Distribution of Childhood Health Indices: Associations with Moves along the "Property Ladder"

Background
Childhood deprivation is a major risk to public health. Poor health in the early years accumulates and is expressed in adult health inequalities. The importance of social mobility - moves into and out of poverty or, indeed, change in relative affluence - for child wellbeing is less well understood. Home ownership and house value may serve as a useful measure of relative affluence and deprivation.
Method
Analysis of the Northern Ireland Longitudinal Study dataset focused on cohort members aged 18 and under at the 2001 census and their families. Using housing tenure and house value reported in 2001 and 2011, moves along the “housing ladder” over ten years were identified. Outcome measures were physical disability and mental health status as reported in 2011. Logistic regression models tested if health outcomes varied by upward and downward changes in house value.
Results
After controlling for variations in age, sex, general health and social class, mental health is worse among those who moved to a lower value house. Compared to ‘no change’, those moving from the upper quintile of house value into social renting accommodation were almost six times more likely to report poor mental health (OR 5.90 95% CI 4.52, 7.70). Conversely, those experiencing the greatest upward movement were half as likely to report poor mental health (OR 0.46 95% CI 0.31, 0.68). There were smaller associations between physical health and downward (OR 2.66 95% CI 2.16, 3.27), and upward (OR 0.75 95% CI 0.61, 0.92) moves.
Conclusion
Poor mental health is more strongly associated with declines in living standards than with improvements. The gradient appears at multiple points along this proxy affluence-deprivation spectrum, not only at the extremes. Further research should explore whether circumstances surrounding moves, or change in social position explains the differential association between the health correlates of upward versus downward mobility.

Potential Therapeutic Effects of Physical Exercise for Bipolar Disorder

Cognitive deficits are observed in a variety of domains in patients with bipolar disorder (BD). These deficits are attributed to neurobiological, functional and structural brain factors, particularly in prefrontal cortex. Furthermore, cortical alterations in each phase (mania/hypomania, euthymia and depression) are also present. A growing basis of evidence supports aerobic exercise as an alternative treatment method for BD symptoms. Its benefits for physical health in healthy subjects and some psychiatric disorders are fairly established; however evidence directly addressed to BD is scant. Lack of methodological consistency, mainly related to exercise, makes it difficult accuracy and extrapolation of the results. Nevertheless, mechanisms related to BD physiopathology, such as hormonal and neurotransmitters alterations and mainly related to brain-derived neurotrophic factors (BDNF) can be explored. BDNF, specially, have a large influence on brain ability and its gene expression is highly responsive to aerobic exercise. Moreover, aerobic exercise trough BDNF may induce chronic stress suppression, commonly observed in patients with BD, and reduce deleterious effects caused by allostatic loads. Therefore, it is prudent to propose that aerobic exercise plays an important role in BD physiopathological mechanisms and it is a new way for the treatment for this and others psychiatric disorders.

Stress, social support, and health risk behaviours as mediators of the forgiveness-health relation /

The mediating roles of stress, social support, and health risk behaviours in the relationships between dispositional forgiveness and mental and physical health were examined. Participants were 748 undergraduate students (554 women, 194 men) entering their first year of studies at Brock University. Participants, ranging in age from 17 to 25 years, completed the Brock University First Year Health Study and were provided monetary compensation. Dispositional forgiveness, stress, social support, health risk behaviours, mental health, and physical health were measured using self-report methods. The data were analyzed separately for women and men because there were significant mean differences on many of the study'S variables. Analyses revealed that the mediated relationships between dispositional forgiveness and health were generally stronger for women than men. Stress was the most robust mediator of the forgiveness-health relation for both women and men. The only health risk behaviour that mediated the forgivenesshealth relation was physical fitness and this result was found for women only. Social support mediated several of the relationships between forgiveness and health but not others. Results were discussed with reference to the literature on forgiveness and health. Several directions for future research were offered, such as conducting longitudinal research designs to assess the direction of causality better, investigating moderator variables of the forgiveness-health relation, and building models, which incorporate multiple mediators using structural equation modelling techniques.

The influence of physical activity behaviour on the relationship between motor proficiency and body composition in children

There is an emerging awareness that children with poor motor abilities are at particular risk for overweight. This cross-sectional study examined the influence of physical activity behaviour on the relationship between motor proficiency and body composition. Participants were 1287 (646 males, 641 females) Grade 6 students in the Physical Health Activity Study project. Height, weight, waist girth, and motor proficiency (Bruininks-Oseretsky Test of Motor Performance BOTMP-SF) were assessed. Physical activity behaviours were also evaluated with a multifaceted approach and reported for school-based, non-school based physical activity, free-time play, and sedentary activities (Participation Questionnaire), and leisure time exercise (Godin-Shephard Leisure Time Exercise Questionnaire GS). Overweight was defined by BMI scores: boys :::20.6-21.2 and <25.1-26.0; girls: ::: 20.7-21.7and <25.4-26.7 and obesity was defined as: boys:::: 25.1-26.0; girls: :::25.4-26.7. Children were classified as case group (CG,::; 10% on BOTMP-SF), borderline case group (BC, > 10% to ::; 20% on BOTMP-SF) or non-case group. Analyses of variance (ANOVAs) uncovered a significant difference in overweight and obesity between the case group and non-case group. Normal-weight children reported higher participation in organized school-sports (intra-mural and inter-school teams). The CG reported significantly lower participation in school sports teams and lower GS results, with a trend towards lower participation in all active pursuits. They also reported a significantly higher duration of television watching and book reading. There were no significant differences between motor proficiency groups by gender, age, nonschool sports, or free-time activity. Multivariate ordinal logistic regression analysis showed that the case group was 10.9 times more likely to be overweight/obese than their peers. No single aspect of physical activity was able to explain the difference in odds ratios for the motor proficiency groups. However, for the entire cohort, children who participated in more organized school sports were less likely to be overweight/obese. These findings confirm that children with low motor proficiency are at significant risk of developing overweight. It is evident that these children have generally attenuated activity levels and heightened levels of sedentary pursuits. School-based activities appear particularly limited, and are the one area where children have near autonomy in their decision to pursue active opportunities. The promotion of school-based programs, specifically intramural sports may be an important aspect in increasing children's overall activity levels. It is also essential to consider the needs of those children with low motor proficiency when designing activity promotion programs. Future research should further explore motor proficiency and overweight/obesity.

Physical activity of children with developmental coordination disorder in the presence of attention deficit hyperactivity disorder : does gender matter?

Baerg, S., Cairney, J., Hay, J., Rempel, L. and Faught, B.E. (2009). Physical Activity of Children with Developmental Coordination Disorder in the Presence of Attention Deficit Hyperactivity Disorder: Does Gender Matter? Brock University, St. Catharines, Ontario, CANADA. Children with Developmental Coordination Disorder (DCD) have difficulties in motor coordination. Attention-deficit hyperactive disorder (ADHD) is considered the condition most co-morbid with DCD at approximately 50%. Children with DCD are generally less physically active (PA) than their peers, while children with ADHD are often considered more physically active. It is not known if the physical activity patterns of children with DCD-ADHD resemble those of children with primarily DCD or that of their healthy peers. The primary objective of this research was to contrast physical activity patterns between children with DCD, DCD-ADHD, and healthy controls. Since boys are generally reported as more physically active than girls, a secondary objective was to determine if gender moderated the association between groups and physical activity. A sample of males (n=66) and females (n=44) were recruited from the Physical Health Activity Study Team (PHAST) longitudinal study. The Movement Assessment Battery for Children (2nd Ed.) was used to identify probable cases of DCD, and Connor's Revised Parent Rating Scale- Short Version to identify ADHD. Subjects (mean age=12.8±.4 yrs) were allocated to three groups; DCD (n=32), DCD-ADHD (n=30) and control (n=48). Physical activity was monitored for seven days with the Actical® accelerometer (activity count, step count and energy expenditure). Children completed the Participation Questionnaire (PQ) during the in-school session of data collection for the PHAST study. Height, weight and body mass index (BMI) were also determined. Analysis of variance showed significant group differences for activity count (F(2,56)=5.36, p=.007) and PQ (F(2,44 )=6. 71, p=.003) in males, while a significant group difference for step count (F(2,37)=3.55, p=.04) was found in females. Post hoc comparison tests (Tukey) identified significantly lower PQ and activity count between males with OCD and controls (p=.004) and males with DCD-ADHD and controls (p=.003). Conversely, females with DCD-ADHD had significantly more step counts than their controls (p=.01). Analysis of covariance demonstrated a gender by DCD groups negative interaction for males (activity count) (F(2,92):;:3.11, p=.049) and a positive interaction for females (step count) (F(1,92)=4.92, p=.009). Hyperactivity in females with DCD-ADHD appears to contribute to more physical activity, whereas DCD may contribute to decreased activity in males with DCD and DCDADHD. Further research is needed to examine gender differences in physical activity within the context of DCD and ADHD.

Dispositional Forgiveness and Health in Romantic Relationships: An Exploration of Sex Differences, Actor Effects, and Partner Effects

The individual and dyadic associations between dispositional forgiveness of self, others, and situations and mental and physical health in individuals involved in romantic relationships were examined. Sex differences in the relationship between dispositional forgiveness and health were examined. Sex differences in the dyadic relationship between forgiveness and health were also examined. The dispositional forgiveness scores of 297 partners involved in a romantic relationship were used to predict their own as well as their partners' physical and mental health. Both members of the relationship separately completed an Internet-based questionnaire assessing personality traits, relationship variables, and physical and mental health. The couple was provided with monetary compensation. Analyses revealed that women's dispositional forgiveness of self, others, and situations were positively associated with their own physical and mental health. Similarly, men's dispositional forgiveness of self, others, and situations were positively associated with their own mental and physical health. At the individual level, there were no sex differences in the relationship between dispositional forgiveness and health, nor were there sex differences in men and women's reports of dispositional forgiveness. Analyses revealed that men's forgiveness of others and situations were positively associated with their female partners' mental health. There were no partner effects for women or for physical health. The implications of these results for research in the forgiveness-health literature and research on forgiveness in romantic relationships were discussed as were directions for future research.

A randomized follow-up study of the general health and quality of life of an elderly edentulous population wearing either mandibular two-implant overdentures or conventional dentures

L’augmentation de la population âgée dans la société indique que les systèmes de soins de la santé font face à de nouveaux défis. Les hauts niveaux d’incapacité qui en résultent peuvent être réduits par les nouvelles technologies, la promotion de la santé ainsi que des stratégies de prévention. Les écrits scientifiques récents soulignent la supériorité des prothèses dentaires implanto-portées par rapport aux prothèses conventionnelles en termes de satisfaction et de qualité de la vie des patients. Cependant, il n'est toujours pas clair si ces avantages ont des effets positifs à long terme sur la santé orale et générale ainsi que sur la qualité de vie des populations âgées. Objectifs, Hypothèses : Notre but était de mesurer l’impact des prothèses mandibulaires retenues par 2 implants sur la qualité de vie associée à la santé bucco-dentaire et générale ainsi que sur la santé orale et la qualité du sommeil des aînés édentés. Nous avons évalué les hypothèses nulles suivantes : il n'y a aucune différence entre les individus portants des prothèses mandibulaires retenues par 2 implants (IODs) et ceux qui portent des prothèses conventionnelles (CDs), par rapport à la qualité de vie reliée à la santé bucco-dentaire et générale, la santé orale et la qualité du sommeil, un an après avoir reçu leurs nouvelles prothèses. Méthodes : Dans cette étude randomisée contrôlée, 255 aînés ont reçu au hasard IODs ou les CDs, les deux types de prothèses étant opposés à des prothèses maxillaires conventionnelles. La qualité de la vie reliée à la santé bucco-dentaire (OHRQoL) et la santé générale subjective ont été mesurées avec les questionnaires Oral Health Impact Profile (OHIP-20) et Short Form-36 (SF-36) en condition pré-traitement et après un an. La qualité du sommeil et la somnolence diurne ont été mesurées à l’aide du questionnaire Qualité de Sommeil de Pittsburg et de l'Échelle de Somnolence Epworth. La santé orale a été évaluée par un examen clinique. Les variables indépendantes étaient le sens de cohérence et le type de prosthèse, ainsi que des variables socio-démographiques. En utilisant des analyses statistiques bi et multi-factorielles, des comparaisons à l’intérieur d’un même groupe et entre deux groupes ont été effectuées. Résultats : Les différences pré et post traitement pour les cotes OHIP étaient significativement plus grandes pour le groupe IOD que le groupe CD (p<0.05). Le type de traitement et la cote pré-traitement étaient des facteurs significatifs à OHRQoL (p < 0.0001). Dans le groupe CD, il y avait une diminution significative par rapport aux cotes de «Physical Component Scores (PCS)», le fonctionnement physique, le rôle physique et la douleur physique entre les données pré-traitement et un an après le traitement, ce qui indique une diminution au niveau de la santé générale subjective. Dans le groupe IOD, une diminution statistiquement non significative a été remarquée par rapport à toutes les cotes des sous-échelles de SF-36, sauf pour la douleur physique. Le modèle final de régression a démontré qu’après ajustement pour les variables âge, sexe, statut marital et type de traitement, la cote totale finale d’OHIP et les données de bases de PCS prédisaient la cote finale de PCS (p < 0.0001). Aucune corrélation significative entre sens de cohérence et OHRQoL n'a été détectée (r =-0.1; p > 0.05). Les aînés porteurs des prothèses conventionnelles avaient presque 5 fois plus de chance d’avoir une stomatite prothétique que ceux portant des prothèses mandibulaires hybrides retenues par 2 implants (p < 0.0001). Les aînés ayant subjectivement une mauvaise santé générale avaient une qualité de sommeil moins bonne que ceux avec une meilleure santé générale subjective (p < 0.05). Les personnes qui avaient une OHRQoL moins bonne étaient presque 4 fois plus somnolentes pendant le jour que celles avec une meilleure OHRQoL (p=0.003, χ2; OR =3.8 CI 1.5 to 9.8). L'analyse de régression a montré que la santé générale subjective et OHRQoL prévoient la qualité du sommeil (p=0.022 et p=0.001, respectivement) et la somnolence diurne (p=0.017 et p=0.005, respectivement). Conclusions: Les résultats de cette étude suggèrent que, chez les aînés édentés, des prothèses mandibulaires hybrides retenues par deux implants amènent une amélioration significative de la qualité de vie reliée à la santé bucco-dentaire et maintiennent la sensation d’une meilleure santé physique. Des prothèses hybrides implanto-portées peuvent contribuer à la santé orale en réduisant les traumatismes infligés à la muqueuse orale et en contrôlant la stomatite prothétique. Les aînés édentés dont le niveau de qualité de vie reliée à la santé bucco-dentaire est bas, peuvent aussi avoir des troubles de qualité du sommeil.

“All work and no play … ?” : a critical investigation of an emerging public health discourse on children’s play.

Dans de nombreuses sociétés industrialisées, une grande valeur est attribuée au jeu des enfants, principalement parce que le jeu est considéré comme étant une composante essentielle de leur développement et qu’il contribue à leur bonheur et à leur bien-être. Toutefois, des inquiétudes ont récemment été exprimées au regard des transformations qui s’opèrent dans le jeu des enfants, notamment en ce qui a trait à la réduction du temps de jeu en plein air. Ces transformations ont été attribuées, en grande partie, à une perception de risques accrus associés au jeu en plein air et à des changements sociaux qui favorisent des activités de loisirs plus structurées et organisées. L’inquiétude concernant la diminution de l’espace-temps accordé au jeu des enfants est d’ailleurs clairement exprimée dans le discours de la santé publique qui, de plus, témoigne d’un redoublement de préoccupations vis-à-vis du mode de vie sédentaire des enfants et d’une volonté affirmée de prévention de l'obésité infantile. Ainsi, les organisations de santé publique sont désormais engagées dans la promotion du jeu actif pour accroître l'activité physique des enfants. Nous assistons à l’émergence d’un discours de santé publique portant sur le jeu des enfants. À travers quatre articles, cette thèse explore le discours émergeant en santé publique sur le jeu des enfants et analyse certains de ses effets potentiels. L'article 1 présente une prise de position sur le sujet du jeu en santé publique. J’y définis le cadre d'analyse de cette thèse en présentant l'argument central de la recherche, les positions que les organisations de santé publique adoptent vis-à-vis le jeu des enfants et les répercussions potentielles que ces positions peuvent avoir sur les enfants et leurs jeux. La thèse permet ensuite d’examiner comment la notion de jeu est abordée par le discours de santé publique. L'article 2 présente ainsi une analyse de discours de santé publique à travers 150 documents portant sur la santé, l'activité physique, l'obésité, les loisirs et le jeu des enfants. Cette étude considère les valeurs et les postulats qui sous-tendent la promotion du jeu comme moyen d’améliorer la santé physique des enfants et permet de discerner comment le jeu est façonné, discipliné et normalisé dans le discours de santé publique. Notre propos révèle que le discours de santé publique représente le jeu des enfants comme une activité pouvant améliorer leur santé; que le plaisir sert de véhicule à la promotion de l’activité physique ; et que les enfants seraient encouragés à organiser leur temps libre de manière à optimiser leur santé. Étant donné l’influence potentielle du discours de santé publique sur la signification et l’expérience vécue du jeu parmi les enfants, cette thèse présente ensuite une analyse des représentations qu’ont 25 enfants âgés de 7 à 11 ans au regard du jeu. L’article 3 suggère que le jeu est une fin en soi pour les enfants de cette étude; qu'il revêt une importance au niveau émotionnel; et qu'il s’avère intrinsèquement motivé, sans but particulier. De plus, l’amusement que procure le jeu relève autant d’activités engagées que d’activités sédentaires. Enfin, certains enfants expriment un sentiment d'ambivalence concernant les jeux organisés; tandis que d’autres considèrent parfois le risque comme une composante particulièrement agréable du jeu. De tels résultats signalent une dissonance entre les formes de jeux promues en santé publique et le sens attribué au jeu par les enfants. Prenant appui sur le concept de « biopédagogies » inspiré des écrits de Michel Foucault, le quatrième article de cette thèse propose un croisement des deux volets de cette étude, soit le discours de santé publique sur le jeu et les constructions du jeu par les enfants. Bien que le discours de la santé publique exhortant au «jeu actif» soit reproduit par certains enfants, d'autres soulignent que le jeu sédentaire est important pour leur bien-être social et affectif. D’autre part, tandis que le « jeu actif » apparait, dans le discours de santé publique, comme une solution permettant de limiter le risque d'obésité, il comporte néanmoins des contradictions concernant la notion de risque, dans la mesure où les enfants ont à négocier avec les risques inhérents à l’activité accrue. À terme, cet article suggère que le discours de santé publique met de l’avant certaines représentations du jeu (actifs) tandis qu’il en néglige d’autres (sédentaires). Cette situation pourrait donner lieu à des conséquences inattendues, dans la mesure où les enfants pourraient éventuellement reconfigurer leurs pratiques de jeu et les significations qu’ils y accordent. Cette thèse n'a pas pour but de fournir des recommandations particulières pour la santé publique au regard du jeu des enfants. Prenant appui sur la perspective théorique de Michel Foucault, nous présentons plutôt une analyse d’un discours émergeant en santé publique ainsi que des pistes pour la poursuite de recherches sur le jeu dans le domaine de l’enfance. Enfin, compte tenu des effets potentiels du discours de la santé publique sur le jeu des enfants, et les perspectives contemporaines sur le jeu et les enfants, la conclusion offre des pistes de réflexion critique.

Health-related quality of life in Huntington's disease: which factors matter most?

The aim of this article was to determine which aspects of Huntington's disease (HD) are most important with regard to the health-related quality of life (HrQOL) of patients with this neurodegenerative disease. Seventy patients with HD participated in the study. Assessment comprised the Unified Huntington's Disease Rating Scale (UHDRS) motor, cognitive and functional capacity sections, and the Beck Depression inventory. Mental and physical HrQOL were assessed using summary scores of the SF-36. Multiple regression analyses showed that functional capacity and depressive mood were significantly associated with HrQOL, in that greater impairments in HrQOL were associated with higher levels of depressive mood and lower functional capacity. Motor symptoms and cognitive function were not found to be as closely linked with HrQOL. Therefore, it can be concluded that, depressive mood and greater functional incapacity are key factors in HrQOL for people with HD, and further longitudinal investigation will be useful to determine their utility as specific targets in intervention studies aimed at improving patient HrQOL, or whether other mediating variables. As these two factors had a similar association with the mental and physical summary scores of the SF-36, this generic HrQOL measure did not adequately capture and distinguish the true mental and physical health-related HrQOL in HD.

Associations of physical activity with body weight and fat in men and women

OBJECTIVE: Increasing physical activity is strongly advocated as a key public health strategy for weight gain prevention. We investigated associations of leisure-time physical activity (LTPA) and occupational/domestic physical activity with body mass index (BMI) and a skinfold-derived index of body fat (sum of six skinfolds), among normal-weight and overweight men and women.

DESIGN: Analyses of cross-sectional self-report and measured anthropometric data.

SUBJECTS: A total of 1302 men and women, aged 18-78 y, who were part of a randomly selected sample and who agreed to participate in a physical health assessment.

MEASUREMENTS: Self-report measures of physical activity, measured height and weight, and a skinfold-derived index of body fatness.

RESULTS: Higher levels of LTPA were positively associated with the likelihood of being in the normal BMI and lower body fat range for women, but few or no associations were found for men. No associations were found between measures of occupational/domestic activity and BMI or body fat for men or women.

CONCLUSION: By using a skinfold sum as a more direct measure of adiposity, this study extends and confirms the previous research that has shown an association between BMI and LTPA. Our results suggest gender differences in the relationship of leisure-time physical activity with body fatness. These findings, in conjunction with a better understanding of the causes of such differences, will have important public health implications for the development and targeting of weight gain prevention strategies.

Using environmental interventions to create sustainable solutions to problems to health and wellbeing

Recent research by Deakin University, in collaboration with Parks Victoria and its Strategic Partners, indicates that contact with nature may promote human health and wellbeing. International research indicates that simply viewing a natural scene or watching wildlife reduces stress and tension, improves concentration, remedies mental fatigue, boosts immunity, and enhances psychological health. This is aside from any physical health benefits flowing from reduced stress, increased exercise and improved air quality when contact with nature involves activities in natural environments. The literature suggests that interacting with nature through gardening or having a companion animal is also beneficial for health, and where these activities involve contact with other humans, might extend benefits beyond the individual to the community, through enhanced social capital. This paper sets out the potential scope of work flowing from the initial research, in terms of target groups, research foci, intervention strategies, and likely benefits, and reports on progress in establishing a program of Australian,based empirical research. It proposes the establishment of alliances between researchers and practitioners in a range of disciplines (including environmental health) to ensure that the links between contact with nature and human health and wellbeing are explored and expressed in ways that are both beneficial and sustainable.

Health status and participation in a range of activities in an Australian community

Introduction: The aim of the research was to determine the relationship between levels of participation in a community and self-assessed health status of people in a rural and regional setting.
Method: A cross-sectional design, using a mailed, self-administered questionnaire was used. Questionnaires were mailed to a random sample of people aged 18 years and over who were registered on the electoral roll of a regional city and rural area, the Barwon and Otway regions of Victoria, Australia. The sample consisted of 1752 participants: 990 females (57%), 739 males (42%) and 23 sex undisclosed (1%). The range of participants was 18-98 years, and the mean age was 50.53 years (SD = 17.19).
Results: Self-assessed physical and mental health were measured using the SF-12 scale. Participants with low incomes, and those with low self-assessed physical and mental health scores, were significantly more likely than other participants to agree with one or more of the social isolation items, indicating that they experienced some social isolation. Low levels of participation in social, sports, leisure or support activities were associated with low self-assessed physical and mental health. Disengagement with the local community was associated with low levels of self-assessed mental health. While younger people were more likely than older people to participate in social, sports, leisure or support activities, they were less involved as members of their community. Females were more likely than males to have been involved in five or more sports, leisure or support activities. Participation in civic activities was associated with high income. Levels of participation in the four different types of activities were combined (social activities, sport, leisure or support activities, community and group activities, and civic activities). Participants classified as low participators were more likely to be older participants, to have a low income and to have low scores for both physical and mental health.
Conclusions: An association was found between health and community participation in a range of activities, and between health and engagement with the community in this rural and regional population. These findings are consistent with those reported from similar research with a metropolitan population sample. The current research suggests that the groups of people of most concern in terms of low participation rates, are people who have low incomes, people aged over 65 years, people who may be defined as possessing poor physical health and people who may be defined as possessing poor mental health. The relationship between age, community participation and health is complex and needs further exploration because it is not known whether poor health reduces community participation or whether reduced community participation results in poor health. However, current research suggests that developing and implementing strategies to promote people's engagement with and involvement in their local community is one important way of promoting the health of the community as a whole.

Promoting the health and well being of older carers : a proactive strategy

Research has indicated that carers are concerned about their ageing status, their deteriorating health and their ability to continue to care for their dependants. Given that the health care system will become increasingly reliant on carers the health care needs of carers should be a concern for all health care professionals. This paper describes the first stage of a project designed to enhance older carers health promotion knowledge and skills and improve their health promoting behaviours. This stage investigated the mental and physical health status of older carers. It also sought information on older carers' levels of participation in health related and social activities and identification of barriers to participation in these types of activities. The results highlighted that carers responding to the survey experienced compromised physical and mental health. Many carers reported being unable to participate in social and health-type activities as they were unable to leave the care recipient. Of note, is that carers identified their own mental fragility and felt they needed further emotional support.

Health and well-being naturally: 'contact with nature' in health promotion for targeted individuals, communities and populations

Issue addressed: The increase in mental health disorders worldwide makes it important to recognise health promotion interventions that are effective, accessible and affordable. Although natural spaces are coming to be recognised as health-promoting settings for general populations, little is understood about the use of nature contact in treatment and care for individuals experiencing ill-health.

Methods: This paper provides a summary of key research findings and presents a case study examining the self reported health and well-being benefits of nature contact for a small clinical sample. The 'Spectrum of Interventions for Mental Health Problems and Mental Disorders' provides a conceptual framework for ordering current and future information relating to nature-based interventions.

Results: Evidence demonstrates that separately, physical activity, social connection, and contact with nature enhance human health and well-being. The case example illustrates how 'active', 'social' and 'adventurous' contact with nature may be combined within a treatment intervention to protect and enhance the health of individuals experiencing chronic mental, emotional and physical health difficulties.

Conclusions: 'Contact with nature' constitutes a health promotion strategy with potential application in prevention, early intervention, treatment and care. Recommendations include further research to investigate the benefits of nature contact within existing interventions, and the impacts of 'active' and 'social' nature contact within tailored interventions for targeted individuals and communities.

Improving infant sleep and maternal mental health: a cluster randomised trial

Objectives: To determine whether a community-delivered intervention targeting infant sleep problems improves infant sleep and maternal well-being and to report the costs of this approach to the healthcare system.

Design: Cluster randomised trial.

Setting: 49 Maternal and Child Health (MCH) centres (clusters) in Melbourne, Australia.

Participants: 328 mothers reporting an infant sleep problem at 7 months recruited during October–November 2003.

Intervention: Behavioural strategies delivered over individual structured MCH consultations versus usual care.

Main outcome measures: Maternal report of infant sleep problem, depression symptoms (Edinburgh Postnatal Depression Scale (EPDS)), and SF-12 mental and physical health scores when infants were 10 and 12 months old. Costs included MCH sleep consultations, other healthcare services and intervention costs.

Results: Prevalence of infant sleep problems was lower in the intervention than control group at 10 months (56% vs 68%; adjusted OR 0.58 (95% CI: 0.36 to 0.94)) and 12 months (39% vs 55%; adjusted OR 0.50 (0.31 to 0.80)). EPDS scores indicated less depression at 10 months (adjusted mean difference –1.4 (–2.3 to –0.4) and 12 months (–1.7 (–2.6 to –0.7)). SF-12 mental health scores indicated better health at 10 months (adjusted mean difference 3.7 (1.5 to 5.8)) and 12 months (3.9 (1.8 to 6.1)). Total mean costs including intervention design, delivery and use of non-MCH nurse services were £96.93 and £116.79 per intervention and control family, respectively.

Conclusions: Implementing this sleep intervention may lead to health gains for infants and mothers and resource savings for the healthcare system.