Public health education for midwives and midwifery students: a mixed methods study

Background: Current national and international maternity policy supports the importance of addressing public health goals and investing in early years. Health care providers for women during the reproductive and early postnatal period have the opportunity to encourage women to make choices that will impact positively on maternal and fetal health. Midwives are in a unique position, given the emphasis of the philosophy of midwifery care on building relationships and incorporating a holistic approach, to support women to make healthy choices with the aim of promoting health and preventing ill health. However, exploration of the educational preparation of midwives to facilitate public health interventions has been relatively limited. The aim of the study was to identify the scope of current midwifery pre registration educational provision in relation to public health and to explore the perspectives of midwives and midwifery students about the public health role of the midwife.

Methods: This was a mixed methods study incorporating a survey of Higher Educational Institutions providing pre registration midwifery education across the UK and focus groups with midwifery students and registered midwives.

Results: Twenty nine institutions (53% response) participated in the survey and nine focus groups were conducted (59 participants). Public health education was generally integrated into pre registration midwifery curricula as opposed to taught as a discrete subject. There was considerable variation in the provision of public health topics within midwifery curricula and the hours of teaching allocated to them. Focus group data indicated that it was consistently difficult for both midwifery students and midwives to articulate clearly their understanding and definition of public health in relation to midwifery.

Conclusions: There is a unique opportunity to impact on maternal and infant health throughout the reproductive period; however the current approach to public health within midwifery education should be reviewed to capitalise on the role of the midwife in delivering public health interventions. It is clear that better understanding of midwifery public health roles and the visibility of public health within midwifery is required in order to maximise the potential contribution of midwives to achieving short and long term public health population goals.

Military Service Pensions for public and civil servants in independent Ireland

In 1924 the Cumann na nGaedheal government introduced the first Military Service Pensions Act to provide monetary compensation for those who fought for Irish independence between 1916 and 1923. Pensioners who were in receipt of remuneration from the state as civil and public servants had a portion of their pension deducted commensurate with their state income. This controversial provision was criticised by all political parties as representing a mean-spirited attitude towards veterans of the independence campaign and treating civil and public servants differently from those in private employment. It was eventually modified in the 1940s and abolished in the 1950s. This article provides a case study that highlights the parsimonious attitude of Irish governments towards veterans of the independence campaign and shows how the treatment of public and civil servants reflected tensions between the government and the civil service in the early years of the state.

General practice-recorded depression and antidepressant use in young people with newly diagnosed Type 1 diabetes: a cohort study using the Clinical Practice Research Datalink

Aims - To investigate whether young people with Type 1 diabetes have an increased rate of depression andantidepressant use and whether their risk varies by age group, time from diabetes diagnosis, calendar period ofdiagnosis or complications status. Methods - A cohort of incident cases of patients with Type 1 diabetes diagnosed before 35 years of age (n = 5548) wasidentified within the Clinical Practice Research Datalink and individually age and sex matched with up to two controlsubjects without diabetes (n = 10 657). Patients with depression were identified through general practice-recordeddepression codes and antidepressant prescriptions. Cox regression models gave hazard ratios for depression in peoplewith Type 1 diabetes compared with control subjects. Results - People with Type 1 diabetes were twice as likely to have a record of antidepressant use and generalpractice-diagnosed depression as their matched control subjects (hazard ratio 2.08, 95% CI 1.73–2.50, P < 0.001).These associations varied by time from diagnosis, with marked increases observed within the first 5 years of diagnosis(hazard ratio 2.14, 95% CI 1.51–3.03, P < 0.001), and by age at diabetes diagnosis, with excesses noted even in the 10-to 19-year age group (hazard ratio 1.45, 95% CI 1.06–1.98, P = 0.02). Conclusions - This population-based study shows that people with Type 1 diabetes have higher rates of generalpractice-recorded depression and antidepressant use. The excess is present within 5 years of diabetes diagnosis,suggesting psychological input for patients is warranted in the early years of their condition.

Bookstart Treasure Implementation Study: A Book-gifting Programme for Pre-school Children

Booktrust Treasure is a bookgifting programme delivered in pre-school and early years settings. The primary intended outcomes of the programme are increased family enjoyment of reading and sharing books. The following study explored the implementation quality of Bookstart Treasure and how this was associated with family reading outcomes.
The findings reveal strong perceptions among practitioners that the intervention is having a positive effect on a wide range of family reading outcomes. Whilst this is a positive finding in relation to programme implementation, it is important to note that this does not, in itself, constitute evidence that Bookstart Treasure is having a positive effect. Unfortunately, measuring programme effectiveness was not possible within this implementation study.
With regard to delivery, the programme was found to be equally well delivered in both voluntary and statutory settings. There is also some evidence that higher quality programme implementation is associated with increased enjoyment and usage of the packs amongst families. Whilst encouraging, it is important to note that it cannot be concluded from this that higher levels of implementation have a direct effect on these family outcomes. Furthermore, the findings also provide some evidence that parents with lower levels of education enjoy and use the packs more than their counterparts with higher levels of education.

Perspectives on the Future of Public Private Partnership in the UK

During the past two decades the UK has played a leading position in the development and application of Public Private Partnership (PPP) based infrastructure procurement through its Private Finance Initiative model. This model had been developed during the last years of the Major Government and expanded during the early years of the Blair Government. The banking and economic crisis of 2007-09 has created major challenges to the use of PPP in the UK, making the sustainability of past levels of PPP investment and the future direction of PPP based infrastructure procurement in that country uncertain. This chapter summarises key developments in UK PPP up to the crisis; reviews the economic issues that have led up to the crisis; discusses the immediate impact of the crisis on the UK PFI and PPP market together with the transition arrangements that were put into to place by the Brown government; and, lastly, looks at recent initiatives taken by Cameron’s Conservative-Liberal Coalition Government under the designation of Private Finance 2 (PF2).

Supervised Aggregative Feature Extraction for Big Data Time Series Regression

In many applications, and especially those where batch processes are involved, a target scalar output of interest is often dependent on one or more time series of data. With the exponential growth in data logging in modern industries such time series are increasingly available for statistical modeling in soft sensing applications. In order to exploit time series data for predictive modelling, it is necessary to summarise the information they contain as a set of features to use as model regressors. Typically this is done in an unsupervised fashion using simple techniques such as computing statistical moments, principal components or wavelet decompositions, often leading to significant information loss and hence suboptimal predictive models. In this paper, a functional learning paradigm is exploited in a supervised fashion to derive continuous, smooth estimates of time series data (yielding aggregated local information), while simultaneously estimating a continuous shape function yielding optimal predictions. The proposed Supervised Aggregative Feature Extraction (SAFE) methodology can be extended to support nonlinear predictive models by embedding the functional learning framework in a Reproducing Kernel Hilbert Spaces setting. SAFE has a number of attractive features including closed form solution and the ability to explicitly incorporate first and second order derivative information. Using simulation studies and a practical semiconductor manufacturing case study we highlight the strengths of the new methodology with respect to standard unsupervised feature extraction approaches.

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.

Exploring the Findings from Three Randomised Controlled Trials of Bookgifting Programmes

Aims: This paper explores the effects from three similar bookgifting programmes on improving reading outcomes of early years’ children, their parents and teachers.
Methods: The paper draws on research data produced by the Centre for Effective Education during three randomised controlled trial (RCT) evaluations of bookgifting programmes (N=1694 participant families in total). The three studies used pre and post test measures to identify effects across a total of 15 social, cognitive and behavioural reading outcomes.
Results: The overall average effect across the 15 outcomes from data provided by 1694 participant families, was d=0.07. This is a relatively small overall effect and there was an overall pattern of small positive effects of this scale across the wide range of the reading outcomes assessed. However, only one significant effect was identified in the 15 outcomes assessed across all three studies.
Conclusions: The review of these three studies suggests that the RCTs struggle to identify significant effects in these low exposure and low cost bookgifting interventions. Furthermore, it is recommended that future RCT studies of this type of programme require very large sample sizes in the scale of 1000’s rather than 100’s to generate enough study power. Or alternatively, these programmes could be evaluated as a component part of more intensive reading interventions.

The Dynamics of Quadropoly: League Position in English Football between 1888 and 2010

The paper explores competitive balance in top tier English league football from its inception in 1888. It examines the extent to which finishing in the top four positions in successive seasons is the preserve of a small number of clubs. Using a range of statistical measures, the analysis shows that the current high levels of competitive imbalance are not new phenomena. The overall pattern approximates a ‘U curve’: current patterns parallel those in the 1890s. In the early years of English league football, differences in resources between clubs soon became apparent. Clubs from the larger conurbations generated consistently larger revenues than their counterparts in the smaller industrial towns. This was primarily the result of the larger crowds that they could attract to their home games. This enabled them to entice the best players to their clubs away from their smaller rivals. The introduction of the maximum wage in 1901 and the transfer system helped to stem these increasing inequalities between clubs. This coincided with a massive wave of new stadia construction which enabled all the clubs to compete on an increasingly level playing field. These conjunctural changes to English football before 1915 produced the era of relatively competitive football during the inter-war years. This continued until the abolition of the maximum wage in 1961. Since that time, competitive balance has reversed and become increasingly restricted. English top-tier football has re-entered an era of extreme competitive imbalance.

Reducing child conduct disordered behaviour and improving parent mental health in disadvantaged families: a 12 month follow-up and cost analysis of a parenting intervention

The effectiveness of the Incredible Years Basic parent programme (IYBP) in reducing child conduct problems and improving parent competencies and mental health was examined in a 12-month follow-up. Pre- to post-intervention service use and related costs were also analysed. A total of 103 families and their children (aged 32–88 months), who previously participated in a randomised controlled trial of the IYBP, took part in a 12-month follow-up assessment. Child and parent behaviour and well-being were measured using psychometric and observational measures. An intention-to-treat analysis was carried out using a one-way repeated measures ANOVA. Pairwise comparisons were subsequently conducted to determine whether treatment outcomes were sustained 1 year post-baseline assessment. Results indicate that post-intervention improvements in child conduct problems, parenting behaviour and parental mental health were maintained. Service use and associated costs continued to decline. The results indicate that parent-focused interventions, implemented in the early years, can result in improvements in child and parent behaviour and well-being 12 months later. A reduced reliance on formal services is also indicated.