bluuebunny/crossref_metadata_2025 huggingface dataset:
OP08 Evaluating the Health Inequalities Impact of the New Deal for Communities Initiative
Authors: Popay J , Whitehead M , Badland H , Stafford M , Nazroo J , Dibbens C , Halliday E , Povall S
Published: September 2012

Background

New Deal for Communities (NDC), a 10-year area-based regeneration initiative begun in 1999 in 39 disadvantaged neighbourhoods in England, has the potential to reduce health inequalities because it focuses on key social determinants of these inequalities: unemployment, crime, education, housing and the physical environment. This study assesses whether the NDC initiative impacted on health inequalities across the socioeconomic spectrum of areas in England.

Methods

The study primarily utilises secondary data including household surveys undertaken as part of a national evaluation of the NDC initiative led by Sheffield University. Representative samples of 500 residents per NDC area and matched comparator area in 2002, 2004, 2006 and 2008 provide data on health, lifestyles, wellbeing, demography and social determinants of health. The Health Survey for England in the same years provides information for representative samples drawn from across the socioeconomic spectrum, here categorised as highest, middle and lowest tertile of area deprivation. Logistic regression was used to estimate baseline differences in health and its social determinants, the time trend and differential time trends in NDC and non-intervention areas adjusted for sex, age, ethnicity and baseline education based on over 125,000 observations across eight years. Outcomes of interest included self-rated health, mental health inventory, smoking, employment status and housing tenure.

Results

Initial analyses indicated a higher likelihood of smoking in non-intervention areas of medium deprivation (OR; 95%CI: 1.33; 1.10, 1.60), non-intervention areas of high deprivation (1.80; 1.48, 2.19), matched comparator areas (1.77; 1.46, 2.15) and NDC areas (1.97; 1.68, 2.31) compared with reference areas of low deprivation. Smoking declined over time but there was no evidence of differential rates of decline in the different areas. The likelihood of unemployment was considerably higher in all areas compared with the reference (for example, 4.29; 3.55, 5.18 in NDC areas). The likelihood of unemployment dropped over time in NDC areas but not in other areas (OR for time by NDC interaction: 0.93; 0.89, 0.96). Results for other outcomes are also available.

Conclusion

The study indicates that the NDC intervention may have contributed to reducing a key social determinant of health inequalities, namely unemployment. Similar reductions were not observed in non-intervention high, medium or low deprivation areas in England which may eventually feed through into a narrowing of health inequalities between NCD and other areas. This initial work will be extended to examine impact across different intervention approaches and historical and current contexts.
OP09 Life-Course Body Mass Index, Birthweight And Lipid Levels in Mid-Adulthood: A Nationwide Birth Cohort Study
Authors: Pereira SM Pinto , Power C
Published: September 2012

Background

Cardiovascular disease (CVD) is a major public health problem. Clinical trials have shown that lowering total- and/or low-density lipoprotein (LDL)-cholesterol reduces the risk of CVD. Therefore, to reduce the burden of CVD, improvement in lipid profiles is an important goal. To achieve this, a better understanding is needed of biological pathways leading to lipid levels. Lipid levels track from childhood to adulthood, implying that influences on adult cholesterol levels begin at young ages. There is scant evidence on the role of growth, including trajectories of body mass index (BMI) across the life-course with respect to lipids. We aimed to determine whether there are phases of the life-course that are particularly important for adult lipid levels.

Methods

In the 1958 British Birth Cohort weight and height were recorded at birth (weight only), 7y, 11y, 16y, 23y, 33y and 45y. In 3,927 men and 3,897 women we assessed whether (i) birthweight was associated with 45y lipids and whether associations were due to catch-up growth to 7y; (ii) there were particular periods when BMI, or change in BMI, influenced subsequent lipid levels; (iii) associations between current BMI and lipid levels were modified by BMI at younger ages; and (iv) duration of obesity was associated with lipid levels. Analyses were sex specific, adjusted for covariates and used multiple imputation to account for missing data.

Results

Birthweight was inversely associated with triglycerides and in women with total- and LDL-cholesterol; associations persisted after adjustment for 7y BMI. Associations with lipids strengthened with age of BMI measurement, e.g. per standard deviation (SD) higher BMI at 11y and 45y triglycerides were higher by 4.01% (95% confidence interval: 2.26%, 5.75%) and 19.75% (18.18%, 21.32%) respectively in women. BMI change was related to lipids, with strongest associations for the interval preceding lipid measurement: per SD increase in BMI 33–45y total-cholesterol and triglycerides were higher by ∼3% and ∼21% respectively. Associations between 45y BMI and lipids were stronger for those with lower than higher BMI at younger ages (P for interactions: <0.01 to ≤0.05). This effect-modification was seen from childhood (7y in women; 11y in men). Obesity in childhood but not thereafter and longer duration of obesity were unrelated to adult lipid levels.

Conclusion

Our study suggests that life-course trajectories of body size influence adult lipid levels, with the consequences of a high adult BMI for adult lipid levels being particularly adverse for those with lower BMI at earlier life-stages.
OP11 The Association of Childhood Adiposity, and its Distribution, with Cardiometabolic Outcomes: Results from 13 European Cohorts
Authors: Patel S , Lawlor DA
Published: September 2012

Background

Adiposity in childhood has been associated with increased cardiovascular risk which may be established in childhood and adolescence. Also centrally distributed fat (waist circumference) has been suggested to be a better marker of cardiometabolic risk compared to body mass index (BMI). We aimed to assess the association of adiposity measures with cardiometabolic outcomes in children and consider if the magnitude of these associations differ by adiposity measurement.

Methods

European cohorts with data available on BMI and waist circumference and cardiometabolic outcomes (at least blood pressure) were invited to participate in the collaborative project. Cross-sectional associations between adiposity measures (age- and gender-standardised z scores) and cardiometabolic outcomes and prospective associations (cardiometabolic outcomes measured at least 12 months after adiposity measurement) were examined. Results from individual cohorts were pooled using a random-effect meta-analysis and heterogeneity between them explored.

Results

A total of 13 cohorts (n=3644–17186 for different outcomes) were included in the cross-sectional analysis. BMI and waist circumference were both positively associated with diastolic and systolic blood pressure (DBP, SBP) and with total cholesterol, LDLc, triglycerides, insulin and CRP, with the magnitudes of association with each outcome being similar for BMI and waist. For example, the mean difference in DBP per standard deviation (SD) increase in BMI was 0.90 mmHg (95% confidence intervals (CI) 0.55, 1.24) and per SD waist was 0.73 mmHg (95%CI 0.33, 1.12); similar results for SBP were 1.73 mmHg (95%CI 1.28, 2.18) and 1.33 mmHg (95%CI 0.83, 1.81). In prospective analysis (6 cohorts, n=3708–7073 for different outcomes) BMI and waist circumference were positively associated with SBP and total cholesterol and inversely with HDLc associations were similar for the two adiposity measurements or were stronger for BMI. For example a 1SD greater BMI was associated with 1.36 mmHg higher SBP (95%CI 0.67, 2.05) compared with 0.96 mmHg (95% CI 0.35, 1.57) for waist. Direct measurements of fat mass, such as DXA or bioelectrical impedance, did not exhibit stronger associations with risk factors than did BMI. Age at adiposity measurement did not consistently influence the heterogeneity of association between studies.

Conclusion

Adiposity in childhood and adolescence is associated with adverse cardiometabolic outcomes. This suggests that interventions should be considered earlier before adverse effects become established. The magnitude of the association is similar between BMI, waist circumference and direct measures of adipostiy. Therefore BMI alone could be considered an adequate measure in public health and health surveillance systems.
OP14 Children’s and Adolescents’ Sedentary Behaviour in Relation to Household Socioeconomic Status, Income, and Area Deprivation: The 2008 Health Survey for England
Authors: Coombs N , Rowland A , Stamatakis E
Published: September 2012

Background

Sedentary behaviour (sitting) is an emerging cardiometabolic risk factor in young people. Little is known about how household socioeconomic position (SEP) and sedentary behaviour are associated in children and adolescents. The aim of this study was to assess the associations between SEP (including area-level deprivation) and sedentary behaviour in school-age children and adolescents.

Methods

The study sample was 4034 participants aged 5–15 yrs participated in the 2008 Health Survey for England which collected information on SEP (household income, Registrar General’s social class of the household reference person) and neighbourhood deprivation. Sedentary behaviour assessment (proxy parental measures for 5–12yrs; self-reported for 13–15yrs) included television viewing and other sitting during non-school times. Total sitting time was measured in a sub-sample (N=611) using accelerometers. We examined the multivariable associations between each SEP indicator and each sedentary time indicator using generalised linear models. Whenever appropriate, models were adjusted for age, sex, body mass index (BMI), physical activity, accelerometer wear time and mutually adjusted for the other SEP indicators.

Results

The mean age of the sample was 10 yrs (±3), 2922 participants were aged 5–12 and 1112 were aged 13- 15yrs. Household income and social class were inversely associated with daily television times (i.e. the higher the SEP the lower the television viewing times), e.g. compared to participants from households in the bottom income quartile, those in the top quartile had 14 minutes /day less (95% CI: 3 to 25, p=0.009) of television viewing. Non-TV sitting during non-school time was higher in nonmanual than in manual social class households by 14 minutes/day (7 to 20, p<0.001). Total (accelerometry-assessed) sitting time was higher among participants from households in the top income half (≥£23135/year) by 22 minutes/day (7 to 37, p<0.00) compared to those in the bottom half. Area deprivation was not associated with sedentary behaviour.

Conclusion

Low socioeconomic position is linked with higher television times but with lower total (accelerometry-assessed) sitting, and non-TV sitting during non-school time in children and adolescents. Inferences from studies looking at socioeconomic position and specific indices of sedentary behaviour (e.g., TV time) in children and adolescents may not be generalizable to total sitting time.
OP15 Neighbourhood Deprivation, Land use and Physical Activity: Combining Accelerometry and Global Positioning Systems
Authors: Hillsdon M , Coombes E , Jones A , Griew P , Wilkinson P , Hajat S
Published: September 2012

Background

Neighbourhood deprivation is associated with physical activity but it is not known whether the locations where physical activity takes place also varies by deprivation. The Forty Area Study (FAST) combined Global Positioning Systems (GPS) technology with accelerometery in UK adults to measure actual locations in which physical activity takes place. We evaluate what proportion of moderate to vigorous intensity physical activity (MVPA) is spent in different locations according to neighbourhood deprivation.

Methods

1084 adults from Northwest England took part. Each participant’s activity levels were recorded for 7 days using an accelerometer. A quarter of our participants also wore a GPS device. The accelerometer and GPS data were integrated into a Geographical Information System (GIS) containing information on the participants’ home locations and the locations where physical activity was recorded. We then examined the land uses where participants undertook their MVPA.

Results

Respondents in the most deprived neighbourhoods undertook a greater proportion of their MVPA in and around their home location, in buildings, on the road network and in shopping areas compared to respondents from the most affluent neighbourhoods. The proportion of MVPA undertaken in green space was considerably higher in the most affluent compared to the most deprived neighbourhoods (28.9% vs. 8.8%). The places where people undertake physical activity vary according to neighbourhood deprivation suggesting differences in the purpose of activity and access to places for physical activity.

Conclusion

Understanding where people undertake their physical activity provides valuable insights into the types of land uses that are important for physical activity and how they vary according to an area based indicator of socio-economic status.
OP16 How is Objectively Measured Physical Activity Associated with Falls and fear of Falling in Older Community Dwelling Men?
Authors: Jefferis BJ , Iliffe S , Kerse N , Kendrick D , Trost S , Lennon LT , Ash S , Wannamethee SG , Morris R , Whincup PH
Published: September 2012

Background

Falls are a major cause of disability in older age and fear of falling (FOF) may limit physical activity. Associations between falls, fear of falling and objectively measured physical activity (PA) has been little studied, particularly in community-dwelling older adults.

Methods

The study sample was men participating in a prospective, population-based cohort study in 24 British towns provided questionnaire information on a history of falls in the previous year, fear of falling, and other medical history and wore an Actigraph GT3X accelerometer for 7 days. Uniaxial accelerometer data were analysed in 60s epochs, excluding bouts of >60 minutes of complete inactivity. Days with >=600 minutes valid wear time were included. PA intensity was categorised as sedentary: <100 counts/minute, light: 100–1952 counts/minute and moderate to vigorous PA (MVPA):>1952 counts/minute. Associations between activity levels and falls, or fear of falling, were estimated using hierarchical linear regression models accounting for clustering and controlling for confounders.

Results

A total of 1543 men with a mean age of 77(range 71–91y) wore the Actigraph; 1100 (72%) had >600 minutes wear time on 5–7 days and questionnaire data. 21% (n=229) had fallen, 30% (n=68) received medical attention. Men who fell took fewer steps/day than men who did not: mean difference (adjusted for age, day order, month, wear time and town) –504 (95%CI –216, –792) and spent more minutes sedentary 13(95%CI 4, 22), and less in light –10(95%CI –1, –19) and MVPA –3.5(95%CI –1.3, –5.8). In relative terms, the reduction in MVPA was greatest: 22%(95%CI 7, 37). Differences were explained by exercise self-efficacy and mobility limitations, but not by exercise outcome expectation. 13% (n=141) men reported FOF, of whom 53% (n=74) had fallen in the past year. Men with FOF took markedly fewer steps than men without:–1325(95%CI –1646, –1005), spent more minutes in sedentary 29(95% 18, 40), and less in light activity –21(95%CI –32, –11) or MVPA –9(95%CI –11, –7). In relative terms, the reduction in MVPA was greatest:–72%(95%CI –93, –52). Differences were partly explained by exercise self-efficacy, mobility limitations, and to a lesser extent, exercise outcome expectation. There was no evidence that FOF had a greater impact on PA levels among men who had fallen compared to those who had not fallen.

Conclusion

PA levels and in particular step counts and MVPA levels, were lower among men who had fallen in the past year, and even more markedly, among those who reported FOF.
OP18 Childlessness in Europe: Implications for Wellbeing in Later Life
Authors: Gibney S
Published: September 2012

Background

In addition to low patterns of fertility experienced in the last 15 years, lifetime childlessness is increasing in Europe. It is now expected that between 10–20% of women born in the 1950s in Western Europe will never have children. Adult children play an important supportive role to their ageing parents; economically, acting as bridges to social support and monitoring health behaviour. This role has been enshrined at various institutional levels, from the family to the welfare state. Explanations of the negative relationship between childlessness and late life wellbeing have mainly focused on social support deficits. However, contradictory evidence of the effect of childlessness on psychological wellbeing exists which may be dependent on the wellbeing measures employed, the life course stage under examination, and differing societal contexts. Furthermore, few studies account for current health or health selection effects. Health-related predictors of childlessness may mediate the relationship between childlessness and late life wellbeing and/or influence wellbeing directly.

Methods

This study utilises data from wave two of the Survey of Health, Ageing and Retirement in Europe (SHARE) and SHARELIFE (retrospective life history data) from 11 countries, spanning Northern, Western, Southern and Eastern Europe. The sample is restricted to those aged 55–75 years (N= 21,295). Two measures of wellbeing are employed: the EURO-D depressive mood scale and the CASP–12 quality of life scale. Standard demographic and socio-economic variables (age, gender education, employment, financial circumstance, marital status, and ethnicity) are utilised in addition to self-reported current and childhood health. Region-specific Ordinary Least Squares (OLS) regression analysis is performed to determine the independent effect of childlessness on each wellbeing measure, controlling for demographic, socio-economic and health variables. Interactions between childlessness and childhood health indicate the role of health selection in this relationship. Interactions between childlessness and marital status are also examined.

Results

Childlessness significantly increases depressive mood in Northern Europe only. However, this effect is contingent on marital status; widowhood and never being married in particular. Relative to being currently married, never being married and widowhood also have a consistent main effect, reducing quality of life and increasing depressive mood. Across all regions there is no evidence to support the hypothesis that health selection mediates the relationship between childlessness and later life wellbeing.

Conclusion

Marital status consistently mediates the relationship between childlessness and wellbeing and therefore should be the context through which the relationship between lifetime childlessness and wellbeing is considered.
OP21 An Economic Evaluation of Non-Communicable Diseases in Brazil
Authors: Rtveladze K , Marsh T , Brown M , Webber L , Kilpi F , McPherson F , Levy D , Conde W , Monteiro C
Published: September 2012

Background

Non-communicable diseases are increasingly recognised as the major health issue facing many governments. Brazil has observed a rapid change in the weight profiles of its population, with the prevalence of obesity and overweight increasing partly as a result of the well documented effect of the nutrition transition. Obesity-related diseases are placing a substantial health and economic burden on the country. While the problem has been recognized, the implications of current trends on future overweight and obesity rates, BMI-related disease and costs associated with that disease burden have not been considered.

Methods

A previously developed micro-simulation model was used to project through the year 2050 the extent of obesity, BMI related diseases, and associated health care costs in Brazil. A Monte-Carlo simulation method has been utilized to simulated BMI related diseases. In total, thirteen conditions were modelled: coronary heart disease, stroke, hypertension, diabetes, knee osteoarthritis, and eight cancers (breast, kidney, colorectal, oesophageal, endometrial, gallbladder, liver and pancreas). The authors also projected a possible decrease in the BMI and its impact on health and health care costs.

Results

In 2010, nearly 45% of the Brazilian male population were overweight or obese (BMI ≥25kg/m²), but by 2050 we project rates as high as 95%. A slightly less pessimistic picture is observed among females: 42% in 2010 increasing to 52% in 2050. The disease incidence figures increase considerably due to obesity patterns. However, BMI reduction across the population will alter these disease projections. Nearly three million diabetes cases and USD 388 million in health care expenditure can be avoided with a five percent reduction in BMI alone by 2050.

Conclusion

Obesity rates are rapidly increasing in Brazil creating a high burden of diseases and associated health care costs. However, even a one and percent reduction in prevalence rates will substantially reduce the disease and cost burden. Though some steps have been taken for tackling the obesity problem, Brazil still needs a strong, comprehensive policy involving multiple agencies and institutions with strong leadership.
OP23 Developing a Single, Evidence-Based Approach Towards Disinvestment: Is a Nice Way the Right Way?
Authors: Flynn H , Gericke CA
Published: September 2012

Background

With the NHS currently facing one of its toughest periods financially, most, if not all, PCTs in England have started to prioritise services and sought to identify those which are either ineffective or of low clinical value for disinvestment. Yet the absence of a nationally accepted list of identified procedures has resulted in PCTs developing their own approaches, with many applying different priority thresholds to different procedures. This has created numerous “black lists” of interventions which will either not be funded or their commissioning severely curtailed. As these decisions are being based on the affordability of procedures rather than clinical efficacy, a post-code lottery in provision has ensued across the UK. Therefore to ensure equitable access to healthcare resources, an evidence based approach towards disinvestment is imperative.

Methods

Working in collaboration with NICE R&D, the project used NICE’s ‘do not do’ (DND) database to identify topics based on rigorous evidence for potential disinvestment. DNDs based upon those treatments with evidence suggesting they are ineffective or of low-clinical value were identified from the 850 + DND database. DNDs relating solely to clinical safety were excluded from the study. Procedures were further prioritised by 34 clinical experts in participating ‘pilot’ implementation sites in the SW Peninsula, who were asked to review populated lists of DNDs to ensure: clinical soundness; practicality of implementation; and any DND of potential high impact locally. Using HES data, volumes of DNDs still being performed in the NHS were also collated to give an estimate of overall usage and potential impact. Each DND identified was subjected to a cost analysis to provide an estimate of potential savings at both a local and national level.

Results

209 DND topics developed between 2007 and 2012 were identified for use in the study. Following local clinical prioritisation, cost analysis and exploration of HES data to give an estimate of usage, 30 procedures for a pilot disinvestment programme were identified solely from the NICE DND database.

Conclusion

The study successfully developed a single, evidence-based approach towards disinvestment through the identification of ineffective and low clinical value treatments from the NICE DND database. Additional planned research which will implement the ‘pilot’ list across the SW Peninsula, will provide valuable information on the practical implications of disinvestment initiatives and identify any incentives/disincentives for future developments.
OP25 Using Linear Spline Multilevel Models to Assess Socioeconomic Differences in Trajectories of Diet, Physical Activity and Fat Mass Across Childhood
Authors: Howe LD , Anderson EL , Cribb V , Emmett P , Ness AR , Lawlor DA , Tilling K
Published: September 2012

Background

Lower socioeconomic position (SEP) is a risk factor for obesity in children and adolescents in high-income countries. Since diet and physical activity are the main drivers of obesity, the socioeconomic differential in obesity is likely to arise through SEP differences in one or both of these.

Methods

We explored SEP differences in trajectories of fat mass, energy intake and physical activity (PA) across childhood and early adolescence, using maternal education as a measure of SEP, in the Avon Longitudinal Study of Parents and Children. Fat mass was measured by DXA scans at mean ages 10, 12, 14, 15 years. Energy intake was assessed using food frequency questionnaires (FFQs) at 3, 4.5, 7, 8.5 years and 3-day diet diaries at 3.5, 5, 7.5, 10, 13 years. PA was assessed by accelerometers worn for 7 days at 12, 14, 16 years, used to calculate mean total counts per minute (CPM) and mean minutes of moderate to vigorous PA (MVPA). Energy intake (adjusted for FFQ vs diary), % fat mass, CPM and MVPA were all modelled using linear spline multilevel models.

Results

5739 individuals had data on maternal education and at least one measure for each of fat mass, energy intake and PA. The sons of women educated to degree level (highest maternal education category) had consistently lower % fat mass across childhood and early adolescence, but differences between the 3 lower SEP categories only began to emerge from age 14. In females there was a stepwise increase in percent fat mass for each decreasing category of maternal education, and the SEP gradient remained largely stable between 10 and 15 years. The SEP patterning in trajectories of energy intake and PA (CPM and MVPA) did not resemble the SEP patterning in trajectories of fat mass. For energy intake, no SEP differences were observed. For PA in males, there was little SEP patterning in MVPA, but for CPM there were higher levels of activity in lower maternal education groups, i.e. the reverse of the fat mass gradient. For females, CPM and MVPA were both higher in the highest maternal education category, but contrary to the fat mass trajectories, differences between the lower three SEP categories were not consistent.

Conclusion

Socioeconomic differences in trajectories of energy intake and PA do not resemble the patterns observed for fat mass. Potential explanations for this finding, including measurement error, will be discussed.
OP26 By-State Comparison of Obesity Trends in The Adult Population of the United States of America
Authors: Kapetanakis V , Brown M , McPherson K , Webber L , Rtveladze K , Marsh T
Published: September 2012

Background

Excess bodyweight is associated with negative effects on longevity, disability-free life-years, quality-of-life, and productivity. High prevalence of obesity and over-weight is often related to socioeconomic status, educational attainment, and ethnic group. The combination of rising obesity prevalence and increased spending on obese people has been estimated to account for 27% of the growth in US health-care expenditure between 1987 and 2001.

Methods

The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest, telephone health survey system, collecting cross-sectional data on health conditions and risk factors in all states of the US yearly since 1984. Telephone interviews provide a cheap alternative to physical examinations and are often used as a way to increase the number of participants in observational studies. Data for 3,814,344 adults from BRFSS were used to investigate trends of obesity levels in each US state. Over the period 1999–2010, the yearly trend in the percentage of the population with body mass index (BMI) in normal-weight (BMI<25), over-weight (BMI 25–29.9), and obese (BMI>30) ranges, is modelled using multinomial logistic regression, stratifying by gender and age group (20–39, 40–59,>60 years). The fitted models are used to compare trends between states and to forecast levels of obesity in the future. A previously developed micro-simulation model is used to assess the burden of 13 diseases caused by obesity and estimate the economic impact implied by the forecasted trends. Data of the US–National Health and Nutrition Examination Survey collected over the same period are used to investigate the extent of self-reporting bias in BRFSS.

Results

In 2010, the proportion of obese (BMI>30) men and women in the US was 33% and 35%, respectively, whilst the proportions of over-weight (BMI 25–30) were 42% and 34%. The fitted models forecast an increase in the proportion of obese individuals to up to 70% by 2030. The results reveal increasing levels of obesity in all states, although the rate of increase varies among states. Comparing BRFSS data with data from NHANES, showed that at all ages both men and women slightly over-report their height, whilst women under-report their weight by 5kg on average. Under-reporting of weight is reduced after age 65.

Conclusion

Obesity rates are rapidly and steadily increasing in the US posing a threat to population health and a substantial economic burden. As self-reporting bias may significantly underestimate BMI in women, the estimated burden of obesity may be conservative.
OP27 Dietary Fibre Intake and Fatal Stroke Risk in the UK Women’s Cohort Study
Authors: Threapleton DE , Burley VJ , Greenwood DC , Cade JE
Published: September 2012

Background

In the UK in 2008, stroke was responsible for over 43,000 deaths. Dietary fibre intake may reduce stroke risk through modifying one or more risk factor such as body weight, blood cholesterol, or blood pressure. Food sources of fibre can be examined in relation to risk as different foods contain different types of fibre which have differing proposed actions within the body.

Methods

31,036 women recruited in 1995 provided dietary information relating to the previous 12 months using a 217-item food frequency questionnaire. Total dietary fibre intakes were estimated as both non-starch polysaccharide (NSP) and Association of Official Analytical Chemist (AOAC) values. Insoluble fibre, soluble fibre and fibre (NSP) from a variety of food sources were also examined. Stroke mortality was registered from baseline through the Office of National Statistics. Cox proportional hazard ratios were generated to explore risk using both categorical (fifths of intake) and continuous exposure variables. Model adjustments: age, body mass index, energy intake, ethanol, physical activity, smoking and socio-economic status.

Results

After 14 years, 130 fatal stroke cases were observed. Fatal stroke risk was similar for total fibre assessed either as NSP or AOAC and both were protectively associated with risk. Overall, risk was roughly halved in each intake category compared to the lowest although this was only significant in the 3rd (NSP/AOAC) and 4th (AOAC) category. Those consuming 24 vs. 14g/d of NSP or 37 vs. 22g/d AOAC had their risk of stroke halved [Englyst: hazard ratio 0.47 (95% confidence interval 0.24, 0.92) p=0.028] [AOAC: 0.47 (0.25, 0.89) p=0.021]. For fibre from nuts and seeds, the highest intake category (0.85g/d) saw a 56% risk reduction [0.44 (0.23, 0.83), p=0.012] compared to the lowest (0g/d). Fibre from fruit was also protectively associated with risk of stroke in the 4th (5.8g/d) vs. 1st category (1.4g/d) [0.50 (0.25, 0.97), p=0.041]. These significant associations were not seen in every category comparison and results for continuous exposures were not statistically significant for any of the exposures explored. No association was observed with fibre from cereals, vegetables or legumes.

Conclusion

Results suggest that fibre from certain food sources and not others may be more beneficial for prevention of stroke. This may occur because different foods contain fibre fractions in varying quantities. Non-significant results for the continuous exposures suggest associations may be non-linear. The results may also reflect benefits simply from ‘fruit’ or ‘nut and seed’ consumption rather than specifically fibre from these sources.
OP32 Health Inequalities in Japan 1986 to 2007 Based on Self-Rated Health, Household Income and a Novel Occupational Classification
Authors: Hiyoshi A , Shipley MJ , Fukuda Y , Brunner EJ
Published: September 2012

Background

While widening or stable inequalities have often been found in relation to economic stagnation in the west, time trends in health inequalities in Japan over the past two decades of economic stagnation are unclear. Comprehensive examination of temporal trends and factors contributing health inequalities in Japan are imperative to population health.

Methods

We analysed a series of eight nationally-representative samples (Comprehensive Survey of the Living Conditions of People on Health and Welfare) between 1986 and 2007 (n=398,303). We used household income and a novel theory-driven occupational social class classification to calculate temporal trends in relative and slope indices of inequality [RII and SII, respectively] in self-rated fair or poor health. Multiple imputation was conducted to account for missing income data. Effects of living conditions, behavioural and psychosocial factors were tested using 1998 and 2001 samples.

Results

Overall, age-standardised self-rated fair or poor health showed U-shaped time trends in both sexes (quadratic term: men p<0.001, women p=0.005), with the lowest prevalence in early/mid 1990s. In men, income RII and SII narrowed significantly over the period (RII declined 1.4% per year, p=0.001; SII declined 0.1% per year, p=0.031). Inequalities in women’s income were stable (RII and SII). The two indices showed constant inequalities across occupational social class in both sexes. After multiple imputation, point estimates became smaller, and narrowing of income inequality over time was significant for RII and SII in both sexes (p<0.05, n=490,632). The annual declines were 1.4% and 1.0% for RII in men and women, respectively, and 0.1% for SII in both sexes. Living conditions, behavioural and psychosocial factors accounted for 28% of men’s and 51% of women’s health inequalities in Japan.

Conclusion

Health inequalities in Japan either narrowed or remained stable from 1986 to 2007, in contrast to studies in western countries. The evidence provided by these analyses suggests that the prolonged economic stagnation in Japan had adverse effects at both ends of socioeconomic hierarchy. Potential explanations include effects of decreased income and increased stress in relation to job insecurity and workload across socioeconomic groups.
OP34 Inequities in Bicycle Usage: Socio-Demographic Predictors of Uptake and Usage of a Public Bicycle Sharing Scheme in London, UK
Authors: Ogilvie F , Goodman A
Published: September 2012

Background

Cycling confers individual and population-level health benefits. Increasing numbers of cities are therefore introducing public bicycle sharing schemes, with London’s Barclays Cycle Hire (BCH) scheme introduced in July 2010. Yet uptake of cycling is not equitable across socio-demographic groups. We sought to examine the characteristics of the BCH scheme’s registered users, and to explore characteristics associated with usage.

Methods

For users registering in the first seven months of the scheme, we obtained complete BCH registration and usage data, comprising: title (from which we inferred gender); home postcode; date of registration; access type; and number of trips made. We used postcodes to calculate distance to the nearest ‘docking station’ and to assign small-area-level data on ethnic composition, income deprivation, and the prevalence of commuter cycling. We compared characteristics of registered users with local residents and workers in the inner-London area served by the scheme. We used multi-level linear regression to examine correlates of ‘mean number of trips’, and logistic regression to examine correlates of ‘ever use’.

Results

100,801 registered individuals made 2.5 million trips between July 2010 and March 2011. Compared with local residents and workers, registered individuals were more likely to be male and to live in areas of low deprivation and high cycling prevalence. Among those registered, females made 1.63 (95%CI 1.74,1.53) fewer trips per month than males. In combination with the fact that fewer females registered in the first place, this meant that only 17.8% of the total number of BCH trips were made by females. Adjusting for the fact that deprived areas were less likely to be close to BCH docking stations, users in the most deprived areas made 0.85 (95%CI 0.63,1.07) more trips per month than those in the least deprived areas.

Conclusion

Females and residents in deprived areas are underrepresented among users of London’s public bicycle sharing scheme. Indeed, the BCH scheme currently appears to be less gender-equal than cycling in general in London. Nevertheless, registered users in more deprived areas made more trips on average, suggesting there may be a greater latent demand for cycling in these areas. The scheme’s expansion into more deprived areas from Spring 2012 has, therefore, the potential to create a more socio-economically equitable uptake of cycling.
OP37 Psychological Consequences of False-Positive Screening Mammograms in the UK: A Systematic Review
Authors: Bond M , Pavey T , Welch K , Cooper C , Garside R , Dean S , Hyde C
Published: September 2012

Background

In the UK women aged 47–73 are invited for screening by mammography every three years. In 2009–10 more than 2.24 million women in this age group in England were invited to take part in the programme, of these 73% attended a screening clinic. Of these 64,104 were recalled for assessment. Of those recalled 81% did not have breast cancer, these women had a false-positive mammogram. The aim of this systematic review was to identify the psychological impact of false-positive screening mammograms and evidence for the effectiveness of interventions designed to reduce this.

Methods

This was a systematic review using the principles of the Centre for Reviews and Dissemination in York.

All UK controlled studies and qualitative studies of women with a false-positive screening mammogram were included. The control group participants had normal mammograms. All psychological outcomes including returning for routine screening were permitted. Titles and abstracts were screened independently by two reviewers. Retrieved papers were reviewed and selected using the same independent process. Data were extracted by one reviewer and checked by another. Each included study was assessed for risk of bias.

Results

The searches returned seven includable studies (7/4,423). Those using disease specific measures found that there could be enduring distress that lasted up to three years; the level of distress was related to the degree of invasiveness of the assessment. At three years the relative risks were, further mammography 1.28 (95% confidence interval 0.82 to 2.00), fine needle aspiration 1.80 (95% confidence interval 1.17 to 2.77), biopsy 2.07 (95% confidence interval 1.22 to 3.52). There was also an enduring impact for those put on early recall 1.82 (95% confidence interval 1.22 to 2.72), However, studies that used generic measures of anxiety and depression found no such impact up to three months after screening. The strongest evidence suggests that women with false-positive mammograms have an increased likelihood of failing to reattend for routine screening, relative risk 0.97 (95% confidence interval 0.96 to 0.98) compared to women with normal mammograms. No studies of women from different socio-economic or ethnic groups were found nor any published qualitative studies.

Conclusion

Having a false-positive screening mammogram can cause breast cancer specific distress for up to three years. It is less likely there will be general anxiety or depression detectable at pathological levels. The degree of distress is related to the invasiveness of the assessment. Women with false-positive mammograms are less likely to return for routine assessment than those with normal ones.
OP44 Race, Bullying and Self-Esteem at the Transition Between Primary and Secondary School
Authors: Hawkins A , Emond A
Published: September 2012

Background

Studies from the US have suggested that children who experience racial discrimination have higher rates of depression, anxiety, behavioural disorders, and lower self-esteem. Children are generally more vulnerable to such problems at the transition from one school to another. Our aim was to investigate the associations between race, bullying, mood, behavioural difficulties and self-esteem during the transition to secondary school in a population-based cohort of English children.

Methods

Children from the Avon Longitudinal Study of Parents and Children (ALSPAC) were asked to define themselves by skin colour when aged 12 years (n=7017). Analyses were performed using logistic regression, adjusting for gender and maternal education. The primary outcome measures were bullying and racial discrimination at 12–12.5 years. Secondary outcomes were bullying at 8 years, depressive symptoms at 11.6 years, behavioural difficulties at 11.6 years, friendships at 12 years, mood and self-esteem at 13.8 years.

Results

94.2% of children defined themselves as white (n=6607), 3.6% as mixed race (n=255) and 2.2% (n=155) identified with a specific ethnic minority group. At primary school (8–11 yrs), there were no differences between these groups in reported bullying, types of friends or prevalence of behavioural problems or depression. At secondary school (12.5 years), the reported prevalence of racially motivated violence was 10–13%, and for name-calling was 31–33%. Compared to white children, ethnic minority but not mixed race children were more likely to experience overt bullying (OR 2.98; 95% confidence interval 1.38 to 6.42). Mixed race children were more likely to retain friends of different races after the transition to secondary school (OR 1.89; 1.32 to 2.71). Ethnic minority children were more likely to feel ‘different from others’ at 13.8 years (OR 1.63; 1.01 to 2.36).

Conclusion

Although children of different colour had similar experiences at primary school, ethnic minority children were more likely than white children to experience bullying and discrimination at the transition to secondary school. Racial discrimination affected up to one third of ethnic minority and mixed race children at 12 years of age, and these children felt more socially isolated and were less happy than their white peers at 13 years. Strategies for prevention of bullying should be targeted at this vulnerable group of children, particularly during this high-risk period of transition.
OP46 The Association Between Private Patient Status and Caesarean Delivery: A Retrospective Cohort Study of 403,642 Childbirth Hospitalisations
Authors: Lutomski JE , Murphy M , Devane D , Meaney S , Greene RA
Published: September 2012

Background

The increase in Caesarean delivery rates over the past decades has resulted in it becoming one of the most commonly performed in-hospital surgical procedures. While many Caesarean deliveries are clinically indicated, other factors, such as medico-legal fears and maternal and health professional preferences, contribute to the decision-making process. To explore non-clinical factors, we investigated differences in Caesarean delivery rates and temporal trends by private and public patient status while giving consideration to patient case-mix.

Methods

A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010 in the Republic of Ireland. Procedural ICD–10-AM codes from hospital discharge records were used to identify emergency and elective Caesarean deliveries. Temporal trends in Caesarean delivery were determined using a Cochrane-Armitage test for trend. Multivariate multinomial regression analysis was used to determine the odds of Caesarean delivery (emergency or elective versus vaginal delivery) by mother’s public or private status while adjusting for age, multiple gestation, previous Caesarean delivery, induction of labour, maternal morbidity and other obstetric complications.

Results

403,642 childbirth hospitalisations reviewed; approximately one-third of women (30.2%) were booked privately. Women booked privately were more likely to be at least 30 years of age or older, married and have had a previous Caesarean delivery. Over the study period, the overall Caesarean rate increased from 22.2% to 23.8% among women booked publicly versus 30.2% to 34.7% among women booked privately (test for trend p-value <0.0001). While the emergency Caesarean rate was similar between both groups of women (14.3% versus 13.3% respectively), women booked privately were almost twice as likely to have an elective Caesarean delivery (17.8% versus 9.4%). After adjustment, women booked privately had an increased odds of both emergency (adjusted OR: 1.32; 95% CI 1.29, 1.35) and elective (adjusted OR: 1.88; 95% CI 1.83, 1.93) Caesarean delivery.

Conclusion

Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have a Caesarean delivery than women booked publicly. Moreover, while increasing trends in Caesarean delivery were observed among all women, the increase was disproportionately higher among women booked privately. These findings suggest that significant differences in Caesarean rates are unlikely to be explained by differences in clinical risk factors. Mixed-method research is clearly warranted to explore disparities in Caesarean delivery rates. Such research should focus on clinical decision making and the role of personal preferences of women and maternity care professionals in decisions regarding mode of birth.