bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP52 Obesity Prevention in Scotland: A Policy Analysis using the Angelo Framework
Authors: Mooney J D , Frank J , Jepson R , Geddes R 
Published: September 2013

BackgroundThe Scottish Government’s ‘Route-Map towards Healthy Weight’ published in 2010, aspired towards a comprehensive cross-government approach to tackling the rising prevalence of obesity, with commitments to addressing the fundamental societal drivers of the epidemic. The subsequent ‘Route-Map Action Plan’ set out 62 policies targeted at nutrition, physical activity or both, at all stages of the life course. We categorised each policy using the ANGELO Framework (Analysis Grid for Environments Linked to Obesity), to assess the appropriateness and likely impact of the balance of measures being proposed. ANGELO uses four broad ‘domains’: Physical, Economic, Legislative and Socio-cultural, as well as two ‘scales’ of intervention: ‘Macro’ for the national, regional or sectorial level and ‘Micro’ for the local neighbourhood/community/institutional level.MethodsTwo assessors (JM & RJ), used the guidance outlined by the originators of ANGELO to independently allocate a category for each intervention according to its domain (Physical, Economic, Legislative or Socio-cultural), scale (Macro or micro); and predominant ‘focus’ (activity versus nutrition). A third assessor (RG) then examined those policies where there were differences in allocation and a consensus on each was agreed by discussion. The resulting distribution of policies by scale and domain was compared with the current consensus of international research evidence around which combinations of measures are likely to have the greatest impact at a population level.ResultsAcross the four environmental domains, the distribution of the 62 separate policy initiatives was skewed towards behavioural (Socio-cultural) measures (37.1%) and the Physical environment (33.1%) (i.e. surroundings), with less emphasis on Legislative measures (21.8%) or Economic interventions (6.4%). The distribution of both intervention scale and focus was more evenly spread with just over half of all policies (51.8%) targeted at the Macro-level scale and just under half (46.7%) having a nutrition focus.ConclusionPolicy interventions (planned or underway), to tackle obesity which are supported by the Scottish Government, span across all four domains of the obesogenic environment as described by the ANGELO framework. The predominance of Socio-cultural/(i.e. behavioural) orientated interventions over Legislative and particularly Economic (or fiscal) measures (such as a sugared beverage tax), is common for most Governments, although the balance of evidence suggests that targeting the latter domains would be more effective. There is a need therefore to strive for a more balanced approach across all spheres of Government influence, with economic interventions representing the area where actions should particularly be increased.
PP55 Socioeconomic Status and Chronic Kidney Disease: Further Findings from the Health Surveys for England 2009 and 2010
Authors: Fraser S D S , Roderick P J , Aitken G R , Roth M A , Mindell J S , Moon G , Matthews B , O’Donoghue D J 
Published: September 2013

BackgroundRenal replacement therapy rates are higher in more deprived populations in developed countries. The relationship between population-level prevalence of chronic kidney disease (CKD) and socio-economic status (SES) is less clear. Albuminuria is also recognised as an independent risk factor for poor CKD outcomes but again little is known about its relationship with SES. The nationally representative Health Surveys for England (HSE) 2009 and 2010 showed mixed evidence for variation of CKD prevalence by area deprivation defined by ‘Spearhead Primary Care Trust’ status. The present study aimed to examine the relationship between CKD and SES in more detail, and to include investigation of associations of albuminuria.MethodsData from the 2009 and 2010 HSEs were combined, giving a total of 5,799 individuals with kidney function data. Prevalence of moderate to severe CKD (stage 3–5), using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) estimating equation, and albuminuria were calculated. Multivariate logistic regression models were used to determine the associations of SES measures with CKD and albuminuria, adjusted for demographic, lifestyle and clinical factors.ResultsPrevalence of CKD Stage 3–5 was 5.2%, and any albuminuria 8.0%. After accounting for age-sex interaction, age-sex adjusted CKD 3–5 prevalence was associated with lack of qualifications (OR 2.27 [95% CI 1.40, 3.69]), low income (1.50 [1.02, 2.21]) and household tenure (1.36 [1.01, 1.84]) for rented vs. ownership). Only tenure remained significant after further adjustment for lifestyle and clinical factors (smoking, body mass index, hypertension, diabetes and ethnicity). Age-sex adjusted albuminuria prevalence was associated with low income (1.79 [1.35, 2.36]) most deprived quintile of index of multiple deprivation (1.72 [1.24, 2.41]), vehicle ownership (1.59 [1.25, 2.02]) and tenure (1.46 [1.18, 1.81]); these associations persisted after full adjustment.ConclusionThere was little evidence of socioeconomic variation in CKD 3-5 prevalence in these HSE participants. By contrast, albuminuria prevalence varied by several measures of SES. This suggests a higher risk of CKD progression in lower SES groups. When combined with the higher prevalence of Type 2 diabetes in lower socioeconomic groups, this may contribute to the inverse gradient of renal replacement therapy rates by SES. This has implications for the early detection of CKD and albuminuria, and for equity of care in managing CKD.
PP67 Psychological Health and Physical Activity from Adolescence To Mid-Adulthood: Evidence of Bi-Directional Associations in the 1958 British Birth Cohort
Authors: Pereira S M Pinto , Geoffroy M C , Power C 
Published: September 2013

BackgroundPhysical activity (PA) is cross-sectionally associated with lower prevalence of depression and other indicators of psychological well-being. Few longitudinal studies examine the possibility of bi-directional associations between activity and psychological health.Using data from the 1958 British Birth cohort (maximum N = 14,072) over four decades of life we examined (i) cross-sectional associations to establish whether psychological ill-health is concurrent with lack of PA at several life-stages, and (ii) longitudinal associations to elucidate the direction of association, i.e. (1) psychological health and prior PA, and (2) PA and prior psychological health.MethodsPsychological health was assessed using validated, age appropriate instruments from questionnaires to teachers (11y, 16y) and participants (23y, 33y, 42y, 50y). Measures were converted to (i) standard deviation (SD) scores and (ii) categorised to represent “severe distress” (top 10% at each age). PA reported by mothers (11y) and participants (16y, 23y, 33y, 42y, 50y), was classified at all ages into four categories. Covariates from different life-stages included: body mass index, socioeconomic position, education and physical limiting illness.ResultsUsing linear regressions, we found that individuals with poorer psychological health were less physically active, but patterns of association varied by age. In adolescence, there was a dose-response relationship: e.g. at 16y, per category higher activity, psychological health was lower by 0.08 (0.07, 0.10) SDs. In adulthood, there was a threshold effect: e.g. at 50y, those active 1+/wk had a 0.20 (0.15, 0.24) lower SD score than those active <1/wk. Associations persisted after adjustment, although attenuated. We assessed directionality using random effects models to (1) psychological health (16-50y) with time-varying PA as an explanatory variable, and (2) PA (16-50y) with time-varying psychological health as an explanatory variable. Preliminary analysis suggests that relationships are bi-directional. The odds ratio of severe distress was 0.81 (95% CI 0.75, 0.89) for those physically active at the previous sweep compared to the inactive. However, there was a suggestion that the relationship weakened with age. Prior psychological health predicted PA similarly across ages. Between 16-50y, the odds of being physically active if severely distressed previously was 0.67 (0.62, 0.73). Results were unchanged after adjustment.ConclusionPA and psychological ill-health are concurrent over decades of life. The relationship appears to be bi-directional, although weakening with age for PA to subsequent psychological ill-health. Findings suggest that PA throughout adolescence and young adulthood may alleviate subsequent psychological ill-health.
PP70 Knowledge Brokers or Policy Entrepreneurs? Strategies to Influence the Policy Process
Authors: Oliver K , Money A , Vocht F de 
Published: September 2013

BackgroundUnderstanding the impact and process of evidence-use in policy has been a major focus for researchers in recent years. Researchers often focus on (a) how to increase uptake of research, (b) validating models of knowledge transfer and (c) advocating for the use of knowledge brokers. Several ‘job descriptions’ for knowledge brokers have been published. However, the influence and impact of knowledge brokers is unclear. Policy actors who are known to be influential can also be characterised in terms of daily activities. This study aims to describe the activities of powerful and influential actors and compare them with knowledge brokerage frameworks from the literature.MethodsA policy community in a large UK conurbation was defined as ‘involved in delivering, developing or implementing public health policy’, and included regional and national actors. Policy actors’ accounts of the policy process (including evidence use, policy processes and policy networks) were gathered through 23 semi-structured interviews and over 18 hours of observations of NHS and local authority meetings, both public and private. Data were analysed using framework analysis.ResultsKnowledge brokerage roles were identified as part of the policy process, but were played by policy makers already in the policy community, rather than researchers and academics. Knowledge brokerage frameworks describe the involvement of policy makers in the research process, but descriptions of other activities involved in the policy process showed that knowledge brokerage strategies formed a small part of a much wider spectrum of policy-influencing strategies; controlling policy organisations, controlling policy content, controlling decision-makers and using relationships. These activities take place over long time periods, and over a range of policy areas, questioning the utility of constructions such as “public health policy” for analysing evidence-use and policy processes.DiscussionKnowledge brokerage is often presented as an intervention to increase research uptake, to be carried out by researchers. We show that the activities described are carried out by actors within the policy environment, questioning the usefulness of such approaches. Knowledge brokerage forms a small part of a spectrum of policy-influencing strategies employed by policy actors, who operate over a longer time-span and a wider range of policies than previously acknowledged. Providing empirical descriptions of the activities of policy actors provides insight into both how to influence policy, and a framework to understand the policy process itself.
PP71 Cultures of Evidence Among Decision-Makers in Non-Health Fields: Systematic Review of Qualitative Evidence
Authors: Lorenc T , Tyner E , Petticrew M , Martineau F , Phillips G , Lock K 
Published: September 2013

BackgroundMany non-health public policy sectors which form part of local government may have impacts on population health outcomes. Decision-makers’ views about research evidence, and their practices of evidence use, are less well understood in these sectors than in healthcare or public health.MethodsSystematic review (PRISMA) of qualitative evidence. A range of sources were searched. Studies were included if: they included local policy-makers or practitioners in transport, housing, urban planning and regeneration, crime and policing, or licensing; and reported substantive data on views, beliefs or experiences regarding research evidence. Study findings were synthesised using a grounded-theory thematic analysis approach.ResultsA range of contextual factors impact on evidence use, including personal contacts, institutional structures and power relationships, and national legal or policy constraints. Academic research evidence is often a relatively small part of the overall knowledge base for decision-making. The types of evidence used vary considerably across sectors: evaluations of effectiveness are generally a secondary concern, with descriptive evidence on contexts being more highly valued. General messages about the value of evidence-based policy and practice have been widely disseminated, and some sectors report relatively high rates of evidence use. However, decision-makers’ understandings of these messages are highly divergent, and the ways evidence is used in practice often do not conform to academic researchers’ preconceptions.DiscussionCompared to healthcare or public health, cultures of evidence in non-health sectors present distinct issues. The findings of this review indicate the need for a broader perspective on evidence use, which takes into account the whole decision-making process, and the interaction of academic research with more informal and situated forms of knowledge. Linear models of ‘knowledge translation’ may not capture the complexity of potential relations between knowledge and practice, and the wide variation in decision-makers’ understandings of the concept of evidence.
PP74 Comparing the Impact of Clinical Governance Policies in Different Countries: the Example of the English PROMS Programme
Authors: Boyce M B , Browne J P 
Published: September 2013

BackgroundThere is considerable variation at a country level in the use of health outcome measures to support clinical governance.In 2009 the NHS in England introduced Patient-Reported Outcome Measures (PROMs) as a national performance indicator for four common elective procedures (hernia repair, varicose veins, and hip/knee replacement). Outcome data is compared at a Trust level and reported publically to promote quality improvements. No such outcome monitoring has been introduced in a neighbouring jurisdiction, the Republic of Ireland. As the Republic of Ireland has a very similar profile of patients and surgeons to those seen in the NHS, it is an ideal comparison for evaluating the impact of the English PROMs Programme. In this study we compare the results of patients undergoing hip replacements in Ireland and England.MethodsPatients undergoing hip replacement surgery were recruited from 16 hospitals in Ireland, under the care of 35 surgeons between April 2011and November 2012. Mirroring the methodology used by the English PROMs Programme, patients were asked to complete a questionnaire which included the Oxford Hip Score (OHS) before and six months after their operation. To enable a comparison with data from the English PROMs programme, the Health and Social Care Information Centre in England provided the OHS mean change score for patients undergoing primary surgery between April 2010 and May 2011.ResultsA mean change score of 20.2 points on the OHS (95% CI 20.1, 20.3) was recorded for the 29,544 patients undergoing primary hip replacement surgery who reported data to the English PROMs Programme. This compares to 20.7 (19.9, 21.4) for the 795 Irish patients. This indicates no statistically significant difference between patient-reported outcomes in the two jurisdictions.ConclusionThis study presents a unique opportunity to assess patient outcomes across health systems with different forms of clinical governance. Our study demonstrates no differences in patient outcomes between a country which benchmarks and publically releases performance data and one which does not. In defence of the English PROMs programme it may be too early to evaluate effectiveness as quality improvements may only be evident when PROMs become influential to the decision making of providers and purchasers. Nevertheless, because our understanding of the value of outcome data in clinical governance is in its infancy, cross country comparisons are useful in the absence of better evidence.
PP75 What Factors are Important in Smoking Cessation and Relapse in Women from Deprived Communities? – A Qualitative Study
Authors: Barber J , Rumsby E , Parker S , Mohebati L , Venables S , Lawson K , Scanlon T , Memon A 
Published: September 2013

BackgroundIt is well established that women start to smoke earlier, are more susceptible to smoking-related disease and find it harder to quit than men. However, little research exists on factors associated with smoking cessation and relapse in women, particularly those from deprived communities. We conducted a qualitative study in South East England to examine these factors.MethodsEleven women who had used the NHS Stop Smoking Service in East Sussex were engaged in focus group discussions. Data were subjected to manual and NVIVO software-based thematic analysis.ResultsWomen confirmed that it is harder for them to quit smoking than men. A number of gender-specific themes were identified for this perceived difference. Women felt that post cessationweight gainwas inevitable and acted as a barrier to quitting.Menstrual fluctuationsandgreater levels of stresswere perceived as obstacles to quitting and reasons for relapse. Conversely, the women cited the effects of smoking onappearance,andguilt aboutexposing young children to passive smokingas powerful motivators to stop and highlighted the force of public health campaigns that focused on these factors. Whilst participants agreed thatfemale smoking is still stigmatisedit was not clear if this motivates cessation. The study exposed divergent views on whetherquitting with someoneclose to you is a help or hindrance. Other non-gender specific themes including alcohol intake, daily routine and being in the presence of smokers all emerged as situational triggers of relapse.DiscussionThese findings support consideration of issues around weight gain, menstrual fluctuations, stress, appearance, stigma and guilt about exposure of young children to passive smoking in the design of public health campaigns and interventions. Female-specific policy/programmes have been shown to facilitate cessation in women, and more research is needed on how to limit the impact and perception of post-cessation weight gain, stress and menstrual fluctuations on cessation attempts and relapses. This study and previous research suggest that national campaigns focusing on appearance and the effect of passive smoke on children may alter behaviour. However, more research is needed to understand how altered appearance can be made more relevant to younger women, and whether mass media specifically targeted at women is more effective at changing female smoking behaviour. Low socioeconomic status and deprivation are the strongest predictors of smoking in women, and more research is needed into how services and interventions can be best designed to impact on women living in deprived communities.
OP25 Benefits and Risks from Aspirin use in the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Review and Overview of Reviews of Randomised Trial Evidence
Authors: Sutcliffe P , Connock M , Gurung T , Freeman K , Johnson S , Kandala N-B , Grove A , Gurung B , Morrow S , Stranges S 
Published: September 2013

BackgroundAlthough the overall benefits and risks are not yet clear, there is a policy push for use of aspirin to be used for primary prevention of CVD and cancer by healthy adults in the UK. We aimed to identify relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses of RCTs to assess harms and benefits.MethodsSearches were performed in MEDLINE; EMBASE; Cochrane Database of Systematic Reviews; CENTRAL; DARE, NHS EED, HTA databases; Web of Science; UKCRN Portfolio Database and Clinical Trials.gov and were limited to publications since 2008. 2,572 potentially relevant papers were identified. 27 met the inclusion criteria. Two reviewers independently extracted data.ResultsAspirin dose used and population inclusion criteria varied. Absolute effects of aspirin were small; for 5,000 people followed for 20 years about 40 deaths would be avoided, while 100 GI bleeds and 17 haemorrhagic strokes would be incurred. Relative benefits ranged from a 6% reduction in relative risk (RR) for all-cause mortality (RR 0.94 [95% CI 0.88, 1.00]) to a 10% reduction in major cardiovascular events (0.90 [0.85, 0.96]) and a 15% reduction in total CHD (0.85 [0.69, 1.06]). Reported pooled odds ratios for total cancer mortality ranged between 0.76 (0.66, 0.88) and 0.93 (0.84, 1.03). Aspirin reduced reported colorectal cancer incidence (0.66 [0.9, 1.02]). Including studies where aspirin was given every other day raised the RR to 0.91 (0.74, 1.11). Reported cancer benefits begin to appear approximately five years from start of treatment. Increased relative risks of adverse events from aspirin use were reported as 37% for gastro-intestinal bleeding (1.37 [1.15, 1.62]), between 54% (1.54 [1.30, 1.82]) and 62% (1.62 [1.31, 2.00]) for major bleeds, and between 32% (1.32 [1.00, 1.74]) to 38% (1.32 [1.01, 1.82]) for haemorrhagic stroke.ConclusionThere is a fine balance between benefits and risks from regular aspirin use in primary prevention of CVD. Effects on cancer prevention have a long lead time and currently rely on post-hoc analyses of trials for other conditions. All absolute effects are small compared to the burden of these diseases. Results of ongoing trials may change the picture but presently we consider a decision to use aspirin for primary prevention of cardiovascular diseases and cancer at population level unjustified.