bluuebunny/crossref_metadata_2025 huggingface dataset:
Insights on the effects of patient perceptions and awareness on ambulance usage in Karachi, Pakistan
Authors: Chandran Aruna , Ejaz Kiran , Karani Rabia , Baqir Muhammad , Razzak Junaid , Hyder Adnan A
Published: September 2013

Background

Prehospital care is a vital part of emergency medical care. Countries with decentralised ambulance systems, such as Pakistan, require patient knowledge as to when to call an ambulance and which service to call. Little is known about how patient perceptions of ambulance services affect ambulance usage in most low- and middle-income countries (LMIC). The purpose of our study was to analyse patient perspectives of the ambulance system in Karachi to understand how to improve ambulance use.

Methods

Indepth interviews were conducted with 30 individuals selected by convenience sampling representing patients who came to the emergency department by private transport versus one of two of the main ambulance service providers in Karachi.

Results

Similar to what has been shown in some LMIC contexts, two of the major themes that emerged which affect patient decision making with regard to ambulance use were a mistrust of the ambulance system or providers and a sense of inadequacy of the local system as compared with international standards. In addition, which has not been shown in previous studies, there was a fundamental misunderstanding of the role of ambulance services in the healthcare infrastructure.

Conclusions

Insight into the main issues affecting patient decisions to use an ambulance service offers possible targets for patient education that could result in an increase in the proper usage of ambulances and thus optimise outcomes from serious injury and illness in an LMIC context.
The prospective association between childhood cognitive ability and somatic symptoms and syndromes in adulthood: the 1958 British birth cohort
Authors: Kingma Eva M , Rosmalen Judith G M , White Peter D , Stansfeld Stephen A , Clark Charlotte
Published: September 2013

Background

Cognitive ability is negatively associated with functional somatic symptoms (FSS) in childhood. Lower childhood cognitive ability might also predict FSS and functional somatic syndromes in adulthood. However, it is unknown whether this association would be modified by subjective and objective measures of parental academic expectations.

Methods

14 068 participants from the 1958 British birth cohort, whose cognitive ability was assessed at 11 years. Outcomes were somatic symptoms at 23, 33 and 42 years. Self-reported irritable bowel syndrome (IBS), chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and operationally defined CFS-like illness were measured at 42 years.

Results

Lower cognitive ability at age 11 years was associated with somatic symptoms at ages 23, 33 and 42 years. Adjusting for sex, childhood internalising problems, previous somatic symptoms and concurrent psychological symptoms, childhood cognitive ability remained negatively associated with somatic symptoms at age 23 years (β=−0.060, 95% CI −0.081 to −0.039, p<0.01), 33 years (β = −0.031, 95% CI −0.050 to −0.011, p<0.01), but not with somatic symptoms at 42 years. Overall, we found no clear association between lower childhood cognitive ability and CFS/ME, CFS-like illness and IBS. Associations between cognitive ability and somatic symptoms at 23 years were moderated by low parental social class, but not by subjective indicators of parental academic expectations.

Conclusions

Lower childhood cognitive ability predicted somatic symptoms, but not CFS/ME, CFS-like illness and IBS in adulthood. While earlier research indicated an important role for high parental academic expectations in the development of early-life FSS, these expectations do not seem relevant for somatic symptoms or functional somatic syndromes in later adulthood.
PPO1 Predicting Future Coronary Heart Disease Mortality trends in England and Wales in 2020: a Bayesian age Period Cohort Approach
Authors: Castillo M Guzman , O’Flaherty M , Bandosz P , Capewell S
Published: September 2013

Background

Although Coronary Heart Disease (CHD) death rates have halved since the 1970s, CHD remains a major cause of mortality in the UK. Furthermore, population ageing plus recent increases in obesity and diabetes may soon increase total CHD deaths. Future CHD mortality predictions are thus potentially problematic. Our aim was therefore to explore future projections of CHD mortality in England & Wales under conventional but contrasting assumptions.

Methods

In SCENARIO 1, we assumed a conventional counterfactual, that recent CHD mortality rates (ONS, ICD10 codes I20-I25) in 2006 would persist unchanged. The future number of deaths was then calculated by projecting those rates into 2020 population estimates. In SCENARIO 2, we assumed that recent changes in CHD mortality rates would continue. We used a well-established hierarchical Bayesian Age Period Cohort (APC) model, which works under the assumption that variability in incidence data can be explained by age, period and cohort effects. We fitted this model to observed CHD mortality rate trends from 1982 to 2006. We then used the model to predict mortality rates in 2020, and then these rates applied to the 2020 population to compute future deaths.

Results

In SCENARIO 1 by assuming that 2006 mortality rates would continue at that level to 2020, the number of CHD deaths would substantially increase: +49% in men and +25% women (104,500 total CHD deaths in 2020). In SCENARIO 2, assuming recent trends continued, the APC model suggested that number of deaths would decrease by -48% (95% CI -25%, -64% in men); and -59% (-39%, -73%) in women (36,425 total deaths in 2020, despite a predicted slowing of the mortality decline in groups aged 35-64 years).

Conclusion

The decline in CHD mortality has been reasonably continuous since 1982, and there is little reason to believe it will soon abruptly halt, (the dubious underlying assumption of a commonly used mortality counterfactual). By contrast, the Bayesian APC model offers a far more plausible prediction of future trends by simultaneously considering age, period and cohort effects. Therefore, despite population ageing, the number of CHD deaths will most likely halve again between 2006 and 2020. However, CHD mortality rates elsewhere have previously shifted rapidly due to changes in population risk factors. There is thus no room for complacency.
PP13 The Association between Alcohol Calorie Intake and Overweight and Obesity in English Adults
Authors: Knott C S , Shelton N J
Published: September 2013

Background

Epidemiological research suggests that alcohol consumption may represent a sizable risk factor for weight gain, though precise causal mechanisms remain unclear and associations inconsistent. Studies focussed on alcohol units have shown linear and J-shaped relationships, with low intensity alcohol consumption associated with lower levels of obesity.

The strength of the alcohol-weight relationship has typically been strongest among men. This gender discrepancy is hypothesised to result from factors including differential drink type preference. While men favour beer, a carbohydrate-rich alcoholic drink, women are more likely to drink wine and therefore consume less energy per unit of alcohol than male drinkers.

The role of alcohol calories has been explored little to date. This study thus set out to determine the association between drink-specific alcohol calorie intake and both overweight and obesity in adults in England.

Methods

Survey-adjusted logistic regression models were constructed using data from the Health Survey for England 2006, a nationally representative cross-sectional population survey of the general population resident in private households in England.

Alcohol: Alcohol calories were calculated by multiplying each self-reported drink-specific consumption volume by the total number of calories they were estimated by Drinkaware to contain. Alcohol calories were then categorised according to the quartiles of a person’s sex-specific recommended daily calorie intake (RDA): 1–24%; 25-49%; 50-74%; 75%+ .

Obesity: Body mass index (BMI) was selected as a marker for overweight (≥ 25 kg/m2) and obesity (≥ 30 kg/m2).

Predictors: Risk factors likely to modify the relationship between alcohol calories and BMI were selected a priori. These included demographic variables (age, education, occupation, sex), health and lifestyle variables (physical activity, smoking status), and drink type.

Analyses were restricted to individuals aged 18+ who provided valid data on drink type, alcohol consumption volume and BMI (8864 adults).

Results

Mean calorie consumption derived from alcohol on their heaviest drink day in the last week equated to the equivalent of 27% of the RDA calorie intake in men and 19% in women. Individuals in the top alcohol calorie quartile had increased odds of obesity (OR 1.65 [95% CI 1.22, 2.22]) and overweight (1.47 [1.10, 1.97]) relative to the bottom quartile. Consumption only of beer was associated with increased odds of overweight and obesity.

Conclusion

Substantial calorie intake is derived from alcohol consumption. This intake is associated with increased odds of overweight and obesity. Awareness of alcohol calories needs to be improved.
PP21 Organisational Influences on Variation in Rates of Caesarean Section Among English NHS Trusts after Accounting for Maternal and Clinical Risk: A Cross-Sectional Study
Authors: Sandall J , Cookson G , Dodwell M , Gibson R , Murrells T , Bewley S , Coxon K , Bick D
Published: September 2013

Background

The proportion of women in England having a caesarean has increased from 9% to 24.8% between 1980 and 2012. There is increasing attention focused on the short and long term effects on the mother and the baby and efforts to have an increased understanding of associated influences. Previous research has adjusted for population case-mix (Bragg al 2010), but there has been less research on the relative impact of organisational factors which is the aim of this study.

Methods

A retrospective cross-sectional analysis was performed using routinely collected data from Hospital Episode Statistics dataset with over 660,000 deliveries in 144 NHS trusts in England. The dataset included all women giving birth between April 2010 and March 2011. The outcome was whether the delivery was by caesarean section. Clinical risk factors were calculated using the NICE intrapartum guideline criteria for women at increased risk of complications at the end of pregnancy. Exploratory statistical analysis of caesarean rates for each trust was performed to identify significant variation in rates (both planned and emergency). A multilevel logistic regression model was used to estimate the likelihood of women having a caesarean section given their maternal (level 1) characteristics (age, ethnicity, parity, socioeconomic deprivation), clinical risk factors (NICE Intrapartum guideline criteria) and organisational (level 2) factors (staffing, trust configuration, number of delivery beds, number of deliveries, teaching and Foundation Trust status, CNST rating and women’s experience).

Results

In 2010/11, 48% of women in England were categorised as low risk according to NICE Intrapartum Guidelines at the end of pregnancy. Among 660,000 deliveries, 24.8% of women were delivered by caesarean section. Unadjusted rates of caesarean section among the NHS trusts ranged from 36.1% down to 15.2%. Following adjustment for socio-demographic and clinical risk factors, adjusted rates were of a similar range but rates for individual trusts changed, and the impact of organisational factors were examined.

Discussion

Once adjusted for socio-demographic and clinical risk factors, it is possible to see how caesarean rates for trusts differ. We discuss the relative impact of organisational characteristics, and what requires further exploration. Routinely collected data can provide information about the type of births that women are experiencing, and provide the means to adjust trust data to take account of the profile of women giving birth in each location, and organisational characteristics. This allows trusts to benchmark its services for quality improvement and provides baseline data for exploring reasons for high and low performing outliers.
PP22 The Health of People with Past Experience of Probation Services - A Qualitative Study
Authors: K Lees , Parkes J , Sinclair J , Richards E
Published: September 2013

Background

A significant proportion of the UK population have had a criminal conviction (15% of 10-52 year olds). There is some evidence those in contact with probation have worse health compared to the general population. This study aimed to increase understanding of the health of people in contact with probation, through experiences of ex-offenders.

The study asked the following research questions:

What role do ex-offenders perceive their health plays in offending behaviour?

Do ex-offenders perceive their health has changed since they were last supervised by Probation?

What were ex-offenders’ experiences of health interventions in probation, including Health Trainers?

What perceived effect does ex-offenders’ health have on those around them?

Methods

Using snowball techniques to recruit, 20 participants were interviewed between June and November 2012. Interviews were semi-structured using a topic guide; recorded with participants’ permission and transcribed. The transcription was coded in Nvivo and analysed using a thematic analysis. The study questions formed initial themes. Sub-themes and key concepts were developed iteratively.

Results

Four themes were identified, each with sub-themes and key concepts.

Theme 1 - Perceived relationship between health and offending: Substance misuse; Mental health

“you need the substance to be well and you need to be well to have the strength to go thieving again.”

Theme 2 - Health of ex-offenders whilst offending and now: Injuries; Infectious disease; Chronic conditions; Nutrition, physical activity and body weight; Sleeping; Sexual health; Improved health since stopping offending; Substance misuse; Barriers to recovery; Mental and emotional health

“I could have easily enough had a season ticket at A&E because I was always cutting myself or falling over”

Theme 3 - Health interventions whilst offending: Healthcare in probation; Health trainers, mentors and peer support; Healthcare in prison; Therapeutic relationship; Service accessibility; Joined up services; Antidepressants

Theme 4 - Significant others: Death and physical health; Impact on children; Domestic violence.

Conclusion

Ex-offenders report a strong association between health and offending behaviour. Most perceive their current health to be much better than when they were offending. Ex-offenders reported a lack of health services whilst in probation. Their experiences of health services whilst offending highlight barriers to access and gaps in provision. Ex-offenders felt their offending behaviour had a negative impact on the health and well-being of significant others. Probation services may be an opportunity to improve the health of a population reporting poor health. Improving the health of those in probation may contribute to reducing re-offending.
PP23 Variation of Primary Care Quality with Contract type: An Observational Study
Authors: Ratneswaren A , Laverty A , Greaves F , Millett C
Published: September 2013

Background

Since 2004, policy reforms in the English NHS have allowed new contracting mechanisms for provision of general practice services. A wider variety of provider organisations were allowed under the alternative provider of medical services (APMS) contract. In addition, Primary Care Trusts have been able to directly provide general practice services via the PCTMS contract. These new contracts were introduced to challenge existing models of care and encourage innovation to meet changing healthcare needs. Concerns have been expressed about the increasing diversity of providers and commercialisation on primary care performance. We looked at whether there is variation in performance amongst practices according to the type of contract they have.

Methods

Fifteen commonly reported performance indicators were selected to represent a broad spectrum of clinical quality covering clinical effectiveness, patient experience, efficiency and access. Practice-level performance data, demographic data and contract-type for all general practices in England with more than 1000 patients for the year 2011/12 were extracted from open Internet sources, including: the GP Patient Survey, the Quality Outcomes Framework, the NHS Information Centre Indicator Portal and NHS Comparators. We compared performance across these indicators by contract type with adjustments for age, gender, ethnicity and deprivation.

Results

In 2011/12, there were 4517 GMS practices, 3313 PMS practices, 217 APMS practices and 72 PCTMS practice. When compared to GMS practices, APMS performed worse across 9 of the 15 indicators, and better on 2 indicators (P < 0.05). APMS practices had greater levels of satisfaction with opening hours and higher rates of generic prescription for statins, but lower performance for patient experience and clinical QOF indicators. PCTMS practices performed worse than GMS on 9 indicators, and better on none. In particular, PCTMS and APMS practices had lower patient experience, higher levels of diabetes exception reporting and higher levels of ambulatory care sensitive admissions to hospitals. (P < 0.01 for all).

Conclusion

There is variation in performance for a number of measures of primary care quality that occurs with contract type, although the cause is not clear. Both APMS and PCTMS practices were consistently more poorly performing in certain areas. It is not clear whether these variations in performance are related to the contract type, or to historical contextual factors (including previous poor management). However these differences remain after adjusting for age, sex, ethnicity and multiple deprivations at practice-level. Further work to identify consequences of increased provider diversity in primary care would be useful.
PP25 Caesarean Section and Subsequent Pregnancy Interval - A Systematic Review
Authors: Neill S M O , Kearney P M , Kenny L C , Henriksen T B , Greene R A , Khashan A S
Published: September 2013

Background

Caesarean section rates have increased significantly in the past three decades, with one in four babies in the United Kingdom (UK) delivered operatively. In light of this, the National Institute for Health and Clinical Excellence (NICE) updated their caesarean section guidelines to give women the right to request a caesarean section without any medical indication. With the long term consequences of caesarean section on fertility unknown, further research is warranted.

Objective

To compare pregnancy interval between women with a previous caesarean to women with a previous vaginal delivery.

Methods

Study Design: Systematic review of the published literature. CINAHL, Cochrane library, Embase, Medline, PubMed, SCOPUS and Web of Knowledge databases were searched (1945-October 2012), using a detailed search-strategy and cross-checking of references. Cohort, case-control and cross-sectional studies were eligible. Two assessors individually reviewed titles, abstracts and full articles to identify eligible studies, using a standardised data-abstraction form and assessed study quality. A meta-analysis was not suitable due to between-study heterogeneity.

Results

Data synthesis: Over 9,184 titles were screened, with 12 articles included. Four studies reported an increased waiting time to next pregnancy following a previous caesarean section delivery. However, variations in the definition of time to next pregnancy or birth used, as well as lack of adjustment for confounders, small sample size, inability to identify the indication for caesarean section, short follow-up time and lack of stratification by number of previous pregnancies were all obvious limitations. Eight studies reported no association between a previous caesarean section delivery and subsequent pregnancy interval. These were methodologically more superior with larger sample sizes, population-based registries, and detailed obstetrical information including indication for mode of delivery and long follow-up periods

Discussion

Evidence on the relationship between caesarean delivery and pregnancy interval is conflicting. Residual confounding is possible and further research of better methodological quality is required to assess whether any delay in pregnancy interval is causal or as a result of parental choice to delay childbirth.
PP26 Caesarean Delivery and Subsequent Birth Interval, Ectopic Pregnancy, Miscarriage or Stillbirth-a Danish Register-based Cohort Study
Authors: O’Neill S M , Agerbo E , Kenny L C , Henriksen T B , Kearney P M , Greene R A , Mortensen P B , Khashan A S
Published: September 2013

Background

Despite high caesarean delivery rates worldwide, limited data are available on the effect of a prior caesarean delivery on subsequent fertility.

Aim

To estimate the time to next birth and the risk of miscarriage, ectopic pregnancy and stillbirth in women with a prior caesarean delivery compared to women with a prior vaginal delivery.

Methods

Using Danish registry data we identified a cohort of women giving birth between 1982 and 2010 (n = 833,162). The cohort was followed from the index birth until the next birth or censoring by death, emigration or study end (31/12/2010). Women with an index caesarean section were compared to women with an index vaginal birth by stratified Cox regression models using SAS version 9.2

Results

Women with an index caesarean were less likely to have a subsequent delivery and had an increased time to next birth (HR 0.83 [95% CI 0.82, 0.84]). Sub-group analyses by smoking status, history of fertility services, maternal BMI, preterm birth & low birth weight did not modify results. Analyses for ectopic pregnancy and miscarriage showed no increased HR among women with a prior caesarean section; however a significantly increased HR for subsequent stillbirth was reported (1.16 [1.04, 1.28]).

Conclusion

Prior caesarean delivery, particularly elective and maternally requested caesareans were associated with an increased time to next birth. An increased hazard ratio of stillbirth in subsequent deliveries but not ectopic pregnancy or miscarriage among women with an index caesarean was also found.
PP33 A N Age-Period-Cohort Analysis for Trends in Body Mass Index in the Republic of Ireland in 18,016 Participants in Slan (Surveys of Lifestyle, Attitudes and Nutrition) 1998-2007
Authors: T Jiang , Gilthorpe M S , Shiely F , Harrington J , Perry I J , Kelleher C C , Tu Y K
Published: September 2013

Background

Obesity has increased in prevalence worldwide in the last 20 years and is associated with a variety of adverse health outcomes. It is valuable to examine these trends in relation to age, period and birth cohort, in conjunction with several evolving environmental factors. Age-period-cohort (APC) analysis is a popular analytic approach, since knowing the separate effects of age, period and cohort allows for a better understanding of the different risk groups based on age and generation cohort, separately, and cohort effects can identify individuals who are particularly at high risk of obesity, to allow for effective public intervention measures.

Methods

Data were obtained in the Republic of Ireland via three consecutive waves of the Surveys of Lifestyle, Attitudes and Nutrition (SLAN), all of which are now publicly available. Data were collected in 1998, 2002 and 2007 through standardised protocols. Participants with missing values were excluded from the analyses. Those over the age of 75 were excluded due to sparse data. Of the original 22,895 participants, we performed analyses on 18,016 participants: 7,796 men and 10,220 women. We applied partial least squares (PLS) methodology to estimate the separate effects of age, period and cohort on the trends in obesity as measured by body mass index (BMI). We also explore and model nonlinear relationships of BMI with age, period and cohort.

Results

PLS analysis revealed a positive period effect. Additionally, men born later tended to have lower BMI (-0.026 kgm-2yr-1[95% CI -0.030, -0.024]) and older men had in general higher BMI (-0.029 kgm-2yr-1[-0.026, -0.033]) Similarly for women, those born later had lower BMI (-0.025 kgm-2yr-1[-0.029, -0.022]) and older women in general had higher BMI (0.029 kgm-2yr-1[0.022, 0.033]) Nonlinear analyses revealed that BMI has a substantial curvilinear relationship with age, though less so with birth cohort.

Discussion

Through the use of PLS we are able to estimate the separate contributions to obesity of age, period and cohort. Consequently, PLS produces more interpretable results than other approaches. Men and women born in Ireland during the period 1924-1989 experienced a steady increase in BMI by year of age, which became more pronounced throughout the study period, mitigated only slightly by improved maternal nutrition of successive cohorts, which would potentially have given rise to better ‘programming’ of children in preparation for an increasingly obesogenic environment experienced in childhood and adulthood.
PP63 The Role of Ethnicity Concerning the Prevalence and Severity of Obstructive Sleep Apnoea in Severely Obese Patients
Authors: Leong W B , Arora T , Jenkinson D , Thomas A , Punamiya V , Banerjee D , Taheri S
Published: September 2013

Background

The South Asian population is at increased risk of cardiovascular disease. South Asians residing in western countries also have increased risk of obesity and associated comborbidities compared to white European counterparts. We compared the prevalence and severity of obstructive sleep apnoea (OSA) along with comorbidities in South Asians and white Europeans with severe obesity.

Methods

Data from consecutive patients attending a specialist weight management service were analysed. Self-reported age, gender and ethnicity were gathered. Medical history was obtained by a trained physician to determine the quantity of comorbidities. Objective measurements of blood pressure, body mass index (BMI), and apnea-hypopnea index (AHI) were also acquired for study purposes.

Results

A total of 308 patients (72.7% women; 13% South Asian) were included with a mean age and BMI of 46 ± 12y and 49 ± 8Kg/m2,respectively. South Asians had significantly increased prevalence of OSA compared to white Europeans (p = 0.017) and were more likely to have severe OSA (p = 0.015). South Asians had significantly higher median AHI (24/hr: interquartile range [IQR] 9.3–57.6 vs. 9/hr: IQR 3.4–26.6; p < 0.01), significantly lower minimum oxygen saturation (76%: IQR 64-84% vs. 83%: IQR 77-87%; p < 0.01) and spent a significantly greater amount of time <90% oxygen saturation (8.4%: IQR 1.0–24.3% vs. 2.4%: IQR 0.2–16.0%; p = 0.03). South Asians also had a significantly greater number of comorbidities (p = 0.02) and poorer glycemic control (HbA1c 7.4 vs. 6.3, p < 0.01) compared to white Europeans. South Asian ethnicity, independent of demographics, BMI, and cardiovascular comorbidities was an independent predictor of OSA β = 0.61 (SE = 0.19), p < 0.01. Furthermore, we confirmed other independent OSA risk factors, consistent with previous studies, including increasing age and BMI and male gender (all p < 0.001).

Conclusion

Severely obese South Asians had significantly greater prevalence and severity of OSA versus white Europeans. OSA may contribute to increased cardiovascular risk in South Asians compared to white Europeans with severe obesity. Mechanisms mediating the observed associations between these ethnicities require further investigation.
PP65 What is the Effect of a Behaviour Change Intervention on the Diets and Physical Activity Levels of Women Attending Sure Start Children’s Centres in Southampton? Findings from a Non-Randomised Controlled Trial
Authors: Baird J , Jarman M , Lawrence W , Black C , Davies J , Tinati T , Begum R , Mortimore A , Robinson S , Margetts B , Cooper C , Barker M , Inskip H
Published: September 2013

Background

A major component of the government response to the obesity epidemic includes action in communities to improve people’s health behaviour. This study evaluated the effects of a community-based intervention on dietary quality and physical activity of women from disadvantaged backgrounds. The intervention consisted of training Sure Start Children’s Centre (SSCC) staff in skills to support behaviour change.

Methods

We conducted a non-randomised controlled trial with mixed methods process evaluation. Participants were 527 women attending Sure Start Children’s Centres in Southampton (intervention area) and 495 women attending Centres in Gosport and Havant (control area). Main outcomes were dietary quality, physical activity, self-efficacy and sense of control assessed before and one year after the intervention. Intervention and control group outcomes were compared using linear regression and adjusting for level of the corresponding variable at baseline.

Results

Process evaluation showed that intervention staff used skills to support behaviour change significantly more than control staff (p < 0.001) one year post-training. There were, however, significant reductions of 0.1 SD in women’s dietary quality, 0.06 SD in self-efficacy and 0.18 SD in sense of control in both the intervention and control groups between baseline and follow up. There were no significant differences between the intervention and control groups in the magnitude of change in dietary quality. We found, however, that the magnitude of decline in self-efficacy and control was significantly smaller in the intervention women than in women from the control areas. There was a statistically significant improvement in physical activity level between baseline and follow up in the intervention group; 22.9% of women reported the highest level of physical activity at follow up compared with 12.4% at baseline. There was a smaller improvement in physical activity in the control group that was not statistically significant. However, the difference in magnitude of change in physical activity level between the groups was not statistically significant.

Conclusion

The intervention led to sustained increase in skills to support behaviour change among SSCC staff, but did not result in improvement in the dietary quality and physical activity of intervention group women compared with controls. There was, however, a protective effect on women’s self-efficacy and sense of control (factors known to be associated with dietary quality). These findings suggest that more prolonged exposure to the intervention may lead to improvements in health behaviour and, given the challenges of evaluation in a community setting, that further evaluation in a more controlled setting is justified.
OP17 Area Deprivation Across the Life Course and Cognitive Capability in Mid-Life: Findings from the 1946 British Birth Cohort
Authors: Murray E T , Hardy R , Tilling K , Southall H , Aucott P , Kuh D , Ben-Shlomo Y , Richards M
Published: September 2013

Background

Recent work has shown that area conditions at single points in time have been found to be associated with cognitive capability outcomes. However, a life course perspective is required to take into account life time processes of cognitive development, changes in residence and secular trends of areas.

Methods

Data from the 1946 British Birth Cohort were used to estimate associations of area deprivation (indicated by % of employed people in each area in partly- or un-skilled occupations) at ages 4, 26 and 53 years (residential addresses linked to census data in 1950, 1972 and 1999) with three measures of cognitive capability at age 53 years: verbal ability [NART], memory and letter cancellation speed. Cross-classified multilevel models were fitted with individuals nested within areas at all three ages. Step-wise models were fitted to assess whether area deprivation was independent of area deprivation at prior time points and current and prior individual socioeconomic position (SEP).

Results

The percent of variance explained by lifetime area was 9.9% for NART and 6.8% for word learning scores. There was no variation across areas, or associations with, cancellation speed for any year. For the NART and word learning outcomes, associations were found between higher area deprivation and lower scores, independent of adjustment for individual social class at the same age (i.e. area deprivation at age 4 years adjustment for childhood SEP); however the longitudinal patterns differed. For the NART, an approximately 2 point lower mean score for a 1-standard deviation increase in area deprivation, for each age, was reduced by half but still apparent, when all three area deprivation measures were fitted in the same model [4 years: -1.0 (-1.8, -0.2); 26 years: -1.5 (-2.2, -0.7); 53 years: -1.4 (-2.1, -0.8)]. Yet all were attenuated with the addition of individual SEP measures at all three ages. For memory, both area deprivation at ages 4 and 53 years were independent of adjustment for area deprivation at the other 2 years [4 years: -0.9 (-1.5, -0.2) and 53 years: -1.9 (-2.6, -1.1)], and the latter was still apparent in full models containing all three area deprivation and individual SEP measures [-0.9 (-1.7, -0.2)].

Conclusion

The deprivation of the area in which a person resides at different ages in their lives may affect cognitive capability in mid-life, with evidence that long-term exposure to area deprivation may negatively affect cognitive ageing (memory).
OP23 Associations between Active Travel to Work and Overweight, Hypertension and Diabetes in the United Kingdom
Authors: Laverty A A , Webb E A , Mindell J , Millett C
Published: September 2013

Background

Increasing active travel (walking & cycling, including to/from public transport) is increasingly seen as integral to strategies to raise population levels of physical activity. This study examined: (1) socio-demographic correlates of active travel to work; (2) associations between active travel and cardiovascular disease risk factors in the United Kingdom.

Methods

Data come from Understanding Society, a nationally representative survey of residents of the four countries of the United Kingdom in 2009–2011. Data come from the 20,000 respondents to the first wave of the survey who were aged 16 – 65 years and in work. Being overweight/obese was defined using self-reported height and weight. Hypertension and diabetes were identified based on responses to the questions “has a doctor ever told you that you have…”Multinomial logistic regression was used to assess associations between socio-demographic factors and mode of transport to work. Logistic regression was used to examine associations between mode of travel and being overweight/obese, having hypertension or diabetes. Analyses were adjusted for age, sex, ethnicity, educational qualifications, social class, and region of residence in the UK.

Results

For 69% of respondents the main mode of travel to work was inactive transport, with public transport, walking and cycling used by 16%, 12% and 3% respectively. Use of active travel was most often reported by respondents living in London. Those with professional/managerial jobs were less likely to use each form of active transport than those with routine jobs (AOR 0.49 [95% CI 0.43, 0.56] for walking). Black respondents were more likely to walk (1.41 [1.08, 1.84]) or take public transport (2.34 [1.88, 2.90]) than white respondents. Using public transport was associated with a lower likelihood of being overweight than inactive transport (0.85 [0.77, 0.95]). Walking and cycling were each associated with a lower likelihood of being overweight (0.80 [0.73, 0.90] for walking and 0.63 [0.53, 0.75] for cycling) or having diabetes than inactive transport, and walking with a lower likelihood of hypertension (0.83 [0.71, 0.95]).

Conclusion

There are wide variations in the mode of travel to work across regions and socio-demographic groups in the United Kingdom. The potentially protective effect of active travel on cardiovascular risk demonstrated in this large, nationally representative study adds to growing evidence that a concerted policy focus in this area will benefit population health.
OP33 How Well do Volunteer Web Panel Surveys Measure Sensitive Behaviours in the General Population, and can they be Improved? A Comparison with the Third British National Survey of Sexual Attitudes & Lifestyles (Natsal3)
Authors: Erens B , Burkill S , Copas A , Couper M , Conrad F
Published: September 2013

Background

Surveys play an important role in providing public health data for researchers and policy-makers. Traditional interviewer-administered surveys are subject to declining response rates and increasing costs. With the spread of the internet among the general population, web surveys potentially provide a cost-effective alternative mode. Volunteer web panels are now widely used for market research and opinion polling, but less for academic and government research due to concerns about their representativeness. Various methods attempt to make web panels more “representative” of the general population. We compared results from four web panels with a national probability sample survey (Natsal3).

Methods

A shortened Natsal3 questionnaire was included on four web panels: two used standard demographic quota controls, and two were “modified” using variables correlated with key outcomes as additional quota controls. After weighting for age and sex, comparisons were made with Natsal3 for demographic characteristics, key behaviour outcomes and attitudes, in order to examine whether surveys using modified quotas would lead to “improved” results.

Results

All four web panels gave significantly different results from Natsal3 on a majority of the variables. Compared with Natsal3, there were more differences among men than women for all the web panels. There were more differences between the web panels and Natsal3 questions asked in CAPI (Computer Assisted Personal Interview) than in CASI (Computer Assisted Self Interview) format. The web panels also differed significantly from each other. One of the modified quota web panels produced estimates closer to Natsal3 than the standard quota panels, but still significantly differed on three-fifths of the variables. Moreover, meeting the modified quotas proved difficult, and the quotas had to be relaxed for both web panels.

Conclusion

When measuring sensitive sexual behaviours in the British population, volunteer web panels provided significantly different estimates than a probability CAPI/CASI survey. Modifying web panel quota controls did not lead to much improvement.
OP39 Are Adverse Effects of Obesity on Cardiovascular Risk Factors Modifiable: the Role of Physical Activity and Sedentary Behaviour in Mid-Life in the 1958 British Cohort
Authors: Power C , Pereira S M Pinto , Law C , Ki M
Published: September 2013

Background

Obesity is associated with increased mortality, cardiovascular disease (CVD), type 2 diabetes (T2D) and associated biomarkers. A key priority is to minimise such obesity-related consequences for the substantial proportion of adults now at risk. Potential modifiable factors, such as physical activity (PA) and sedentary lifestyles could mediate or moderate the obesity - ill-health association. However, research is scant on whether benefits of activity vary by obesity status across multiple biomarkers and whether there are corresponding patterns for sedentary behaviour. To establish whether the obesity −CVD and T2D risk associations can be lessened by PA or lower sedentary behaviour we aimed to assess whether (i) obesity, PA and sedentary behaviour are independently associated with biomarkers for CVD and T2D, and (ii) PA or sedentary behaviour moderate the obesity-biomarker associations.

Methods

In the 1958 British birth cohort (N = 9377) we examined associations between early adulthood obesity (33y) with subsequent biomarkers (45y) together with PA and sedentary behaviour (indicated by TV-viewing) recorded before or at 45y. The temporal sequence follows the ordering of potential interventions to reduce health burdens associated with obesity. Analyses were sex-specific, adjusted for covariates and used multiple imputation to account for missing data.

Results

Obesity was associated with lower HDL-cholesterol and higher systolic (SBP), diastolic (DBP) blood pressure, glycosylated haemoglobin (HbA1c) and triglycerides in both sexes (LDL-cholesterol in women only) by 4.30% (95% CI 3.19, 5.41) for SBP to 24.7% (18.8, 30.4) for triglycerides. Men active at least weekly had 1.09% (0.28, 1.90) lower DBP than less active men; triglycerides were 2.08% (0.52, 3.64) lower per unit higher PA (on 4-point scale). TV-viewing was independently associated with several biomarkers, e.g. per unit higher TV-viewing (on 4-point scale) DBP was raised by 0.50% (0.09, 0.90) and triglycerides by 3.61% (1.58, 5.64). For both TV-viewing and PA, associations with HbA1c were greatest for the obese (p-interaction≤0.04): compared to a reference value of 5.20 HbA1c% in non-obese men viewing 0–1h/day, HbA1c% differed little for those viewing >3 h/day; however, among obese men HbA1c% was 5.36 (5.22, 5.51) and 5.65 (5.53, 5.76), for 0–1 and >3 h/day respectively. For PA in non-obese men, the reduction associated with activity at least weekly was negligible compared to a reference value of 5.20 HbA1c% for those less active; but there was a benefit among obese men, HbA1c% was 5.50 (5.40, 5.59) vs 5.66 (5.55, 5.77) respectively.

Conclusion

Reduced sedentary behaviour and prevention of infrequent activity has greatest benefit among obese groups, particularly for glucose metabolism.
OP59 Social Mobility Matters for Children’s Well-Being – what are the Mechanisms? Findings from a UK Longitudinal Cohort Study
Authors: Kelly Y , Bartley M , Sacker A
Published: September 2013

Background

Social mobility features high on political agendas and debates around inequalities in health but little is known about the impact of social mobility on well-being in children. Firstly, we assess whether child well-being is linked to social mobility in the first few years of life. Secondly, we examine two hypothesised mechanisms by which social mobility could influence markers of child well-being: i) via material resources - mobility is plausibly linked to changes in income and housing conditions; ii) via changes in parenting behaviours - mobility might result in changes in the home learning environment.

Methods

We used data on over 9000 children from the UK Millennium Cohort Study. Social mobility was considered as change in parental occupational class (professional/managerial, intermediate, routine) in the first five years of life. Markers of child well-being were socio-emotional difficulties and performance on tests of reading, maths and spatial abilities at age 7.

Results

13.7% of families were upwardly mobile and 14.5% were downwardly mobile. There were finely graded relationships between occupational class mobility and markers of child well-being. The prevalence of clinically relevant socioemotional difficulties according to mobility categories ranged from 2.9% in children whose parents remained in the professional/managerial class for all five years to 10% in children of parents remaining in routine occupations, 5.0% of children of parents who moved from any other class to professional had difficulties, as did 8.2% of those moving from any class to routine (all p < 0.01). The equivalent mobility groups’ reading scores were: stable professional 118, stable routine 106, up to professional 113, down to routine 109 (all p < 0.01). Similar patterns were observed for maths and spatial ability scores. The contribution of changes in material and parenting behavioural influences to markers of child well-being will be examined.

Conclusion

Health, educational and developmental outcomes are known to be more favourable in children of more advantaged social classes, but the reasons for this are contested. Here we examine the relationships in children whose parent’s social class changes during their first 5 years. Upwardly mobile children do better than those in their class of origin but not as well as their class of destination; downwardly mobile children do better than their class of destination but not as well as their class of origin. We test the extent to which this may be because social mobility is accompanied by changes in material circumstances and/or parenting behaviours that improve the home learning environment.
OP74 Is ‘volunteering’ a Public Health Intervention: A Systematic Review and Meta-Analysis
Authors: Richards S , Jenkinson C , Dickens A , Jones K , Thompson-Coon J , Taylor R , Rogers M , Bambra C , Lang I
Published: September 2013

Background

Community participation interventions such as volunteering have been identified in the UK Government’s ‘Building the Big Society’ policy (2010) as a way of engaging people in their local communities and improving social capital, while the Marmot Review (2010) concluded they may have potential public health benefits such as improving wellbeing and decreasing health inequalities. Internationally, 2011 saw the European ‘Year of the Volunteer’, while the US Corporation for National and Community Service Strategic Plan (2011-2015) advocates supporting volunteer’s wellbeing and prioritising recruitment and engagement of underrepresented populations. Within this context, we examined the effect of formal volunteering on volunteer’s physical and mental health and survival, and explored the influence of volunteering type and intensity on health outcomes.

Methods

We sought evidence from experimental and cohort studies comparing the physical and mental health outcomes and mortality for a volunteering group (intervention) compared with a non-volunteering group (control). We searched electronic databases (Cochrane Library, Medline, Embase, PsychINFO, CINAHL, ERIC, HMIC, SSCI, ASSIA, Social Care Online, Social Policy and Practice) from inception to January 2013 and used citation tracking. No language, country or date restrictions were applied. Methodological quality was appraised and a risk of bias score generated. Data were synthesised using vote counting and random effects meta-analysis of mortality risk ratios.

Results

40 papers were selected: 5 randomised controlled trials (RCTs, 7 papers); 4 non-RCTs; and 17 cohort studies (29 papers). While most cohort studies were large and well designed (25/29 low risk bias, 4/29 moderate risk), most RCTs (4 studies) were at moderate or high risk of bias (e.g. small samples). Cohort studies show volunteering has favourable effects on depression, life satisfaction, wellbeing but not on physical health. However, these findings were largely unconfirmed by experimental studies. Meta-analysis of 5 cohort studies found volunteers to be at lower risk of mortality (risk ratio: 0.78 [95% CI 0.66, 0.90]). There was insufficient evidence to demonstrate a consistent influence of volunteering type or intensity on outcomes.

Conclusion

Observational evidence suggests that volunteering benefits mental health and survival although the causal mechanisms are unclear and selection effects cannot be discounted. Consequently, there is limited robustly designed research to guide the development of volunteering as a public health promotion intervention. Future studies should explicitly map intervention design to clear health outcomes as well as use pragmatic RCT methodology to test effects.