Parent health and wellbeing at home before and during COVID-19.

Environments of parenthood are changing with increasing rates of dual-working households, more single-parent and non-traditional families, increasing cost of childcare, and growing reliance on online communities for information and support. However, everyday parenthood activities are still primarily conducted at "home". In this paper, we draw on a study which initially aimed to explore parent health and wellbeing in everyday contexts before COVID-19, but the pandemic shaped the enquiry further. Our empirical research is based on an online survey with a sample of UK parents (n = 274). Findings presented here relate to qualitative data focused on descriptions of parenthood at home, analysed thematically. Our study reveals how everyday activities of parenthood, including intersections with work and socialisation, are experienced in and through the home in ways that impact health and wellbeing. Significantly, it connects home-life changes created during COVID-19 "lockdowns" with longer-term considerations of parent needs.

Polycyclic aromatic hydrocarbons (PAHs) in seabird eggs in Ireland.

Seabird eggs are considered a favourable matrix for monitoring marine pollutants and are widely used as higher trophic level indicators. Concentrations of Polycyclic aromatic hydrocarbons (Σ15PAH) were determined in the eggs of four piscivorous seabirds in Ireland from multiple colonies for the first time, Common Guillemot Uria aalge, Northern Gannet Morus bassanus, Common Tern Sterna hirundo and Arctic Tern S. paradisaea. PAH concentrations were generally lower than levels detected in eggs from other seabird studies and considerably lower than concentrations associated with no adverse effect in the eggs of domestic avian species. This study indicates potential site and species differences in PAH concentrations. Baseline data of PAHs in a range of seabird species from this study may provide an important reference point should a major pollution event occur in European waters, such as an oil spill.

Legacy and emerging contaminants in common guillemot Uria aalge eggs in Ireland and Wales.

Guillemot eggs from multiple Irish colonies and one Welsh colony were analysed for legacy pollutants such as polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and other organochlorine compounds (OCs), as well as metals. Stable isotope ratios of carbon (δ13C) and nitrogen (δ15N) were measured in eggs to understand the influence of diet on contaminant levels detected. Wide-scope target and suspect screening techniques were used on a single guillemot egg, providing novel information on contaminants of emerging concern. Stable isotope ratio analysis showed that guillemots from Great Saltee Island and Lambay Island (Ireland's east coast) had a similar carbon source (δ13C) and fed at similar trophic levels (δ15N), pollutant levels were higher in eggs from Lambay Island near Dublin, Ireland's industrialised capital city. Guillemot eggs from Aughris Head (Atlantic west coast of Ireland), and Skomer Island (Wales) had differing isotopic niches to other colonies. Egg samples from Aughris Head had the lowest levels of pollutants in this study (with the exception of mercury) and amongst the lowest levels reported worldwide. In contrast, Skomer Island had the highest level of pollutants with higher concentrations of Σ16PCB, Σ6PBDE and HCB than Irish colonies, most likely a result of its proximity to historically industrial areas. Levels of PCBs, p,p' -DDE and mercury in guillemot eggs have decreased over time according to this study, in concurrence with worldwide trends. Levels of pollutants in guillemot eggs, in this study, fall below existing thresholds for adverse effects in other species, with the exception of mercury.

Persistent pollutants in fresh and abandoned eggs of Common Tern (Sterna hirundo) and Arctic Tern (Sterna paradisaea) in Ireland.

Higher levels of persistent pollutants (Σ16PCB, Σ6PBDE, ΣHCH, ΣDDT, ΣCHL) were detected in fresh eggs of Common Terns Sterna hirundo from Rockabill Island near Dublin (Ireland's industrialised capital city) compared to Common and Arctic Terns S. paradisaea from Ireland's west coast. Intra-clutch variation of pollutant levels in Common Terns was shown to be low, providing further evidence that random sampling of one egg may be an appropriate sampling strategy. Significant differences in pollutant concentrations were detected between fresh and abandoned eggs on Rockabill. However, abandoned eggs can still provide a useful approximation of pollutants in bird eggs if non-destructive sampling is preferred. Levels of p,p' -DDE in tern eggs have decreased over time according to this study, in concurrence with worldwide trends. Results in this study fall below toxicological thresholds for birds and OSPARs EcoQO thresholds set for Common Tern eggs, except for mercury and HCH in the west coast.

Persistent pollutants in Northern Gannet Morus bassanus eggs in Ireland: Levels and colony differences.

Seabird eggs are considered a favourable matrix for monitoring marine pollutants and are widely used as higher trophic level indicators. Persistent organic pollutants such as polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and other organochlorine compounds (OCs) as well as metals have been shown to have deleterious impacts on seabirds. The Northern Gannet Morus bassanus is an avian sentinel; the largest breeding seabird in Ireland and an obligate piscivore. Gannet eggs were collected from two island colonies off the east coast of Ireland in locations with divergent history of industrialisation. Contaminant levels were measured and differences in concentrations between colonies compared. Stable isotope ratios of carbon (δ13C) and nitrogen (δ15N) were measured in each egg to understand the influence of diet and trophic position on contaminant levels detected. Significantly higher levels of Σ14PCBs, Σ7PBDEs and total mercury were detected in Gannet eggs from Lambay Island near Dublin (Ireland's industrialised capital city) compared to Great Saltee Island. No differences were observed in levels of other OCs (HCB, ΣHCH, ΣCHL, ΣDDT) between the two colonies. Though Gannets travel significant distances when foraging for food, tracking studies have demonstrated that birds from proximal breeding colonies maintain exclusive feeding areas. Stable isotope ratio analysis in this study demonstrated that Gannets at both locations occupy similar dietary niches, indicating that dietary differences may not be the driver of differing contaminant levels between colonies. Levels of persistent pollutants in the Gannet eggs fall below most existing thresholds for adverse effects and are within internationally reported values. Recent population growth and range expansion of Gannets in Ireland suggest that persistent pollutants are not having an immediate impact on the Gannet population. This study will inform potential monitoring programmes that can help Ireland achieve good environmental status under the European Union's Marine Strategy Framework Directive.

Ageing with a learning disability: Care and support in the context of austerity.

Recent work in geography has begun to look at the opportunities for care from siblings, friends and neighbours alongside parents and spouses. This paper examines the daily relationships that middle to older age adults with a learning disability have with remaining kin members, friends, and neighbours, within the context of declining formal day services. Adults with learning disabilities are more likely to have different life course experiences and be living on low incomes and in poor housing than the rest of the population as they have had less opportunity to work and save money through their lives. We draw on two qualitative studies with adults with learning disabilities. Findings suggest that friend and kin networks are anything but certain, as opportunities to meet and socialise shrink, and connections with siblings do not necessarily lend themselves to support. The findings raise the possibility of a space of attenuated care to convey the increasingly limited fronts from which support can be derived.

'Hopeful adaptation' in health geographies: Seeking health and wellbeing in times of adversity.

Living with adversity can create wide-ranging challenges for people's health and wellbeing. This adversity may arise through personal embodied difference (e.g. acquiring a brain injury or losing mobility in older age) as well as wider structural relations that shape a person's capacity to adapt. A number of dichotomies have dominated our understanding of how people engage with health and wellbeing practices in their lives, from classifying behaviours as harmful/health-enabling, to understanding the self as being defined before/after illness. This paper critically interrogates a number of these dichotomies and proposes the concept of 'hopeful adaptation' to understand the myriad, often non-linear ways that people seek and find health and wellbeing in spite of adversity. We highlight the transformative potential in these adaptive practices, rather than solely focusing on how people persist and absorb adversity. The paper outlines an agenda for a health geography of hopeful adaptation, introducing a collection of papers that examine varied forms of adaptation in people's everyday struggles to find health and wellbeing whilst living with and challenging adversity.

Treatment Planning for Mandibular Third Molars.

NICE guidance for mandibular third molars has been available since 2000. This was set up to limit the surgical treatment of these teeth to symptomatic patients. There are numerous risks involved with surgical treatment of mandibular third molars and these should be explained in detail to the patient. Common and serious complications of mandibular third molar surgery are damage to the inferior alveolar and lingual nerve. Predicting the risk of inferior alveolar nerve injury is useful for treatment planning. The orthopantomogram (OPT) is the baseline special test for assessing this and numerous signs on an OPT can predict an increased risk of injury to the nerve. Cone beam computed tomography (CBCT) is being more frequently used to assess this relationship further and can influence treatment planning. Coronectomy is a technique whereby the crown of the tooth is sectioned and removed leaving the roots in situ. This has proven to be a useful technique in high risk cases, but is not without its own complications. The increase in availability of CBCT imaging and the recent resurgence of coronectomy as a treatment modality can increase the number of treatment options available to patients. We have proposed an algorithm to aid the treatment planning and informed consent processes associated with mandibular third molar surgery. Clinical relevance: This article is relevant to primary and secondary care dental practitioners as it will aid the investigation, treatment planning, correct referral and management of patients with problematic mandibular third molars.

Heritage, health and place: The legacies of local community-based heritage conservation on social wellbeing.

Geographies of health challenge researchers to attend to the positive effects of occupying, creating and using all kinds of spaces, including 'green space' and more recently 'blue space'. Attention to the spaces of community-based heritage conservation has largely gone unexplored within the health geography literature. This paper examines the personal motivations and impacts associated with people's growing interest in local heritage groups. It draws on questionnaires and interviews from a recent study with such groups and a conceptual mapping of their routes and flows. The findings reveal a rich array of positive benefits on the participants' social wellbeing with/in the community. These include personal enrichment, social learning, satisfaction from sharing the heritage products with others, and less anxiety about the present. These positive effects were tempered by needing to face and overcome challenging effects associated with running the projects thus opening up an extension to health-enabling spaces debates.

Peer advocacy in a personalized landscape: The role of peer support in a context of individualized support and austerity.

Whilst personalization offers the promise of more choice and control and wider participation in the community, the reality in the United Kingdom has been hampered by local council cuts and a decline in formal services. This has left many people with intellectual disabilities feeling dislocated from collective forms of support (Needham, 2015). What fills this gap and does peer advocacy have a role to play? Drawing on a co-researched study undertaken with and by persons with intellectual disabilities, we examined what role peer advocacy can play in a context of reduced day services, austerity and individualized support. The findings reveal that peer advocacy can help people reconnect in the face of declining services, problem-solve issues and informally learn knowledge and skills needed to participate in the community. We argue that peer advocacy thus offers a vital role in enabling people to take up many of the opportunities afforded by personalization.

Osteochondroma of the mandibular condyle: an unusual case of dentofacial asymmetry.

An osteochondroma of the mandibular condyle is a rare tumour of the maxillofacial region that could first present to the general dental practitioner. This case report describes an osteochondroma of the posterio-medial mandibular condyle presenting with marked facial asymmetry and trismus over a six- month period. Appropriate referral and investigation enabled successful removal of the tumour, recontouring of the condyle and an uncomplicated, positive outcome for our patient. Clinical Relevance: Temporomandibular joint disorders can be a cause of dento-facial asymmetry. Pathology of the temporomandibular joint should be considered in the differential diagnosis when such a patient presents.

Making space for belonging: critical reflections on the implementation of personalised adult social care under the veil of meaningful inclusion.

This paper critically reflects on the way in which recent adult social care reform has been evolving beneath the alleged policy goal of prioritising the cultivation of meaningful inclusion and 'belonging' in the community. With this goal, there has been a focus away from 'services' for persons with intellectual disabilities, to supporting natural connections within the community. This paper draws on a grounded theory study of the perspectives of those responsible for overseeing community living arrangements for persons with disabilities, drawing on interviews and focus groups with service providers and relevant government officials. It examines the socio-spatial implications of the gradual shift towards 'belonging' as a disability policy goal, as it has evolved in two discrete settings - British Columbia, Canada and Ireland. The findings identify the complexities involved in facilitating active community connection for persons with intellectual disabilities and reveal important cautionary lessons for other jurisdictions where community living policy has arguably been moving away from communal services towards self-managed supports in 'real' communities through personal budgets in an effort to remove barriers to participation. The paper thus critically reflects on the rapid pursuit for transformation in personalised adult social care in government policy, arguing that the process of fostering meaningful community inclusion will and should take time.

Association between constipation and colorectal cancer: systematic review and meta-analysis of observational studies.

OBJECTIVES: Constipation is common in the community, and may affect survival adversely. An association between constipation and development of colorectal cancer (CRC) could be one possible explanation. We performed a systematic review and meta-analysis examining this issue. METHODS: We searched MEDLINE, EMBASE, and EMBASE Classic (through July 2012). Eligible studies were cross-sectional surveys, cohort studies, or case-control studies reporting the association between constipation and CRC. For cross-sectional surveys and cohort studies, we recorded number of subjects with CRC according to the constipation status, and for case-control studies, number of subjects with constipation according to CRC status were recorded. Study quality was assessed according to published criteria. Data were pooled using a random effects model, and the association between CRC and constipation was summarized using an odds ratio (OR) with a 95% confidence interval (CI). RESULTS: The search strategy identified 2,282 citations, of which 28 were eligible. In eight cross-sectional surveys, presence of constipation as the primary indication for colonoscopy was associated with a lower prevalence of CRC (OR=0.56; 95% CI 0.36-0.89). There was a trend toward a reduction in odds of CRC in constipation in three cohort studies (OR=0.80; 95% CI 0.61-1.04). The prevalence of constipation in CRC was significantly higher than in controls without CRC in 17 case-control studies (OR=1.68; 95% CI 1.29-2.18), but with significant heterogeneity, and possible publication bias. CONCLUSIONS: Prospective cross-sectional surveys and cohort studies demonstrate no increase in prevalence of CRC in patients or individuals with constipation. The significant association observed in case-control studies may relate to recall bias.

Voluntarism, health and place: bringing an emerging field into focus.

Featuring a review of health geography contributions to the recent 'voluntary turn' in the health and social sciences, this paper introduces a theme section comprising five other papers that explore the links among voluntarism, health and place. The introductory paper elucidates the emergence of health voluntarism as a field of study within geography and highlights the crucial difference 'place' makes to understanding voluntary activity in the context of health, care and wellbeing. Questions are raised about theoretical, methodological and policy contributions and potential avenues for fulfilling a more inclusive 'health geographies of voluntarism' are discussed.

When care is left to roam: carers' experiences of grassroots nonprofit services in Ireland.

Increasingly countries are turning to nonprofit organisations to provide health and social care, particularly for people with disabilities. Alongside this change, debates continue about how states should manage the relationship with such organisations. Should features of the old-style "welfare" model be retained? Should aspects of the "new public management" model be chosen to measure the impact of the work? Yet others argue that grassroots organisations should form the basis of a service provision system. In the context of these debates, Ireland serves as an interesting case study of the system of care that can emerge when the state operates a "relaxed control" approach. This paper takes the perspectives of users themselves: family carers who are accessing services for a disabled adult child, to examine the effects of this approach on the ground. We show how geography played a central role in shaping these experiences, and discuss how we can learn from the Irish context. Rather than arguing for narrowly defined contractual measures, we conclude by proposing a renewed focus on relationship building with the aim of effective system operation, in the future of care services.

Predicting which people with psychosocial distress are at risk of becoming dependent on state benefits: analysis of routinely available data.

OBJECTIVES: To examine whether there was significant variation in levels of claiming incapacity benefit across general practices. To establish whether it is possible to identify people with mental health problems who are more at risk of becoming dependent on state benefits for long term health problems based on their general practice consulting behaviour. DESIGN: Interrogation of routinely available data in the Scottish Health Surveys and the British Household Panel Survey. SETTING: Scotland and the United Kingdom. PARTICIPANTS: Respondents to the Scottish Health Surveys in 1995, 1998, and 2003 (7932, 12,39 and 11,72 respondents, respectively). Respondents to the British Household Panel Survey, 1991-2007 (more than 5000 households). MAIN OUTCOME MEASURES: Intracluster correlation coefficient for probability of work incapacity by general practice. Caseness according to the general health questionnaire (GHQ-12) and frequency of consultation with general practitioner in years before and after starting to claim incapacity benefit. RESULTS: There was a small and non-significant amount of variation across general practices in Scotland in rate of claims for incapacity benefit after adjustment for other explanatory variables (intracluster correlation coefficient 0.01, P=0.135). There was a significant increase in rates of GHQ-12 caseness from two years before the start of claiming incapacity benefit (odds ratio 1.6, 95% confidence interval 1.3 to 1.9) and an increase in frequent consultation with a general practitioner from three years before the start of claiming incapacity benefit (1.8, 1.3 to 2.4). People with GHQ-12 caseness showed a significant increase in frequent consultations with a general practitioner from two years before the start of claiming incapacity benefit (2.1, 1.4 to 3.2). CONCLUSIONS: There was no variation in levels of claiming incapacity benefit across general practices in Scotland after adjustment for differences in population characteristics and so initiatives targeted at practices with high levels are unlikely to be effective. People with mental health problems who are likely to have problems remaining in work can be identified up to three years before they transit on to long term benefits related to ill health.

'A coal face option': GPs' perspectives on the rise in antidepressant prescribing.

BACKGROUND: Levels of antidepressant prescribing have dramatically increased in Western countries in the last two decades. AIM: To explore GPs' views about, and explanations for, the increase in antidepressant prescribing in Scotland between 1995 and 2004. DESIGN: Qualitative, interview study. SETTING: General practices, Scotland. PARTICIPANTS: GPs in 30 practices (n = 63) purposively selected to reflect a range of practice characteristics and levels of antidepressant prescribing. METHOD: Interviews with GPs were taped and transcribed. Analysis followed a Framework Approach. RESULTS: GPs offered a range of explanations for the rise in antidepressant prescribing in Scotland. Few doctors thought that the incidence of depression had increased, and many questioned the appropriateness of current levels of prescribing. A number of related factors were considered to have contributed to the increase. These included: the success of campaigns to raise awareness of depression; a willingness among patients to seek help; and the perceived safety of selective serotonin reuptake inhibitors, making it easier for GPs to manage depression in primary care. Many GPs believed that unhappiness, exacerbated by social deprivation and the breakdown of traditional social structures, was being 'medicalised' inappropriately. CONCLUSION: Most antidepressant prescriptions in Scotland are issued by GPs, and current policy aims to reduce levels of prescribing. To meet this aim, GPs' prescribing behaviour needs to change. The findings suggest that GPs see themselves as responders to, rather than facilitators of, change and this has obvious implications for initiatives to reduce prescribing.

Factors influencing variation in prescribing of antidepressants by general practices in Scotland.

BACKGROUND: The prescribing of antidepressants has been rising dramatically in developed countries. AIM: As part of an investigation into the reasons for the rise and variation in the prescribing of antidepressants, this study aimed to describe, and account for, the variation in an age-sex standardised rate of antidepressant prescribing between general practices. DESIGN OF STUDY: Cross-sectional study involving analyses of routinely available data. SETTING: A total of 983 Scottish general practices. METHOD: Age-sex standardised prescribing rates were calculated for each practice. Univariate and multivariate regression analyses were undertaken to examine how the variation in prescribing was related to population, GP, and practice characteristics at individual practice level. RESULTS: There was a 4.6-fold difference between the first and ninth deciles of antidepressant prescribing, standardised for registered patients' age and sex composition. The multivariate model explained 49.4% of the variation. Significantly higher prescribing than expected was associated with more limiting long-term illness (highly correlated with deprivation and the single most influential factor), urban location, and a greater proportion of female GPs in the practices. Significantly lower prescribing than expected was associated with single-handed practices, a higher than average list size, a greater proportion of GP partners born outside the UK, remote rural areas, a higher proportion of patients from minority ethnic groups, a higher mean GP age, and availability of psychology services. None of the quality-of-care indicators investigated was associated with prescribing levels. CONCLUSION: Almost half of the variation in the prescription of antidepressants can be explained using population, GP, and practice characteristics. Initiatives to reduce the prescribing of antidepressants should consider these factors to avoid denying appropriate treatment to patients in some practices.

'It's the system working for the system': carers' experiences of learning disability services in Ireland.

The aim of this article is to examine the experiences of families with young adults with learning disabilities trying to access services. The landscape of disability services for this group is made up of day care, special vocational training and respite places. It aims to identify the extent of an implementation gap between government rhetoric and the degree to which services are characterised as being non-supportive interactions on the ground. Using Ireland as a case study, during a time when the economy is booming and government rhetoric claims unparalleled developments in allocating resources and extra respite 'places', this article identifies the main challenges faced by family carers associated with accessing appropriate services for their disabled adult child, in their attempt to achieve greater independence. This article reports the findings of a qualitative study in which individual semistructured interviews were held with family carers (n = 25) and representatives from national carer organisations (n = 6) in Ireland. These were people caring for an adult (18-30 years) with a learning disability and their experiences were also useful in cross-checking the carer organisation interviews. The findings show that there is limited flexibility, choice and availability in meeting the preferences of the service-users, and throughout the study, services were characterised as being non-supportive interactions. This is not simply symptomatic of a lack of resources. Despite improved funding, supportive attitudes and flexibility are still crucial in meeting user requirements at the level of delivery; thus highlighting that often the system works for the system, not for the user.