bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP85 Do Good Health and Material Circumstances Protect Older People from the Increase in Mortality after Bereavement?
Authors: Shah S M , Carey I M , Harris T , DeWilde S , Victor C R , Cook D G 
Published: September 2012

BackgroundDeath of a spouse or partner is a common major life event for older people. The adverse health effects of bereavement are well recognised with an increased risk of death described in several populations. The impact of modifying factors, such as chronic disease and material circumstances, is less well understood. In this study, we use a large UK primary care database to examine the modifying and mediating effect of physical comorbidity and material socio-economic circumstances on the rise in mortality in the first year after bereavement.MethodsWe identified 171,120 older (60 years and over) couples in a UK primary care database (THIN) based on a shared household identifier. The couples were followed up between 2005 and 2010 for an average of 4 years. 26,646 (15.5%) couples experienced bereavement with mean follow up after bereavement of 2 years. The effect of bereavement on risk of death in the surviving partner was examined in a survival model adjusted for age, sex, comorbidity at baseline, material deprivation based on area of residence, season and smoking. Further analysis examined the effect of changes in comorbidity during follow up.ResultsThe fully adjusted hazard ratio (HR) for bereavement in the first year after bereavement was 1.25 (95% CI: 1.18 to 1.33). Further adjustment for changes in comorbidity throughout follow up did not alter the hazard ratio for bereavement (HR 1.27, 95% CI: 1.19 to 1.35). The effect of bereavement was not modified by age, gender or baseline comorbidity. The relative rise in mortality after bereavement was greatest in individuals with no significant chronic comorbidity throughout follow up (HR 1.50, 95% CI: 1.28 to 1.77) and in more affluent couples (P=0.035).ConclusionWe have confirmed the increased risk of mortality after bereavement and demonstrated its independence of pre-existing physician recorded chronic comorbidity and social status. Our analysis, taking account of changes in morbidity before and after bereavement, suggests that the rise in mortality after bereavement is not primarily mediated through new or worsening chronic physical disease. Furthermore, there was no evidence that pre-existing or continuing good health or affluence protect individuals. The results also suggest that, paradoxically, good health and high social status may accentuate the rise in mortality after bereavement. Our findings suggest that the rise in mortality after bereavement acts as a leveller, affording no protection to the affluent or healthy, and is best explained by an increase in sudden unexpected deaths.
OP86 More Rapid Decline in CHD Incidence among Scottish Towns than among English towns from the 1980S to the 2000s
Authors: Cecil E , Hardoon SL , Wannamethee SG , Whincup PH , Morris RW 
Published: September 2012

BackgroundThe incidence of coronary heart disease (CHD) has declined in the UK since the late 1970s. However, regional differences in this decline are unknown. We investigate the change in CHD incidence from the period 1980–1988 to 2000–2008 according to UK region. We also examine regional differences in changes in established coronary risk factors over these periodsMethodsThe British Regional Heart Study recruited 7735 men between 1978 and 1980 when aged 40–59 from 24 British towns. Established risk factors were measured at baseline examination and on 4252 participants twenty years later (1998–2000). CHD incidence over eight years from baseline was compared with incidence over eight years following re-examination. Age-adjusted Cox regression models including an interaction between an indicator for time period and region were used to assess relative hazards of CHD incidence between the two time periods according to UK region: South England (7 towns), Midlands/Wales (4 towns), North England (10 towns) and Scotland (3 towns).. Age-adjusted linear and logistic models with the same interaction term assessed changes in risk factors between the two periods according to region.ResultsCHD incidence for 1980–1988 in the South, Midlands/Wales, North and Scotland was 0.6, 0.8, 0.9 and 1.1 per 100 person years, and 1.1, 1.5, 1.3, and 1.1 for 2000–2008 when participants were 20 years older. Age-adjusted hazard ratios for the second versus first period in the four regions were 0.40, 0.50, 0.32 and 0.22 (p for interaction = 0.05), indicating that age-adjusted CHD incidence declined considerably in all regions but most rapidly among Scottish towns. While risk factor profiles were more favourable in the South than other regions in the first period, evidence of period/regional interactions were found in the analysis of some risk factors. Compared with the South, statistically significantly faster declines occurred in mean systolic blood pressure for North England and Scotland (by 3.1 mmHg and 4.1 mmHg respectively), in mean total cholesterol for Midlands/Wales (0.24 mmol/l), in smoking for Scotland (ratio of odds ratios 0.74), and faster increases in moderate physical activity in North England and Scotland (ratio of odds ratios 1.20 and 1.41 respectively). However mean BMI increased similarly across all regions.ConclusionFall in CHD incidence was faster in the Scottish towns than the English towns. An impressive improvement in coronary risk profiles was likely to be responsible, especially with respect to blood pressure, smoking and physical activity.
PS03 Systematic Review and Meta-Analysis of School-Based Interventions to Reduce Body Mass Index
Authors: Lavelle HV , Pell JP , Mackay DF 
Published: September 2012

BackgroundChildhood obesity predisposes to adult obesity and increases the risk of many diseases. Schools provide a vehicle to deliver public health interventions to all children.MethodsMedline and Embase were used to undertake a systematic review of published studies on school-based interventions aimed at reducing body mass index (BMI) of children ≤ 18 years. Preferred reporting items for systematic review and meta-analyses guidelines were followed, and eligible studies subjected to a random effects meta-analysis.ResultsBetween 1991 and 2010, 43 published studies provided 60 measurements of effect. The pooled effect was a 0.17 (95% CI: 0.08, 0.26,P<0.001) reduction in BMI. Heterogeneity was high (I2=93.4%) but there was no significant small study bias (Egger’s test,P=0.422) nor significant variation by length of follow-iup. The intervention comprised physical activity only in 11 (26%) studies, education only in three (7%), and combinations of these and improved nutrition in the remaining 29 (67%). On stratified analysis, physical activity used in isolation (-0.13, 95% CI: -0.22, -0.04,P=0.001) or combined with improved nutrition (-0.17, 95% CI: -0.29, -0.06,P<0.001) was associated with significant improvements in BMI. Interventions targeted at overweight/obese children reduced their BMI by 0.35 (95% CI: 0.12, 0.58,P=0.003). Those delivered to all children reduced it by 0.16 (95% CI: 0.06, 0.25,P=0.002).ConclusionThere is growing evidence that school-based interventions that contain a physical activity component may be effective in helping to reduce BMI in children.
PS19 Lifetime Socioeconomic Inequalities in Physical and Cognitive Ageing
Authors: Hurst L , Stafford M , Cooper R , Richards M , Kuh D 
Published: September 2012

BackgroundThe maintenance of physical and cognitive function for the maximal period of time is a key component of healthy ageing, associated with continued independent living, better quality of life and reduced morbidity and mortality risk. There is growing interest in investigating life course influences on healthy ageing to identify potential intervention targets, beyond those already identified by chronic disease epidemiology.Using data from the MRC National Survey of Health and Development (NSHD), we assess:1. the relative importance of socioeconomic position (SEP) in childhood and adulthood across a range of physical and cognitive functional ageing outcomes at age 60–64; 2. the contribution of key social, behavioural and developmental intermediary factors to the relationship between child SEP and functional ageingMethodsAgeing outcomes (lung function, grip strength, chair rise time, standing balance, timed up and go (TUG), verbal memory, processing speed and simple reaction time) were regressed on childhood and adult SEP ridit scores (calculated as the proportion of the population higher than the midpoint for each category) and sex. The ridit score coefficient is the slope index of inequality (SII), interpreted as the absolute difference in outcome between the hypothetical top and bottom of the SEP gradient. These were converted to the relative index of inequality to provide an estimate of the relative SEP difference across outcomes and over time. Regression models were then adjusted to examine the influence of potential mediators (education, smoking, BMI, height and childhood cognition) on the SII.ResultsSubstantial childhood and adult socioeconomic gradients were observed in all physical and cognitive outcomes. The hypothetical top of the childhood SEP distribution performed between 9 and 18 per cent better, relative to the hypothetical bottom (p ≤ 0.05 for association between childhood SEP with all outcomes). These associations persisted on adjustment for adult SEP, with the exception of standing balance. The hypothetical top of the adult SEP distribution performed between 6 and 26 per cent better, relative to the hypothetical bottom (p ≤ 0.05 for association between adult SEP with all outcomes). With the exception of processing speed (in women only), chair rise time, and TUG, associations between adult SEP and outcomes persisted on adjustment for childhood SEP. Adjusting for potential mediators attenuated specific associations.ConclusionChild and adult SEP were independently associated with physical and cognitive ageing at age 60–64. The different social, behavioural and developmental pathways partly mediating these associations may guide appropriate intervention strategies.
PS20 Prospective Audit of Paediatric Unintentional Injury
Authors: Jessop V 
Published: September 2012

BackgroundInjury is a leading cause of death among children and adolescents and around 16% of the world’s burden of disease can be attributed to injury, reflecting the disproportionate burden of injuries among young people and added years of life lived with disability. The majority of injuries can be prevented or at least controlled and the costs of prevention are much lower than the costs of the consequences of injuries.There is a crucial lack of data and injury surveillance systems to inform prevention. In high income countries it has been shown that many child and adolescent injuries can be prevented through careful analysis and appropriate action. In January 2012 The Department of Health published‘A public health outcomes framework for England, 2013–2016’, which includes‘Hospital admissions caused by unintentional and deliberate injuries in under 18s’as an indicator of population health.Research has shown that a relationship exists between increasing numbers of children presenting to Accident and Emergency with injuries and higher levels of area level socioeconomic deprivation. The Indices of Deprivation 2010 show that the London Borough of Tower Hamlets (LBTH) remains one of the most deprived areas in the country.MethodsA prospective audit has been designed for use in The Paediatric Emergency Department at The Royal London Hospital in the LBTH. The audit tool will include the WHO core minimum dataset for injury surveillance and ICD-10 for injuries, as part of an enhanced injury dataset that has been incorporated in the College of Emergency Medicine’s proposed ‘emergency medicine minimum dataset’. Subsequent mapping of injuries to LBTH postcodes will allow identification of injury ‘hot spots’ requiring further investigation and targeted interventions.ResultsA preliminary retrospective audit of paediatric unintentional injury using data collected from computerised Accident and Emergency records for children aged 0 to <18 years who attended Royal London Hospital between July to September 2011 showed that unintentional injury results in high rates of attendance, with 40% of children attending as consequence of unintentional injury (n=3,013 attendances). The main reasons for attendance were for fractures, joint and head injuries and soft tissue inflammation. However, details of where injuries occurred, mechanisms and severity were lacking; prompting a prospective audit.ConclusionKnowledge of the epidemiology of paediatric injury is lacking. It is imperative that routine monitoring and surveillance of paediatric injuries occurs nationally in order to inform effective injury prevention strategies.
PS23 How well does the NHS Support Employees Who wish to Breastfeed on return to Work?
Authors: Watson LI , Neufeind J , George E , Fenske I 
Published: September 2012

BackgroundIn line with EU and UK law, NHS organisations have policies to support employees who wish to continue breastfeeding on return to work, which has numerous health benefits. The NHS employs many women of reproductive age, but anecdotally some face significant barriers in continuing breastfeeding. The objectives of the study were to describe awareness of relevant policies, describe breastfeeding behaviours and experience of staff in relation to these, and identify any areas for improvement. Fife NHS Board provides full hospital and primary care services in southeast Scotland and employs 8,000 staff.MethodsA questionnaire survey with quantitative and qualitative elements was sent from the Department of Human Resources to eligible employees of NHS Fife who had been on maternity leave between 2007–09.This was adapted from previous surveys with input from experts and was piloted in two stages. Those with serious complications e.g. stillbirth were excluded. Full ethical review was not required.Results651 women were eligible, with 87 questionnaires undelivered, and 342/564 (61%) returned. Respondents were comparable to female employees of NHS Fife.; 203/329 (62%) reported awareness of the breastfeeding and return to work policy. 26/342 (8%) reported being offered information on support breastfeeding on return to work. 63/270 (23%) who breastfed at all continued on their return and this was more common with increasing age, but not related to setting eg ward, community. 18/270 (7%) would have breastfed longer if their employer had been more supportive, and 43/270 (16%) cited returning to work as a reason they stopped.; 102/254 (40.2%) felt not very or not at all confident to approach their employer regarding support. Women who were aware of the policies were significantly more likely to feel confident than women who were not, (p<0.001). 4 respondents used a suitable area to express milk and 3 made use of a designated fridge for storage.Key themes described were that it was perceived that managers and other workers grudged the extra time for expressing milk or breastfeeding, and lack of facilities.ConclusionExperience of staff was highly variable suggesting the policy was not implemented consistently. Suggested areas for improvement include: clearer information regarding policies with specific information on support for continued breastfeeding, line managers initiating discussion regarding the possibility of breastfeeding on return to work, and ensuring that women who do continue are not stigmatised by colleagues.While these results may not be fully generalisable, it is likely that there are similar issues for NHS employees more widely.
PS30 The Joint Effect of Unemployment and Cynical Hostility on All Cause Mortality
Authors: Christensen U , Kriegbaum MK , Rod NR , Osler MO , Lund RL 
Published: September 2012

BackgroundUnemployment as well as hostility has been associated with mortality and morbidity. Hostility and socioeconomic position, including unemployment is highly associated. One of the hypothetical models on the relation between hostility, health and life context, states that hostility moderates the relationship between health problems and stressful conditions in the environment, such as unemployment. The aim of this study is to analyze the joint effect of labor market exclusion and hostility on all cause mortality.MethodsThis study is based on The Danish Longitudinal Study on work, Unemployment and Health, a survey carried out in the Spring 2000 among a random sample of 40 and 50 year old men and women and an oversampled group of previously unemployed individuals. The survey included self-reported measures on employment, education, age and hostility, measured by the eight-item Cynical Distrust Scale.The exposure variable was: 1) employed-not hostile ; 2) employed - hostile; 3) unemployed- not hostile and 4) unemployed - hostile. Outcome was defined as all-cause mortality. We used Cox’s proportional hazard regression model, with age as the underlying time scale and with entry time January 1st 2000. All individuals who reported not working due to illness at the time of the survey were excluded in the analyses. The joint effect of unemployment and hostility was assessed as departure from multiplicativity.ResultsEmployed men and women who were hostile did not have an increased mortality risk. Unemployed men had an increased risk of mortality even when they were not hostile HR=2.30 (95% CI, 1.27–4.16) and the joint effect of unemployment and hostility was higher than what would have been expected from their separate effects, HR=2.57 (95% CI, 1.50–4.42). Unemployed women did not have a significantly increased mortality risk if they were not hostile HR=1.35 (95% CI, 0.73–2.50), however, the joint effect of unemployment and hostility was higher than what would have been expected from their separate effects, HR=2.23 (95% CI, 1.17–4.24).ConclusionThe joint effect of unemployment and hostility is a novel finding, indicating that the health damaging consequences of unemployment are accentuated by hostility.
PS32 Breast Cancer Screening Uptake in Different Ethnic Groups in London
Authors: Jack RH , Møller H , Robson T , Davies EA 
Published: September 2012

BackgroundBreast screening uptake is lower in London than other areas of England. Knowledge of cancer screening programmes varies between ethnic groups, and previous studies have shown variation in uptake between broad ethnic groups. This study aimed to determine whether breast cancer screening uptake varies between 16 ethnic groups in London.MethodsInformation on women resident in London who were sent a breast cancer screening invitation between 31/03/2006 and 31/12/2009 was obtained from the London Quality Assurance Reference Centre. Women aged 50–52 who had a first call invitation (a first invitation to the national screening programme) in this period, and women aged 50–69 who had a routine recall invitation (after previously having a mammography as part of the screening programme) were analysed. Where ethnicity was not known, multiple imputation was used. First call and routine recall data were analysed separately. Screening uptake in different ethnic groups was assessed using logistic regression, and adjusted for age at invitation, socioeconomic deprivation and screening area. Data for the six individual screening areas were also analysed separately.ResultsData on 159,078 women were included in the first call analysis, and on 496,438 women in the routine recall analysis. Ethnicity information was available for 475,478 (72.5%) of these women. Compared with White British women, all other ethnic groups were less likely to attend their first call screening invitation. White British women were also most likely to attend for routine recall screening sessions. Some screening areas showed less variation, with women from several ethnic groups having similar screening uptake to White British women.ConclusionBreast cancer screening attendance varies by ethnic group for both the first invitation and for subsequent invitations after previously being screened, with White British women more likely to attend. Collaboration between areas to find successful practices for engaging with different communities should improve breast cancer screening uptake.
PS34 Recording and Management of Obesity in Primary Care, 1997-2006
Authors: Booth HP , Gulliford M 
Published: September 2012

BackgroundPrimary care services play a potentially important role in the diagnosis and management of obesity but little evidence exists on current routine practice. The aim of this study was to describe the recording of body mass index and interventions used in the management of body weight in UK primary care in different categories of body weight.MethodsA retrospective cohort study was implemented using the UK General Practice Research Database (GPRD). Participants were aged between 18 and 100 and had a diagnosis of obesity and/or a record indicating a weight management intervention between 1997 and 2006. Diagnoses of obesity were identified by a medical code for obesity or a body mass index (BMI) record of ≥30kg/m2.Interventions were identified by medical and therapy codes and included advice on diet, body weight control or exercise, referral to specialist care for obesity or prescription of anti-obesity drugs.ResultsPatients (n=69,102) with a diagnosis of obesity or who received a weight management intervention were identified at 128 UK general practices. Average BMI rose slightly over the study period from 35.0kg/m2in 1997 to 35.8kg/m2in 2006, with a higher proportion of patients gaining rather than losing or maintaining their weight each year. Monitoring of BMI was infrequent with just 48% of patients previously identified as obese having a BMI recorded in 2006. The proportion of patients with one or more interventions for weight control recorded increased from 29% in 1997 to 37% in 2006. The most frequent intervention throughout the study period was the provision of dietary advice, recorded in 13,097 (40.7%) patients in 2006 compared to 3,401 (32.3%) in 1997. Prescription of anti-obesity drugs increased by almost 60-fold over the study period. The proportion of morbidly obese patients (BMI ≥40kg/m2) receiving a weight control intervention in 1997 was 38%, rising to 63% in 2006. In obesity category I (BMI 30–34.9kg/m2) the proportion receiving treatment was 43% in 1997 and 53% in 2006 and in category II (BMI 35–39.9kg/m2) 41% and 56% respectively.ConclusionMonitoring of obesity in diagnosed patients was inconsistent in this population with less than half having a BMI recorded in each year of the study. The frequency of interventions for weight management increased substantially in primary care between 1997 and 2006.