bluuebunny/crossref_metadata_2025 huggingface dataset:
PP20 Improved Identification of Chronic Kidney Disease Cases in Primary Care
Authors: K Oliver , Humphreys J , Harvey G , Betzlbacher A , Entwistle V , Hegarty J
Published: September 2013

Background

Undiagnosed chronic kidney disease (CKD) leads to a high cost and care burden in secondary care. Current stage 3–5 prevalence is estimated at 6.35%, but recorded prevalence in primary care is often significantly lower. Increasing the prevalence of diagnosed CKD in primary care would allow management and prevention of deterioration, but detection rates for CKD remain low. We developed a primary care quality improvement intervention to help identify and manage CKD patients.

Methods

A 2x12-month improvement project using financial incentives and structured facilitation was carried out in 30 general practices in Greater Manchester. Practices were helped to identify improvement objectives tailored to their context, (such as validating and updating practice registers) and were monitored by the improvement team. In the first 12 months, practices were provided with in-depth facilitation by knowledge transfer associates. The second phase was less resource-intensive; seconding a clinical facilitator, developing a change package, replacing collaborative meetings with fewer web seminars, and introduction of a CKD audit tool. Key indicators of change were: number of recorded patients with CKD on practice registers: percentage of patients on registers achieving nationally recognised blood pressure targets. Data were collected by practice staff. Practices also received a readiness to change questionnaire to assess practice culture and flexibility.

Results

Baseline prevalence across the practices was 4.2%. By the end of the project, recorded prevalence reached 5.4%. Practice registers recorded an increase of 22% of patients with CKD, indicating improved identification of cases. Overall, 2042 patients were added to registers, although taking miscoded patients into account the true number of newly identified patients is likely to be higher. Management of patients also improved from 38% managed to blood pressure target at baseline increasing to 64%. Wide variation amongst practices was accounted for by readiness to change. The two-stage project allowed learning, knowledge and skills to be developed in phase 1, which could then be streamlined and put into practice in phase 2.

Discussion

The quality improvement project was associated with a 22% increase in identification of CKD patients, and a 170% increase in patients managed to NICE recommended blood pressure targets. These represent a potential huge saving for the NHS in estimated avoided vascular events. Clinical facilitation and use of a structured audit tool were associated with accelerated and sustained improvement in case finding, building on an earlier phase of experimentation and relationship-building.
PP28 Exploring the Associations between Diabetes and Site-Specific cancer Mortality: Evidence from the Health Survey for England and Scottish Health Survey linked to Mortality Data
Authors: Gordon-Dseagu VLZ , Shelton N , Mindell J
Published: September 2013

Background

The associations between diabetes and mortality from a number of causes, such as cardiovascular and renal disease, are clearly understood. Concurrently, there is a growing body of evidence demonstrating an increase in cancer mortality among those with diabetes, although there is heterogeneity regarding the strength of the association and uncertainty around confounding by overweight/obesity. Around 2.9 million individuals in the UK are currently living with diabetes; this figure is expected to increase to 5 million by 2025, caused by rising rates of obesity and population ageing. The high prevalence of diabetes means that even a small increased risk of cancer mortality could equate to a large number of deaths among the diabetic population. This large cohort study utilised data from the Health Survey for England and the Scottish Health Survey, linked to mortality data, to explore overall and site-specific cancer mortality.

Methods

Nationally-representative, cross-sectional data from the Health Survey for England (HSE: 1994-2008) and Scottish Health Survey (SHeS: 1995, 1998 and 2003) linked with mortality records up to the first quarter of 2011 and 2008 respectively. Odds ratios (OR) and 95% confidence intervals (CI) adjusted for age-group, sex and smoking status and additionally for BMI category were estimated for all and site-specific cancer mortality using logistic and multinomial logistic regression respectively. To allow for a consideration of the time sequence of any association between the two diseases, individuals with cancer at baseline were excluded from the analyses.

Results

The study sample included 204,537 participants (6,258 with diabetes) and 5,562 cancer deaths. After adjustment for age, sex and smoking status, those with diabetes were at greater risk of dying from cancer compared with those without diabetes (OR 1.16 [1.02, 1.31]). This increase remained after adjustment also included BMI (1.19, 1.04-1.36). For site-specific cancer mortality, there were statistically significant increases for pancreatic (1.77 [1.16, 2.72], breast (1.62 [1.02, 2.65]) and lung (1.34 [1.05, 1.72]) cancer when adjustment included age, sex, smoking and BMI; as well as point estimate increased risk for cancers of the colorectum, bladder, stomach, lymphoid and haematopoietic, kidney and oesophagus.

Conclusion

The high and rising prevalence of diabetes is of public health concern. Those with diabetes have increased overall cancer mortality and site-specific cancers of the pancreas, breast and lung, unaffected by measurements of overweight/obesity. Although some cases of pancreatic cancer may be reverse causality, health services for people with diabetes need to be aware of the increased cancer mortality found among this cohort.
PP29 Association between Consanguinity and Fasting Blood Glucose in A Saudi Arabian Population
Authors: Gosadi I , Teare D , Goyder E
Published: September 2013

Background

Case control studies have suggested synergism between history of parental consanguinity and risk of developing type 2 diabetes. Genetic components of fasting blood glucose (FBG) have been reported by heritability estimates and genetic association studies.

Methods

In a cross-sectional study, 102 male healthy subjects were randomly selected from 13 primary health care centres in Jazan, Saudi Arabia. Each two subjects were siblings and total number of families was 51. Subjects were interviewed to construct extended pedigrees. Extended pedigrees were used to measure degree of consanguinity by calculating inbreeding coefficients (ICs). Constructed pedigrees included information about family history of type 2 diabetes. Pearson’s correlation coefficient was used to calculate correlation of FBG between siblings of each family. To account for the effect of environmental covariates such as food intake and physical activities on FBG, electronic-based questionnaires were utilised to calculate average daily calorific and level of physical activity. These questionnaires were based on questionnaires produced by the European Prospective Investigation of Cancer (EPIC). Additional modifications were applied to make the questionnaires suitable for Saudi Subjects.

Results

The overall correlation of FBG between siblings was 0.317 (P = 0.04). To examine a possible effect of consanguinity, correlations were calculated in 4 steps each considering a more restricted range of consanguinity. In the first step all families with zero inbreeding coefficients were removed resulting in an increase of FBG correlation (r = 0.419 P = 0.015). Secondly, correlation was restricted to families with ICs larger than 0.04% which resulted in further increase of correlation (r = 0.584 P = 0.003). The third step involved restricting correlation to families with ICs larger than 1.5% which showed similar trend (r = 0.699 P = 0.001). Finally, correlation was calculated in families with ICs larger than 3% (r = 0.711 P = 0.009). The effect of ICs on correlation FBG was adjusted for the difference in age, caloric intake and physical activity between siblings of each family.

Conclusion

There is an observed trend of increase in correlation of FBG of siblings with increased level of consanguinity. After accounting for the effect of age and environmental variations between siblings, this trend might indicate that there is a strong genetic influence on FBG correlation and this genetic effect is augmented by degree of parental consanguinity.
PP36 Use of Electronic Health Records to Implement a Cluster Randomised Trial in Primary Care
Authors: Ashworth M , Charlton J , Little P , Moore M , Yardley L , Gulliford M , Dregan A , Staa T van , McDermott L , McCann G
Published: September 2013

Background

Electronic health records (EHRs) represent a potentially valuable resource for evaluating health interventions. This research aimed to evaluate the feasibility of implementing a cluster randomised trial in a primary care database. The trial intervention aimed to reduce antibiotic prescribing in respiratory tract infections (RTIs).

Methods

The trial was implemented using the Clinical Practice Research Datalink (CPRD). All CPRD general practices in England and Scotland were invited to participate. Allocation was stratified by region/country and practice list size. Non-trial practices provided an external comparison group. Interventions were electronic reminders, activated during consultations for respiratory infections by persons aged 18 to 59 years, installed remotely at intervention practices. Outcomes at 12 months were evaluated through analysis of EHR data collected into CPRD with linked HES. The primary outcome was the proportion of consultations for RTI with antibiotics prescribed.

Results

There were 104 (53 Intervention, 51 Control) CPRD general practices were recruited to the study. Individual participants were Intervention, 294,259; Control, 264,065; and External Comparison, 518,315. Interventions were successfully installed at all intervention practices. Banners offering accessing to the intervention material were regularly viewed, but prompts were actively viewed at only 47 per 1,000 consultations for sore throat. The median (IQR) practice-specific proportion of RTI consultations with antibiotic prescribed were: Intervention, 53 (45, 57) Control, 54 (45, 59); External comparison 54 (45, 62). The linkage of CPRD with HES suggested no increase in hospital admissions following the intervention.

Conclusion

Cluster randomised trials may be implemented successfully, with large numbers of participants, using a primary care electronic database. Remote delivery of interventions to practices is feasible but future development of more effective interventions is required.
PP41 Alcohol-Related ‘risk Factors’ Predict Under-Reporting of Alcohol Consumption more than Socio-Demographic Factors: Evidence from a Mixed-Methods Study
Authors: Boniface S , Kneale J , Shelton N
Published: September 2013

Background

Under-reporting of alcohol consumption is widespread: surveys typically capture only 40-60% of alcohol sales. Little is known about the population distribution of under-reporting.

Methods

This study uses mixed methods to identify social, demographic, and alcohol-related ‘risk factors’ for under-reporting, using the nationally-representative Health Survey for England (HSE) 2011. Two methods of measuring alcohol consumption were used: a retrospective computer-assisted personal interview (CAPI), and a seven-day drinking diary (n = 5,040 adults, 55% women). Predictors of an individual’s diary being greater than the CAPI were identified using multivariate linear regression. Three outcomes were investigated: drinking days in the week recorded, heaviest drinking day in the week recorded (in UK units), and weekly alcohol consumption (in UK units). Qualitative semi-structured interviews (n = 10) were conducted with HSE 2011 participants who completed the drinking diary in participants’ homes or workplaces. Emergent themes were identified to reveal additional ‘risk factors’ for under-reporting.

Results

Number of drinking days was similar in the diary and the CAPI. The diary estimates were higher than those of the CAPI for heaviest drinking day in the week recorded (0.7 units greater among men, 0.8 units among women), and weekly alcohol consumption (2.9 units greater among men, 3.0 units among women).Unfortunately, the results from the quantitative study are embargoed until the HSE 2011 dataset is deposited in the UK Data Archive in spring 2013. I am happy to update this section once the embargo has been lifted.The qualitative interviews identified having a non-routine drinking pattern, perception of the self as a less frequent drinker, and usually tracking drinking using qualitative approaches as being linked to experiencing surprise at the diary.

Conclusion

Heavier drinking and more ‘chaotic’ drinking patterns may be associated with under-reporting of alcohol consumption. Estimates of the prevalence of drinking above the recommended levels, hazardous levels, or even harmful levels that are based on self-reported consumption may be disproportionately under-estimated.
PP42 The Influence of Parental Monitoring and School Environment on Adolescent Alcohol Use
Authors: McCann M , Higgins K , Perra O , McCartan C , McLaughlin A
Published: September 2013

Background

The importance of social determinants of adolescent health behaviour such as alcohol use has stimulated interest in family and school environments that may act as risk or protective factors. This study looked at characteristics of schools and parents, and how they influence young people’s alcohol use.

Methods

The Belfast Youth Development Study began in 2000. It surveyed secondary school children annually for five years of compulsory schooling, and two further years (age 16/17 & 21/22). This study is based on data from the first five data sweeps. We used the Stattin & Kerr parental monitoring measures, and alcohol use coded as: rarely/never, infrequently, monthly or less, weekly or more.

Phase 1: Cross-lagged structural equation models assessed bi-directional associations between parental monitoring and subsequent alcohol use.

Phase 2: Multilevel regression models assessed between-school variation in alcohol use frequency and the effect of parental monitoring.

Phase 3: Structural equation models assessed the effect of parental attachment and parental monitoring, and how these two factors interacted to influence alcohol use.

Results

Analysis was based on 4,775 respondents attending 38 schools, the proportions drinking weekly or more frequently in each of the five years of the study were 4%, 11%, 21%, 27% and 34%.

Phase 1: Parental monitoring was protective against frequent alcohol use (OR = 0.76, p < 0.01). More frequent alcohol use was also associated with lower parental monitoring to a lesser extent (b = -0.04 p < 0.05).

Phase 2: Around 6% of the variation in alcohol use was attributable to differences between schools. The effect of parental monitoring on alcohol use varied widely between schools (OR 0.70 [95% coverage interval 0.52, 0.93]).

Phase 3: Higher parental monitoring, and better parental attachment were protective against alcohol use. Better parental attachment was also associated with lower levels of parental monitoring; this meant better parental attachment was indirectly associated with higher frequency of drinking due to its effect to reduce monitoring. The combination of these two opposing influences led to parental attachment having zero overall influence on alcohol use.

Conclusion

School and home environment play an important role in shaping young people’s health risk behaviours. What these findings show is that the school environment may influence the extent to which parental behaviours can successfully reduce risk behaviour. While parent-child attachment may provide an important role for overall social functioning, improving monitoring behaviour may have a greater influence on alcohol use than improving attachment.
OP14 Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Syria
Authors: Wilcox M , Mason H , Fouad F M , Rastam S , Ali R Al , Capwell S , O’Flaherty M , Page T F , Maziak W
Published: September 2013

Background

Coronary heart disease (CHD) and stroke account for approximately half of all-deaths in Syria. The country’s CHD mortality rate has escalated by nearly two-thirds between 1996 and 2006, partly reflecting substantial increases in systolic blood pressure (SBP). In high income countries, reduction of dietary salt intake represents a cost effective means of decreasing CHD events via reduced SBP levels. This study aims to assess the potential costs and benefits of implementing contrasting salt reduction policies in Syria, with particular emphasis on the feasibility of policies within the country’s socioeconomic and political realities.

Methods

A projected 10-year period cost-effectiveness analysis of salt reduction policies was conducted comparing three different approaches: health promotion campaign about salt reduction, labelling of salt content on packaged foods, reformulation of salt content within packaged foods, or a comprehensive strategy involving all three approaches. The incremental cost of a policy was calculated as the sum of CHD-related savings in healthcare costs and the costs of implementing and monitoring the policy, with costs presented in international dollars using 2010 purchasing power parity (PPP) exchange rates. Benefits were defined as life years gained (LYG) due to fewer CHD events. Data sources included existing national resources, international literature, and interviews with local food producers, manufacturers, and government agencies. The effect of salt reduction on SBP was based on review of the literature. Health care costs, LYG and expected CHD events were calculated using the IMPACT CHD model. Sensitivity analyses were conducted to account for the uncertainty in the reduction of salt intake.

Results

All policy combinations resulted in LYG when compared to no policy. Health promotion and labelling of salt content were both associated with low private sector costs and large healthcare savings. This resulted in cost savings for both policies alone and the comprehensive approach combining all three policies. Reformulation alone, reformulation plus health promotion, and reformulation plus labelling were not cost saving due to high private sector costs associated with reformulation (+PPP $96,000,000). However, the three policy approaches were very cost-effective with incremental costs of $5453 PPP, $2125 PPP, and $2201 PPP per LYG, respectively (well below the region’s established cost effectiveness threshold of PPP$12,250).

Conclusion

All salt reduction policies analysed resulted in a reduction of CHD deaths and were either cost-effective or even cost saving. This paper will provide further details concerning the feasibility of such policies in the context of a developing country.
PP43 Feasibility and Acceptability of a Brief Intervention to Reduce Alcohol Consumption in Sexual Health Clinic Attendees
Authors: Dimitrov B D , Sundaram S , Roderick P , Frater A , Leydon G , Sheron N , Dewhirst S , Tucker L , Maskell J , Chatwin J , Harindra V
Published: September 2013

Background

Alcohol misuse and poor sexual health are closely related Hazardous drinking is more prevalent in sexual health clinic (SHC) attendees than in the general population leading to risky sexual behaviours. Little data exists on the feasibility of integrating a Brief Intervention (BI) into the sexual health consultation.

Methods

The aim was to assess the feasibility and acceptability of a brief intervention to SHC attendees. SHC attendees (≥ 16 years) were screened using the short Alcohol Use Disorders Identification Test (AUDIT) - Consumption (C) questionnaire (AUDIT-C). Males scoring ≥ 5 and females scoring ≥ 4 were randomised to either receive BI or usual care (UC) which included a standard alcohol leaflet. Clinical staff members were randomised to receive BI training. Patients saw only trained staff in BI arm and non-trained staff in UC arm. Patients completed full AUDIT questionnaire, alcohol diary and questions on sexual behaviour at baseline and follow-up. Follow-up at 6 weeks and 6 months was largely by phone interviews. A sample of consultations was audio-recorded for intervention fidelity check. Patients with AUDIT score >15 were initially excluded; this was subsequently relaxed to a score > 20.

Results

Out of total 664 patients screened, 215 were eligible for randomisation and 207 were included in the final analysis - 103 (BI) and 104 (UC). Mean age was 25 years, 66% were female, most were white, nearly 50% were employed fulltime and 27% were students. Follow-up sample at 6 weeks and 6 months was 54% and 47%, respectively, being slightly higher in the UC group, although not statistically significant at either time. Both groups reduced their alcohol consumption significantly, but the total alcohol units/week fell more sharply in UC (p < 0.05). There was no significant difference in sexual behaviour between the groups though an evidence of decrease over time in the frequency of partners was seen in both groups. The fidelity check showed that BI was delivered as intended and increased consultation time by an average of 5 minutes. The staff found it acceptable and appropriate for the SHC setting.

Conclusion

The brief intervention for alcohol misuse is feasible and acceptable in a SHC. The study was not powered to detect outcome differences. Screening alone was sufficient to influence drinking and sexual behaviour in both groups. Further research to optimise this intervention is needed in those drinking most heavily.
PP45a Use it, Don’t Lose it! The Role of Lifestyle Behaviours on 20-year Cognitive Decline
Authors: Cadar D , Pikhart H , Mishra G , Stephen A , Richards M
Published: September 2013

Background

Cognitive decline represents a major public health impact on individuals and governments around the world. There is a well-established relationship between specific lifestyle behaviours and cognitive decline, but extremely limited research on the role of combined behaviours. The aim of these analyses was to examine the role of lifestyle behaviours (smoking, physical activity and dietary choice) separately and in combination on 20-year cognitive decline from from age 43 years to 60–64 (60+) years in a prospective longitudinal population-based study.

Methods

Participants were 1018 study members from the UK MRC National Survey of Health and Development regularly followed up since birth in 1946. Cognitive functioning was measured at age 43 years and 60+ years using tests of verbal memory (maximum words recalled 45) and timed visual search (maximum letter searched 600). Lifestyle behaviours were examined at 36 & 43 years and overall early-midlife scores were calculated. Smoking was classified as non-smoker, moderate or heavy smoker (20+ cigarettes per day). Physical activity was classified as inactive, moderate or mostly active (> 5+ activities/month). Dietary choice was classified as high/low quality diet based on breakfast consumption, type of milk & bread, daily portions of fruit and vegetables and energy derived from fat. The covariates included in these analyses were social class of origin, childhood cognition, education, adult social class and depression.

Results

Key findings were that high quality dietary choices made in early-midlife were associated with slower memory decline β = 0.64 (95% CI 0.05 to 1.24) as compared to low quality dietary choices, and most active levels of physical activity were associated with a slower visual search speed decline β = 13.45 (2.43 to 24.47) compared to those who were inactive. Heavy smoking was marginally associated with faster decline in visual search speed compared to non-smokers, but not with memory decline. These associations were independent from each other in terms of lifestyle behaviours as well as from the selected covariates.

Conclusion

The current results suggest that physical activity and healthy dietary choice are protective of cognitive decline, and that smoking is harmful in this respect. Public health interventions based on modifiable lifestyle behaviours across the life course represent high level priorities and should be regarded as an important line of defence against cognitive decline and dementia.
PP46 Screening and Alcohol Brief Intervention in Antenatal Care: A Realist Evaluation
Authors: Doi L , Jepson R , Cheyne H
Published: September 2013

Background

In an effort to protect the health and safety of the unborn child, the Scottish Government in collaboration with National Health Services (NHS) Health Scotland implemented screening and alcohol brief interventions (ABIs) in a range of health care settings, including antenatal care setting. Yet while there is strong evidence of the benefits of screening and ABIs in reducing hazardous and harmful drinking among primary care population, evidence of their effectiveness with the antenatal care population is limited. Further, the few studies evaluating screening and ABIs in antenatal care settings have tended to rely on randomised controlled trials which often produce inconsistent findings regarding their effectiveness. Moreover, they do not give adequate account of why the intervention worked or not. Realist evaluation focuses on which aspects of the intervention work for whom, how and under what circumstances. In this study we aimed to use realist evaluation design to increase understanding of the factors likely to influence the effectiveness of the recently implemented screening and ABIs in Scottish antenatal setting, delivered at the first antenatal visit.

Methods

The study employed a realist evaluation methodology, where a priori program theories were first identified through systematic reviews and face-to-face policy implementers’ interviews data. The program theories were tested and later refined using interviews and focus group data with pregnant women and midwives. The qualitative data was analysed by thematic content analysis.

Results

Training and resources provided to midwives improved their skills and confidence. However, as many of the women reported to have reduced or abstained from alcohol in pregnancy, most of the midwives had not subsequently employed the motivational interviewing skills acquired from training. Midwives’ confidence therefore decreased leading to missed opportunities to appropriately deliver ABIs to eligible women. Further, it negatively affected midwives’ attitudes as they then accorded ABIs low priority in their workload. Lack of adequate rapport at the first antenatal interview also led to women providing socially desirable responses to alcohol consumption questions.

Conclusion

As trust-based relationships are essential to effective screening and ABI delivery, delivering them at the first antenatal visit when they are likely to make the most impact, may be particularly challenging and may require adequate motivational interviewing skills. However, the limited number of ABI delivered in antenatal care require that midwives may need on-going support to sustain their motivation and skills in order to ensure benefits for the few pregnant women who are drinking at hazardous and harmful levels.
PP47 The Cost of Overweight and Obesity on the Island of Ireland
Authors: Dee A P , Perry I J , O’Neill C , Doherty E , Callan A , Kearns K , O’Dwyer V , Staines A , McVeigh T , Sweeney M R , Sharp L , Balanda K , Hughes J , Kee F
Published: September 2013

Background

Overweight and obesity are increasing in prevalence worldwide In Ireland, their prevalence makes up over 60% of the population. The incidence of many chronic diseases, and some cancers, is increased in those who are overweight and obese. This places pressure on the health service, financially and otherwise. There is also a cost on society in terms of productivity loss. Many countries have studied the costs involved, but as each country has a unique profile of risk prevalence and health service, the costs are country specific. In order to inform prevention policies and ignite political will in the public health battle against obesity, the measurement of direct and indirect costs of overweight and obesity is a useful exercise. This study was a collaborative effort to enumerate these costs for the island of Ireland.

Methods

A comprehensive literature review was performed examining the international evidence on cost of overweight and obesity. Regression analyses of data from SLAN and TILDA in the Republic of Ireland, and The 2010/11 Health Survey for Northern Ireland were performed to give estimates of direct health care costs in both jurisdictions, and of indirect costs due to absenteeism. In addition, Population Attributable Fractions were applied to hospital activity, drug reimbursement, social welfare and mortality data for both jurisdictions to give additional information where no survey data were available, and to triangulate results. Adjustments were made for inflation and purchasing power parity to allow for the production of an estimate in one currency for a single year.

Results

The literature review yielded 45 studies and showed heterogeneity of methodology between studies. However, in almost all cases there was a positive correlation between obesity and increased healthcare costs, and indirect costs were in all cases greater than direct costs. The cost of overweight and obesity for the Republic of Ireland was estimated to be €1,166,050,482 and for Northern Ireland it was €510,323,754 for the year 2009. Direct healthcare costs represented 38% of the total, and 2.9% of total healthcare spend in the Republic of Ireland and, in Northern Ireland, 25% of the total and 2.8% of total healthcare spend.

Conclusion

Urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity. The cost of associated chronic disease is substantial, and if prevalence rates continue to rise, will cause unsustainable health service cost escalation, and productivity losses to the wider economy.
PP53 Predictive Risk Modelling of Childhood Overweight or Obesity at age 10-11 years: An Epidemiological Analysis of National Child Measurement Programme and Birth Notification Data
Authors: Gilchrist K , Memon A
Published: September 2013

Background

Although childhood overweight and obesity rates have been falling in England in recent years, they remain an important public health concern because of the association between adolescent obesity and increased ill health risks in adult life including an increased risk of mortality from all causes independent of adult weight. Early intervention is important since behaviours contributing to obesity, higher energy diet and increased sedentary behaviour, are also prevalent during early childhood. We have conducted an epidemiological analysis of routine data collected at birth to examine the factors associated with overweight and obesity in children aged 10-11 years.

Methods

Administrative records of children in aged 10-11 years, measured between September 2006 and July 2010, as part of the National Child Measurement Programme in a large area on the South East coast of England were examined. Of the 19,924 children in the study with a valid height and weight measurement, 29% were overweight/obese. Factors identified from the literature as potential predictors of childhood overweight or obesity were extracted, where recorded. These are age; birth weight; gender; maternal smoking; previous live births; multiple birth; mother’s age; and Index of Multiple Deprivation quintile.

Results

Factors independently associated with an increased risk of overweight or obesity included deprivation (OR 1.6 [95% CI 1.4, 1.9]) (children born in most deprived areas compared with least deprived), regular maternal smoking during pregnancy (1.3 [1.2, 1.4]) and high brith weight (1.5 [1.2, 1.9]). Low birth weight (0.8 [0.7, 0.9]), being female (0.8 [0.8, 0.9]) and maternal age <20 years (0.7 [0.6, 0.9]) were independently associated with a reduced risk of childhood overweight/obesity. There was a significant participation bias by gender, with girls less likely to be measured which may explain the apparent protective effect for girls. This finding could impact on the results of the NCMP nationally if also found elsewhere. The predictive model, whilst significant, did not discriminate well at the population level. The limited set of data recorded before 2003 restricted the factors which could be included in the model. With better recording of factors such as breastfeeding and ethnicity there is potential to enhance the model in the future.

Conclusion

Factors associated with childhood overweight and obesity at age 10-11 were neighbourhood deprivation, regular maternal smoking during pregnancy and high birth weight. Potential protective factors include low birth weight and young maternal age. Early intervention in tackling inequalities and maternal smoking in pregnancy are important strategies to help reduce childhood overweight and obesity.
PP58 Prevention of Stroke following a TIA – who Receives Care? A descriptive study of Patients Referred to TIA Clinics between 2007-2010 in a NHS Foundation Trust
Authors: Campbell F , Croot E , Read J , Ryan T , Venables G
Published: September 2013

Background

A TIA can offer a vital warning to the risk of a disabling or fatal stroke. Appropriate help seeking behaviour, followed by referral to TIA services allows diagnosis and treatment of conditions that are major risk factors for stroke such as hypertension, as well as opportunities to alter behavioural risk factors. The incidence, and prevalence of stroke and the risk of mortality following stroke is substantially higher in patients from lower socioeconomic groups. This study sought to explore access to TIA prevention services following a TIA, in order to understand the profile of patients both represented and underrepresented and also the patterns of referral that enable patients to access prevention services.

Methods

Routine hospital data was collected and anonymised. Analysis was performed using Microsoft excel and SPSS software. Collected data included patient’s age, ethnic origin, sex and socioeconomic status as measured by Index of Multiple Deprivation. It also included source of referral and the time between referral and being seen in clinic.

Results

Over the three years, 3069 patients attended TIA clinics, including patients who were later found to have alternative diagnosis but had suffered symptoms suggestive of a TIA. More women (n = 1613) were seen than men (n = 1456). Risk of stroke is higher in men, and this disparity is seen both nationally and locally. Our data suggests that men are not help seeking following symptoms of a TIA as responsively as women. The mean age of patients was 69.6 years. The majority were ‘British white’ (97%), only 3% described themselves as members of minority ethnic groups. The proportion of the population in Sheffield from ethnic minority groups is 7.2%. Again this would suggest that members of these groups are not responding to TIA symptoms and seeking help, enabling appropriate referral or alternatively not being appropriately referred after seeking help. Rates of referral from more deprived areas were also lower than projected figures would predict. The majority of referrals to secondary care following a TIA came from general practitioners (60%), suggesting that most patients do not see their symptoms as an emergency ((7%) were referred via emergency services).

Conclusion

Our research suggests that targeted work addressing help seeking behaviour amongst groups less well represented at TIA clinics might serve to address some inequalities in stroke. However, these differences in access of prevention services are not sufficient to explain the extent of the socioeconomic disparity in disease burden caused by stroke.
PP64 The Contribution of Media Analysis to the Evaluation of Environmental Interventions: The Commuting and Health in Cambridge Study
Authors: Kesten J M K , Cohn S C , Ogilvie D O
Published: September 2013

Background

The media has the potential to define the terms in which we think about the world, both reflecting and constructing reality. Media content can consequently increase people’s awareness of, and shape their interactions with, public health interventions. As part of a mixed-method, natural experimental evaluation of the travel, physical activity and health impacts of the Cambridgeshire Guided Busway (CGB), this paper analyses related print and social media (Twitter) to understand how the new infrastructure has become embedded in public discourse and the implications for evaluation.

Methods

Using systematic searches, newspaper articles from 2004 to 2012 were retrieved from the Lexis Nexus database and tweets from 2008 to 2012 were identified from an online archive. An inductive thematic analysis was performed and the interaction between Twitter and print media was explored by examining how print coverage was reconceptualised.

Results

The media facilitated the promotion of the CGB to non-bus users, for example by appealing to those who perceived buses to be uncomfortable through the publicising of features such as leather seats, free WiFi and air-conditioning. Passenger numbers and a transport award for innovation were publicised as markers of the interventions success. The process by which the CGB then became part of people’s everyday lives was reflected in references to shared experiences and familiarisation with novel aspects, such as railway-style ticket machines. Initial impressions were important, and if the anticipated immediate benefits — such as reduced journey times — were not realised, some users reported reluctance to use the service. The walking and cycling route alongside the busway received less media attention than the new bus service. The lack of lighting was defended by stakeholders as environmentally friendly, but criticised by the public, on Twitter and in print, on safety grounds. The Twitter content (including re-tweets and conversations) decoded the print media in a variety ways. By repeating, opposing and supporting messages, Twitter users frequently reconceptualised official media, for example using humorous puns such as ‘the mis-guided busway’. Through this process, print communication was often recontextualised to convey a different meaning.

Conclusion

Media content offers an indication of the public discourse surrounding an issue and can inform public attitudes, beliefs and behaviours. These findings contribute to further evaluation of the CGB, informing hypotheses about how the local population interact with the infrastructure, which will be explored further in interviews. Future natural experimental studies should acknowledge the media’s contribution to people’s experience, interpretation and acceptance of environmental interventions.
PP72 Does Investment in the Health Sector Promote or Inhibit Economic Growth?
Authors: Reeves A , Basu S , McKee M , Meissner C , Stuckler D
Published: September 2013

Background

Is existing provision of health services in Europe affordable during the recession or could cuts damage economic growth? This debate centres on whether government spending has beneficial or perverse effects on economic growth. We assessed the return on government investment by estimating the “fiscal multiplier” (number of PPP dollars returned in economic growth for each PPP $1 government spending).

Methods

Cross-national data on government expenditure among 25 EU countries from 1995 to 2007 were used to estimate fiscal multipliers using fixed-effects regression.

Results

The multiplier for total government spending was 1.61 (95% CI 1.37, 1.86). Results ranged widely across sectors, from -9.8 for defence (-16.7, -3.0) and 0.06 for economic affairs including bailouts (-0.71, 0.84) to 2.9 for social protection spending (1.9, 3.8) and 4.3 for health (2.5, 6.1). The degrees of domestic absorption of investment explain these differences. Tradable components of government spending, like defence, are linked to significantly more negative trade balance (β = -2.87, p = 0.02), whereas non-tradable areas of the budget, including health and education, had no such association (peducation = 0.22; phealth = 0.21).

Conclusion

Government spending on health may have short-term effects that make recovery more likely.
OP20 The Effects of Social Mobility on Blood Pressure at Ages 50 and 60 years- In the Newcastle Thousand Families Study
Authors: Howe N L , Mann K D , Pearce M S
Published: September 2013

Background

Many studies have suggested an association between early life circumstances and adult health. Relatively few studies have explored the effects on health of social mobility, the movement of an individual through social classes throughout their lifecourse. This study aimed to examine the effect of social mobility on blood pressure at age 50 and 60 years.

Methods

Using data from the Newcastle Thousand Families study, a prospective birth cohort, linear and logistic regression examined the potential association between social mobility, sex, Body Mass Index (BMI), smoking status, physical activity and hypertensive medication upon systolic and diastolic blood pressures at age 50 and 60 years.

Results

Upward social mobility was associated with decreased blood pressure, whilst downward mobility was associated with increased blood pressure, compared to socially stable individuals. Social mobility between 25-60 years significantly predicted systolic (P = 0.042) and diastolic (P = 0.041) blood pressure at age 50 years. Social mobility between 25-60 years was a significant predictor of systolic blood pressure (P = 0.044) after adjusting for sex, and diastolic blood pressure (P = 0.002), after adjusting for smoking status but was not significant after adjustment for BMI and physical activity. Social mobility between 50-60 years was significantly associated with high blood pressure at age 50 years (P = 0.009).

Conclusion

Social mobility between certain life stages may be predictive of blood pressure in later life. However, blood pressure is also influenced, to a greater extent, by confounding factors such as BMI.
OP22 Effectiveness and Equity Impact of Town-Wide Cycling Investment in England: A Longitudinal, Controlled Natural Experimental Study
Authors: Goodman A , Panter J , Sharp S , Ogilvie D
Published: September 2013

Background

In England, six Cycling Demonstration Towns received substantial, town-wide cycling investment from 2005 to 2011, as did 12 Cycling Cities and Towns from 2008 to 2011. The initiatives included a mixture of capital investment (e.g. cycle lanes, cycle parking) and revenue investment (e.g. promotional activities, cycle training). We examined the effects of these investments on the prevalence of cycling, walking and driving to work and whether and how those effects differed by socio-economic deprivation.

Methods

This controlled before-after natural experimental study used data on travel to work from successive decennial English censuses up to and including 2011. Our outcomes were the proportion of commuters reporting cycling, walking and driving as their usual, main mode of travel to work (‘commute modal share’). We measured pre-post changes among commuters living in the 18 intervention towns and compared these to changes in three comparison groups (matched towns, unfunded towns and a national comparison group) using the difference-of-differences method. We used the Indices of Multiple Deprivation to measure area deprivation at Lower Super Output Area level and used random-effects meta-analysis to compare effects across towns.

Results

Among 1.3 million commuters in the 18 intervention towns, the commute modal share for cycling rose from 5.8% in 2001 (pre-intervention) to 6.6% in 2011 (post-intervention). This represented a significant increase relative to all three comparison groups (e.g. difference-of-differences 0.64 percentage points (95% CI 0.56, 0.73) for intervention vs. matched towns). Walking to work also increased significantly in intervention towns versus comparison towns, while driving to work declined. These changes were observed across all fifths of area deprivation, with larger changes in deprived areas relative to comparison groups or national trends. There was, however, substantial heterogeneity between towns, with the overall positive effects being driven by large increases in a few large towns. The pooled town-level effect estimates were therefore non-significant (e.g. difference-of-differences 0.23 (-0.31, 0.8) for intervention vs. matched towns).

Conclusion

The proportion of commuters cycling to work has increased significantly in the intervention towns, while the proportion driving to work has decreased. The distribution of these changes appears relatively equitable, with the observed socio-economic differences being smaller than would otherwise have been expected given unfavourable background trends. The heterogeneity in effects between towns indicates uncertainty regarding the likely impact of comparable investment in future towns. Nevertheless these results support the case for considering and evaluating further town-wide cycling investment.
OP24 Are Fast Food Outlets Concentrated in more Deprived Areas? A Geo-Statistical Analysis of an Urban Area in Central England
Authors: Rudge G M , Suglani N , Saunders P , Middleton J
Published: September 2013

Background

The concept of an ‘obesogenic environment’ a term first used in 1997 has become embedded in Public Health and health geography research. Research suggests that deprived populations in Britain not only have worse access to sources of affordable, healthy foodstuffs, but they also appear to be more exposed to take-away outlets offering cheap, energy-dense food. However measuring the relationship between socio-economic factors and food geography is methodologically complex. This observational study has two aims. Firstly, to describe the availability of pre-prepared hot food in a large urban population, with reference to walk-time geography and secondly, to explore the association between access to take-away outlets and neighbourhood deprivation.

Methods

Using Geographical Information System (GIS) software, we measured access to fast food outlets from a large number of randomly generated points (n = 3803) in residential areas of two Local Authorities in central England. Two regression models were built. One modelled the relationship between deprivation and walking distance to the nearest outlet and the other modelled the relationship between deprivation and the number of outlets within a 640 metre ‘short walk’. Adjustments were made for interactions, road connectivity and population density.

Results

After adjustment for other variables, we found a statistically significant association (p < 0.001) between deprivation and fast food accessibility. Points in poorer neighbourhoods were closer to an outlet and had a greater density of outlets within a short walking distance. The effect size was modest however. Adjusting for other variables, our model predicted points at the 75thcentile of deprivation were about two minutes closer to the nearest outlet by foot, compared to points at the 25thcentile of deprivation (467 m, lcl = 455m, ucl = 480 m compared to 603 m, lcl = 588 m, ucl = 618 m). In the density analysis, our model predicts that there will be fewer than one outlet in a 640 metre walk where deprivation is at the 25th centile (0.84, lcl = 0.78, ucl = 0.91) and at least one in the same radius at the 75thcentile (1.41, lcl = 1.34, ucl = 1.48).

Conclusion

Many Local Authorities, including those in this study, have policies to restrict the growth of take-away outlets, especially near to schools. However we concluded that the existing food landscape already has an abundance of outlets and all neighbourhoods both deprived and less deprived have a large choice and ready access. This calls into question how effective planning laws will be in modifying the food environment.