bluuebunny/crossref_metadata_2025 huggingface dataset:
PP74 Comparing the Impact of Clinical Governance Policies in Different Countries: the Example of the English PROMS Programme
Authors: Boyce M B , Browne J P
Published: September 2013

Background

There is considerable variation at a country level in the use of health outcome measures to support clinical governance.In 2009 the NHS in England introduced Patient-Reported Outcome Measures (PROMs) as a national performance indicator for four common elective procedures (hernia repair, varicose veins, and hip/knee replacement). Outcome data is compared at a Trust level and reported publically to promote quality improvements. No such outcome monitoring has been introduced in a neighbouring jurisdiction, the Republic of Ireland. As the Republic of Ireland has a very similar profile of patients and surgeons to those seen in the NHS, it is an ideal comparison for evaluating the impact of the English PROMs Programme. In this study we compare the results of patients undergoing hip replacements in Ireland and England.

Methods

Patients undergoing hip replacement surgery were recruited from 16 hospitals in Ireland, under the care of 35 surgeons between April 2011and November 2012. Mirroring the methodology used by the English PROMs Programme, patients were asked to complete a questionnaire which included the Oxford Hip Score (OHS) before and six months after their operation. To enable a comparison with data from the English PROMs programme, the Health and Social Care Information Centre in England provided the OHS mean change score for patients undergoing primary surgery between April 2010 and May 2011.

Results

A mean change score of 20.2 points on the OHS (95% CI 20.1, 20.3) was recorded for the 29,544 patients undergoing primary hip replacement surgery who reported data to the English PROMs Programme. This compares to 20.7 (19.9, 21.4) for the 795 Irish patients. This indicates no statistically significant difference between patient-reported outcomes in the two jurisdictions.

Conclusion

This study presents a unique opportunity to assess patient outcomes across health systems with different forms of clinical governance. Our study demonstrates no differences in patient outcomes between a country which benchmarks and publically releases performance data and one which does not. In defence of the English PROMs programme it may be too early to evaluate effectiveness as quality improvements may only be evident when PROMs become influential to the decision making of providers and purchasers. Nevertheless, because our understanding of the value of outcome data in clinical governance is in its infancy, cross country comparisons are useful in the absence of better evidence.
PP75 What Factors are Important in Smoking Cessation and Relapse in Women from Deprived Communities? – A Qualitative Study
Authors: Barber J , Rumsby E , Parker S , Mohebati L , Venables S , Lawson K , Scanlon T , Memon A
Published: September 2013

Background

It is well established that women start to smoke earlier, are more susceptible to smoking-related disease and find it harder to quit than men. However, little research exists on factors associated with smoking cessation and relapse in women, particularly those from deprived communities. We conducted a qualitative study in South East England to examine these factors.

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 confirmed that it is harder for them to quit smoking than men. A number of gender-specific themes were identified for this perceived difference. Women felt that post cessationweight gainwas inevitable and acted as a barrier to quitting.Menstrual fluctuationsandgreater levels of stresswere perceived as obstacles to quitting and reasons for relapse. Conversely, the women cited the effects of smoking onappearance,andguilt aboutexposing young children to passive smokingas powerful motivators to stop and highlighted the force of public health campaigns that focused on these factors. Whilst participants agreed thatfemale smoking is still stigmatisedit was not clear if this motivates cessation. The study exposed divergent views on whetherquitting with someoneclose to you is a help or hindrance. Other non-gender specific themes including alcohol intake, daily routine and being in the presence of smokers all emerged as situational triggers of relapse.

Discussion

These findings support consideration of issues around weight gain, menstrual fluctuations, stress, appearance, stigma and guilt about exposure of young children to passive smoking in the design of public health campaigns and interventions. Female-specific policy/programmes have been shown to facilitate cessation in women, and more research is needed on how to limit the impact and perception of post-cessation weight gain, stress and menstrual fluctuations on cessation attempts and relapses. This study and previous research suggest that national campaigns focusing on appearance and the effect of passive smoke on children may alter behaviour. However, more research is needed to understand how altered appearance can be made more relevant to younger women, and whether mass media specifically targeted at women is more effective at changing female smoking behaviour. Low socioeconomic status and deprivation are the strongest predictors of smoking in women, and more research is needed into how services and interventions can be best designed to impact on women living in deprived communities.
OP25 Benefits and Risks from Aspirin use in the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Review and Overview of Reviews of Randomised Trial Evidence
Authors: Sutcliffe P , Connock M , Gurung T , Freeman K , Johnson S , Kandala N-B , Grove A , Gurung B , Morrow S , Stranges S
Published: September 2013

Background

Although the overall benefits and risks are not yet clear, there is a policy push for use of aspirin to be used for primary prevention of CVD and cancer by healthy adults in the UK. We aimed to identify relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses of RCTs to assess harms and benefits.

Methods

Searches were performed in MEDLINE; EMBASE; Cochrane Database of Systematic Reviews; CENTRAL; DARE, NHS EED, HTA databases; Web of Science; UKCRN Portfolio Database and Clinical Trials.gov and were limited to publications since 2008. 2,572 potentially relevant papers were identified. 27 met the inclusion criteria. Two reviewers independently extracted data.

Results

Aspirin dose used and population inclusion criteria varied. Absolute effects of aspirin were small; for 5,000 people followed for 20 years about 40 deaths would be avoided, while 100 GI bleeds and 17 haemorrhagic strokes would be incurred. Relative benefits ranged from a 6% reduction in relative risk (RR) for all-cause mortality (RR 0.94 [95% CI 0.88, 1.00]) to a 10% reduction in major cardiovascular events (0.90 [0.85, 0.96]) and a 15% reduction in total CHD (0.85 [0.69, 1.06]). Reported pooled odds ratios for total cancer mortality ranged between 0.76 (0.66, 0.88) and 0.93 (0.84, 1.03). Aspirin reduced reported colorectal cancer incidence (0.66 [0.9, 1.02]). Including studies where aspirin was given every other day raised the RR to 0.91 (0.74, 1.11). Reported cancer benefits begin to appear approximately five years from start of treatment. Increased relative risks of adverse events from aspirin use were reported as 37% for gastro-intestinal bleeding (1.37 [1.15, 1.62]), between 54% (1.54 [1.30, 1.82]) and 62% (1.62 [1.31, 2.00]) for major bleeds, and between 32% (1.32 [1.00, 1.74]) to 38% (1.32 [1.01, 1.82]) for haemorrhagic stroke.

Conclusion

There is a fine balance between benefits and risks from regular aspirin use in primary prevention of CVD. Effects on cancer prevention have a long lead time and currently rely on post-hoc analyses of trials for other conditions. All absolute effects are small compared to the burden of these diseases. Results of ongoing trials may change the picture but presently we consider a decision to use aspirin for primary prevention of cardiovascular diseases and cancer at population level unjustified.
OP34 Assessing the Social Determinants of Teenage Pregnancy: A Time-Space Analysis using an Obstetric Database from 1950-2010
Authors: McCall S J T , Bhattacharya S , Macfarlance G J , Okpo E
Published: September 2013

Background

Teenage-pregnancy is a known social problem and has remained at the forefront of policy within the UK. The social aetiology of teenage pregnancy is known to be linked with deprivation. However, deprivation is a multifaceted term making it difficult to quantify, this is shown by the large number of measures that have been created in the UK. This study compared the discriminating ability of these measures with respect to teenage pregnancy. Furthermore, this project also examined the temporal-spatial patterns of teenage-conceptions within Aberdeen City.

Methods

This was a population based study from 1950–2010, using registry based data from the Aberdeen Maternity Neonatal Databank (AMND). The AMND holds information on fertility and obstetric related events since 1951 to the present. The main outcome variable was a conception age of less than twenty years. This outcome was compared by a number of deprivation measures, these were the Scottish Index of Multiple Deprivation (SIMD), Carstairs Index, and Registrar General’s Occupation based social class. Each measure was commenced at different times resulting in a varying sample size for each of the measures. Logistic regression models showing the strength of the association and receiver operating characteristic (ROC) curves showing the discriminating ability of the measure were constructed as part of the analysis. Spatial analysis comprised of creating post code based maps of teenage pregnancies.

Results

There was a decline in teenage-conceptions over the sixty year period. All the measures of socio-economic status were highly associated with teenage-pregnancy and given as Odd Ratios. For example the adjusted association between SIMD and teenage conception had an OR of 10.36 (95% CI 8.46, 12.68) which compared the most deprived decile to the least deprived decile. The ROC curves showed that socioeconomic measures performed better than chance at determining teenage conceptions (X2= 158.7, P < 0.0001). They further showed that the SIMD performed best at predicting teenage pregnancies by having the largest area under the curve with a value of 0.73.

Conclusion

Despite a slight decline in teenage pregnancies over past decades, there is still an evident association between deprivation and teenage pregnancy. Moreover, this study shows that the SIMD measure is the most suitable measure at determining teenage-conceptions. As the SIMD is the most recent and multifaceted measure of socioeconomic status, this supports its future use in health inequality research.
OP36 Socioeconomic and Geographic differences in Adolescent Sexual Behaviour: A Multilevel Cross-Sectional Study of 15 year Olds in Scotland
Authors: Levin K A , Henderson M
Published: September 2013

Background

Scotland has one of the highest rates of early sexual activity among 15-year-old girls compared with other countries in Europe and North America, and diagnosis of STDs in Scotland has increased over the last decade. As there are known socioeconomic and geographic inequalities in adult health, the aim of this study is to describe socioeconomic and urban-rural differences in sexual behaviour of 15-year old boys and girls in Scotland in 2010.

Methods

Data from the 2010 Scotland Health Behaviour in School-Aged Children survey, boosted to provide a representative sample of rural and remote areas, were modelled using multilevel logistic modelling for outcome ‘has/has not had sexual intercourse’. Individual’s family affluence, type of school (state versus private) and area level deprivation (SIMD 2012 quintiles) were included in the analyses as measures of socioeconomic status. The Scottish Household Survey Rurality indicator was also included in the analyses.

Results

Prevalence of having had sex was higher among girls (33% [95% CI 30, 36]) than boys (25% [22, 28]). Similarly, prevalence among those with low family affluence (FAS) was higher than those with high FAS. However, when modelled, adjusting for school type and area-level deprivation, FAS was no longer significant. Girls living in SIMD 1 and SIMD 2 (most deprived quintiles) had higher odds of having had sex (OR 1.74 [95% CI 0.99, 3.07] and 1.87 [1.19, 2.95] respectively) relative to those living in SIMD 5. This was also true for boys, although odds were lower, approximately 1.3 in the 2 most deprived quintiles, relative to SIMD 5. School type was significantly associated with sex among girls, with higher odds in state schools (1.96 [1.01, 3.82]). When rurality was added to the models, this was not significant in the boys’ model. However, girls living in Accessible and Remote Towns (i.e. towns of between 3,000 and 10,000 residents) had higher odds of having sexual intercourse (OR 1.73 and 1.61 respectively), as did those living in Accessible Rural areas (settlements of less than 3,000 people, less than 30 minute drive time from an urban centre) (OR 1.64) relative to those living in the 4 Cities.

Conclusion

Area-level deprivation and school type were stronger predictors of having had sexual intercourse than family affluence. Although rurality was not associated with boy’s sexual behaviour, girls from Accessible and Remote Towns and Accessible Rural Scotland were more likely to have had sexual intercourse.
OP42 Mental Disorders Across the Adult Lifecourse and Future Coronary Heart Disease: Evidence for General Susceptibility
Authors: Gale C R , Batty G D , Osborn D P J , Tynelius P , Rasmussen F
Published: September 2013

Background

Depression, anxiety, and psychotic disorders have been associated with an increased risk of developing coronary heart disease (CHD). The underlying mechanisms are uncertain. It is unclear whether the association between mental health and risk of CHD is present across a wider range of mental disorders, and whether it varies according to the chronicity of the disorder. We used data on over a million Swedish men who underwent psychiatric and medical assessment in early adulthood and were followed up for hospital admission for mental disorder and CHD. Our first objective was to investigate whether the risks of incident CHD associated with a range of mental disorders diagnosed in early adulthood were similar to those associated with subsequent hospital admission for these disorders. Our second objective was to examine the extent to which risk factors measured in early adulthood (blood pressure, body mass index (BMI), smoking, alcohol intake and intelligence) together with socioeconomic circumstances in childhood or later adult life, explained these associations.

Methods

Participants were 1,095,249 Swedish men conscripted for military service at a mean age of 18.3 years. Schizophrenia, other non-affective psychotic disorders, bipolar disorders, depressive disorders, neurotic and adjustment disorders, personality disorders, alcohol-related and other substances use disorders were assessed by psychiatric interview on conscription and data on hospital admissions for these mental disorders and for CHD (fatal and non-fatal) were obtained from national registers during a mean follow-up period of 22.6 years.

Results

Increased risk of incident CHD was evident across the range of mental disorders whether diagnosed at conscription or on later hospital admission. Age-adjusted HRs (95% CIs) according to diagnoses at conscription ranged from 1.27 (1.03, 1.58) (depressive disorders) to 1.92 (1.60, 2.31) (alcohol-related disorders). The equivalent figures according to diagnoses during hospital admission were higher, ranging from 1.49 (1.22, 1.79) (schizophrenia) to 2.87 (2.58, 3.20) (other substance use disorders). Associations were little changed by adjustment for early-life socioeconomic status, BMI and blood pressure, but were partially attenuated by adjustment for smoking, alcohol intake, intelligence, education and late-life socioeconomic position. Risk of CHD rose with exposure to more chronic and perhaps more severe mental disorder (p for linear trend < 0.0001).

Conclusion

Increased risk of incident CHD is present across a range of mental disorders and is observable when disorders are diagnosed at a young age. Men with early onset mental disorder who subsequently require psychiatric hospital admission are at particularly high risk.
OP45 Walking, Cycling and Driving to Work in the English and Welsh 2011 Census: Trends, Socio-Economic Patterning and Relevance to Travel Behaviour in General
Authors: Goodman A , Koupil I
Published: September 2013

Background

Increasing walking and cycling, and reducing motorised vehicle use, are increasingly recognised as health and environmental priorities. This paper examines levels and trends in the use of different commute modes in England and Wales, both overall and with respect to small-area deprivation. It also examines how far commute modal share can serve as a proxy for travel behaviour more generally.

Methods

25.1 million adult commuters reported their usual main mode of travelling to work in the 2011 England and Wales census; similar data were available for 1971-2001. Indices of Multiple Deprivation were used to examine socio-economic patterning. The UK National Travel Survey 2002-2010 was used to examine correlations between commute modal share and modal share of total travel time in 150 non-overlapping populations defined by region, year band and income.

Results

Among commuters in 2011, 67.1% used private motorised travel as their usual main commute mode (-1.8% change since 2001); 17.3% public transport (+1.4% change); 11.3% walking (+0.4% change); and 3.0% cycling (0.0% change). Walking and, to a marginal extent, cycling were more common among those from deprived areas, but these gradients had flattened over the previous decade to the point of having essentially disappeared for cycling. In the National Travel Survey, commute modal share and total modal share were highly correlated for private motorised transport (r = 0.94), public transport (r = 0.96) walking (r = 0.88 excluding London) and cycling (r = 0.77).

Conclusion

England and Wales remain car-dependent, but the trends are slightly more encouraging. Unlike many health behaviours, it is more common for socio-economically disadvantaged groups to commute using physically active modes, but this association is weakening and may soon reverse for cycling. At a population level, commute modal share is reasonably highly correlated with total modal share, enhancing the value of the census data in characterising background trends and evaluating interventions.
OP47 Is Active Commuting Good for Our Health?
Authors: Flint E , Cummins S , Sacker A
Published: September 2013

Background

Physical activity reduces the risk of cardiovascular disease and is an important factor in healthy weight maintenance. However, overall levels of physical activity have declined in the developed world, and tackling obesity is a public health priority. Active commuting is thought to be a particularly effective way of getting exercise, as walking and cycling are easily adopted and likely to be maintained as part of one’s daily routine. In addition to improving cardiovascular health and fitness, greater uptake of active travel has been shown to reduce air and noise pollution, traffic congestion and CO2emissions.

Methods

Using data from Understanding Society Wave 2, this study investigates the extent to which active commuting predicts four objectively measured health outcomes: body mass index (BMI); percentage body fat; lung function; and blood pressure. Commuting mode was defined using three categories designed to capture increasing levels of physical activity: private transport (car, motorcycle, taxi); public transport (bus, train, etc); active transport (walking or cycling). The analytic sample was restricted to those who worked outside of the home and had complete data for commuting mode and biological measurements (n = 3352 men; n = 4103 women). Gender-stratified nested multivariate linear regression analyses were utilised, in order to adjust for the following hypothesised confounding covariates: age, age2, distance travelled, limiting illness or disability, occupational social class, work-related physical activity level, participation in sporting activity and diet quality.

Results

In the age-adjusted analyses, compared with using private transport; public transport and active transport were associated with lower BMI for men (public transport: b -1.1, p < 0.001; active transport: b -0.9, p = 0.002) and women (public transport: b -0.6, p = 0.05; active transport: b -0.6, p = 0.01). Adjustment for all other hypothesised confounders did not greatly attenuate this association for men (public transport: b -1.0, p < 0.001; active transport: b -0.7, p = 0.016) or for female active travellers (public transport: b -0.6, p = 0.09; active transport: b -0.9, p = 0.001). Similar results were found for percentage body fat. Findings for blood pressure and lung function varied by gender and told a more complex story.

Conclusion

The results from this investigation corroborate findings from other studies in suggesting that incorporating a greater level of physical activity into the commute may help individuals maintain a healthy weight and body composition. The use of biomeasure outcomes in a large, nationally representative sample increases our confidence in the robustness of these findings.
OP57 The Contribution of Neighbourhoods and Schools to Cognitive Test Performance at Age Seven - Findings from the UK Millennium Cohort Study
Authors: Heilmann A , Kelly Y , Stafford M , Watt R G
Published: September 2013

Background

The relevance of neighbourhoods for children’s cognitive development, while receiving increasing attention, is still subject to debate. One mechanism that has been proposed is via institutional resources such as schools. Another hypothesis is that neighbourhood aspects influence maternal psychological well-being and parenting practices. However, the contribution of schools to the neighbourhood effect is understudied, and findings regarding the role of maternal mental health and parenting have so far been inconsistent. The aim of this research was twofold: first, to partition the variability in children’s cognitive test performance between neighbourhoods, schools and families, and second, to examine whether maternal psychological distress and parenting practices were on the pathway between neighbourhood characteristics and these outcomes.

Methods

We analysed data from the UK Millennium Cohort Study. Outcome measures were cognitive test performance at age 7 in reading, maths and a pattern construction test. Data were analysed for 9,412 children who had not changed school and lived in the same neighbourhood since age 5, and for whom information was complete. Neighbourhoods were defined as Lower Layer Super Output Areas. Cross-classified multilevel models were used to simultaneously estimate the variability in cognitive test outcomes between neighbourhoods and schools before and after adjusting for family-level covariates; and to examine the contribution of maternal psychological distress and parenting practices.

Results

At age 7, the percentage of the unadjusted variance in cognitive test performance between neighbourhoods was about 5% for reading, 9% for maths and 7% for pattern construction. The unadjusted variance between schools was about 10% for reading, 12% for maths, and 6% for pattern construction. After allowing for a range of family background characteristics, the neighbourhood variance for reading was no longer statistically significant, while a school effect of about 7% remained. For maths, the remaining variance attributable to neighbourhoods and schools was 7% and 10% respectively, while for pattern construction, this was about 3% at both levels. Reading and math test performance were independently associated with neighbourhood median household income, and pattern construction scores with the IMD education domain in the expected direction. Our data did not support the hypothesis of a mediating effect via maternal psychological distress and parenting practices.

Conclusion

Our findings highlight the importance of including both neighbourhoods and schools when aiming to determine the contribution of contextual factors to children’s cognitive test performance. Differences between neighbourhoods and schools appear to contribute to inequalities in children’s cognitive development already at this early age.
OP58 Exploring Household Dynamics: The Reciprocal Effects of Parent and Child Characteristics
Authors: Panico L , Webb E A , Becares L
Published: September 2013

Background

Studies show a strong relationship between maternal mental health and child socio-emotional development. This literature is based on examinations of dyadic relationships, where maternal mental health is hypothesised to have a direct effect on children’s development. However, household dynamics are complex, with other household members having an effect both on the mother and the child. Furthermore, the child’s characteristics can also have a feedback effect on their career’s outcomes.

Methods

In this paper, we employ a multilevel structural equation model with cross lagged effects to understand the reciprocal effects of maternal mental health, child socio-emotional development, and quality of parental relationship. Analyses were conducted on longitudinal data from the Millennium Cohort Study, a prospective national birth cohort of children born in the UK 2000–2001. The Millennium Cohort Study has a wealth of information on the socioeconomic background of the household, and has collected data on the mother’s mental health (Kessler 6), the quality of the parents’ relationship (Golombok-Rust), and the children’s socio-emotional development (SDQ). Our results relate to households with two continuously partnered parents, with complete data on the three key variables, producing a sample size of 6570 households. In this work we look at data relating to age 3 and 5 years.

Results

Child socio-emotional development at age 3 has an influence on maternal mental health when their child is age 5 (standardised β = 0.03 [95% CI 0.001, 0.05]) and maternal mental health at age 3 has an influence on child socio-emotional development at age 5 (0.07; 0.05–0.10). Quality of the parental relationship at age 3 has an influence on maternal mental health when their child is age 5 (0.04 [0.02, 0.06]) but does not influence child socio-emotional development at age 5. Neither child socio-emotional development nor maternal mental health at age 3 influence the quality of the parental relationship when their child is age 5.

Conclusion

We find complex significant relationships between maternal mental health, child socio-emotional development and quality of parental relationship. This points to the need to consider all household members in order to properly capture household dynamics and to understand drivers of parental and child wellbeing.
OP62 How do Adiposity Trajectories Vary by Birth Cohort and Parental Social Class? Evidence from the West of Scotland Twenty-07 Study
Authors: Shaw R J , Green M , Popham F , Benzeval M
Published: September 2013

Background

Over the last 80 years the association between social class and obesity has changed. In the 1930s obesity rates were low and wealthy people tended to have a higher risk of obesity than poor people. However, rising affluence and industrialisation has lead to both rising rates of obesity and an obesogenic environment in which socioeconomically disadvantaged people have the highest risk of obesity. This study investigates the magnitude of these changes by modelling trajectories of adiposity by social class and cohort using the Twenty-07 study.

Methods

The Twenty-07 study contains three cohorts of people (n = 4510), born in Glasgow in the 1930s, 1950s and 1970s. Two measures of adiposity, BMI and Waist to Height Ratio (WHtR), were recorded at baseline in 1987/8 when study participants were aged 15, 35 or 55, and again on 4 further occasions over 20 years. Parental social class (manual/non-manual) was collected at baseline. For each gender, we apply multilevel models to identify trajectories of adiposity by cohort and social class.

Results

The trajectories indicated that adiposity increased with age and rates of increase varied by cohort, social class and gender. For any given age the youngest cohort had the fastest rate of increase and the highest predicted adiposity. For example, at age 35 for non-manual men, BMI was 24.2 (95% CI 23.7, 24.8) for the 1950s cohort and 27.2 (26.8, 27.5) for the 1970s cohort. By the end of the study respondents in more recent cohorts had BMI values approximately equivalent to those of people aged 20 years older in an earlier cohort. Cohort variation was much greater than socioeconomic variation. The smallest cohort difference in BMI was 2.10 (0.94, 3.26), a comparison of the 1950 and 1930s cohorts for non-manual men at age 55. In contrast, the largest social class difference in BMI, a comparison of manual and non manual women at age 64, was only 1.18 (0.37, 1.98). Socioeconomic inequalities tended to be smaller for men than women, particularly for the 1930s cohort where there was no evidence of a socioeconomic gradient for men unlike for women. The main difference between WHtR and BMI was that increases in WHtR accelerated with age whilst increases in BMI slowed with age.

Conclusion

Increases in adiposity for younger cohorts across all socioeconomic groups dwarf any socioeconomic inequalities in adiposity. This highlights the damaging impact for the whole population of living in an obesogenic environment.
OP63 Body Size and Body Composition: A Comparison between Children in India and in the UK through Infancy and Early Childhood
Authors: D’Angelo S , Crozier S R , Chittaranjan Y , Joglekar C , Lubree H , Fall C H , Inskip H M
Published: September 2013

Background

Indian children have been shown to be smaller in all body measurements compared with white Caucasian British children at birth, one and four years, but they show a particular pattern of smallness, with relative sparing of subcutaneous fat– the so-called ‘thin-fat’ phenotype. Recently, Indian children at age 6 years were found to have a higher body fat percentage from DXA measurements than white British children, despite a lower BMI. However, no study has compared Indian anthropometric measurements at birth and at multiple ages through early childhood to 6 years with a large (> 500) population sample of British children, using the same measurement protocols throughout.

Methods

We used data from 631 liveborn, singleton children from the Pune Maternal Nutrition Study (PMNS) and 3012 liveborn, singleton, white British children from the Southampton Women’s Survey (SWS), which included anthropometric measurements at birth and 1, 2, 3 and 6 years. t-tests and Mann-Whitney U-tests were used to compare the means and medians of the two populations. Birth measurements were adjusted for gestational age and sex, using linear regression, while the measurements at the other ages were adjusted only for sex. Southampton measurements were used as a reference and standard deviation (SD) scores were generated: Pune SD score = (Pune observation-Southampton mean)/ (Southampton SD).

Results

At all ages and for all anthropometric measurements considered, Pune children were smaller than those in Southampton. At all ages after birth, the largest difference was found in head circumference, followed by mid-upper arm circumference and weight. At birth and through infancy and childhood, subscapular skinfold thickness was always the most spared measurement, indicating that the body composition of Pune children was characterised by fat preservation at all ages.

Conclusion

This study suggests that the previously described ‘thin-fat phenotype’ characterises Indian babies not only at birth but also through infancy and childhood up to 6 years of age. Compared with the Southampton children, they are smaller but have greater preservation of subcutaneous fat, and this pattern is sustained to age 6 years. It is well known that adult Indians have a higher percentage body fat than those from European populations, but this propensity is established before birth and does not alter through early life.
OP71 The Funding Pressures Facing the NHS from 2010/11 to 2021/22
Authors: Roberts A D , Marshal L M , Charlesworth A
Published: September 2013

Background

Spending on the UK National Health Service (NHS) has risen by an average of 4% a year in real terms since its introduction in 1948. This growth has now halted due to reductions in public spending. The English NHS is therefore targeting efficiency savings of £15–20 billion by 2014–15 to meet rising pressures. This research looks beyond 2014–15 to estimate the financial challenge facing the NHS in England in 2021–22, examining the potential impact of various policies in managing these pressures.

Methods

To estimate funding pressures facing the English NHS, healthcare activity was broken down by type: acute, maternity, mental illness, general practice, and prescribing. A least-squares approach was used to model determinants of demand for each type in the base year. Results were applied to projections of population, mortality and chronic conditions, with estimated cost then applied. The cost of projected healthcare activity was compared to potential scenarios for government funding of the English NHS, with the gap representing the required efficiency gain by 2021–22. The effect of three key factors on closing this gap was examined: pay restraint, management of chronic conditions demand, and increased acute sector productivity.

Results

Funding pressures on acute NHS services in England are estimated to rise by 3% a year due to combined effects of population change and rising hospital admissions for chronic conditions. If pay rises with recent trend, total acute sector pressure will rise by 4% a year. If spending remains flat in real terms, the funding gap will reach £44–54 billion in 2021–22. If the current efficiency challenge is met in 2014–15, this reduces to £28–34 billion. Closing this gap will require a combination of measures: releasing all savings related to productivity gains made prior to 2015–16 (£6bn), preventing increases in the probability of being admitted to hospital with a chronic condition (£6bn), and restricting pay growth to rising with inflation (£8bn). The remaining £8bn gap will require further productivity gains of 1% a year between 2015–16 and 2021–22.

Conclusion

The current austerity experienced by the English NHS is likely to extend beyond the 4-year period to 2014–15 that is currently the focus of planned efficiency savings. If funding pressures increase with recent trends, further savings of 4% a year will be needed between 2015–16 and 2021–22 to meet rising demands on healthcare. This will require unprecedented sustained increases in health service productivity to avoid cuts to services or falls in quality.
OP88 What Factors Drive Unhealthy Diet? Novel Analysis of Food Frequency Questionnaire Data using Canonical Correspondence Analysis
Authors: Goffe L A , Rushton S P , White M
Published: September 2013

Background

Diet is a major contributor to obesity, but the processes that influence intake remain unclear. Understanding the factors driving food consumption at the population scale requires detailed knowledge of the relationships between dietary patterns and socio-demographic factors. Objectively measuring diet is problematic, but food frequency questionnaires (FFQ) are an established, if imperfect, method for population studies. Such data is inherently multifactorial and various methods have been used to reduce dimensionality. We aimed to evaluate the role of socio-demographic factors in determining different dietary patterns using novel methods.

Methods

Data were from a survey of dietary habits of 5044 adults in Newcastle-upon-Tyne, 2001–2002. This included the European Prospective Investigation of Cancer (EPIC) 134 item FFQ and socio-demographic data. We used canonical correspondence analysis (CCA), an extension of correspondence analysis that constrains the ordination to relate FFQ responses to relevant socio-demographic variables. Ordination methods summarise continuous trends according to socio-demographic variables, creating ‘components’ to describe trends in multivariate data. Results can be displayed graphically using scatter plots, showing the position of each food item and arrows, varying in length and direction, to show the strength of influence of each demographic variable.

Results

Two main axes emerged from the FFQ data, describing dietary patterns. The first axis related to the level of processing; highly processed food items generally scoring low and raw ingredients scoring high. The second axis related to a Mediterranean diet; relevant items (e.g. pasta, rice, fruits and vegetables, cheese, yoghourt and wine) scored high, whereas those related to a traditional British diet (i.e. ‘meat and two veg’) scored low. Food consumption is highly individual but by constraining the ordination with reported age, dietary knowledge, educational attainment, socio-economic status and receipt of welfare benefits, it was possible to show their relationship to eating habits. These correlates accounted for 5.8% of variation, age exerting the strongest influence. Older people showed a strong preference for a British, low-processed food diet. University education was associated with consumption of a low-processed Mediterranean diet, whereas those living in deprived areas were associated with a highly-processed traditional British diet.

Discussion

CCA provides a robust, descriptive and conceptually superior method for dietary pattern analysis using FFQ data. Results confirm findings of qualitative research, suggesting that diet is strongly culturally patterned among specific, identifiable population subgroups. Such work is limited by cross-sectional data, but CCA may enable better tailoring and targeting of interventions for those at greatest risk from an unhealthy diet.
OP92 Improving the Effectiveness of Multidisciplinary Team Meetings for Patients with Chronic Diseases: Assessing the Predictors of Decision Implementation
Authors: Raine R , Xanthopoulou P , Wallace I , Nic a’ Bháird C , Barber J , Clarke A , Lanceley A , Ardron D , Harris M , Blazeby J , Ferlie E , Gibbs S , King M , Livingston G , Michie S , Prentice A
Published: September 2013

Background

Department of Health policy states that health care for chronic diseases should be delivered through multidisciplinary team meetings (MDMs). It is known that multidisciplinary teams should include certain features (for example commitment to leadership) to be effective. But additional factors need to be considered: e.g. the context in which MDMs operate, group decision processes, and patient related factors such as their preferences and socio-demographic characteristics. There is, therefore, a need for research on MDMs to identify factors that promote effective MDM decision-making in terms of decision implementation. We report on a study, unique in its size and scope, making its results applicable across the NHS.

Methods

We undertook an observational study of 370 MDMs in 12 different teams (gynaecological, skin and haematological cancers, mental health, heart failure and memory clinics) in the North Thames area. Analyses used random effects logistic regression models, allowing for MDM clustering, to investigate the influence of MDM and patient related factors on decision implementation. Decision implementation and patient demographics were ascertained from medical records. The MDM characteristics examined were Team Climate Score, disease type, team skill-mix (Adjusted Teachman’s Index and number of professional categories represented), and whether defined co-morbidities and patient preferences were considered. The patient characteristics examined were age, gender and Index of Multiple Deprivation (IMD) score.

Results

We will present descriptive analyses on 6053 discussions of 3184 patients. For example, discussions on 17% of patients led to no decision. Decision implementation ranged from 67% (Mental Health) to 79% (Memory Clinics). Reasons for non-implementation will be presented.

We will present the results of logistic regression on the patient and MDM related factors associated with decision implementation, including the extent to which patient related factors, for example their socio-economic circumstances, were associated with implementation. We will also describe the patient and MDM related factors associated with patient preferences being taken into account.

Conclusion

We address recent calls for empirical research on MDM decision-making in routine practice to understand how and under what conditions MDMs produce effective decisions, as well as methods to effectively obtain and consider patient preferences. As the largest study of its kind in this area, and the first to examine and compare MDMs for different chronic diseases, this study enables identification of factors associated with good outcomes that are generalisable across healthcare.
OP95 Public Involvement in Health and Social Care Research: Exploring Areas of Consensus and Conflict
Authors: Snape D A , Jacoby A , Gradinger F , Gibson A , Newman J , Popay J
Published: September 2013

Background

Public involvement (PI) in research, promoted by the UK Department of Health, has gained considerable momentum. Despite this, examination of the actual impacts of this involvement or how such impacts might be measured effectively remains limited. Evidence about the impact of PI is essential to ensure integrity, avoid harmful effects and to justify resources. In light of this, the overall aim of this MRC multi-phase study was to advance understanding of the impacts of PI, to contribute to more robust assessment of these impacts and to improve standards of PI practice. The Delphi process described here formed part of the multi-phase study.

Methods

A modified Delphi approach integrated qualitative and quantitative research methods. Three workshops were conducted to generate qualitative data around PI values and normative debates; and to generate items for a subsequent two-round Delphi survey.Criticalconsensus andclearconsensus criterion were pre-determined at 70% and 60% respectively. Through open questions participants were able to make additional comments and to generate potential solutions to identified problems. Written responses were analysed thematically. Workshop and Delphi study participants were drawn from diverse settings including universities, health and charitable organisations. Participants included members of the public, academic, clinical and user-researchers, research funders and managers, self-selected as having some clear previous experience of PI in research; 42 participated in the workshops and 231 completed both rounds of the Delphi survey.

Results

Critical consensus was reached across the different stakeholder groups that the public: have unique knowledge and expertise complimentary to that of researchers which should be valued equally (90%); can influence how research is used (85%); should be involved in publicly funded research, and are entitled to say what and how research is undertaken (80%); and that the public perspective, when considered at all stages, ensures more ethical research (70%). However, it was also agreed that assessing how PI influences a research project is methodologically problematic. Qualitative analysis highlighted the multi-dimensional nature of ‘PI process’ considerations. Researchers were sometimes seen as lacking understanding of the ‘added value’ of PI. The current PI Policy imperative was perceived by many as encouraging ‘tokenism’. Participants felt that a ‘fit for purpose’ approach, reflecting study and social contexts, was a more appropriate way of assuring effective PI than dependence on pre-conceived models.

Conclusion

Host organisations, including academic institutions, need to strengthen infrastructure to ensure that systems promote and facilitate PI better.
PL03 Associations between Birth Characteristics and Eating Disorders Across the Life Course: Findings from two Million Males and Females Born in Sweden 1975-1998
Authors: Goodman A , Heshmati A , Malki N , Koupil I
Published: September 2013

Background

Recent years have seen considerable interest in the developmental origins of eating disorders (ED) but results have been conflicting, perhaps reflecting low power in many studies. Limited power has also prevented robust comparisons of associations with ED subtypes or the use of within-family designs to address the potential for confounding.

Methods

We used total population data to create a cohort of 2,011,908 males and females, born 1975-1998 in Sweden to Swedish-born mothers. Birth characteristics included twin/triplet status; gestational age; birthweight; birth length; premature rupture of the membranes; delivery method; Apgar score at 5 minutes; birth traumas; mother’s smoking during pregnancy; and mother’s weight gain during pregnancy. We adjusted for multiple family and social characteristics, and conducted within-family analyses to test for confounding at the maternal/family level. Our outcomes were hospitalisation for anorexia, bulimia or eating disorder not-otherwise-specified (EDNOS)’ after age 12, with follow-up period until end 2010.

Results

Anorexia was independently predicted by multiple birth (AOR 1.33 [95% CI 1.15, 1.53] for twin/triplet vs. singleton) and lower gestational age (HR 0.96 [0.95, 0.98] per extra week of gestation). Gestational age showed a clear dose-response pattern. These associations were largely specific to anorexia, and were only seen in the cohort members affected; within-family analyses revealed that the maternal siblings of twins or preterm individuals showed no increased risk, and provided no evidence of residual maternal-level confounding. Higher birthweight for gestational age showed a strong, positive dose-response association with bulimia (HR 1.15 [1.09, 1.22]) per sex-standardised standard deviation increase). Again, this association was specific to bulimia and within-family analyses provided no evidence of residual confounding. By contrast, although mother’s smoking predicted anorexia, this did seem likely to reflect maternal-level confounding. Other birth characteristics showed little or no association with any ED outcome, except a trend towards increased bulimia and EDNOS among mothers who gained excessive weight during pregnancy.

Conclusion

These findings are consistent with a causal role of earlier gestational age upon anorexia and higher birthweight upon bulimia. Further research is needed to elucidate the mechanisms, but the dose-response nature of these associations indicates that they do not simply reflect pathological responses at the extremes of the distribution. The strong association with multiple births is noteworthy as many of the largest population-based studies of ED prevalence have been conducted in twins: our findings suggest the possibility that such studies substantially overestimate ED prevalence.
AN INTRODUCTION TO THE EINSTEIN TOOLKIT
Authors: ZILHÃO MIGUEL , LÖFFLER FRANK
Published: September 2013

We give an introduction to the Einstein Toolkit, a mature, open-source computational infrastructure for numerical relativity based on the Cactus Framework, for the target group of new users. This toolkit is composed of several different modules, is developed by researchers from different institutions throughout the world and is in active continuous development. Documentation for the toolkit and its several modules is often scattered across different locations, a difficulty new users may at times have to struggle with. Scientific papers exist describing the toolkit and its methods in detail, but they might be overwhelming at first. With these lecture notes we hope to provide an initial overview for new users. We cover how to obtain, compile and run the toolkit, and give an overview of some of the tools and modules provided with it.