bluuebunny/crossref_metadata_2025 huggingface dataset:
OP61 The Future Health and Economic Consequences of Recent Obesity Trends in Ireland
Authors: Keaver L M , Webber L , Dee A , Marsh T , Balanda K , Perry I J
Published: September 2013

Background

Given the scale of the current obesity epidemic and its consequences for health there has been increasing concern about the economic burden placed on society in terms of direct healthcare costs and indirect societal costs. In the Republic of Ireland obesity related costs (direct and indirect) have been estimated at 1.13 billion for 2009. The total direct healthcare costs for six major obesity related conditions (coronary heart disease & stroke, cancer, hypertension, type 2 diabetes and knee osteoarthritis) in the same year were estimated at 2.55 billion. The aim of this research is to project disease burden and direct healthcare costs for major obesity related conditions in Ireland to 2030 using the established model developed by the National Heart Forum (UK) for the Foresight: Tackling Obesities project.

Methods

Routine data sources were used to derive incidence, prevalence, mortality and survival for coronary heart disease, stroke, cancer, hypertension, type 2 diabetes and knee osteoarthritis as inputs for the model. The model utilises a two stage modelling process to predict future BMI rates, disease prevalence and costs. Stage 1 employs a non-linear multivariate regression model to project BMI trends; stage 2 employs a microsimulation approach to produce longitudinal projections and test the impact of interventions upon future incidence of obesity-related disease.

Results

Overweight and obesity are projected to reach levels of 89% and 85% in males and females respectively by 2030. This will result in an increase in the obesity related prevalence of CHD and stroke by 97%, cancers by 61% and type 2 diabetes by 21%. Prevalence of hypertension and knee osteoarthritis is also projected to increase but to a lesser degree. The direct healthcare costs for the six conditions, associated with the projected increase in obesity will amount to €5.4 billion by 2030. A 5% fall in population BMI levels by 2030 is projected to decrease the incidence of CHD & stroke and type 2 diabetes by 35 984 and 37 788 cases respectively, resulting in savings of €495 million in direct healthcare costs.

Discussion

These findings have significant implications for policy, highlighting the need for effective strategies to prevent this avoidable health and economic burden.

Keywords Foresight; Obesity; Co-morbidities; Burden of disease; Healthcare costs
OP64 More than Obesity Prevention? Defining Outcomes in the Healthy Towns Programme in England
Authors: Sautkina E , Cummins S , Petticrew M , Goodwin D , Jones A , Ogilvie D , White M
Published: September 2013

Background

In 2008, £30 million was invested by UK Government in the Healthy Towns (HT) Programme in England. Nine urban areas were selected to develop and implement interventions to tackle the obesogenic environment. These involved multi-sector approaches to promoting physical activity and improve diet through the use of environmental interventions. In this paper, we explore how stakeholders conceptualised and defined programme outcomes in relation to national and local priorities, and across multiple policy sectors.

Methods

We undertook semi-structured, face-to-face interviews with 65 HT staff (programme leads, intervention managers and staff) in 2010–2011. Interviews lasted 50 to 110 minutes and were digitally recorded, anonymised and transcribed verbatim. Participants were asked about: the main outcomes and benefits of the HT programme, and links and synergies with other policy areas. Thematic analysis was undertaken; three authors developed and discussed the coding framework, coding outputs and agreed the resultant main themes.

Results

Programme staff conceptualised outcomes as extending beyond obesity-related behaviours and identified multiple, complementary policy areas that they were attempting to address through the initiative. Four broad categories of outcomes were articulated: [1] direct obesity-related outcomes (healthy diet, physical activity); [2] indirect obesity-related outcomes (obesity awareness, infrastructure provision); [3] wider health-related outcomes (air quality, social capital); [4] non-health outcomes (environmental sustainability, monetary savings). Stakeholders emphasised the interrelatedness of these four categories of outcomes. For example, tackling obesity, improving transport planning and air quality could all be addressed using active travel interventions; tackling obesity, enhancing social capital and promoting environmental sustainability could be addressed using ‘growing food’ interventions. Furthermore, obesity and non-obesity agendas were seen as complementary in terms of delivery of their respective outcomes.

Discussion

The range and number of outcomes identified may have been both a consequence of the multi-sector, holistic approach taken by HT programme and the ‘on the ground’ reality of implementing complex interventions, whose components touch a wide variety of policy sectors. When planning programmes and their evaluation, consideration of the impact on outcomes that extend beyond the focus of a particular programme could also be beneficial. In the HT programme, policy makers and practitioners believed that delivered interventions could address a range of complementary policy areas, which were all equally important. Taking such a ‘joined-up’ perspective could help increase the efficiency and acceptability of social, environmental, and health policies and interventions.
OP65 What’s Best for Mental Health: No Job or Any Job at All?
Authors: McManus S , Butterworth P , Leach L , Stansfeld S
Published: September 2013

Background

In terms of mental health, employment is generally better for people than joblessness. But is that still the case when the choice is between unemployment and a demanding job with low levels of control, security and reward? The prevalence of psychiatric disorders among people who are unemployed has rarely been compared with those in jobs of differing psychosocial quality.

Methods

The Adult Psychiatric Morbidity Survey (APMS) was commissioned by the NHS Information Centre, with funds from the Department of Health. It is a probability sample general population survey, from which the rates of treated and untreated mental illness in England are derived. Participants’ mental health is assessed using the Clinical Interview Schedule (CIS-R), a validated assessment tool operationalising criteria for anxiety and depressive disorders, as specified in the International Classification of Diseases 10. In the 2007 survey, we included a module covering the Job Strain and Effort-Reward Imbalance models of work-related stress. Quality of work was assessed by the number of adverse psychosocial job conditions reported (high demands, and low control, security and esteem). We examined prevalence and risk of common mental disorders (CMDs) among the 2603 participants aged 21 to 54 years who were either (i) unemployed and looking for work at the time of interview, or (ii) employed (in jobs banded by their psychosocial quality).

Results

A logistic regression model adjusted for age, sex, partnership status, debt and housing conditions was run to produce ORs for CMD. They were 0.16 ([95% CI 0.10, 0.26], p < 0.001) for people employed the highest quality jobs and 0.79 ([0.41, 1.54], p = -0.492) among unemployed people, compared with employees in the poorest quality jobs.

Conclusion

While people who are unemployed or in low quality work have worse mental health than those in high quality work, jobs of poor psychosocial quality may be no better for mental health than being unemployed. Getting the jobless back into work is, of course, a priority for recession-hit Britain. But so are the Government’s plans to improve national wellbeing. These results highlight the relevance of what goes on in the workplace for the wellbeing agenda, and show that policies aimed at increasing the employment rate should not be at the expense of job quality.
OP67 Increase in State Suicide Rates in the USA During Economic Recession
Authors: Reeves A , Stuckler D , McKee M , Gunnell D , Chang S-S , Basu S
Published: September 2013

Background

Evidence from European countries indicates a significant rise in suicides from the economic recession, totalling more than 1000 excess deaths in the UK alone. Among the worst affected economies in Europe, such as Greece, suicides have risen by more than 60% since 2007. Thus far, there has been little or no analysis of US mental health data, mostly owing to delays in data availability.

Methods

We use data on suicide mortality rates from 1999 to 2010 from the Centers for Disease Control and Prevention. Unemployment data come from the Bureau of Labour Statistics. Time-trend regression models were used to assess excess suicides occurring during the economic crisis—i.e., deaths over and above the level that would be expected if historical trends continued.

Results

In the years before the onset of the crisis (from 1999 to 2007), the suicide mortality rate in the USA was rising on average at a rate of 0·12 per 100 000 per year (95% CI 0.09, 0.14). Coinciding with the onset of the recession, the suicide rate accelerated. There were an additional 0·51 deaths per 100000 per year (0.28, 0.75) in 2008–10. This acceleration corresponds to an additional 1580 suicides per year (860, 2300). Thus, during the recessionary period after 2007, there were an estimated 4750 excess suicide deaths (2750, 6920). Next we investigated the association between rising unemployment and suicide mortality rates. A one percentage point rise in unemployment is associated with a 0·99% increase in the suicide rate ([0.60, 1.38], p < 0.0001), which is closer to the association estimated when there were no labour market protections (1·06%).

Conclusion

Our findings have immediate implications for policy. Given that some countries have avoided increases in suicides despite significant economic downturns, there is a clear need to implement policy initiatives that promote the resilience of populations during the ongoing recession. Active labour market programmes—projects that immediately help the unemployed find social support and new work opportunities (even part time)—and mental health prevention programmes seem to mitigate significantly the negative mental health effects of recessions.
OP68 Chronic Pain and Mental Health: What can we Learn from the Health Survey for England 2011?
Authors: Whalley R E , Bridges S
Published: September 2013

Background

Chronic pain persists over a period of time, typically for three months or more. Questions on chronic pain were included in the Health Survey for England (HSE) 2011 for the first time, as recommended by the Chief Medical Officer’s 2008 report: ‘Pain: Breaking Through the Barrier’. This landmark publication was unable to present definitive estimates of chronic pain prevalence. Results from HSE 2011 fill this gap and allow the mental health and social characteristics of those living with it to be explored.

Methods

All participants who lived with chronic pain were asked about the intensity of pain, areas affected, interference with everyday life and any support received. Chronic pain grades were assigned using Von Korff’s scale ranging from Grade 0 ‘Pain Free’ to Grade IV ‘Severely limiting pain’. Results were analysed by measures of mental health, socio-economic status and the Index of Multiple Deprivation. Results will also be analysed by Healthy Foundations segmentation, which categorises segments of the population by personal motivation, material deprivation and well-being, developed by the Department of Health to improve the effectiveness of targeting health policy and interventions.

Results

Overall, 31% of men and 37% of women reported experiencing any level of chronic pain, with 18% of men and 19% of women experiencing ‘severely limiting pain’; higher than the 11% previously estimated in the Chief Medical Officer’s report. Chronic pain was more prevalent among the poorest in society. Those living in the lowest income households were more likely to be living with chronic pain than those living in higher income households. The same pattern was evident by deprivation with the prevalence of chronic pain being higher among those living in more deprived areas. Mental wellbeing was associated negatively with chronic pain. Those with chronic pain were significantly more likely to report feelings of anxiety or depression; 70% of men and 68% of women with ‘Severely Limiting’ pain reported feelings of anxiety or depression compared with 17% and 22% respectively among those who were pain-free.

Conclusion

The 2011 HSE data provides a new, representative, insight into the prevalence, social characteristics and mental health of living with chronic pain. Additional analysis using the Healthy Foundations segmentation will provide further insight into the social patterning of health behaviours. This is an important insight into a key health issue and highlights how chronic pain, like many other health behaviours, is socially patterned and related to other inequalities.
OP07 The Association between Socioeconomic Position and Longitudinal Adult Social Integration in a British Birth Cohort
Authors: Harvey K , Muniz G , Kuh D , Stafford M
Published: September 2013

Background

The quantity and quality of an individual’s social relationships have been associated with health behaviours, healthcare utilisation and health outcomes. The Public Health and Health and Social Care Outcomes Frameworks include social isolation indicators but do not explicitly consider socioeconomic patterning.

Observational studies suggest that social network characteristics are socioeconomically patterned, with those with lower educational attainment, income or occupational grade having more frequent contact with family but smaller friendship networks and less frequent participation in groups. Results, however, are not consistent and studies fail to consider changes over time.

Methods

Using data from the MRC National Survey of Health and Development (also known as the 1946 British birth cohort), this study takes a lifecourse approach to exploring the relationship between socio-economic position on trajectories of social integration between age 36 and 60–64 (n = 1487). Trajectories of social integration were developed from observed variables (frequency of social group participation, frequency of informal social contact and marital status) using Latent Class Analysis. Socio-economic position in childhood (father’s occupation) and early adulthood (educational attainment and head of household occupation) were modelled as covariates to explore how the odds of following each profile varied by socioeconomic position.

Results

Four profiles of social integration were identified for men, one increasing and three decreasing. Higher levels of education were associated with reduced odds of following a profile of decreasing social integration (ORs 0.61 to 0.73) compared to the increasing social integration profile. Four profiles were identified for women: one stably high, one increasing and two declining. The relationship with socioeconomic position was stronger and consistent across measures. Those with higher education or higher head of household occupation were more likely to maintain high levels of social integration (each one level increase in educational attainment was associated with an OR of maintaining high social integration of 2.89). An association between childhood socioeconomic position and head of household was also found.

Conclusion

These findings suggest that those with lower socioeconomic position are more at risk of declining social integration up to age 60–64, particularly amongst women. Previous research suggests that low levels of social integration are related to both morbidity and mortality. Further research is required to explore the health impact of profile of social integration and the potential benefit of intervention to support maintenance of social networks at older ages, particularly for those with lower educational attainment or lower occupational grade.
OP75 Increased Consumption of Fruit and Vegetables for the Primary Prevention of Cardiovascular Diseases – A Cochrane Systematic Review
Authors: Hartley L C , Igbinedion E , Holmes J , Thorogood M , Clarke A , Stranges S , Hooper L , Rees K
Published: September 2013

Background

Cardiovascular disease (CVD) is a global burden and varies between regions. This regional variation has been linked in part to dietary factors and low fruit and vegetable intake has been associated with higher rates of CVD. Objectives: To determine the effectiveness of advice to increase fruit and vegetable consumption and the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.

Methods

The following electronic databases were searched with no language restrictions from their inception to October 2012: MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library and trial registers. Included studies fulfilled the following criteria: study design – RCT’s, participants - free of CVD (includes those at high risk of CVD), intervention - advice to increase fruit and vegetable consumption or the provision of fruit and vegetables to increase consumption, comparator - no intervention or minimal intervention (e.g. no face to face advice), outcomes - diagnosis of CVD or change in the risk factor profile for CVD (blood pressure, lipids). Two reviewers independently screened titles and abstracts, assessed shortlisted studies for formal inclusion/exclusion, abstracted data and assessed methodological quality.

Results

Database searching resulted in 7222 of which 298 went forward for informal inclusion and exclusion. Nine RCT’s met the inclusion criteria. Five trials investigated the provision of fruit and vegetables, and four trials examined advice to increase fruit and vegetable consumption. The intervention components, and the dietary advice provided differed between trials. None of the trials reported clinical events. There was no strong evidence for effects of individual trials of provision of fruit and vegetables on cardiovascular risk factors, but trials were heterogeneous and short term. Dietary advice showed favourable effects on blood pressure (SBP: mean difference -3.0 mmHg [95% CI -4.91, -1.08], DBP: mean difference -0.85 mmHg [-1.96, 0.26]) and to a lesser extent total cholesterol levels over six months (mean difference -0.13 mmol/l [-0.33, 0.08]), but few trials contributed to each analysis.

Conclusion

There are very few studies to date examining provision of, or advice to increase the consumption of, fruit and vegetables in the absence of additional dietary interventions or other lifestyle interventions for the primary prevention of CVD. The limited evidence suggests advice to increase fruit and vegetables as a single intervention has favourable effects on CVD risk factors but more trials are needed to confirm this.
OP79 Physical Activity Levels Across Adult Life and Grip Strength In Early Old Age: Updating findings from a British Birth Cohort
Authors: Dodds R , Kuh D , Sayer A Aihie , Cooper R
Published: September 2013

Background

Observational studies do not always find positive associations between physical activity and muscle strength despite intervention studies consistently showing that resistance exercise improves muscle strength in older adults. In previous analyses of the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort, there was no evidence of an association between leisure time physical activity (LTPA) across adulthood and grip strength at age 53 years. This new study tested the hypothesis that cumulative benefits of physical activity across adulthood on grip strength will have emerged by age 60–64 years.

Methods

Data from the MRC NSHD were used to investigate the associations between self-reported participation in LTPA at ages 36, 43, 53 and 60–64 years and grip strength at 60-64. Linear regression models were constructed to examine the effect of activity at each age separately and as a cumulative score, including adjustment for potential confounders (gender, height, weight, smoking status, limiting disability, educational attainment and occupational class). Formal testing of two different life course hypotheses, the sensitive period and accumulation models, was also performed.

Results

There were complete longitudinal data available for 778 men and 867 women. Being more active at ages 36, 53 (men only) and 60–64 was associated with stronger grip at 60-64 in models adjusted for gender only. These findings attenuated after adjustment for confounders but associations with LTPA at 53 and 60–64 remained, with for example those who were most active at 60–64 having 1.73 kg ([95% CI 0.61, 2.85], p < 0.01) stronger grip than those who were inactive. There was also evidence of a cumulative effect of LTPA across mid-life; compared to the third of participants who reported the least LTPA participation across the four time points, those in the top third had on average 2.11 kg ([0.88, 3.35], p < 0.01) stronger grip after adjustment for confounders. Consistent with this, in comparison to a fully saturated model, an accumulation model best fit the data.

Conclusion

Increased levels of physical activity across adulthood were associated with stronger grip at age 60–64, in both men and women. As these associations have emerged since age 53 years it suggests that LTPA across adulthood may prevent decline in grip strength in early old age. Given the negative health outcomes associated with weaker grip at similar ages, the findings from this observational study provide additional evidence in support of guidelines which recommend that physical activity should be maintained across adult life.
OP80 Inequalities in Heart Failure in Older Age: Prospective Associations between Socioeconomic Measures and Heart Failure Incidence in A 10-Year follow-up Study
Authors: Ramsay S E , Whincup P H , Papacosta O , Morris R W , Lennon L , Wannamethee S G
Published: September 2013

Background

Few studies have examined the prospective associations between socioeconomic measures and incident heart failure, and little is known about possible mechanisms underlying the relationship. The aim of this study was to investigate the association of socioeconomic measures with incident heart failure in older adults and to examine possible underlying pathways.

Methods

A socially and geographically representative cohort of men aged 60–79 years in 1998–2000 from 24 British towns was followed-up for 10 years for incident heart failure (fatal and non-fatal based on death certificates and doctor-diagnosis). Adult socioeconomic measures included longest-held occupational social class, education, pension (state only or state with private), and amenities (car and house ownership, access to central heating) – a cumulative score of adverse socioeconomic measures from 0 to ≥ 4 was used. Childhood socioeconomic measures included father’s occupational social class, and household amenities. Prevalent myocardial infarction and heart failure cases were excluded.

Results

Among 3839 men, 232 incident cases of heart failure occurred over 10 years. The hazard for heart failure was higher in the lowest occupational social classes; hazard ratio for social class IV & V (lowest social class) was 1.70 (95% CI 0.97, 2.96) compared to social class I (highest social class). Heart failure risk increased with increasing score of adverse adult socioeconomic measures (p for trend = 0.0006). Compared to men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.17 (1.34, 3.53), which was attenuated to 1.85 (1.11, 3.08) after adjusting for systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor and plasma vitamin C slightly weakened the hazard ratio to 1.72 (1.01, 2.94). Risk of heart failure did not vary by childhood socioeconomic measures.

Conclusion

Inequalities in heart failure in older populations need to be addressed – the risk of heart failure in older age was greater in the most deprived socioeconomic groups, which was only partly explained by established and novel risk factors for heart failure.
OP81 Not Eating Breakfast is Associated with increased Type 2 Diabetes Risk Markers in a Multiethnic Population of Children: the Child Heart and Health Study in England (CHASE)
Authors: Donin A S , Nightingale C M , Owen C G , Rudnicka A R , Stephen A M , Cook D G , Whincup P H
Published: September 2013

Background

Prevention of type 2 diabetes and one of its precursor obesity are important public health priorities both in adults and in children. In adults, not eating breakfast regularly has been associated with increased risks of obesity and possibly type 2 diabetes. However, little information is available on the influence of breakfast consumption on type 2 diabetes risk markers in children. We therefore examined the relations between self-reported breakfast consumption, type 2 diabetes risk markers and dietary energy and nutrient intakes in childhood.

Methods

Information was collected on usual breakfast frequency in a multi-ethnic population of primary school children in London, Birmingham and Leicester. Children provided detailed 24 hour recalls, measurements of body composition and fasting blood samples which enabled fasting blood lipids, glucose, HbA1c and insulin resistance to be measured.

Results

Among 4283 children studied, 26% did not eat breakfast every day; these children had higher insulin resistance, HbA1c, glucose, triglycerides, systolic BP, C-reactive protein, skinfold sum and fat mass index than children who reported eating breakfast daily. Differences in insulin resistance, HbA1c, glucose persisted after adjustment for adiposity. Children who did not eat breakfast every day had lower total energy intakes but higher energy density and total fat% energy (particularly mono unsaturated fat% energy). They also had lower intakes of carbohydrates, total non-starch polysaccharides; all micronutrient intakes were also much lower including vitamin B12, folate, vitamin C, calcium and iron. However, adjustment for these differences in diet could not fully account for the differences in type 2 diabetes markers observed.

Conclusion

Children who did not eat breakfast had an adverse type 2 diabetes risk profile and higher body fat. These patterns could not be fully explained by observed differences in diet. Breakfast consumption may protect against emerging diabetes risk in childhood, but the underlying reasons for this have still to be established.
OP82 Ethnic Differences in Alcohol-Related Diseases in Scotland
Authors: Bhala N , Brin G , Bansal N , Ward H , Bhopal R
Published: September 2013

Background

Alcohol-related harms, most commonly liver disease-related, are a public health priority in Scotland. Previous research has identified variations in liver disease mortality endpoints using country of birth as a proxy for ethnicity in the UK. We report ethnic differences in the incidence of alcohol-related and liver disease using an adequate measure of ethnicity in Scotland.

Methods

Using the Scottish Health & Ethnicity Linkage Study (SHELS), linking NHS hospital admissions and mortality to the Scottish census 2001, we explored ethnic differences in incidence (2001-2010) of specific alcohol-related diseases (ARD) (ISD definition for ARD, all liver diseases, alcoholic liver disease) in Scotland. Risk ratios (RR) were calculated using Poisson regression with robust variance and multiplied by 100, by gender and adjusted for age. The White Scottish population was the standard reference population (100).

Results

For alcohol-related diseases, White Irish had about a 2 fold higher risk for both men (RR 225 [95% CI 196, 258]) and women (182 [147, 224]); other British women also had a 25% higher risk (126 [107, 148]). Other White British men had a 10% lower risk (89 [80, 98]), with risks even lower in Pakistani men (66 [55, 78]) and women (49 [30, 78]) and Chinese men (47 [38, 58]). For alcoholic liver disease, White Irish had about a 50% higher risk of ALD for both men (165 [130, 209]) and women (150 [117, 193]). Other White British men had about a third lower risk of ALD (61 [50, 75]), as did Pakistani men (62 [42, 90]) and a composite of South Asian women (75 [58, 91]). For all liver diseases, some ethnic groups had about a third higher risk: Chinese men (144 [50, 175]) and women (133 [107, 165]) as well as Pakistani women (140 [112, 176]). Lower risks for all liver diseases occurred in other White British men (72 [62, 83]) and women (77 [69, 87]) and other White women (74 [64, 90]).

Conclusion

These findings show persistent differences in incidence by ethnicity for both alcohol-related and liver disease in Scotland, with important health implications throughout the UK. New policy, research and practical action are required to address these differences.
OP83 Contribution of Behavioural Risk Factors and Socio-Economic Position to Mortality in British South Asian and European Adults: 17 year follow-up of the Newcastle Heart Project Cohort
Authors: Tran A , Hayes L , McNally R , Unwin N , Bhopal R , White M
Published: September 2013

Background

British South Asians experience excess cardiovascular disease (CVD) morbidity and mortality. Evidence for this is often based on studies using place of birth as a proxy for ethnicity. We examined the contribution of CVD risk factors and socio-economic position (SEP) to mortality in Europeans and South Asians, who provided confirmation of their ethnicity.

Methods

South Asian and European origin individuals, aged 25–74 years, were recruited (April 1993 to March 1997). Ethnicity was determined by self-identified ancestry; at least 3 grandparents born in India, Pakistan or Bangladesh indicated South Asian ethnicity. Lifestyle, SEP, biochemical and anthropometric data were collected. Participants were mortality flagged with the NHS Medical Research Information Service. A lifestyle risk score, including BMI and self-reported physical activity, diet, smoking and alcohol consumption (range 0–5) was dichotomised to categorise a ‘healthy’ (score 0–2) or ‘unhealthy’ lifestyle (score 3–5). SEP was determined by the occupation of the head of the household. Age-adjusted hazard ratios (HR) for death were derived from Cox regression analyses.

Results

817 Europeans and 684 South Asians were followed up for 12-17 years. Mean follow-up was 14.9 and 13.9 years for Europeans and South Asians respectively. 5 Europeans and 34 South Asians were lost to follow-up, most commonly because individuals were no longer NHS registered (2 Europeans, 27 South Asians). Mortality ratios, standardised to a Newcastle-upon-Tyne European population, for Europeans and South Asians were 76.5 and 60.3 respectively (z-test of significance for difference between ethnic groups, p = 0.168). 28% and 49% of European men and women respectively (chi-square for difference, p < 0.001), and 23% and 26% (South Asian men and women, NS) were classified as having a healthy lifestyle. Having an unhealthy lifestyle was significantly associated with mortality in European women only (HR 1.8; 95% CI 1.03, 3.25). SEP was associated with mortality in European women and South Asian men (HR for manual vs non-manual occupation 3.1 [1.3, 7.5] and 3.7 [1.4, 9.9] respectively). SEP attenuated the effects of lifestyle on mortality in further models.

Conclusion

No significant difference in SMR between Europeans and South Asians found at 12–17 years of follow-up, although in contrast to previous studies we report a higher SMR in Europeans than in South Asians. There was a trend towards higher mortality in those with a less healthy lifestyle, but this was statistically significant only in European women. Adjusting for SEP attenuated the relationship between lifestyle and mortality suggesting that both SEP and lifestyle influence mortality.
OP86 Dietary Patterns in Older Men: Influence of Early Life Social Circumstances and Area of Residence
Authors: Atkins J L , Whincup P H , Morris RW , Wannamethee S G
Published: September 2013

Background

Few studies have examined diet quality in older adults in Great Britain. We examined the influence of area of residence and early life social circumstances on dietary patterns among older British men.

Methods

We conducted a cross-sectional study of 4252 older men (aged 60-79 years) from the British Regional Heart Study. Food frequency questionnaire data were used to examine daily fruit and vegetable consumption and to generate two dietary scores – the Healthy Diet Indicator (HDI) and the Elderly Dietary Index (EDI), with higher scores indicating greater compliance with dietary recommendations. Linear and logistic regression analyses assessed associations of adult and childhood social class (based on father’s occupation) and area of residence with dietary patterns, adjusting for age, energy intake, smoking, physical activity and body mass index.

Results

Men with non-manual childhood social class had higher EDI scores (adjusted mean difference = 0.54, p < 0.001) and were slightly more likely to consume fruit and vegetables daily (OR 1.22 [95% CI 0.98, 1.51]), independent of adult social class. Men with non-manual adult social class also had higher EDI scores (adjusted mean difference = 1.30, p < 0.001) and were much more likely to consume fruit and vegetables daily (1.56 [1.26, 1.93]), independent of childhood social class. HDI score was not associated with childhood or adult social class. Region of birth and region of residence were related to daily fruit and vegetable consumption and to both HDI and EDI scores, with the highest consumption/scores seen in the Southern region and the lowest in Scotland.

Conclusion

Dietary patterns in older men are influenced by area of residence and social class, with adult social class being more influential than early life social class in determining dietary patterns.
OP90 Non-Attendance at Diabetes Eye Screening and Risk of Sight-Threatening Diabetic Retinopathy: Population-based Cohort Study
Authors: Forster A S , Forbes A , Dodhia H , Connor C , Chemin A Du , Sivaprasad S , Mann S , Gulliford M C
Published: September 2013

Background

Population-based diabetes eye screening aims to reduce the occurrence of visual loss from diabetic eye disease. This study evaluated whether repeated non-attendance for diabetes eye screening is associated with risk of sight-threatening diabetic retinopathy (STDR).

Methods

A population-based cohort study was conducted using diabetes eye screening appointments and results bare presented for N = 35,253 patients resident in three South London boroughs invited for screening between 2008 and 2011. Analysis examined associations between the number of years in which screening was missed and risk of sight-threatening diabetic retinopathy. We also describe uptake and socio-demographic and clinical associations with non-attendance.

Results

There were 16,985 participants who were invited for screening in all four years, from 2008 to 2011, including 10,208 (60%) who were screened in every year, 6,564 (39%) who did not attend screening for up to three years, and 213 (1%) who did not attend screening in any year. Compared with participants who were screened annually, the adjusted relative odds of STDR were 2.28 ([95% CI 1.86, 2.78], p < 0.001) for participants who did not attend one year’s screening and 5.51 ([3.89, 7.80], p < 0.001) for participants who did not attend two year’s screening. In participants with mild non-proliferative retinopathy at their first screen, the adjusted relative odds of moderate or severe non-proliferative retinopathy or proliferative retinopathy at the next screen were 8.35 ([4.56, 15.26], p < 0.001) when one year of screening was missed and 24.08 ([11.52, 50.31], p < 0.001) when two years of screening was missed.

Conclusion

Patients who do not attend diabetes eye screening are at increased risk of developing sight threatening diabetic retinopathy. This risk is greater after two years of non-attendance or when background retinopathy has already been diagnosed. Quality assurance in the screening programme should focus on repeat non-attenders who already have some evidence of retinopathy.
PL01 Common Epidemiological Misconceptions: “Mutually Adjusted” – What does it mean and why might it be Misleading?
Authors: Tilling K , Howe L D , Lawlor D A , Gilthorpe M S
Published: September 2013

Background

Each year, numerous studies relate an outcome (e.g. offspring birthweight) to several exposures (e.g. maternal characteristics) using standard multiple linear/logistic regression. The results are often reported as coefficients/odds ratios for all exposures simultaneously, described as “mutually adjusted”. As discussed recently by Westreich and Greenland, depending on the nature of the theoretical model underpinning the data, this approach confuses the effects of exposures, confounders and mediators. The results presented in such a table are often uninterpretable. Interpretation of the different exposures is often only achievable through multiple models, informed bya prioriknowledge of the data structure. We use the example of the associations between multiple maternal characteristics and birthweight, and show how directed acyclic graphs (DAGs) can help to clarify which analyses should be reported.

Methods

The Avon Longitudinal Study of Parents and Children (ALSPAC) is a prospective population-based birth cohort study that recruited 14,541 pregnant women resident in Avon, UK with expected dates of delivery 1st April 1991 to 31st December 1992 (http://www.alspac.bris.ac.uk/). Here, we focus on the 10,104 singletons with complete data on offspring birthweight and sex, and the following maternal characteristics: age at delivery; parity; social class; height; ethnicity; smoking during early pregnancy; education level.

Results

In considering each putative exposure, several plausible DAGs were drawn, resulting in different sets of confounders to be included in some instances. The effect estimates for each exposure, adjusted only for appropriate confounders, are compared to those from the single, “mutually adjusted” model. For example, when considering maternal education as an exposure, the only factors which could be considered as genuine confounders on the grounds of temporality were ethnicity and (possibly) height. In the mutually-adjusted analysis (i.e. adjusted for all other maternal characteristics) there was no evidence of an association between maternal education and birthweight (coefficient for degree compared to ‘O’ Level 0.02 kg ([95% CI 0.01, 0.05], p=0.062). When appropriately adjusted for only the genuine confounding factors of ethnicity and height, there was weak evidence of an association between maternal education and birthweight (coefficient for degree compared to ‘O’ Level 0.04 kg ([0.00, 0.07], p=0.04).

Conclusion

The common practice to analyse several exposures simultaneously can lead to errors in interpretation, as they cannot all be confounders for each other. More careful consideration of the use of multiple regression is required, with distinction between genuine confounders and mediators becoming more widely understood.
PL02 An Analysis of the Changing Prices of Unhealthy and Healthier Foods: the First Step towards Tracking the Affordability of a Healthy Diet
Authors: NRV Jones , A Conklin , P Monsivais
Published: September 2013

Background

The public health importance of monitoring the affordability of a nutritious diet has been highlighted by the UK Department for Food, Environment and Rural Affairs. The economic and health-related aspects of food and diet are currently tracked by separate government agencies. Here we demonstrate how linking routine economic and health data can facilitate the study of food prices in relation to nutrition and investigate food price trends for the period 2002-2012.

Methods

We obtained national median price data for 94 foods and beverages included in the UK Consumer Price Index from 2002-2012 from the Office of National Statistics and linked these foods to items in the National Diet and Nutrition Survey food database. This linkage produced a unique dataset containing nutrition information per 100 g and price per 1000kcal across an 11 year period. Each food and beverage item was categorised as either ‘unhealthy’ or ‘healthier’ using the Food Standards Agency’s (FSA) Ofcom nutrient profiling model, developed by the FSA as a tool to differentiate foods based on their nutritive value. We tested statistical significance using a t-test for cross-sectional analyses and repeated measures ANOVA for time-series analyses.

Results

There were 43 foods categorised as ‘unhealthy’ and 51 as ‘healthier’. The mean 2012 price/1000 kcal was £2.50 for unhealthy items and £7.49 for healthier items (p < 0.001). From 2002 to 2012 the absolute price of unhealthy and healthier products had risen by £0.74 and £1.92/1000 kcal, respectively. The ANOVA results confirmed that prices had risen over time, that there was a difference in price between the unhealthy and healthier items, and that the effect of time on price was different for unhealthy and healthier foods, with the price of healthier foods rising more substantially (p < 0.001).

Conclusion

Analyses of UK price trends for foods in relation to their nutrient content revealed that foods and beverages designated as unhealthy cost less than healthier foods per unit of energy. Moreover, since 2002, absolute prices per 1000 kcal for healthier foods and drinks have been rising faster than prices per 1000 kcal for unhealthy items. A widening price gap between healthy and unhealthy foods may indicate that a nutritious diet is increasingly difficult to afford, a trend that may contribute to social inequalities in nutrition. The novel linkage we have demonstrated could serve as the basis for on-going monitoring of food prices to inform public health policy relating to diet and non-communicable disease.
Variable heat flux effect on magnetohydrodynamic flow and heat transfer over an unsteady stretching sheet in the presence of thermal radiation
Authors: Megahed Ahmed M.
Published: September 2013

The unsteady laminar magnetohydrodynamic flow over an unsteady stretching sheet in the presence of thermal radiation and variable heat flux is investigated. The governing time-dependent boundary layer equations are transformed into ordinary differential equations containing a radiation parameter, space index parameter, time index parameter, Prandtl number, magnetic parameter, and unsteadiness parameter. These equations are solved numerically by applying the Chebyshev spectral method. The velocity profiles, temperature profiles, the skin friction coefficient, and the dimensionless surface temperature are computed and discussed in detail for various values of the different parameters. It is found that increasing the unsteadiness parameter leads to a fall for both the velocity and temperature distribution. Moreover, the temperature increases with the magnetic parameter, but the reverse is true for the velocity distribution. Likewise, the temperature decreases for increasing both values of space index parameter and time index parameter.
Imaging surface water waves for the determination of surface tension and spatial attenuation
Authors: Eadkhong T. , Danworaphong S.
Published: September 2013

We propose the use of the image analysis technique to determine the surface tension of water and the attenuation coefficients of surface water waves in terms of frequency. Tap water from two different locations is used in our experiments. Water waves are continuously generated at various frequencies in a ripple tank by a plastic blade driven by a function generator. Images of the water waves are then captured by a digital camera and analyzed by using Tracker. As a result, we obtain the surface tension of water at 25 °C from both locations that are in good agreement with those resulting from the capillary rise technique. In addition, a linear relationship between the attenuation coefficient of the water waves and driven frequencies, ranging from 40 to 90 Hz, can be observed. Our results indicate that the greater the surface tension the longer distance the water wave takes before its amplitude decreases to 1/e of its original value. This work brings forward a relatively simple technique that can be applied to determine the surface tension and attenuation coefficients of surface water waves in a ripple tank with notable results.
On the adaptive benefits of mammal migration
Authors: Avgar T. , Street G. , Fryxell J.M.
Published: September 2013

Migration is well developed among mammals, but there has been little attempt to date to review common ecological constraints that may guide the evolution of migration among mammals, nor to consider its prevalence across different taxa. Here we review several alternate hypotheses for the evolution of migration in mammals based on improvements in energetic gain and mate-finding contrasted with reduction in energetic costs or the risk of predation and parasitism. While there are well-documented examples of each across the order Mammalia, the available evidence to date most strongly supports the energy gain and predation risk hypotheses in the terrestrial realm, whereas a combined strategy of reducing energetic costs in one season but improving energetic gain in another season seems to characterize aquatic mammal species, as well as bats. We further discuss behavioral and physiological specialization and provide a taxonomic cross section of mammalian migration.
USEFULNESS CLASSES OF TRAVELING ENTANGLED CHANNELS IN NONINERTIAL FRAMES
Authors: METWALLY N.
Published: September 2013

The dynamics of a general two qubit system in a noninetrial frame is investigated analytically, where it is assumed that both of its subsystems are differently accelerated. Two classes of initial traveling states are considered: self-transposed and generic pure states. The entanglement contained in all possible generated entangled states between the qubits and their anti-qubits is quantified. The usefulness of the traveling states as quantum channels to perform quantum teleportation is investigated. For the self-transposed classes, it is shown that the generalized Werner state is the most robust class and starting from a class of pure state, one can generate entangled states more robust than self-transposed classes.
THE ELECTRON TRANSPORT IN A NANOSTRUCTURE MODULATED BY THE MAGNETIC FIELD AND THE δ-DOPING
Authors: LU JIAN-DUO , XU BIN , ZHENG WEI
Published: September 2013

We theoretically investigate the effect of the δ-doping on the electron transport in a magnetic nanostructure, which can be experimentally realized by depositing one ferromagnetic stripe on the top of a semiconductor heterostructure. We find that the position and the strength of the δ-doping as well as the distance between the two magnetic fields play an important role on the electron transport properties such as the transmission probability, the conductance and the spin polarization. These interesting results may be very helpful for analyzing the spin-dependent transport mechanism of the electron and making the new types of the spintronic devices.
HALF-SKYRMION IN SPINOR BOSE–EINSTEIN CONDENSATES
Authors: LIU YONG-KAI , ZHANG CONG , YANG SHI-JIE
Published: September 2013

In this paper, we present exact solutions to the F = 1 spinor Bose–Einstein condensates with only spin-independent energy by adopting a method of separating the variables, which exhibit nontrivial topology. These solutions can form solitonic fractional vortex and solitonic half-skyrmion with a Q = 1/2 topological charge in the two-dimensional system. We further address a three-dimensional prototype solution.