The impact of parental mental health and socioeconomic position on child preschool health

Background

Many children, approximately one out of four to five, live in families with parental mental health problems. Knowledge on the impact of other mental health problems than depression or anxiety is sparse as well as the impact of the father. Therefore, we aimed to examine the effect of maternal and paternal mental health on child respiratory illness.

Methods

A population-based birth cohort study was conducted including all Danish children born from 2000-2012 using the Danish nationwide registers. Two follow-up periods were created: From age 1-2 and age 3-5. Mental health was categorised in three: No mental health problems, minor mental health condition if handled in solely primary healthcare; and moderate-severe if handled in psychiatric healthcare settings. Child respiratory illness was identified by prescribed medication or hospital-based diagnoses. Incidence rate ratios (IRR) were calculated using Poisson regression analysis.

Results

The analyses included 810,243 children. 26% of the mothers and 17% of the fathers were classified with mental health conditions. Children of parents with mental health conditions were more likely to have respiratory illness (10-12% vs. 7.7%). Adjusted IRRs revealed higher risks for children of mothers with minor (IRR 1.32 (CI95% 1.30-1.34)) and moderate-severe mental health conditions (IRR 1.48 (CI95% 1.44-1.51)). For paternal mental health, the IRRs were 1.14 (CI95% 1.12-1.16) for minor and IRR 1.14 (CI95% 1.11-1.17) for moderate-severe mental health conditions. The IRRs were a little higher for the children aged 1-2 years compared to 3-5-years.

Conclusions

Children of parents with mental health conditions were at greater risk of respiratory illness. This was evident for the mental health of both parents, most pronounced for the mother. Not only moderate-severe, but also minor mental health conditions increased the risk of respiratory illness.

The risk of preterm birth in combinations of mental disorder and socioeconomic position among Danish women

Background

Inequality in preterm birth is a public health challenge requiring identification of pregnant women at particularly high risk of preterm birth. Therefore, the aim was to estimate the risk of preterm birth in women with different combinations of mental health conditions and socioeconomic position.

Methods

Based on Danish registries, we conducted a nationwide cohort study including all first-time mothers giving birth to a singleton liveborn infant in Denmark between 2000 through 2016. We examined the risk of preterm birth (<37 weeks of gestation) in different combinations of mental health conditions (no, minor, and moderate/severe) and educational level (high, intermediate, and low) in three age strata (<25, 25-30, and >30 years). The relative risk of preterm birth was estimated using Poisson regression with a robust error variance. We measured the attributable proportion to assess additive interaction between the effects of exposures.

Results

Of the 415,523 included first time mothers, 29,069 (7,0%) gave birth preterm. The risk of preterm birth increased in combinations of higher degree of mental health conditions, lower degree of educational level, and increasing age. Women aged>30 years with moderate/severe mental health conditions and low educational level had the highest risk of preterm birth (13.7%). The analysis of additive interaction revealed only a limited additional effect of being exposed to mental health conditions and lower educational levels in each age strata. However, positive additive interaction was found between age>30 year and combinations of mental health conditions and educational level.

Conclusions

Substantial inequality in preterm birth remains with increasing risk in women with combinations of higher degree of mental health conditions and lower degree of educational level. In the prevention of inequality in preterm birth special attention on women aged>30 years exposed to mental health conditions and lower educational levels is essential

Contradictory explanatory models of doctors and ischemic heart patients with low health literacy

Background

Health literacy has been used to explain the social inequalities in ischemic heart disease that exists globally. However, most conceptualizations of health literacy employ an isolated focus on the patient's cognitive abilities without considering the social context. By using the cultural health capital framework, this paper aims at exploring how differences in social dispositions influence the interaction between doctors and ischemic heart patients with low health literacy and low socioeconomic status.

Methods

The paper is based on 30 qualitative interviews with Danish ischemic heart patients with low health literacy and low socioeconomic status and supplementary, contextual observations. The data collection was nationwide and carried out between October 2018 and August 2019.

Results

The findings showed that the patients and the doctors derived from different social spheres, which meant that they had developed dissimilar habitus and therefore used different explanatory models to understand and articulate the patient's problem. The doctors were primarily oriented towards the biomedical understanding of the malfunctioning of the body and therefore less aware of the patients' psychosocial illness experience. For the patients, these contradictions resulted in feelings of not being acknowledged, lack of trust in the healthcare system and disruption of treatment.

Conclusions

The findings suggest that to understand barriers for treatment of socially disadvantaged ischemic heart patients it is not only relevant to look at the patient's individual cognitive abilities but also to explore class-based contradictions in explanatory models between the patients and doctors.

Key messages

Health literacy should be understood as something embedded in the interplay between social structures and interpersonal dynamics. Contradictions in explanatory models may help explain barriers for treatment of socially disadvantaged ischemic heart patients.

User involvement in developing community-based public health services: a scoping review of methods

Background

User involvement in developing community-based public health services has been on the agenda for decades. User involvement refers to the variety of ways in which service users or public citizens participate in the development of health services: from proving information on their needs to actively being involved in decisions about future services. Former studies found that user involvement is meaningful to the people involved and could have a favorable impact on the quality of services. Thus, it is timely to systematically identify and provide a comprehensive overview of user involvement methods used in public health studies. The aim of this scoping review is to provide an overview of the current body of empirical research where user involvement methods have been used to develop community public health services and identify its possible impact on the individual as well as services.

Methods

A systematic scoping review of user involvement methods aiming to develop public health services followed Arksey and O'Malley, 2005 framework. Six databases: CINAHL, Cochrane Library, Embase, PsycINFO. PubMed, Scopus and ProQuest, were searched from October till November, 2019. Search terms were: user involvement, methods and health care with corresponding synonym. All hits were double screened.

Results

6.044 studies were identified of which 38 studies lived up to the criteria. Preliminary findings from coding and synthesizing studies have identified a variety of user involvement

Methods

19 of the studies used complex, multi-facetted packages of methods aiming to identify needs, prioritize and formulate recommendations for future services. 19 studies used different kinds of group meetings and some used certain techniques to facilitate the process. Many reported the impact, and 13 evaluated the methods. The impact of using the methods varied from impact on individual, group, or service/political level. Final results will be presented at the conference.

Key messages

Studies on user involvement methods in developing community public health services and its impact are sparse. User involvement is privotal in developing sustainable public health community services.

Impact of maternal mental health problems on perinatal outcomes for the infant

Background

Mounting evidence suggests that mental health problems in pregnant women may negatively affect the intra- and extrauterine health and development of the child. This is especially of concern as the prevalence of mental health problems in pregnant women is high and believed to be increasing. We set out to quantify the effect of maternal mental health status on the risk of adverse perinatal outcomes for the infant.

Methods

We undertook a nationwide register-based cohort study including children born alive in Denmark between 2000 and 2016. The exposed cohort was children born to mothers with mental health problems in the two years prior to childbirth that had been cared for in primary care settings only (Group 1, minor problems, n = 71 759) or had required psychiatric intervention (Group 2, moderate-severe problems, n = 41 099). All non-exposed children served as comparison group (n = 908 268). We calculated risk ratios (RRs) with 95% confidence intervals (CI) for each perinatal outcome of interest.

Results

Infants in Group 1 as well as Group 2 were at higher risk of neonatal death than infants born to unaffected mothers, although for Group 2 the trend was non-significant (Group 1: adjusted RR (aRR) 1.34, 95% CI 1.17-1.52; Group 2: aRR 1.11, 95% CI 0.94-1.32). Both exposure groups were furthermore at significantly increased risk of 5-minute Apgar scores <7 (Group 1: aRR 1.27, 95% CI 1.17-1.37; Group 2: aRR 1.52, 95% CI 0.94-1.32) and <4 (Group 1: aRR 1.26, 95% CI 1.10-1.44; Group 2: aRR 1.28, 95% CI 1.08-1.52) and of hospital admission in the neonatal period (Group 1: aRR 1.22, 95% CI 1.19-1.24; Group 2: 1.29, 95% CI 1.26-1.32), paralleled by a significantly higher risk of preterm birth and several neonatal morbidities.

Conclusions

Infants born to mothers with moderate-severe as well as minor mental health problems were at increased risk of multiple adverse perinatal outcomes, thus calling for effective preventive strategies to improve outcomes in both groups.

Supportive maternity care services: A Danish study exploring parents’ experiences with perinatal mental health issues

Background

Mental illness can have negative impact on pregnant women, their infants and their families, including adverse birth outcomes, as well as place children at risk of developing mental illness later in life. It is recommended to offer additional support in the ante - and postnatal period, but to be able to offer appropriate, timely and effective care, more knowledge is needed on women's own experiences. The aim of this paper is to explore women's experiences with mental illness in the context of pregnancy and early motherhood, and how they experience and engage with supportive services.

Methods

This paper presents selected findings from an ethnographic field study carried out in a Danish municipality. The findings are based on data from 22 women, who were recruited when they were pregnant or had a newborn baby. The women were currently facing or had previously suffered from one or multiple mental health conditions.

Results

Analysis found that women with current or prior mental illness experienced a high level of fear, worries and uncertainty during pregnancy and early motherhood, which shaped how they engaged with supportive maternity services. Some were deeply worried about their mental health and reached out for support to cope with this. Concerns about being a bad mother and about the potential influence of their mental illness on their infants were common. Furthermore, some women were scared of being judged as unfit mothers and losing custody of their children. Many experienced stigma surrounding mental illness, making some more hesitant about reaching out for support.

Conclusions

By providing new insight into women's own perspectives, this study contributes with in-depth knowledge on women's experiences with mental illness during pregnancy and early motherhood, and illustrates how engaging with supportive services may be an ambivalent experience.

The effect of breast cancer on work participation in different sectors. A Danish registry based study

Background

A breast cancer diagnosis affects an individual’s affiliation to the labor market, but whether the effect of breast cancer variates in different sectors in a Danish setting has not been examined. The present study investigated the effect of stage IA breast cancer (tumor<20 mm and no lymph nodes involved in six sectors among Danish women being part of the work force. Stage IA breast cancer has a good prognosis, and it would be assumed that the majority have returned to work after 1 year.

Methods

This registry-based cohort study was based on data from linked Danish nationwide registries. We identified 5,543 women (aged 25-63 years) diagnosed with breast cancer (BC) stage IA (exposed) and 65.889 women without breast cancer (unexposed) and included women from the different sectors. We calculated a yearly Work Participation Score (WPS), defined as the proportion of weeks being self-supported during a year. We compared the means of WPS for exposed and unexposed women in six different sectors: 1) teaching, 2) childcare, 3) eldercare, 4) cleaning, 5) administration and 6) hospitality industry.

Results

BC had a negative effect on being self-supporting for women in all six sectors in all three years, although the effect declined. In the first year, the difference in WPS varied between 0.38 and 0.54. During the second year all BC patients had still significantly lower WPS with the largest difference in hospitality industry (0.65 (95% CI 0.50-0.80) for exposed women and 0.86 (95% CI 0.83-0.88) for unexposed women). In the third year, the effect further declined although WPS was still significantly lower for most sectors with the biggest difference in the cleaning sector.

Conclusions

A stage IA BC diagnosis had a negative effect on being self-supportive after 2 and 3 years among women in all six sectors, although the difference was largest among cleaning workers. This may indicate, that individual follow-up in relation to work participation is necessary.

Key messages

Although breast cancer stage IA has a good prognosis, it still affects being self-supporting after three years. A diagnosis of breast cancer affects the affiliation to the labour market, but the effect differs according to different sectors.

Parental mental vulnerability and use of healthcare services in infants

Background

Parental mental illness has been associated with a number of consequences for the health and use of healthcare services of the child. However, most research has focused on maternal depression. Research examining the impact of paternal mental vulnerability (MV) as well as different degrees of MV are needed to plan interventions. Therefore, the aim of this study was to examine the association between different categories of individual and combined parental MV and the child’s use of healthcare services the first year of life.

Methods

A population-based birth cohort study was conducted including all Danish children born from 2000-2016 using the Danish national registers. Exposure was parental MV of three categories according to the degree of MV: Group 1 “minor MV” with mental related contacts to primary healthcare and/or prescribed psychopharmaceuticals, group 2 “moderate MV” and group 3 “severe MV” both with contacts to psychiatric hospital. Outcome was contacts to GP the first year of life expressed as incidence-rate ratios (IRR) using Poission’s regression analyses.

Results

The analyses included 952,709 children. 21% of the mothers and 11% of the fathers were in the MV groups. Parental MV (any parent, any MV-group) was associated with an increased risk of GP contacts daytime and out-of-hour contacts. If both parents were classified as group 1 MV, IRR were 1.21 (CI95 1.20-1.22). IRR were 1.18 (1.17-1.18) resp. IRR 1.05 (1.04-1.06) if only the mother resp. father were in MV group 1. The same pattern were seen for out-of-hour contacts; IRR 1.28 (1.26-1.31) for both parents in group 1 and IRR 1.19 (1.18-1.20) resp. IRR 1.09 (1.08-1.11) for the mother resp. father.

Conclusions

Maternal and paternal MV were associated with an increased risk of GP contacts daytime and out-of-hour contacts although maternal MV had the highest risk. Even minor MV had an impact on healthcare contacts and the risk increased further if both parents were classified as minor MV.

Key messages

Both maternal and paternal mental vulnerability has an impact on the child’s healthcare contacts. Our results indicate the need for a focus also on minor mental vulnerability in the planning of interventions.

Systemic cobalt toxicity from total hip arthroplasties

As adverse events related to metal on metal hip arthroplasty have been better understood, there has been increased interest in toxicity related to the high circulating levels of cobalt ions. However, distinguishing true toxicity from benign elevations in cobalt levels can be challenging. The purpose of this review is to examine the use of cobalt alloys in total hip arthroplasty, to review the methods of measuring circulating cobalt levels, to define a level of cobalt which is considered pathological and to review the pathophysiology, risk factors and treatment of cobalt toxicity. To the best of our knowledge, there are 18 published cases where cobalt metal ion toxicity has been attributed to the use of cobalt-chromium alloys in hip arthroplasty. Of these cases, the great majority reported systemic toxic reactions at serum cobalt levels more than 100 μg/L. This review highlights some of the clinical features of cobalt toxicity, with the goal that early awareness may decrease the risk factors for the development of cobalt toxicity and/or reduce its severity.

Take home message: Severe adverse events can arise from the release of cobalt from metal-on-metal arthroplasties, and as such, orthopaedic surgeons should not only be aware of the presenting problems, but also have the knowledge to treat appropriately.

Cite this article: Bone Joint J 2016;98-B:14–20.

Systemic cobalt toxicity from total hip arthroplasties

Recently, the use of metal-on-metal articulations in total hip arthroplasty (THA) has led to an increase in adverse events owing to local soft-tissue reactions from metal ions and wear debris. While the majority of these implants perform well, it has been increasingly recognised that a small proportion of patients may develop complications secondary to systemic cobalt toxicity when these implants fail. However, distinguishing true toxicity from benign elevations in cobalt ion levels can be challenging.

The purpose of this two part series is to review the use of cobalt alloys in THA and to highlight the following related topics of interest: mechanisms of cobalt ion release and their measurement, definitions of pathological cobalt ion levels, and the pathophysiology, risk factors and treatment of cobalt toxicity. Historically, these metal-on-metal arthroplasties are composed of a chromium-cobalt articulation.

The release of cobalt is due to the mechanical and oxidative stresses placed on the prosthetic joint. It exerts its pathological effects through direct cellular toxicity.

This manuscript will highlight the pathophysiology of cobalt toxicity in patients with metal-on-metal hip arthroplasties.

Take home message: Patients with new or evolving hip symptoms with a prior history of THA warrant orthopaedic surgical evaluation. Increased awareness of the range of systemic symptoms associated with cobalt toxicity, coupled with prompt orthopaedic intervention, may forestall the development of further complications.

Cite this article: Bone Joint J 2016;98-B:6–13.

Pain-relieving effect of sucrose in newborns during heel prick

We assessed the effect of sucrose as a pain reliever in a population of newborns when cuddled and comforted during heel prick for diagnosis of phenylketonuria. In addition, the influences of gender, gestational age, postnatal age, ponderal index and behavioural state of the infant before the heel prick were studied, as judged by the neonatal infant pain scale (NIPS) score, on crying time (CT) and subsequent NIPS score. 100 healthy full-term infants were enrolled in this double-blind, randomized controlled trial. Before the heel prick, the newborns, when cuddled by the parent(s), were either given 2 ml 50% sucrose solution or 2 ml sterile water. The sessions were videotaped and analyzed for determination of CT and NIPS scores. The frequency distribution of CT showed a bimodal pattern in both the sucrose and the placebo groups. Sucrose significantly reduced CT and NIPS scores after the heel prick. No influence of gender, gestational age, postnatal age or ponderal index on CT was found. NIPS scores before the heel prick correlated significantly and positively with CT and subsequent NIPS scores in both the sucrose and the placebo groups. Intra-orally administered sucrose given before heel prick can be recommended as a useful pain reliever. Furthermore, the findings indicate that factors calming the newborn and creating low NIPS scores before the procedure can reduce the pain reaction equivalently and additively to sucrose administration.