bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP43 Are we Overestimating the Beneficial Effects of Alcohol in Later Life? the Case of Young Non-Drinkers
Authors: Fat L Ng 
Published: September 2012

BackgroundNon-drinkers have been repeatedly shown to have worse health than moderate drinkers in later life particularly as regards conditions such as coronary heart disease, leading some researchers to suggest that moderate alcohol consumption has beneficial effects on health. However the causal direction between non-drinking and worse health has been contested. Whether poor health is associated with non-drinking among young adults in relation to social and health factors will be investigated. Such a finding would imply that poor health may precede non-drinking even at early stages of the life course.MethodsWe performed logistic regression analysis of cross-sectional national survey data on 18 to 34 year olds, collected from The Health Survey for England 2006 and 2008. Data was collected through face to face interviews and is self-reported. Logistic regression analysis of longitudinal data collected from the National Child Development Study 1958 were also conducted. This is a follow up study to assess whether poor health at age 16 is associated with non-drinking at age 23, and whether these people are more likely to abstain at subsequent age sweeps.ResultsHSE 06 & 08: Having a limiting longstanding illness during early adulthood increased the odds of being a non-drinker 1.74 times for men (p<0.01), and 1.45 times for women (p<0.01). In both men and women belonging to the lowest income quintile or having no qualifications was associated with increased odds of being a non-drinker (p<0.001) indicating that the social gradient in non-drinking begins at an early age. Men and women aged 18 to 34 years with the lowest activity levels were also more likely to be non-drinkers (p<0.01).NCDS: Preliminary analysis reveals that non-drinkers at age 23 have higher rates of medical conditions at age 16 as assessed by a medical officer such as having a mental condition (p<0.001) a physical condition and heart and haematological condition (p<0.01).ConclusionYoung adults who have a limiting longstanding illness are more likely not to drink alcohol even after adjusting for a range of social and demographic measures. Studies on the putative health benefits of moderate alcohol consumption later in life need to take account of early life history. Further analysis using longitudinal data will explore whether poor health precedes non-drinking right at the start of drinking history and whether people with poor health continue to abstain from alcohol at older ages.
OP54 Short-Term Impact of the Smokefree Legislation in England on Hospital Admissions for Asthma Among Adults
Authors: Sims M , Gilmore A 
Published: September 2012

BackgroundComprehensive smokefree laws prohibiting smoking in enclosed public places and workplaces have now been introduced in several jurisdictions and there is a growing body of evidence documenting the immediate health benefits to adults, focusing primarily on hospital admissions for heart attacks. A few studies have examined the association between smokefree laws and asthma in adults, but these have limitations such as lacking appropriate adjustment for long-term trends, or having limited statistical power due to a small study population. In this study we investigated the short-term impact of the introduction of smokefree legislation in England on 1st July 2007 on hospital admissions for asthma in adults.MethodsThe immediate effect of the legislation was investigated using monthly numbers of emergency admissions for asthma (primary diagnosis, ICD–10 code J45 and J46) in the nine Government Office Regions from April 1997 to December 2010, in the population aged 16 and over. The analysis was conducted using a quasi-Poisson generalised additive model that adjusted for seasonality and region-specific, non-linear, long-term trends.ResultsAfter adjusting for the long-term trend in admissions, we observed a 4.9% (95% CI: 0.6, 9.0) reduction in admissions for asthma immediately after introduction of smokefree legislation in the population as a whole. This implies that almost 1900 emergency admissions for asthma were prevented during the first year of the legislation. The reduction in admissions did not vary significantly across regions.ConclusionOur finding, based on the largest study to date, adds to the expanding body of evidence that smokefree legislation is associated with positive health outcomes. Further research evaluating the impact of legislation on asthma admissions in other jurisdictions is needed in order to support these findings.
OP57 All-Cause and Cause-Specific Mortality among Individuals with and Without Diabetes in England and Scotland
Authors: Gordon-Dseagu VLZ , Mindell J , Shelton N 
Published: September 2012

BackgroundAlthough a growing body of evidence demonstrates an increase in cardiovascular disease (CVD) mortality among those with diabetes mellitus, the results related to other causes of death are less homogenous. The strength of the association between diabetes and mortality appears to differ by geographic location. The role that Body Mass Index (BMI) plays also requires further exploration. In the UK, one in 20 individuals is estimated to have diabetes. Therefore, even a small increase in mortality risk among those with diabetes, could result in a large number of deaths among those with the disease. This large general-population cohort study used data from England and Scotland to explore the associations between diabetes and risk of all-cause and cause-specific mortality, and examine the extent to which any increase was attributable to raised BMI.MethodsNationally-representative, cross-sectional data from 15 years of the Health Survey for England (HSE) (1994–2005) and Scottish Health Survey (SHeS) (1995, 1998 and 2003) were linked with mortality records up to the first quarter of 2011. Odds ratios (OR) and 95% confidence intervals (CI) adjusted for age-group and sex (model 1), plus smoking status (model 2) and additionally for BMI category (model 3) were estimated using logistic and multinomial logistic regression. Participants mentioning cancer at baseline were excluded from the study.ResultsWithin this sample of 166,600 participants (5,131 with diabetes) there were 19,483 deaths (1,060 among those with diabetes, 18,423 without diabetes). All-cause mortality was greater among those with diabetes when adjusted for age, sex and smoking status (OR 1.52, 95% CI 1.41–1.65), with no reduction when adjusting for BMI category (OR 1.49, 1.37–1.64). Cause-specific mortality among those with diabetes was raised for CVD (model 2 OR 1.73, 1.55–1.93), cancer (1.24, 1.08–1.43) and ‘Other’ (1.77, 1.54–2.04) with a non-significant increase for respiratory diseases (1.21, CI 0.99–1.47). Additional adjustment for BMI had a minimal impact upon the excess mortality found among those with diabetes: CVD (OR 1.69, 1.49–1.93), cancer (1.24, 1.05–1.45), ‘Other’ causes (1.75, 1.49–2.07), and respiratory diseases (1.16, 0.92–1.47). Survival was also lower among those with diabetes compared with those without the disease at baseline.ConclusionDiabetes is associated with an excess of all-cause and cause-specific mortality from CVD, cancer, and ‘Other’ causes but probably not respiratory diseases. Increased BMI does not appear to be a mediating factor within the association between diabetes and cause-specific mortality.
OP68 The Contribution of Doctors’ Decisions to Healthcare Inequalities: Towards Fourth Generation Studies
Authors: Marceau LD , McKinlay JB , Piccolo RS 
Published: September 2012

BackgroundHealthcare variations are a worrisome and well-documented problem. Such variations occur at different levels: between health care systems, geographic areas, organizational settings, patients, and doctors. Research is increasingly focused on the contribution of doctors’ decision making to the generation or amplification of healthcare disparities. Clinical decision making studies continue to evolve through generations of work that focus on different types of influence:First generationstudies identified patient-level attributes (e.g., gender, age, race/ethnicity, SES, health insurance status);Second generationstudies on variations associated with physician characteristics (e.g., age, gender and education, specialty and type of remuneration);Third generationstudies on health system and organizational influences (e.g., size, profit status, location and population served, and most recently, organizational culture).MethodsWe used a factorial experimental design in which the subjects, primary care doctors (n=192), viewed clinically authentic vignettes of “patients” presenting with identical signs and symptoms suggesting diabetes. They were stratified according to gender and level of experience. During an in-person interview, they were asked how they would diagnosis and manage the vignette ‘patient’.ResultsAfter controlling for the first two levels of influence (patient and provider), each of which contributed 4.4 and 2% respectively, organizational culture significantly contributed to their behavior, accounting for 14.3% of the variation in clinical decision-making for diabetes. Considering nine different dimensions of practice culture, organizational trust and business emphasis contributed most to the variance in treatment for diabetic foot neuropathy.ConclusionAttempts to reduce health care variations continues to focus on the levels of patient attributes and physician characteristics (e.g. improved educational efforts). Findings from this experiment suggest a need to further investigate the contribution of of organizational factors (third generation) and suggest appropriate interventions at that level. As important however, is the consideration of afourth generation: cognitive aspects of physician decisions. Qualitative methods (i.e. “think aloud”) and newly developing methods to objectively measure unconscious bias (e.g., the Implicit Association Test) can provide more robust assessment of what goes on “inside the doctors’ head,” which eventually produce healthcare disparities.
OP84 Do Supermarket Interventions Improve Food Access, Fruit and Vegetable Intake and BMI? Evaluation of the Philadelphia Fresh Food Financing Initiative
Authors: Flint E , Cummins S , Matthews SA 
Published: September 2012

BackgroundStructural interventions to improve access to healthy food in deprived communities are a current policy priority. In 2010, the Obama administration unveiled the Healthy Food Financing Initiative to promote interventions that expand access to nutritious foods. The initiative provided more than $400 million in funding to bring grocery stores and health food retailers to deprived communities. However, no evidence for the effectiveness of such policy interventions exists. This paper is a first attempt to evaluate the effect of this intervention on perceptions of the food environment, fruit and vegetable intake and body mass index (BMI) in Philadelphia, USA.MethodsData from the Philadelphia Neighbourhood Food Environment Study were used. This study utilised a prospective quasi-experimental design comparing baseline and follow up data in an ‘intervention’ community with a matched ‘comparison’ community. The intervention was the introduction of a large food supermarket in an underserved area. Outcomes were BMI, weekly fruit and vegetable consumption (Block FFQ), and perception of the neighbourhood food environment. Data were analysed using an intention-to-treat (ITT) and adopters vs non-adopters (ANA) approach. Difference-in-differences analyses (DID) assessed whether significantly different changes over time existed between intervention and comparison groups. Models were adjusted for age, sex, income, race, education, household composition and employment status.ResultsIn ITT and ANA analyses no significant difference-in-differences in mean BMI and mean weekly fruit and vegetable consumption were found. ITT analyses demonstrated a significant improvement in perceptions of the neighbourhood food environment in the intervention versus comparison neighbourhood (DID=1.71, p=0.001). Using ANA, a similar result was found for adopters, with those who used the grocery store as their primary shop (DID=1.57, p=0.05) and those who used it for any food shopping (DID=2.34, p<0.001) having significantly better perceptions of the neighbourhood food environment compared to non-adopters. After adjustment, ITT analyses remained significant (DID=1.65, p=0.002). For ANA, significant DID results were attenuated for primary adopters (DID=1.30, p=1.105) but remained significant for those undertaking any food shopping (DID=2.18, p<0.001).ConclusionThe introduction of a new grocery store had a positive effect on how local residents perceive the quality of their neighbourhood food environment. However, this did not have a significant effect on fruit and vegetable consumption or BMI. Improvement in perceptions of neighbourhood food environment quality did not translate into improved dietary behaviour or reductions in BMI.
OP95 Risk Factors for First Venous Thromboembolism in and around Pregnancy: A Population Based Cohort Study from the United Kingdom
Authors: Sultan A Abdul , Tata LJ , West J , Fiaschi L , Fleming KM , Nelson-Piercy C 
Published: September 2012

BackgroundVenous thromboembolism (VTE) remains one of the leading causes of maternal mortality in high income countries. A lack of robust data on women’s risk factors for antepartum and postpartum VTE limit potential prevention. There is a need for estimates of absolute risks at population level according to recognised risk factors.MethodsUsing a large primary care database, we analysed 376,154 pregnancies ending in live births or stillbirths from women 15–44 years of age between 1995 and 2009. We assessed the impact of risk factors on the absolute and relative incidence of VTE for antepartum and postpartum periods using Poisson regression.ResultsPostpartum, the strongest risk factor was stillbirth (Absolute VTE Rate=2,444/100,000 person-years) followed by varicose veins, BMI >30kg/m2, obstetric haemorrhage, preterm delivery, medical co-morbidities (either SLE, IBD, nephrotic syndrome or cancer) and caesarean section (AR=637/100,000 person-years or higher). BMI >30kg/m2 conferred a substantial increase in postpartum risk (AR=926/100,000 person-years) but only a modest increase antepartum (AR=109/100,000 person-years). Women age>35 years, current smokers, and those with acute systemic infections had small relative increases in antepartum and postpartum VTE to those without such risk factors.ConclusionAntepartum VTE varies modestly by recognised risk factors, yet women with stillbirths, preterm births, obstetric haemorrhage, caesarean section delivery, co-morbidities or BMI >30kg/m2 are most likely to benefit from thromboprophylaxis postnatally. For example, we estimate that up to 17 to 159 annual VTEs could be avoided annually if all women with stillbirth, preterm birth or caesarean section in the UK received appropriate thromboprophylaxis.
PL01 A Simple Morbidity Score for UK Primary Care: A New Tool for Research and Healthcare Outcome Monitoring
Authors: Carey IM , Shah SM , Harris T , DeWilde S , Cook DG 
Published: September 2012

BackgroundAdjustment for morbidity level is important in ensuring fair comparison of outcomes between patient groups and healthcare providers. The Quality and Outcomes Framework (QOF) in UK primary care, which records numerous diseases systematically, offers potential for developing a standardised morbidity score that can be easily applied in research and service settings.MethodsUsing The Health Improvement Network (THIN), a large primary care database of 375 UK general practices in 2008–9, half the practices were randomly selected as a training set to derive a morbidity score based on chronic conditions recorded in QOF, and the other practices formed a validation set to assess predictive performance. A total of 653,780 patients aged 60 and over registered in 2008 were included, and mortality at one year was assessed.ResultsNine QOF conditions were identified as robust co-predictors (Hazard Ratio ≥1.2) of mortality independent of age and sex, and were assigned integer score weights based on the strength of their association with mortality. Cancer (HR=3.4) and Dementia (HR=2.8) were the strongest predictors. In a Cox model with age and sex included, the addition of the QOF score improved model discrimination in predicting mortality (c-statistic=0.82 vs. 0.78), performing similarly to the Charlson index, an established morbidity index. In a multilevel logistic model, an individual’s QOF score explained more of the variation in mortality between practices than the Charlson index (46% compared to 32%). At practice level, the mean QOF score per patient was strongly correlated with practice standardised mortality ratios (r=0.64) and explained more variation in practice death rates than the Charlson index.ConclusionA simple score derived from routine QOF recording provides a morbidity index which is highly predictive of one year mortality in older UK Primary Care patients, is simpler to implement than existing morbidity scores, and explains practice level variations in mortality. This new score has potential utility in research and healthcare outcome monitoring and could be easily implemented nationally through existing mechanisms for anonymised collection of QOF data from practices.
PS01 Associations of Health, Physical Activity and Weight Status with Motorised Travel and Transport Carbon Dioxide Emissions
Authors: Goodman A , Brand C , Ogilvie D 
Published: September 2012

BackgroundMotorised travel and associated carbon dioxide (CO2) emissions generate substantial health costs, many of which disproportionately affect socio-economically disadvantaged groups. These health costs may include contributing to rising obesity levels. Obesity has in turn been hypothesised to increase motorised travel and/or CO2emissions, both because heavier people may use motorised travel more and because heavier people may choose larger and less fuel-efficient cars. These hypothesised associations have not been examined empirically, however, nor has previous research examined associations with other health characteristics. Recent years have, however, seen increasing research and policy attention to the potential ‘co-benefits’ of pursuing policies which simultaneously enhance public health and promote environmental sustainability. We therefore aimed to examine how and why weight status, health, and physical activity are associated with transport CO2emissions.Methods3463 adults (18–91 years, 45% male) completed questionnaires in the baseline iConnect survey at three study sites in the UK, self-reporting their health, weight, height and past-week physical activity. Seven-day recall instruments were used to assess travel behaviour and, together with data on car characteristics, were used to estimate CO2emissions. We used path analysis to examine how far active travel, motor travel and car engine size mediated associations between health characteristics and CO2emissions.ResultsCO2emissions were higher in overweight or obese participants (multivariable standardized probit coefficients 0.16, 95% CI 0.08, 0.24 for overweight vs. normal; 0.16, 95% CI 0.04, 0.28 for obese vs. normal). Lower active travel and, particularly for obesity, larger car engine size explained 19–31% of this effect, but most of the effect was directly mediated by greater motorised travel distance. Walking for recreation and leisure-time physical activity predicted higher motorised travel distance and therefore higher CO2emissions, while active travel predicted lower CO2emissions. Poor health and illness did not independently predict CO2emissions.ConclusionEstablishing the direction of causality between weight status and travel behaviour requires longitudinal data, but the engine size association suggests at least a potential causal effect of obesity on CO2emissions. More generally, transport CO2emissions are differently associated with different health characteristics, including associations between a health good and an environmental harm (recreational physical activity and high emissions). Thus health-environmental ‘co-benefits’ cannot be assumed. Instead, attention should also be paid to identifying and mitigating potential areas of tension, for example promoting low-carbon recreational activity.
PS09 Sleep Problems: An Emerging Global Epidemic? Findings from the Indepth Who-Sage Study among over 40,000 Older Adults from Eight Countries Across Africa and Asia
Authors: Stranges S , Tigbe W , Gómez-Olivé FX , Thorogood M , Kandala N-B 
Published: September 2012

BackgroundSeveral studies have reported downward trends in the average duration of sleep and an increasingly higher prevalence of sleep problems across different Western populations. However, the evidence from low-income countries is limited. This study aims to fill this gap by examining the prevalence of sleep problems and associated factors in low-income settings.MethodsCommunity-wide samples were taken from eight countries across Africa and Asia participating in the INDEPTH WHO-SAGE multicentre collaboration during 2006–2007. The participating sites included rural populations in Ghana, Tanzania, South Africa, India, Bangladesh, Vietnam and Indonesia, and an urban area in Kenya. The overall sample comprised 24,434 women and 19,501 men, for a total of 43,935 participants, aged 50 years and over. Two measures of sleep quality, over the last 30 days, were assessed alongside a number of socio-demographic variables, measures of quality of life, and co-morbidities.ResultsOverall 16.6% of participants reported severe/extreme nocturnal sleep problems, with a striking variation across the eight populations, ranging from 3.9% (Purworejo, Indonesia, and Nairobi, Kenya) to over 40.0% (Matlab, Bangladesh). There was a consistent pattern of higher prevalence of sleep problems in women and older age groups. In bivariate analyses, lower education, not living in partnership, and poorer self-rated quality of life were consistently associated with higher prevalence of sleep problems (P<0.001). In multivariate logistic regression analyses, limited physical functionality or greater disability and feelings of depression and anxiety were consistently strong, independent correlates of sleep problems, both in women and men, across the eight sites (P<0.001).ConclusionA large number of older adults in low-income settings are currently experiencing sleep problems, which emphasises the global dimension of this emerging public health issue. This study corroborates the multifaceted nature of sleep problems, which are strongly linked to poorer general wellbeing and quality of life, and psychiatric co-morbidities.