bluuebunny/crossref_metadata_2025 huggingface dataset:
PP48 The Tension between Innovation, Politics and Evidence Generation in Environmental Approaches to Tackling Obesity: Stakeholder Interview Study from the English Healthy Towns Initiative
Authors: Goodwin D , Cummins S , Sautkina E , Ogilvie D , Petticrew M , Jones A , Wheeler K , White M
Published: September 2013

Background

In 2008 Department of Health commissioned nine the ‘Healthy Towns’ (HT) in England to implement and evaluate community-based environmental interventions to prevent obesity. Healthy Towns were encouraged to test whole-town approaches to tackling the obesogenic environment, which included ‘innovative’ interventions. This research examines the role evidence played in the development and implementation of the HT programme at the national and local level, and the stimulation of innovative interventions.

Methods

Participants were purposively selected to represent successful HT bid and management teams and key national policy actors involved in the implementation of the HT programme and allocation of funds. During July and October 2010, twenty qualitative interviews with local programme stakeholders and national policy actors were conducted. The majority of interviews were face-to-face, with one conducted over the telephone. Interview transcripts were coded and thematically analysed. Initial analyses were guided by research questions regarding the nature and role of evidence in the development and implementation of the Healthy Towns programme and the capacity for evidence generation to inform future policy and practice.

Results

Local anecdotal and observational evidence, rather than empirical evidence, was considered abundant and influential and was predominantly used to guide intervention development. While the programme was seen by stakeholders as an opportunity to pilot new and innovative approaches, the requirement to predict likely health impacts and adopt evidence-based practice was viewed as contradictory to this goal. These difficulties were exacerbated by political change and the impact of austerity measures during programme delivery. Overall stakeholders believed opportunities to add to the existing empirical evidence base were missed due to a lack of clarity and planning, particularly around timing, in local and national evaluations.

Discussion

The development of innovative population-level programmes to tackle obesity is beset by tensions and contradictions. Because of fear of failure, a strong emphasis on relying on existing evidence based practice and producing positive outcomes may have impeded the opportunity to implement truly innovative programmes. As determinants of obesity are complex and multi-factorial, governments should be realistic about the likely effects of single interventions and allow for the formative piloting of innovative projects that are not necessarily driven by targets.
OP15 Identifying the most effective public health nutrition policies: The views of policy-makers and thought-leaders across 14 EU countries
Authors: Lloyd-Williams F , Bromley H , Orton L , Taylor-Robinson D , O’Flaherty M , Moonan M , McGill R , Calder N , Anwar E , Castillo M Guzman , Rayner M , Capewell S
Published: September 2013

Background

EuroHeart 2 is a European research programme led by the European Heart Network and European Society of Cardiology (http://www.ehnheart.org/euroheart-ii.html). One aspect of the project aimed to identify the most effective public health nutrition policies, in order to inform future evidence-based strategies to promote cardiovascular health. We interviewed senior policy-makers and thought-leaders in 14 diverse EU countries to elicit their views on a very wide range of possible nutrition strategies covering the entire public health policy spectrum aimed at improving approaches to public health nutrition.

Methods

We first mapped national nutrition policies across 30 European countries. We then identified contacted and recruited potential participants in 14 diverse countries. Policy-makers, thought-leaders and others active in the field of public health nutrition at the national level were interviewed. Questions were first developed and piloted with senior stakeholders in the UK. The interviews were conducted in English, either by person, telephone or Skype. The interviews typically lasted between 45 and 60 minutes. The interviews were transcribed and entered into NVIVO software. The Framework approach was used to analyse the transcripts.

Results

We conducted 66 interviews in 14 countries across Europe. The interviews enabled more up to date and accurate information than was provided on websites or in reports. Responses revealed important differences between official lists of food policies and their actual implementation “on the ground”. European countries are at very different stages of addressing public health nutrition issues. Most are promoting dialogue, recommendations and guidelines (often considered an early part of the policy process). Voluntary reformulation of foods is also common, especially for salt, sugar and total fat. However, legislation regulation or fiscal interventions targeting salt, sugar, fat or fruit and vegetable consumption are still uncommon. Many interviewees expressed a preference for regulation and fiscal interventions and generally believed they were more effective, albeit politically more challenging. Conversely, information-based interventions were often seen as being more politically feasible.

Conclusion

Public health nutrition policies in Europe represent a complex, dynamic and rapidly changing arena. Encouragingly, the majority of countries are engaged in activities intended to increase consumption of health food, and decrease the intake of junk food and sugary drinks. Exemplar countries demonstrating notable progress might include Finland, Norway, Iceland, Hungary, the UK and Portugal. However, most countries fall well short of optimal activities. Implementation of potentially powerful nutrition policies remains frustratingly patchy across Europe.
PP54 Ethnic differences in Upper Gastrointestinal Disease in Scotland
Authors: Brin G I , Ward H , Bansal N , Bhopal R , Bhala N
Published: September 2013

Background

There is a paucity of data assessing ethnic variations in upper gastrointestinal (GI) disease: we sought to study the incidence of upper GI diseases using adequate measure of ethnicity in Scotland.

Methods

Using the Scottish health and 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 upper GI diseases (peptic ulcer disease, oesophagitis, gastritis, gallstones and pancreatitis) in Scotland. Risk ratios (RR) were calculated using Poisson regression with robust variance and multiplied by 100, by gender, adjusted for age and subsequently country of birth. The White Scottish population was the standard reference population (100). 95% confidence intervals (CI) were calculated to enable comparison and exclude 100 in the results below.

Results

The total numbers of first events within the 9 years period of interest (over almost 29 million of Person-Year (PY) at risk) was 44,612 for peptic ulcer, 102,706 for oesophagitis, 141,235 for gastritis, 87,556 for gallstones and 17,177 for pancreatitis. Looking at risk ratios for all specific upper GI diseases and compared to respectively White Scottish men and women, other White British and other White had a lower risk of upper GI diseases even after adjustment for country of birth. White Irish had an increased risk of upper GI diseases but not significant after adjustment for country of birth. There were consistent ethnic variations in non–White minority ethnic group even after adjustment for country of birth. Chinese men and other South Asian (SA) men and women had a 1.5 to 1.7 fold increased risk of peptic ulcer disease. Pakistani and Bangladeshi had a 1.3 to 2 fold increased risk of oesophagitis whereas Chinese had a lower risk (RR 63.5 [95% CI 50.2, 80.2] for men, 67.4 [51.6, 88.1] for women). South Asian had a 1.2 to 1.5 fold increased risk of gastritis whereas it was lower for men of African origin (65.6 [49.3, 87.3]). Gallstones was more incident in Chinese men (140.2 [117.5, 167.2]) and Pakistani women (131.3 [115,4, 149.4]). The later also had an increased risk of pancreatitis (151.7 [123.3, 186.6]).

Conclusion

This unique data allowing the comparison of specific upper GI diseases incidences between ethnic groups has shown major differences. Further exploration on risk factors and understanding of differences is needed to promote health equality.
PP56 Prevalence of Chronic Kidney Disease in Ethnic Minority Groupings: Findings from the Health Surveys for England 2003 and 2004
Authors: Aitken G , Moon G , Roderick P J
Published: September 2013

Background

In the UK, people from South Asian and Black communities have higher rates of Renal Replacement Therapy (RRT) compared to the White population. It is not clear why ethnic minorities have such high rates: possibilities include a higher prevalence of Chronic Kidney Disease (CKD) or a faster rate of progression to End Stage Renal Failure (ESRF). This study aimed to examine ethnic variation in the prevalence of CKD by a range of socio-economic, clinical and measurement characteristics.

Methods

The 2003 and 2004 Health Surveys for England were combined, totalling 9970 individuals aged over 16 with a valid serum creatinine value. Ethnicities were grouped into three categories; White, South Asian and Black. Prevalence of CKD stage 3–5 was calculated using the more accurate Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) estimating equation. Binomial logistic regression models (multivariate and stepwise selection) were used to determine the associations of ethnicity with CKD adjusted for socio-economic, health and clinical measurement factors.

Results

Prevalence of CKD stage 3–5 for White individuals was 7.6%, for South Asian was 2.8% and for Black was 4.9%. CKD prevalence increased consistently for White individuals by age grouping; the rate of increase was different for Black and South Asian individuals. Black and South Asian CKD prevalence was higher than Whites for those aged 35-54 and Black CKD prevalence was approximately double that of South Asian for ages 55-74. CKD 3–5 was strongly associated with nearly all covariates for White ethnicity, less so for South Asian and Black individuals. Odds Ratios for South Asian and Black were far higher than White for selected associated covariates. Adjustment for age and other covariates only produced only one statistically significant difference; an age-sex adjusted model confirming South Asian with lower risk of CKD compared to White (OR 0.64 [95% CI 0.44, 0.92]).

Conclusion

South Asian and Black ethnicities have lower CKD prevalence compared to White, but there is evidence of higher CKD prevalence in younger age groupings for South Asian/Black participants. Lack of statistical difference when adjusting for age and wide confidence intervals for minorities imply further research is needed with a larger sample size of ethnic minority groupings.
PP59 Predictors of Depressive Symptoms After Stroke: Longitudinal data Analysis of the Stroke Outcomes Study 2 (SOS2)
Authors: Munyombwe T , West R M , Hill K M
Published: September 2013

Background

There is a lack of studies that model patient-specific recovery patterns in depressive symptoms after stroke. Patient- specific recovery patterns provide insight into how patients progress overtime, critical time periods and time varying factors that influence these recovery patterns. This study used a multilevel modelling approach to indentify trajectories of depressive symptoms after stroke and investigated the effect of socio-demographic factors and baseline stroke severity on recovery patterns after stroke.

Data Secondary data analysis of 592 stroke patients who participated in a stroke outcomes study (SOS2) was conducted. The General health questionnaire (GHQ) 28 depressive and anxiety subscales were assessed at multiple time points over a year (3, 6, 13, 26 and 52 weeks). Average recovery trajectories for anxiety and depression subscales were characterised using multilevel modelling approach. Random intercept and random slopes models were preferred based on change in deviance. The predictors were age, sex, marital status, education, ethnicity and presence of hemianopia, occupation, house ownership, smoking, baseline stroke severity measured by Barthel index and River mead mobility index.

Results

The mean age of the sample was 70.34 (SD 11.89) and 253(43%) were female. The average anxiety and depressive trajectories showed that most change occurred in the initial-13 week period. Female gender (B = 1.029; SE = 0.288), younger age (B = -0.035; SE = 0.015), presence of hemianopia (B = 1.251: SE = 0.497), increased baseline stroke severity (B = -0.073; SE = 0.029), living in a council/tenant house (B = 1.026; SE = 0.315) were associated with increased anxiety symptoms.

Conclusion

Multilevel modelling has indicated that most change in depressive symptoms after stroke occurs in the initial 13 week period. Gender, place of residence, age, presence of hemianopia and baseline stroke severity are significant predictors of depressive symptoms after stroke
PP60 Probable Airflow Obstruction in Adults: Data from the Health Survey for England 2010
Authors: Scholes S , Moody A , Hawkins N , Mindell J
Published: September 2013

Background

In the UK, chronic obstructive pulmonary disease (COPD) causes approximately 25,000 deaths annually. Around three million people are estimated to have COPD, of whom fewer than one-third have been diagnosed. Using spirometry, fixed thresholds (FT) and lower limit of normal (LLN) criteria define airflow obstruction (AO) differently. FTs use cut-offs for lung function measurements regardless of age, sex, height and ethnicity; LLN criteria use cut-offs (e.g. 5th centile) based on normalised values for a healthy person of a given age, sex, height and ethnic group. Although FTs are widely used, LLN criteria are recommended in epidemiological studies as FTs overestimate AO in the elderly due to age-related changes in lung function.

Methods

The Health Survey for England 2010 focused on respiratory health and included spirometry (without bronchodilators) in a nationally representative random general population sample. For participants aged ≥45years without asthma (n = 1635), we estimated the prevalence of self-reported doctor-diagnosed COPD. Using the Global Lungs Initiative 2012 multi-ethnic reference equations, prevalence rates of probable AO were estimated using four definitions:

FT: FEV1/FVC<0.70

FT + : FEV1/FVC<0.70andFEV1<80% predicted

LLN: FEV1/FVC

LLN + : FEV1/FVC and FEV1

These definitions areoverlapping. We estimated the prevalence of COPD within each probable AO group. Potential risk factors for COPD or for probable AO were analysed using logistic regression (five separate outcomes).

Results

5% of participants reported doctor-diagnosed COPD. The prevalence of probable AO was 24% (FT), 12% (FT +), 14% (LLN) and 7% (LLN +). 17% of participants in the FT + group reported COPD compared with 24% of participants in the LLN + group. Pack-years smoked and respiratory symptoms significantly increased the odds of COPD and of AO after adjustments for age, sex, socioeconomic status and exposure to passive smoking. Compared with never regular smokers, those with 50 + pack-years had 5.8 (95% CI 2.6, 13.0) times higher odds of reporting diagnosed COPD, and 5.5 (3.0, 10.3) and 6.8 (3.2, 14.8) times higher odds of probable AO by FT + and LLN + criteria, respectively. Participants with respiratory symptoms had 2.5 (1.1, 5.7), 2.0 (1.0, 4.0) and 2.8 (1.3, 5.7) times higher odds of COPD/AO respectively than those without respiratory symptoms. Participants meeting LLN probable AO criteria had higher odds of diagnosed COPD: FT 2.0 (1.2, 3.5); FT + 40 (2.2, 7.1); LLN 4.2 (2.4, 7.3); LLN + 5.7 (3.0, 10.8).

Conclusion

As post-bronchodilator spirometry was not used in HSE 2010, our results may overestimate thetrueprevalence of AO, but this large population survey confirms that substantial underdiagnosis of COPD remains likely. LLN criteria appear to identify fewer, more severely affected individuals than FT criteria.
PP61 Neighbourhoods and Ethnic Differences in Biological ‘Wear and Tear’
Authors: Molaodi O R , Leyland A H , Ellaway A , Kearns A , Harding S
Published: September 2013

Background

We recently showed that ethnic minorities tend to live in deprived neighbourhoods with a high density of fast food outlets and less green space. We examine whether these neighbourhood characteristics were associated with ethnic differences in biological ‘wear and tear’. The hypothesis is that ethnic minorities may experience early physiological deterioration as a result of persistent high level coping with chronic neighbourhood stressors.

Methods

Individual level data from the Health Surveys for England (1999 and 2004) were combined with area level data on neighbourhood food and physical activity environments, deprivation and ethnic density. A summary biological risk score, allostatic load – AL, was created from nine biological indicators of elevated risk; serum levels of C-reactive protein, fibrinogen, glycated haemoglobin, total and high-density lipoprotein cholesterol, BMI, waist, and systolic and diastolic blood pressure. Multi-level models examined ethnic differences in AL, as a continuous (0–9) and dichotomous (> = 4) score, in relation to neighbourhood and individual level characteristics.

Discussion

Black Caribbeans, Pakistani and Bangladeshis had a higher probability of a mean and high risk AL score than Whites, increasing with age, and more clearly delineated among women than men. Individual and area deprivation were related to AL but did not explain ethnic differences in AL. The density of fast food outlets, supermarkets, physical activity facilities, or ethnic density was not associated with AL.

Conclusion

Living in deprived neighbourhoods was associated with greater biological wear and tear, independent of individual socio-economic circumstances, but did not explain the worse physiological profiles of some ethnic groups.
PP66 Positively Living Positively Working - Lifestyle Behaviours in a Working and Non-Working Population
Authors: McCarthy V J C , Perry I J , Greiner B A
Published: September 2013

Background

The difference between a working and a non-working middle to older aged population and their lifestyle behaviours has not been investigated previously. Furthermore, the association between positive job characteristics for current older workers and the co-occurrence of positive lifestyle behaviours (PLBs) is scarcely known.

Methods

We carried out a cross-sectional study on a sample of 2,047 males and females aged between 50-69 years. Data were collected on socio-demographic factors, and on PLBs (five or more portions of fruit and vegetables a day, ex/non-smoker, light alcohol intake and high/moderate physical activity). Just over half the sample were current workers (n= 1,025). Job characteristics were determined using the Copenhagen Psychosocial Questionnaire, specifically looking at demands and resources at work. Descriptive statistics were used to examine PLBs for the complete sample (workers and non-workers). Multinomial logistic regression was used to investigate job characteristics and the co-occurrence of PLBs for workers only.

Results

The average PLBs were higher for the worker than the non-worker across most socio-demographic factors. Non-workers, with low levels of education, had lower mean PLBs. Workers with medium or high demands were significantly more likely to have 2 (OR 2.84 [95% CI 1.15, 7.02], p=0.02), 3 (3.54 [1.43, 8.75], p=0.01) and 4 (4.99 [1.90, 13.11], p<0.01). PLBs versus none, in comparison to those with low demands. In addition workers with medium/high possibility for development were more likely to have 2 (2.95 [1.19, 7.29], p=0.02), and 3 (2.81 [1.14, 6.93], p=0.03) PLBs versus 0 in comparison to those with low possibility for development.

Discussion

Workers and non-workers differ with regard PLBs however, within workers, those with higher demands in work also have more PLBs. This is counter-intuitive, but may be the result of looking at the modern workplace with a modern tool. These findings can help inform health promotion initiatives in our communities and workplaces.
PP68 Prevalence and Risk Factors of Poor Sleep in a Community-Dwelling Older Population: Findings from the Hertfordshire Cohort Study
Authors: Denison H J , Jameson K A , Baird J , Dennison E M , Edwards M H , Patel H P , Cooper C , Sayer A Aihie
Published: September 2013

Background

Poor sleep is associated with morbidity and mortality, and research indicates that poor sleep quality is common in older people. The aim of this investigation was to determine the prevalence and risk factors of poor sleep in a community-dwelling older population.

Methods

The target population was 591 men and women aged 71-80 years from the Hertfordshire Cohort Study. 443 (75.0%) agreed to participate. Sleep was assessed using the validated Pittsburgh Sleep Quality Index (PSQI) in a self-administered questionnaire. The response rate was 91.7% (n = 406). The PSQI assesses a variety of factors related to sleep quality, including estimates of duration and latency and the frequency of specific sleep disturbances. A PSQI score of >5 indicates poor sleep quality.

Results

153 (41%) participants had a PSQI score of > 5. The majority (97.3%) reported at least one symptom of disturbed sleep occurring at least once in the past month. The most commonly reported reason for disturbed sleep was getting up to use the bathroom, with 240 (60.3%) participants reporting that this woke them at least 3 times a week. 52 (13.1%) participants reported having taken medication to help them sleep at least once in the past month.

Smoking was associated with sleep duration in men but not women, with men who had ever smoked sleeping 35 minutes less compared to those who had never smoked (95% CI 16, 54, p < 0.001). Self-rated general health was also associated with sleep duration in men but not women, with men who rated their general health as fair/bad/very bad sleeping 46 minutes less than those who rated their health as good/very good (95% CI 21, 71, p < 0.001). Women, but not men, with great or some difficulty making ends meet financially were more likely to have a PSQI score >5 compared to those who easily made ends meet (OR 4.0, 95% CI 1.5, 11.0, p = 0.007). In both men and women, worse self-rated general health was significantly associated with a PSQI score of >5 [OR (95% CI) for fair/bad/very bad health compared to good/very good health: 5.0 (2.3, 11.0), p < 0.001 for men, 2.8 (1.4, 5.8), p = 0.005 for women]. Age, BMI, weight and height were not associated with either sleep duration or poor sleep (PSQI > 5).

Conclusion

There was a high prevalence of poor sleep in this population. These findings reinforce the need for sleep assessment to be included in routine medical examinations of older people, especially in those with poorer general health.
PP69 Occupational Sedentary Time, Socioeconomic Position, and Obesity
Authors: Coombs N , Stamatakis E
Published: September 2013

Background

Higher status occupations are associated with higher levels of occupational sedentary time, yet lower levels of obesity compared to lower social class groups. We hypothesised that leisure-time physical activity and sedentary time explain this paradox: when not at work individuals in higher status occupations spend more time physically active and less time sedentary, offsetting their sedentary jobs. This study examines if the positive association between occupational sedentary time and obesity persists after adjustment for leisure-time physical activity and leisure-time sedentary time.

Methods

The sample comprised of 4282 economically active participants from the 2008 Health Survey for England (mean age 43.4 ± 13.2, 2160 women). Respondents reported sedentary time at work (sitting/standing), TV viewing, leisure-time non-TV sitting and moderate to vigorous physical activity (MVPA). Logistic regression models were run for obesity (BMI> = 30) with occupational sedentary time, TV time, non-TV leisure-time sitting, and leisure-time MVPA as main exposures. Covariates included age, sex, indicators of socioeconomic position (occupational social class, household income quartile, highest educational qualification and area deprivation quintile) smoking status, frequency of alcohol consumption, and frequency of fruit and vegetable consumption. The complex sample design was taken into account and non-response weights applied.

Results

Occupational sedentary time was associated with obesity after adjusting for TV time and leisure-time MVPA (OR 1.08 per hour [95% CI 1.04, 1.12]). Leisure-time non-TV sitting was not associated with obesity. TV time was positively associated with obesity (1.2 [1.14, 1.27]), and leisure-time MVPA was negatively associated with obesity (0.8 [0.7, 0.9]).

Conclusion

The associations between occupational sedentary time and obesity were independent of leisure-time sedentary behaviour and MVPA. Sedentary occupations are associated with obesity regardless of occupational social class, TV viewing and leisure-time MVPA. Lower levels of obesity among higher social class groups, despite higher levels of occupational sedentary time, cannot be explained by leisure-time sedentary and physical activity behaviours.
PP73 Evaluation of a Regional Health Trainer Programme; Reaching the Parts others do not Reach
Authors: Lees K , Rahman E , Parkes J
Published: September 2013

Background

The NHS South Central Health Trainers Programme includes 7 Health Trainer (HT) services in the South Central area (n = 73 staff). The programme aims to engage the ‘hard to reach’, deliver sustained improvements to the health of the people through behavioural change, provide access to and encouraging the appropriate use and take up of NHS and other local services, and increase capacity and capability of the community.

Methods

We conducted an analysis on the HT dataset that reported service activity over time; service users demographics; assessment process, health gains, and the HT profile data (April 2006 - March 2012). Data were described, using descriptive statistics and compared to national, regional or local comparators. The findings were evaluated against overall aims of the service.

Results

The HT Service saw 9,959 people (2006-2012). The number of people seen increased year by year. 59% (n = 5822) seen by the HT service were women. 74% (n = 7338) stated ethnicity as White British. Over 15% of HT service users are from an ethnic minority other than White British, which is higher compared to the SE population. The majority of people seen lived in the two most deprived quintiles (over 90%), suggesting HTs are targeting people living in the most deprived communities. 10% of people seeing HT were not registered with a GP, and are therefore a ‘hard to reach’ group, for the NHS. Just over half (n = 5113) of people seen had their primary issue recorded, the most common issue of those recorded, was diet (56% 2865/5113).HTs recorded agreed behavioural goals with just over 4/10 of their service users. Over three quarters of those who agreed behavioural goals made a full or partial behavioural change. HTs signposted 34% of service users to other services, which included a wide range of NHS and other local services. Much of the data regarding service users’ health behaviours and health outcomes was missing. Robust data is vital in order to monitor evaluate and improve the service. The service should review data fields to ensure usefulness, ensure staff capacity training and motivation for data entry.

Conclusion

Health Trainers are a valuable workforce engaging with more deprived populations and data suggests that they have a positive effect on lifestyle behavioural change. However data is incomplete and of only moderate quality. Better recording with high quality robust data would facilitate evaluation of the service, and enable estimates of effectiveness and sustainability to be demonstrated.
PP76 Exploring Barriers and Solutions to take up of Interventions to Address Fuel Poverty: A Health Impact Assessment of Fuel Poverty Policy in England
Authors: Ogilvie F , Earwicker R , Petrokofsky C , Wynne P , Jenkins S , Coates H
Published: September 2013

Background

Fuel poverty – whereby households are unable to keep warm at reasonable cost – is an on-going problem within the UK. There are known health impacts of living in cold homes, and a number of free or subsidised interventions are available to help address fuel poverty. There is however concern that such interventions are not being taken up by those in greatest need. A Health Impact Assessment (HIA) was therefore conducted to explore barriers and solutions to take up of interventions to address fuel poverty in England, in order to make policy recommendations to the Department of Energy and Climate Change (DECC).

Methods

In line with the HIA steps of screening; scoping; profiling; evidence gathering and appraisal; and making recommendations; we formed a steering group of staff from the Department of Health and DECC to set the scope of the HIA. We used data from the 2010 English Housing Survey to explore the socio-demographic profile of fuel poor households, and reviewed the evidence on the health impacts of fuel poverty on different population sub-groups. We conducted a literature review to explore barriers and potential solutions to take up of fuel poverty interventions, and used the findings from the HIA to develop policy recommendations.

Results

While there are known health impacts of outdoor and indoor cold, the relationship between fuel poverty and health is complex, with a lack of evidence for specific impacts on population sub-groups such as those with disabilities and the elderly. Barriers to take up of existing fuel poverty interventions include lack of perception of need; lack of knowledge about options and their benefits; difficulty accessing further information; and unwillingness or inability to take action. A number of initiatives have tried to promote take up of interventions, however none have been robustly evaluated, meaning little is known about which are most effective.

Conclusion

The findings from the HIA led to policy recommendations for improving the understanding of the relationship between fuel poverty and health, including the relationship between fuel poverty and excess winter deaths; improving the match between fuel poor households and those who are eligible for interventions to address fuel poverty; collecting data on the characteristics of households that do not take up interventions they are eligible for; addressing the known barriers to take up of interventions to address fuel poverty; evaluating the effectiveness of programmes that aim to address low take up of interventions; and ensuring on-going cross-government working.
PP77 Changes Ahead – Again! Lessons Learned from a Study Exploring Receptivity to Policy Changes in NHS Commissioning
Authors: McCafferty S , Bate A , Finch T , McGovern T
Published: September 2013

Background

In the National Health Service (NHS) in England commissioning is the process of prioritising resources to ensure that health and care services are provided effectively to meet the needs of the population. Commissioning policy has been subject to extensive tremendous reforms and recent years have witnessed the introduction and termination of the ‘World Class Commissioning’ (WCC) initiative, the White Paper ‘Equity and Excellence: Liberating the NHS’ and the subsequent transfer of commissioning responsibility from primary care trusts (PCTs) to clinical commissioning groups (CCGs). The impact of these reforms and how receptive organisations are to these policy changes is not fully understood. This research utilised the opportunity of the changing policy landscape as a natural experiment to explore the receptivity of a commissioning organisation to these changes.

Methods

A case study approach was adopted within one PCT following its evolution to CCG. A series of in-depth interviews were conducted across three time points (n = 11, total 34), to understand organisational responses to changes in commissioning policy. Thematic analysis and a constant comparative approach were used to identify themes.

Results

This research identified the key factors influencing the organisation’s ability to deliver policy objectives, in terms of key relationships structures and processes. Four key factors were identified. These were: policy, change agenda and locale, culture, and system management. Sub themes within these factors were also identified, particularly of note were: the level of commitment generated through the policy, the clarity of goals, historical working practices and perceptions of power.

Conclusion

These results have significant implications for emerging CCGs and provide guidance for future policy development. Previous commissioning policy initiatives have failed to adequately manage and address issues within the broader NHS system. Further continual reorganisation was found to be particularly disruptive. Results suggest that commissioning organisations are likely to be more receptive to future commissioning policies which are coherent, feasible and generate buy-in from key stakeholders. During this time of extended policy change transitions need to be carefully managed to avoid loss of valuable expertise.
OP18 Does Dementia Risk Begin in Early Life? Examining the Relationship Between Height and Dementia Mortality in an Individual Participant Meta-analysis of 181,800 People from Eighteen Prospective Cohort Studies
Authors: Russ T C , Kivimaki M , Stamatakis E , Starr J , Batty G D
Published: September 2013

Background

Risk factors measured in middle age do not fully explain the occurrence of future dementia risk. This raises the possibility that pre-adult risk factors may be implicated in its aetiology. Height is a proxy for early life circumstances (early life illness, adversity, nutritional privation, or psychosocial stress). Lower physical stature is associated with elevated cardiovascular disease (CVD) rates. Since CVD and dementia have a shared aetiology, we examined the little-explored association between height and later-life dementia. This individual participant meta-analysis is the largest study to date to examine this relationship.

Methods

We pooled raw data from 18 country-wide, independent, prospective cohort studies comprising the Health Survey for England (N = 15) and the Scottish Health Survey (N = 3). Between 1994 and 2008, a total of 181,800 people aged 16 years or older participated in baseline surveys. Height was measured to the nearest millimetre with shoes removed with the study member stretching to their maximum height. Covariate data, including health behaviours, weight, self-reported general health, and socioeconomic status were quantified using standard protocols. Cause-specific mortality was ascertained through linkage to national mortality registers

Results

A mean follow-up of 10 years gave rise to 426 dementia deaths in men and 667 in women. There was a dose-response association between shorter stature and risk of dementia death that was stronger for men (age- and sex-adjusted HR per standard deviation decrease in height 1.26 [95% CI 1.14, 1.40]) than women (1.10 [1.14, 1.19]). Incorporating measures of adulthood socioeconomic status, health, and health behaviours into the multivariable model had a negligible effect on the strength of these associations

Conclusion

Early life circumstances, as indexed by adult height, may influence later dementia risk. These findings suggest that improved early life conditions may decrease dementia risk.
OP19 Increased Adherence to the Mediterranean Diet Protects Memory Decline over 20 years in a Longitudinal Study
Authors: Cadar D , Pikhart H , Mishra G , Nipp W , Stephen A , Richards M
Published: September 2013

Background

Cognitive decline is the first outward sign of dementia and represents a major public health effect. Evidence suggests that dietary patterns are associated with cardiovascular and cerebrovascular risk factors. A high quality diet such as Mediterranean diet might protect against Alzheimer’s disease, but its association with age-associated cognitive decline has been less explored.

Aim

The current analyses aim to examine the association between the adherence to a Mediterranean-style diet and 20 years of cognitive decline from age 43 years to 60–64 (>60) years in a prospective longitudinal population-based study.

Methods

Participants were 1018 study members from the MRC National Survey of Health and Development (the British 1946 birth cohort) regularly followed up since birth in 1946 across their entire life. Cognitive functioning was measured at age 43 years and older than 60 years by tests of verbal memory (maximum words recalled 45) and timed visual search (maximum letter searched 600). The adherence scale to the Mediterranean diet was constructed with information from a 5-day estimated diet diary at both 36 and 43 years, using the Trichopoulou model (2003). Participants were divided into 3 groups of adherence to the Mediterranean diet (low, middle, and high tertiles) and an average early-midlife score was calculated. The confounding variables were social class of origin, childhood cognition, education, adult social class depression and other lifestyle behaviours such as smoking and physical activity. The associations between the adherence to the Mediterranean diet and change in cognitive tests were tested via multiple linear regression.

Results

There was a significant association between a higher level of adherence to the Mediterranean diet in early midlife and a slower verbal memory over 20 years period from 43 to 60+ in a fully adjusted model β = 1.03 (95% CI 0.24, 1.83) compared to the lower level of adherence. This association maintained its significance even after adjusting for the early-midlife level of smoking and physical activity. A higher adherence to the Mediterranean diet did not show a significant protection for the visual search decline over the same time period.

Conclusion

The results from these analyses suggest that higher adherence to the Mediterranean diet in early midlife is protective of verbal memory decline from mid to later life independent of other lifestyle behaviours such as smoking or physical activity. Public health interventions based on healthy dietary styles (such as Mediterranean diet) should be considered as important measures of defence against cognitive decline and dementia in later life.
OP02 Women’s Views on Smoking Cessation Services and National Tobacco Control Measures
Authors: Barber J , Rumsby E , Parker S , Mohebati L , Venables S , Lawson K , Scanlon T , Memon A
Published: September 2013

Background

A large proportion of public health resource is dedicated to smoking cessation services and national campaigns to control tobacco. Although it is well established that women start to smoke earlier, are more susceptible to smoking-related disease and find it harder to quit smoking than men, little research has been done to understand the perception of women regarding smoking cessation services and national tobacco control measures.

Methods

Eleven women who had used the NHS Stop Smoking Service in East Sussex were engaged in focus group discussions. Data were subjected to manual and NVIVO software-based thematic analysis.

Results

Women felt that tailoring of services to their needs would improve cessation rates. They expect the smoking cessation counsellors to be non-judgmental and to offer a psychological insight into addiction, however they shared differing opinions on the need for counsellors to be female or ex-smokers. They praised the continuity of care, capacity for peer support, flexibility of time and location and free cessation aids offered. Conversely, they felt the service was poorly advertised, that access was not universally good and that women would be more likely to access and engage with services if female-only groups and drop-in clinics were available. Use of social networking and integration of services into schools were highlighted as ways to engage young women. Opinion varied on the effect that removing cigarettes from view, limiting availability and increasing price would have on initiation and cessation. Campaigns focusing on appearance and consequences of passive smoke inhalation in children were praised, whilst most shock tactics were felt to be ineffective, with a more positive message being favoured.

Discussion

Women value service flexibility in terms of group size, location and timing. Improved advertising, more universal access and more female-centred options such as female only groups may help to better meet women’s needs. Women’s suggestions of services, such as drop-in groups, which already exist is evidence that service promotion should be improved. Women are engaged by national campaigns focusing on appearance and effects of passive smoking on children; however more research is needed on whether positive messaging can have a greater impact on female cessation than shock tactics, and on how the effects of smoke on appearance can be made more relevant to younger women. More research is needed on the importance of counsellor characteristics, the effectiveness of group interventions, and whether social networking and support and accessing schools can alter smoking behaviour in younger women.
OP21 Modelled Health Impacts of the London Cycle Hire Scheme
Authors: Goodman A , Tainio M , Cheshire J , O’Brien O , Woodcock J
Published: September 2013

Background

Bicycle sharing systems are being implemented in many cities worldwide, but have received little robust evaluation. We modelled the impacts of the London cycle hire scheme (LCH) upon the health of its users.

Methods

Data sources included total-population operational registration and usage data for LCH (April 2011-March 2012); surveys of LCH users (2011); and London data on travel, physical activity, road traffic collisions and PM2.5 air pollution (collected 2005-2012). We quantified health impacts in terms of disability-adjusted life years (DALYs), using a stochastic macro-simulation model.

Results

Over the year examined, 578,607 users made 7.4 million LCH trips (estimated 71% by men). These would mostly otherwise have been walked (31%) or used public transport (47%). To date there have been no fatalities on hire bikes and a trend towards fewer injuries than expected for London cycling. Using these observed injury rates, LCH benefits substantially outweighed risks (gain currently estimated at 116 DALYs (95% CI 80, 172) among males; 28 (19, 64) among females). When we modelled injury rates as being equal to rates for all cycling in central London, however, these benefits reduced and became non-significant for women (97 DALYs (95% CI 60, 153) among males; 5 DALYs (-9, 40) among females). This sex difference reflected comparatively high road collision fatality rates for female cyclists in London.

Conclusion

LCH has positive health impacts overall, but these benefits are clearer for males than females. The benefits of bicycle sharing systems, and cycling more generally, do not necessarily apply to all groups in all settings.
OP26 Cardiovascular Disease Incidence and Dietary Fibre intake in the UK Women’s Cohort Study
Authors: Threapleton D E , Greenwood D C , Burley V J , Cade J E
Published: September 2013

Background

Cardiovascular disease (CVD) is a major cause of mortality and morbidity in developed countries. CVD risk can be modified via lifestyle habits and some prospective studies indicate greater fibre intake is associated with lower CVD risk. The aim of this work was to explore this association using data from the UK Women’s Cohort Study.

Methods

27,731 middle-aged women, with no prior history of CVD, were recruited in the mid 1990’s and followed for a median of 14.7 years. Habitual dietary intake was assessed with a food-frequency questionnaire at study baseline, along with other health and lifestyle information. Risk of incident coronary heart disease (CHD), stroke and CVD were assessed in relation to intakes of total dietary fibre, soluble fibre, insoluble fibre and fibre from key food sources. Cox proportional hazard regression was used to explore risk using both categorical (fifths of intake) and continuous exposure variables adjusting for age, body mass index, energy intake, ethanol, physical activity, smoking and socio-economic status.

Results

After 14.7 years, 513 CHD, 406 stroke and 902 CVD cases were observed. After adjustment, a number of inverse associations were observed with increasing intakes of dietary fibre, specifically for total fibre intake with stroke and CVD. Risk was reduced in each intake quintile which was compared to the lowest. CVD risk was also significantly reduced with greater insoluble fibre intake, in each intake quintile compared to lowest; HR 0.71 (95% CI 0.54, 0.95), p= 0.019 for highest vs. lowest consumers.

Stroke risk was significantly reduced with greater cereal fibre intake in a continuous model, for each 3g/day increase; HR 0.93 (0.86, 1.00), p=0.048. Stroke and total CVD risk reduction were also associated with greater fibre from nuts/seeds in each intake category vs. lowest consumers and CHD risk was reduced in highest vs. lowest consumers of fibre from nuts/seeds; HR 0.71 (0.51, 1.00), p=0.048.

Conclusion

Fibre intakes in the UK and many other countries fall below recommendations. Results indicate greater intakes, especially of cereal fibre, may be protective against risk of incident CVD. Although fibre intakes from different sources correlate, the contrasting observations for different exposures indicate associations are food-specific rather than simply result from residual confounding of lifestyle characteristics. However, associations may be explained by other non-fibre components within foods. Promoting intake of particularly beneficial food sources of fibre may prevent CVD development.