Term Health Conditions Research Articles

The influence of maternal long term health conditions including multimorbidity on child oral health: A scoping review and evidence gap map protocol

Objective This scoping review will map the extent and type of evidence in relation to the association between maternal long term health conditions (LTCs), including multimorbidity, and child oral health. Introduction Newer theories are emerging that detail the many factors that can influence child oral health at child, family and community levels. More recently, the association between maternal general health and child oral health has been explored, with preliminary evidence suggesting a link between shared environmental factors and diet/substance use during pregnancy causing childhood caries. Inclusion criteria All published studies that describe the relationship between maternal LTCs (including multimorbidity) and child oral health. There will be no limitation on the date of publication due to the limited number of studies available from the initial search of PubMed. The review will exclude case studies, abstracts, and grey literature. Literature must be in English language. Methods The following databases will be searched; CINAHL, Cochrane Library, Maternity and Infant Care, Medline via PubMed, Scopus, Web of Science. The search will include sources in English only and will be undertaken between April and July 2024. Studies to be included will be of any type of study design that describe a relationship between maternal long term health conditions, including maternal long term oral health conditions, and child oral health. Data extraction will be undertaken using tabulation of results by at least two independent reviewers. Narrative analysis of the evidence will be undertaken, and results will be presented in a narrative and tabular manner due to the heterogenous and limited evidence base found in the test search. This review has been registered prospectively on Open Science Framework, (https://doi.org/10.17605/OSF.IO/ECSWJ). The review will also inform an Evidence Gap Map (EGM) to illustrate the current evidence base regarding maternal health factors that influence child oral health.

Adverse childhood experiences and multimorbidity of internalising and cardiometabolic conditions in an older-age population.

BackgroundTackling multimorbidity (ICM-MM) of internalising conditions (IC) and cardiometabolic conditions (CM) is key to improving the future of healthcare. Early life factors such as adverse childhood experiences (ACEs) have been linked to long term, poor mental and physical health conditions. AimsThis study investigated whether: 1) ACEs increase the risk of IC, CM and ICM-MM; 2) the effect of ACEs on risk of developing CM depends on the presence of IC and vice versa; 3) how risk differs by gender, socioeconomic status and ethnicity. MethodsIn UK Biobank, the Childhood Trauma Screener was used to identify 157,256 participants with ACE data. Electronic healthcare records (EHR) and interview data identified those with anxiety or depression (IC) and those with hypertension, obesity, type 2 diabetes, dyslipidaemia or chronic kidney disease (CM). Multivariate logistic regression models were employed to find associations between ACEs and IC, CM and ICM-MM. Covariates included age, gender, ethnicity, socioeconomic status, diet, alcohol intake, smoking behaviour and physical activity. ResultsAll ACEs significantly increase risk for IC (all ACEs, p = <2e-16). Emotional neglect, physical neglect and emotional abuse increase risk of CM (e.g. physical neglect, OR = 1.43, CF = 1.30-1.58, p = 1.88e-13). ACEs appear to increase IC and CM risk independently. ConclusionsThe effects of ACEs last well into adulthood and confer risk for IC and, sometimes, CM. ACE history should be included in routine primary care and the development of therapeutic interventions tailored to older adults with ACEs is key to reducing poor health.

A meta-narrative review of research traditions on hidden workers in aging population for transdisciplinary implementation research.

Hidden workers are defined as the three vulnerable subgroups of workers: the underemployed, the unemployed, and the discouraged workers. Hidden workers indeed the group with multiple identities; a transitioning retiree, jobseeker, caring for some, who may also have long term health conditions and ethnic minority all at the same time. Designing an intervention for this group necessitates the transdisciplinary knowledge. Transdisciplinary knowledge is crucial because it can inform how the intersectoral challenges might be addressed in interventions, and how the intersectoral implementation design and evaluation on hidden workers might be designed. This paper maps the intellectual landscape of the hidden workers in aging population literature to identify key disciplinary research clusters; and to find out how those research clusters are investigating hidden workers. With the meta-narrative review methodology on studies retrieved from the Web of Science Core Collection, five research clusters were identified: (1) public health approaches to hidden workers, (2) welfare state and aging workforce, (3) older jobseekers, (4) life course perspective, (5) retirement transitions. Each research cluster focuses on different aspects of hidden workers, with varying research questions and rationales. These include conceptualising the determinants of the hidden workers in aging populations and the complex interrelation with public health. Furthermore, we suggest an analytical framework to allow for better understanding between the research traditions based on (1) the chosen socioecological level of analysis, (2) whether the research question is on the determinant for hidden workers or on the outcome of being hidden and (3) the chronosystem (early/middle/later life) timeframe of research question that is addressed. Through this study, we can identify the main issues faced by hidden workers among the older adults and the measures to address these issues as well as opening up a possibility for cross-sectoral policy responses.

Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study.

Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated associations between individuals' characteristics (including socioeconomic deprivation and long term health conditions (LTC)) and the frequency of emergency department (ED) attendances, in the Norfolk and Waveney subregion of the East of England. The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year from 1 April 2022 to 31 March 2023. Linked primary and secondary care and geographical data included each individual's sociodemographic characteristics, and number of ED attendances during the same year and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendances were estimated using Poisson regression models. 1,027,422 individuals were included of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population ED attendances were more frequent in individuals aged under five years, (adjusted Incidence Rate Ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15-35 years); living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63)) for least deprived compared to most deprived,and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)). In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance.

Development of the intelligent knee osteoarthritis lifestyle app: a person-based approach

BackgroundKnee osteoarthritis is one of the most prevalent long term health conditions globally. Exercise and physical activity are now widely recognised to significantly reduce joint pain, improve physical function and quality of life in patients with knee osteoarthritis. However, prescribed exercise without regular contact with a healthcare professional often results in lower adherence and poorer health outcomes. Digital mobile health (mHealth) technologies offer great potential to support people with long-term conditions such as knee osteoarthritis more efficiently and effectively and with relatively lower cost than existing interventions. However, there are currently very few mHealth interventions for the self-management of knee osteoarthritis. The aim of the present study was to describe the development process of a mHealth app to extend the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through self-management, personalised physical activity, education, and social support.MethodsThe development of the intelligent knee osteoarthritis lifestyle application intervention involved an iterative and interconnected process comprising intervention ‘planning’ and ‘optimisation’ informed by the person-based approach framework for the development of digital health interventions. The planning phase involved a literature review and collection of qualitative data obtained from focus groups with individuals with knee osteoarthritis (n = 26) and interviews with relevant physiotherapists (n = 5) to generate ‘guiding principles’ for the intervention. The optimisation phase involved usability testing (n = 7) and qualitative ‘think aloud’ sessions (n = 6) with potential beneficiaries to refine the development of the intervention.ResultsKey themes that emerged from the qualitative data included the need for educational material, modifying activities to suit individual abilities and preferences as well as the inclusion of key features such as rehabilitation exercises. Following a user-trial further changes were made to improve the usability of the application.ConclusionsUsing a systematic person-based, development approach, we have developed the intelligent knee osteoarthritis lifestyle application to help people maintain physical activity behaviour. The app extends the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through personalised physical activity guidance, education, and social support.

Food insecurity in adults with severe mental illness living in Northern England: Peer research interview findings.

Food insecurity means that a person does not have access to sufficient nutritious food for normal growth and health. Food insecurity can lead to many health problems such as obesity, heart disease, diabetes, and other long term health conditions. People living with a severe mental illness are more likely to experience food insecurity than people without mental illness. Peer-led in-depth interviews were conducted with adults with severe mental illness from Northern England, during which their experiences of food insecurity and strategies to tackle food insecurity were discussed. Interviews took place between March and December 2022, with interviews being transcribed and analysed using deductive and inductive thematic analysis. Thirteen interviews were conducted, finding that food insecurity in adults with severe mental illness was often a long-standing issue. Unemployment, the cost-of-living crisis and fuel poverty impacted on experiences of food insecurity. Difficulties accessing food banks such as transport, stigma, and the limited selection of available food was also discussed. Strategies to tackle food insecurity centred on making food banks more accessible and improving the quality of available food. Future research should aim to eradicate food insecurity for adults with severe mental illness, as limited research and action focuses on this population group over and above 'mental illness' or 'poor mental health'. Removing barriers to accessing food such as lack of transport, and providing food which is of adequate nutritional quality, should be prioritised, as well as tackling the stigma and accessibility issues surrounding food banks use.

O.5.2-4 ‘Experience of the menopause transition with reference to symptoms, health, and wellbeing, and how they impact motivators, facilitators, and barriers to physical activity engagement’

Abstract Purpose To explore experiences of the menopause transition (MT) of women living in Ireland with reference to symptoms, health, and wellbeing, and how they impact motivators, facilitators, and barriers to physical activity (PA) engagement. Methods Eleven, perimenopausal, Irish women (age: 51 ± 3 years) participated in individual, online, semi-structured interviews. During each interview women were asked about their experience of the MT and its influence on PA engagement. All interviews were digitally recorded and transcribed verbatim, resulting in ≈ 51, 951 of words for descriptive and thematic analysis. Three to four themes were identified under the headings of motivators, facilitators, and barriers to PA engagement. Results The MT was a significant event in most women’s lives that influenced PA engagement. The main motivators to engage in PA throughout the MT included safeguarding against long term health conditions, managing menopause symptoms, enjoyment through both socialising and achievement, as well as encouragement from family and role models. Many women discussed that feelings of community and collective experience through menopause fraternities, adapting and modifying, and medical supports were key factors that facilitated PA engagement throughout this life stage. There were a multitude of barriers that women in midlife faced before they could engage in PA, such as fears surrounding their capability to engage in PA, symptoms associated with the MT, the busyness of life and competing demands, as well as a lack of relatable opportunities and feelings of belonging within certain PA environments alongside other practicalities, including environment location and cost. Conclusion The specific motivators, facilitators, and barriers to PA engagement that women experience throughout the MT are unique which is an important consideration for stakeholders when facilitating women to either continue or (re)introduce PA during this life stage. Support/funding source Sport Ireland Research Grant Scheme.

O.4.2-3 Physical activity participation among disabled people: secondary analysis of the 2018/19 Active Lives survey

Abstract Purpose Disabled people face significant barriers to being physically active and typically have low levels of activity. To enhance both access to and engagement in physical activity, it is valuable to understand the activity choices of disabled people. This study describes the types and duration of physical activity participation among disabled people and compares this to participation among non-disabled people. Methods This study used data from the 2018/19 sweep of Sport England’s Active Lives survey, a nationally representative assessment of activity levels in adults living in England. From a prespecified list of 212 activities, participants reported their participation in the previous 12 months (yes/no) and duration in the previous four weeks (min/week). For this study, activities were subsequently collapsed into 17 mutually exclusive groups, which included ‘leisure activities’ (for example, walking, and gardening) and ‘invasion games’ (for example, football and rugby). Participants also reported whether they had a long term (>12 months) health condition and whether this affected their normal daily activities; this informed the classification of participants into three groups: limiting disability, non-limiting disability, and no disability. Results Data were available for 171,121 participants, of whom 31,666 (18.5%) had a limiting disability, 34,955 (20.4%) a non-limiting disability, and 104,500 (61.1%) no disability. Leisure activity was the most common activity type and had the highest median mins/week of activity (median, 315 [IQR = 120-705] limiting disability; median, 390 [IQR = 180-750], non-limiting disability; median, 379 [IQR = 165-750] no disability). Across the three participant groups, walking, swimming, and gym-based activity were among the most common activities undertaken. Compared to participants with no disability, participants with a limiting disability reported lower engagement and durations for all activity types, except motorsports. Conclusions The types of activities undertaken by disabled people were largely similar to that of non-disabled people, but engagement and duration was typically lower. The necessary next step is understanding how to improve adoption of and adherence to different activity types among disabled people. Support/Funding Source This research was funded by a University of East Anglia Faculty of Medicine and Health Studentship.

Formulating finger millet (Eleusine coracana L) and cowpea (Vigna unguiculata) food blend for enhanced micronutrients for children below 5 years

Malnutrition of children under 5 years is a public health concern because it is the most vulnerable stage of child’s growth where its impact results in long term health conditions such as stunting, wasting, obesity and poor cognitive development. This study aimed at developing a Rapoko-Cowpea porridge blend to enhance dietary micronutrients among children below the age of 5 years and assess its sensory acceptability. A mixed methods research approach was adopted consisting of a quasi- experiment and a cross sectional survey. Vendors from Mbare market were clustered based on the source of their finger millet and cowpea grains (Masvingo, Murewa, Gokwe). A Completely Randomised Design (CRD) was used with three treatments (blends) replicated three times. Proximate analysis was done using standard AOAC methods. Compared to cowpea, finger millet had the highest levels of carbohydrates (78.12g/100g), iron (8.7mg/100g), zinc (3.77mg/100g). Results also show that 75:25. Rapoko-Cowpea blend ratio had the ability to meet WHO daily nutrient requirements for children under the age of 5 years. Blend ratio of Rapoko: cowpeas (75:25) had the highest carbohydrates (69.41g/100g), protein (25.64g/100g), zinc (1.74mg/100g), iron (5.14mg/100g), energy (411.37kcal), and vitamins (0.11 mcg RAE) with RaCoB1 blend having the lowest nutrient composition. Results have showed that finger millet (Rapoko), cowpeas and RaCoB (Rapoko-Cowpea blend) blends have high macro and micronutrients (iron and zinc) to support daily nutritional requirements of children below the age of 5 years and may help in addressing malnutrition. Sensory evaluation was done with 100 panellists from the University of Zimbabwe and of the three blends, a 75:25 ratio was the most preferred (90.88%). Further studies need to analyse the effects of anti-nutritional factors, bioavailability of nutrients, shelf life of the food blend and commercialization potential of RaCoB blends. The government is therefore encouraged to provide agronomic support for increased productivity of small grains and pulses through improved research and extension. There is a need to develop a policy at national level that promotes blending of cereals and pulses as well as innovative small scale food processing initiatives through private-public partnerships. Key words: Children under 5 years, Cowpea, food blending, Malnutrition, Micronutrients, Rapoko, Sensory evaluation

Evaluation of a Virtual Compassionate Living Group for Patients with Chronic Pain

Chronic pain affects around 28 million people in the UK. Those living with chronic pain can frequently experience internalised self-stigma and negative self-evaluations as a result of the pain itself and due to difficult life experiences. Previous research has found Compassion Focused Therapy to be effective for people living with long term health conditions like chronic pain. The current study sought to evaluate a routine Virtual Compassionate Living Group for patients with chronic pain on the measures of self-compassion, self-criticism and pain self-efficacy. The evaluation took place in a routine clinical setting. 13 outpatients attended the online group across three separate groups. Groups were delivered over eight or ten sessions with the group content focusing on psychoeducation of the Compassion Focused Therapy model and Compassionate Mind Training. Reliable and clinically significant change analyses were used to assess the data. Results showed that there had been improvements on the measures of self-compassion with 6 out of 13 patients exhibiting reliable and clinically significant change. Some improvements had also been made on pain self-efficacy and self-criticism but to a lesser extent. Thematic analysis was used to analyse the evaluation feedback forms for the course. Three superordinate themes were identified; <em>sense of belonging</em>, <em>flourishing</em> <em>and virtual benefits</em>. The service evaluation indicated that a Virtual Compassionate Living Group for patients with chronic pain can lead to improvements in self-compassion. This is consistent with previous research evidence, but larger scale evaluations are required to verify conclusions.

P55 Work ready champions for young people: the role of occupational therapy in addressing the pre-vocational and early-employment needs of young people with long term health conditions

Introduction/BackgroundDeveloping a vocational identity is an important part of adolescent development and vocational morbidities have been recognized in young people with long term health conditions including rheumatic disease. Challenges in educational settings and/or workplaces have been reported by young people. Young people have also identified this area to be a research priority. Occupational Therapy (OT) is well placed to assume a lead role in this area, as it is the only health profession that has occupation at the core of its philosophy and practice.Description/MethodThe aim of this study was to explore the pre-vocational and early-employment needs of adolescents and young adults with long term health conditions from the perspectives of OTs and to examine their current and potential role in addressing these needs.MethodsA questionnaire was developed using Qualtrics software and piloted with two OTs and amended accordingly. A snowballing recruitment method via email and Twitter was employed. Initial contact was made via colleagues of the project team and cascaded to OT networks. Data included demographic, involvement in health care planning with education, perceived importance of addressing pre-vocational issues for young people, respondents’ knowledge and confidence, and the role of OT.Discussion/ResultsThe survey received 130 responses, of which 76 responses had complete data available (59%). A complete case analysis approach was taken. The majority of respondents were in clinical roles, primarily working in hospital or community settings and duration in practice ranged from 10 months to 40+ years. The perceived importance of addressing a wide range of vocational issues was consistently greater than the perceived knowledge and confidence of the professionals to address these. The majority of respondents (75%) perceived a need to address vocational issues for young people in their setting although only 22% reported that there was a designated member of their multidisciplinary team who would address these. The majority of such personnel identified by respondents were OTs but also included youth workers, education officer in the youth justice service, social worker.63% routinely assessed productive/vocational occupations such as employment/education. Half of respondents (51%) did not know where to signpost/refer young people for vocational/employment advice. The majority (92%) reported not having any training in addressing vocational/employment issues specifically for young people aged 10-24 years and only 20% reported training in this area with adults. The majority (70%) however did perceive a difference in providing such advice to young people compared to adults. The main perceived barrier to addressing this area in practice was limited clinical time.Key learning points/ConclusionThis study echoes previous calls for vocational issues to be addressed with young people with long-term health conditions and highlights the need for this to be addressed in both training and service provision.

P59 Growing up in rheumatology: An Evaluation of a Young Adult Rheumatology Service

P59 Growing up in rheumatology: An Evaluation of a Young Adult Rheumatology Service

P50 Addressing the vocational development of young people with long-term health conditions in health care settings: a systematic review and mixed methods synthesis

Introduction/BackgroundLong term health conditions (LTHC) such as rheumatic conditions have significant impact on the biopsychosocial development of young people (YP) including vocational development. Educational transitions are prominent during adolescence and young adulthood yet not all transitional care programmes in rheumatology address this area [1]. The aim of this study was to identify and synthesise the benefits and experiences of addressing the vocational development of YP with LTHC in health care settings.Description/MethodA mixed methods synthesis approach [2] was employed. We systematically searched 10 bibliographic databases. Restrictions were applied on publication date (1996-2020) and publication language (English). Articles reporting quantitative and/or qualitative primary research on addressing vocational needs/issues of YP with LTHC in health care settings were included. YP was defined as 10-24 years [3]. Two reviewers independently screened records using predetermined inclusion/exclusion criteria [4]. Quality appraisal was undertaken following study selection. Qualitative data were synthesised thematically. Quantitative data were synthesised narratively, given that a pooled synthesis was not considered appropriate. A cross-study synthesis integrated findings from both the qualitative and quantitative syntheses.Discussion/Results43 articles were included. The quality of qualitative evidence was good; however, the quality of quantitative evidence was poor. The thematic synthesis of stakeholders’ perspectives (n = 23 qualitative studies) resulted in seven recommendations for interventions: provide skills training; provide psychological support; offer to liaise with key stakeholders in educational/workplace settings; provide specialist career advice; provide information, signposting and facilitate access to supporting services; provide/facilitate access to social support; provide flexible care and optimal disease management to support education/employment transitions. The narrative synthesis summarised the results of 17 interventions. The cross-study synthesis mapped interventions against the set of recommendations arising from stakeholders’ perspectives: four interventions met five recommendations; two interventions met four recommendations; five interventions met three recommendations; six interventions met two recommendations. Transitional care interventions were the type of intervention that most comprehensively met the recommendations. The way in which interventions addressed vocational issues was not always clear, with some interventions addressing them directly and others indirectly. No interventions had vocational issues as the core, defining component of the intervention.Key learning points/ConclusionExisting stakeholder evidence highlights that vocational development is an important area to address in the care of YP with LTHC such as rheumatic diseases. The resulting set of recommendations provides guidance for future research in this area and transitional care developments in rheumatology. Further work in this area should address these aspects to enable better quality evidence and ensure consistency.

Does air pollution negate benefits of exercise in those with long-term health conditions? – Rapid review

BACKGROUND AND AIM In healthy adults, exercise is generally beneficial for health unless air pollution levels are very high (Tainio, 2016). However, recent studies (e.g. Sinharay et al 2018) raise the possibility that air pollution at levels seen on busy streets in western countries may offset the physiological benefits of exercise for people with long-term health conditions. The aim of this study was to conduct a rapid literature review to inform the European Space Agency funded Personalized Space Technology Exercise Platform (P-STEP) app development. The app will advise people with pre-existing conditions on exercising based on environmental conditions such as air pollution and meteorology. METHODS We identified papers in PubMed, with search terms on air quality, long-term conditions and exercise. Additional papers were identified from authors’ own library. Papers selection and data extraction was conducted by a single reviewer (MP). RESULTS A relatively small number of papers were identified. Designs were heterogeneous including chamber and cardiac stress test (experimental), panel and cohort studies considering short or long-term exposures. Short-term exposure to traffic pollution may offset some of the beneficial cardiopulmonary effects of walking for individuals with ischemic heart diseases and COPD, affecting autonomic function, heart rhythm and associated with ST segment depression (a marker of ischaemia) and angina symptoms. On the other hand, long-term studies in Asia and Europe suggest long-term benefits of exercise on mortality and disease risk in those with chronic disease even in moderate air pollution settings, despite adverse effects seen in short-term studies. CONCLUSIONS More studies are needed to be able to quantify short-term air pollution concentrations that may offset beneficial effects of exercise in those with chronic disease. However, long-term studies available suggest exercise remains a good way to reduce future disease risk. KEYWORDS #exercise, #air pollution, #long-term health conditions, #temperature, #short-term effects

Analysis of disease clusters and patient outcomes in people with multiple long term conditions using hypergraphs.

ObjectivesHaving multiple long term health conditions (MLTCs), also known as multimorbidity, is becoming increasingly common as populations age. Understanding how clusters of diseases are likely to lead to other diseases and the effect of multimorbidity on healthcare resource use (HRU) will be of great importance as this trend continues.
 ApproachGraph-based approaches, also called network analysis in the literature, have been used previously to study multimorbidity. The use of hypergraphs, which are generalisations of graphs where edges can connect to any number of nodes, and their application to the problem of understanding multimorbidity will be discussed. Analysis using hypergraphs was carried out using a population-scale cohort of people in the Secure Anonymised Information Linkage (SAIL) Databank to find the diseases and disease sets which are most important based on a measure of prevalence and measures of healthcare resource utilisation in secondary care.
 ResultsThe most important sets of diseases based on the centrality of a hypergraph weighted by a measure of prevalence featured hypertension, and the most important was hypertension and diabetes. The most important sets of diseases based on the centrality of a hypergraph weighted by a measure of unplanned inpatient HRU were arrhythmia, heart failure and hypertension while for a measure of outpatient HRU the most important set of diseases was diabetes and hypertension.
 ConclusionHypergraphs are very flexible and general mathematical objects and there is still a great deal of development that can be done to make them more useful in epidemiological settings and beyond.

Care burden, loneliness, and social isolation in caregivers of people with physical and brain health conditions in English-speaking regions: Before and during the COVID-19 pandemic.

BackgroundPublic health restrictions due to the COVID‐19 (SARS CoV‐2) pandemic have disproportionately affected informal caregivers of people living with long term health conditions. We aimed to explore levels of care burden, loneliness, and social isolation among caregivers of people with enduring physical and brain health conditions in English‐speaking regions worldwide, by investigating outcomes before and during the COVID‐19 pandemic.MethodsA cross‐sectional anonymous online survey data from 2287 English‐speaking caregivers of people with long term health conditions from four English‐speaking regions (UK, Ireland, USA, New Zealand) included measures of care burden, loneliness, and social isolation, reported before and during the COVID‐19 pandemic. Analyses were descriptive, followed by an ordinal regression model for predictors of burden.ResultsCompared to pre‐pandemic levels, all caregivers experienced a significant increase in burden, loneliness, and isolation. Caregivers of people with both brain health and physical conditions were the most burdened and had the highest levels of loneliness and isolation compared to caregivers of people with either a brain health or physical condition only. The increase in care burden among caregivers of people with brain health challenges was associated with caregiver's gender, moderate and severe emotional loneliness, magnitude and frequency of isolation during the pandemic, and care circumstances (cohabitation with the care recipient, restrictions on the ability to provide care).ConclusionsHealth and social care interventions should target caregivers' care circumstances and psychological outcomes, particularly in women, accounting for the significant additional burden of care, loneliness, and isolation resulting from pandemic‐related restrictions.

A Systematic Review and Meta-analysis of Face-to-face Medication Adherence Interventions for Patients with Long Term Health Conditions.

Although previous reviews demonstrated effectiveness related to medication adherence interventions, they incorporated various digital platforms and other multiple delivery modes, which makes difficult to distinguish what aspects of the interventions led to effectiveness. This review aimed to (i) estimate the efficacy of face-to-face medication adherence interventions on adherence outcomes, in adults with Long Term Health Conditions (LTHCs) and (ii) identify the Behaviour Change Techniques (BCTs) used in the interventions and examine their potential impact on efficacy. Cochrane Controlled Register of Trials, Embase, MEDLINE (Ovid), PsycINFO, Web of Science, PubMed, and Scopus databases were searched. Randomized controlled trials were included if they described an intervention to improve medication adherence, delivered via face-to-face only, and included patients with LTHCs. Studies were excluded if they used additional delivery modes, involved family members or used a group format. In addition, use of BCTs was coded. 20 studies were included (n = 3667). Statistically significant pooled effects were found favoring the intervention than control, for the following MEMS (electronic monitoring) measures: percentage of prescribed doses taken on time over a period of 3 weeks to 2 months (MD 9.34, 95% CI 4.36-14.33, p = .0002; I2 =0%); percentage of prescribed doses taken for a period of 1 week to 2 months (MD 5.63, 95% CI 1.62-9.64, p = .006; I2 = 51%) and for 1 month (OR = 2.51, 95% CI 1.37-4.57, p = .003; I2 = 0%); percentage of days correct doses taken for 1 month to 14 weeks (MD 6.59, 95% CI 0.74-13.15, p = .03; I2 = 68%). Studies using the Morisky scale showed a significant between group difference for 1-3 months (MD 0.86, 95% CI 0.59-1.13, p < .00001; I2 = 0%). Overall, more BCTs were identified in intervention conditions than in comparison conditions (22 vs. 10). The impact of BCTs on intervention effectiveness could not be established as the analyses were underpowered. Face-to-face interventions increased adherence to medication among adult patients with LTHCs. Although we were able to identify BCTs among interventions, data were insufficient to determine the impact of particular BCTs on intervention effectiveness.

Do family and maternal background matter? A multilevel approach to modelling mental health status of Australian youth using longitudinal data

Most previous research place great importance on the influence of family and maternal background on child and adolescents' mental health. However, age of onset studies indicates that the majority of the mental health disease prevalence occurs during the youth years. This study investigates the relationship of family and maternal background, as well as individual circumstance on youth mental health status. Data from 975 participants and 4632 observations of aged cohort 15 to 19 years in the Household, Income and Labour Dynamics in Australia (HILDA) longitudinal study were followed for 10 years (2007-2017). Multilevel logistic regression models were used to analyse the impact of youth circumstances on mental health status. The findings suggests that not all dimensions of family and maternal background (especially maternal education) have impacts on youth mental health. We found low household income (AOR: 1.572, 95% CI: 1.017-2.43) and adverse living arrangement (AOR: 1.586, 95% CI: 1.097-2.294) significantly increases mental disorder odds whereas maternal education or occupation fixed effects were not significant. Individual level circumstances have much stronger impact on youth mental health. We found financial shock (AOR: 1.412, 95% CI: 1.277-1.561), life event shock (AOR: 1.157, 95% CI: 1.01-1.326), long term health conditions (AOR: 2.855, 95% CI: 2.042-3.99), smoking (AOR: 1.676, 95% CI: 1.162-2.416), drinking (AOR: 1.649, 95% CI: 1.286-2.114) and being female (AOR: 2.021, 95% CI: 1.431-2.851) have significant deteriorating effects on youth mental health. Our finding is in contrast to the majority of studies in the literature which give a preeminent role to maternal characteristics in child and youth mental health status. Mental health interventions should consider heterogeneity of adverse youth circumstances and health-related behaviours.

P175 Work Ready Champions for Young People: the role of occupational therapy in addressing the pre-vocational and early-employment needs of young people with long term health conditions

Abstract Background/Aims Developing a vocational identity is an important part of adolescent development and vocational morbidities have been recognized in young people with long term health conditions including rheumatic disease. Challenges in educational settings and/or workplaces have been reported by young people. Young people have also identified this area to be a research priority. Occupational Therapy (OT) is well placed to assume a lead role in this area, as it is the only health profession that has occupation at the core of its philosophy and practice. The aim of this study was to explore the pre-vocational and early-employment needs of adolescents and young adults with long-term health conditions from the perspectives of OTs and to examine their current and potential role in addressing these needs. Methods A questionnaire was developed using Qualtrics software and piloted with two OTs and amended accordingly. A snowballing recruitment method via email and Twitter was employed. Initial contact was made via colleagues of the project team and cascaded to OT networks. Data included demographic, involvement in health care planning with education, perceived importance of addressing pre-vocational issues for young people, respondents’ knowledge and confidence, and the role of OT. Results The survey received 130 responses of which, 76 responses had complete data available (59%). A complete case analysis approach was taken. The majority of respondents were in clinical roles, primarily working in hospital or community settings and duration in practice ranged from 10 months to 40+ years. The perceived importance of addressing a wide range of vocational issues was consistently greater than the perceived knowledge and confidence of the professionals to address these. The majority of respondents (75%) perceived a need to address vocational issues for young people in their setting although only 22% reported that there was a designated member of their multidisciplinary team who would address these. The majority of such personnel identified by respondents were OTs but also included youth workers, education officers in the youth justice service and social workers. 63% routinely assessed productive/vocational occupations such as employment/education. Half of respondents (51%) did not know where to signpost/refer young people for vocational/employment advice. The majority (92%) reported not having any training in addressing vocational/employment issues specifically for young people aged 10-24 years and only 20% reported training in this area with adults. The majority (70%) however did perceive a difference in providing such advice to young people compared to adults. The main perceived barrier to addressing this area in practice was limited clinical time. Conclusion This study echoes previous calls for vocational issues to be addressed with young people with long-term health conditions and highlights the need for this to be addressed in both training and service provision. Disclosure J. Hackett: None. L. Lunt: None. C. Pidgeon: None. A. Farre: None. J. McDonagh: Consultancies; Pfizer, CSL-Behring.

Young carers in the COVID-19 pandemic: risks for mental health.

The COVID-19 pandemic has disrupted lives across the world, however for some groups, the disruption has been more keenly experienced - this includes young carers. Young carers are children, adolescents and young adults who provide informal care to someone else, typically a parent or other family member with a disability, long term health condition or who is elderly. In developed countries, it is estimated that 2-8% of those aged under 18 years are young carers [1]. The disadvantage and invisibility of young carers, already substantial prior to the COVID-19 pandemic, has been exacerbated during the pandemic, with likely implications for their ongoing mental health and well-being.