bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP32 Symptoms, Diagnosis and Treatment in Socio-Economic Inequalities of Health
Authors: Hardcastle A C , Steel N , Bachmann M O , Melzer D 
Published: September 2013

BackgroundIll health and relative poverty are connected. This study aimed to determine first whether the worse health experienced by poorer participants was matched by appropriately greater receipt of healthcare, and second whether any inequalities in receipt occurred at the stage of diagnosis or treatment.MethodsThe English Longitudinal Study of Ageing is a cohort of participants aged 50 years or older. The relative distributions by wealth of symptoms, diagnosis and treatment of five common chronic conditions (angina, diabetes, depression, osteoarthritis, and cataract) were analysed in four waves of data collected from 2002 to 2010. Symptoms were defined for angina using the Rose Angina scale, diabetes using fasting HbA1c level, depression using the Centre for Epidemiologic Studies Depression Scale, osteoarthritis as self-reported pain and disability, and cataract as self-reported poor vision. Doctors’ diagnoses for all conditions were self-reported. Treatment was defined for angina as beta-blocker prescription, osteoarthritis and cataract as surgery, and diabetes and depression as receiving treatment described in quality indicators. Binomial regression models tested variations between the hypothetically poorest and richest individuals for age and sex adjusted symptoms, diagnosis and treatment across the waves, using a slope index of inequality.ResultsSymptoms were commoner in poorer participants in all 5 conditions at all 4 timepoints, with ORs ranging from 2.5 to 7.0. In angina, depression and diabetes, receipt of diagnosis and treatment was similarly higher in poorer participants, with ORs ranging from 1.9 to 5.6. In osteoarthritis and cataract, receipt of diagnosis and treatment did not show substantial matching variations by wealth, with ORs ranging from 0.8 to 1.9. For example, ORs for diabetes in 2008 were broadly similar for symptoms (2.5 [95% CI 1.5, 4.0], diagnosis (3.8 [3.0, 4.9]) and treatment (3.1 [2.4, 4.0]). In contrast, osteoarthritis ORs were substantially larger for symptoms (6.9 [5.2, 9.1]) than for diagnosis (1.4 [1.2, 1.7]) or treatment (0.8 [0.5, 1.3]).ConclusionPoorer participants were much more likely to have symptoms of osteoarthritis and cataract, but not much more likely to receive a diagnosis. The block in equitable receipt of healthcare was at the stage of diagnosis rather than treatment, and so interventions to reduce inequalities in osteoarthritis and cataract should focus on the diagnostic process. The same relative inequalities in diagnosis were not seen in angina, depression and diabetes, which have all been the target of multiple quality improvement initiatives. These patterns remained consistent over 8 years.
OP38 A Nationally Representative Study Exploring the Relationship between Sleep and Obesity in the United Kingdom
Authors: Ellison G T H , Scott E M , Al-Naji A , Afif N Al , Barnes M , Law G R 
Published: September 2013

BackgroundThis study explored the potential role that sleep, and sleep improvement, might play in the aetiology of obesity, using data from the first wave of the Understanding Society (USoc) cohort – a longitudinal household panel study representative of the UK population.MethodsThe first wave of USoc collected data on seven self-reported sleep-related variables comprising measures of: sleep duration; sleep quality; snoring and/or coughing while asleep; falling asleep within 30 minutes; use of sleep medication; night time waking; and staying awake during the day. Linear (for log-transformed BMI) and multinomial logistic (for BMI categorised as underweight through morbidly obese) regression analyses were conducted using STATA 12.0, before and after adjustment for age, sex, pregnancy, household income per person and household crowding index (bedrooms per person) as potential confounders. Models were specified using a Directed Acyclic Graph.ResultsComplete data were available on 20,956 (41.1%) of the 50,994 cohort participants. Regardless of the sleep-related variable and whether BMI was operationalised as a continuous or multinomial variable, there was a strong, consistent and statistically significant association between sleep and BMI. Shorter, worse quality and more frequently medicated, disturbed and inadequate sleep were all associated with elevated BMI or an increased risk of overweight and obesity before and after adjustment for confounding. The sleep-related variable most strongly associated with BMI was “cough or snore loudly” where participants who reported doing so “most nights” had an adjusted odds of morbid obesity of 11.94 (95% CI 8.35, 17.07). However, even the sleep-related variable with the weakest association with BMI (“medicine for sleep”) was associated with more than twice the odds of obesity and morbid obesity amongst those participants reporting “medicine for sleep” use three or more time per week. Indeed, the overall consistency of the association between sleep and BMI was evident not only across all seven of the different sleep measures but also in the trends observed for those measures with continuous or ordinal scales.ConclusionThis is the first nationally representative study to demonstrate a powerful association between sleep duration, sleep quality and obesity in the UK. However, the study is limited by: the substantial number of participants with missing data; its cross-sectional design; and potential clustering of sleep and BMI within households. Further research is therefore required to explore whether naturally occurring changes in sleep duration and quality are associated with changes in BMI to strengthen the evidence for a causal link between sleep and obesity.
OP41 Practising Partnership: A Qualitative Analysis of Public Health and Local Authority Co-Implementation of Health and Mental Wellbeing Improvement Interventions
Authors: Johnson R E , Clarke A , Stewart-Brown S 
Published: September 2013

BackgroundThe 2010 NHS White Paper Equity and Excellence: Liberating the NHS proposed major changes to how public health services are delivered from 2013. The imminent transition of public health into local authorities will have implications for how services are planned, commissioned and implemented, particularly for wellbeing initiatives. Anticipating this transition, a city-wide initiative brought together Local Authority and NHS Public Health partners to plan, manage and implement a health and mental wellbeing improvement programme over three years (2009-2012). This qualitative study examines the attitudes and views of stakeholders on their involvement in this programme and their experiences of ‘practising partnership’.MethodsQualitative thematic analysis (as part of a mix-methods study). Purposive sampling was used to identify potential participants from three groups (programme stakeholders): directorate, programme managers and intervention managers. One-to-one semi-structured interviews were conducted. We used Schutz’s theory of social phenomenology to support the analytical method and the One Sheet of Paper technique was used to identify emerging themes. Creswell’s (2009) strategies for qualitative validity were used to enhance the accuracy of our findings.ResultsFifteen one-on-one interviews were completed, out of seventeen requests for interview, with five participants from each stakeholder group. Interview times ranged from 45 minutes to 2 hours and were conducted after participants gave informed consent. Three main themes emerged. The first theme, ‘defining, designing and adapting’ represents stakeholders’ challenges using language with culturally different organisational meaning, introducing new concepts (such as mental wellbeing) and designing a programme with implementation and evaluation structures that were both rigid and flexible. The ‘practice of partnership’ theme reflected how partnership was more of a ‘façade’ at the programmes’ commencement and how, by working through stages of conflict and confusion, stakeholders developed an understanding of what the practice of partnership meant and achieved clarity on how it could be done. The third theme ‘knowledge, learning and understanding’ describes how knowledge was created, diffused and utilised. For example ‘evidence’ was used for different strategic ends depending on the stakeholder perspective -- to promote new ideas or interventions or to bolster an existing intervention to prove its merit.ConclusionThis study demonstrates the challenges and opportunities for partnership working that are likely to be encountered in the transition of Public Health into local authorities. It offers insight into understanding and practising partnership and has implications for planning, managing and implementing public health and wellbeing improvement interventions post-transition.
OP43 Explaining High Parenting Stress in the Growing Up in Scotland Study for Mothers with Both High and Low Educational Levels: The Role of Employment and Social Support for Parenting
Authors: Parkes A , Sweeting H , Wight D 
Published: September 2013

BackgroundStresses associated with raising a child may lead to less optimal parenting, with consequences for children’s development. Parent’s employment and receipt of social support may impact on stress differently according to family affluence. Affluent parents may be most pressured when balancing employment with child-related commitments. They may also have relocated, restricting informal support. Disadvantaged parents commonly report barriers to accessing formal parenting support and are more likely to have experienced family break-up, also restricting informal support. This study explores how aspects of employment and social support are associated with parenting stress among mothers grouped according to educational level.MethodsData were collected from mothers in the Growing up in Scotland study interviewed when their child was 10 months (N = 5870 out of 6127 main carers contacted in 2011/12). Parenting stress was self-reported using an abbreviated version of the Parental Stress Scale. “High stress” was defined as the bottom quartile of stress scores.Results33% of mothers were educated to degree level, 59% had lesser qualifications and 7% none. High stress was more likely among both degree-educated mothers (OR 1.15 [95% CI 1.02, 1.30]) and those with no qualifications (1.60 [1.23, 2.08]), compared to mothers with lesser qualifications. More degree-educated mothers worked full-time (36%) compared to those with lesser (13%) or no (6%) qualifications, but work patterns did not explain stress differences. More mothers with degrees (30%) or no qualifications (31%) were born outside Scotland compared to those with lesser qualifications (13%). High stress levels were greater among degree-educated ‘incomers’ (1.60 [1.34, 1.90]) than mothers with lesser qualifications, but did not differ betweennativedegree-educated mothers and those with lesser qualifications. When compared to mothers with lesser qualifications, odds of high stress among degree-educated ‘incomers’ reduced (1.21 [0.90, 1.62]) after adjustment for difficulty arranging childcare and less frequent contact with friends and the child’s grandparents. Incomer status, childcare problems and frequency of informal support did not explain stress among mothers with no qualifications. Low awareness of and/or receptivity to formal support, and feeling less close to family/friends, attenuated odds of stress for this group to 1.30 (0.97, 1.72).ConclusionParenting stress in degree-educated mothers born outside Scotland was related to childcare problems and more generally to less frequent informal support. Among mothers with no qualifications, fewer close informal ties and more perceived barriers to formal support were associated with stress. Findings suggest different approaches to parenting support are appropriate for different social groups.
OP44 Trends in Community Violence in England and Wales 2005-2009
Authors: Sivarajasingam V , Page N A , Morgan P , Matthews K , Moore S , Shepherd J P 
Published: September 2013

BackgroundRecognising the need for clarity in national violence trends, injury records from Emergency Departments (EDs) have been studied over the last decade as part of the work of the National Violence Surveillance Network (NVSN) and provide information about local, regional and national violence levels and trends in England and Wales. The purpose of the current study is to evaluate overall, gender, age-specific and regional trends in community violence in England and Wales from an ED perspective for the period 2005-2009.MethodsViolence-related injury data were collected prospectively in a stratified sample of 77 EDs (Types 1, 3 and 4) in the nine Government Office Regions in England and in Wales over five years, January 1 2005 to 31st December 2009. Attendance date, age and gender of patients who reported injury in violence were studied. Time series statistical methods were used to detect national trends.ResultsIn total 221,673 (163,384 males: 74%) violence-related attendances were identified. Overall estimated annual injury rate was 6.5 per 1000 resident population (9.8 and 3.4 for males and females respectively). Violence affecting males and females decreased significantly in England and Wales over the five year period (p < 0.05), with an overall estimated annual decrease of 2.4%. Attendances for those aged 17 years and under and those aged 31 years and over decreased significantly (p < 0.05), however violence affecting those aged 18-30 years did not change. There were significant regional differences in violence-related ED attendances with decreases in Eastern, North East, North West, South East Regions and Wales and increases in East Midlands, London, South West and West Midlands regions (p < 0.05). Regarding seasonal differences, violence-related ED attendances were highest during the months of May and July and lowest in February.ConclusionFrom this ED perspective overall violence in England and Wales decreased over the period 2005-2009 but increased in the East Midlands, London, South West and West Midlands. Since 2006, overall trends according to the Crime Survey for England and Wales (CSEW), police and ED measures were similar, though CSEW and ED measures reflect far greater numbers of violent incidents than police data. Causes of decreases in some regions need to be identified, shared and solutions implemented within regions where violence increased. Violence prevention efforts should also be extended so that the December drink driving and safety campaigns are implemented in the period May – July.
OP46 Walking to Work: The Contribution to Adult Physical Activity Levels
Authors: Audrey S , Procter S , Cooper A R 
Published: September 2013

BackgroundThere is increasing evidence of the link between adult obesity levels and travel behaviour: countries with highest levels of active travel generally have the lowest obesity rates. Walking is a popular, familiar, convenient, and free form of exercise that can be incorporated into everyday life and sustained into old age. Walking at a moderate pace (5 km/hour) expends sufficient energy to meet the definition of moderate intensity physical activity. The study aims to objectively examine the contribution of walking to work on adult physical activity levels.MethodsEmployees (n = 145) at 17 workplaces in Bristol, who lived within 2 miles of the workplace, were asked to wear accelerometers for 7 days from waking in the morning to going to bed at night, and to carry a GPS receiver during the daily commute to and from work. GPS data were matched with accelerometer data to provide a measure of duration of the journey and associated physical activity. Outcome measures included: overall volume of physical activity; moderate to vigorous physical activity (MVPA) levels; temporal pattern of physical activity (to identify when activity has increased and whether there is a compensatory decrease in activity at other times), and; objective measures of routes taken and physical activity associated with journey.ResultsDaily physical activity volume for employees using the car compared to those who walk (Mean (SD)) of 310.5 (149.7) vs 570 (177) (p < 0.001) counts per minute. MVPA in minutes for employees using the car compared to those who walk shows 41.4 (31.7) vs 84.4 (25.4) (p < 0.001). Sedentary time in minutes for employees using the car compared to those who walked was 627.7 (73.8) vs 576.7 (94.8) (p = 0.017). Employees who walked to work showed higher accelerometer counts per minute between 6–9am and 4–7pm which was maintained throughout the day compared to those who used the car. Combined GPS and accelerometer trace showed the journey to work provides employees with more MVPA.ConclusionWe are not aware of any other study in adults using objective methods to measure the contribution of walking to work on physical activity levels. Our study clearly shows that the daily commute provides an opportunity for adults who live within walking distance of their workplace to meet their daily physical activity requirements and reduces sedentary time.
OP05 From Industries to Services: Occupational Mobility and Health in Scotland
Authors: Kampanellou E 
Published: September 2013

BackgroundThe majority of research exploring the impact of deindustrialisation on health is centred on industrial employees. This study explores this association even further. It compares population groups engaged in industries and services and takes into account their occupational transition: unemployment, inactivity and re-employment. The current study assesses the self-rated health and limiting long term illness (LLTI) of industrial and service sector employees who became unemployed and inactive, in comparison to employees still working in similar industries and services, and those reabsorbed in other sectors of the economy.MethodsThe data was derived from the Scottish Longitudinal Study (SLS), a census based study representing 5.3% of the Scottish population in the years between 1991 and 2001. The sample included the employed population in the industrial and services sector aged 20–54 in the year 1991 followed up in the year 2001. The service sector was divided between high-paid and low-paid jobs. Overall health was measured by two indicators, LLTI and self-reported health. Logistic regression models were conducted in order to examine whether industrial employees were more likely to report overall health deterioration compared to the service sector employees through redundancy and re-employment. The analysis was stratified by gender and accounted for socio-economic and demographic circumstances together with pre-existing LLTI.ResultsThe main sample comprised of 63,150 individuals (52% males and 48% females). The reference group is the employees who remained in manufacturing/mining sector for both census years. Industrial employees transferred to low-paid service jobs report higher probability of not good health (OR 1.26, 95% CI 0.95, 1.66) compared to individuals who continue in manufacturing. Employees who change jobs within the service sector demonstrate the highest likelihood of LLTI (1.51 [1.29, 1.76]). In contrast individuals who change occupation within the industrial sector illustrate lower probability of LLTI (0.98 [0.74, 1.29]). Unemployed from high-paid service jobs (LLTI: 4.46 [3.36, 5.92], Not good health: 5.15 [3.61, 7.34]) and inactive from the industrial sector show more chances of overall health deterioration (LLTI: 17.99 [15.73, 20.58], Not good health: 21.08 [17.70, 25.09]).ConclusionThis study shows that there is an association between health and occupational transition. In addition, unemployment and inactivity do not have the same health effect on employees across sectors.
OP50 Socio-Economic Inequalities in Lung Cancer Treatment: The Role of Histological Subtype and Performance Status
Authors: Forrest L F , Adams J M , White M 
Published: September 2013

BackgroundSocio-economic inequalities in receipt of lung cancer treatment have been demonstrated in our recently published systematic review and meta-analysis, in both universal (UHCS) and non-universal healthcare systems. These findings could not be explained by type of healthcare system or stage at diagnosis. However, not all of the included studies reported details of stage and histology, both of which influence treatment type, and very few UHCS studies took co-morbidity into account. Performance status (PS), a measure of general patient wellbeing, might also be an important determinant of lung cancer treatment. The review recommended that the reasons for socio-economic inequalities in treatment be more thoroughly investigated. Cancer registry (NYCRIS), Hospital Episode Statistics (HES) and lung cancer audit (LUCADA) data-sets from the North-east of England were linked in order to examine the influence of stage, histology, PS and co-morbidity on socio-economic inequalities in lung cancer treatment.MethodsNYCRIS data for 65,210 patients with a primary diagnosis of lung cancer (ICD10 C33 and C34), diagnosed between 1999 and 2010 were analysed. Of these, 18,896 had a linked HES co-morbidity record. Subgroup analysis of the 7773 patients diagnosed between 2006 and 2010, who had stage and PS recorded in LUCADA, was also carried out. Multivariable logistic regression was used to examine the likelihood of receipt of surgery, chemotherapy and radiotherapy by socioeconomic position (SEP), taking into account age, sex, histology, year of diagnosis and co-morbidity, and, for the subgroup, stage and PS.ResultsSocioeconomic inequalities in receipt of surgery and chemotherapy, but not radiotherapy, were found in the full cohort after control for age, sex, histology, year of diagnosis and co-morbidity. The odds of receiving surgery were significantly lower in the lowest compared to the highest SEP group (OR 0.68 [95% CI 0.63, 0.75], p < 0.001) and this remained in the subgroup when stage and PS were additionally controlled for (0.62 [0.46, 0.83], p < 0.001). Inequalities in receipt of surgery were substantially attenuated by histological subtype. Patients in the lowest SEP group were significantly less likely to receive chemotherapy in the full cohort (0.56 [0.52, 0.60], p < 0.001), but not in the subset when stage and PS were included in the model (0.85 [0.70, 1.03], p=0.09).ConclusionSocio-economic differences in PS may account for the observed socio-economic differences in receipt of chemotherapy. Socio-economic inequalities in receipt of surgery may be partially explained by socio-economic differences in tumour type.