On the 27th January over 200 people congregated at the University of Salford for the MECC conference run by Health Education England with support from Public Health England. The conference started off with a welcome and a bit of a dance (as we are told is tradition in some other conferences), but it proved to set the scene for what was an informative but also welcoming event. Sir Stephen Moss in his forward outlines MECC as ‘enables the systematic delivery of consistent and simple lifestyle advice, helping people to make positive changes that will improve their health and wellbeing.’
To start there was a bit of a race through some of the evidence, policy and local level examples of MECC. Shirley Cramer outlined the definition of the wider workforce and next steps, but also the importance of the workers’ situation in the community that they serve, while Sir Stephen Moss talked about changing the culture to embed MECC into everyday practice. Dr Charles Alessi reiterated the important message of ‘don’t let there be more missed opportunities when we could be doing something’. Dr Paul Chadwick reminded us that we need to reflect on our own behaviour and motivations as health practitioners, since MECC relies on us having the confidence to raise sensitive issues. A challenge of MECC is gaining consistent evaluation to explore the impact due to the diverse nature and content on the brief interventions; what is clear is that it can impact communities – as shown by Professor Kate Arden in Wigan.
The keynote session was followed with presentations on examples of tools kits, those produced at both a local and national level. There were examples provided by Claire Cheminade, the Public Health Wider Workforce lead in Wessex and Sally James the Public Health Workforce Specialist for the west midlands, which showed how MECC is embedded across all areas right from training of the new workforce. Nigel Smith and Mandy Harling used the session to help launch the ‘MECC: quality checklist for training resources’ and ‘MECC: implementation guide’, developed by Public Health England and Health Education England.
On breaking out for the session before and after lunch there was a chance to hear about more examples, but also look at settings and behaviour change, to help with understanding the theory and practice. During lunch there was an opportunity to take a seat in the MECC cinema where a short film was shown which illustrated different people who have undertaken MECC training and put it into practice successfully. In the afternoon, one of the workshops, titled ‘NICE Guidelines and Behaviour Change Approaches’ was led by Dr Paul Chadwick. This included an interesting lecture and some useful group work. It enabled attendees to consider how their own behaviour and beliefs could impact on the implementation of MECC in their setting.
As part of @SalfordPH involvement throughout the day, eight of the MSc public health students (as pictured below), were on hand to support the event staff and delegates with their day. Additionally Penny and Anna chaired the initial sessions around “what the system is saying about MECC and why it is important” and “Implementing MECC”.
Volunteer MSc Students
This also provided our students with the chance to hear from some leading experts in this area and be able to hear examples of how what we talk about in lectures relates to worked examples. Our thanks go to each of the students for taking the time to support the day.
Although MECC is going through a difficult time in many local areas in relation to funding, it is clear from this day there are many people who carry out the premise of MECC in their everyday working and it is something we can all be more aware of doing.
Alcohol and pregnancy are a dangerous mix. The physical effects of alcohol on a developing foetus are well known and potentially devastating. It is known to impact physical development – causing stunted growth, craniofacial abnormalities, reduced head and brain size, sight and hearing problems, and limb and organ defects. Foetal alcohol exposure causes problems in cognitive and psychological functions such as learning, speech and language, memory, attention, inhibition, social cognition, planning, motor skills, attachment, and behaviour. The name given to the range of outcomes caused by prenatal exposure to alcohol is foetal alcohol spectrum disorder (FASD).
Double jeopardy: adding childhood neglect
Children who are exposed to alcohol prenatally are also at risk of what has been described as a case of double jeopardy: they are much more likely to experience adverse environmental experiences during the first months and years of development. These experiences can include neglect of daily care, abandonment, and emotional, sexual and physical abuse. The effects of such experiences can compound the effects of prenatal alcohol exposure, as they impact development in a similar way. Maltreatment such as neglect and abuse, especially if this is prolonged and lasts beyond the first six months of life, can have a significant impact on attachment, cognitive, psychological and social development and even physical growth.
By D Sharon Pruitt [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
To make matters worse, children who suffer maltreatment during early childhood miss out on normal attachment development. This can seriously impact their own parenting skills as adults, and lead to dysfunctional attachment behaviour if and when they become parents themselves. Those who suffer from foetal alcohol spectrum disorders are more likely to develop alcohol misuse issues, and are more likely to be involved in risky sexual behaviours. This can increase the risk of unplanned pregnancies, and so the cycle can be self-perpetuating.
Forthcoming research on FASD and neglect
The effects of a) prenatal alcohol exposure and b) early childhood maltreatment are well documented, but there is a surprising lack of research into their combined effects. My research will address this gap, first of all by conducting a systematic review into all published studies into the combined effects of prenatal alcohol exposure and early childhood maltreatment. I am currently writing up the results of this review for publication. It found only six articles on the subject, four of which used experimental methods to assess the impact of both issues. The main finding of these four articles is that speech and language deficits are more likely in children with both issues, compared to children with one or the other.
There are several other aspects of cognitive development that are yet to be addressed in this population, and so the next stage of my research will assess deficits in social cognition and executive function – two of the most prominent areas of deficit in children with foetal alcohol spectrum disorders and in children with a history of maltreatment. I aim to study these deficits using a combination of caregiver reports and behavioural tasks conducted in a lab at the University of Salford. I am also planning to incorporate a measure of brain activity using functional near infra-red spectroscopy (fNIRS) – a non-invasive technology that uses light waves on the near infra-red spectrum to measure blood movement in the cerebral cortex – the outer layer of the brain. This technology is especially useful in samples of young children, and this will be the first time fNIRS will have been used in this population.
I am currently in the process of applying for ethical approval, and hope to begin data collection soon.
The new Department of Health guideline on alcohol says that there is no safe alcohol limit for pregnant women. Alcohol should simply be avoided.
Alcohol exposure during pregnancy can cause damage to the body and brain of the baby, causing a range of lifelong problems. These problems are grouped under the umbrella term “foetal alcohol spectrum disorders” (FASD). The most recognised form of FASD is foetal alcohol syndrome (FAS). People with FAS have distinctive facial features, are small for their age and have problems with learning.
The exact number of drinks a woman can have before harming her baby is unknown (and is likely to vary from woman to woman), so most countries, including Canada, Australia and the USA, have taken a conservative approach and recommended that no alcohol is the safest option. This new guideline now brings the UK in line with those and many other countries.
Recent research has revealed a large number of problems experienced by people with FASD. Around half of all people with FASD have attention-deficit hyperactivity disorders (ADHD), 62% have vision impairment (a rate more than 30 times higher than the general population), 58% have hearing problems (more than 100 times higher than the general population), 83% have speech and language delays and 91% suffer from impulsivity and inappropriate behaviour.
Each person with FASD may have some or all of these problems, and each person may have these problems from a mild to severe degree.
May be as prevalent as autism
We don’t know how many people have FASD in the UK, but based on a large review of data from other countries, it’s estimated that it may affect as much as 2% of the population. This would put FASD on a par with well-recognised developmental disorders such as autism spectrum disorder. In fact, a significant proportion of children currently diagnosed with ADHD or autism may have undiagnosed FASD as an underlying cause of their learning problem.
One problem with recognising the extent of the hidden epidemic is that FASD is significantly under reported. For example, out of a search of five years’ worth of outpatient hospital data in England, no cases of FASD were recorded. The researchers also looked at hospital admission data, expecting to find that areas with higher levels of alcohol-related illness in young women (such as in the north-west and north-east of England) would also have higher levels of FASD. This was not the case, suggesting that either FASD is not diagnosed, or it is diagnosed but not routinely recorded in hospital data.
A difficult diagnosis
Diagnosis is dogged by difficulties, including the fact that many healthcare professionals don’t know much about FASD and specialist training is needed to make a diagnosis. A diagnosis has to be made by a team of different professionals following a thorough assessment of the child that involves a physical examination, intelligence tests, occupational and physical therapy, and psychological, speech and neurological evaluations, as well as genetic tests to rule out genetic causes of problems.
Another difficulty with getting a diagnosis is that the behavioural and developmental problems that are signs of FASD may not emerge until a child is at primary school, by which time vital evidence about whether the birth mother drank during pregnancy may be missing. This information is crucial to make a diagnosis if the distinctive facial features seen in full-blown FAS are not present. Another difficulty is that people with FASD usually have other disorders (such as ADHD or autism spectrum disorder), making it difficult to isolate FASD.
To get the true number of people with FASD, it would be necessary to screen a whole group of the general population. This has been done in other countries, such as Italy, the USA and Canada, but there has been no such study in the UK.
Action at last
Last summer, a cross-party group of MPs took an interest in FASD, forming the All Party Parliamentary Group (APPG) for FASD. In its first report, released in December 2015, it made a number of recommendations including the call for a public health campaign to raise awareness of FASD. The APPG also called for “urgent consideration to be given by the government into commissioning a UK-wide study to ascertain the prevalence of FASD”. This would be a vital first step in uncovering the true extent of FASD.
Why is such recognition important? The consequences of unrecognised and unsupported FASD are wide, including addiction, mental health problems and disengagement with education. Children can appear bright and talkative and can appear to learn, but often forget what they have learned by the following day. They can also behave inappropriately. Because the cause of their difficult behaviour is not understood, they frustrate teachers and are often labelled as “naughty”. Sadly, another tragic consequence of unrecognised FASD, is that many go on to find themselves in trouble with the law.
Early detection and intervention are important because with the right support, there is growing evidence that people with FASD can live and work independently. But, until the UK catches up with the USA, Canada and Italy, many people with FASD will continue to suffer in silence.
Ahmed Mohammed Al gharib is an international student from the UAE who is currently studying public health at Salford. Public Health is still developing in the UAE. Ahmed has written a short reflection around his thoughts about the importance of Public Health to the UAE.
Two major factors in UAE are of particular importance to public health; the very high socio-economic status; and the impact of the built environment. In this regard, there is a larger population of wealthy individuals from all over the world who live in the UAE. In the major cities like Dubai and Abu Dhabi it is not common to see poorer-class citizens. This socio-economic status is likely to impact on their health.
The wealth of the country has led to a huge increase in the number of tower blocks being built. Within these, there is an emphasis on using the most up-to date technologies available, so potentially relying a lot at technology during work and/or at home, (e.g. through “smart house”) which is also likely to impact health conditions. In particular, the Gulf countries face pretty high diabetic and obese populations compared to other countries. This is in part due to the wealthy lifestyle and the consistent cultural/traditional hospitality; i.e. invitations to dinners with a huge amount of food. Culture plays a major role in this.
In the region:
Kingdom of Saudi Arabia has the world’s highest number of diabetic people.
Saudi Arabia takes 3rd place in Obesity.
Kuwait is the highest number of obese people worldwide.
I believe that the Public Health sector, when working alongside other professional sectors in cross-sectional teams, will carry out research that can work towards resolving many complex problems in the UAE and Gulf countries -that are a cause of mortality and morbidity. Public Health staff are very useful, as they think critically about an issue to determine its origins, work along management and policy makers, and implement strategic decisions that will improve health, and health care delivery. Advanced methods in public health have the potential to help people and organisations to cope with the rapid technological/industrial and organizational issues in the UAE to make the best possible decisions in relation to health and wellbeing. There is also the potential for aspects of public health maximizing productivity, profitability, and life satisfaction within the region.
In addition, there is a need for being ready to deal with future challenges resulting from changes in the interaction between people and the environment and implementing epidemiological skills to the field of public health. It is also important to correlate environmental and Public Health concepts to protect the citizens and the environment from stressors or contaminants there. Particularly as the weather in UAE gets very hot during summer times; it over 54 Celsius! As such there is a need for public health solutions in relation to this area and suitable interventions and education.
Implementing the theoretical and practical knowledge of Public Health (e.g. in relation to communicable and non-communicable diseases) within the UAE has the potential to have a stronger impact compared to other countries.
My name is Umar Kabo Idris from Kano state, Nigeria. I am a passionate public health professional who is highly interested to be a part of strengthening health systems and closing the wide gap of health inequality in Nigeria. In pursuance of this interest, I was fortunate to work with an NGO that plays a vital role in health systems in northern Nigeria through the use of appropriate technology. My interest grew even bigger while working in many rural areas across various states. After working for almost two years, I thought of getting a masters degree in the field of public health in order to acquire the appropriate research skills and vast knowledge to fulfil the desired passion and achieve my end goal of changing people’s lives in the area of better health services and to also advocate for better health policies. With gratitude to God, that has been achieved as I have just concluded my masters degree program in Public Health from the prestigious University of Salford, Manchester.
During the masters programme time, I thought of a dissertation topic that would fit into what could change or bring in better health policies, add value to our localities particularly with regards to improving the lives of people in my state. I arrived at something to do with technology because from my ideas and those found from research, it is clear that technology is massively used to support many interventions through health systems strengthening in many developing countries. The research looked at the impact of local public health workers using GIS technology for polio vaccination coverage. It was a successful research, in the end we explored on ways the same technology could be used in other local interventions especially now that Nigeria is officially no longer listed as a polio endemic countries. Thereafter, that led us to find out the prevalent diseases that needed more attention and how the technology could be used to support those interventions.
The journey of my passion did not stop at that, my masters research has given me a broad scope of what I love to do. I immediately got the opportunity to apply for an opening of Assistant Project Manager in my second week of coming back. I applied and was called for interview due to my experience of work in the same organization I left for masters last year. Part of the job interview focused on my dissertation findings and it was an easy ride for me. In the end, I can say I got the job and my first task is to be a part finding out how we can use appropriate technology to support the upcoming measles campaign scheduled to take place in the third week of November 2015. I am highly exited and happy to get my masters from a great team of public health in the University of Salford, even more so from my inspiring project supervisor (Anna Cooper). I am also happy that I am on the right track of achieving my aim.
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