bluuebunny/crossref_metadata_2025 huggingface dataset:
OP01 How a Detailed Understanding of Industry Activities can Inform Public Health Policy: The example of Cigarette Pricing in Britain
Authors: Gilmore A B , Tavakoly B , Taylor G , Reed H
Published: September 2013

Background

Tobacco tax increases are the most effective means of reducing tobacco use and inequalities in smoking but effectiveness depends on transnational tobacco company (TTC) pricing strategies, specifically whether TTCs overshift tax increases (increase prices on top of the tax increase) or undershift the taxes (absorb the tax increases so they are not passed onto consumers), about which very little is known. Our routine monitoring of TTC activity had shown that, despite falling sales and consumers shifting down to cheaper cigarette brands, TTC profits were increasing. We therefore aimed to examine tobacco industry pricing strategy in Britain and the extent to which it might undermine the public health objectives of tobacco taxation policy.

Methods

A. Review of industry and retail literature was used to inform the allocation of cigarette brands to price segments. Analysis survey, commercial and routine data covering the period 1999 to 2009 was used to explore (i) value and volume market share by price segment; (ii) real price trends using CPI indexation; (iii) revenue by price segment; (iv) the extent to which tax increases were transferred to consumers and whether this differs by price segment; (v) whether commonly used price indices, including the retail price index for cigarettes accurately reflect price trends when compared with the weighted average price of cigarettes.

B. TTCs categorise brands into four price segments: premium, economy, mid and “ultra-low-price” (ULP). TTCs have only sold ULP brands since 2006 whence their real price has remained virtually static and their market share doubled. The price gap between premium and ULP brands is increasing because the industry differentially shifts tax increases between brand segments: while on average taxes are overshifted, taxes on ULP brands are not always fully passed onto consumers. Most notably, at the point each year when tobacco taxes increase, the industry is absorbing taxes on the ULP brands. Price indices reflect the price of premium brands only, despite the fact that the market share of premium brands has fallen substantially over time and thus fail to detect these problems.

Conclusion

Industry initiated price changes appear timed to reassure price-sensitive smokers and accentuate the price gap. While overshifting should benefit public health, the growing price-gap enables downtrading to cheaper products and may explain smoking-related inequalities. Governments must monitor cigarette prices by price segment and consider industry pricing strategies in setting tobacco tax policies. Monitoring of corporate activities can inform public health policy developments.
PP03 A Big Problem for a Big Country. The Health and Economic Burden of Cardiovascular Diseases in Russia
Authors: Rtveladze K , Marsh T , L Webber , M Brown , McPherson K , Konstevaya A , Staradubova A , Goryakin Y E
Published: September 2013

Background

Cardiovascular disease (CVD) mortality in Russia is 2-3 times higher than in the rest of the developed world and accounts for 57% of all deaths. It has been observed that in recent years mortality from stroke is declining, whereas that from myocardial infarction is increasing. Modifiable risk factors: excessive alcohol and tobacco consumption, diet and sedentary lifestyles, have a negative effect on life expectancy resulting in high mortality rates. Russia, similar to most developed countries has observed a steady increase in body mass index (BMI) leading to a high burden of coronary heart disease (CHD), stroke and hypertension and associated costs. This paper looks at obesity related CVDs and costs for the Russian healthcare system.

Methods

A Markov-type simulation has been utilised to estimate the future burden of the weight changes and costs up to 2050. Incidence, mortality and healthcare costs were collected for CHD, stroke and hypertension. The results have been simulated for 3 hypothetical scenarios to project a potential impact of policy interventions: a) assuming no reduction in BMI; b) 1% reduction in BMI across the population; c) 5% reduction in BMI across the population.

Results

The disease prevalence rates will triple for diseases by 2050. Prevalence of CHD and stroke is projected to increase from 4,455 in 2010 to 12,723 cases only in 2050 (per 100,000 population). Hypertension prevalence is estimated to increase from 18,833 to 36,438 between 2010 and 2050. For the year 2050 in isolation, it is projected that nearly 280 incidence cases of CHD and stroke and 820 incidence cases of hypertension can be avoided with a 1% decrease in BMI across the population (per 100,000). A 5% reduction in BMI would, for 2050, cause a fall of nearly 7,600 incidence cases of CHD and stroke and 15,250 incidence cases of hypertension (per 100,000). Costs savings are substantial; 3-9 million Euros can be saved each year due to reduction in the BMI by 1% and 5% respectively.

Conclusion

Disease and economic burden attributed to the projected obesity rates are severe and have alarming adverse effects on the Russian healthcare. Despite the recent decreasing trend in rate of stroke, it is projected to increase along with CHD and hypertension due to increased obesity prevalence. The risk factors, however, are modifiable and Russia should act immediately to establish a strong policy to prevent the future increases in rates of morbidity and economic consequences of CVDs.
PP05 Shifts in the type of Coronary Heart Disease Hospitalisations: Increasing Proportions of Chronic forms, Especially among the Elderly
Authors: Koopman C , Bots M I , Dis I van , Vaartjes I
Published: September 2013

Background

Shifts in the burden of coronary heart disease (CHD) from an acute to chronic illness may have important public health consequences. The objective of this study was to assess age-gender-specific time trends in rates and characteristics of acute and chronic forms of CHD hospital admissions in the Netherlands.

Methods

Using nationwide Dutch registers, we assessed time trends between 1998 and 2007 in hospitalisation rates of 188,266 acute myocardial infarction (AMI, ICD-9 410), 294,374 unstable angina (ICD-9 411, 413) and 203,881 chronic forms of CHD (ICD-9 412, 414) admissions.

Results

Between 1998 and 2007, the age-standardised CHD hospitalisation rate declined from 688 to 545 per 100,000 in men and from 281 to 229 per 100,000 in women. Overall trends masked age differences, with increasing hospitalisation rates in very old age (≥85 years). The annual percentage change in hospitalisation rates was larger for AMI (men: -5.1%, women: -4.4%) than for unstable angina patients (men: -2.0%, women: -2.0%). For chronic CHD, the average annual percentage change was +0.5% in men and +2.1% in women. The proportion of chronic CHD in the total of CHD admissions increased between 1998 and 2007 from 29% to 36% in men and from 23% to 30% in women. The proportion of AMI decreased from 30% to 24% in men and from 27% to 22% in women.

Conclusion

An increasing proportion of CHD hospital admissions in the Netherlands were for chronic forms of CHD. This may in part be accounted for by the increased use of revascularization procedures, especially among the elderly.
PP07 Are Cardiovascular Trial Results Systematically different between Europe and North America? A Multi-Study Analysis
Authors: Hartley L C , Bowater R J , Girling A , Lilford R J
Published: September 2013

Background

Concerns that there are international differences in treatment effectiveness have led many countries to be reluctant to extrapolate foreign clinical data to use as the basis of their guideline recommendations and in the approval of new interventions. Much of the evidence on which these concerns are based, however, comes from a limited data set, with few studies directly assessing international differences in treatment effectiveness. The aim of this study was to assess differences in the results of cardiovascular trials between Europe and North America and further, investigate if certain intervention types were more prone to such differences. This was done using the panoramic meta-analytic approach.

Methods

A literature search was conducted over the Cochrane Library (2000 to 2008) and Medline (2005-2008) for all meta-analyses which contained randomised control trials for the treatment or prevention of cardiovascular diseases. The analysis was then conducted both within and over the included meta-analyses by comparing the trial results between Europe and North America for both fatal and non-fatal endpoints.

Results

Over all meta-analyses, for fatal endpoints, interventions conducted in Europe showed more beneficial effects over controls compared to North America but this was not statistically significant. A similar pattern was seen for non-fatal endpoints with this reaching statistical significance (p = 0.017). The types of intervention prone to inter-continental differences could not be identified for fatal or non-fatal endpoints. Methodological quality of individual trials between continents was assessed with the Jadad scale and no statistically significant differences were seen between Europe and North America (p = 0.274).

Conclusion

Some evidence, although not strong, is provided that international differences in treatment effectiveness exist between Europe and North America. This suggests that those developing guidelines and approving new interventions should be cautious about the extrapolation of trial data between continents.
OP11 Missing Women? The Health Inequalities Impact of Low Control and Gender Discrimination: A Theory-Led Systematic Review of Observational Studies
Authors: Pennington A J , Orton L , Ring A , Fox D , Petticrew M , White M , Sowden A , Whitehead M M
Published: September 2013

Background

Increasing control and empowerment are considered central to efforts to reduce health inequalities. From our critical review of theory, low control or powerlessness emerged as a potentially fundamental mechanism underlying social inequalities in health. Amartya Sen’s theories of “freedom” and “capabilities” to live a long and healthy life have been influential: focusing attention on the health consequences of a lack of freedom for women in contexts where there is pervasive gender discrimination. We conducted a systematic review, which addressed the question: what is the empirical evidence of the extent and nature of the relationship between control in the living environment and health-related outcomes, differentiated by gender, socio-economic status or ethnicity? Findings relating to gender inequalities are presented here.

Methods

Logic models developed from our critical review of theory were used to guide our search strategy and to locate relevant literature. Studies were identified by searching seven bibliographic databases, screening reference lists, consulting key informants and searching organisational websites. Observational studies of any design were included that addressed our review question. Data extraction and quality appraisal of included studies were carried out by two reviewers, with disagreements brought to the wider team for discussion. This was followed by a narrative synthesis.

Results

We identified 61 studies, 25 of which reported findings on the health-related outcomes of low control/discrimination against women, all but one set in low and middle-income countries. There is some evidence that women with low control have reduced freedom of movement and control over important determinants of health such as access to food and nutrition, household resources, healthcare, education, employment, land and property ownership and reproductive rights. For women, low control or autonomy was associated with increased anxiety, stress and depression, increased childhood malnutrition and mortality, higher fertility, poorer reproductive health and higher levels of violence against women. Son preference, in societies characterised by low female control and discrimination, is associated with poorer health outcomes that include reduced survival of girls and women; resulting in the phenomenon of “missing women”. The effects of gender discrimination on survival begin before birth through selective abortion of female foetuses, leading to distorted population demographics.

Conclusion

There is empirical evidence of an adverse impact on the health of women and female children living in societies in which they suffer low control and overt gender discrimination. Purposeful measures to improve the economic, social and political position of women in their societies are advocated to improve the situation.
PP12 Interventions to Promote Healthy Eating: A Systematic Review Of Regulatory Approaches
Authors: Hendry V , Monsivais P , Almiron-Roig E , Jebb S , Neelon S Benjamin , Griffin S , Ogilvie D
Published: September 2013

Background

Unhealthy diets are a risk factor for many chronic diseases, accounting for around 40% excess cardiovascular and cancer mortality annually across the United Kingdom. Multifactorial strategies may help address this, and governments employ a variety of approaches to influence individual diets, the prevalence of obesity and population health. This systematic scoping review considers the effectiveness of regulatory interventions to change diet or diet-related behaviour.

Methods

The review includes regulation, rules and legislation (collectively, “regulation”) seeking to directly alter diet, dietary behaviour or nutrition by influencing (a) dietary behaviour (e.g. through regulating labelling, calorie display, marketing, food in schools, or built environments; or by using taxes or subsidies) or (b) the nutritional content of food (e.g. by specifying salt or trans fat levels). The review follows Cochrane and EPPI-Centre guidance and comprises a scoping review of regulatory interventions, and in-depth reviews on (1) school-based fruit and vegetable schemes and (2) control of trans fats. Medline, Embase, ISI WoK, EconLit, grey literature and bibliographic searches to the end of December 2012 identified 134 studies eligible for full text review. Studies were included if they had a recognisable research design.

Results

Studies of information labels (packaging or menus) and compliance with school food standards occurred most frequently. Six studies of school-based fruit and vegetable schemes provided moderate evidence of short-term increases in intake but weak evidence for any longer term behaviour changes. Thirteen studies examined trans fat controls through bans or labelling. These measures achieved good compliance if regulation was monitored, with evidence of food reformulation following both bans and labelling. Removing trans fats had minor effects on food availability, price or quality, although some ‘trans free’ foods commanded a price premium. The costs of removing trans fats were not reported.

Conclusion

Regulations with monitoring achieved compliance, but whether this affects food choices, dietary behaviour, nutrition, obesity prevalence or other health outcomes is unclear since those impacts have been under-evaluated. Regulation to influence dietary behaviour as well as the nutritional content of food can be used as a structural intervention to help create healthier living environments. Mandated labelling may risk exacerbating inequalities unless individual behaviour is also considered, and could be used to mislead consumers by providing a ‘healthy halo’ for unhealthy food. Understanding the effectiveness and costs of regulatory interventions will highlight where government-led action may be effective in promoting healthy diets in the population.
PP15 National Longitudinal Study of the Nutritional Habits of Adults with an Intellectual Disability - Analysis of Baseline Data
Authors: Hayes C B , Duffy P , Burke E , McCallion P , McCarron M
Published: September 2013

Background

Adults with intellectual disability (ID) are known to have poor dietary habits and high rates of obesity. This population is thus at high risk for developing chronic conditions. Moreover, the process of de-institutionalisation is changing the way adults with ID are leading their lives and as this is a more recent phenomenon the effects of more independent living on dietary habits are largely unknown. This study provides a detailed account of the nutritional habits of older people (age 40+) with intellectual disability (ID) in Ireland.

Methods

The data was collected as part of the first wave of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS TILDA) on 753 persons with mild, moderate, severe and profound ID, to better understand their dietary habits. IDS-TILDA is a multi-wave national longitudinal study of older adults with ID. This analysis examined overall intake and variations in intake of food and beverages by age, gender, place of residence, level of ID and BMI. A multivariable analysis is currently being carried out.

Results

Overall, carbohydrate, dairy and meat intake were broadly in keeping with recommended guidelines although milk intake was poor (38% reporting never or rarely drinking milk). Fruit intake was also poor, (25% reporting eating two or more portions per day), although 50% of all participants reported drinking fruit juice daily. One-third of participants reported eating more than one portion of vegetables per day. Age and gender had little effect on nutritional habits. Preliminary analysis showed that those with mild/moderate ID were more likely eat more bread (p < 0.001), eat less meat (p < 0.05), vegetables (p < 0.05) and dairy products (p < 0.05) than those with severe or profound ID. They were also more likely to be obese (p < 0.05) and much more likely to live independently or with family (p < 0.001) reflecting greater autonomy in their food choices.

Conclusion

The study demonstrated important differences in dietary habits between those with mild /moderate ID who were much more likely to live independently or with family compared to those with severe/profound ID who were more likely to be in residential care. It highlighted a number of areas where the dietary habits of older adults with ID could be improved. As the data provides detailed analysis on the dietary habits of a national sample of older people with ID for the first time, it will inform the development of nutritional policy advice for this group of people and their carers.
PP17 The Personal and Professional Impact of Stillbirth on Consultant Obstetricians
Authors: Nuzum D , Meaney S , O’Donoghue K
Published: September 2013

Background

Stillbirth remains amongst the most challenging areas in obstetric practice. In Ireland, consultant obstetricians are ultimately responsible for care provided to mothers following stillbirth. This study explores the impact of stillbirth on consultants working in an Irish tertiary maternity hospital (9,000 births per annum) where the stillbirth rate is 4.6/1000.

Methods

Semi-structured qualitative interviews lasting 30-60 minutes were conducted in 2012 with a 50% sample of consultant obstetricians and gynaecologists (n = 8). The study explored how consultants care for parents following stillbirth and the impact of stillbirth on them personally and professionally. The data were analysed using Interpretative Phenomenological Analysis.

Results

The human response and the weight of responsibility were the dominant personal and professional themes identified. The human response to stillbirth highlighted the personal impact stillbirth has on consultants and how in turn it shapes the care they provide. Stillbirth was deemed one of the most difficult experiences; described as amongst ‘the most devastating news’ with the exception of two who felt stillbirth was not the worst outcome. Most consultants stressed the importance of their ‘human response’ to parents following a stillbirth. All stated that bereaved parents should receive direct care from a consultant. The weight of professional responsibility revealed the sense of burden that consultants feel when a baby dies. The possibility of a medico-legal challenge was a significant factor; mostly for those who are primarily gynaecologists, resulting in the question “what have I missed?”. Consultants also felt that ‘expectations are high that outcomes are going to be good’ which adds to the weight of professional responsibility

Conclusion

Despite the impact and importance of stillbirth care, none of the obstetricians received any formal training in perinatal bereavement care yet all are required to care for families following the death of a baby. This study highlights a gap in training and the considerable impact of stillbirth on obstetricians professionally and personally. Medico-legal concerns following stillbirth potentially impact on the depth of care and warrants further research.
PP18 Spatial Profiling of General Practice Registration: Evidence From Southwark, London, UK
Authors: Lewis D J
Published: September 2013

Background

General Practices have a duty to serve their local community, and in doing so act as an advocate for further care, and as gatekeepers to the wider NHS. However, as reforms to the NHS erode the geographic basis for care commissioning via SHAs and PCTs, and with GP designed catchment areas largely unrepresentative of the distribution of patients served, particularly in urban areas, there is a need to better understand the characteristics of local enrolment.

Methods

A set of “communities” are defined spatially for each of the 47 GP surgeries in the London Borough of Southwark, based upon a complete patient register. Each GP surgery has a set of communities that enclose the smallest geographic area (s) within which a given threshold of the GP surgery’s patients are served. Thus, a 50% threshold will enclose the smallest region (or set of regions) within which half of all that surgery’s patients reside. These, often complex, delineations are based upon the observed spatial distribution of patients, and offer a much finer grain insight into patterns of registration than might otherwise be possible with GP or area level data. These bespoke patient service communities allow for the comparison of a practice population against the resident population, and an analysis of how local communities sort and order themselves by care provider can be made.

Results

Evidence from Southwark suggests that patient ethnicity is a major factor in the sorting of population by GP surgeries, with some groups, notably African, Muslim and East Asian patients, being over twice as likely to use particular surgeries than might be expected given their proportion in the normal resident population. As GP service is a constrained system, concentrations in one location can lead to dispersions at others, and a distinct re-mapping of population between residence and service.

Conclusion

This research uncovers the spatial dynamics that define patterns of GP registration, demonstrating that the characteristics of patient lists can differ depending on how a community is defined. Insights of this nature are key to a better understanding of how healthcare can be managed, commissioned and improved. They stress the need for robust spatial understandings of “local communities”, and highlight that the patient choice agenda is largely already in effect for dense, diverse urban environments. Improvements in care, particularly by GP-led groups, will come from a better understanding of patient and place.
PP19 Formative Evaluation of a Community-based NHS Health Check Service
Authors: Visram S
Published: September 2013

Background

Cardiovascular disease (CVD) is the leading cause of death in the UK. The national CVD prevention strategy centres on the NHS Health Check Programme, which involves offering a vascular risk assessment to those aged 40-74 years without established disease. It is estimated that the programme could prevent 9,500 cardiovascular events and 2,000 deaths each year, if there is universal uptake. Durham County Council commissioned a health check service to be delivered in the community by health trainers. Socioeconomic deprivation is associated with higher risk of CVD, yet response rates for screening programmes tend to be lower in deprived areas. The service targets those who would not usually access screening and offers them tailored lifestyle support, thereby addressing health inequalities.

Methods

A mixed methods design was used to evaluate the implementation, acceptability and impact of this service, involving:

i) Secondary analysis of monitoring data from all clients between January and June 2012 (n = 774). Descriptive and summary statistics were produced.

ii) Interviews and focus groups with a purposive sample of staff and key stakeholders (n = 20). A thematic content approach was used to analyse all transcripts and field notes.

iii) Summary data obtained from anonymous patient experience questionnaires (n = 181).

Results

Women who accessed the service were more likely than men to be eligible for a health check (34% vs. 27%); yet eligible men were more likely to attend the health check (59.4% vs. 33.8%). More than half (57.6%) of clients were under the age of 50 and a similar proportion (60.5%) were from socioeconomically deprived areas. However, only 32.7% of those from the least affluent areas accepted the offer of a health check, in comparison with 44.4% from more affluent areas. More than half (57.4%) of the health checks resulted in a low CVD risk score, whereas 12.9% were high risk. Stakeholders perceived the service to be an effective way of engaging people from target communities in conversations about their health. It was felt that many clients would not have accessed support regarding their cardiovascular health from other providers. The vast majority (99%) of respondents to the patient experience questionnaire were satisfied with the service.

Discussion

A community-based, health trainer-led service can add value by offering an alternative to health checks delivered in primary care settings. The service appears to be successful in engaging men and younger age groups. However, there is the potential for intervention-generated inequalities.
OP12 The Health Behaviours of Mothers in England: A Latent Class Analysis
Authors: Wardle H , Hall J , Graham H , Law C , McAloney K , Platt L
Published: September 2013

Background

Promoting healthier lifestyles is at the heart of England’s public health strategy. The dominant focus has been on single health behaviours; however, most adults engage in multiple risk behaviours. Very few studies have investigated patterns among parents and children. This paper focuses on four health behaviours among mothers; part of a broader project examining multiple risk behaviours among parents and children.

Methods

Data from theHealth Survey for England(years 2006 and 2008) identified 4,218 mothers living with children under the age of 16. Latent Class Analysis classified mothers into groups with differing combinations of cigarette smoking, alcohol, fruit and vegetable consumption and physical activity engagement. Logistic regression identified the characteristics associated with membership of each group.

Results

Six mutually exclusive groups of mothers were identified. The first (31% of mothers) had average fruit, vegetable and alcohol consumption, average physical activity engagement and were non-smokers. This group had higher income levels than other mothers. The second group had lower levels of alcohol consumption, were non-smokers with lower physical activity levels. They were from lower income groups. The third group drank alcohol most regularly, were cigarette smokers and had lower physical activity engagement and fruit and vegetable consumption. These women were more likely to be single and to be in employment. The fourth group were frequent consumers of alcohol but had high levels of fruit and vegetable consumption and higher engagement in physical activity. They had higher levels of educational attainment than other mothers. The fifth group were either ex or current smokers, infrequent drinkers, average engagers in sports physical activity but had higher fruit and vegetable consumption. They were more likely to live in rented accommodation. The sixth group were current cigarette smokers with lower physical activity engagement, lower fruit and vegetable consumption and were infrequent drinkers. A higher proportion of this group lived in more deprived areas.

Discussion

This analysis shows for the first time for mothers in England, how risk behaviours cluster and the differential social patterning associated with the clusters. It indicates how targeted interventions aimed at different ‘risk’ groups may be appropriate. These implications will be discussed.
PP24 Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications to People with Dementia Living in Residential Care: A Systematic Review
Authors: Coon J Thompson , Abbott R , Rogers M , Whear R , Pearson S , Lang I , Cartmell N , Stein K
Published: September 2013

Background

The use of antipsychotic medications in dementia is associated with increased mortality. A significant proportion of long-term antipsychotic use is believed to be inappropriate. The Department of Health National Dementia Strategy recently targeted a two-thirds reduction in antipsychotic usage. The aim of this review is to explore qualitative and quantitative literature to identify interventions that have been used to reduce inappropriate prescribing of antipsychotics and the barriers and enablers to the implementation of these interventions.

Methods

Potentially relevant papers were identified in the following ways i) electronic searches inMedline, PsycINFO, Embase, AMED, Social Policy and Practice including AgeInfo (OvidSp); CDSR, CENTRAL (Cochrane Library); CINAHL (EBSCOhost); British Nursing Index, AMED (NHS Evidence) and Science Citation Index and Social Science Citation Index (Web of Science) from inception to November 2012, ii) forward and backward citation chases, iii) hand searches of review papers identified in the search, iii) searching of relevant organisations’ websites. All comparative studies were included. Screening of articles for inclusion, data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary.

Results

Eleven studies (involving staff and patients in 55 care homes) met the inclusion criteria. All reported quantitative data. Studies were conducted in the UK (n = 4), Canada (n = 2), USA (n = 2) Australia (n = 1) and Norway (n = 1). Studies were of varied design with associated quality issues. No papers in which barriers to the implementation of interventions had been studied were identified. All interventions were unique and involved the delivery of an education or training package (n = 5), the use of in-reach teams in which regular visits by psychiatrists, mental health nurses and psychologists enabled regular patient review in the care home (n = 4), audit followed by feedback and re-audit (n = 1) or regular review, education and the development of a behavioural management approach (n = 1). In all studies, the proportion of residents receiving antipsychotic medication was reduced following the intervention.

Conclusion

There is some evidence to suggest that simple changes to the way patients are reviewed and monitored and/or enhanced education and training can reduce the prescription rates of antipsychotics for people with dementia living in residential care. In order to guide best practice in this area, further qualitative study is required to explore the barriers and enablers to successful implementation of these interventions. Large rigorous studies with extended post-intervention data collection are also necessary to ascertain the long term impact on prescribing practices.
PP31 Fertility Rates in Women with Inflammatory Bowel Disease Compared with the General Female Population: A United Kingdom Population-Based Cohort Study
Authors: Ban L , Tata I J , Fiaschi L , Card T
Published: September 2013

Background

Previous studies have raised concerns about reduced fertility in women diagnosed with inflammatory bowel disease (IBD). Our objectives were to compare estimates of age-specific fertility rates in women with and without IBD and to assess whether relative fertility was different before and after clinical diagnoses in comparison with the general female population.

Methods

We included all women aged 15 to 44 years between 1990 and 2010 from a large United Kingdom primary care database. Women with IBD were defined as those with a clinically diagnosed IBD in their medical records. Each woman was assigned an IBD diagnosis date corresponding to the date of the first record of IBD or the date of the first prescription of 5-aminosalicylic acid (excluding sulfasalazine) if this was before the first diagnostic recording. We estimated overall and age-specific fertility rates by 5-year age bands as the number of live births per 1000 person-years for all women with IBD and separately during the time before and after first clinical recognition, using Poisson regression to compare rates in women without IBD in the general population. Maternal smoking and socioeconomic status were added into the univariate model one at a time and variables that changed the magnitude of the fertility rate ratios by at least 10% were retained in the final model. We also calculated fertility rates for women with Crohn’s disease (CD) and ulcerative colitis (UC) separately.

Results

Fertility rates were 46.2 (95% CI 44.6, 47.9) and 49.3 (49.2, 49.5) live births per 1000 person-years in 9,639 women with IBD and 2,131,864 without IBD, respectively (rate ratio [RR] 0.94 [0.90, 0.97]). Age-specific fertility rates showed that the lower fertility rates in women with IBD were restricted to the 15-24 and 35-44 year age groups. Fertility rates were low in women with IBD after diagnosis (RRs compared with women never clinically diagnosed with IBD 0.88 [0.84, 0.93], 0.91 [0.85, 0.98] and 0.85 [0.79, 0.93] for IBD overall, CD and UC respectively), but not before.

Conclusion

Compared with women in the general population, women with IBD have decreased fertility especially after they are clinically diagnosed. Gastroenterologists and obstetricians should be aware of women’s fertility plan and are advised to communicate this information to women with IBD.
PP32 Are there Socio-Inequalities Associated With Type 2 Diabetes Care?
Authors: Christie A , Wilkinson J , Adams J , White M
Published: September 2013

Background

There has been increasing research interest in the adverse effects of public health interventions; notably concern that processes in the planning or delivery of an intervention may create or exacerbate the health differences between population groups. The aim of this study was to contribute to current understanding of ‘intervention-generated inequalities’ by examining the impact of secondary and tertiary preventive interventions for Type 2 diabetes by socio-economic status (SES). Previous research has shown that Type 2 diabetes places a disproportionate health burden on individuals from more disadvantaged backgrounds. It addition, managing the condition involves multiple processes and health professionals, all of which all could potentially exacerbate existing health inequalities.

Methods

A secondary data analyses of patient level data collected by a hospital trust diabetes register from 1999 to 2007 was conducted to determine if receiving the same care was associated with differential health outcomes by SES. Two indicators of care were used: the number of recommended care processes (quality of care) and attendance at a hospital diabetes care clinic (shared care) each year. The Index of Multiple Deprivation 2004 was used as an indicator of patients’ SES. A series multilevel models were fitted with hbA1c, an indicator of patient’s diabetes control, as the dependent variable with interaction effects between SES and intervention indicators. Repeated measurements were nested within patients, nested within the general practice they registered with per year. Relevant socio-demographic, anthropometric, lifestyle, health and other intervention data controlled for in each model.

Results

The initial descriptive analyses showed that high SES was statistically significantly receive greater quality of care and less likely to receive shared care than low SES patients. Overall, in both multilevel models high SES patients were more like more favourable hbA1c rates than low SES patients. However the interaction effects suggest that amongst patients receiving high quality of care, high SES patients were significantly more likely to have poorer HbA1c compared to low SES patients. In contrast amongst patients receiving shared care, high SES patients were more likely to have more favourable HbA1c rates than low SES patients.

Discussion

There was evidence that low SES patients received a poor quality of care but had greater access to specialist, secondary care. In addition, there was evidence to suggest that patients receiving the same care were associated with a differential impact on patients HbA1c. More complex analyses need to be conducted to determine the direction of these associations.
PP34 Interventions to Promote Informed Consent for Invasive Healthcare Procedures: A Cochrane Systematic Review and Meta-Analysis
Authors: Kelly M J , Kinnersley P , Phillips K , Savage K , Farrell E , Morgan B , Whistance R , Lewis V , Mann M , Stephens B L , Blazeby J , Elwyn G J , Edwards AGK
Published: September 2013

Background

Informed consent is required before any surgery or invasive procedure is performed. Achieving ethically valid informed consent can be difficult: too little information may leave patients poorly informed and too much information may be overwhelming. As such interventions to promote information provision for informed consent are warranted. This study aimed to evaluate the impact of such interventions on a range of outcomes including patient knowledge, anxiety, and satisfaction.

Methods

Medical databases were searched using keywords and subject headings (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO). Reference lists of included studies were searched. Randomised controlled trials (RCTs) of interventions to promote informed consent for patients undergoing surgical or invasive procedures were included. Studies were dual-assessed. Random effects meta-analyses were conducted for all outcomes with sufficient information. Standardised mean differences summarised the output. Narrative synthesis was also performed.

Results

65 RCTs were identified from 12 countries. In total 9,021 patients were randomised into these trials. Interventions employed various formats including written material, audio-visual tools and decision aids. Meta-analyses demonstrated statistically significant improvements in knowledge when measured immediately after interventions, shortly afterwards (between 24 hours and 15 days) and at a later date (15 days or more) (Immediate knowledge SMD 0.53 [95% CI 0.37, 0.69], I273%; Short-term knowledge SMD 0.68 [0.42, 0.93], I285%; Long-term knowledge SMD 0.78 [0.50, 1.06], I282%). Satisfaction with decision making also improved (SMD 2.25 [1.36, 3.15], I299% and decisional conflict was reduced (SMD -1.80 [-3.46, -0.14], I299%). No statistically significant differences were found for generalised anxiety, anxiety with the consent process or satisfaction with the consent process (generalised anxiety SMD -0.11 [-0.35, -0.01], I282%, anxiety with the consent process SMD 0.01 [-0.21, 0.23], I270%; satisfaction with the consent process SMD 0.12 [-0.09, 0.32], I276%).

Conclusion

Interventions to promote informed consent consistently improve patient knowledge, an important prerequisite for informed consent and this is achieved without any significant harmful effects. Such interventions can thus be considered effective at promoting informed consent for invasive healthcare procedures. Further studies are necessary to investigate all aspects of informed consent as a unified concept.
PP39 Research using Ankle Brachial Pressure Index Statistically Reassessed
Authors: Alnaji A , Law G R
Published: September 2013

Background

Ankle Brachial Pressure Index (ABPI) is the ratio of ankle to brachial systolic blood pressure. It is widely used as a non-invasive, relatively simple method for the diagnosis of peripheral arterial diseases (PAD) in symptomatic patients. It is also widely used to estimate PAD prevalence. Furthermore, low ABPI – as an indicator of atherosclerosis – was also used to predict cardiovascular morbidity and mortality in many epidemiological studies. Several researchers think that ABPI is overvalued and its use in epidemiological studies had attracted some statistical pitfalls. This paper aims to investigate these pitfalls, and to suggest possible advance statistical solution for some of them.

Methods

Critical review of literature

Results

The use of ABPI was proposed by studies comparing ABPI with peripheral angiography and Doppler ultrasound. However, most of these studies either had small sample size (issues with representativeness and generalisability of the result), compared asymptomatic legs with symptomatic legs using independent sample t-test (inappropriate test as legs of the same patients are not independent), or chosen cases from old age group and controls from young age group (age is a potential confounder which might had distorted their results). There were no attempts to test for the potential association between ABPI and other variables such as gender, obesity, cholesterol level and physical activity. Nevertheless, several researchers tested the correlation between ABPI and brachial systolic blood pressure and claimed that ABPI is usually lower in patients with high brachial systolic blood pressure even in the absence of PAD. Some of these researchers used correlation coefficients, however, using Pearson correlation test is inappropriate as brachial pressure is mathematically coupled to the ABPI, thus a null hypothesis of zero correlation is erroneous and the conclusion based on it should be rendered invalid. Ordinary Least Square Linear Regression model will be unsuitable as well for the same reason. Bland-altman plot or Ordinary Least Product Regression would be more appropriate. Furthermore, most of the studies that used ABPI as a predictor of cardiovascular morbidity and mortality had introduced some major statistical flaws in their regression analysis such as collinearity, mathematical coupling and reversal paradox. Such statistical issues would have distorted those studies’ associations.

Conclusion

Caution should be taken when using ABPI in epidemiological studies. Covariate selection and adjustment for confounder should be done carefully in regressing analysis. Directed Acyclic Graph (DAG) is a good method for addressing these issues.
PP40 An Ethnic Minority Cohort of Young People – Feasibility of follow-up in Early Adulthood?
Authors: Enayat Z E , Read U M , Molaodi O , Cassidy A , Harding S
Published: September 2013

Background

Under-representation of ethnic minorities in cohort studies is common. The Determinants of (now) Adult Social well-being and Health (DASH) study examines how interaction of social and biological exposures influences ethnic differences in physical and mental health over the life course. It started 10 years ago with 6643 11-13y London schoolchildren, 80% ethnic minorities. A feasibility study examined best practice for follow-up of the cohort now aged 21-23y.

Methods

300 DASH participants, 50 for each major ethnic group (White British, Black African, Black Caribbean, Indian, Pakistani and Bangladeshi), were invited. They were offered assessments in different locations (GP surgeries, community pharmacies, clinical research facilities, homes, colleges) to collect a range of questionnaire and physical data (e.g. age appropriate mental health measures, 24 hour dietary data, accelerometry, blood biomarkers, arterial stiffness, bio-impedance). Consents were sought for DNA analysis, linkage of NHS records and to contact parents to participate in a generational study. Various retention and engagement initiatives were tried, including social media, a participant advisory group (PAG) and ‘Bring a DASH friend’ (BDF).

Results

<1% refused, 45% of participants were seen in a university setting, 19% in pharmacies, 28% in GP surgeries, and 7% in clinical research facilities. GP surgeries were keen to support DASH but busy environments compromised quality and pace of data collection. High street pharmacies proved ideal locations for satellite clinics. The primary influence on participants’ choice of location was proximity to home or convenience to stop en route from work. Item non-response for questionnaire-based measures and refusal rates for wearing monitors were low (<1%). Less than 5% refused to have bloods taken, with no ethnic bias. All were keen to get feedback on results, particularly cholesterol level, and consented to storage of bloods for DNA and for linkage of NHS records. 81% of the baseline cohort was traced using multiple measures. Three key initiatives worked best: PAG’s input on appropriateness of measures, retention and advocacy including use of social media; BDF due to continuing contact with school friends; and a community link worker to conduct advocacy activities in community-based spaces such as markets and places of worship, and to engage community champions. All participants agreed to contact with parents.

Conclusion

These positive findings challenge conventional wisdom on underrepresentation of ethnic minorities in cohort studies. They also suggest effective mechanisms to enhance engagement with diverse communities and exploit the public health value of findings across ethnic groups.