bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP04 Persisting Gender Differences and Attenuating Age Differences in Cardiovascular Drug use for Prevention and Treatment of Coronary Heart Disease
Authors: Koopman C , Vaartjes I , Heintjes E M , Spiering W , Dis I van , Herings R M C , Bots M I 
Published: September 2013

BackgroundEvidence on recent time trends in age-gender differences in cardiovascular drug use is scarce. We studied time trends in age-gender-specific cardiovascular drug use for primary prevention, in-hospital treatment and secondary prevention of CHD.MethodsThe PHARMO database network was used for record linkage of drug dispensing, hospitalisation and population data to identify drug use between 1998 and 2010 in 1,206,469 persons ≥25 years eligible for primary prevention, 84,621 persons hospitalised for an acute coronary syndrome (ACS) and 15,651 persons eligible for secondary prevention.ResultsBetween 2003 and 2010, the proportion of women that used lipid lowering drugs for primary prevention was lower compared with the proportion of men (5.8% vs. 7.4% in 2010, P < 0.001). The higher proportion of women that used blood pressure lowering drugs in primary prevention, compared to men, attenuated over time (P < 0.001, 14.1% vs. 15.3% in 2010). During hospital admission for an ACS, the proportion of women that used cardiovascular drugs was lower compared to men. In long-term secondary prevention (36 months after hospital discharge) for ACS patients, drug use was lowest in young women. The proportion receiving lipid lowering drugs declined after the age of 75. This age difference attenuated over time (P < 0.001), however a marked decline in lipid lowering drug use after age 85 years remained in all three settings.ConclusionThe use of cardiovascular drugs for in-hospital treatment, primary and secondary prevention of CHD increased in recent years in the Netherlands. Age differences in drug use tended to attenuate over time, while gender differences persisted.
PP06 Cardiovascular Risk Factor Patterns in Long-Settled Roma and Recently Settled Indian Populations
Authors: Bhopal A , Bhopal R S 
Published: September 2013

BackgroundLinguistic and genetic evidence shows that Romani people, now numbering around 10-12 million in Europe, originate from North India. Romanis are thought to have migrated from North India around 10th-11th Century AD. Cardiovascular health is extremely poor in recently settled Indians living in Europe. Diabetes is also highly prevalent. As Romanis emigrated from India, we hypothesised their cardiovascular health would be similar to recently settled South Asians. The recent Indian migration of the 1950’s onwards comes 500 years after the Romani’s first movements into Europe.MethodsThis paper is not a systematic review but, background data were found by a search for abstracts using PubMed. Key search terms were Roma/Romani/Gypsy/Gipsy and/or health, cardiovascular health, genetics, linguistics, diabetes, stroke, Body Mass Index, maternal health and birth outcomes. In all over 70 abstracts were read, of which 30 were discarded due to lack of relevance to the specific review focus while 4 were discarded due to being unable to gain access to the journal. 36 papers were downloaded from online journals and from this 19 papers were used in final the review. The websites of the United Nations Development programme, the World Health Organisation, the Open Society Institute and the Roma Decade of Inclusion were examined. Grey literature was particularly valuable in drawing demographic data.The results use data from key papers which are compared to the best equivalent data available on the same topic of Indians living in the United Kingdom.ResultsStudies have shown Romanis to have higher levels of several cardiovascular risk factors when compared to local populations; these include diabetes (30% vs. 10%), central obesity (38% vs. 20%), hypertriglyceridemia (66% vs. 39%), smoking and raised BMI. Low birth weight and gestational age also mirror trends of the Indian ethnic origin population in the United Kingdom.Romanis in Europe are well documented to have a 10-15 year reduced average lifespan compared to the majority - the age distribution pyramid in fact more resembles a developing country pattern than that of industrialised countries.ConclusionOur findings demonstrate commonality of several cardiovascular risk factors – underlying reasons for this are discussed. This work potentially offers insights into the high rates of cardiovascular diseases in both populations. To our knowledge no previous work has examined the matter from this perspective.
PP08  Work Status and Blood Pressure – “A Job of Work”
Authors: McCarthy V J C , Perry I J , Harrington J M , Greiner B A 
Published: September 2013

BackgroundThe effect of work on blood pressure (BP) relative to a non-working status with appropriate adjustment for confounders is not well defined. High job control has been found to be associated with lower BP and with nocturnal BP dipping. However, with older workers this may be compromised.MethodsA cross-sectional study was carried out on a sample of the Irish general population. In total, 2,047 males and females aged 50-69 years were recruited. Data were collected on socio-demographic factors, medication and clinic BP measurements on workers (n= 1,025) and non-workers (n= 950). A sub-sample of the participants had ambulatory blood pressure monitoring (ABPM) done (n= 1,112). Job control was measured using two scales from the Copenhagen Psychosocial Questionnaire (COPSOQ) – possibility for development and influence at work. Nocturnal systolic blood pressure (SBP) dipping was the reduction in SBP from day to night-time and was calculated using the following formula (1-asleep SBP/awake SBP)*100.ResultsThose who were hypertensive on the clinic and ABPM SBP readings tended to be >58 years, male, overweight/obese and taking anti-hypertensive medication. Typically workers were younger, male, had a normal body mass index and had significantly lower clinic SBP than non-workers (p≤0.02). In analysis adjusted for socio-demographic factors, there was a significant difference between workers and non-workers for SBP dipping (OR 1.69 [95% CI 1.13, 2.53], p=0.01), but not for clinic or asleep SBP. When the analysis was stratified by anti-hypertensive treatment, workers were significantly more likely than non-workers to have a high clinic SBP (1.45 [1.00, 2.11]) and SBP dipping (2.07 [1.19, 3.61]). Looking only at workers, those who were on anti-hypertensive treatment with a high possibility for development were three times more likely to be SBP dippers than those with a low possibility for development (p= 0.03). There was no significant association found for influence at work and SBP dipping.DiscussionWhile workers had higher clinic SBP readings than non-workers they were also more likely to have nocturnal SBP dipping a factor known to be beneficial to cardiovascular health. Furthermore, this study showed that allowing workers to develop their skills in the workplace positively influenced their blood pressure.
PP16 The Contribution of Changes in Diet and other Risk Factors to recent Favourable Trends in Blood Pressure in Middle-Aged Irish Adults
Authors: Perry I J , Harrington J M , Kabir Z , Browne G , Fitzgerald A P , Kearney P M 
Published: September 2013

BackgroundRecent declines in cardiovascular mortality in Ireland and other developed countries are partially attributable to favourable secular trends in blood pressure (BP). However the underlying causes of these BP trends are not well defined. In particular, the contribution of changes in the dietary and other lifestyle determinants of population BP levels is unclear. We examined changes in distribution and determinants of systolic blood pressure (SBP) in middle-aged Irish adults over a 12 year periodMethodsData are from two cross-sectional studies of men and women aged 47-73 years recruited from 17 General Practices in Cork and Kerry (N = 1018, response rate 70%) and from one large General Practice in Cork (N = 2047, response rate 67%) in 1998 and 2010 respectively. Similar procedures were used at both time points, including recruitment methods, exclusion criteria, health and lifestyle questionnaire, dietary assessment (food frequency questionnaire [FFQ]) and physical examination (height, weight and blood pressure). Dietary quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) score constructed from the FFQ: higher scores indicating healthier diets. Changes in mean SBP were examined in linear regression models and are presented as means (95% CI).ResultsMean SBP fell by 7.1 mmHG (138.0, 130.9) in men and 4.7 mmHG (133.0, 128.3) in women between 1998 and 2010. Adjusted for age, gender and education mean SBP, was 5.8 mmHG (-7.3, -4.5) lower in 2010 than in 1998. Average BMI increased from 27.8 (4.0) to 29.1 (4.1) in men and from 27.4 (4.6) to 28.0 (5.1) in women. By contrast diet quality improved over the period in men and women from 22.5 (4.4) to 27.6 (5.6) and from 23.5 (4.7) to 30.1 (5.6) respectively. Significant trends in physical activity (favourable), smoking (favourable), and alcohol intake (unfavourable) were observed. The proportion of the sample with doctor diagnosed hypertension increased from 25% to 29% over the 12 year period. Adjusting for age, gender, education, BMI, smoking and alcohol the change in mean SBP remained relatively unchanged. Adjusting for DASH diet score the mean SBP change it was reduced to 4.1 mmHG (-6.5, -1.7) and on further adjustment for doctor diagnosed hypertension it was reduced to 3.9 mmHG (-6.3, -1.6).DiscussionThe findings suggest that average blood pressures levels in the population are falling, despite increasing prevalence of obesity. Much of the change is due to improvements in diet.
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

BackgroundUndiagnosed 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.MethodsA 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.ResultsBaseline 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.DiscussionThe 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

BackgroundThe 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.MethodsNationally-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.ResultsThe 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.ConclusionThe 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

BackgroundCase 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.MethodsIn 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.ResultsThe 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.ConclusionThere 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

BackgroundElectronic 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).MethodsThe 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.ResultsThere 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.ConclusionCluster 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

BackgroundUnder-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.MethodsThis 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.ResultsNumber 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.ConclusionHeavier 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.