bluuebunny/crossref_metadata_2025 huggingface dataset:
OP64 Parental Suicide Attempt and Offspring Self-Harm and Suicidal Thoughts: Results from the Alspac Birth Cohort
Authors: Geulayov G , Metcalfe C , Gunnell DJ
Published: September 2012

Background

Exposure to parental self-harm has been linked to an increased risk of self-harm and suicidal thoughts in their offspring. Much of the available evidence is from population registers or clinical samples and relates to parental death by suicide; few studies have investigated associations of non-fatal suicide attempts in parents with community presenting non-fatal self-harm and suicidal thoughts in offspring. We studied the association of parental suicide attempt (SA) with offspring self-harm and suicidal thoughts using a large two-generational prospective cohort.

Methods

The sample comprised 4,396 children, their mothers and 2,541 of the mothers’ partners from the Avon Longitudinal Study of Parents and Children (ALSPAC). Parents were asked to report on incident episodes of SA on 10 separate occasions from pregnancy until the children were 11 years old. Information on lifetime childhood self-harm, with and without suicidal intent, and suicidal thoughts, with and without suicidal plan, was collected through child-completed questionnaires at the age of 16–17 years.

Results

Based on preliminary results, SA was reported by 1.5% of the mothers and 0.7% of the partners. Adjusting for sociodemographic factors and parental depression, maternal SA was associated with 3-fold increased risk of self-harm with suicidal intent in their children [Adjusted odds ratio (AOR) 3.0, 95% confidence interval (CI) 1.4–6.1] but not with self-harm with no suicidal intent (AOR 0.8, 95% CI 0.3–1.9). Children exposed to maternal SA were more likely than unexposed children to report both suicidal thoughts with and without suicidal plan (AOR 5.2, 95% CI 2.3–11.6; AOR 2.2, 95% CI 1.1–4.4, respectively). Partner SA was associated with 2.3-fold increased risk of self-harm with suicidal intent (95% CI 0.5–10.6) and with an increased risk of suicidal thoughts with suicidal plan (AOR 3.5, 95% CI 0.8–16.0) but these results are consistent with chance. There was no evidence of an association between partner suicide attempt with offspring self-harm with no suicidal intent (AOR 0.4, 95% CI 0.1–3.5) or with offspring suicidal thoughts without a suicidal plan (AOR 0.6, 95% CI 0.1–4.5).

Conclusion

Parental SA in childhood increases the risk of self-harm with suicidal intent in offspring but is unrelated to risk of self-harm without suicide intent. Parental SA is associated with larger effect size on suicidal thoughts with a suicidal plan than without a plan. Findings provide limited evidence that maternal SA is a more potent risk factor than partner SA.
OP70 Place of Cancer Deaths in England, 2001-2010: Time Trends and Determinants
Authors: Gao W , Ho Y , Verne J , Glickman M , Higginson IJ
Published: September 2012

Background

Place of death is an important quality indicator for end of life care. Understanding where patients with cancer die and what factors are associated with place of death is important for improving end of life care and has significant health care cost implications. There is, however, limited up-to-date evidence to guide practice.

Methods

This is a whole population-based observational study. All deaths with cancer as the underlying cause of death (ICD–10 codes: C00-C97), which occurred in the period 2001–2010, were extracted from death registrations in England. The time trends in place of death (coded as hospital, home, hospice, nursing home and elsewhere) were described and tested by using the Cochran-Armitage Trend Test. Factors associated with hospital death (age, gender, year of death, cancer site, index of multiple deprivation (IMD), region) were evaluated using the generalised linear model. The clustering effect within region was accounted for using an exchangeable working correlation structure.

Results

A total of 1,270, 071 cancer deaths were recorded over the 10 years period, of which 47.4% occurred in hospitals, 24.1% in homes, 17.1% in hospices, 6.6% in nursing homes and 4.8% elsewhere. In the study period, deaths in hospital decreased from 49.7% to 42.2% (annual decrease 0.8%; Pz=59.6<0.001), and home deaths increased from 22.3% to 27.6% (annual increase 0.4%; Pz=48.7<0.0001). Independent risk factors for dying in hospitals were: being older (Adjusted OR75–84 vs 18–54(AOR): 1.25; 95% confidence interval (95%CI): 1.24–1.26) and living in deprived areas (AORs:1.06–1.31). Leukaemia (AORref=lung: 3.66; 95%CI: 3.65–3.68), Non-Hodgkin’s Lymphoma (AORref=lung: 2.89; 95%CI: 2.88–2.90) and Bladder cancer (AORref=1.46; 95%CI: 1.45–1.47) were the top three cancer deaths most likely to occur in hospitals. Men had a slightly higher chance than women of dying in hospitals (AOR: 1.13; 95%CI: 1.13–1.14). Cancer deaths in hospitals were more likely to occur in London than in South West (AORs range: 0.84 in South East Coast to 1.27 in London).

Conclusion

We found an overall reducing trend in hospital deaths and an increasing trend in home deaths in the past ten years. However, significant inequality in place of death still exists. Future research needs to explore the underlying reasons.
OP75 The Relative Importance of Objective and Subjective Socio-Economic and School-Based Social Status for Adolescent Health and Substance use
Authors: Sweeting H , Hunt K , Bhaskar A
Published: September 2012

Background

Contrasting with findings from adults and children, most studies of adolescents find little variation in health according to conventional (objective) socio-economic status (SES) measures. Adolescent smoking is patterned by SES, but relationships between SES and drinking are weaker or non-existent.Subjectivestatus captures perceptions of relative rank and may also be important for health. Most studies of health and subjective status focus on adults, use subjective SES and explore self-reported health rather than behaviours. However, subjectiveschool-basedstatus may be more important than subjective SES for health in adolescence. This study examines the relative importance of objective SES, subjective SES and school-based social status for adolescent self-reported health and health behaviours.

Methods

Data were obtained via schools-based self-completion questionnaires in 2010 with follow-up in 2011 when 2,503 (85% of baseline) 13–15 year olds participated. Variables allowing derivation of family affluence were included in 2010; all other data were obtained in 2011. Scottish Index of Multiple Deprivation (SIMD) was derived via postcodes. Pupils rated subjective SES via the MacArthur Scale of Youth Subjective Social Status, a 10-rung ladder with the top representing ‘the best off people in Scotland’. Seven ladders asked them to rate various aspects of their own status, compared to their school year-group. Questionnaires also asked about self-rated health, psychological distress (GHQ–12), smoking and drinking. Analyses suggested three subjective school-based social status dimensions: ‘peer’, ‘scholastic’ and ‘sports’. Objective SES and all social status measures were each collapsed into three categories for inclusion in logistic regression analyses which were conducted on those with full data (N=1,819) on these measures.

Results

Correlations between objective SES and all subjective status measures were weak. In preliminary multivariate logistic regression analyses, adjusted for gender and age, family affluence was not associated with health, smoking or drinking and deprivation was not associated with health. However, each subjective school-based status measure was associated with both health and behaviours. For example, odds (95% confidence intervals) of fair/poor self-rated health among those ‘low’ compared with ‘high’: family affluence 1.1 (0.68–1.81); SIMD 1.23 (0.86–1.76); subjective SES 1.42 (0.97–2.08); subjective ‘peer’ status 1.73 (1.20–2.50); ‘scholastic’ 2.93 (2.01–4.27); ‘sports’ 2.93 (1.98–4.35). Odds of ever smoking among those low (vs. high): family affluence 1.43 (0.93–2.21); SIMD 2.28 (1.67–3.13); subjective SES 1.20 (0.84–1.71); ‘peer’ 0.30 (0.21–0.42); ‘scholastic’ 11.80 (8.05–17.29); ‘sports’ 2.00 (1.41–2.84).

Conclusion

Subjective school-based social status is more important for adolescent health and substance use than either objective or subjective SES measures.
OP85 Do Good Health and Material Circumstances Protect Older People from the Increase in Mortality after Bereavement?
Authors: Shah S M , Carey I M , Harris T , DeWilde S , Victor C R , Cook D G
Published: September 2012

Background

Death of a spouse or partner is a common major life event for older people. The adverse health effects of bereavement are well recognised with an increased risk of death described in several populations. The impact of modifying factors, such as chronic disease and material circumstances, is less well understood. In this study, we use a large UK primary care database to examine the modifying and mediating effect of physical comorbidity and material socio-economic circumstances on the rise in mortality in the first year after bereavement.

Methods

We identified 171,120 older (60 years and over) couples in a UK primary care database (THIN) based on a shared household identifier. The couples were followed up between 2005 and 2010 for an average of 4 years. 26,646 (15.5%) couples experienced bereavement with mean follow up after bereavement of 2 years. The effect of bereavement on risk of death in the surviving partner was examined in a survival model adjusted for age, sex, comorbidity at baseline, material deprivation based on area of residence, season and smoking. Further analysis examined the effect of changes in comorbidity during follow up.

Results

The fully adjusted hazard ratio (HR) for bereavement in the first year after bereavement was 1.25 (95% CI: 1.18 to 1.33). Further adjustment for changes in comorbidity throughout follow up did not alter the hazard ratio for bereavement (HR 1.27, 95% CI: 1.19 to 1.35). The effect of bereavement was not modified by age, gender or baseline comorbidity. The relative rise in mortality after bereavement was greatest in individuals with no significant chronic comorbidity throughout follow up (HR 1.50, 95% CI: 1.28 to 1.77) and in more affluent couples (P=0.035).

Conclusion

We have confirmed the increased risk of mortality after bereavement and demonstrated its independence of pre-existing physician recorded chronic comorbidity and social status. Our analysis, taking account of changes in morbidity before and after bereavement, suggests that the rise in mortality after bereavement is not primarily mediated through new or worsening chronic physical disease. Furthermore, there was no evidence that pre-existing or continuing good health or affluence protect individuals. The results also suggest that, paradoxically, good health and high social status may accentuate the rise in mortality after bereavement. Our findings suggest that the rise in mortality after bereavement acts as a leveller, affording no protection to the affluent or healthy, and is best explained by an increase in sudden unexpected deaths.
OP86 More Rapid Decline in CHD Incidence among Scottish Towns than among English towns from the 1980S to the 2000s
Authors: Cecil E , Hardoon SL , Wannamethee SG , Whincup PH , Morris RW
Published: September 2012

Background

The incidence of coronary heart disease (CHD) has declined in the UK since the late 1970s. However, regional differences in this decline are unknown. We investigate the change in CHD incidence from the period 1980–1988 to 2000–2008 according to UK region. We also examine regional differences in changes in established coronary risk factors over these periods

Methods

The British Regional Heart Study recruited 7735 men between 1978 and 1980 when aged 40–59 from 24 British towns. Established risk factors were measured at baseline examination and on 4252 participants twenty years later (1998–2000). CHD incidence over eight years from baseline was compared with incidence over eight years following re-examination. Age-adjusted Cox regression models including an interaction between an indicator for time period and region were used to assess relative hazards of CHD incidence between the two time periods according to UK region: South England (7 towns), Midlands/Wales (4 towns), North England (10 towns) and Scotland (3 towns).. Age-adjusted linear and logistic models with the same interaction term assessed changes in risk factors between the two periods according to region.

Results

CHD incidence for 1980–1988 in the South, Midlands/Wales, North and Scotland was 0.6, 0.8, 0.9 and 1.1 per 100 person years, and 1.1, 1.5, 1.3, and 1.1 for 2000–2008 when participants were 20 years older. Age-adjusted hazard ratios for the second versus first period in the four regions were 0.40, 0.50, 0.32 and 0.22 (p for interaction = 0.05), indicating that age-adjusted CHD incidence declined considerably in all regions but most rapidly among Scottish towns. While risk factor profiles were more favourable in the South than other regions in the first period, evidence of period/regional interactions were found in the analysis of some risk factors. Compared with the South, statistically significantly faster declines occurred in mean systolic blood pressure for North England and Scotland (by 3.1 mmHg and 4.1 mmHg respectively), in mean total cholesterol for Midlands/Wales (0.24 mmol/l), in smoking for Scotland (ratio of odds ratios 0.74), and faster increases in moderate physical activity in North England and Scotland (ratio of odds ratios 1.20 and 1.41 respectively). However mean BMI increased similarly across all regions.

Conclusion

Fall in CHD incidence was faster in the Scottish towns than the English towns. An impressive improvement in coronary risk profiles was likely to be responsible, especially with respect to blood pressure, smoking and physical activity.
PS03 Systematic Review and Meta-Analysis of School-Based Interventions to Reduce Body Mass Index
Authors: Lavelle HV , Pell JP , Mackay DF
Published: September 2012

Background

Childhood obesity predisposes to adult obesity and increases the risk of many diseases. Schools provide a vehicle to deliver public health interventions to all children.

Methods

Medline and Embase were used to undertake a systematic review of published studies on school-based interventions aimed at reducing body mass index (BMI) of children ≤ 18 years. Preferred reporting items for systematic review and meta-analyses guidelines were followed, and eligible studies subjected to a random effects meta-analysis.

Results

Between 1991 and 2010, 43 published studies provided 60 measurements of effect. The pooled effect was a 0.17 (95% CI: 0.08, 0.26,P<0.001) reduction in BMI. Heterogeneity was high (I2=93.4%) but there was no significant small study bias (Egger’s test,P=0.422) nor significant variation by length of follow-iup. The intervention comprised physical activity only in 11 (26%) studies, education only in three (7%), and combinations of these and improved nutrition in the remaining 29 (67%). On stratified analysis, physical activity used in isolation (-0.13, 95% CI: -0.22, -0.04,P=0.001) or combined with improved nutrition (-0.17, 95% CI: -0.29, -0.06,P<0.001) was associated with significant improvements in BMI. Interventions targeted at overweight/obese children reduced their BMI by 0.35 (95% CI: 0.12, 0.58,P=0.003). Those delivered to all children reduced it by 0.16 (95% CI: 0.06, 0.25,P=0.002).

Conclusion

There is growing evidence that school-based interventions that contain a physical activity component may be effective in helping to reduce BMI in children.
PS19 Lifetime Socioeconomic Inequalities in Physical and Cognitive Ageing
Authors: Hurst L , Stafford M , Cooper R , Richards M , Kuh D
Published: September 2012

Background

The maintenance of physical and cognitive function for the maximal period of time is a key component of healthy ageing, associated with continued independent living, better quality of life and reduced morbidity and mortality risk. There is growing interest in investigating life course influences on healthy ageing to identify potential intervention targets, beyond those already identified by chronic disease epidemiology.

Using data from the MRC National Survey of Health and Development (NSHD), we assess:

1. the relative importance of socioeconomic position (SEP) in childhood and adulthood across a range of physical and cognitive functional ageing outcomes at age 60–64; 2. the contribution of key social, behavioural and developmental intermediary factors to the relationship between child SEP and functional ageing

Methods

Ageing outcomes (lung function, grip strength, chair rise time, standing balance, timed up and go (TUG), verbal memory, processing speed and simple reaction time) were regressed on childhood and adult SEP ridit scores (calculated as the proportion of the population higher than the midpoint for each category) and sex. The ridit score coefficient is the slope index of inequality (SII), interpreted as the absolute difference in outcome between the hypothetical top and bottom of the SEP gradient. These were converted to the relative index of inequality to provide an estimate of the relative SEP difference across outcomes and over time. Regression models were then adjusted to examine the influence of potential mediators (education, smoking, BMI, height and childhood cognition) on the SII.

Results

Substantial childhood and adult socioeconomic gradients were observed in all physical and cognitive outcomes. The hypothetical top of the childhood SEP distribution performed between 9 and 18 per cent better, relative to the hypothetical bottom (p ≤ 0.05 for association between childhood SEP with all outcomes). These associations persisted on adjustment for adult SEP, with the exception of standing balance. The hypothetical top of the adult SEP distribution performed between 6 and 26 per cent better, relative to the hypothetical bottom (p ≤ 0.05 for association between adult SEP with all outcomes). With the exception of processing speed (in women only), chair rise time, and TUG, associations between adult SEP and outcomes persisted on adjustment for childhood SEP. Adjusting for potential mediators attenuated specific associations.

Conclusion

Child and adult SEP were independently associated with physical and cognitive ageing at age 60–64. The different social, behavioural and developmental pathways partly mediating these associations may guide appropriate intervention strategies.
PS20 Prospective Audit of Paediatric Unintentional Injury
Authors: Jessop V
Published: September 2012

Background

Injury is a leading cause of death among children and adolescents and around 16% of the world’s burden of disease can be attributed to injury, reflecting the disproportionate burden of injuries among young people and added years of life lived with disability. The majority of injuries can be prevented or at least controlled and the costs of prevention are much lower than the costs of the consequences of injuries.

There is a crucial lack of data and injury surveillance systems to inform prevention. In high income countries it has been shown that many child and adolescent injuries can be prevented through careful analysis and appropriate action. In January 2012 The Department of Health published‘A public health outcomes framework for England, 2013–2016’, which includes‘Hospital admissions caused by unintentional and deliberate injuries in under 18s’as an indicator of population health.

Research has shown that a relationship exists between increasing numbers of children presenting to Accident and Emergency with injuries and higher levels of area level socioeconomic deprivation. The Indices of Deprivation 2010 show that the London Borough of Tower Hamlets (LBTH) remains one of the most deprived areas in the country.

Methods

A prospective audit has been designed for use in The Paediatric Emergency Department at The Royal London Hospital in the LBTH. The audit tool will include the WHO core minimum dataset for injury surveillance and ICD-10 for injuries, as part of an enhanced injury dataset that has been incorporated in the College of Emergency Medicine’s proposed ‘emergency medicine minimum dataset’. Subsequent mapping of injuries to LBTH postcodes will allow identification of injury ‘hot spots’ requiring further investigation and targeted interventions.

Results

A preliminary retrospective audit of paediatric unintentional injury using data collected from computerised Accident and Emergency records for children aged 0 to <18 years who attended Royal London Hospital between July to September 2011 showed that unintentional injury results in high rates of attendance, with 40% of children attending as consequence of unintentional injury (n=3,013 attendances). The main reasons for attendance were for fractures, joint and head injuries and soft tissue inflammation. However, details of where injuries occurred, mechanisms and severity were lacking; prompting a prospective audit.

Conclusion

Knowledge of the epidemiology of paediatric injury is lacking. It is imperative that routine monitoring and surveillance of paediatric injuries occurs nationally in order to inform effective injury prevention strategies.
PS23 How well does the NHS Support Employees Who wish to Breastfeed on return to Work?
Authors: Watson LI , Neufeind J , George E , Fenske I
Published: September 2012

Background

In line with EU and UK law, NHS organisations have policies to support employees who wish to continue breastfeeding on return to work, which has numerous health benefits. The NHS employs many women of reproductive age, but anecdotally some face significant barriers in continuing breastfeeding. The objectives of the study were to describe awareness of relevant policies, describe breastfeeding behaviours and experience of staff in relation to these, and identify any areas for improvement. Fife NHS Board provides full hospital and primary care services in southeast Scotland and employs 8,000 staff.

Methods

A questionnaire survey with quantitative and qualitative elements was sent from the Department of Human Resources to eligible employees of NHS Fife who had been on maternity leave between 2007–09.This was adapted from previous surveys with input from experts and was piloted in two stages. Those with serious complications e.g. stillbirth were excluded. Full ethical review was not required.

Results

651 women were eligible, with 87 questionnaires undelivered, and 342/564 (61%) returned. Respondents were comparable to female employees of NHS Fife.; 203/329 (62%) reported awareness of the breastfeeding and return to work policy. 26/342 (8%) reported being offered information on support breastfeeding on return to work. 63/270 (23%) who breastfed at all continued on their return and this was more common with increasing age, but not related to setting eg ward, community. 18/270 (7%) would have breastfed longer if their employer had been more supportive, and 43/270 (16%) cited returning to work as a reason they stopped.; 102/254 (40.2%) felt not very or not at all confident to approach their employer regarding support. Women who were aware of the policies were significantly more likely to feel confident than women who were not, (p<0.001). 4 respondents used a suitable area to express milk and 3 made use of a designated fridge for storage.

Key themes described were that it was perceived that managers and other workers grudged the extra time for expressing milk or breastfeeding, and lack of facilities.

Conclusion

Experience of staff was highly variable suggesting the policy was not implemented consistently. Suggested areas for improvement include: clearer information regarding policies with specific information on support for continued breastfeeding, line managers initiating discussion regarding the possibility of breastfeeding on return to work, and ensuring that women who do continue are not stigmatised by colleagues.

While these results may not be fully generalisable, it is likely that there are similar issues for NHS employees more widely.
PS30 The Joint Effect of Unemployment and Cynical Hostility on All Cause Mortality
Authors: Christensen U , Kriegbaum MK , Rod NR , Osler MO , Lund RL
Published: September 2012

Background

Unemployment as well as hostility has been associated with mortality and morbidity. Hostility and socioeconomic position, including unemployment is highly associated. One of the hypothetical models on the relation between hostility, health and life context, states that hostility moderates the relationship between health problems and stressful conditions in the environment, such as unemployment. The aim of this study is to analyze the joint effect of labor market exclusion and hostility on all cause mortality.

Methods

This study is based on The Danish Longitudinal Study on work, Unemployment and Health, a survey carried out in the Spring 2000 among a random sample of 40 and 50 year old men and women and an oversampled group of previously unemployed individuals. The survey included self-reported measures on employment, education, age and hostility, measured by the eight-item Cynical Distrust Scale.

The exposure variable was: 1) employed-not hostile ; 2) employed - hostile; 3) unemployed- not hostile and 4) unemployed - hostile. Outcome was defined as all-cause mortality. We used Cox’s proportional hazard regression model, with age as the underlying time scale and with entry time January 1st 2000. All individuals who reported not working due to illness at the time of the survey were excluded in the analyses. The joint effect of unemployment and hostility was assessed as departure from multiplicativity.

Results

Employed men and women who were hostile did not have an increased mortality risk. Unemployed men had an increased risk of mortality even when they were not hostile HR=2.30 (95% CI, 1.27–4.16) and the joint effect of unemployment and hostility was higher than what would have been expected from their separate effects, HR=2.57 (95% CI, 1.50–4.42). Unemployed women did not have a significantly increased mortality risk if they were not hostile HR=1.35 (95% CI, 0.73–2.50), however, the joint effect of unemployment and hostility was higher than what would have been expected from their separate effects, HR=2.23 (95% CI, 1.17–4.24).

Conclusion

The joint effect of unemployment and hostility is a novel finding, indicating that the health damaging consequences of unemployment are accentuated by hostility.
PS32 Breast Cancer Screening Uptake in Different Ethnic Groups in London
Authors: Jack RH , Møller H , Robson T , Davies EA
Published: September 2012

Background

Breast screening uptake is lower in London than other areas of England. Knowledge of cancer screening programmes varies between ethnic groups, and previous studies have shown variation in uptake between broad ethnic groups. This study aimed to determine whether breast cancer screening uptake varies between 16 ethnic groups in London.

Methods

Information on women resident in London who were sent a breast cancer screening invitation between 31/03/2006 and 31/12/2009 was obtained from the London Quality Assurance Reference Centre. Women aged 50–52 who had a first call invitation (a first invitation to the national screening programme) in this period, and women aged 50–69 who had a routine recall invitation (after previously having a mammography as part of the screening programme) were analysed. Where ethnicity was not known, multiple imputation was used. First call and routine recall data were analysed separately. Screening uptake in different ethnic groups was assessed using logistic regression, and adjusted for age at invitation, socioeconomic deprivation and screening area. Data for the six individual screening areas were also analysed separately.

Results

Data on 159,078 women were included in the first call analysis, and on 496,438 women in the routine recall analysis. Ethnicity information was available for 475,478 (72.5%) of these women. Compared with White British women, all other ethnic groups were less likely to attend their first call screening invitation. White British women were also most likely to attend for routine recall screening sessions. Some screening areas showed less variation, with women from several ethnic groups having similar screening uptake to White British women.

Conclusion

Breast cancer screening attendance varies by ethnic group for both the first invitation and for subsequent invitations after previously being screened, with White British women more likely to attend. Collaboration between areas to find successful practices for engaging with different communities should improve breast cancer screening uptake.
PS34 Recording and Management of Obesity in Primary Care, 1997-2006
Authors: Booth HP , Gulliford M
Published: September 2012

Background

Primary care services play a potentially important role in the diagnosis and management of obesity but little evidence exists on current routine practice. The aim of this study was to describe the recording of body mass index and interventions used in the management of body weight in UK primary care in different categories of body weight.

Methods

A retrospective cohort study was implemented using the UK General Practice Research Database (GPRD). Participants were aged between 18 and 100 and had a diagnosis of obesity and/or a record indicating a weight management intervention between 1997 and 2006. Diagnoses of obesity were identified by a medical code for obesity or a body mass index (BMI) record of ≥30kg/m2.Interventions were identified by medical and therapy codes and included advice on diet, body weight control or exercise, referral to specialist care for obesity or prescription of anti-obesity drugs.

Results

Patients (n=69,102) with a diagnosis of obesity or who received a weight management intervention were identified at 128 UK general practices. Average BMI rose slightly over the study period from 35.0kg/m2in 1997 to 35.8kg/m2in 2006, with a higher proportion of patients gaining rather than losing or maintaining their weight each year. Monitoring of BMI was infrequent with just 48% of patients previously identified as obese having a BMI recorded in 2006. The proportion of patients with one or more interventions for weight control recorded increased from 29% in 1997 to 37% in 2006. The most frequent intervention throughout the study period was the provision of dietary advice, recorded in 13,097 (40.7%) patients in 2006 compared to 3,401 (32.3%) in 1997. Prescription of anti-obesity drugs increased by almost 60-fold over the study period. The proportion of morbidly obese patients (BMI ≥40kg/m2) receiving a weight control intervention in 1997 was 38%, rising to 63% in 2006. In obesity category I (BMI 30–34.9kg/m2) the proportion receiving treatment was 43% in 1997 and 53% in 2006 and in category II (BMI 35–39.9kg/m2) 41% and 56% respectively.

Conclusion

Monitoring of obesity in diagnosed patients was inconsistent in this population with less than half having a BMI recorded in each year of the study. The frequency of interventions for weight management increased substantially in primary care between 1997 and 2006.
PS36 Probation and NHS Working Together to Reduce Health Inequalities: Great Expectations or a Tale of Two Services
Authors: Parkes J , Roderick P , Panozzo S
Published: September 2012

Background

Offenders within the community are considered a socially excluded population experiencing poorer health than the general population and difficulties in accessing health care. There is little research focused on Community based offenders supervised by Probation. This study explored probation staff’s knowledge, perceptions and attitudes to offender health needs and access to health services.

Methods

Using information derived from qualitative research with probation staff and following a pilot, a national on-line questionnaire survey was conducted of probation staff involved in the management of offenders from a geographically representative sample of Probation Trusts in England and Wales. The questionnaire covered: offender health issues, enablers and barriers to health service access, and the NHS/CJS partnership. Models of good/innovative practice were sought.

Results

Sixteen Probation Trusts participated and 611/2810 (22%) responses were obtained. 72% were female, 58% had 6–15 years of experience in probation service. The main offender health issues were substance misuse, mental health (MH), learning disabilities and chronic disease, with alcohol misuse the most important. Provision of easily accessible mental health (for mild –moderate severity) and alcohol treatment services were considered to be inadequate (often/occasional lack of adequate provision 65% alcohol treatment vs 42% drug treatment vs 90% MH).

The main barrier reported was poor communication between probation and the NHS in particular with Primary Care services. It was felt that many offenders had not registered with a GP and that there was little joint working, understanding and education between primary care and probation. In addition the chaotic lifestyle of offenders lead to them having difficulties in negotiating health services and having appropriate health seeking behaviours, often accessing health services at a point of crisis (A&E). Responsiveness of health services was perceived to be lacking. Provision of in-house services (particularly mental health) was considered to be very useful where available.

Suggested improvements included undertaking health needs assessments to inform joint strategic planning, focus on improvement of alcohol treatment provision; joint education sessions for GPs and Offender Managers, exploration of in-house mental health services; increased access to health trainers, and greater health focus in probation staff training.

Conclusion

Probation staff participants were very supportive of improving health of offenders. This study identified some key barriers to addressing the health needs of offenders and their access to services, with practical solutions identified by participants providing implications for policy within the ‘new’ NHS, health service commissioning, and future research.
PS37 Does the Route to Diagnosis Affect Outcomes for Oesophago-Gastric Cancer Patients
Authors: Palser T , Cromwell D , Hardwick R , Riley S , Greenaway K , Meulen J van der
Published: September 2012

Background

The UK Cancer Reform strategy aims to improve early diagnosis but there is little evidence on how the route to diagnosis and affects outcomes for patients with oesophago-gastric (O-G) cancer. We investigated the relationship between the route to diagnosis, patient characteristics, treatment intent and one-year survival among O-G cancer patients

Methods

The study was undertaken in 142 English NHS trusts and 30 cancer networks, with data being prospectively collected on patients diagnosed with O-G cancer between October 2007 and June 2009. Route to diagnosis was defined as general practitioner (GP) referral - urgent or non-urgent, hospital consultant referral, or after an emergency admission. The association between patients’ route of diagnosis, treatment intent and survival was estimated using logistic regression.

Results

Among 14,102 cancer patients, 66.3% were diagnosed after a general practitioner (GP) referral, 16.4% after an emergency admission, and 17.4% after hospital consultant referral. Of the 9,351 GP referrals, 68.8% were urgent. Compared to urgent GP referrals, a markedly lower proportion of patients diagnosed after emergency admission had a curative treatment plan (36% v 16%; adjusted odds ratio (OR) = 0.62, 95% CI: 0.52 to 0.74) and a lower proportion of survived one year (43% v 27%; OR=0.78; 0.68 to 0.89). Urgency of GP referral did not affect treatment intent or survival. Routes to diagnosis varied across the 30 cancer networks, with the proportion of patients diagnosed after emergency admission ranging from 8.7% to 32.3%.

Conclusion

Outcomes for cancer patients are worse if diagnosed after emergency admission. Networks should examine the causes of large regional variations to reduce rates of diagnosis after emergency admission.
PS38 Sarcopenic Obesity and Risk of All-Cause and Cardiovascular Mortality in Older Men
Authors: Atkins JL , Whincup PH , Morris RW , Wannamethee SG
Published: September 2012

Background

Sarcopenic obesity refers to the age-associated loss of muscle mass coupled with high adiposity levels. Although it is known that both obesity and low muscle mass are associated with increased mortality, few studies to date have examined the combined effects of sarcopenia and obesity on all-cause or cardiovascular mortality. We examined the relationship between sarcopenic obesity and all-cause and cardiovascular mortality in older men.

Methods

4,252 men from the British Regional Heart Study, aged 60–79 years in 1998–2000, were followed prospectively until 2011 for mortality. At baseline, midarm muscle circumference (MAMC) measurement was used to provide information on muscle mass and measurement of bioelectrical impedance analysis (BIA) to provide fat free mass index. Obesity was assessed by measurement of body mass index (BMI), waist circumference (WC), and BIA (providing fat mass, FM, index). Participants were classified as either normal, sarcopenic, obese, or sarcopenic obese using varying measures of adiposity and muscle mass, since no consensus definition for sarcopenic obesity exists. Associations between the four sarcopenic obesity groups and mortality rates (all-cause and cardiovascular) were examined using Cox regression, adjusting for age, smoking, alcohol intake, social class and physical activity.

Results

There were 1,456 deaths during follow-up (mean=10.1years), 578 (40%) of which were cardiovascular. Obesity (assessed by BMI, WC and FM index) was not significantly associated with all-cause mortality, but BMI and WC were significantly associated with cardiovascular mortality (p<0.05). Low muscle mass (MAMC only) was significantly associated with all-cause mortality (p<0.001) but not with cardiovascular mortality. Sarcopenic obese men (MAMC ≤24.95cm; WC>102cm) had the greatest relative risk of all-cause mortality (RR: 1.66, 95% CI:1.23–2.25). Risks of all-cause mortality were also increased among men who were sarcopenic only (RR: 1.25, 95% CI:1.09–1.43) and obese only (RR:1.44, 95% CI:1.25–1.64) compared with normal men. Similar, though weaker, relationships were seen using MAMC and BMI to define sarcopenic obesity, but not when using combined BIA measures. Sarcopenic obese men had a less marked excess cardiovascular mortality risk (RR: 1.20, 95% CI:0.69–2.08), compared with obese men (RR: 1.35, 95% CI:1.09–1.67).

Conclusion

Sarcopenic obese older men are at an increased risk of all-cause mortality compared with those with only sarcopenia or obesity or normal body composition. MAMC and WC appeared to be the best markers of muscle mass and obesity for predicting all-cause mortality, compared with BMI and BIA measures. The added effect of sarcopenia and obesity, however, did not have a synergistic effect on cardiovascular mortality. Efforts to promote healthy ageing in the elderly should focus on both preventing obesity and maintaining muscle mass.
PS42 Inequalities in Child Obesity: Where Do These Occur and is the Gap Widening?
Authors: Dinsdale H , Ridler C
Published: September 2012

Background

Child obesity is an important public health problem. Of particular concern are the considerable inequalities in obesity prevalence between socioeconomic and ethnic groups. The Department of Health’s recently publishedCall to Action on Obesitymakes a commitment to achieving a sustained downward trend in the level of excess weight in children and states that it is vital that action on obesity reduces health inequalities.

Methods

This analysis uses data collected by the National Child Measurement Programme (NCMP). The NCMP is an annual programme that measures the height and weight of children aged 4–5 years (Reception) and 10–11 years (Year 6) in schools in England. Approximately one million children are measured every year.

The NCMP collects information on ethnicity and place of residence for each child. Five years of good quality data are now available (2006/07, 2007/08, 2008/09, 2009/10, 2010/11) and these have been analysed in detail by the National Obesity Observatory to examine how patterns of child obesity prevalence vary by demographic and socioeconomic group.

Results

Obesity prevalence among children who live in the most deprived areas of England is approximately twice that of children living in the least deprived areas. NCMP data suggest that health inequalities among boys in Reception and girls in Year 6 are widening. Health inequalities do not seem to be widening or narrowing for girls in Reception or boys in Year 6 but substantial health inequalities do persist among these groups.

When all years of NCMP measurements are considered the Bangladeshi ethnic group seems to have shown the greatest increases over time. Children in the ‘White Other’ ethnic group appear to be experiencing a decrease in obesity prevalence.

Conclusion

In order to achieve a reduction in obesity prevalence among children a particular focus on deprived groups may be required. This would help tackle persistent health inequalities. Children from the Bangladeshi ethnic group may benefit from particular attention, given the evidence that obesity prevalence is increasing for these children at a greater rate than for other ethnic groups.
PS56 Risk Of Intentional Self-Harm In Young People With Selected Mental And Chronic Physical Conditions In England
Authors: Seminog O , Goldacre M
Published: September 2012

Background

Self-harm is a well recognised act of psychological distress in some young people. Children and young adults with chronic disease are known to have an increased risk of psychological distress, but their risk of intentional self-harm is not well documented in England. We aimed to determine the risk of intentional self-harm in an English population aged 10–24 years with a range of psychological disorders, namely schizophrenia, bipolar disorder, anorexia/bulimia, depression and in those with chronic medical conditions, including diabetes mellitus, asthma and epilepsy.

Methods

We used a dataset of English national linked Hospital Episode Statistics for 1999 – 2011. We identified all the records of people who were admitted to the National Health Service (NHS) hospitals with these conditions. Each condition-specific cohort was constructed by identifying the first admission for the “exposure” condition in people aged 10 to 24 years, and we analysed the dataset for any subsequent admission for intentional self-harm. The rate of self-harm in each exposure cohort was compared with that in a reference cohort comprising people admitted for a wide range of minor medical and surgical conditions; and expressed as a rate ratio (RR) with 95% confidence intervals (CI).

Results

The RR (95% CI) for intentional self-harm was significantly and substantially high in people with schizophrenia 5.93 (5.7 to 6.17), bipolar disorder 7.93 (7.26 to 8.64), anorexia/bulimia 5.29 (4.97 to 5.63), and depression 10.25 (9.95 to 10.57). It was also significantly high, though much less so, in people with diabetes 1.60 (1.52 to 1.68), asthma 1.52 (1.48 to 1.56) and epilepsy 1.88 (1.80 to 1.96). These rates remained elevated after we excluded the cases of self-harm in the first year following hospitalisation with each exposure condition.

Conclusion

Children and young adults with the psychiatric conditions studied are at substantially increased risk of intentional self-harm. People with the chronic medical diseases studied were also at increased risk, although not nearly as high as that associated with the psychiatric disorders. The elevated risks were maintained more than a year after admission, and are likely to be associated with the disorder rather than the fact of hospital admission. Self-harm is important not only for the distress of the act itself, but it is also recognised as a predictor for eventual suicide. Our findings suggest that current suicide prevention programmes should consider targeting these risk groups as a priority.
THE HOMOTOPY ANALYSIS METHOD IN BIFURCATION ANALYSIS OF DELAY DIFFERENTIAL EQUATIONS
Authors: BEL ANDREA , REARTES WALTER
Published: September 2012

In this paper we apply the homotopy analysis method (HAM) to study the van der Pol equation with a linear delayed feedback. The paper focuses on the calculation of periodic solutions and associated bifurcations, Hopf, double Hopf, Neimark–Sacker, etc. In particular, we discuss the behavior of the systems in the neighborhoods of double Hopf points. We demonstrate the applicability of HAM to the analysis of bifurcation and stability.
AUTOWAVES IN MEMRISTIVE CELLULAR NEURAL NETWORKS
Authors: PHAM VIET-THANH , BUSCARINO ARTURO , FORTUNA LUIGI , FRASCA MATTIA
Published: September 2012

Memristor has received a significant amount of attention after a solid state implementation of it was realized in the Hewlett–Packard laboratories, because of the potential applications of such device in different areas. In this brief paper, we introduce a Cellular Neural/Nonlinear Network based on memristive cells for autowave generation. The basic cell consists of a three-component circuit (the parallel of a capacitor, an inductor and an active memristor) and displays slow–fast dynamics. Such a circuit is then connected through passive resistors to other identical cells to form a reaction–diffusion system. Simulation results show that the system is able to generate autowaves and open the way to the study of other complex phenomena like spiral waves or pattern formation in memristive circuits.
BIFURCATIONS OF 2-2-1 HETERODIMENSIONAL CYCLES UNDER TRANSVERSALITY CONDITION
Authors: LIU DAN , HAN MAOAN , ZHANG WEIPENG
Published: September 2012

Bifurcations of generic 2-2-1 heterodimensional cycles connecting to three saddles, in which two of them have two-dimensional unstable manifolds, are studied by setting up a local moving frame. Under a certain transversal condition, we firstly present the existence, uniqueness and noncoexistence of a 3-point heterodimensional cycle, 2-point heterodimensional or equidimensional cycle, 1-homoclinic cycle and 1-periodic orbit bifurcated from the 3-point heterodimensional cycle, and the bifurcation surfaces and bifurcation regions are located when the u-component [Formula: see text] of the vector [Formula: see text] under the Poincaré mapping [Formula: see text] is nonzero. Conversely, we obtain some sufficient conditions such that the bifurcation of a 2-fold 1-periodic orbit occurs and a 1-periodic orbit coexists with the surviving heterodimensional cycle, showing some new bifurcation behaviors different from the well-known equidimensional cycles.
A NEW DATA RATE ADAPTION COMMUNICATIONS SCHEME FOR CODE-SHIFTED DIFFERENTIAL CHAOS SHIFT KEYING MODULATION
Authors: XU W. K. , WANG L. , KOLUMBÁN G.
Published: September 2012

In a binary Transmitted Reference (TR) system each bit is encoded into two wavelets of finite duration. The information is transmitted by the sign of correlation measured between the two wavelets. The Code-Shifted Differential Chaos Shift Keying (CS-DCSK) modulation scheme transmits the two wavelets in the same time slot and applies two Walsh code sequences to keep the wavelets separated. The CS-DCSK modulation scheme is generalized here by transmitting more than one information bearing wavelets with one reference. The orthogonality of wavelets is assured by different Walsh code sequences. The new Generalized CS-DCSK (GCS-DCSK) scheme is a multilevel modulation where the symbol period is kept constant but the data rate can be varied in an adaptive manner by adding new or removing existing information bearing wavelets, each of them is isolated by Walsh code. Exploiting the Gaussian approximation, an analytical expression is derived for the noise performance of GCS-DCSK modulation. Its accuracy is verified by computer simulation.
ITERATED FUNCTION SYSTEMS WITH A GIVEN CONTINUOUS STATIONARY DISTRIBUTION
Authors: STENFLO ÖRJAN
Published: September 2012

For any continuous probability measure μ on ℝ we construct an IFS with probabilities having μ as its unique measure-attractor.