bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP56 Differential Effects of Smoking Cessation During Pregnancy on Birth Weight in a Cohort of Disadvantaged Women
Authors: Hayes CB , Kearney M , Collins C , O’Carroll H , Wyse E , Geary M , Kelleher CC 
Published: September 2012

BackgroundSmoking during pregnancy is recognized as the most important preventable risk factor. Maternal smoking accounts for 20–30% of low birth weight infants (<2,500g), the most common adverse outcome in pregnancy. The objective of this study was to explore the effects of maternal smoking habits: stopping smoking in the first and second trimesters, continuing to smoke, number of cigarettes smoked and socio-demographic factors on infant birth weight.MethodsThe study was a longitudinal cohort study of 1,000 pregnant smokers attending public hospital clinics in a disadvantaged catchment area at first pre-natal visit (V1), and assessed at 28–32 weeks (V2) and at one week after birth (V3) using an interviewer-administered questionnaire. The primary outcome variables were: change in smoking status based on self-reported response and urinary cotinine measurement for those who had quit. ANOVA was carried out to test for differences in mean birth weight. A multiple regression analysis with birth weight as the dependent variable was carried out on demographic and smoking characteristics and derived smoking category variables at V3: sustained quitters, continued smokers, successful quitters at V3 and intermittent quitters.ResultsThe mean difference in birth weight between continued smokers and sustained quitters was significant, (mean difference = 233g, 95% CI=60 – 406g, p=0.008), as was the difference between continued smokers and intermittent quitters (mean difference = 202g, 95% CI =17 – 386g, p=0.03). Regression on baseline variables showed that only 2.4% of the variance (R2) was explained by smoking characteristics; that is, number of smokers in the home other than self or partner (p=0.008) and number of cigarettes smoked per day (p=0.02). A second regression model showed gestation at delivery to be the best predictor of birth weight (R2=44.2). The number of cigarettes smoked at V2 explained an additional 2.1% (p<0.001) and being a sustained quitter 0.5% (p=0.02).ConclusionIn this study a clear gradient was observed around smoking behaviour and birth weight with continued smokers having infants with lowest birth weights, sustained quitters the highest and intermittent quitters somewhere in between. The study also demonstrated that the negative effects of maternal smoking on birth weight are at least partly reversible. It thus showed a beneficial effect of quitting smoking for at least part of pregnancy and a link between passive smoking and birth weight. These findings are important for the delivery of targeted health promotion messages to smoking women in early pregnancy.
OP58 Is the Excess Risk of Myocardial Infarction Among People with Diabetes Falling Over Time?
Authors: Hardoon SL , Whincup PH , Petersen I , Morris RW 
Published: September 2012

BackgroundIncidence of myocardial infarction (MI) in the UK general population has declined considerably in recent years. However it is unclear whether the decline in MI risk has occurred among people with diabetes. People with diabetes have an estimated two-fold excess risk of MI, compared to those without diabetes. A differential trend in MI incidence among diabetic patients could correspond to a rise or fall in this excess risk, which has implications for prognosis and management of diabetes. We compared recent trends in MI incidence among those with and without diabetes in a representative UK population sample, and estimated the excess risk of MI among diabetic patients in different calendar periods.MethodsThe population sample comprised 2,927,137 patients (49% men) aged 30 years and over, with no prior MI, from 434 general practices belonging to The Health Improvement Network (THIN) UK-wide primary care database in 1995–2008. Incidence of MI in 1995–1998 was compared with that 10 years later in 2005–2008. Rate ratios comparing incidence over these intervals were estimated from multi-level Poisson regression (patients nested in practices), with an indicator for time interval as a covariate, adjusting for age and gender, with practice as a random effect. An interaction between time interval and an indicator for diabetes was used to assess whether the rate ratios comparing intervals differed among those with and without diabetes, and equivalently whether the excess relative risk among diabetic patients has changed over time.ResultsIn 1995–1998 age-standardised incidence rates for MI (per 1000 person years) among those without and with diabetes were 3.22 (95% CI 3.10–3.34) and 9.56 (8.42–10.7) respectively. In 2005–2008, corresponding incidence rates were 1.47 (1.44–1.50) and 4.43 (4.23–4.65). Among people without diabetes, the rate ratio comparing incidence in 2005–2008 with 1995–1998 was 0.46 (0.44–0.48). Among people with diabetes, the corresponding rate ratio was 0.31 (0.28–0.35), indicating a greater decline in MI incidence over the period (p<0.001 for interaction between interval and diabetes). Correspondingly, the rate ratio comparing incidence among those with diabetes to those without diabetes was attenuated from 2.70 (2.42–3.02) in 1995–1998 to 1.90 (1.80–2.00) in 2005–2008. Gender-specific analyses revealed the attenuation of the relative risks to be significant among both women and men.ConclusionThe excess risk of MI among diabetic patients appears to be falling over time. However, despite their improved prognosis, people with diabetes remain at a considerable excess risk of MI, emphasizing the need for continued concerted efforts to manage diabetes.
OP59 Do Demands and Worries from Close Social Relations Increase the Risk of Subsequent Incident IHD Hospitalization? A 7 Year Longitudinal Study of Middle-Aged Danish Men and Women
Authors: Lund R , Rod NH , Thielen K , Christensen U 
Published: September 2012

BackgroundThe association between support from social relations and ischemic heart disease is well described, however the possible hazardous effects of negative aspects of social relations on cardiovascular health are less well known. The purpose of the present study was to analyze the possible influence of negative aspects of social relations (NASR) at baseline on the risk of development of ischemic heart disease (IHD) defined as incident hospitalized cases of acute myocardial infarction and chronic IHD during 7 year follow-up. NASR were defined as demands or worries from partner, children, family, and friends.MethodsParticipants were included in a questionnaire-based study in 2000 and were a random sample (N=6767) of Danish men and women aged 40 or 50 years by October 1st 1999 from the Danish Longitudinal Study on Work, Unemployment and Health. Data for the present study are based on baseline questionnaire data in 2000 and register linked data from the period 2000–2007 on hospitalization for IHD (ICD10: I21–25). Cases of IHD (I21–25) four years prior to baseline were excluded from the analyses. In total 127 new cases of IHD were identified during follow-up.ResultsMen who always or often experienced worries or demands from their partner had an increased risk of incident IHD compared to those who seldom/never experienced worries and demands HR(95%CI)=2.28(1.14–4.53) adjusted for age, socioeconomic status, cohabitation status, depressive symptoms, smoking and emotional support from all social relations . There was no association between demands/worries from partner and risk of development of IHD among women. Both men and women who experienced frequent worries and demands from their family (other than partner and children) were at increased risk of IHD HR=1.76(1.10–2.81) adjusted for above mentioned covariates and gender. Demands and worries from children and friends were not associated with significantly increased risk of IHD although estimates were in the same direction as for demands/worries from partner and family.ConclusionFor men, frequent demands and worries from a partner seem to be associated with increased risk of incident IHD hospitalization during 7 year follow-up. Demands/worries from family are risk factors for both women and men. Adjustment for the level of social support from all social relations did not change these conclusions. These findings confirm earlier findings of an association between NASR and self-reported angina pectoris. The weaker findings for women may partly be explained by the substantially smaller number of cases in this middle-aged cohort.
OP62 The Influence of Prenatal Maternal and Paternal Anxiety and Depression on Cardiovascular Biomarkers in the Child at age 10: Findings from the Avon Longitudinal Study of Parents and Children (ALSPAC)
Authors: Dawe K , Dijk AE Van , Stronks K , Gemke RJBJ , Vrijkotte TGM , Eijsden M Van , Lawlor DA 
Published: September 2012

BackgroundThe aim of the current study was to investigate whether exposure to prenatal maternal anxiety and depression influenced later offspring glucose, lipid and inflammatory markers via intrauterine mechanisms.MethodsData from a prospective birth cohort based in the South West of England were used. Our analysis included 2839 mother-children duos and 2361 father-child duos for outcomes assessed at mean age 9.9 years (non-fasting cholesterol, triglycerides, low density and high density lipoprotein cholesterol (LDLc and HDLc), C-reactive protein (CRP) and interleukin 6 (IL–6) and 2011 and 1726 parent-child duos for outcomes at mean age 15.4 years (fasting glucose, insulin, lipids and CRP). We compared associations of maternal exposures with offspring outcomes to those of the same paternal exposures with offspring outcomes. The rationale for this comparison was that if maternal depression/anxiety influenced offspring outcomes via intrauterine mechanisms we would expect stronger maternal compared with paternal associations. We also examined whether any association of exposures during pregnancy reflected a postnatal effect, with persistence of depression/anxiety into the postnatal period.ResultsMaternal anxiety at 18 and 32 weeks gestation, and maternal depression at 32 weeks gestation were associated with increased CRP in children at 9.9 years (mean difference (95% CI): 0.031 (0.005 to 0.057), 0.030 (0.004 to 0.056), and 0.021 (0.003 to 0.040) respectively), but not at 15.4 years. These associations remained when adjusting for potential confounders (maternal age, ethnicity, pre-pregnancy BMI, parity, social class, smoking and alcohol consumption). Paternal anxiety and depression (measured at 18 weeks gestation)were also associated with increased CRP in children at 9.9 years (mean difference (95% CI): 0.039 (0.003 to 0.076) and 0.026 (0–0.052) respectively), but not at 15.4 years. The magnitudes of the paternal associations were similar to those seen in mothers. Maternal and paternal postnatal depression/anxiety symptoms were also associated with offspring CRP at age 9.9 and appeared to explain much of the antenatal association.There were no consistent associations between maternal or paternal anxiety or depression during the antenatal or postnatal periods and any of offspring glucose, insulin, IL-6 or lipids at either age.ConclusionWe have found evidence of a relationship between maternal and paternal anxiety and depression during pregnancy and CRP levels in childhood, which does not persist to adolescence. Our results suggest that these associations are unlikely to be explained by intrauterine mechanisms and may be explained by shared familial confounding or postnatal effects.
OP65 Parent Understanding and Management of Rtis in Children: Implications for Health Practitioner Communication
Authors: Cabral CL , Horwood JP , Hay AD , Ingram JC 
Published: September 2012

BackgroundRespiratory tract infections (RTIs) are among the commonest reason parents consult their GP, representing a significant burden on primary health care services. Many of the symptoms associated with RTIs are a cause of anxiety for parents, but they are often unsure when to consult. This study investigated parents’ experiences of consulting for RTI in their child as part of a wider TARGET programme to improve the care of children with RTIs.MethodsParents were recruited through 6 practices in areas of high, middle and low deprivation to capture a range of patient populations. Parents with a child aged between 3 months and 12 years who had consulted for acute RTI within the previous 3 months (excluding children with serious or chronic health problems) were invited to participate. Sampling ensured that parents with younger and older children and parents who were more or less frequent consulters were sampled. Semi-structured interviews explored parent’s experience of consulting for RTIs in their children, information and advice needs; and their understanding of RTIs and treatment options. Interviews were audio-recorded, transcribed and imported into NVivo8 for coding. A thematic analysis was conducted using constant comparison techniques.ResultsThirty parents were interviewed and the sample captured a range of socio-economic backgrounds, both single and double parent families, with between 1 and 4 children. Consultation rates ranged from 1 to 24 times per year. New parents often had little knowledge of RTIs in children; felt uncertain about which symptoms might indicate a serious illness; and were surprised at how long a RTI could persist for and how frequently a child could get a RTI, particularly in the first years of life. This was true for parents from all socio-economic backgrounds and with different levels of education. When consulting, parents were often seeking a medical assessment and reassurance. However, parents felt that clinicians were often dismissive and had not properly evaluated the child, often leading to re-consultations. In addition, clinician explanations of diagnosis and treatment recommendations were not well understood by parents, and they remained unclear about how to manage an RTI and when to consult.ConclusionParents’ poor knowledge and un-realistic expectations in relation to RTIs in children contribute to high rates of consultation. Despite awareness of parental perspectives, there remains a problem with parent-HP communication in relation to key information needed by parents to manage child’s illness confidently and know when to consult in future.
OP66 A Profile of Undiagnosed Diabetics in the Community: Results from the Boston Area Community Health (Bach) Pre-Diabetes Survey
Authors: Piccolo RS , McKinlay JB , Marceau LD 
Published: September 2012

BackgroundResearch suggests almost 30% of the United States population has undiagnosed diabetes and that diabetics typically have the disease for 4 to 7 years before eventual diagnosis. Delay in initial diagnosis results in greater diabetes-related complications, poorer patient outcomes, and reduced quality of life. Most diabetes research is necessarily confined to diagnosed diabetes. Our objective was to identify risk factors for remaining undiagnosed.MethodsThe Boston Area Community Health (BACH) Pre-Diabetes study is an ongoing community-based random-sample cohort study that has enrolled 2,974 participants to date. Participants were asked to fast for 8 hours prior to their interview. Fasting glucose (FG) and glycated hemoglobin (HbA1c) were collected during in-home interviews. Undiagnosed diabetes was defined as FG >125 mg/dL or HbA1c ≥ 6.5%. Risk factors were organized into four logical groupings: 1) socio-demographics, 2) lifestyle/behavioral, 3) utilization/access to healthcare, and 4) health status/comorbidities. Logistic regression was used to estimate the odds ratio (OR) for diagnosed vs. undiagnosed diabetes.ResultsThe prevalence of diabetes in the BACH study was 27.8% (n=827). 21.2% of diabetes cases were undiagnosed. The data indicate that healthcare utilization and the presence of co-morbid conditions had a large impact on diabetes diagnosis. Participants who visited a health care provider 5 or more times in the past year were 90% more likely to be diagnosed (OR=1.9, p<0.001) than participants who had 5 or fewer visits. Participants with a history of high cholesterol were more than twice as likely to be diagnosed (OR=2.7, p<0.001). High blood pressure or a history of heart disease also increased the likelihood a participant was diagnosed. Participants with a documented family history of diabetes were more likely to be diagnosed (OR=2.9, p<0.001). Finally, English-speaking participants were more than twice as likely to be diagnosed (OR=2.6, p=0.01) than their Spanish-speaking counterparts.ConclusionUndiagnosed diabetes is highly prevalent problem in the United States that leads to poorer patient outcomes and significant health-care costs. These results indicate that access to care, health care utilization and the presence of co-morbid conditions have an important impact on diabetes diagnosis. Individuals who do not have the traditional risk factors for diabetes (i.e. family history) have a greater risk of remaining undiagnosed. These findings suggest that improving access to care in the United States may greatly increase the likelihood of diagnosing previously undiagnosed diabetes.
OP69 The use of NHS Routine Data to Analyse The Effects of Healthcare Interventions
Authors: Cecil E V , Soljak M , Osipovic D , Peckham S , Majeed A 
Published: September 2012

BackgroundIn 2007, the strategy ‘Healthcare for London’ planned the establishment of polyclinics in each PCT to help improve the primary care infrastructure. These polyclinics serve as a hub for a group of GP practices which combined form a polysystem. We aimed to investigate the impact of services provided in a polysystem on unplanned (emergency) admissions, using routine NHS activity data. In one polysystem case study, a pulmonary rehabilitation service for COPD was established. In another, a diabetes patient education programme was offered.MethodsWe used routine Hospital Episodes Statistics inpatient data from 2004/5 to 2009/10 covering around 1500 London practices. Differences in adjusted trends in emergency admission rates were compared between the polysystem GP practices case studies and other London practices. Multilevel regression models assessed standardized rate ratios, controlling for year variation, GP practice and population factors. We incorporated interaction terms to allow the effects of the polysystem to vary independently by year.ResultsOver the study period COPD emergency admission rates fell across London with a yearly admission rate ratio of (95% CI) 0.98 (0.97, 0.99, p<0.001). The rates in the study polysystem did not differ from the rest of London at baseline and there was not enough evidence to suggest that the introduction of the polysystem service in May 2007 had any effect on the admission rates. A total of 12% of the registered COPD population was seen as new contacts in the first year of the service.Diabetes emergency admission rates have been falling across London over the study period with a yearly admission rate ratio (95% CI) of 0.98 (0.96, 0.99, p=0.001). In the first year of the diabetes intervention, the rate of emergency admissions for diabetes fell by 80% in patients from the polysystem practices compared with London, with an interaction factor (95% CI) of 0.20 (0.13, 0.31) p<0.001 and this fall was maintained in the following year. Intervention in this London Polysystem covered 70% of the diabetic population. The power to detect an effect was increased due to the coverage.ConclusionNHS routine data can be used to assess the impact of health service interventions that are aimed at reducing admissions. Commissioners must be aware that to assess the impact of interventions, the implementation needs to be on a large scale and that medium term follow up is required in order to study the trends.
OP71 Discriminating Clinical Outcome Models May Drift Unacceptably: Example of Cardiac Surgery Mortality
Authors: McAllister K , Hickey G , Grant S , Bridgewater B , Buchan I 
Published: September 2012

BackgroundClinical prediction models are used for different purposes, but purpose-specific validation is not usually carried out. The ability of a model to discriminate between true positives and false positives has applications in clinical decision making, screening, and service evaluation. The calibration (goodness-of-fit) of a model is a key indicator of how well a model’s predicted outcomes reflect those actually observed. Initial validation of models usually includes assessment of these features but re-evaluation over time might not be performed.EuroSCORE is an adult cardiac surgery risk model which has been in use since 1998. It predicts in-hospital mortality and is used for clinical decision making and service evaluation. It is widely acknowledged to have demonstrated ‘calibration drift’, but this has not been formally evaluated in the UK population.MethodsWe assessed the performance of EuroSCORE in the Central Cardiac Audit Database (CCAD), covering all NHS cardiac procedures in the UK. Discrimination was tested using the area under the Receiver Operator Characteristic (ROC) curve (AUC). Calibration was assessed with the Hosmer-Lemeshow goodness of fit test. In addition, we developed new models with longer-term outcomes using the data, and tested year-on-year model performance.ResultsA total of 399,314 eligible procedures from 1st April 1998 to 31st March 2011 were included in the analysis. Assessing the discrimination of EuroSCORE by financial year showed consistency across the period (AUC values ranging from 0.788 to 0.818). Model calibration, however, drifted considerably with a cumulative mortality over-estimate of 10,801 deaths by the end of the period (increasing from 147 over-estimated deaths in 1998 to 1,500 in 2010). This represented a predicted overall mortality rate of 6.0% compared with the observed rate of 3.4%. We will also present findings relating to year-on-year performance of a panel of models tailored to longer-term outcomes in specific procedures.ConclusionModels that retain accurate discrimination while undergoing calibration drift may be implemented in settings for longer than is appropriate. A model that maintains good discrimination may be useful in a subset of scenarios, but for most purposes good calibration is also crucial. For models developed for multiple applications, purpose-specific validation and recalibration should be considered. Model performance should be appraised in context and not by indicators in isolation.