bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP04 The English North-South Divide: Risk Factors for Cardiovascular Disease Accounting for Cross-Sectional Socioeconomic-Position
Authors: Kumar R , Dalton ARH 
Published: September 2012

BackgroundGeographic inequalities in health are widely discussed, with an English North-South divide a popular notion. Data indicate the North-South divide in all cause mortality has persisted, even widening in recent years. Given the impact of cardiovascular disease (CVD) mortality on health inequalities, we aimed to assess the extent of a salient North-South divide in risk factors for CVD, controlling for markers of socioeconomic-position (SEP).MethodsWe conducted a cross-sectional analysis using the 2006 Health Survey for England using respondents aged 16 years and over. We assessed the population means of systolic blood pressure, total cholesterol, body mass index (BMI) and smoking prevalence. We built nested regression models (all linear regression except for logistic for smoking) adding; demographic (age /sex /ethnicity), SEP indicators (individual income, education attainment, housing tenure, car ownership, occupational classification and area level IMD), behavioural risk factors and vascular disease status. We tested variables for multi-collinearity, assumptions of normality for linear outcomes and use valid survey weights. We finally examine interactions between the North-South divide and age and sex on the risk factors.ResultsThe North of England showed more deprived characteristics across markers of SEP; except for greater home-ownership. Controlling for demographic variables, we found a significant North-South difference (excess in North) in systolic blood pressure (1.94 [se=0.38]), BMI (0.47 [0.11]) and smoking prevalence (2.93% [0.50]). The difference in smoking prevalence was entirely abolished by markers of SEP; both systolic blood pressure and BMI differences were attenuated by SEP, behavioural and vascular disease indicators (1.52 [0.38] & 0.31 [0.11] respectively), but remained significant. The North-South divide in systolic blood pressure was attributed to differences in men (2.18 [0.54]), being non-significant in women; and in middle age groups (2.70 [0.76] aged 40- 59, compared with 2.29 [0.78] aged 16–39) and was non-significant aged 60 and over.ConclusionSmoking is a major factor behind morbidity and mortality. In line with work from different settings, patterns in smoking can be explained through adverse, cross-sectional patterns of SEP. Addressing underlying poverty and disadvantage may be required to fully tackle smoking inequalities. Using a suite of measures designed to address different constructs of SEP, although cross-sectional, we find excesses in blood pressure and BMI in the North of England. These differences may, in part, explain previously found differences in mortality. If we are to understand, and therefore reduce, geographic inequalities, current measures of SEP may require improvement, for example accounting for aspects of the life-course.
OP13 Diet and Physical Activity Levels Among UK Youth
Authors: McAloney K , Graham H , Hall J , Law C , Platt L , Wardle H 
Published: September 2012

BackgroundBoth physical activity levels and dietary behaviours have consistently been linked with the development of chronic disease, obesity and ill-health in both adult and youth samples. Nationally there are established recommendations of minimum levels of physical activity and fruit and vegetable consumption necessary to promote good health. Developing healthy behaviour is particularly important for young people, as adult behaviours that are detrimental or positive for health and well-being are often established in childhood and adolescence. This paper aims to investigate the prevalence of physical activity and fruit and vegetable consumption and to explore the co-occurrence of these behaviours among young people in the UK, using the newly availableUnderstanding Societystudy.MethodsThis study is part of an ongoing secondary analysis ofUnderstanding Society: The UK Household Longitudinal Study. The analysis sample consisted of 4,395 young people aged 10 - 15 living in the UK in 2009/2010 who participated in the first wave of the study. The prevalence of physical activity and fruit and vegetable consumption within the sample, and patterns of co-occurrence across the two behaviours, were explored descriptively. Multinomial regression models were estimated to investigate the social patterning of the health behaviour co-occurrence patterns, using socio-demographic characteristics of the young person and mother.Results85.2% of young people did not meet the government recommendation for fruit and vegetable consumption, reporting less than 5 portions of fruit and vegetable daily. 70.6% of young people did not meet the recommendation for participation in daily physical activity. A small minority did not consume any fruits and vegetables (5.0%); and 6.4% reported participating in physical activity less often than weekly. On examining the patterns across combinations of the two behaviours, most young people did not meet both recommendations (62%), while only 6.1% of young people met both recommendations. Multinomial regression models indicated that gender, ethnicity and religion and socio-economic status were significantly associated with health behaviour patterns.ConclusionThis paper presents an analysis of the most recently available health-risk behaviour data on children from all four countries of the UK. The results indicate that a high proportion of young people do not achieve levels of fruit and vegetable consumption or levels of participation in physical activity considered to be a minimum for good health, and these two behaviours tend to co-occur. The implications of these behaviour patterns and the associations with socio-demographic characteristics are discussed.
OP20 A Comparative Analysis of Deployment Associated Mental Health Issues in United States and United Kingdom Armed Forces
Authors: Sundin J , Fear NT , Greenberg N , Riviere L , Herrell R , Adler A , Hoge C , Bliese P , Wessely S 
Published: September 2012

BackgroundThere are several differences in health outcomes between UK and US military personnel who have deployed to the recent conflicts in Iraq or Afghanistan. Rates of survey-based posttraumatic stress disorder (PTSD) tend to be higher in US personnel, whilst self-reported rates of alcohol use tend to be higher in UK personnel. To explore potential reasons why mental health prevalence rates differ in the two countries a comparative analysis of UK and US Armed Forces combined data was carried out.MethodsTwo samples of UK (n=313) and US (n=1560) regular enlisted Army male personnel who were deployed to Iraq in 2007 were combined. Primary outcomes included PTSD, alcohol use, anger and physical symptoms. The samples were compared on a list of 11 combat experiences, socio-demographics and military characteristics.ResultsThere were several differences between the UK and US samples: the UK sample was younger, more likely to hold a degree and a rank of officer, had served for a longer time, more likely to be married or in a long term relationship, and more likely to rate their marriage as good. The US sample reported more combat experiences. The samples did not differ on physical symptoms, but the US sample was more likely to report PTSD, adjusted odds ratio (AOR) 1.75 (95% Confidence Interval 1.01 – 3.03) and less likely to report alcohol misuse, AOR 0.27 (95% CI 0.20 –0.37) compared to the UK sample.ConclusionUS military personnel deployed to Iraq were more likely to report PTSD whilst UK personnel are more likely to report alcohol misuse. Whilst, there were several differences between the US and UK samples in terms of socio-demographics and combat experiences, these did not explain the difference in health outcomes.Understanding the differences, as well as the similarities, between the UK and US Armed Forces is important, as it can influence the way military personnel are managed in both nations. It can also influence the way military personnel who have developed mental health problems as a result of their service are treated.
OP22 Projections of Healthcare Costs in the Last Year of life for Older Cancer Patients in European Union Member States (2008-2030)
Authors: Petkova H , Dawoud D , McCrone P , Higginson IJ 
Published: September 2012

BackgroundDespite advances, cancer remains a major cause of pain, suffering and death. The highest incidence and mortality occurs in older people (≥65), and given demographic change the numbers are expected to rise in the coming years. This has financial consequences and key implications for service planning. We estimated the current and future cost of providing care for older cancer patients in the last year of life (LYOL) in the 27 European Union (EU) member-states between 2008 and 2030.MethodsOur cost projection models combined: a) WHO-GLOBOCAN mortality data; b) an average UK-based estimate of the cost of care per cancer patient in the LYOL; c) country-specific adjustment factor; d) annual cost inflation correction range 5%–15%: 5% (conservative scenario), 10% (realistic scenario), 15% (highest expected increase scenario), and e) an adjustment for ageing to reflect the increasing life expectancy (LE) and the related morbidity expansion.ResultsThe total EU cost of care for older cancer patients in the LYOL is expected to increase by 48% (2008–2030) reflecting mortality rates only (baseline model). Assuming 5% cost rise per year (model 1), we projected more than a two-fold increase in the total EU cost by 2030 at an average annual rate of 9.6%. Model 2 involved 10% inflation and no ageing-adjustment, predicting a 3.7 times cost rise during the next two decades. This equated an annual average increase at 16.9%. We predicted a slightly higher cost rise when we allowed for ageing in addition to the 10% annual inflation (model 3) at approximately 17% increase year on year. This represents $81 billion absolute increase during the projected period or $3.6 average annual increase for Europe as a whole. The highest cost increase is expected in model 4 (15% inflation with ageing-adjustment). Costs are predicted to rise more than five times between 2008 and 2030, marking a 24.3% average annual increase. There is a marked cost variation across Europe.ConclusionCosts of care for older cancer patients in the LYOL are projected to rise substantially in the foreseeable future. Our models outline cost variation between 2.2% and 24.3%, with the most realistic increase expected at 17% annually. This has key implications for short and medium-term service planning of how to provide care in the LYOL for the rising number of older citizens dying from cancer, taking into account the current economic climate in Europe.
OP36 A Cross-Sectional Assessment of the Effect of the Free Older Persons’ Bus Pass On Active Travel and Regular Walking Among Adults ≥60 Years in England Using Data from the National Travel Survey 2005-2008
Authors: Coronini-Cronberg S , Millett C , Laverty A , Webb E 
Published: September 2012

BackgroundThe benefits of physical activity for all age groups is well-documented and there is increasing interest in the promotion of incidental physical activity, such as active transport, which includes walking, cycling and use of public transport. For older adults, even small increases in activity may have significant benefits: for example, the relative risk of disability is reduced by 7% for each additional hour of relatively gentle physical activity undertaken each week. Our study assessed the potential public health benefit of theNational Bus Pass, introduced in 2006, which permits free local bus travel for older adults (≥60 years) in England.MethodsData from the year prior to the pass being introduced (2005) to the most recently available (2008) were extracted from an annual cross-sectional survey, the National Transport Survey, resulting in a sample size of 15 175 older adults. Models assessed associations between possessing a bus pass and our main outcome measures: use of active transport (walking, cycling and use of public transport), use of buses and walking three or more times a week. Since participants were sampled by household, all models were adjusted for clustering at the household level, as well as a range of confounders, including: age, sex, and socio-economic status.ResultsPreliminary results show that having a free pass is significantly associated with greater use of active travel among both disadvantaged and advantaged groups. It is also associated with increased use of buses and a greater likelihood of walking three or more times a week.ConclusionOlder people in England with a free bus pass are more likely to use active transport, buses and undertake regular walking than those without, regardless of their socio-economic status. This suggests public subsidies enabling free bus travel for older persons may confer significant population health benefits through increasing incidental physical activity levels.
OP40 Selenium Supplementation for the Primary Prevention of Cardiovascular Disease (CVD) – A Cochrane Systematic Review
Authors: Rees K , Hartley L , Day C , Clarke A , Stranges S 
Published: September 2012

BackgroundSelenium is a key component of a number of selenoproteins which protect against oxidative stress and have the potential to prevent chronic diseases including CVD. However, observational studies have shown inconsistent associations between selenium intake and CVD risk; in addition there is concern around an increased risk of type 2 diabetes with high selenium exposure.ObjectiveTo determine the effectiveness of selenium only supplementation for the primary prevention of CVD and examine potential adverse effects on type 2 diabetes.MethodsThe following electronic databases were searched with no language restrictions from their inception to July 2011: MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library and trial registers. Studies were included if they fulfilled the following criteria: study design - RCTs, participants - free of CVD (includes those at high risk), intervention - selenium only supplementation, comparator – no intervention or placebo, outcomes – diagnosis of CVD or change in the risk factor profile for CVD (blood pressure, lipids) or adverse effects (type 2 diabetes). Two reviewers independently screened titles and abstracts, assessed shortlisted studies for formal inclusion/exclusion, abstracted data and assessed methodological quality. Data were analysed using RevMan 5.1 software.ResultsDatabase searching resulted in 1310 hits of which 43 went forward for formal inclusion/exclusion; 9 RCTs met the inclusion criteria. Included trials were heterogeneous in the participants recruited, dose of selenium, intervention and follow-up periods, outcomes reported, country of recruitment and baseline selenium status. Meta-analysis was possible for 2 trials reporting clinical events, but the analysis was dominated by the SELECT trial which carried over 80% of the weight. There were no statistically significant effects of selenium supplementation on total mortality (RR 0.97, 95% CI 0.88, 1.08), CVD mortality (RR 0.97, 95% CI 0.79, 1.2) or non-fatal CVD events (RR 0.97, 95% CI 0.9, 1.05). Similarly, the SELECT trial dominated the findings from 3 trials reporting type 2 diabetes, where selenium supplementation increased the risk of type 2 diabetes (RR 1.06, 95%CI 0.97, 1.16) although this did not reach statistical significance. There were no statistically significant effects of selenium on total or HDL cholesterol (measured in 2 trials (5 intervention arms) with varying doses of selenium supplementation).ConclusionThere is still a lack of evidence of the effects of selenium supplementation in the primary prevention of CVD. More trial evidence is needed especially to clarify the potential adverse effect of selenium supplementation on type 2 diabetes.
OP49 Socioeconomic Status and Late Adolescent Trajectories of Smoking, Drinking, and Psychiatric Distress
Authors: Green MJ , Leyland AH , Sweeting H , Benzeval M 
Published: September 2012

BackgroundProblems with smoking, alcohol use and psychiatric distress usually develop in adolescence and often co-occur. These problems may be inter-related but their co-occurrence could result from a common cause such as socioeconomic disadvantage.MethodsThe Twenty–07 Study includes self-reported data on smoking, alcohol use and psychiatric symptoms (GHQ–12) from 1,515 adolescents at approximate ages of 15 (baseline), 16 and 18. Latent class analysis (n=1238 with valid data) was used to identify distinct patterns of late adolescent development in smoking, alcohol use and psychiatric distress and relate these to various indicators of socioeconomic status (leaving school at 16, baseline area deprivation, and baseline parental measures of social class, education, housing tenure, income, employment status and family structure) whilst adjusting for gender.ResultsFour latent classes were identified: 1) a low-risk class with low levels of smoking at all ages, low early drinking, moving towards regular drinking at age 18, and low levels of psychiatric symptoms; 2) a class with similar patterns for smoking and drinking but with high levels of psychiatric distress; 3) a class which engaged with alcohol earlier, many of whom were heavy drinkers by age 18, and had medium levels of distress; and 4) a high-risk class who engaged early with both smoking and drinking, most of whom were heavy smokers by age 18, and had medium and increasing levels of distress. In unadjusted analyses most indicators of socioeconomic disadvantage were associated with raised odds of membership in the high-risk class (reference group: low-risk class). With mutual adjustment for gender and all socioeconomic variables, those leaving school at 16 (OR 6.01; 95% CI 3.93–9.17) and in rented accommodation (OR 1.74; 1.19–2.56) still had significantly raised odds of membership in the high-risk class relative to those staying in school or in owner-occupied accommodation. Rented accommodation was protective for membership in the class with drinking but not smoking problems (OR 0.51; 0.30–0.86) and those in the most deprived areas were less likely to be in the class with psychiatric distress only (OR 0.37; 0.17–0.83) than those in more affluent areas.ConclusionSocioeconomic disadvantage is implicated as a common cause of smoking, alcohol use, and psychiatric distress. Relationships with socioeconomic status are complex however and depend on the combination of outcomes, for example, trajectories with drinking but not smoking problems and those with psychiatric distress alone were more likely at the higher end of the socioeconomic distribution.
OP51 Maternal Employment and Socio-Emotional Behaviour at Age 7: Findings from the UK Millennium Cohort Study
Authors: Hope SC , Pearce A , Law C 
Published: September 2012

BackgroundMaternal employment in the UK has increased significantly in recent years, but evidence of its relationship with child socio-emotional behaviour is mixed. Given the policy importance of both family employment and children’s wellbeing, this relationship needs to be better understood. This study seeks to investigate whether cumulative exposure to maternal employment is associated with socio-emotional behaviour at age 7.MethodsThe study comprises a longitudinal analysis of the United Kingdom Millennium Cohort Study (MCS), based on 10,723 singleton children who participated in all four sweeps of the study (at ages 9 months, 3, 5 and 7 years). Socio-emotional behaviour was measured using total Strengths and Difficulties Questionnaire (SDQ) scores, dichotomised using an established cut-off for borderline / abnormal behaviour. Risk ratios (RR) were estimated using Poisson regression for borderline / abnormal SDQ scores at age 7 according to cumulative maternal employment over four sweeps of the MCS (at 9 months, 3, 5 and 7 years), unadjusted (uRR) and adjusted (aRR) for confounders (age at first live birth, ethnicity, family size, lone parenthood, and maternal psychological distress, all recorded at 9 months). In order to disentangle whether there was a differential impact of earlier and current employment, additional analyses estimated the risk associated with employment up to age 5 years, adjusting for employment at age 7.ResultsThe risk of borderline/abnormal scores decreased linearly by number of MCS sweeps that mothers were in employment; after adjustment for confounders the gradient attenuated but remained significant. Children growing up in households where mothers were employed in all MCS sweeps were significantly less likely to display borderline / abnormal behaviour at age 7 (compared to never in paid employment): uRR=0.37 (0.32–0.44); aRR=0.68 (0.56–0.81). Analyses differentiating early employment (between ages 9 months and 5 years) and current employment (at age 7) suggest that the cumulative impact of prior non-employment may be ameliorated once a mother gains employment. After adjusting for current employment and confounders, there was no increased risk of borderline / abnormal socio-emotional behaviour associated with non-employment in all earlier sweeps up to age 5 compared to being in paid employment continuously (baseline): aRR=1.01 (0.82–1.23).ConclusionThis longitudinal analysis supports an association between maternal employment and child socio-emotional behaviour. Possible explanations and implications will be discussed.