1,  1University of Oxford, Oxford, UK, 2University of Queensland, Herston, Australia

Background Studies have suggested that the mortality rate associated with type 1 diabetes differs between women and men.  We performed a meta-analysis to provide the most reliable estimates of any sex differences in the effect of type 1 diabetes on risk of all-cause and cause-specific mortality.

Methods PubMed MEDLINE was systematically searched for all studies published between January 1, 1966 and March 24, 2014. Eligible studies had to have reported sex-specific estimates of the standardized mortality ratio (SMR) associated with type 1 diabetes either for all-cause mortality or cause-specific mortality. Random effects meta-analyses with inverse variance weighting were used to obtain sex-specific SMR and their pooled ratio (women:men) for all-cause mortality, and mortality due to coronary heart disease, stroke, cardiovascular disease, renal disease, cancer, and accident and suicide associated with type 1 diabetes.

Findings Data from 23 studies including 93,846 individuals and 6,434 events were included. The pooled ratio of the women: men SMR for all-cause mortality was 1.43 (95% CI: 1.19-1.72), for incident stroke 1.37 (1.03-1.81) and for renal disease 1.44 (1.02-2.05). For coronary heart disease events the sex difference was more extreme; the pooled ratio of SMR was 2.54 (95% CI: 1.80–3.60).  There was no significant evidence of a sex difference for mortality associated with type 1 diabetes from cancer, or from accident and suicide.

0207 Societal costs of diabetes mellitus in denmark according to gender, age and complication state in 2011- a register based study of all centrally available diabetes data.Camilla Sortsoe1,3, Anders Green1,2, Peter Bjoernholt Jensen2, Martha Emneus1,  1Institute of Applied Economics and Health Research (ApEHR),, Copenhagen, Denmark, 2Odense Patient data Explorative Network (OPEN), Odense University Hospital and University of Southern Denmark, Odense, Denmark, 3Centre of Health Economics Research (COHERE), Department of Business and Economics, University of Southern Denmark, Odense, Denmark

Diabetes attributable costs (DAC) by age, gender, education, complication progression are presented for RWE health, pharmaceuticals, nursing, productivity costs. All diabetes register person data were linked to cost data from 5 health/social registers. Complication groups were defined through National Hospital Register data. DAC reached 31.8 billion DKK in 2011 (107,000 DKK per PYRS). Steep increasing costs with increasing complications are evidenced across all components (health care 12 and nursing 33 times). The 25% of persons with complications consume 60% of resources pointing to secondary prevention. RWE helps evaluating cost-effectiveness of future efforts and burdens, and targeting specific groups.

0112 Usual blood pressure and risk of new onset diabetes: evidence from 4.1 million adults and a meta-analysis of prospective studiesConnor Emdin1, Simon Anderson1, Kazem Rahimi1,  1The George Institute for Global Health, Oxford, UK

Background: The relationship between systolic blood pressure (SBP) and risk of new onset diabetes is unclear.

Methods: A cohort of 4.1 million adults was assembled from linked electronic health records. Cox models were used to examine the relationship between usual blood pressure and diabetes.

Results: A 20 mm Hg higher SBP was associated with a 58% higher risk of new onset diabetes (hazard ratio 1.58 95% confidence interval 1.56, 1.59). No evidence of a nadir was observed. The strength of the association declined with increasing BMI.

Conclusions: Elevated blood pressure is associated with an increased risk of new onset diabetes.

Female Health

0043 Women's Attitudes towards the Medicalization of ChildbirthYael Benyamini1, Heidi Preis1, Uzi Dan2, Miri Gozlan2,  1Tel Aviv University, Tel Aviv, Israel, 2Maccabi Health Services, Rishon LeZion, Israel

Framework - women today can choose birth modes, from homebirth to cesarean delivery. Methods and hypotheses - a 16-item measure of women's attitudes towards the medicalization of childbirth was developed and tested with data from 836 pregnant and 129 non-pregnant women. Results - Attitudes towards the medicalization of childbirth did not differ between pregnant and non-pregnant and between primiparas and multiparas; they changed only along the first pregnancy. These attitudes were significantly associated with fear of birth, birth plans, and actual birth modes.Conclusions - understanding women's views of the medicalization of childbirth may be a key to understanding their choices.

0062 Knowledge, Attitude and Practice of Preconception Care Among Women of Reproductive Age in Alimosho Local Government Area, Lagos State.Yusuf Shittu1, Kofo Odeyemi1,  1College of Medicine, University of Lagos, Lagos, Nigeria

Theory: This study examines the knowledge, attitude and practice of preconception care among women of reproductive age in Alimosho area of Lagos, Nigeria.

Methods/Hypotheses: A cross-section of 400 women of reproductive age was coopted for interview using multi-stage sampling technique.

Results: Only 30.5% of the women had heard of preconception care, even less(21.4%) defined it correctly. Most respondents demonstrated a good attitude despite poor practice(84.4%). Also, increase in knowledge resulted in significant increase in positive attitude and practice. [p<0.05]

Conclusion: This study demonstrated the poor level of awareness and practice of preconception care amongst the participants despite their positive attitude.

0003 Down with Masculinity: the need to rethink the social determinants of men's healthJohn Macdonald1,  1University of Western Sydney, Penrith, NAW, Australia

Until recently "men's health" has concerned itself with male-specific clinical pathologies like prostate cancer or social pathologies of men- their reluctance to attend the doctor, their diffidence in talking about problems etc. The sad incidences of male violence have ensured that this phenomenon is almost the starting point for reflection and action on men's health. "Masculinity", hegemonic or otherwise, is seen to be at the root of much male ill-health and of course, that of women also.

At the same time, the scholarship on the social determinants of populations has grown apace. WHO has contributed a lot to this broadening of the bio-medical perspective to include the importance of contexts like the social gradient and social

inclusion/exclusion in understanding health in general.

This perspective has not often been applied to men and we remain, globally, with medical preoccupations (important in themselves) and a Western exported understanding of men and their health based on a deficiency model born from western feminism thinking and practice.

The time has come to challenge this paradigm by simply applying a social determinants of health approach to boys' and men's health. Otherwise the shocking revelation by WHO that there is a difference of over 20 years in terms of life expectancy for men in one suburb of Glasgow, Scotland and those in another is going to be attributed to "masculinity". The irrationality of this calls for a rethink of the social determinants of men's health. Based on an Australian experience, this paper will take a global perspective.

Sessions starting Saturday 10.20Health Economics / Older Age

0014 On Death and Dying: Changing Expectations and Outcomes for Care at End of LifeNancy Zionts1,  1Jewish Healthcare Foundation, Pittsburgh, PA, USA, 2Colaition for Quality and End of Life, Pittsburgh , PA, USA

In the U.S., 32% of Medicare spending is on patients in their last two years of life. While 70% would prefer to die at home, only 25% actually do. The healthcare system too often fails families and patients at end-of life, presenting emotional, physical and financial burdens. But other realities are possible.  This session will explore how Closure -- a model of enhanced health professions training (medical, legal, social, cultural-familial and spiritual aspects of death and dying), advanced care planning, and frank discussions about death and options (e.g., hospice and palliative care) can change practice, patient experience and costs.

0150 Health Care Expenditure in the Last Year of LifeWorawan Chandoevwit1,2, Tirnud Paichayontvijit2,  1Khon Kaen University, Khon Kaen, Thailand, 2Thailand Development Research Institute, Bangkok, Thailand

The elderly in Thailand are under either the Civil Servant scheme (CS) or the Universal Coverage scheme (UC). Both schemes pay inpatient care using the DRG system. The rate of payment per one adjusted RW is lower for the UC.

Hypothesis: Elderly under the CS scheme have higher health care expenditure (HCE).

Data include 336,537 elderly who were admitted between 2007 and 2011. The elderly in the UC scheme have a shorter life. Using log-linear regression, the results show that HCE in the last year of life among CS elderly are 13 percent higher than UC elderly.

0142 Labor supply decision and mental health: Does retirement matter?Ruozhi Xu1,  1Hong Kong University of Science and Technology, Hong Kong, Hong Kong

Retirement is one of the main life course shocks that faced by individuals and households. Studying impacts of retirement is important for labor force participation and policy maker. Using CHARLS 2011 and 2013 wave data, the study adopts fuzzy regression discontinuity (RD) design and an instrumental variable (IV) "eligible for mandatory retirement age" to establish causal effects of retirement on multiple mental health outcomes among Chinese elderly. Preliminary results indicate that, for subjective outcomes, retirement has significant negative effects on life satisfaction among men. For cognitive abilities, retirement has delay negative effects on episodic memory for women.

Mental Health and HIV

0044 Rethinking our understanding and application of autonomy and human dignity in the context of demented patients' care-taking - a Multicultural Perspective.Miriam Bentwich1, Amitai Oberman2,1, Nomy Dickman1,  1Faculty of Medicine, Bar-Ilan University, Safed, Israel, 2Padeh Medical Center, Poriya, Israel

Treating patients with dementia triggers questions regarding the extent to which their autonomy and human dignity can be respected. However, much of the literature in this area represents a Western-liberal perspective. We present the results of a mixed-methods study, based on interviews and questionnaires administered to nurses, social workers and other professional caretakers from three main cultural groups in Israel: Arabs, Jews born in Israel and migrants from Russia. Our results show differences between these groups in interpreting human dignity and autonomy, while suggesting significant possible extensions to the application of both concepts in the care-taking of demented patients.

0218 The International AIDS Vaccine Initiative's capacity building activities in East AfricaGavin Cochrane1, Enora Robin1, Joanna Chataway1,  1RAND Europe, Cambridge, UK

The International AIDS Vaccine Initiative is a Product Development Partnership created to bridge the gap between scientific potential and the health needs of populations in low and middle income countries. Its capacity building activities aim to strengthen the ability to conduct clinical trials, spanning scientific and technological capacity but also organisational, advocacy and broader development capabilities to encourage research use in HIV policy. Our study used a multi-method approach, combining desk-based research and fieldwork in Kenya, Rwanda and Uganda to understand the impact of IAVI's capacity building activities on HIV research uptake in policy at a national and regional level.

0101 The costs of HIV care using layworker support in in sub-Saharan Africa: a case-study from TanzaniaGodfather Kimaro1,3, Victoria Simms2, Sokoine Kivuyo1, Jaffar Shabbar2, Godfrey Mfinanga1, Amos Kahwa1, Lorna Guinness3,  1National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania, 2Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK, 3Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK

We evaluated the cost implications of adding community-based layworker support to the first weeks of HIV care in order to reduce the high mortality rate evident in this period. We used an ingredients approach to cost HIV services at the individual level. The mean annual per patient cost was US$ 519 (95%CI, 498 - 541) with layworker support costing $42.46/ patient (95%CI 38.49 - 46.47). These data fill an important gap in the evidence of the costs of the HIV programmes.

Information and Public Health

0019 Willingness of future A/H7N9 influenza vaccine uptake, Hong KongCalvin KY Cheng1, Greta Tam1, Zhe Huang1, Poyi Lee1, Emily YY Chan1,  1Chinese University, Hong Kong, Hong Kong

We conducted a cross-sectional population-based telephone survey between 15 and 28 February 2014 in Hong Kong during the second wave of influenza A/H7N9 outbreak to delineate the willingness of future A/H7N9 vaccine uptake and factors affecting their choices. We found half of the respondents were willing, which was independent of demographic factors. High anxiety level and a vaccine history were associated with willingness to uptake future A/H7N9 vaccine.  Understanding the willingness of A/H7N9 influenza vaccine uptake in the community help policy makers to decide suitable strategies to control the re-emerging of this influenza virus.

0084 Managing Fearbola - a public relations perspective on Canada's travel VISA restriction in response to the Ebola outbreakYun-Ju Song1, Alexandre Sevigny1,  1McMaster University, Hamilton, Ontario, Canada

Canada imposed a travel VISA ban to 3 Ebola stricken countries in November of 2014. The ban is a direct violation of the International Health Regulation. This multiple case study research explores public relations paradigms to managing Ebola. By promoting dialogical communication, PR are crucial to relationship building, reputation maintenance, and crisis response in public health. This research can be used to critically appraise past responses towards SARS, H1N1, and other infectious diseases in terms of its appropriateness to issues management. It also highlights PRs contribution to building better diplomatic relations in an increasingly collaborative environment of global private-public partnerships.

0061 Frameworks of Patient Empowerment- A reviewAisha Umar Akeel1, Darren Mundy1,  1University of Hull, Scarborough, UK

The presence and increase of challenges to ehealth in today’s society have begun to generate doubts about the capability of patient empowerment especially with the frameworks. Through the review of existing frameworks and articulation of patient demands, weaknesses in current structures to support empowerment are explored, and key constituents of a framework for patient empowerment are determined. This paper argues that existing frameworks for patient empowerment in the healthcare system, although well intentioned, are insufficiently constituted, as they are fragmented. System theory concepts such as holism and iteration are considered vital in improving patient empowerment framework.

Research and Incentives

0095 The COHRED Fairness Index for ethical and equitable research collaborations to address health needs in low and middle-income countries.Najia Musolino1, Carel IJsselmuiden1, Janis Lazdins1, Jacintha Toohey2,  1Council on Health Research for Development, Geneva, Switzerland, 2Council on Health Research for Development, KwaZulu Natal, South Africa

Global support for health in low middle-income countries has resulted in many improved products and services, but has not substantially improved the systems that countries need to conduct or partner research and to translate results into effective policy and practice. The COHRED Fairness Index developed through a multi-sector consultation involving a Technical Working Group proposes a certification scheme for best practices in international collaborative partnerships in research for health. The added values of its implementation will be to improve the alignment of interests of all partners in global health research, to reduce inequity in health and ultimately stimulate socio-economic development.

0094 Contextual factors associated with the utilization of rapid response mechanisms for urgent decision-making research evidence needsRhona Mijumbi1, Nelson Sewankambo1,  1Makerere University, Kampala, Uganda

There is a drive to scale up rapid response mechanisms in low and middle income countries, following pilots that have shown the feasibility of this innovative strategy aimed at meeting urgent research evidence needs for policy and decision-making. Using process evaluation methods informed by the theory of planned behavior, we determined the contextual factors associated with the utilization of such mechanisms. The mechanism’s objectives, operational procedures, target clientele and products are some of the categories under which we identified associated factors.

0067 Do user fee exemption policies for maternal health services work? Studying the impact of Free Delivery and Caesarean Policy in Senegal.Divya Parmar1,  1City University London, London, UK

This study investigates the impact of a user fees exemption policy (Free Delivery and Caesarean Policy, FDCP), introduced in 2005-06 in Senegal. We study the impact of FDCP on facility-based deliveries, caesarean births and antenatal care. Using household surveys covering a period from 2003 to 2009, multivariate logistic regressions are conducted to study the impact of FDCP across different groups based on their socio-economic status, place of residence, ethnicity and mother's education. Although FDCP substantially increased utilisation of maternal healthcare services; this increase was not equitable. Efforts to improve access among the most vulnerable groups need to be strengthened.

Children and Public Health

0040 Breastfeeding Experiences among a group of Thai adolescent under 16 year old mothers in Suphanburi province, ThailandWilawan Dhanawan1,  1Boromarajonani College of Nursing Suphanburi, Thailand., Suphanburi, Thailand

The adolescent mothers maybe had stressful events, that are challenging for health care providers. This study was to explore breastfeeding experiences in a group of Thai adolescent under 16 year old mothers. A Qualitative Study was used. The purposive of 14 adolescent mothers who had had experiences of breastfeeding participated. Individual perspective by adolescent mothers and breastfeeding supporting are two mains themes with three categories emerged from the text. The adolescent mothers consider great and more self esteem when they had breastfeeding to the babies. Positive support from family and nurses can be encouraged adolescent mothers to successful in breastfeeding.

0085 Three-wheeler motor van (Mom's Van) for emergency transporation for women with obstetric complications in rural Bangladesh.Nazmul Alam1,  1Université de Montréal, Montreal, Quebec, Canada

Poor transportation directly and indirectly contributes to high maternal mortality and morbidity in low and middle-income countries by limiting access to care for maternal emergencies. We have conducted a feasibility study of three-wheeler motor ambulance (Moms van) intervention in rural Bangladesh. We have collected data from survey, key informant interviews, focus group discussions and chart abstraction of log books. Poor transportation and related cost were reported as key barriers to seek care during pregnancy and delivery. Mom's van intervention created huge positive response in the community and its business model of limited income generation was found to be financially feasible.

0226 The development of the Economic impacts of Smoking in Pregnancy (ESIP) model for measuring the impacts of smoking and smoking cessation during pregnancyMatthew Jones1, Sarah Lewis1, Steve Parrot2, Murray Smith1, Tim Coleman1,  1University of Nottingham, Nottingham, UK, 2University of York, York, UK

Smoking in pregnancy a major cause of morbidity and mortality, and a significant cost burden to the NHS. However, at least 12% of all mothers report smoking throughout pregnancy. While interventions have demonstrated effectiveness, the economic literature on cessation during pregnancy is underdeveloped, failing to take into account both the within-pregnancy effects of smoking and the long term impacts for both the mother and her child. ESIP captures both the within-pregnancy for mother and child, with extensions for the remaining life of the mother and the infant's childhood, hence producing better estimates of the cost-effectiveness of the cessation interventions.

Sessions starting Saturday 11.20

Care and Patients

0238 Improving the safety and continuity of medicines management at care transitionsGerry Armitage1,  1University of Bradford, Bradford, UK, 2University of Leeds, Leeds, UK

As part of our ‘Improving safety and continuity of medicines management at care transitions’ (ISCOMAT) programme, we updated a systematic review of the effectiveness of interventions to reduce discontinuity.  We identified 13 RCTs published in the three years since the original review. Rigorously evaluated trials were uncommon, but in those with a measurable impact on health outcomes, interventions were multifaceted. They involved multiple points in the patient journey, repeated contact with health professionals, and structured communication. This paper considers the implications of these findings for patient involvement and evaluation of existing systems as part of a novel research design

0167 “The moment you come out of hospital you’re on your own.” Cardiology patients' social networks for medicines management.Beth Fylan Gwynn1, Gerry Armitage1, Alison Blenkinsopp1, Deirdre Naylor0,  1University of Bradford, Bradford, UK

Medicines management is a system that supports patients’ medicines use. Patients experience greater risk from their medicines when their care is transferred following hospitalisation, often due to poor medicines management. Using phase 1 of a Social Network Analysis (SNA), sixty semi-structured interviews explored professional and lay medicines management functions. Transcribed interview data were analysed thematically. Network functions were identified as: supporting medicines use; medicines orientation; and health condition management. Patients experienced safety incidents as a function of their networks through communication failures and supply errors. SNA can reveal valuable insights into the quality and safety of primary care medicines management.

Ethnicity and Migrants

0173

0240

Ethnicity, health service delivery and engagementSabrina Gupta1,2, Rosalie Aroni1, Helena Teede1,  1Monash University, Melbourne, Victoria, Australia, 2La Trobe Unversity, Melbourne, Victoria, Australia

A cultural competence framework underpinned this study.

Aim: to explore views of South Asians (SA) and Anglo-Australians with type 2 diabetes and/or cardiovascular disease (CVD) of their relationships with health professionals and the Australian health care system.

Methods: Audio recorded in-depth interviews were conducted with SAs and Anglo-Australians with type 2 diabetes and/or CVD in Australia. Thematic analyses were performed.

Conclusions: SA participants perceived a lack of cultural competence, knowledge and understanding amongst their treating clinicians producing disillusionment and disengagement with their health practitioners and the health system. This contrasts with the perceived engagement of the host population.

Thematic Study on cost-analysis of health care provisions to migrants and ethnic minorities - Preliminary resultsAnna-Theresa Renner, Ursula Trummer, Sonja Novak Zezula, Ina Wilczewksa1

1Center for Health and Migration, Vienna, Austria

Access to health care in most countries is connected to certain preconditions like insurance or citizenship. Ongoing debates argue that exclusion may cause "forced emergencies" resulting in higher costs than timely treatment. In this thematic study, commissioned by the International Organization for Migration, the costs of providing primary care versus hospital care to irregular migrants in four European countries were investigated using a vignette approach. The preliminary results of the micro-costing exercise from three perspectives (patient, third party payer, society) depict that particularly the third party payer could benefit from inclusion of irregular migrants in the health care system.

Distance and Travel

0202 Health-Related Constraints to Travel among Older AdultsBob Lee1,  1Bowling Green State University, Bowling Green, Oh, USA

As baby boomers grow into advanced age, it drives a large portion of older population to express their leisure on the road.  Older adults rated travel as the number one choice of retirement activities. However, to be able to travel for pleasure, many of them must negotiate health-related constraints.

The purpose of this study is to identify health conditions that may intervene seniors’ travel.  Data was collected through interviewing 206 older adults during the years of 2012-2013. The respondents’ health status was measured and analyzed within SPSS. Result identified key variables that may help to explain why seniors not travel.

0184 The effect of home to hospital travel time on 30day mortality after PCI in STEMI patients in the Lazio region (Italy)Riccardo Di Domenicantonio1, Giovanna Cappai1, Valeria Belleudi1, Paolo Sciattella1, Francesca Mataloni1, Mariangela D'Ovidio1, Mirko Di Martino1, Roberto Ricci2, Carlo Alberto Perucci2, Marina Davoli1, Danilo Fusco1,  1Department of Epidemiology of the Regional Health Service , Rome, Lazio, Italy, 2Local health authority Roma E, Rome, Lazio, Italy

OBJECTIVES: To evaluate the relationship between travel time from home to hospital and 30¬day mortality after percutaneous coronary intervention (PCI) among patients with STEMI. METHODS: A cohort of STEMI patients who underwent PCI in the Lazio Region were selected using administrative data. Travel time from census block to hospitals were calculated using geographic information system. RESULTS: Travel time of 20 or more minutes versus travel time equal to 0¬19 minutes was associated with mortality in 0¬89 minutes cohort (OR=2.29; IC: 1.07¬4.90). CONCLUSIONS:Travel time affects 30¬day survival, its utilization could contribute to better estimate patient's mortality risk in hospitals outcome evaluation.

Mixed - Pain and Intervention

0200 Inequalities, Blind Spots and Lack of Evidence: Rethinking Interventions to understand a Public Health of DisabilityMaria Berghs1,  1University of York, York, UK

We no longer perceive disability as a distinct category but understand it as more encompassing, affecting anyone, including those with pre-existing chronic conditions and mental health problems. This is why current international understandings are moving away from a strictly medical definition to one more in tune with how people experience disability in their day-to-day life. Public health research has been slow to accommodate these shifts. The use of inappropriate definitions and measurement tools-with disability represented in terms of cost, risk or burden-along with a more general struggle to accommodate diverse social experiences, make it difficult to provide evidence on successful interventions.

0214

Diabetes

0035

Describing the characteristics, treatment pathways, outcomes and costs of people with chronic non-cancer pain managed by community pain clinics in Nottingham and generating an indicative estimate of cost-effectivenessSaja Almazrou1, Shiekha Alaujan1, Roger Knaggs1, Rachel Elliott1,  1University of Nottingham, Nottingham, UK

Community pain clinics (CPC) are considered to be a rational option to manage musculoskeletal pain (MP). Knowing that these services are resource intensive, evidence is needed to demonstrate their cost effectiveness (CE). This study aims to describe the management of patients with musculoskeletal pain in Nottingham CPC to derive an indicative estimate of CE.

We will collect data from eligible patients on health outcomes and resource utilization at baseline, three and six months later. Resource use collected by costing diaries will be compared with electronic records. Finally data derived from the previous stages will be integrated in a decision model.

Type 2 diabetes diet as a determinant of the quality of life. A Polish perspectiveRenata Bogusz1, 1Independent Medical University of Lublin, Lublin, Poland

Quality of life as sociomedical indicator of health reflects the treatment results and patients expectations. Type 2 diabetes which is becoming epidemic of 21st century requires both: treatment and radical changes in lifestyle. The goal of the study was to analyse the relationship between type 2 diabetes diet and the quality of life. An opinion poll was conducted and an original standardized questionnaire was used in the group of 127 patients. Although respondents were aware of the need of appropriate diet they did not adhere it. The highest level of quality of life was directly proportional to adhering strict diet.

Sessions starting Saturday 14.20Care and Death

0016 Dying for Change: An Examination of the affects of Hopice Programs in the US Penal SystemKori Novak1,  1The Mellivora Group, Lititz, PA, USA

The number of individuals living their lives within the U.S. penal system has increased substantially. Convicted offenders are receiving longer sentences and being sent to correctional facilities at older ages. This has created issues specifically healthcare issues and healthcare costs for aging offenders. This study employed qualitative measures through case studies to examine how end-of-life programs affect prison cultur. The researcher hypothesized there would be a significant affect on prisons with hospice units. While the effects are more difficult to ascertain in inmate populations, it was determined a culture shift occurred within the administration in conjunction with a hospice program.

0151 Grief experiences of older and young workers: Implications for workplace bereavement policyFrank Eyetsemitan1,  1Roger Williams UNiversity, Bristol Rhode Island, USA

Levels of attachment to the deceased and employers' reaction to loss experience were explored for older and young workers. 145 volunteers participated; 35 were forty years and over while 109 were thirty-nine years and under. Ages ranged from 18-65 years (M=30.95)--67% females and 33% males.  "Relationship of Community" type of loss was experienced mostly by young employees while "Relationship of Attachment" type of loss mostly by older employees. No difference however for both groups, in number of paid days given off work for mourning.  Workplace bereavement policies should consider employees' age and attachment types in developing workplace bereavement policies.

Mental Health, Alternative Medicine

0058 Why people believe in alternative medicine

Helena Matute1, Fernando Blanco1, Ion Yarritu1,  1Deusto University, Bilbao, Spain

Framework: People preferring alternative medicine over evidence-based medicine are increasing. This is a public health problem. We propose this requires understanding how people attribute causes to effects. Method: Students estimated the effectiveness of a drug that was administered to fictitious patients. Most patients recovered, regardless of whether they took the drug. Variables that might affect the illusion that it was working were tested.Results: An illusion that the pill was effective was observed. In addition, some strategies were found that reduced this illusion.Conclussion: These strategies could be used in campaigns to reduce the illusion that alternative treatments are effective.

0089 Self-Balancing Sanctuarying:  A Classical Glaserian Grounded Theory of Relaxation and Autogenic Training for Generalized AnxietyRuth T Naylor1, Sue Holttum2,1,  1British Autogenic Society, London, UK, 2Canterbury Christ Church University, Canterbury, UK

Aims: elucidate how Relaxation and Autogenic Training work; develop clinical practice recommendations; influence access to relaxation therapies throughout the NHS.

Data: forty-six interviews, thirty-four diaries; non-anxious community volunteers and moderate-severe anxious clients of AT therapists. Classical Glaserian grounded theory analysis methodology determined participants' main concern (self-balancing) and how this concern was resolved (sanctuarying).

Theory: 3 switching strategies; restorative benefits enable and maintain allostatic balance, integrate/strengthen the core self, connect people to community, expand self-discovery, and develop character.

Adds: a grounded perspective to the spiritual well-being debate; theoretically situates and/or challenges extant descriptive/conceptual models of Relaxation and AT.

Care Trajectories, Psychology

0206 Exploring Healthcare Trajectories and Their Analytical Value in Assessing Effects of Healthcare Interventions and Development ProcessesProochista Ariana1, Marco Haenssgen2,3,  1University of Oxford, Nuffield Department of Medicine, Oxford, UK, 2University of Oxford, Department of International Development, Oxford, UK, 3Hertford College, Oxford, UK

It is widely accepted that health-seeking behaviour is neither limited to nor terminated by access to one single healthcare provider. However, interventions aiming at promoting healthcare access tend to focus on a narrow range of mutually exclusive behaviours, potentially disregarding the complexity of people's healthcare-seeking trajectories. Using a simple survey instrument, descriptive statistics, and sequence analysis, we explore 119 unique healthcare trajectories among 637 respondents in rural India and China. The emerging patterns do not only reveal locational and socio-demographic healthcare idiosyncrasies, but also yield deeper insights into development processes than a conventional emphasis on "access to formal healthcare" would.

0109 Review of evidence about occupational health in palliative medicineAsta Medisauskaite1, Caroline Kamau1,  1Birkbeck, University of London, London, UK

Theory: There are risks to the occupational health of doctors who work in palliative medicine because of the regular experience of patient death and grieving families.

Methods: We use PRISMA guidelines to systematically review quantitative articles. To date, the systematic review is at the end of the first search stage and will be completed for discussion.

Results: The presentation will discuss the data extraction and synthesis, identifying the most frequent occupational health outcomes of working in the end-of-life care.

Conclusion: Understanding the occupational health problems caused by working in palliative medicine will help us plan and deliver appropriate intervention programmes.

Patient Outcomes

0190 Short Generic Patient-Reported Quality MeasuresTim Benson1,2,  1R-Outcomes Ltd, Newbury, UK, 2UCL, London, UK

Current regulatory and governance processes fail to assure quality. We do not routinely track and provide feedback on changes in patients’ health status, engagement and experience.

We have developed and tested a new generation of short generic patient-reported measures, howRu (health status), howRwe (experience) and HCS (health confidence score measuring engagement). These have proven effectiveness across health and social care using a range of collection and reporting methods.

The challenge now is to collect this type of outcome measure at scale in routine care, and to provide feedback dashboards for patients, commissioners, providers and professionals.

0080 The anchoring vignette approach: can survey design improve response consistency and vignette equivalence?Rachel Knott1, Mark Harris2, Nigel Rice3, Bruce Hollingsworth4, Paula Lorgelly1,  1Monash University, Melbourne, Victoria, Australia, 2Curtin University, Perth, WA, Australia, 3University of York, York, UK, 4Lancaster University, Lancaster, UK

The anchoring vignette approach is used as a method to identify systematic differences in the use of categorical response scales (differential item functioning, DIF) in self-assessments of health.  This study contributes to the design and validity of the approach by examining whether survey design can enhance adherence to the assumptions required for the method to adequately identify DIF.  Using online survey responses (N=1782) we find that 'priming' respondents by switching the usual order of the survey such that the vignette evaluations are undertaken before self-assessments increases assumption adherence, while the degree of vignette complexity does not appear to influence assumptions.

POSTER PRESENTATIONS

0020 Searching Cost-Effectiveness of Laboratory Processing on Infectious Diseases Sector in Crete AreaEliona Gkika1, Anna Psaroulaki1, Yannis Tselendis1,  1University of Crete, Faculty of Medicine, Heraklion, Crete, Greece

The study is associated with laboratory cost and especially with managing infectious diseases analysis procedures. It aims toward control of cost with respect to hospitalized patients who are under treatment for infectious diseases. Can we reduce hospital expenditures offering at the same time high quality health services to “infected” patients?

Focused on a list of 31 syndrome based pathogens, laboratory data from 8 public Hospitals of Crete region were analyzed for a period of 3 years. Application of multiple criteria approaches on both quantitative and qualitative data, high correlation between samples analyzing process, patient therapy and hospital expenses was achieved.

0028 Self-rated health and its relation to marital breakup and relationship-status in later adulthoodBina Knöpfli1, Stéphane Cullati2, Delphine Courvoisier2, Claudine Burton-Jeangros2, Pasqualina Perrig-Chiello1,  1University of Bern, Bern, Switzerland, 2University of Geneva, Geneva, Switzerland

This research examines the impact of relationship-status and marital breakup on self-rated health (SRH) by taking into account intrapersonal and social resources. Data stem from a Swiss-based survey of 1355 participants aged 40-65 years. Three groups are compared: continuously married (n=399), single divorcees (n=532) and repartnered divorcees (n=424). Results underline the positive effect of an intimate relationship on SRH. Our results suggest further that personality traits and social resources are significant predictors of SRH, whereas age and duration of ex-partnership were not related to SRH.

0030 The road to defining preference-sensitive careJudit Zsuga1, Klára Bíró1, Gábor Bányai1,  1University of Debrecen, Hungary

Preference-sensitive care refers to care scenarios in which there are significant tradeoffs among the available options, therefore the rate at which they are delivered is sensitive to, or in part depends upon the patient or the provider's preference. In the era of evidence based medicine however health professionals are inclined to base treatment decisions on the recommendations of practice guidelines. As these guidelines are based solely on the clinical evidences acquired in clinical trials they lack information on possible trade-offs. Based on the accumulated literature, methodological aspects for defining preference sensitive care will be overviewed.

0038 Translating Evidence into Safer Practice: Review of Codeine Use in Paediatrics in a Tertiary Hospital in SingaporeKae Shin Lim1, Jamie Stephanie1,  1KK Women's and Children's Hospital, Singapore,

Singapore

Reports of fatal respiratory depression in children taking codeine preparations triggered safety concerns on its use. The Pharmacy and Therapeutics (P & T) committee of KK Women's and Children's Hospital (KKH), Singapore evaluated safety data on codeine in children, including pharmacokinetic data and recommendations from various healthcare agencies. Consequently, codeine was contraindicated in those below 12 years old, with an alert set in the system to discourage prescribing in this population. Since then, there have been no codeine prescriptions or orders for this age group. This initiative details the implementation of a hospital policy based on evidence.

0042 Psychophysical adaptation of emergency patients 30 days after admissionLukas Faessler1, Philipp Shuetz1,  Beat Mueller1, Pasqualina Perrig-Chiello2,   1University Department of Internal Medicine, Aarau, Switzerland, 2Institute of Psychology, Berne, Switzerland

Framework: Little is known about how patients adapt psychophysically after being admitted to an emergency department. This study aims at identifying classes of adaptation in terms of psychophysical outcomes in emergency patients 30 days after admission. Method: Data of a representative sample of adult emergency patients (N=1575) with acute medical conditions are presented. Exploratory latent class analyses based on psychophysical variables (e.g. psychological distress, subjective health) are used to explore different patient profiles. Between-class differences are estimated on covariates (e.g. diagnosis, adverse medical outcomes). Conclusion: Results are discussed referring to design prevention and intervention strategies.

0107 Nursing Students' the Causes of Profession Selection and Perceptions of Nursing: A Quantitative And Qualitative AnalysisDilek Öcalan1, Ayşe Koyun1,  1Afyon Kocatepe University, Afyonkarahisar, Turkey

The purpose of this research is to examine student's opinion about the nursing profession and the reasons for choosing. Both quantitative and qualitative research methods were used. This study was conducted at Afyon Kocatepe University, Nursing Department between 01.03.2014 and 30.03.2014. The 250 students participated in the quantitative research and 24 students participated in the qualitative research. The focus group interviews were conducted with four groups. Reasons for choosing the profession of nursing students are easy to find work and love the profession. Female students' views on nursing are more positive. Projects should be increased for nursing education and promotion.

0114 Knowledge and attitude towards breastfeeding during Ramadan among women in Najran, Saudi ArabiaHatem Mohamed1,2, Stephen Handsley1, Eid Brima3, Abdullah Shawl2, Parvez Haris1,  1De Montfort University Leicester, Leicester, UK, 2Najran University, Najran, Saudi Arabia, 3King Khalid University, Abha, Saudi Arabia

The objective of this study was to assess the attitude of women in Najran City surrounding breastfeeding during the month of Ramadan.  We tested the hypothesis as to if women consider breastfeeding whilst fasting during Ramadan is acceptable. A questionnaire was completed by 169 women.  The majority of the women showed positive attitudes towards breastfeeding.  They were more likely to breastfeed during the month of Ramadan although some were unsure. Most women disagree that fasting can alter the composition of breast milk. Health care providers need to provide support and advice to women regarding breastfeeding during the month of Ramadan.

0157 Experience of life in patients with heart failureGulcan Bakan1, Asiye Durmaz Akyol1,  1Pamukkale University, Denizli, Turkey

Framework: To explore beliefs, behaviors, experiences of dealing with the condition, and adaptive strategies of patients with heart failure

Methods: Individual Diagnostic Form and semi-configured Interview Form were used to collect data from 21 patients. All interviews with patients were done face-to-face by using the in-depth interviewing technique.

Results: Three main themes and fifteen sub-themes were created that related to the life experience. Poor points to cope with the diseases were found.

Conclusions: When the nurses received a patient’s report with information on the patient’s mental, physical and social status, nurses could contribute to creating a safe and secure environment.

0177 Enhancing health resilience in the built-environment for the elderlyRipin Kalra1,  1University of Westminster, London, UK

The paper will focus on the particular needs of the elderly and the infirm within the built-environment (our public spaces and buildings) The elderly are most vulnerable in the context of chronic stresses in the built-environment such as environmental pollution, thermal stress, energy shortages, location and condition of health services, climate variability.

The paper will explore to what extent health and care sector frameworks commonly applied within the health-care services are also adaptable as a design tool for the built-environment in promoting healthy living and quality of life for the elderly and infirm.

0204 Papillary Thyroid Cancer. Hashimoto's Thyroiditis, Adenomatoid Hyperplasia. Do They Have Any Connection?Mariam Khachatryan1, Levon Mkhitaryan1,  1Yerevan State Medical University, Erebuni Medical Center, Yerevan, Armenia, Armenia

During the period of 2010-2014, 183 patients were operated on with papillary thyroid cancer (pathohistologically diagnosed too) in the clinic of general and endocrine surgery of "Erebuni" MC. 34 of the mentioned patients (18.6%) were diagnosed with Hashimoto's thyroiditis as a premorbid status, another 51 (27.9%) had adenomatoid hyperplasia as a premorbid status while for the 98 of the patients (53.5%) papillary thyroid cancer was identified de novo. 74 (40.4%) of the patients were below 40 years old while 109 (59.6) were under 40.

0209 Challenges and Enablers of using Cluster-Randomised Stepped Wedge Research Designs in a Domiciliary Aged Care ContextMohammadreza Mohebbi1,2, Goetz Ottmann1,2,  1Deakin University, Melbourne, Australia, 2The Encouraging Best Practice in Residential Aged Care Program (Australian Government Department of Social Services), Victoria, Australia

Objectives: To evaluate a CDC model to suit the needs of older people in CALD communities in Victoria.

Background: Cluster-Randomised Stepped Wedge (CRSW) designs are a relatively novel feature in the field of domiciliary aged care. Yet CRSW designs can create considerable challenges in terms of methodological integration, implementation, and analysis and practitioners should be aware of these in order to take the necessary steps to deal with them should they occur.

Methods: While CRSW designs present the opportunity for a full integration of qualitative methods, there is a gap in the current research literature as to how to achieve this in a methodologically robust manner. Methodological questions regarding how the staggered nature of the CRSW can be integrated with previous or subsequent qualitative methods (that may not

be staggered) need to be explored in greater detail.

Conclusion: CRSW designs can be successfully used within a domiciliary aged care context and can be integrated into mixed method design. However, careful planning is required to accommodate methodological, analytical, and practical challenges.

0220 A method for the screening of residual solvents in pharmaceutical control.Francesca Pettinau1, Barbara Pittau1,  1Consiglio Nazionale delle Ricerche, Istituto di Farmacologia Traslazionale UOS Cagliari, Pula (Ca), Italy

To determine the quality of medicinal products a GC/MS method for the screening of residual solvents (class 1, 2) has been developed. These solvents permit an initial screening of pharmaceuticals in tablets involved in equivalence assessment. The proposed method uses a generic capillary column (utilized for the other assays involved in the equivalent assessment between pharmaceutics), and a cheap headspace sampling preparation. Moreover the analysis time has been optimized using fast temperature ramping. This application permits to achieve a considerable gain in laboratory productivity and a reduction in time and money.This work has been supported by grant L.R. 7/2007 RAS.

0232 Health outcomes of fathering involvementLigia Santis1, Elizabeth Barham1,  1Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil

Father involvement is important for family wellbeing. We present a systematic literature review, conducted in Brazil, using the following databases: APA, PsycNET, Bireme, PEPSIC and Web of Science, and the following keywords: "envolvimento", "paterno", "avaliação" and "instrumento", in Portuguese, and "involvement", "father", "measure" "instrument", "scale" and "tool", in English. Of the 85 articles retrieved, many studies provided information about the effects of father involvement on measures of health and wellbeing. This information can contribute to the development of intervention programs for fathers, designed to prevent health problems among the fathers, the mothers and the children.

0237 Local Reminiscence TherapySharifah Rose Ee1, Rachel Lim1, Sue-Ann Tan1, Chun Ying Foo1, Iris Quah1,  1Temasek Polytechnic, Singapore

Research have shown reminiscence activities to slow down the progression of dementia Conducted at Senior Activity Centres at selected neighbourhood., issue is not mainly the long waiting list to be enrolled in these centres, but the professionals who were employed to conduct them, many of whom from neighbouring countries. As Singapore progresses as a nation, the communication between generations widens, as culture does. This project customises reminiscence therapies for the locals as well as a skill-based tool for any Singaporeans to communicate with PWD reducing verbal communication. Favourable results were yielded, including unexpected positive feedback such as the confidence level in caring for PWD.