Maternal health inequalities and GP provision: investigating variation in consultation rates for women in the Born in Bradford cohort

Background The ‘Five Year Forward View’ (NHS England) calls for a radical upgrade in public health provision. Inequalities in maternal health may perpetuate general patterns of health inequalities across generations; therefore equitable access to GP provision during maternity is important. This paper explores variation in GP consultation rates for disadvantaged mothers. Method Data from the Born in Bradford cohort (around 12,000 women), combined with GP records and GP practice variables, were modelled to predict GP consultation rates, before and after adjusting for individual health and GP provision. Results Observed GP consultation rates are higher for women in materially deprived neighbourhoods and Pakistani women. However these groups were found to consult less often after controlling for individual health. This difference, around one appointment per year, is ‘explained’ by the nature of GP provision. Women in practices with a low GP to patient ratio had around 9 fewer consultations over the six year period compared to women in practices with the highest ratio. Conclusions Equitable access to GP services, particularly for women during the maternal period, is essential for tackling deep-rooted health inequalities. Future GP funding should take account of neighbourhood material deprivation to focus resources on areas of the greatest need

HCPs’ Professional Experience.

<p>HCPs’ Professional Experience.</p

Integration of couple and HCP themes (themes from Tables 4 & 5).

<p>Integration of couple and HCP themes (themes from Tables <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133837#pone.0133837.t004" target="_blank">4</a> & <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133837#pone.0133837.t005" target="_blank">5</a>).</p

Couple Demographics.

<p>Couple Demographics.</p

Examples of interview questions.

<p>Examples of interview questions.</p

Additional file 1: Figure S1. of The health and wellbeing of Australian farmers: a longitudinal cohort study

Directed Acyclic Graph for Farming and Mental Health Outcomes. Figure S2. Directed Acyclic Graph for Farming and Physical Health Outcomes. Figure S3. Directed Acyclic Graph for Farming and Wellbeing. Figure S4. Directed Acyclic Graphs for Farming and Visits to the Doctor. Figure S5. Directed Acyclic Graph for Farming and Seeking Help from a Mental Health Professional. Table S1. DIRECT effect. Longitudinal analysis over 5 years for Physical health outcomes and GP service use. Farmers v’s Non-Farm workers. Results show Beta values for continous variables and odds ratios for dichotomous variables (95 % Confidence Intervals). Table S2. DIRECT effect. Longitudinal analysis over 5 years for Wellbeing, Mental health outcomes and Visiting a Mental Health Professional. Farmers v’s Non-Farm workers. Results show Beta values for continuous variables and odds ratios for dichotomous variables (95 % Confidence Intervals). (PDF 667 kb

Stages of framework analysis for couples’ views on their experience with cancer and HCPs.

<p>Stages of framework analysis for couples’ views on their experience with cancer and HCPs.</p

Additional file 1: of Is small size at birth associated with early childhood morbidity in white British and Pakistani origin UK children aged 0–3? Findings from the born in Bradford cohort study

Table S1. Comparison of models of predicted child outcome measures (with 95% CI), by ethnicity, low birth-weight and small for gestational age (SGA-GROW) with and without adjustment for socio-economic variables (predicted rates with 95% CI). Table S2. Comparison of adjusted* incidence rate ratios (95% CI) of child outcome measures by ethnicity, low birth-weight and small for gestational age (SGA-GROW) with and without adjustment for socioeconomic variables. (DOC 89 kb

Additional categories of functions that were not already included in the survey.

<p>Participants listed additional functions that they wanted to perform with a prosthesis that were not already included in the survey. In cases where a participant mentioned multiple functions that could be classified into a single category, the participant was counted only once for that category.</p

Factors associated with interest in novel interfaces for upper limb prosthesis control

<div><p>Background</p><p>Surgically invasive interfaces for upper limb prosthesis control may allow users to operate advanced, multi-articulated devices. Given the potential medical risks of these invasive interfaces, it is important to understand what factors influence an individual’s decision to try one.</p><p>Methods</p><p>We conducted an anonymous online survey of individuals with upper limb loss. A total of 232 participants provided personal information (such as age, amputation level, etc.) and rated how likely they would be to try noninvasive (myoelectric) and invasive (targeted muscle reinnervation, peripheral nerve interfaces, cortical interfaces) interfaces for prosthesis control. Bivariate relationships between interest in each interface and 16 personal descriptors were examined. Significant variables from the bivariate analyses were then entered into multiple logistic regression models to predict interest in each interface.</p><p>Results</p><p>While many of the bivariate relationships were significant, only a few variables remained significant in the regression models. The regression models showed that participants were more likely to be interested in all interfaces if they had unilateral limb loss (p ≤ 0.001, odds ratio ≥ 2.799). Participants were more likely to be interested in the three invasive interfaces if they were younger (p < 0.001, odds ratio ≤ 0.959) and had acquired limb loss (p ≤ 0.012, odds ratio ≥ 3.287). Participants who used a myoelectric device were more likely to be interested in myoelectric control than those who did not (p = 0.003, odds ratio = 24.958).</p><p>Conclusions</p><p>Novel prosthesis control interfaces may be accepted most readily by individuals who are young, have unilateral limb loss, and/or have acquired limb loss However, this analysis did not include all possible factors that may have influenced participant’s opinions on the interfaces, so additional exploration is warranted.</p></div