bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP70 Prioritising Outcome Measures for Ambulance Service Care: A Three Stage Consensus Study
Authors: Coster J E , Turner J E , Sirwardena N , Wilson R , Phung V-H 
Published: September 2013

BackgroundHistorically ambulance care quality and performance has been measured by response times rather than clinical need or effectiveness. This limits the evidence about the effectiveness of the care the ambulance service provides. The Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) project is a 5 year research programme which aims to develop new ways of measuring the performance, quality and impact of ambulance service care that better reflect the care provided.MethodsWe held a 1 day consensus event with a multi-stakeholder group to identify and prioritise which features of ambulance service care are important and worth further development as measures of performance and quality. The day comprised a series of small group discussions to share opinions about measures identified from literature reviews and the opportunity for participants to add their ideas, together with a live vote to help identify and rank measures for further development. Time measures were considered in a separate online questionnaire. The results from the online questionnaire and Consensus Event were fed into a Delphi study.Results43 participants attended the consensus event, representing a range of participant groups including patient and public, ambulance services, commissioners and policy groups. The top 5 outcome measures prioritised by the participants were: accuracy of dispatch decisions; completeness and accuracy of patient records; accuracy of call taker identification of different conditions or needs (e.g. heart attack, stroke, suitable for nurse advice); pain measurement and symptom relief; and patient experience. From the online survey of time measures the top 5 measures were time of call to time of arrival at scene; time symptoms start (e.g. chest pain) to time of treatment with balloon for heart attack; time taken to answer the emergency call; total time spent on scene; and incident or start of symptoms to calling the ambulance service.ConclusionUsing consensus methods we have identified a set of outcome measures that can potentially be used to measure the performance and quality of ambulance service care. Some of these measures fit with existing government targets, such as response times and time taken to answer the emergency call. However, most measures are new ways of measuring ambulance service care and the importance of these measures and methods of measurement will be assessed as part of an on-going Delphi study.
OP72 Relationship between Age and Deprivation in Emergency Admission for ACS Conditions
Authors: Blunt I 
Published: September 2013

BackgroundAround one fifth of emergency admissions to hospital are for conditions regarded as “ambulatory care sensitive”, that is the need for admission could have potentially been avoided through timely access to primary care. Previous studies have found that age and deprivation have strong influence on the likelihood of hospital admission. The present study examines whether rates of emergency admission for ACS conditions are disproportionately higher for deprived older people.MethodsAn observational study based on routinely collected hospital admission data from April 2011 to March 2012 from NHS hospitals in England. Age-specific emergency admission rates were calculated at the national level using population and deprivation estimates for small area of residence. An admission was categorised as “ambulatory care sensitive” if any of 27 specific ACS conditions were noted in the ICD-10 diagnostic codes associated with the admission.ResultsRates of ACS admission increase with deprivation in every age band. The inequality is least evident for people aged between 15 and 19, when the least deprived group have 64 ACS admissions per 100,000 while the most deprived group have 104 admission per 100,000 (a rate 1.6 times higher). As rates of admission increase with age, so does the disparity between deprivation groups, reaching a maximum of 3.8-fold difference in the 45-49 age group (49 vs 184 admissions per 100,000). From that point the inequality narrows as age continues to increase, with people aged 85 and over having just a 1.6-fold difference between the least and most deprived groups (993 vs 1,610 admissions per 100,000). Emergency admissions for ACS conditions are more strongly influenced by deprivation than those for non-ACS conditions, and patterns of admission vary by individual ACS condition.ConclusionRates of admission for conditions potentially amenable to primary care increase with both increasing patient age and local levels of deprivation. The degree of increase due to deprivation does not vary linearly with age. This suggests that efforts to prevent hospital admission, which traditionally focus on patients aged 65 and over, may benefit from including adults up to twenty years younger in the most deprived areas.
OP73 How can we Develop More Effective Public Health Interventions?
Authors: Payne N , Goyder E , Kelly M P , Nicholl J 
Published: September 2013

BackgroundA number of recent trials and systematic reviews of public health interventions have had disappointing conclusions despite a major investment in trials. An elegant evaluation design to test a poorly developed intervention is clearly unsatisfactory, so to what extent is the effectiveness of public health compromised by interventions that are poorly developed in the first place? Guidance on the development of complex interventions highlights the need to develop theory-based interventions to the point where they can reasonably be expected to have a worthwhile effect. However, in practice many public health interventions are complex, have arisen from a variety of sources, contain elements the quantity and quality of which arises from chance rather than design, have not been through a pre-intervention development phase, are not theory based, and are relatively poorly defined and described.MethodsFirstly, a systematic search was conducted to find literature which describe methods for the development of public health interventions (as opposed to how to evaluate them). Secondly, a step-wise comparison was carried out between the development of new drugs and the development and introduction of public health interventions.ResultsThere is little literature on the development of public health interventions which suggests that the “science” of intervention development (in public health) is still at an early stage. Recommended stages in intervention development include: identifying the evidence base; identifying and developing appropriate theory – and, while evidence-based guidance on the development of behaviour change interventions in public health has been produced, there may be several competing theories requiring judgement in respect of which is most appropriate. Moreover, the key components of complex public health interventions, including their implementation, need to be better identified and described in terms of their interrelations and replicability. While pharmaceutical products have a distinct development phase which is well planned and appropriately funded, this is not the case for public health interventions although it is clear that there are lessons for public health from drug development. In part the problem arises because of the lack of a champion or sponsor for the development of public health interventions, and also because of the absence of funding to develop those interventions in the first place.DiscussionFor public health interventions to be as successful and effective as they have the potential to be, we must review and revise how such interventions are initially designed and developed. A clear development and sponsorship process for public health interventions of all complexity needs establishing.
OP76 Who Runs Public Health?
Authors: Oliver K , Vocht F de , Money A , Everett M 
Published: September 2013

BackgroundPersistent health inequalities encourage researchers to identify new ways of understanding the policy process. Research shows that informal relationships are implicated in finding evidence and making decisions for public health policy. However, few studies use specialised methods such a network analysis to identify key relationships and actors in the policy process. Furthermore, little is known about the strategies used by these influential individuals to control the policy process. This study aimed to use relational methods to identify important individuals in the public health policy process, and to produce explanations for their influence.MethodsWe combined network and qualitative data to identify the most influential individuals in public health policy in a UK conurbation, and describe strategies they used to influence policy. Network data were collected by asking for nominations of powerful and influential people in public health policy (n = 152, response rate 80%), and 23 semi-structured interviews with a sub-sample of the network population were analysed using a framework approach.ResultsThe most influential public health policy makers in this conurbation were identified as public health professionals and mid-level managers in the NHS and local government. However, public health professionals were not influential throughout the policy process, playing only a few roles. Influential managers described four main strategies to influence policy: controlling policy processes through gatekeeping key organisations, providing policy content, and managing selected experts and executives to lead on policies. Public health professionals and academics are indirectly connected to policy via managers, but neither group are described in connection with key strategies.ConclusionThe most powerful individuals in public health are managers, not usually considered targets for research. As we show, they are highly influential through all stages of the policy process. Understanding the daily activities of influential policy individuals provides a new framework for understanding policy, and providing concrete examples of influence questions current approaches to knowledge translation. The study demonstrates the utility of using network analysis methods and potential applications of the method for researchers who wish to influence policy are suggested.
OP77 Proxy Reporting of Health-Related Quality of Life using the Euroqol-5D in Care Home Residents; how Good is it and how should we Deal with Clustering Effects?
Authors: Devine A M , Taylor SJC , Spencer A , Diaz-Ordaz K , Eldridge S , Underwood M 
Published: September 2013

BackgroundSome care home residents are unable to complete the measures of health utility needed for cost-utility analyses. Proxy measures are an alternative source of data; however, the level of agreement in the EQ-5D between residents and care home staff and the impact of clustering on this agreement has not been investigated previously. Using data nested in a large clinical trial, we aimed to (1) identify inter-rater agreement levels for the reporting of EQ-5D by care home residents and carers, (2) investigate whether proxies have a greater tendency to choose ‘some problems’ at the domain level and (3) investigate factors influencing agreement.MethodsKappa statistics were used to examine the level of agreement between proxy and self-completed responses at the domain level and intraclass correlation coefficients (ICCs) were used for EQ-5D index scores, visual analogue scales and total quality-adjusted life-years (QALYs). Importantly, the calculation of the Kappa and ICC relies on the assumption of independence of the observations, so the impact that clustering might have upon our results was also examined. The percentage of residents and proxies choosing each level of each domain was compared to examine whether responders have a consistent preference for one of the levels. Finally, a mixed model was used to consider the extent to which the difference in EQ-5D-S and EQ-5D-P was affected by other variables at baseline.ResultsWe found slight to fair agreement at the domain level (cluster-adjusted Kappa 0.02–0.30) and fair agreement at the score level (cluster-adjusted ICC 0.30–0.32) and for QALYs (cluster-adjusted ICC 0.38). Proxies had a greater tendency to use the ‘some problems’ compared to self-report. The random effect mixed model showed that a higher GDS-15 (and likelihood of depression) and lower MMSE score (and lower cognitive impairment) were both associated with greater discrepancy between proxy and self-completed scores.ConclusionProxies appear to be a reliable source of data for QALY scores but may be less reliable if individual domains are considered. As expected, the presence of more severe depression or cognitive impairment in residents reduced their agreement with proxy scores. The frequent reporting of ‘some problems’ by proxies suggests that a 4-level measure would counter this tendency to choose the ‘middle’ option.
OP78 The Role of Social Relationships in Understanding Healthful Dietary Behaviours: Evidence from People Aged 50 and over in the Epic-Norfolk Cohort
Authors: Conklin A , Forouhi N , Wareham N , Monsivais P 
Published: September 2013

BackgroundSocial relationships are an integral aspect of a person’s social environment that may offer protection against chronic conditions and may facilitate recovery from disease. Social relationships have also been linked to dietary behaviour which may be an important pathway through which social circumstances impact health. Yet, questions remain about which aspects of social ties most influence healthful dietary behaviours among women and men and to what extent different types of social ties interact to produce a combined influence.MethodsUsing prospective data from adults (≥50 years) in the European Prospective Investigation of Cancer-Norfolk (EPIC-Norfolk) study, multivariable linear regression analysis was used to examine sex-specific associations between structural social ties (marital status, living arrangement, friend contact, family contact) and a dietary score for variety of fruits (ranging between 0–11) or vegetables (0–26). Separate interaction models tested whether overall effects of marital status changed by living arrangement or by friend contact, and of living arrangement by friend contact. All analyses adjusted for known confounders (energy intake, age, education and, where appropriate, sex).ResultsNegative associations of non-partnered or lone-living persons and fruit variety were stronger in men than women, compared with those who were partnered or in shared-living. Women and men differed in the negative association of widowhood with vegetable variety (women: Beta = −0.79,p< 0.001; men: Beta = −2.17,p< 0.001), as well as in the relationship between lone-living and vegetable variety (women: Beta = −0.66,p< 0.001; men: Beta = −1.46,p< 0.001). Decreasing friend contact was negatively associated with variety of fruits and vegetables in a graded trend for women but was stronger in men. Family contact appeared to have no association with vegetable variety in men while variety scores in women were initially positive but decreasing with decreasing contact. Results were most striking in revealing the combined influence of two types of social ties in relation to variety when looking at both sexes together. For example, the negative association of lone-living with vegetable variety was significantly different (p= 0.007) between infrequent friend contact (Beta = −1.62;p< 0.001) and frequent contact (Beta = −0.80;p< 0.001).ConclusionVariety scores of men were more influenced than those of women by marital status, living arrangement or friend contact. Interactions between two social ties were striking, revealing the combined influences on healthful dietary behaviours. Results highlight the importance of considering living arrangement and frequency of social contact when assessing whether widowed or single older adults are at risk of lower fruit and vegetable variety.
OP08 Using Linked Administrative Data and Multilevel Modelling to Identify Targets for Interventions to Tackle Health Disparities
Authors: Jorm L R , Randall D A , Falster M O , Leyland A H 
Published: September 2013

BackgroundLinked administrative data for whole populations, combined with multilevel modelling methods, offers a powerful approach to identifying targets for tackling health disparities. Two studies will be presented, examining disparities between Australian Aboriginal and non-Aboriginal people, in very different outcomes: (i) revascularisation and mortality after acute myocardial infarction (AMI); and (ii) rates of serious road traffic injury.MethodsBoth studies used whole-of-population hospital inpatient data for the state of New South Wales, Australia, linked with mortality data. For Study (i), hazard ratios for revascularisation following AMI were estimated using multilevel Cox regression and ORs for 30- and 365-day post-admission mortality were estimated using multilevel logistic regression. For Study (ii), adjusted rate ratios were estimated using multilevel Poisson regression models.ResultsStudy (i) found that Aboriginal patients had a revascularisation rate 37% lower than non-Aboriginal patients of the same age, sex, year of admission and AMI type (adjusted hazard ratio [AHR] 0.63 [95% CI 0.57, 0.70]). This disparity was no longer significant after adjusting for hospital of admission, comorbidities, substance use and private health insurance (AHR 0.96 [0.87, 1.07]). After adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR 1.07 [0.83, 1.37]) but a higher risk of dying within 365‐days (AOR 1.34 [1.10, 1.63]). Study (ii) found that, overall, Aboriginal people had higher rates of road transport injuries (incidence rate ratio [IRR] 1.18 [95% CI 1.09, 1.28]). However, there was no significant difference when geographic clustering was taken into account (1.00 [0.96-1.04]). This effect was further influenced by mode of transport for the injury, with Aboriginal people having higher rates of pedestrian (IRR 1.96 [1.75, 2.19]) and lower rates of motorcycle (IRR 0.64 [0.59, 0.70]) injuries in all almost all local areas, while there was no systematic pattern across geographic areas for small vehicle injuries (IRR 1.01 [0.94, 1.08]).ConclusionUse of linked administrative data and multilevel modelling permitted quantification of the contributions of personal, geographic and health system factors to health disparities, and thereby of the potential contributions of primary prevention, primary care, and hospital care to tackling these. It is essential that geography is taken into account in studies of health disparities, especially in countries with significant differences in the distribution of disadvantaged populations, and in the provision of health services, between urban and rural areas.
OP85 Fruit and Vegetable Consumption and Mortality: A Cox Regression Analysis
Authors: Oyebode O , Gordon-Dseagu V , Walker A , Mindell J 
Published: September 2013

BackgroundFollowing World Health Organisation recommendations, the UK government promotes a daily intake of at least five portions of fruit and vegetables.MethodsWe used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular (CVD) mortality, adjusting for age, sex, BMI and social class in data from 85,347 adult participants in the Health Survey for England 2001-2008.ResultsFruit and vegetable consumption had a substantial protective effect for all-cause mortality (adjusted HR for 6-<7 portions 0·64 (95% CI 0·54–0·76)), stronger when deaths within a year of baseline were excluded (HR 0·57 (0·45–0·72) or when fully-adjusting for physical activity (0·48 (0·36–0·66). Consumption was significantly associated with reduced cancer (HR for 5- < 7 portions 0·78 (0·63–0·96) and CVD mortality, with increasing benefits being seen up to more than seven daily portions of fruit and vegetables for CVD (0·69 (0·53–0·89)). Consuming up to three to four portions of fruit daily and up to 3 + portions of vegetables a day was associated with decreased mortality. Vegetables had a greater effect than fruit (HR for 2- < 3 portions 0·82 (0·74–0·91) and 0·91 (0·83–0·99) respectively).ConclusionThere is no threshold for the association between fruit and vegetable consumption and CVD survival up to a total of seven portions daily. Maximal benefit was conferred by six daily portions for all deaths and five portions for cancer. Vegetables have greater benefit than fruit.
OP87 Urban-Rural Differences in Adolescent Eating Behaviour: A Multilevel Cross-Sectional Study of 15 year Olds in Scotland
Authors: Levin K A 
Published: September 2013

BackgroundImproving the diet of the Scottish population has been a government focus in recent years. Adolescent eating behaviour in Scotland has improved over time, while socioeconomic inequalities in eating behaviours have persisted with no significant change. Population health is known to vary between geographies, therefore alongside trends and socioeconomic inequalities in eating behaviour, urban-rural differences should also be monitored. The aim of this study is to describe urban-rural differences in eating behaviour among 15-year olds living in Scotland in 2010.MethodsData from the 2010 Scotland Health Behaviour in School-Aged Children survey were modelled using multilevel linear modelling for fruit, vegetables, sweets, crisps and chips consumption frequency outcome variables, and multilevel logistic modelling for eating behaviour outcomes: dieting, family meals, food poverty and breakfast consumption. Geographic differences in a combined ‘healthy eating score’ were also analysed.ResultsAdolescents living in remote rural Scotland have the highest consumption frequency of vegetables (on average consumed on 6.68 days a week) and the lowest consumption frequency of sweets and crisps (on 4.27 and 3.02 days a week respectively). However, it is not the 4 Cities, but the geography described by the classification ‘other urban areas’ (large towns of between 10,000 and 125,000 residents) that has the poorest diet. Categorical family affluence was significantly associated with vegetables and chips consumptions and the healthy eating score. Area-level deprivation (SIMD score) and rurality were independently associated with consumption frequencies for all but fruit consumption. Socioeconomic inequalities in fruit consumption were particularly great in accessible and remote rural areas, and significantly greater than those in urban areas. Thus, those living in the most deprived areas of remote rural Scotland (SIMD score = 48.87) consumed fruit on approximately 1 day less a week than those living in 4 Cities of equivalent deprivation. However, among the most affluent (SIMD = 3.03), Remote Rural residents ate fruit on average on 0.6 days more than their urban counterparts. Sharing a family meal, dieting behaviour, food poverty and breakfast consumption did not differ by rurality. Variance at the school level was significant for fruit and vegetable consumption frequencies and for irregular breakfast consumption.ConclusionYoung people from rural areas have a healthier diet than those living in urban areas. The eating behaviours examined did not explain these differences. Socioeconomic inequalities in fruit consumption were greater in rural areas. Future research should investigate why urban-rural differences in consumption frequencies exist.