bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP21 Organisational Influences on Variation in Rates of Caesarean Section Among English NHS Trusts after Accounting for Maternal and Clinical Risk: A Cross-Sectional Study
Authors: Sandall J , Cookson G , Dodwell M , Gibson R , Murrells T , Bewley S , Coxon K , Bick D 
Published: September 2013

BackgroundThe proportion of women in England having a caesarean has increased from 9% to 24.8% between 1980 and 2012. There is increasing attention focused on the short and long term effects on the mother and the baby and efforts to have an increased understanding of associated influences. Previous research has adjusted for population case-mix (Bragg al 2010), but there has been less research on the relative impact of organisational factors which is the aim of this study.MethodsA retrospective cross-sectional analysis was performed using routinely collected data from Hospital Episode Statistics dataset with over 660,000 deliveries in 144 NHS trusts in England. The dataset included all women giving birth between April 2010 and March 2011. The outcome was whether the delivery was by caesarean section. Clinical risk factors were calculated using the NICE intrapartum guideline criteria for women at increased risk of complications at the end of pregnancy. Exploratory statistical analysis of caesarean rates for each trust was performed to identify significant variation in rates (both planned and emergency). A multilevel logistic regression model was used to estimate the likelihood of women having a caesarean section given their maternal (level 1) characteristics (age, ethnicity, parity, socioeconomic deprivation), clinical risk factors (NICE Intrapartum guideline criteria) and organisational (level 2) factors (staffing, trust configuration, number of delivery beds, number of deliveries, teaching and Foundation Trust status, CNST rating and women’s experience).ResultsIn 2010/11, 48% of women in England were categorised as low risk according to NICE Intrapartum Guidelines at the end of pregnancy. Among 660,000 deliveries, 24.8% of women were delivered by caesarean section. Unadjusted rates of caesarean section among the NHS trusts ranged from 36.1% down to 15.2%. Following adjustment for socio-demographic and clinical risk factors, adjusted rates were of a similar range but rates for individual trusts changed, and the impact of organisational factors were examined.DiscussionOnce adjusted for socio-demographic and clinical risk factors, it is possible to see how caesarean rates for trusts differ. We discuss the relative impact of organisational characteristics, and what requires further exploration. Routinely collected data can provide information about the type of births that women are experiencing, and provide the means to adjust trust data to take account of the profile of women giving birth in each location, and organisational characteristics. This allows trusts to benchmark its services for quality improvement and provides baseline data for exploring reasons for high and low performing outliers.
PP22 The Health of People with Past Experience of Probation Services - A Qualitative Study
Authors: K Lees , Parkes J , Sinclair J , Richards E 
Published: September 2013

BackgroundA significant proportion of the UK population have had a criminal conviction (15% of 10-52 year olds). There is some evidence those in contact with probation have worse health compared to the general population. This study aimed to increase understanding of the health of people in contact with probation, through experiences of ex-offenders.The study asked the following research questions:What role do ex-offenders perceive their health plays in offending behaviour?Do ex-offenders perceive their health has changed since they were last supervised by Probation?What were ex-offenders’ experiences of health interventions in probation, including Health Trainers?What perceived effect does ex-offenders’ health have on those around them?MethodsUsing snowball techniques to recruit, 20 participants were interviewed between June and November 2012. Interviews were semi-structured using a topic guide; recorded with participants’ permission and transcribed. The transcription was coded in Nvivo and analysed using a thematic analysis. The study questions formed initial themes. Sub-themes and key concepts were developed iteratively.ResultsFour themes were identified, each with sub-themes and key concepts.Theme 1 - Perceived relationship between health and offending: Substance misuse; Mental health“you need the substance to be well and you need to be well to have the strength to go thieving again.”Theme 2 - Health of ex-offenders whilst offending and now: Injuries; Infectious disease; Chronic conditions; Nutrition, physical activity and body weight; Sleeping; Sexual health; Improved health since stopping offending; Substance misuse; Barriers to recovery; Mental and emotional health“I could have easily enough had a season ticket at A&E because I was always cutting myself or falling over”Theme 3 - Health interventions whilst offending: Healthcare in probation; Health trainers, mentors and peer support; Healthcare in prison; Therapeutic relationship; Service accessibility; Joined up services; AntidepressantsTheme 4 - Significant others: Death and physical health; Impact on children; Domestic violence.ConclusionEx-offenders report a strong association between health and offending behaviour. Most perceive their current health to be much better than when they were offending. Ex-offenders reported a lack of health services whilst in probation. Their experiences of health services whilst offending highlight barriers to access and gaps in provision. Ex-offenders felt their offending behaviour had a negative impact on the health and well-being of significant others. Probation services may be an opportunity to improve the health of a population reporting poor health. Improving the health of those in probation may contribute to reducing re-offending.
PP23 Variation of Primary Care Quality with Contract type: An Observational Study
Authors: Ratneswaren A , Laverty A , Greaves F , Millett C 
Published: September 2013

BackgroundSince 2004, policy reforms in the English NHS have allowed new contracting mechanisms for provision of general practice services. A wider variety of provider organisations were allowed under the alternative provider of medical services (APMS) contract. In addition, Primary Care Trusts have been able to directly provide general practice services via the PCTMS contract. These new contracts were introduced to challenge existing models of care and encourage innovation to meet changing healthcare needs. Concerns have been expressed about the increasing diversity of providers and commercialisation on primary care performance. We looked at whether there is variation in performance amongst practices according to the type of contract they have.MethodsFifteen commonly reported performance indicators were selected to represent a broad spectrum of clinical quality covering clinical effectiveness, patient experience, efficiency and access. Practice-level performance data, demographic data and contract-type for all general practices in England with more than 1000 patients for the year 2011/12 were extracted from open Internet sources, including: the GP Patient Survey, the Quality Outcomes Framework, the NHS Information Centre Indicator Portal and NHS Comparators. We compared performance across these indicators by contract type with adjustments for age, gender, ethnicity and deprivation.ResultsIn 2011/12, there were 4517 GMS practices, 3313 PMS practices, 217 APMS practices and 72 PCTMS practice. When compared to GMS practices, APMS performed worse across 9 of the 15 indicators, and better on 2 indicators (P < 0.05). APMS practices had greater levels of satisfaction with opening hours and higher rates of generic prescription for statins, but lower performance for patient experience and clinical QOF indicators. PCTMS practices performed worse than GMS on 9 indicators, and better on none. In particular, PCTMS and APMS practices had lower patient experience, higher levels of diabetes exception reporting and higher levels of ambulatory care sensitive admissions to hospitals. (P < 0.01 for all).ConclusionThere is variation in performance for a number of measures of primary care quality that occurs with contract type, although the cause is not clear. Both APMS and PCTMS practices were consistently more poorly performing in certain areas. It is not clear whether these variations in performance are related to the contract type, or to historical contextual factors (including previous poor management). However these differences remain after adjusting for age, sex, ethnicity and multiple deprivations at practice-level. Further work to identify consequences of increased provider diversity in primary care would be useful.
PP25 Caesarean Section and Subsequent Pregnancy Interval - A Systematic Review
Authors: Neill S M O , Kearney P M , Kenny L C , Henriksen T B , Greene R A , Khashan A S 
Published: September 2013

BackgroundCaesarean section rates have increased significantly in the past three decades, with one in four babies in the United Kingdom (UK) delivered operatively. In light of this, the National Institute for Health and Clinical Excellence (NICE) updated their caesarean section guidelines to give women the right to request a caesarean section without any medical indication. With the long term consequences of caesarean section on fertility unknown, further research is warranted.ObjectiveTo compare pregnancy interval between women with a previous caesarean to women with a previous vaginal delivery.MethodsStudy Design: Systematic review of the published literature. CINAHL, Cochrane library, Embase, Medline, PubMed, SCOPUS and Web of Knowledge databases were searched (1945-October 2012), using a detailed search-strategy and cross-checking of references. Cohort, case-control and cross-sectional studies were eligible. Two assessors individually reviewed titles, abstracts and full articles to identify eligible studies, using a standardised data-abstraction form and assessed study quality. A meta-analysis was not suitable due to between-study heterogeneity.ResultsData synthesis: Over 9,184 titles were screened, with 12 articles included. Four studies reported an increased waiting time to next pregnancy following a previous caesarean section delivery. However, variations in the definition of time to next pregnancy or birth used, as well as lack of adjustment for confounders, small sample size, inability to identify the indication for caesarean section, short follow-up time and lack of stratification by number of previous pregnancies were all obvious limitations. Eight studies reported no association between a previous caesarean section delivery and subsequent pregnancy interval. These were methodologically more superior with larger sample sizes, population-based registries, and detailed obstetrical information including indication for mode of delivery and long follow-up periodsDiscussionEvidence on the relationship between caesarean delivery and pregnancy interval is conflicting. Residual confounding is possible and further research of better methodological quality is required to assess whether any delay in pregnancy interval is causal or as a result of parental choice to delay childbirth.
PP26 Caesarean Delivery and Subsequent Birth Interval, Ectopic Pregnancy, Miscarriage or Stillbirth-a Danish Register-based Cohort Study
Authors: O’Neill S M , Agerbo E , Kenny L C , Henriksen T B , Kearney P M , Greene R A , Mortensen P B , Khashan A S 
Published: September 2013

BackgroundDespite high caesarean delivery rates worldwide, limited data are available on the effect of a prior caesarean delivery on subsequent fertility.AimTo estimate the time to next birth and the risk of miscarriage, ectopic pregnancy and stillbirth in women with a prior caesarean delivery compared to women with a prior vaginal delivery.MethodsUsing Danish registry data we identified a cohort of women giving birth between 1982 and 2010 (n = 833,162). The cohort was followed from the index birth until the next birth or censoring by death, emigration or study end (31/12/2010). Women with an index caesarean section were compared to women with an index vaginal birth by stratified Cox regression models using SAS version 9.2ResultsWomen with an index caesarean were less likely to have a subsequent delivery and had an increased time to next birth (HR 0.83 [95% CI 0.82, 0.84]). Sub-group analyses by smoking status, history of fertility services, maternal BMI, preterm birth & low birth weight did not modify results. Analyses for ectopic pregnancy and miscarriage showed no increased HR among women with a prior caesarean section; however a significantly increased HR for subsequent stillbirth was reported (1.16 [1.04, 1.28]).ConclusionPrior caesarean delivery, particularly elective and maternally requested caesareans were associated with an increased time to next birth. An increased hazard ratio of stillbirth in subsequent deliveries but not ectopic pregnancy or miscarriage among women with an index caesarean was also found.
PP33 A N Age-Period-Cohort Analysis for Trends in Body Mass Index in the Republic of Ireland in 18,016 Participants in Slan (Surveys of Lifestyle, Attitudes and Nutrition) 1998-2007
Authors: T Jiang , Gilthorpe M S , Shiely F , Harrington J , Perry I J , Kelleher C C , Tu Y K 
Published: September 2013

BackgroundObesity has increased in prevalence worldwide in the last 20 years and is associated with a variety of adverse health outcomes. It is valuable to examine these trends in relation to age, period and birth cohort, in conjunction with several evolving environmental factors. Age-period-cohort (APC) analysis is a popular analytic approach, since knowing the separate effects of age, period and cohort allows for a better understanding of the different risk groups based on age and generation cohort, separately, and cohort effects can identify individuals who are particularly at high risk of obesity, to allow for effective public intervention measures.MethodsData were obtained in the Republic of Ireland via three consecutive waves of the Surveys of Lifestyle, Attitudes and Nutrition (SLAN), all of which are now publicly available. Data were collected in 1998, 2002 and 2007 through standardised protocols. Participants with missing values were excluded from the analyses. Those over the age of 75 were excluded due to sparse data. Of the original 22,895 participants, we performed analyses on 18,016 participants: 7,796 men and 10,220 women. We applied partial least squares (PLS) methodology to estimate the separate effects of age, period and cohort on the trends in obesity as measured by body mass index (BMI). We also explore and model nonlinear relationships of BMI with age, period and cohort.ResultsPLS analysis revealed a positive period effect. Additionally, men born later tended to have lower BMI (-0.026 kgm-2yr-1[95% CI -0.030, -0.024]) and older men had in general higher BMI (-0.029 kgm-2yr-1[-0.026, -0.033]) Similarly for women, those born later had lower BMI (-0.025 kgm-2yr-1[-0.029, -0.022]) and older women in general had higher BMI (0.029 kgm-2yr-1[0.022, 0.033]) Nonlinear analyses revealed that BMI has a substantial curvilinear relationship with age, though less so with birth cohort.DiscussionThrough the use of PLS we are able to estimate the separate contributions to obesity of age, period and cohort. Consequently, PLS produces more interpretable results than other approaches. Men and women born in Ireland during the period 1924-1989 experienced a steady increase in BMI by year of age, which became more pronounced throughout the study period, mitigated only slightly by improved maternal nutrition of successive cohorts, which would potentially have given rise to better ‘programming’ of children in preparation for an increasingly obesogenic environment experienced in childhood and adulthood.
PP63 The Role of Ethnicity Concerning the Prevalence and Severity of Obstructive Sleep Apnoea in Severely Obese Patients
Authors: Leong W B , Arora T , Jenkinson D , Thomas A , Punamiya V , Banerjee D , Taheri S 
Published: September 2013

BackgroundThe South Asian population is at increased risk of cardiovascular disease. South Asians residing in western countries also have increased risk of obesity and associated comborbidities compared to white European counterparts. We compared the prevalence and severity of obstructive sleep apnoea (OSA) along with comorbidities in South Asians and white Europeans with severe obesity.MethodsData from consecutive patients attending a specialist weight management service were analysed. Self-reported age, gender and ethnicity were gathered. Medical history was obtained by a trained physician to determine the quantity of comorbidities. Objective measurements of blood pressure, body mass index (BMI), and apnea-hypopnea index (AHI) were also acquired for study purposes.ResultsA total of 308 patients (72.7% women; 13% South Asian) were included with a mean age and BMI of 46 ± 12y and 49 ± 8Kg/m2,respectively. South Asians had significantly increased prevalence of OSA compared to white Europeans (p = 0.017) and were more likely to have severe OSA (p = 0.015). South Asians had significantly higher median AHI (24/hr: interquartile range [IQR] 9.3–57.6 vs. 9/hr: IQR 3.4–26.6; p < 0.01), significantly lower minimum oxygen saturation (76%: IQR 64-84% vs. 83%: IQR 77-87%; p < 0.01) and spent a significantly greater amount of time <90% oxygen saturation (8.4%: IQR 1.0–24.3% vs. 2.4%: IQR 0.2–16.0%; p = 0.03). South Asians also had a significantly greater number of comorbidities (p = 0.02) and poorer glycemic control (HbA1c 7.4 vs. 6.3, p < 0.01) compared to white Europeans. South Asian ethnicity, independent of demographics, BMI, and cardiovascular comorbidities was an independent predictor of OSA β = 0.61 (SE = 0.19), p < 0.01. Furthermore, we confirmed other independent OSA risk factors, consistent with previous studies, including increasing age and BMI and male gender (all p < 0.001).ConclusionSeverely obese South Asians had significantly greater prevalence and severity of OSA versus white Europeans. OSA may contribute to increased cardiovascular risk in South Asians compared to white Europeans with severe obesity. Mechanisms mediating the observed associations between these ethnicities require further investigation.
PP65 What is the Effect of a Behaviour Change Intervention on the Diets and Physical Activity Levels of Women Attending Sure Start Children’s Centres in Southampton? Findings from a Non-Randomised Controlled Trial
Authors: Baird J , Jarman M , Lawrence W , Black C , Davies J , Tinati T , Begum R , Mortimore A , Robinson S , Margetts B , Cooper C , Barker M , Inskip H 
Published: September 2013

BackgroundA major component of the government response to the obesity epidemic includes action in communities to improve people’s health behaviour. This study evaluated the effects of a community-based intervention on dietary quality and physical activity of women from disadvantaged backgrounds. The intervention consisted of training Sure Start Children’s Centre (SSCC) staff in skills to support behaviour change.MethodsWe conducted a non-randomised controlled trial with mixed methods process evaluation. Participants were 527 women attending Sure Start Children’s Centres in Southampton (intervention area) and 495 women attending Centres in Gosport and Havant (control area). Main outcomes were dietary quality, physical activity, self-efficacy and sense of control assessed before and one year after the intervention. Intervention and control group outcomes were compared using linear regression and adjusting for level of the corresponding variable at baseline.ResultsProcess evaluation showed that intervention staff used skills to support behaviour change significantly more than control staff (p < 0.001) one year post-training. There were, however, significant reductions of 0.1 SD in women’s dietary quality, 0.06 SD in self-efficacy and 0.18 SD in sense of control in both the intervention and control groups between baseline and follow up. There were no significant differences between the intervention and control groups in the magnitude of change in dietary quality. We found, however, that the magnitude of decline in self-efficacy and control was significantly smaller in the intervention women than in women from the control areas. There was a statistically significant improvement in physical activity level between baseline and follow up in the intervention group; 22.9% of women reported the highest level of physical activity at follow up compared with 12.4% at baseline. There was a smaller improvement in physical activity in the control group that was not statistically significant. However, the difference in magnitude of change in physical activity level between the groups was not statistically significant.ConclusionThe intervention led to sustained increase in skills to support behaviour change among SSCC staff, but did not result in improvement in the dietary quality and physical activity of intervention group women compared with controls. There was, however, a protective effect on women’s self-efficacy and sense of control (factors known to be associated with dietary quality). These findings suggest that more prolonged exposure to the intervention may lead to improvements in health behaviour and, given the challenges of evaluation in a community setting, that further evaluation in a more controlled setting is justified.