bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP14 Children’s and Adolescents’ Sedentary Behaviour in Relation to Household Socioeconomic Status, Income, and Area Deprivation: The 2008 Health Survey for England
Authors: Coombs N , Rowland A , Stamatakis E 
Published: September 2012

BackgroundSedentary behaviour (sitting) is an emerging cardiometabolic risk factor in young people. Little is known about how household socioeconomic position (SEP) and sedentary behaviour are associated in children and adolescents. The aim of this study was to assess the associations between SEP (including area-level deprivation) and sedentary behaviour in school-age children and adolescents.MethodsThe study sample was 4034 participants aged 5–15 yrs participated in the 2008 Health Survey for England which collected information on SEP (household income, Registrar General’s social class of the household reference person) and neighbourhood deprivation. Sedentary behaviour assessment (proxy parental measures for 5–12yrs; self-reported for 13–15yrs) included television viewing and other sitting during non-school times. Total sitting time was measured in a sub-sample (N=611) using accelerometers. We examined the multivariable associations between each SEP indicator and each sedentary time indicator using generalised linear models. Whenever appropriate, models were adjusted for age, sex, body mass index (BMI), physical activity, accelerometer wear time and mutually adjusted for the other SEP indicators.ResultsThe mean age of the sample was 10 yrs (±3), 2922 participants were aged 5–12 and 1112 were aged 13- 15yrs. Household income and social class were inversely associated with daily television times (i.e. the higher the SEP the lower the television viewing times), e.g. compared to participants from households in the bottom income quartile, those in the top quartile had 14 minutes /day less (95% CI: 3 to 25, p=0.009) of television viewing. Non-TV sitting during non-school time was higher in nonmanual than in manual social class households by 14 minutes/day (7 to 20, p<0.001). Total (accelerometry-assessed) sitting time was higher among participants from households in the top income half (≥£23135/year) by 22 minutes/day (7 to 37, p<0.00) compared to those in the bottom half. Area deprivation was not associated with sedentary behaviour.ConclusionLow socioeconomic position is linked with higher television times but with lower total (accelerometry-assessed) sitting, and non-TV sitting during non-school time in children and adolescents. Inferences from studies looking at socioeconomic position and specific indices of sedentary behaviour (e.g., TV time) in children and adolescents may not be generalizable to total sitting time.
OP15 Neighbourhood Deprivation, Land use and Physical Activity: Combining Accelerometry and Global Positioning Systems
Authors: Hillsdon M , Coombes E , Jones A , Griew P , Wilkinson P , Hajat S 
Published: September 2012

BackgroundNeighbourhood deprivation is associated with physical activity but it is not known whether the locations where physical activity takes place also varies by deprivation. The Forty Area Study (FAST) combined Global Positioning Systems (GPS) technology with accelerometery in UK adults to measure actual locations in which physical activity takes place. We evaluate what proportion of moderate to vigorous intensity physical activity (MVPA) is spent in different locations according to neighbourhood deprivation.Methods1084 adults from Northwest England took part. Each participant’s activity levels were recorded for 7 days using an accelerometer. A quarter of our participants also wore a GPS device. The accelerometer and GPS data were integrated into a Geographical Information System (GIS) containing information on the participants’ home locations and the locations where physical activity was recorded. We then examined the land uses where participants undertook their MVPA.ResultsRespondents in the most deprived neighbourhoods undertook a greater proportion of their MVPA in and around their home location, in buildings, on the road network and in shopping areas compared to respondents from the most affluent neighbourhoods. The proportion of MVPA undertaken in green space was considerably higher in the most affluent compared to the most deprived neighbourhoods (28.9% vs. 8.8%). The places where people undertake physical activity vary according to neighbourhood deprivation suggesting differences in the purpose of activity and access to places for physical activity.ConclusionUnderstanding where people undertake their physical activity provides valuable insights into the types of land uses that are important for physical activity and how they vary according to an area based indicator of socio-economic status.
OP16 How is Objectively Measured Physical Activity Associated with Falls and fear of Falling in Older Community Dwelling Men?
Authors: Jefferis BJ , Iliffe S , Kerse N , Kendrick D , Trost S , Lennon LT , Ash S , Wannamethee SG , Morris R , Whincup PH 
Published: September 2012

BackgroundFalls are a major cause of disability in older age and fear of falling (FOF) may limit physical activity. Associations between falls, fear of falling and objectively measured physical activity (PA) has been little studied, particularly in community-dwelling older adults.MethodsThe study sample was men participating in a prospective, population-based cohort study in 24 British towns provided questionnaire information on a history of falls in the previous year, fear of falling, and other medical history and wore an Actigraph GT3X accelerometer for 7 days. Uniaxial accelerometer data were analysed in 60s epochs, excluding bouts of >60 minutes of complete inactivity. Days with >=600 minutes valid wear time were included. PA intensity was categorised as sedentary: <100 counts/minute, light: 100–1952 counts/minute and moderate to vigorous PA (MVPA):>1952 counts/minute. Associations between activity levels and falls, or fear of falling, were estimated using hierarchical linear regression models accounting for clustering and controlling for confounders.ResultsA total of 1543 men with a mean age of 77(range 71–91y) wore the Actigraph; 1100 (72%) had >600 minutes wear time on 5–7 days and questionnaire data. 21% (n=229) had fallen, 30% (n=68) received medical attention. Men who fell took fewer steps/day than men who did not: mean difference (adjusted for age, day order, month, wear time and town) –504 (95%CI –216, –792) and spent more minutes sedentary 13(95%CI 4, 22), and less in light –10(95%CI –1, –19) and MVPA –3.5(95%CI –1.3, –5.8). In relative terms, the reduction in MVPA was greatest: 22%(95%CI 7, 37). Differences were explained by exercise self-efficacy and mobility limitations, but not by exercise outcome expectation. 13% (n=141) men reported FOF, of whom 53% (n=74) had fallen in the past year. Men with FOF took markedly fewer steps than men without:–1325(95%CI –1646, –1005), spent more minutes in sedentary 29(95% 18, 40), and less in light activity –21(95%CI –32, –11) or MVPA –9(95%CI –11, –7). In relative terms, the reduction in MVPA was greatest:–72%(95%CI –93, –52). Differences were partly explained by exercise self-efficacy, mobility limitations, and to a lesser extent, exercise outcome expectation. There was no evidence that FOF had a greater impact on PA levels among men who had fallen compared to those who had not fallen.ConclusionPA levels and in particular step counts and MVPA levels, were lower among men who had fallen in the past year, and even more markedly, among those who reported FOF.
OP18 Childlessness in Europe: Implications for Wellbeing in Later Life
Authors: Gibney S 
Published: September 2012

BackgroundIn addition to low patterns of fertility experienced in the last 15 years, lifetime childlessness is increasing in Europe. It is now expected that between 10–20% of women born in the 1950s in Western Europe will never have children. Adult children play an important supportive role to their ageing parents; economically, acting as bridges to social support and monitoring health behaviour. This role has been enshrined at various institutional levels, from the family to the welfare state. Explanations of the negative relationship between childlessness and late life wellbeing have mainly focused on social support deficits. However, contradictory evidence of the effect of childlessness on psychological wellbeing exists which may be dependent on the wellbeing measures employed, the life course stage under examination, and differing societal contexts. Furthermore, few studies account for current health or health selection effects. Health-related predictors of childlessness may mediate the relationship between childlessness and late life wellbeing and/or influence wellbeing directly.MethodsThis study utilises data from wave two of the Survey of Health, Ageing and Retirement in Europe (SHARE) and SHARELIFE (retrospective life history data) from 11 countries, spanning Northern, Western, Southern and Eastern Europe. The sample is restricted to those aged 55–75 years (N= 21,295). Two measures of wellbeing are employed: the EURO-D depressive mood scale and the CASP–12 quality of life scale. Standard demographic and socio-economic variables (age, gender education, employment, financial circumstance, marital status, and ethnicity) are utilised in addition to self-reported current and childhood health. Region-specific Ordinary Least Squares (OLS) regression analysis is performed to determine the independent effect of childlessness on each wellbeing measure, controlling for demographic, socio-economic and health variables. Interactions between childlessness and childhood health indicate the role of health selection in this relationship. Interactions between childlessness and marital status are also examined.ResultsChildlessness significantly increases depressive mood in Northern Europe only. However, this effect is contingent on marital status; widowhood and never being married in particular. Relative to being currently married, never being married and widowhood also have a consistent main effect, reducing quality of life and increasing depressive mood. Across all regions there is no evidence to support the hypothesis that health selection mediates the relationship between childlessness and later life wellbeing.ConclusionMarital status consistently mediates the relationship between childlessness and wellbeing and therefore should be the context through which the relationship between lifetime childlessness and wellbeing is considered.
OP21 An Economic Evaluation of Non-Communicable Diseases in Brazil
Authors: Rtveladze K , Marsh T , Brown M , Webber L , Kilpi F , McPherson F , Levy D , Conde W , Monteiro C 
Published: September 2012

BackgroundNon-communicable diseases are increasingly recognised as the major health issue facing many governments. Brazil has observed a rapid change in the weight profiles of its population, with the prevalence of obesity and overweight increasing partly as a result of the well documented effect of the nutrition transition. Obesity-related diseases are placing a substantial health and economic burden on the country. While the problem has been recognized, the implications of current trends on future overweight and obesity rates, BMI-related disease and costs associated with that disease burden have not been considered.MethodsA previously developed micro-simulation model was used to project through the year 2050 the extent of obesity, BMI related diseases, and associated health care costs in Brazil. A Monte-Carlo simulation method has been utilized to simulated BMI related diseases. In total, thirteen conditions were modelled: coronary heart disease, stroke, hypertension, diabetes, knee osteoarthritis, and eight cancers (breast, kidney, colorectal, oesophageal, endometrial, gallbladder, liver and pancreas). The authors also projected a possible decrease in the BMI and its impact on health and health care costs.ResultsIn 2010, nearly 45% of the Brazilian male population were overweight or obese (BMI ≥25kg/m²), but by 2050 we project rates as high as 95%. A slightly less pessimistic picture is observed among females: 42% in 2010 increasing to 52% in 2050. The disease incidence figures increase considerably due to obesity patterns. However, BMI reduction across the population will alter these disease projections. Nearly three million diabetes cases and USD 388 million in health care expenditure can be avoided with a five percent reduction in BMI alone by 2050.ConclusionObesity rates are rapidly increasing in Brazil creating a high burden of diseases and associated health care costs. However, even a one and percent reduction in prevalence rates will substantially reduce the disease and cost burden. Though some steps have been taken for tackling the obesity problem, Brazil still needs a strong, comprehensive policy involving multiple agencies and institutions with strong leadership.
OP23 Developing a Single, Evidence-Based Approach Towards Disinvestment: Is a Nice Way the Right Way?
Authors: Flynn H , Gericke CA 
Published: September 2012

BackgroundWith the NHS currently facing one of its toughest periods financially, most, if not all, PCTs in England have started to prioritise services and sought to identify those which are either ineffective or of low clinical value for disinvestment. Yet the absence of a nationally accepted list of identified procedures has resulted in PCTs developing their own approaches, with many applying different priority thresholds to different procedures. This has created numerous “black lists” of interventions which will either not be funded or their commissioning severely curtailed. As these decisions are being based on the affordability of procedures rather than clinical efficacy, a post-code lottery in provision has ensued across the UK. Therefore to ensure equitable access to healthcare resources, an evidence based approach towards disinvestment is imperative.MethodsWorking in collaboration with NICE R&D, the project used NICE’s ‘do not do’ (DND) database to identify topics based on rigorous evidence for potential disinvestment. DNDs based upon those treatments with evidence suggesting they are ineffective or of low-clinical value were identified from the 850 + DND database. DNDs relating solely to clinical safety were excluded from the study. Procedures were further prioritised by 34 clinical experts in participating ‘pilot’ implementation sites in the SW Peninsula, who were asked to review populated lists of DNDs to ensure: clinical soundness; practicality of implementation; and any DND of potential high impact locally. Using HES data, volumes of DNDs still being performed in the NHS were also collated to give an estimate of overall usage and potential impact. Each DND identified was subjected to a cost analysis to provide an estimate of potential savings at both a local and national level.Results209 DND topics developed between 2007 and 2012 were identified for use in the study. Following local clinical prioritisation, cost analysis and exploration of HES data to give an estimate of usage, 30 procedures for a pilot disinvestment programme were identified solely from the NICE DND database.ConclusionThe study successfully developed a single, evidence-based approach towards disinvestment through the identification of ineffective and low clinical value treatments from the NICE DND database. Additional planned research which will implement the ‘pilot’ list across the SW Peninsula, will provide valuable information on the practical implications of disinvestment initiatives and identify any incentives/disincentives for future developments.
OP25 Using Linear Spline Multilevel Models to Assess Socioeconomic Differences in Trajectories of Diet, Physical Activity and Fat Mass Across Childhood
Authors: Howe LD , Anderson EL , Cribb V , Emmett P , Ness AR , Lawlor DA , Tilling K 
Published: September 2012

BackgroundLower socioeconomic position (SEP) is a risk factor for obesity in children and adolescents in high-income countries. Since diet and physical activity are the main drivers of obesity, the socioeconomic differential in obesity is likely to arise through SEP differences in one or both of these.MethodsWe explored SEP differences in trajectories of fat mass, energy intake and physical activity (PA) across childhood and early adolescence, using maternal education as a measure of SEP, in the Avon Longitudinal Study of Parents and Children. Fat mass was measured by DXA scans at mean ages 10, 12, 14, 15 years. Energy intake was assessed using food frequency questionnaires (FFQs) at 3, 4.5, 7, 8.5 years and 3-day diet diaries at 3.5, 5, 7.5, 10, 13 years. PA was assessed by accelerometers worn for 7 days at 12, 14, 16 years, used to calculate mean total counts per minute (CPM) and mean minutes of moderate to vigorous PA (MVPA). Energy intake (adjusted for FFQ vs diary), % fat mass, CPM and MVPA were all modelled using linear spline multilevel models.Results5739 individuals had data on maternal education and at least one measure for each of fat mass, energy intake and PA. The sons of women educated to degree level (highest maternal education category) had consistently lower % fat mass across childhood and early adolescence, but differences between the 3 lower SEP categories only began to emerge from age 14. In females there was a stepwise increase in percent fat mass for each decreasing category of maternal education, and the SEP gradient remained largely stable between 10 and 15 years. The SEP patterning in trajectories of energy intake and PA (CPM and MVPA) did not resemble the SEP patterning in trajectories of fat mass. For energy intake, no SEP differences were observed. For PA in males, there was little SEP patterning in MVPA, but for CPM there were higher levels of activity in lower maternal education groups, i.e. the reverse of the fat mass gradient. For females, CPM and MVPA were both higher in the highest maternal education category, but contrary to the fat mass trajectories, differences between the lower three SEP categories were not consistent.ConclusionSocioeconomic differences in trajectories of energy intake and PA do not resemble the patterns observed for fat mass. Potential explanations for this finding, including measurement error, will be discussed.
OP26 By-State Comparison of Obesity Trends in The Adult Population of the United States of America
Authors: Kapetanakis V , Brown M , McPherson K , Webber L , Rtveladze K , Marsh T 
Published: September 2012

BackgroundExcess bodyweight is associated with negative effects on longevity, disability-free life-years, quality-of-life, and productivity. High prevalence of obesity and over-weight is often related to socioeconomic status, educational attainment, and ethnic group. The combination of rising obesity prevalence and increased spending on obese people has been estimated to account for 27% of the growth in US health-care expenditure between 1987 and 2001.MethodsThe Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest, telephone health survey system, collecting cross-sectional data on health conditions and risk factors in all states of the US yearly since 1984. Telephone interviews provide a cheap alternative to physical examinations and are often used as a way to increase the number of participants in observational studies. Data for 3,814,344 adults from BRFSS were used to investigate trends of obesity levels in each US state. Over the period 1999–2010, the yearly trend in the percentage of the population with body mass index (BMI) in normal-weight (BMI<25), over-weight (BMI 25–29.9), and obese (BMI>30) ranges, is modelled using multinomial logistic regression, stratifying by gender and age group (20–39, 40–59,>60 years). The fitted models are used to compare trends between states and to forecast levels of obesity in the future. A previously developed micro-simulation model is used to assess the burden of 13 diseases caused by obesity and estimate the economic impact implied by the forecasted trends. Data of the US–National Health and Nutrition Examination Survey collected over the same period are used to investigate the extent of self-reporting bias in BRFSS.ResultsIn 2010, the proportion of obese (BMI>30) men and women in the US was 33% and 35%, respectively, whilst the proportions of over-weight (BMI 25–30) were 42% and 34%. The fitted models forecast an increase in the proportion of obese individuals to up to 70% by 2030. The results reveal increasing levels of obesity in all states, although the rate of increase varies among states. Comparing BRFSS data with data from NHANES, showed that at all ages both men and women slightly over-report their height, whilst women under-report their weight by 5kg on average. Under-reporting of weight is reduced after age 65.ConclusionObesity rates are rapidly and steadily increasing in the US posing a threat to population health and a substantial economic burden. As self-reporting bias may significantly underestimate BMI in women, the estimated burden of obesity may be conservative.
OP27 Dietary Fibre Intake and Fatal Stroke Risk in the UK Women’s Cohort Study
Authors: Threapleton DE , Burley VJ , Greenwood DC , Cade JE 
Published: September 2012

BackgroundIn the UK in 2008, stroke was responsible for over 43,000 deaths. Dietary fibre intake may reduce stroke risk through modifying one or more risk factor such as body weight, blood cholesterol, or blood pressure. Food sources of fibre can be examined in relation to risk as different foods contain different types of fibre which have differing proposed actions within the body.Methods31,036 women recruited in 1995 provided dietary information relating to the previous 12 months using a 217-item food frequency questionnaire. Total dietary fibre intakes were estimated as both non-starch polysaccharide (NSP) and Association of Official Analytical Chemist (AOAC) values. Insoluble fibre, soluble fibre and fibre (NSP) from a variety of food sources were also examined. Stroke mortality was registered from baseline through the Office of National Statistics. Cox proportional hazard ratios were generated to explore risk using both categorical (fifths of intake) and continuous exposure variables. Model adjustments: age, body mass index, energy intake, ethanol, physical activity, smoking and socio-economic status.ResultsAfter 14 years, 130 fatal stroke cases were observed. Fatal stroke risk was similar for total fibre assessed either as NSP or AOAC and both were protectively associated with risk. Overall, risk was roughly halved in each intake category compared to the lowest although this was only significant in the 3rd (NSP/AOAC) and 4th (AOAC) category. Those consuming 24 vs. 14g/d of NSP or 37 vs. 22g/d AOAC had their risk of stroke halved [Englyst: hazard ratio 0.47 (95% confidence interval 0.24, 0.92) p=0.028] [AOAC: 0.47 (0.25, 0.89) p=0.021]. For fibre from nuts and seeds, the highest intake category (0.85g/d) saw a 56% risk reduction [0.44 (0.23, 0.83), p=0.012] compared to the lowest (0g/d). Fibre from fruit was also protectively associated with risk of stroke in the 4th (5.8g/d) vs. 1st category (1.4g/d) [0.50 (0.25, 0.97), p=0.041]. These significant associations were not seen in every category comparison and results for continuous exposures were not statistically significant for any of the exposures explored. No association was observed with fibre from cereals, vegetables or legumes.ConclusionResults suggest that fibre from certain food sources and not others may be more beneficial for prevention of stroke. This may occur because different foods contain fibre fractions in varying quantities. Non-significant results for the continuous exposures suggest associations may be non-linear. The results may also reflect benefits simply from ‘fruit’ or ‘nut and seed’ consumption rather than specifically fibre from these sources.