bluuebunny/crossref_metadata_2025 huggingface dataset:
OP68 The Contribution of Doctors’ Decisions to Healthcare Inequalities: Towards Fourth Generation Studies
Authors: Marceau LD , McKinlay JB , Piccolo RS
Published: September 2012

Background

Healthcare variations are a worrisome and well-documented problem. Such variations occur at different levels: between health care systems, geographic areas, organizational settings, patients, and doctors. Research is increasingly focused on the contribution of doctors’ decision making to the generation or amplification of healthcare disparities. Clinical decision making studies continue to evolve through generations of work that focus on different types of influence:First generationstudies identified patient-level attributes (e.g., gender, age, race/ethnicity, SES, health insurance status);Second generationstudies on variations associated with physician characteristics (e.g., age, gender and education, specialty and type of remuneration);Third generationstudies on health system and organizational influences (e.g., size, profit status, location and population served, and most recently, organizational culture).

Methods

We used a factorial experimental design in which the subjects, primary care doctors (n=192), viewed clinically authentic vignettes of “patients” presenting with identical signs and symptoms suggesting diabetes. They were stratified according to gender and level of experience. During an in-person interview, they were asked how they would diagnosis and manage the vignette ‘patient’.

Results

After controlling for the first two levels of influence (patient and provider), each of which contributed 4.4 and 2% respectively, organizational culture significantly contributed to their behavior, accounting for 14.3% of the variation in clinical decision-making for diabetes. Considering nine different dimensions of practice culture, organizational trust and business emphasis contributed most to the variance in treatment for diabetic foot neuropathy.

Conclusion

Attempts to reduce health care variations continues to focus on the levels of patient attributes and physician characteristics (e.g. improved educational efforts). Findings from this experiment suggest a need to further investigate the contribution of of organizational factors (third generation) and suggest appropriate interventions at that level. As important however, is the consideration of afourth generation: cognitive aspects of physician decisions. Qualitative methods (i.e. “think aloud”) and newly developing methods to objectively measure unconscious bias (e.g., the Implicit Association Test) can provide more robust assessment of what goes on “inside the doctors’ head,” which eventually produce healthcare disparities.
OP84 Do Supermarket Interventions Improve Food Access, Fruit and Vegetable Intake and BMI? Evaluation of the Philadelphia Fresh Food Financing Initiative
Authors: Flint E , Cummins S , Matthews SA
Published: September 2012

Background

Structural interventions to improve access to healthy food in deprived communities are a current policy priority. In 2010, the Obama administration unveiled the Healthy Food Financing Initiative to promote interventions that expand access to nutritious foods. The initiative provided more than $400 million in funding to bring grocery stores and health food retailers to deprived communities. However, no evidence for the effectiveness of such policy interventions exists. This paper is a first attempt to evaluate the effect of this intervention on perceptions of the food environment, fruit and vegetable intake and body mass index (BMI) in Philadelphia, USA.

Methods

Data from the Philadelphia Neighbourhood Food Environment Study were used. This study utilised a prospective quasi-experimental design comparing baseline and follow up data in an ‘intervention’ community with a matched ‘comparison’ community. The intervention was the introduction of a large food supermarket in an underserved area. Outcomes were BMI, weekly fruit and vegetable consumption (Block FFQ), and perception of the neighbourhood food environment. Data were analysed using an intention-to-treat (ITT) and adopters vs non-adopters (ANA) approach. Difference-in-differences analyses (DID) assessed whether significantly different changes over time existed between intervention and comparison groups. Models were adjusted for age, sex, income, race, education, household composition and employment status.

Results

In ITT and ANA analyses no significant difference-in-differences in mean BMI and mean weekly fruit and vegetable consumption were found. ITT analyses demonstrated a significant improvement in perceptions of the neighbourhood food environment in the intervention versus comparison neighbourhood (DID=1.71, p=0.001). Using ANA, a similar result was found for adopters, with those who used the grocery store as their primary shop (DID=1.57, p=0.05) and those who used it for any food shopping (DID=2.34, p<0.001) having significantly better perceptions of the neighbourhood food environment compared to non-adopters. After adjustment, ITT analyses remained significant (DID=1.65, p=0.002). For ANA, significant DID results were attenuated for primary adopters (DID=1.30, p=1.105) but remained significant for those undertaking any food shopping (DID=2.18, p<0.001).

Conclusion

The introduction of a new grocery store had a positive effect on how local residents perceive the quality of their neighbourhood food environment. However, this did not have a significant effect on fruit and vegetable consumption or BMI. Improvement in perceptions of neighbourhood food environment quality did not translate into improved dietary behaviour or reductions in BMI.
OP95 Risk Factors for First Venous Thromboembolism in and around Pregnancy: A Population Based Cohort Study from the United Kingdom
Authors: Sultan A Abdul , Tata LJ , West J , Fiaschi L , Fleming KM , Nelson-Piercy C
Published: September 2012

Background

Venous thromboembolism (VTE) remains one of the leading causes of maternal mortality in high income countries. A lack of robust data on women’s risk factors for antepartum and postpartum VTE limit potential prevention. There is a need for estimates of absolute risks at population level according to recognised risk factors.

Methods

Using a large primary care database, we analysed 376,154 pregnancies ending in live births or stillbirths from women 15–44 years of age between 1995 and 2009. We assessed the impact of risk factors on the absolute and relative incidence of VTE for antepartum and postpartum periods using Poisson regression.

Results

Postpartum, the strongest risk factor was stillbirth (Absolute VTE Rate=2,444/100,000 person-years) followed by varicose veins, BMI >30kg/m2, obstetric haemorrhage, preterm delivery, medical co-morbidities (either SLE, IBD, nephrotic syndrome or cancer) and caesarean section (AR=637/100,000 person-years or higher). BMI >30kg/m2 conferred a substantial increase in postpartum risk (AR=926/100,000 person-years) but only a modest increase antepartum (AR=109/100,000 person-years). Women age>35 years, current smokers, and those with acute systemic infections had small relative increases in antepartum and postpartum VTE to those without such risk factors.

Conclusion

Antepartum VTE varies modestly by recognised risk factors, yet women with stillbirths, preterm births, obstetric haemorrhage, caesarean section delivery, co-morbidities or BMI >30kg/m2 are most likely to benefit from thromboprophylaxis postnatally. For example, we estimate that up to 17 to 159 annual VTEs could be avoided annually if all women with stillbirth, preterm birth or caesarean section in the UK received appropriate thromboprophylaxis.
PL01 A Simple Morbidity Score for UK Primary Care: A New Tool for Research and Healthcare Outcome Monitoring
Authors: Carey IM , Shah SM , Harris T , DeWilde S , Cook DG
Published: September 2012

Background

Adjustment for morbidity level is important in ensuring fair comparison of outcomes between patient groups and healthcare providers. The Quality and Outcomes Framework (QOF) in UK primary care, which records numerous diseases systematically, offers potential for developing a standardised morbidity score that can be easily applied in research and service settings.

Methods

Using The Health Improvement Network (THIN), a large primary care database of 375 UK general practices in 2008–9, half the practices were randomly selected as a training set to derive a morbidity score based on chronic conditions recorded in QOF, and the other practices formed a validation set to assess predictive performance. A total of 653,780 patients aged 60 and over registered in 2008 were included, and mortality at one year was assessed.

Results

Nine QOF conditions were identified as robust co-predictors (Hazard Ratio ≥1.2) of mortality independent of age and sex, and were assigned integer score weights based on the strength of their association with mortality. Cancer (HR=3.4) and Dementia (HR=2.8) were the strongest predictors. In a Cox model with age and sex included, the addition of the QOF score improved model discrimination in predicting mortality (c-statistic=0.82 vs. 0.78), performing similarly to the Charlson index, an established morbidity index. In a multilevel logistic model, an individual’s QOF score explained more of the variation in mortality between practices than the Charlson index (46% compared to 32%). At practice level, the mean QOF score per patient was strongly correlated with practice standardised mortality ratios (r=0.64) and explained more variation in practice death rates than the Charlson index.

Conclusion

A simple score derived from routine QOF recording provides a morbidity index which is highly predictive of one year mortality in older UK Primary Care patients, is simpler to implement than existing morbidity scores, and explains practice level variations in mortality. This new score has potential utility in research and healthcare outcome monitoring and could be easily implemented nationally through existing mechanisms for anonymised collection of QOF data from practices.
PS01 Associations of Health, Physical Activity and Weight Status with Motorised Travel and Transport Carbon Dioxide Emissions
Authors: Goodman A , Brand C , Ogilvie D
Published: September 2012

Background

Motorised travel and associated carbon dioxide (CO2) emissions generate substantial health costs, many of which disproportionately affect socio-economically disadvantaged groups. These health costs may include contributing to rising obesity levels. Obesity has in turn been hypothesised to increase motorised travel and/or CO2emissions, both because heavier people may use motorised travel more and because heavier people may choose larger and less fuel-efficient cars. These hypothesised associations have not been examined empirically, however, nor has previous research examined associations with other health characteristics. Recent years have, however, seen increasing research and policy attention to the potential ‘co-benefits’ of pursuing policies which simultaneously enhance public health and promote environmental sustainability. We therefore aimed to examine how and why weight status, health, and physical activity are associated with transport CO2emissions.

Methods

3463 adults (18–91 years, 45% male) completed questionnaires in the baseline iConnect survey at three study sites in the UK, self-reporting their health, weight, height and past-week physical activity. Seven-day recall instruments were used to assess travel behaviour and, together with data on car characteristics, were used to estimate CO2emissions. We used path analysis to examine how far active travel, motor travel and car engine size mediated associations between health characteristics and CO2emissions.

Results

CO2emissions were higher in overweight or obese participants (multivariable standardized probit coefficients 0.16, 95% CI 0.08, 0.24 for overweight vs. normal; 0.16, 95% CI 0.04, 0.28 for obese vs. normal). Lower active travel and, particularly for obesity, larger car engine size explained 19–31% of this effect, but most of the effect was directly mediated by greater motorised travel distance. Walking for recreation and leisure-time physical activity predicted higher motorised travel distance and therefore higher CO2emissions, while active travel predicted lower CO2emissions. Poor health and illness did not independently predict CO2emissions.

Conclusion

Establishing the direction of causality between weight status and travel behaviour requires longitudinal data, but the engine size association suggests at least a potential causal effect of obesity on CO2emissions. More generally, transport CO2emissions are differently associated with different health characteristics, including associations between a health good and an environmental harm (recreational physical activity and high emissions). Thus health-environmental ‘co-benefits’ cannot be assumed. Instead, attention should also be paid to identifying and mitigating potential areas of tension, for example promoting low-carbon recreational activity.
PS09 Sleep Problems: An Emerging Global Epidemic? Findings from the Indepth Who-Sage Study among over 40,000 Older Adults from Eight Countries Across Africa and Asia
Authors: Stranges S , Tigbe W , Gómez-Olivé FX , Thorogood M , Kandala N-B
Published: September 2012

Background

Several studies have reported downward trends in the average duration of sleep and an increasingly higher prevalence of sleep problems across different Western populations. However, the evidence from low-income countries is limited. This study aims to fill this gap by examining the prevalence of sleep problems and associated factors in low-income settings.

Methods

Community-wide samples were taken from eight countries across Africa and Asia participating in the INDEPTH WHO-SAGE multicentre collaboration during 2006–2007. The participating sites included rural populations in Ghana, Tanzania, South Africa, India, Bangladesh, Vietnam and Indonesia, and an urban area in Kenya. The overall sample comprised 24,434 women and 19,501 men, for a total of 43,935 participants, aged 50 years and over. Two measures of sleep quality, over the last 30 days, were assessed alongside a number of socio-demographic variables, measures of quality of life, and co-morbidities.

Results

Overall 16.6% of participants reported severe/extreme nocturnal sleep problems, with a striking variation across the eight populations, ranging from 3.9% (Purworejo, Indonesia, and Nairobi, Kenya) to over 40.0% (Matlab, Bangladesh). There was a consistent pattern of higher prevalence of sleep problems in women and older age groups. In bivariate analyses, lower education, not living in partnership, and poorer self-rated quality of life were consistently associated with higher prevalence of sleep problems (P<0.001). In multivariate logistic regression analyses, limited physical functionality or greater disability and feelings of depression and anxiety were consistently strong, independent correlates of sleep problems, both in women and men, across the eight sites (P<0.001).

Conclusion

A large number of older adults in low-income settings are currently experiencing sleep problems, which emphasises the global dimension of this emerging public health issue. This study corroborates the multifaceted nature of sleep problems, which are strongly linked to poorer general wellbeing and quality of life, and psychiatric co-morbidities.
PS14 A Systematic Review of Evidence on Malignant Spinal Metastases: Technologies for Identifying Patients at High Risk of Vertebral Fracture and Spinal Cord Compression
Authors: Suttcliffe P , Connock M , Shyangdan D , Court R , Kandala N , Clarke A
Published: September 2012

Background

Spinal metastases are common and can lead to significant morbidity and reduction in quality of life towards the end of life due to spinal cord compression (SCC). Between 5% and 20% of patients with spinal metastases develop metastatic spinal cord compression (MSCC) during the course of their disease. Understanding early diagnosis of spinal metastases and prediction of collapse of the metastatic vertebrae is important.

Methods

A systematic review was undertaken to identify patients at high risk of vertebral fracture and SCC. Thirteen electronic bibliographic databases were searched. A quality assessment instrument was used to assess bias in six domains: study population, attrition, prognostic factor measurement, outcome measurement, confounding measurement and account, and analysis.

Results

2,425 potentially relevant articles were identified, of which 31 met the inclusion criteria. Seventeen studies reported retrospective data, 10 were prospective studies, and three were other study designs. There was one systematic review. There were no randomised controlled trials. There were approximately 7,900 participants (4 studies did not provide this information) in the included studies and 5,782 participants were analysed (3 studies did not provide this information). The sample sizes ranged from 41 to 859. Cancers reported were: lung alone (n=3); prostate alone (n=6); breast alone (n=7); mixed cancers (n=13); and unclear (n=1). Ninety-three prognostic factors were identified as potentially significant in predicting risk of SCC or collapse. Many of the included studies provided limited information about patient population and selection criteria and they varied in methodological quality, rigour and transparency. Several studies with mixed case populations identified type of cancer (e.g. breast, lung or prostate cancer) as a significant factor in predicting SCC, but determining the risk differential is difficult because of residual bias in studies.

Conclusion

Perhaps not surprisingly, the overall findings from this systematic review showed that the more spinal metastases present and the longer a patient is at risk, the greater the chance of development of SCC and collapse. Other prognostic factors include total burden of metastatic disease and immediate symptomatology suggestive of spinal column involvement. Current clinical consensus favours magnetic resonance imaging and computed tomography for investigation of SCC and vertebral fracture, but this important area is clearly under-researched.
PS17 Commissioning Care for People with Long Term Conditions
Authors: Porter AM , Smith JA , Shaw S , Mays N
Published: September 2012

Background

The landscape of health care commissioning is being reshaped in England, as clinical commissioning groups prepare to take on the role now held by Primary Care Trusts (PCTs). Long term conditions are likely to remain a priority area, with concerns about increasing prevalence driving a shift towards care delivered in the community and early intervention to avoid hospitalisation. We report on a NIHR-funded study which used action research in three NHS local health communities to examine in detail the practice of PCT commissioning of care for people with long term conditions.

Methods

The study was undertaken in three contrasting PCT areas (Somerset, Wirral and Calderdale), and focused on diabetes and another locally selected condition in each site. The design combined a largely ethnographic approach with action research, allowing for responsive intervention to meet local commissioners’ needs. Formal data collection over a 15 month period to January 2012 consisted of 104 semi structured interviews, observation of 27 meetings, and analysis of over 300 documents. A thematic framework was developed to guide analysis in terms of processes, resources and outcomes of commissioning.

Results

Findings highlighted the complex nature of health care commissioning, far removed from the ‘commissioning cycle’ which sets out a formal, sequential model emphasising contracting. Instead, commissioning developments took place over a number of years through an incremental process of review and revision where negotiation and relationships were prominent. Providers often played a significant role in identifying needs and designing new models of care. The sheer scale of labour involved in commissioning was striking. Greatest success with shifting models of care towards nationally recommended good practice came where there was a combination of effective prioritisation of developments, persistence and pragmatic bounding of tasks within a wider strategic framework. Measuring the impact of commissioning practice on clinical outcomes was challenging.

Conclusion

To fulfill national policy towards remodelling care for people with long term conditions, NHS commissioners are engaged in labour-intensive, steadily paced and incremental work with providers. Planned reforms to commissioning in England raise questions about whether this approach can continue in the face of straitened budgets for management support, an increased emphasis on provider competition and disruptions to established relationships between commissioners and providers.
PS28 Impact of Number and Type of Comorbidity on Depression Prevalence and Health Care Costs. Population-Based Cohort Study
Authors: Bhattarai N , Charlton J , Rudisill C , Gulliford M C
Published: September 2012

Background

The degree to which the number of comorbidities and the presence of depression impact health care use and costs has been unexplored employing actual resource use data representing a general population. We aimed to evaluate the impact of number and type of comorbidities on depression prevalence, health care utilisation and health care costs.

Methods

Cohort study and included in the study were 300,020 participants aged 30 years of age registered with the UK General Practice Research Database. We used the UK General Practice Research Database to examine participants’ diagnoses and resource use in primary and secondary care from 2005 to 2009. Healthcare unit costs and the costs of each individual prescription item were analysed.

Results

In participants with no comorbidity, the age-standardised prevalence of depression was 7% in men and 14% in women. The likelihood of having depression increased in participants with single comorbidities including diabetes mellitus (men 13%, women 22%), CHD (men 15%, women 24%), stroke (men 14%, women 26%) or colorectal cancer (men 10%, women 21%). Patients with concurrent diabetes, CHD and stroke had a very high prevalence of depression (men 23%, women 49%) with women being more likely to suffer depression. Patients with a single comorbidity were 1.63 (95% confidence interval 1.59 to 1.66) times more likely to be depressed than those without comorbidity while those with two and three comorbidities were 1.96 (1.89 to 2.03) and 2.35 (2.03 to 2.59) times more likely. Depression increased the total costs of resources utilised per year in all participants across both genders, all age groups and across all comorbidities analysed in this study. Individuals with depression had higher total annual health care costs (males = £1014, females=£1212) than those without comorbidity or depression (males = £380, females = £517). Those with diabetes alone had £1144 for males and £1393 for females but £ 2534 for males and £ 3017 for females when depression was present alongside diabetes. When patients had diabetes, CHD and had suffered a stroke these patients’ costs were £1541 for males and £1879 for females without depression and £3420 for males and £4072 for females with depression. Depression increased the associated cost of any comorbidity.

Conclusion

The prevalence of depression appears to be more strongly determined by the number of comorbidities rather than the precise nature of the comorbid diagnoses. Additional costs of health care utilisation are considerably higher when depression is associated with single or multiple comorbidities.
PS29 Youth Exposure to Online Alcohol Advertising in The UK: An Analysis of Social Media Websites
Authors: Winpenny E , Marteau TM , Nolte E
Published: September 2012

Background

There is increasing evidence that youth exposure to alcohol marketing is a risk factor for underage drinking. In 2011, online marketing became the largest channel for marketing for the first time, overtaking television. However, there is little understanding of the level of exposure of young people to online alcohol marketing.

Methods

We obtained data on the top 3 social media sites in the UK for each month from December 2010 to May 2011, based on unique user figures, by gender and age (6–14, 15–24). We analysed the reach (the proportion of available internet users who used the site in each month) and impressions (the number of individual pages viewed on the site in each month) of the overall top three social media sites, Facebook, YouTube and Twitter in each demographic. Using data from the top 10 TV channels in the UK we identified 5 drinks brands, which had the highest TV advertising exposure to children (4–15) during this 6 month period. During February and March 2012, we examined each of these brands across the 3 social media sites. We analysed the brand presence and page content on each site and assessed the use and effectiveness of age restrictions.

Results

Facebook was the most-used social media site, with an average reach across the observation period ranging from 39% in males aged 6–14 to 91% among females aged 15–24. The average impressions per month varied between 697 million and 2,717 million. YouTube had a similar average reach (41–81%) while Twitter had a considerably lower usage in the age groups studied. All 5 of the alcohol brands studied maintained a brand website, facebook page and twitter page, while 3 of the 5 also hosted a YouTube channel. Features such as the ‘like’ button on facebook and the use of competitions and games enable spread of brand engagement through the network.

Age restrictions to alcohol brand content varied across the sites. Facebook users under the age of 18 years were not able to access ‘official’ alcohol brand pages, although most user-generated content and some brand-generated applications were still accessible. By contrast, YouTube and Twitter did not maintain age-restriction with users of all ages able to view and interact with brand content.

Conclusion

Social media sites are heavily used by children and young adults. Their exposure through these sites to alcohol marketing warrants intervention.
PS31 Patterns of Partnership Smoking During Pregnancy
Authors: Prady SL , Graham H , Pickett KE
Published: September 2012

Background

Partner’s smoking status is an important predictor of maternal smoking in pregnancy; however there are few UK-wide surveys which look at these effects. We investigated partnership smoking, quitting and cutting down during pregnancy in the UK’s Millennium Cohort Study.

Methods

We used multinomial logistic and linear regression to investigate retrospective self-reported smoking status and reductions in cigarettes smoked of mothers and their partners. All analyses were weighted for the complex sampling design and non-response, both unadjusted and adjusted for socio-demographic status.

Results

Seventy-six percent of women had respondent partners, 22% were couples who both smoked around the time of the pregnancy (unweighted N=2,954). Of these smoking couples, 37% of women quit during their pregnancy, 41% cut down, and 23% smoked the same amount (persistent smokers), respective percentages for partners were 16%, 25% and 56%. Compared to women who quit, women who cut down were more likely to have a partner who was a persistent smoker (RRR 7.6, 95% CI 4.9 to 11.7), or a cut-down smoker (5.7, 3.8 to 8.5). Compared to persistent smokers, those who cut down were slightly heavier smokers (women mean difference 1.1 cigarettes/day, partners 2.0). Women who cut down reduced average consumption to 6.3 a day (mean reduction 9.3, 95% CI 9.0 to 9.8) and partners to 10.1 (8.7, 8.1 to 9.3). There was no difference in the effect of partners’ persistent smoking on the risk of women cutting down or persistent smoking (P=0.38), but partner cutting down was a significantly larger predictor of women cutting down compared to women continuing to smoke (P=0.02). After reduction, women whose partners cut down smoked an average of 2.2 more cigarettes more than those whose partners quit (P=0.043). There was no evidence of variation in reduction for those who had partners who quit and those who were persistent smokers (d=0.87, P=0.42).Resultswere robust to adjustment for socio-demographics; fully adjusted results will be presented.

Conclusion

Most women cut down and this was associated with partner cutdown, however this strategy was limited as partners were more likely to be persistent smokers. Significant reductions in the maternal number smoked were achieved, but the influence of partner smoking (whether persistent or cut down) may limit reduction. Cutting down as a strategy has questionable impact on in-utero exposure and may put at infants at risk for environmental tobacco smoke exposure postpartum. For maximum effect, partner and targeted couples interventions are warranted.
PS51 Could More Than Three Million Older People Be At Risk Of Alcohol-Related Harm? A Cross-Sectional Analysis Of Age-Specific Drinking Guidelines
Authors: Knott C , Scholes S , Shelton NJ
Published: September 2012

Background

To determine the effect of recently proposed age-specific alcohol consumption guidelines upon the estimated proportion and number of older individuals potentially at risk of alcohol-related harm. Nationally representative cross-sectional population data from Health Survey for England (HSE).

Methods

Random sample of the general population living in private households in England. For reliable comparison of adult alcohol consumption by age and sex across a five-year period, data were extracted from HSE 2003 and 2008 for all participants aged 16 or over. The sample included those who drank in the previous week, never drinkers, non-drinkers and adults who reported not having consumed alcohol in the week prior to interview. Excluded from the sample were those for whom data on drinking behaviour or unit alcohol consumption were missing (around one per cent of the total available sample). The sample from HSE 2003 thus comprised 14,718 participants, while the 2008 sample comprised data on 14,939 individuals.

Results

The total number of individuals aged 65 or over classified as drinking in excess of daily recommended limits would have increased to over three million in 2008 under age-specific guidelines proposed by the Royal College of Psychiatrists, equating to an at-risk population of 809,000 individuals greater than found within the 16–24 age group during the same year. Proposed revisions to existing binge drinking classifications defined almost 1,200,000 people aged 65 or over as hazardous consumers of alcohol in 2008, equating to a rise of 258% by comparison with existing definitions.

Conclusion

The introduction of new age-specific drinking guidelines put forward by the Royal College of Psychiatrists would increase the elderly population drinking in excess of daily recommended limits by more than two-fold, and increase by more than three-fold the number of binge drinkers. However, there remains at present a dearth of evidence sufficient for guiding age-specific revisions to existing and already problematic alcohol consumption thresholds. Nevertheless, vigilance regarding heavy late-life drinking remains important in light of older people’s heightened sensitivity to the effects of alcohol and the rising number within the sub-population potentially at risk of alcohol-related harm.
PS52 Are There Gender Differences In The Social Patterning Of Binge Drinking In The Czech Republic, Russia, Poland And Lithuania? A Cross-Sectional Study
Authors: Asher L , Pikhart H , Bobak M
Published: September 2012

Background

Binge drinking may have played a central role in mortality fluctuations in the former Soviet Union (fSU). In Eastern Europe, binge drinking is more common in men than women and in men of lower socio-economic position (SEP). Yet intersections of these factors have rarely been addressed with sufficient power to detect social patterns in binge drinking amongst women. The aim of this study was to determine whether there are gender differences in the social patterning of binge drinking in the Czech Republic, Russia, Poland and Lithuania.

Methods

Cross-sectional baseline data from the HAPIEE (Health, Alcohol and Psychosocial factors in Eastern Europe) study was used. The participants were men and women aged 45–69 years randomly selected from population registers in the Czech Republic, Russia, Poland and Lithuania. Logistic regression was used to examine the association between social factors (education, employment status, household amenities and deprivation) and binge drinking (>100g (men) and >60g (women) ethanol per occasion ≥1x/month) in each gender and country separately. Amenities score was derived from 18 (Lithuania) or 12 (other countries) individual questions on household items. ‘Few amenities’ was defined as a score in the lowest quartile for the participant’s country.

Tests for interaction between gender and each variable were carried out. Tests for interaction between country and each variable were also completed. Pooled data (all countries) was interpreted where there was no evidence of country heterogeneity.

Results

There were 34,069 participants with complete data. Amongst men in all countries, all markers of low SEP were associated with increased odds of binge drinking (e.g. OR 1.22, 95% CI 1.10–1.35 for few amenities, fully adjusted model). In women, few amenities (OR 0.81, 0.70–0.94, fully adjusted model), and to a lesser extent low education level, were associated with decreased odds of binge drinking. The associations between social factors, gender and binge drinking were homogenous between countries (few amenities test for country heterogeneity p=0.72 men, p=0.51 women) with the exceptions of education and deprivation in women.

Conclusion

In Russia and Eastern Europe binge drinking in men and women is socially patterned, but in contrasting ways. Men with lower SEP may binge drink due to social instability and poor coping mechanisms. Women with higher SEP may binge drink due to greater resources and exposure to, and adoption of, male drinking patterns through employment or higher education. Policy to tackle binge drinking should take into account its gender-specific social determinants.
PS53 Effect Of Geographical Access To Health Facilities On Child Mortality In Rural Ethiopia: A Community Based Cross Sectional Study
Authors: Okwaraji Y , Cousens C , Berhane Y , Mulholland K , Edmond K
Published: September 2012

Background

There have been few studies which have examined associations between access to health care and child health outcomes in remote populations most in need of health services. This study assessed the effect of travel time and distance to health facilities on mortality in children under five years in a remote area of rural north-western Ethiopia.

Methods

This study involved a randomly selected cross sectional survey of 2,058 households. Data were collected during home visits to all resident women of reproductive age (15–49 years). A geographic information system (GIS) was used to map all households and the only health centre in the district. The analysis was restricted to 2,206 rural children who were under the age of five years during the five years before the survey. Data were analysed using random effects Poisson regression.

Results

90.4% (1,996/2,206) of children lived more than 1.5 hours walk from the health centre. Children who lived >1.5hrs from the health centre had a two–three fold greater risk of death than children who lived<1.5 hours from the health centre (children with travel time 1.5–<2.5hrs adjusted relative risk [adjRR] 2.3[0.95–5.6], travel time 2.5–<3.5hrs adjRR 3.1[1.3–7.4] and travel time 3.5–<6.5hrs adjRR 2.5[1.1–6.2]).

Conclusion

Distance to a health centre had a marked influence on under five mortality in a poor, rural, remote area of Ethiopia. This study provides important information for policy makers on the likely impact of new health centres and their most effective location in remote areas.
PS54 Biomarkers Associated With Mortality In A Community Based Population With Cardiovascular Risk Factors: Data From The Screening To Prevent Heart Failure (STOP HF) Study
Authors: Conlon CM , Kelleher CC , Dawkins I , McDonald L , Ledwidge M , McDonald K
Published: September 2012

Background

The STOP HF cohort is an ongoing longitudinal study of 1,040 individuals with cardiovascular risk factors and no known ventricular dysfunction at baseline. The study is located in South Dublin and the Southeast of Ireland. This is an analysis of the deaths reported at the interim analysis conducted in January 2012 (mean follow-up, 4 years, range 3.5–7.0 years).

Methods

Univariable analyses compared the profiles of survivors to those deceased. Logistic regression identified the foremost associates of death. Cox’s proportional hazard models estimated the risk of death over time, considering the presence of certain factors.

Results

Between January 2005 and April 2008 1,040 individuals were recruited into the STOP HF study (Mean age 65, 49% male, hyperlipidemia 53%, hypertension 47%, CAD 16%, MI 8%, arrhythmia 8%, diabetes 12%, smoker 14%). At the interim analyses 64 deaths were reported, (6.1% of the cohort). Univariable analyses indicated those deceased were older (65 vs. 71 years, p<0.0001) with lower diastolic blood-pressure (p<0.005) and a 17% greater prevalence of diabetes (p<0.0001). Those deceased had biomarker levels more frequently ≥75th percentile for gender in BNP (p<0.005), hsCRP (p<0.0001), Urea (p<0.005), Creatinine (p<0.0001) and ALP (p<0.05) and were more likely to be taking ACE inhibitor (p<0.02) and anti-diabetic therapy (p<0.0001). The final multivariable model identified age (ExpB=1.07, OR 1.03–1.11, p<0.0001), diabetes (ExpB=3.44, OR 1.96–7.00, P=0.001), BNP (ExpB=1.00, OR 1.000–1.007, p=0.075) and hsCRP (ExpB=1.07, OR 1.04–1.11, p<0.000) as associates of mortality (model χ2(4, N=1041)=50.240, p<0.001). Controlling for age, cox’s proportional hazard models indicated that those with diabetes had a 3 times higher risk of death (ExpB=3.117, OR 1.801–5.304, p<0.0001); those with a hsCRP level ≥75th percentile for gender were almost 3.5 times more likely to die (ExpB=3.439, OR 1.995–5.498, p<0.0001) and those with ALP ≥75th percentile for gender were also more likely to die durin the follow-up period (ExpB=1.919, OR 1.096–3.359).

Conclusion

Diabetes is associated with in excess of a 3 times increase in the likelihood of death over 4 years follow-up in this population, while other morbid conditions such as coronary disease and atrial fibrillation show no significant association. Despite aggressive cardiovascular risk management through primary and secondary prevention strategies, those with diabetes continue to have a poor prognostic outlook. Observation of biomarkers such as hsCRP and ALP may be of added value in monitoring cohorts with existing cardiovascular risk factors and identifying those that may be sub-clinically manifesting heightened risk of mortality in this setting.
EVOLUTIONARY MOTIFS FOR THE AUTOMATED DISCOVERY OF SELF-ORGANIZING DIMER AUTOMATA
Authors: ARENDT DUSTIN , CAO YANG
Published: September 2012

It is usually difficult to reverse engineer a simple rule that exhibits some desirable and interesting behavior. We approach this problem by searching for dimer automaton rules exhibiting a broadly defined behavior, self-organization. We expected the simple and asynchronous nature of dimer automata to hinder self-organization, but an exhaustive search quickly yielded three rules that do, in fact, exhibit properties of self-organization. Two of these rules are applicable to actual physical phenomena, motivating searching for additional, more complex rules. However, exhaustive searches scale poorly here because of the rarity of interesting rules combined with the fast growth rate of the search space. To address these challenges we developed the evolutionary motifs algorithm. This algorithm finds the building blocks of the previously found dimer automaton rules, and combines them to form new rules in an evolutionary manner. Our evolutionary algorithm was more effective than an exhaustive search, producing a diverse population of rules exhibiting self-organization.
Clinical Evaluation of COBAS TaqMan PCR for the Detection ofMycobacterium tuberculosisandM. aviumComplex
Authors: Ikegame Satoshi , Sakoda Yoritake , Fujino Nao , Taguchi Kazuhito , Kawasaki Masayuki , Kajiki Akira
Published: September 2012

A retrospective observational study was performed to determine the sensitivity and limitation of PCR test for the detection ofMycobacterium tuberculosisandM. aviumcomplex. We obtained clinical specimens collected from the respiratory tract, culturedM. tuberculosisorM. aviumcomplex, and performed PCR analysis. A total of 299 samples (M. tuberculosis, 177;M. avium, 35;M. intracellulare, 87) were analyzed by COBAS TaqMan PCR from April 2007 to March 2011. The PCR positivity rates were 50–55%, 70–100%, 88–98%, and 100% in smear-negative, smear 1+, 2+, and 3+ groups, respectively. The PCR positivity of tuberculosis in smear 1+ was 80.6%, which was statistically significantly (P<0.001) lower than that of smear 2+ (97.3%). From January 2005 to March 2007, we collected an additional 138 samples (M. tuberculosis, 74;M. avium, 21; M. intracellulare, 43), which were analyzed by COBAS Amplicor PCR. The PCR positivity rates obtained using COBAS TaqMan PCR and COBAS Amplicor PCR were not significantly different. The sensitivity of PCR test for mycobacteria is not sufficient in case of smear 1+. Careful consideration must be given to the interpretation of negative PCR test results in smear 1+, because smear-positive tuberculosis is the criterion for isolation.
Regional Patterns of Sea Surface Temperature Change: A Source of Uncertainty in Future Projections of Precipitation and Atmospheric Circulation*
Authors: Ma Jian , Xie Shang-Ping
Published: September 2012

Precipitation change in response to global warming has profound impacts on environment for life but is highly uncertain. Effects of sea surface temperature (SST) warming on the response of rainfall and atmospheric overturning circulation are investigated using Coupled Model Intercomparison Project simulations. The SST warming is decomposed into a spatially uniform SST increase (SUSI) and deviations from it. The SST pattern effect is found to be important in explaining both the multimodel ensemble mean distribution and intermodel variability of rainfall change over tropical oceans. In the ensemble mean, the annual rainfall change follows a “warmer-get-wetter” pattern, increasing where the SST warming exceeds the tropical mean, and vice versa. Two SST patterns stand out both in the ensemble mean and intermodel variability: an equatorial peak anchoring a local precipitation increase and a meridional dipole mode with increased rainfall and weakened trade winds over the warmer hemisphere. These two modes of intermodel variability in SST account for one-third of intermodel spread in rainfall projection.

The SST patterns can explain up to four-fifths of the intermodel variability in intensity changes of overturning circulations. SUSI causes both the Hadley and Walker circulations to slow down, as articulated by previous studies. The weakening of the Walker circulation is robust across models as the SST pattern effect is weak. The Hadley circulation change, by contrast, is significantly affected by SST warming patterns. As a result, near and south of the equator, the Hadley circulation strength change is weak in the multimodel ensemble mean and subject to large intermodel variability due to the differences in SST warming patterns.
Arabs, Latins and Persians bearing gifts: Greek translations of astrolabe treatises, ca. 1300
Authors: Fisher Elizabeth A.
Published: September 2012

Although translation of foreign literature was rare in Byzantium, in c. 1300 three Greek translations of treatises on using the astrolabe appeared, two from Latin and one from Persian or Arabic; all three are assessed in terms of Greek style and significance for Byzantine culture. The Islamic treatise translated by Shams al-Din al-Bukhari includes a translator’s preface, edited in full and translated into English here for the first time. In the preface, Shams describes a deluxe astrolabe sent to Andronikos II with the treatise in the hope, it is argued, of some personal benefit in return.
Shaping the sacred: light and the experience of worship in middle Byzantine churches
Authors: Nesbitt Claire
Published: September 2012

Byzantine churches have been extensively studied in terms of their architectural development and in their role as places to display religious art. However there has been less research into one of the most fundamental aspects of the Byzantine ritual experience, illumination. In practical terms, churches had to be illuminated sufficiently for worship to take place. In experiential terms, lighting can be seen as the medium by which the iconographic programmes and liturgical practices were staged and enhanced. This paper considers the archaeological and textual evidence linking physical illumination of buildings with the experience of their sacred function.
First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of Pediatric Population in the Middle East and North Africa (MENA): the CASPIAN-III study
Authors: Mansourian Marjan , Marateb Hamid Reza , Kelishadi Roya , Motlagh Mohammad Esmaeil , Aminaee Tahereh , Taslimi Mahnaz , Majdzadeh Reza , Heshmat Ramin , Ardalan Gelayol , Poursafa Parinaz
Published: September 2012

Background

The World Health Organization (WHO) is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA). This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10–19 years, and to explore how well these anthropometric data match with international growth references.

Methods

In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10–19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI)-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE) method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines.

Results

The study population comprised 5430 school students consisting of 2312 (44%) participants aged 10–14 years , and 3118 (58%) with 15–19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%), 20% had high BMI (overweight: 14% and obesity: 6%), and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P < 0.001). The mean BMI-for-age, and the average height-for-age of Iranian children aged 10–19 years were lower than the WHO 2007 and United states Centers for Disease Control and Prevention 2000 (USCDC2000) references.

Conclusions

The current growth curves generated from a national dataset may be included for establishing WHO global database on children’s growth. Similar to most low-and middle income populations, Iranian children aged 10–19 years are facing a double burden of weight disorders, notably under- and over- nutrition, which should be considered in public health policy-making.