bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP82 An Evaluation of the Effect of the New School Food Policy on Children’s Nutritional Intake and Socio-Economic Consequences in North East England
Authors: Spence S , Shen J , Delve J , White M , Vale L , Adamson AJ 
Published: September 2012

BackgroundAfter 20 years with no regulation of school food and a plethora of evidence on the state of children’s diets, new food and nutrient-based standards were re-introduced in 2006 to schools in England. As a major policy change receiving financial and legislative support from Government, our objectives were to evaluate the effect of this policy on children’s nutritional intake, and its wider consequences including the added costs.MethodsA cross-sectional study was undertaken in primary (n=13) and middle (n=5) schools in North East England. Dietary, anthropometric and socio-economic data were collected from children aged 4–7y and 11–12y using identical quantitative methods pre, and post-implementation. In the 4–7y olds a four day food diary was completed using an observational method, the 11–12y olds completed 2x3 day food diaries followed by an interview. Economic analysis was conducted in the form of cost-consequence analysis, comparing the differences in costs with all of its possible consequences in a tabular format.ResultsThe effect of lunch type (school or packed) and year had a significant effect on total dietary intake in the 4–7y olds (n=1,017). Children having school lunches post-implementation had a slightly higher mean daily intake of energy (93 kcals, p=0·004), but lower mean daily % energy from fat (3%, p<0·001) and saturated fat (1%, p<0·001). Mean daily intakes of micronutrients such as vitamin C, and iron were higher in children consuming school lunches. In contrast, there was limited evidence of the effect of lunch type post-implementation on the total diet in 11–12y olds (n=883). The exception was % energy from fat. In 1999–2000 children consuming a school lunch had a higher % energy from fat than those consuming a packed lunch, post-implementation this difference was no longer apparent. The cost per school meal following implementation of the school food policy is higher than pre-implementation, ranging from £29 to £55 per child per year depending on how differences in prices of food pre and post-implementation were adjusted for inflation. Wider social consequences, for example, a reduction in socio-economic inequality, educational benefits and change in health behaviour were also set against the increased cost.ConclusionThese findings demonstrate that the introduction of the school food policy has the potential to have a positive impact not only on food eaten at school but also on children’s total diet. Economic analysis highlights the trade-offs between significant improvement of nutrient intakes of children and the increased cost.
OP91 Does Anonymity Increase the Reporting of Mental Health Symptoms?
Authors: Fear NT , Seddon R , Jones N , Greenberg N , Wessely S 
Published: September 2012

BackgroundThere is no doubt that the perceived stigma of having a mental disorder acts as a barrier to help seeking. It is possible that individuals may be reluctant to admit to symptoms suggestive of poor mental health when data can be linked to them, even if their personal details are only used to help them access care. This may be particularly relevant because individuals who have a mental health problem are more likely to experience barriers to care and hold stigmatising beliefs. If that is the case, then mental health screening programmes where personal details are required may not be effective in detecting those most in need of care. We aimed to compare mental health symptom reporting when using an anonymous versus identifiable questionnaire among UK military personnel on deployment in Iraq (early 2009).MethodsThis was a survey among UK military personnel using two questionnaires, one anonymous (n=315) and one identifiable (n=296). Questionnaires were distributed by alternative allocation. The questionnaire included the 12-item General Health Questionnaire (measuring symptoms of common mental disorder, CMD), the Post-Traumatic Stress Disorder (PTSD) Checklist Civilian Version (measuring probable PTSD) and 11 stigma statements relating to barriers of care and perceived social stigma.ResultsOf 612 personnel approached to take part, 99.8% completed the survey. The overall prevalence of probable PTSD was 3.3% and 20.5% for symptoms of CMD. No significant difference in the reporting of symptoms of CMD was found (18.1% identifiable vs. 22.9% anonymous, P=0.150). Personnel were more likely to report borderline and probable PTSD when completing questionnaires anonymously (borderline PTSD: 2.4% identifiable vs. 5.8% anonymous; probable PTSD: 1.7% identifiable vs. 4.8% anonymous, P=0.022). Of the 11 barriers to care and perceived social stigma statements considered, those completing the anonymous questionnaire were more likely to endorse: “leaders discourage the use of mental health services” (9.3% vs. 4.6%, P=0.029), “it would be too embarrassing” (41.6% vs. 32.5%, P=0.023) and “I would be seen as weak” (46.6% vs. 34.2%, P=0.003).ConclusionWe found a significant effect on the reporting of PTSD and certain stigmatising beliefs (but not CMD) when using an anonymous compared to identifiable questionnaire. Our findings have implications for the current post-deployment screening policy used in the US militaryin which identifiable data are collected. These results suggest that researchers need to weigh up the balance between full anonymisation against the use of non-anonymised but confidential survey methods, which permit future follow up.
OP93 Orlistat and the Risk of Acute Liver Injury: A Self-Controlled Case-Series Study in United Kingdom General Practice Research Database
Authors: Langham J , Smeeth L , Brauer R , Bhaskaran K , Douglas I 
Published: September 2012

BackgroundIn 2009, based on spontaneous reports of serious liver injury the US Food and Drug Administration announced Orlistat may be linked to an increased risk of hepatic events. However, no causal association has been established. The aim of this study was to investigate the association between Orlistat and the incidence of acute liver injury.MethodsThis was a self-controlled case-series design using the United Kingdom General Practice Research Database (GPRD) and linked Hospital Episode statistics (HES). People were eligible if they had an incident occurrence of idiopathic acute liver injury with a diagnoses recorded (in GPRD or HES) and were exposed to Orlistat at any time in the observation period. If there was evidence of a known cause for liver disease, such as alcoholism, patients were excluded. Observation time for each patient was divided into strata determined by Orlistat exposure status (30 day strata) and current age. Within-person rate ratios (with 95% confidence intervals) for liver injury were estimated using conditional Poisson regression (Stata 12), comparing exposed with unexposed periods.ResultsIn the GPRD, between 1999 and 2010, 94,695 people had received at least one prescription for Orlistat, of whom 1,741 had an eligible diagnosis recorded. Of these, 408 people fulfilled eligibility criteria for a definite event (including abnormal liver function test results and a referral). We found a higher incidence of events in the first 30 days of exposure, (compared to unexposed) RR 2.27 (95% CI 1.12 to 4.59) and in the 90 day pre-exposure period RR 1.96 (95% CI 1.35 to 2.85). There was no difference in the incidence of events between 90 days prior and 0–90 days post prescribing, RR 0.78 (95% CI 0.42 to 1.42).ConclusionThis is the first study we are aware of to explore the risk of incident liver injury associated with Orlistat. We found an increased risk of liver events in the 90 days immediately prior to and post first Orlistat prescription, but no difference in risk between the pre and initial exposure periods. This suggests that Orlistat may be initiated during a period of time when adverse liver events are more likely due to poor underlying health, but does not suggest the risk increases with initiation of Orlistat.
OP94 Evidence for the Effectiveness Ofopiate Substitution Treatment in Relation to HIV Transmission in People who Inject Drugs: A Systematic Review and Meta-Analysis
Authors: MacArthur GJ , Minozzi S , Martin N , Vickerman P , Bruneau J , Davoli M , Hickman M 
Published: September 2012

BackgroundInjecting drug use is a major risk factor for the acquisition and transmission of HIV among people who inject drugs (PWID), and between PWID and the wider community. Worldwide there are an estimated 15.9 million PWID of whom 3 million may be HIV-positive. Methadone and buprenorphine (opiate substitution treatments, OST) reduce heroin use, injecting risk behaviour, and drug related mortality and are included in the World Health Organization list of essential medicines. A small number of individual cohort studies and a Cochrane narrative systematic review suggest that OST may reduce HIV incidence, but no pooled quantitative synthesis has been carried out. We have undertaken a systematic review and meta-analysis of published and unpublished studies to quantify the effect of OST on HIV transmission.MethodsMedline, EMBASE and PsychINFO were searched to October 2011 to identify studies that examined the effectiveness of OST in relation to HIV transmission. Authors of prospective studies that assessed HIV incidence in PWID were contacted to obtain unpublished data.ResultsFifteen studies conducted in seven countries were relevant for inclusion. Data from ten of the studies were pooled, two of which were unpublished. Analysis included over 22,000 person-years of follow-up and 738 incident HIV infections. Preliminary random effects meta-analysis demonstrates that OST reduces risk of HIV transmission among PWID by 49% (RR 0.51, 95% CI 0.37–0.71; p<0.001) although there was significant heterogeneity between studies (I259.5%, χ222.2, p=0.008). Study-level covariates including publication year, gender, median age, and ethnicity of participants did not significantly influence the impact of OST in meta-regression analyses. However, sub-group analysis demonstrated that whilst continuous OST significantly reduced risk of HIV infection, the effectiveness of interrupted or detoxification treatment was less clear (RR 1.26, 95% CI 0.77–2.07; p=0.360).ConclusionThese preliminary data provide further evidence that OST can reduce the risk of HIV infection among PWID and for the first time quantify the effect. Ensuring sufficient coverage of OST as part of a package of harm reduction interventions is critical to reduce the burden of HIV among PWID and to prevent onward transmission between PWID and to the wider community.
PS02 “We Can all just Get on a bus and Go”: Rethinking Independent Mobility in the Context of the Universal Provision of Free Bus Travel to Young Londoners
Authors: Goodman A , Jones A , Roberts H , Steinbach R , Green J 
Published: September 2012

BackgroundRecent years have seen increasing attention to ‘independent mobility’ as a determinant of children’s physical health and psychosocial development. Previous research, however, largely frames independent mobility as a matter of having parental permission to travel without adults. It also predominantly focuses upon walking any cycling trips in the local area by young children. We therefore aimed to extend the independent mobility literature by examining mobility on public transport, mobility beyond the local area and mobility by adolescents. For this we use as a case study the recent provision of universal free bus travel to all young people in London, UK. We argue that idea of independent mobility can usefully be situated within the broader conception of opportunity and process freedoms which underpin Amartya Sen’s influential ‘capabilities approach’ to human development.MethodsAs part of theOn the busesstudy, 118 young Londoners (age 12–18, 65 females) took part in 43 in-depth interviews (group size 1–3, 61 individuals) and 10 focus groups (group size 4–8, 57 individuals). Interviews and focus groups elucidated tacit, or everyday, influences on and effects of young people’s transport mode choices. We analysed this data qualitatively, drawing on techniques from the constant comparative method, including initial micro-level open coding and an iterative approach to identifying and refining emerging conceptual categories.ResultsFree bus travel enhanced young Londoners’ capability to shape their daily mobility, both directly by increasing financial access and indirectly by facilitating the acquisition of the necessary skills, travelling companions and confidence. These capabilities in turn extended both opportunity freedoms (e.g. facilitating non-“necessary” recreational and social trips) and process freedoms (e.g. feeling more independent by decreasing reliance on parents). Moreover, the universal nature of the entitlement often seemed crucial as it meant that free bus travel was typically held by all of a peer group. This rendered buses a socially inclusive way for groups to travel and spend time together, thereby enhancing group-level capabilities.ConclusionWe believe this attention to individual and group-level capabilities for self-determination provides the basis for a broader and more child-centered view of independent mobility than is typical in health research. The importance of the universal nature of the entitlement to free bus travel also provides an example of how policy interventions with universal coverage may have effects which are more than the ‘sum of the parts’ of alternative, targeted approaches.
PS05 Men With Prostate Cancer Make Positive Dietary Changes Following Treatment in a Randomised Trial: A Prospective Cohort Study
Authors: Avery KNL , Donovan JL , Gilbert R , Davis M , Emmett P , Down E , Oliver S , Neal DE , Hamdy FC , Lane JA 
Published: September 2012

BackgroundProstate cancer (PC) is the second most frequently diagnosed cancer of men worldwide. A healthy diet may improve clinical outcomes but there is currently no disease-specific dietary advice available to aid survivorship after a PC diagnosis. The effect of a PC diagnosis on men’s diet remains uncertain because, although cancer survivors report dietary changes, the direction and magnitude of changes are poorly understood. This study examined dietary changes in men before and after treatment for PC within the Prostate Testing for Cancer and Treatment (ProtecT) randomised trial.MethodsThis was a prospective cohort study embedded within the ProtecT randomised trial of treatments for PC. Participants were men aged 50–69 years tested for PC in primary care centres in nine areas of the UK. 3935 men completed a validated food frequency questionnaire before diagnosis and 678 with localised disease repeated the questionnaire one year later (response 82.7%). Pre-diagnosis dietary intakes of men with different diagnoses subsequently (negative diagnosis, at risk, localised PC, advanced PC) were compared using linear regression. Dietary changes after a diagnosis of localised PC were examined using non-parametric tests. Effects of cancer treatments (radical prostatectomy, conformal external beam radiotherapy or active monitoring) were examined using linear regression.ResultsBefore diagnosis, all men consumed largely similar amounts of key nutrients and foods. The diagnosis of localised PC led to dietary changes in 29.2% of men. Changes observed were generally in a healthy direction, with 234 (34.7%) men eating more fresh tomatoes (p<0.0001) and 156 (23.5%) more tomato products (p=0.01). 271 (40.0%) men consumed more protein (p<0.0001) and 193 (28.6%) more fruit/vegetable juice (p<0.0001). Less macronutrients were obtained from dairy products (p<0.01). Men undergoing active monitoring (regular assessment of disease status) drank more fruit/vegetable juice than men who had received surgery (p=0.004).ConclusionDiagnosis of localised PC prompted around one third of men to adopt healthier diets and eat more ‘prostate-healthy’ foods. Dietary choices were influenced by treatment received, with more interest in dietary factors for survivorship in men undergoing active monitoring than those undergoing radical treatment. PC survivors are motivated to improve their diet and are able to access and act on healthy eating advice. Diagnosis of PC may serve as a “teachable moment”, thereby providing opportunities for clinicians to provide targeted advice that could be beneficial to general (and prostate-specific) health and to support survivorship.
PS06 Finding the Missing Units: Identifying Under-Reporting of Alcohol Consumption in England
Authors: Boniface S 
Published: September 2012

BackgroundAlcohol sales coverage (reported consumption as a percentage of total sales) is typically 40–60%. This study explores how accidental under-estimation of alcohol in drinks poured at home might contribute to low sales coverage.Methods283 drinking adults (16+) completed a face-to-face survey comprising a questionnaire and pouring task on 12 occasions at six sites in and near London in summer 2011. Actual and perceived number of units poured in a ‘usual glass’ of wines and spirits is explored by demographic and social factors.ResultsThere were 283 participants (54% women) who completed the questionnaire and pouring task. The 283 participants poured a total of 465 glasses of wine and spirits. 52% wine estimates and 42% spirit estimates were within 0.5 units of their actual value. More participants over-estimated the amount of alcohol they had poured than under-estimated. Multinomial logistic regression found significant risk factors for under-estimating wine were increasing volume of wine poured (RRR 1.02 95% CI 1.01–1.02, P<0.0001), belonging to a non-white ethnicity (RRR 3.88, 1.65–9.16, P=0.002), and being unemployed or retired (RRR 4.30, 1.08–17.07, P=0.038). Only the volume of spirits poured was a significant predictor of under-estimating spirits (RRR 1.04, 1.01–1.06, P=0.003). For both wines and spirits, not having a degree was significantly associated with an increased risk ofover-estimating the amount of alcohol poured.ConclusionAs participants were more likely to over-estimate than under-estimate, this survey is not able to explain low sales coverage as a product of accidental under-estimation of the amount of alcohol poured drinks drunk at home. A future qualitative study will explore how recall accuracy may contribute to low sales coverage.
PS08 Is there a Protective Effect of High Mineral Content in Drinking Water on Coronary Heart Disease Mortality? A Cross-Sectional Ecological Study of a Large Population in Central England
Authors: Rudge GM , Mohammed MA 
Published: September 2012

BackgroundIt has been hypothesised that dissolved minerals in water, particularly calcium carbonate and magnesium carbonate, are protective against heart disease. Animal studies suggest biologically plausible mechanisms for this and statistically significant effects have been presented from several large ecological studies.SettingThe West Midlands Government Office Region in central England, has a large and diverse population which has great variation in water hardness over a relatively small area. Our units of analysis were West Midlands neighbourhoods (lower level super output areas) falling in areas supplied by two water companies. We obtained exposure estimates from water industry measurements taken in 2007.MethodsUsing geographical information system software, digitised supply water supply maps were mapped to our neighbourhood geography. Having established the distribution of water hardness through neighbourhoods, we mapped tertiles of hardness and identified neighbourhoods inside them. To these we linked emergency myocardial infarction (MI) admissions for 45–74 year-old residents for a three year period, adjusting for the age distribution of the neighbourhoods, ethnic mix and socio-economic deprivation. We used a negative binomial model to determine the degree of association between water hardness and MI admission counts, adjusting for the other variables.ResultsWe were able to accurately determine the mineral content of water supplied to 2,925 neighbourhoods with a total population of over 4.5 million. Contrary to other studies, we found just a small but non-significant negative correlation between hardness and MI admissions were seen in men, with an incidence rate ratio (IRR) of 0.97, per tertile, (0.92 – 1.03, p=0.37) and a small, non-significant positive one seen in women, IRR=1.02, (0.93 – 1.12, p=2).ConclusionWe found no evidence of a protective effect of hard water against acute MI admission, contrary to other published studies. This may be because our methods allowed us to better account for possible confounding variables. We go on to hypothesise that as water supply networks developed historically, with soft water from upland areas being used supply the needs of rapidly industrialising areas and other areas left to use local groundwater, some interesting accidental correlations between neighbourhood socio-economic status and water hardness arose which may have confounded previous work. However, mass differential exposure to highly bio-available minerals, especially calcium and magnesium, does raise some interesting further questions about the relationship between water supply and population health, which our methods can be used to investigate further.