bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP32 Health Inequalities in Japan 1986 to 2007 Based on Self-Rated Health, Household Income and a Novel Occupational Classification
Authors: Hiyoshi A , Shipley MJ , Fukuda Y , Brunner EJ 
Published: September 2012

BackgroundWhile widening or stable inequalities have often been found in relation to economic stagnation in the west, time trends in health inequalities in Japan over the past two decades of economic stagnation are unclear. Comprehensive examination of temporal trends and factors contributing health inequalities in Japan are imperative to population health.MethodsWe analysed a series of eight nationally-representative samples (Comprehensive Survey of the Living Conditions of People on Health and Welfare) between 1986 and 2007 (n=398,303). We used household income and a novel theory-driven occupational social class classification to calculate temporal trends in relative and slope indices of inequality [RII and SII, respectively] in self-rated fair or poor health. Multiple imputation was conducted to account for missing income data. Effects of living conditions, behavioural and psychosocial factors were tested using 1998 and 2001 samples.ResultsOverall, age-standardised self-rated fair or poor health showed U-shaped time trends in both sexes (quadratic term: men p<0.001, women p=0.005), with the lowest prevalence in early/mid 1990s. In men, income RII and SII narrowed significantly over the period (RII declined 1.4% per year, p=0.001; SII declined 0.1% per year, p=0.031). Inequalities in women’s income were stable (RII and SII). The two indices showed constant inequalities across occupational social class in both sexes. After multiple imputation, point estimates became smaller, and narrowing of income inequality over time was significant for RII and SII in both sexes (p<0.05, n=490,632). The annual declines were 1.4% and 1.0% for RII in men and women, respectively, and 0.1% for SII in both sexes. Living conditions, behavioural and psychosocial factors accounted for 28% of men’s and 51% of women’s health inequalities in Japan.ConclusionHealth inequalities in Japan either narrowed or remained stable from 1986 to 2007, in contrast to studies in western countries. The evidence provided by these analyses suggests that the prolonged economic stagnation in Japan had adverse effects at both ends of socioeconomic hierarchy. Potential explanations include effects of decreased income and increased stress in relation to job insecurity and workload across socioeconomic groups.
OP34 Inequities in Bicycle Usage: Socio-Demographic Predictors of Uptake and Usage of a Public Bicycle Sharing Scheme in London, UK
Authors: Ogilvie F , Goodman A 
Published: September 2012

BackgroundCycling confers individual and population-level health benefits. Increasing numbers of cities are therefore introducing public bicycle sharing schemes, with London’s Barclays Cycle Hire (BCH) scheme introduced in July 2010. Yet uptake of cycling is not equitable across socio-demographic groups. We sought to examine the characteristics of the BCH scheme’s registered users, and to explore characteristics associated with usage.MethodsFor users registering in the first seven months of the scheme, we obtained complete BCH registration and usage data, comprising: title (from which we inferred gender); home postcode; date of registration; access type; and number of trips made. We used postcodes to calculate distance to the nearest ‘docking station’ and to assign small-area-level data on ethnic composition, income deprivation, and the prevalence of commuter cycling. We compared characteristics of registered users with local residents and workers in the inner-London area served by the scheme. We used multi-level linear regression to examine correlates of ‘mean number of trips’, and logistic regression to examine correlates of ‘ever use’.Results100,801 registered individuals made 2.5 million trips between July 2010 and March 2011. Compared with local residents and workers, registered individuals were more likely to be male and to live in areas of low deprivation and high cycling prevalence. Among those registered, females made 1.63 (95%CI 1.74,1.53) fewer trips per month than males. In combination with the fact that fewer females registered in the first place, this meant that only 17.8% of the total number of BCH trips were made by females. Adjusting for the fact that deprived areas were less likely to be close to BCH docking stations, users in the most deprived areas made 0.85 (95%CI 0.63,1.07) more trips per month than those in the least deprived areas.ConclusionFemales and residents in deprived areas are underrepresented among users of London’s public bicycle sharing scheme. Indeed, the BCH scheme currently appears to be less gender-equal than cycling in general in London. Nevertheless, registered users in more deprived areas made more trips on average, suggesting there may be a greater latent demand for cycling in these areas. The scheme’s expansion into more deprived areas from Spring 2012 has, therefore, the potential to create a more socio-economically equitable uptake of cycling.
OP37 Psychological Consequences of False-Positive Screening Mammograms in the UK: A Systematic Review
Authors: Bond M , Pavey T , Welch K , Cooper C , Garside R , Dean S , Hyde C 
Published: September 2012

BackgroundIn the UK women aged 47–73 are invited for screening by mammography every three years. In 2009–10 more than 2.24 million women in this age group in England were invited to take part in the programme, of these 73% attended a screening clinic. Of these 64,104 were recalled for assessment. Of those recalled 81% did not have breast cancer, these women had a false-positive mammogram. The aim of this systematic review was to identify the psychological impact of false-positive screening mammograms and evidence for the effectiveness of interventions designed to reduce this.MethodsThis was a systematic review using the principles of the Centre for Reviews and Dissemination in York.All UK controlled studies and qualitative studies of women with a false-positive screening mammogram were included. The control group participants had normal mammograms. All psychological outcomes including returning for routine screening were permitted. Titles and abstracts were screened independently by two reviewers. Retrieved papers were reviewed and selected using the same independent process. Data were extracted by one reviewer and checked by another. Each included study was assessed for risk of bias.ResultsThe searches returned seven includable studies (7/4,423). Those using disease specific measures found that there could be enduring distress that lasted up to three years; the level of distress was related to the degree of invasiveness of the assessment. At three years the relative risks were, further mammography 1.28 (95% confidence interval 0.82 to 2.00), fine needle aspiration 1.80 (95% confidence interval 1.17 to 2.77), biopsy 2.07 (95% confidence interval 1.22 to 3.52). There was also an enduring impact for those put on early recall 1.82 (95% confidence interval 1.22 to 2.72), However, studies that used generic measures of anxiety and depression found no such impact up to three months after screening. The strongest evidence suggests that women with false-positive mammograms have an increased likelihood of failing to reattend for routine screening, relative risk 0.97 (95% confidence interval 0.96 to 0.98) compared to women with normal mammograms. No studies of women from different socio-economic or ethnic groups were found nor any published qualitative studies.ConclusionHaving a false-positive screening mammogram can cause breast cancer specific distress for up to three years. It is less likely there will be general anxiety or depression detectable at pathological levels. The degree of distress is related to the invasiveness of the assessment. Women with false-positive mammograms are less likely to return for routine assessment than those with normal ones.
OP44 Race, Bullying and Self-Esteem at the Transition Between Primary and Secondary School
Authors: Hawkins A , Emond A 
Published: September 2012

BackgroundStudies from the US have suggested that children who experience racial discrimination have higher rates of depression, anxiety, behavioural disorders, and lower self-esteem. Children are generally more vulnerable to such problems at the transition from one school to another. Our aim was to investigate the associations between race, bullying, mood, behavioural difficulties and self-esteem during the transition to secondary school in a population-based cohort of English children.MethodsChildren from the Avon Longitudinal Study of Parents and Children (ALSPAC) were asked to define themselves by skin colour when aged 12 years (n=7017). Analyses were performed using logistic regression, adjusting for gender and maternal education. The primary outcome measures were bullying and racial discrimination at 12–12.5 years. Secondary outcomes were bullying at 8 years, depressive symptoms at 11.6 years, behavioural difficulties at 11.6 years, friendships at 12 years, mood and self-esteem at 13.8 years.Results94.2% of children defined themselves as white (n=6607), 3.6% as mixed race (n=255) and 2.2% (n=155) identified with a specific ethnic minority group. At primary school (8–11 yrs), there were no differences between these groups in reported bullying, types of friends or prevalence of behavioural problems or depression. At secondary school (12.5 years), the reported prevalence of racially motivated violence was 10–13%, and for name-calling was 31–33%. Compared to white children, ethnic minority but not mixed race children were more likely to experience overt bullying (OR 2.98; 95% confidence interval 1.38 to 6.42). Mixed race children were more likely to retain friends of different races after the transition to secondary school (OR 1.89; 1.32 to 2.71). Ethnic minority children were more likely to feel ‘different from others’ at 13.8 years (OR 1.63; 1.01 to 2.36).ConclusionAlthough children of different colour had similar experiences at primary school, ethnic minority children were more likely than white children to experience bullying and discrimination at the transition to secondary school. Racial discrimination affected up to one third of ethnic minority and mixed race children at 12 years of age, and these children felt more socially isolated and were less happy than their white peers at 13 years. Strategies for prevention of bullying should be targeted at this vulnerable group of children, particularly during this high-risk period of transition.
OP46 The Association Between Private Patient Status and Caesarean Delivery: A Retrospective Cohort Study of 403,642 Childbirth Hospitalisations
Authors: Lutomski JE , Murphy M , Devane D , Meaney S , Greene RA 
Published: September 2012

BackgroundThe increase in Caesarean delivery rates over the past decades has resulted in it becoming one of the most commonly performed in-hospital surgical procedures. While many Caesarean deliveries are clinically indicated, other factors, such as medico-legal fears and maternal and health professional preferences, contribute to the decision-making process. To explore non-clinical factors, we investigated differences in Caesarean delivery rates and temporal trends by private and public patient status while giving consideration to patient case-mix.MethodsA retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010 in the Republic of Ireland. Procedural ICD–10-AM codes from hospital discharge records were used to identify emergency and elective Caesarean deliveries. Temporal trends in Caesarean delivery were determined using a Cochrane-Armitage test for trend. Multivariate multinomial regression analysis was used to determine the odds of Caesarean delivery (emergency or elective versus vaginal delivery) by mother’s public or private status while adjusting for age, multiple gestation, previous Caesarean delivery, induction of labour, maternal morbidity and other obstetric complications.Results403,642 childbirth hospitalisations reviewed; approximately one-third of women (30.2%) were booked privately. Women booked privately were more likely to be at least 30 years of age or older, married and have had a previous Caesarean delivery. Over the study period, the overall Caesarean rate increased from 22.2% to 23.8% among women booked publicly versus 30.2% to 34.7% among women booked privately (test for trend p-value <0.0001). While the emergency Caesarean rate was similar between both groups of women (14.3% versus 13.3% respectively), women booked privately were almost twice as likely to have an elective Caesarean delivery (17.8% versus 9.4%). After adjustment, women booked privately had an increased odds of both emergency (adjusted OR: 1.32; 95% CI 1.29, 1.35) and elective (adjusted OR: 1.88; 95% CI 1.83, 1.93) Caesarean delivery.ConclusionIrrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have a Caesarean delivery than women booked publicly. Moreover, while increasing trends in Caesarean delivery were observed among all women, the increase was disproportionately higher among women booked privately. These findings suggest that significant differences in Caesarean rates are unlikely to be explained by differences in clinical risk factors. Mixed-method research is clearly warranted to explore disparities in Caesarean delivery rates. Such research should focus on clinical decision making and the role of personal preferences of women and maternity care professionals in decisions regarding mode of birth.
OP47 Effect of High Profile Quality Failures On Patient Numbers in the English NHS
Authors: Laverty AA , Millett C 
Published: September 2012

BackgroundPolicy architects are keen to emphasise that releasing information on the quality of hospitals into the public domain will drive patients away from poor quality providers and thus motivate system wide improvements. However, previous evidence on the impact of releasing quality information to the public have been mixed, with various reasons being proposed as possible barriers, including patients being unaware of the information available, being unable to understand it, or feeling it to be irrelevant. We examined three cases of high profile reports into failings in quality and safety at English NHS hospitals in order to assess whether this negative publicity was associated with a decrease in patient numbers. These reports all garnered significant media attention and presented a stark picture of performance and so we hypothesise that such negative coverage may have induced a fall in patient numbers.MethodsWe analysed trends in admission for nonemergency admissions with a difference-in-difference approach, using four separate comparison groups: (1) matched on previous hospital numbers; (2) the five closest hospitals geographically; (3) hospitals in the same administrative area; (4) a national comparison group. We also employed waiting time as an instrumental variable to account for possible effects on waiting times on patient numbers. We used three outcomes: overnight admissions; day-case admissions; and patients not attending for their booked appointments, and used a model segmented into three month periods after report publication in order to examine the range of short and longer term effects.ResultsTwo out of three of the hospitals we examined showed no difference in patient numbers at any point in the 12 months after negative reports were published. One of the hospitals showed a reduction in overnight patients for 3 months (–12%, p=0.003) and 6 months (–14%, p<0.001) after report publication, but patient levels returned to normal after this. Additional examination of patient numbers in advance of these reports coming out also did not change these results.ConclusionThe publication and dissemination of highly critical reports by a health care regulator does not appear to have resulted in patients’ sustained avoidance of the hospitals involved. We only found an impact in one of the three hospitals we examined, and this only persisted for 6 months. This reminds us that simplistic assumptions regarding the power of information to drive patient numbers are unrealistic, and that reliance on these alone to drive quality improvement may be misguided.
OP52 Long-Term Exposure to Income Inequality: Implications for Physical and Mental Health at Older Ages
Authors: Vries R de , Blane D , Netuveli G 
Published: September 2012

BackgroundThe ‘inequality hypothesis’ proposes that higher levels of societal income inequality have a detrimental effect on both physical and mental health. Previous studies have provided only mixed support for this hypothesis, particularly among older people. However, by using only contemporary income inequality estimates, or estimates from a single lag period, the majority of previous studies have not accounted for people’s continued exposure to income inequality over the long-term. In this study, we addressed this problem by examining the association between older people’s experience of inequality over an extended period and their subsequent health.MethodsThe data for this project were taken from three comparable nationally representative surveys (covering 16 countries) of the health and circumstances of older people; the English Longitudinal Study of Ageing, the Survey of Health and Retirement in Europe, and the U.S. Health and Retirement Study. Standardised estimates of national income inequality from 1960–2006 were taken from the Standardised World Income Inequality Database. We used multilevel regression methods to model the association between average inequality over this period and four measures of individual health: Objectively measured grip strength and lung function, and subjectively reported physical limitation and depressive symptoms.ResultsWe found that, after adjusting for individual and country-level covariates, exposure to higher average levels of inequality over the long-term was significantly negatively related to objectively measured grip strength and lung function, but unrelated to self-reported physical limitations or depressive symptoms.ConclusionOur results show that long-term exposure to income inequality may indeed be detrimental to the physical health of older people. However, we found no evidence of an effect of inequality on subjectively reported limitations or depressive symptoms. This may be an effect of unmeasured covariates, or it may be due to the greater accuracy afforded by the objective health measures. To our knowledge this study represents the first direct evidence linking experience of inequality to the health of older people which has made use of either objective measures of health at the individual level, or a measure of inequality exposure over the long term.
OP53 Defining the Long-Term Trend in a Public Health Intervention Study: A Cautionary Tale
Authors: Salway R , Gilmore A , Sims M 
Published: September 2012

BackgroundNumerous studies have reported on the impact of comprehensive smoke-free laws on population health. Many early studies have ignored the potential effect of the long-term trend of the health outcome, and when included, subsequent studies have focused on either linear or non-linear trends. However, the choice of appropriate trend is not always straightforward. We illustrate this by investigating the short-term impact of smoke-free legislation in England, introduced on 1st July 2007, on myocardial infarction mortality.MethodsWe investigate the impact of the legislation using weekly counts of all cases aged 18 years or older residing in England with a primary cause of death of a myocardial infarction (ICD–10 I21) between July 2002 to December 2010 (providing 5 years pre-legislative and 3 years and 6 months post-legislative data). We compare a number of models based on an interrupted time series design with a quasi-Poisson generalised additive model that adjusts for seasonality and long-term trends.ResultsMyocardial infarction mortality shows a marked decline over the study period. We identify two competing models. The first shows evidence of a complex interaction between the introduction of smoke-free legislation and the long-term trend. We observe an initial statistically significant reduction in mortality (–8.5%, 95% CI –11.1% to –5.8%) coupled with a change in the long-term trend from a reduction of 4% over a six month period to a reduction of 3.5%. The second model fits a nonlinear trend and shows no significant smoke-free effect. Both models offer an almost identical fit.ConclusionInvestigating small effects in the presence of a pronounced long-term trend is complicated by the limitations of the available data. In particular, it is not clear whether we observe a gradual change in the long term trend or a discrete effect directly attributable to the legislation. The two models have near-identical fitted values and GCV scores, but have very different interpretation. We conclude that the data alone are insufficient to distinguish between the two models and warn that overly-simplistic analyses in such situations may result in misleading conclusions.
OP55 Socioeconomic Inequalities in Childhood Exposure to Secondhand Smoke Before and after Smoke-Free Legislation in three UK Countries
Authors: Moore GF , Currie D , Gilmore G , Holliday JC , Moore L 
Published: September 2012

BackgroundSecondhand smoke (SHS) exposure is higher among children from lower socioeconomic status (SES) families, contributing to the intergenerational reproduction of health inequalities. Legislation prohibiting smoking in enclosed public places was introduced in all UK countries between 2006 and 2007. Although opponents argued that it would displace smoking into the home, legislation has been associated with reduced childhood SHS exposure and increased prevalence of smoke-free homes. In some UK countries however, trends towards widening inequality in childhood SHS exposure have been reported following legislation. This paper combines datasets from 3 UK countries to examine socioeconomic patterning in childhood SHS exposure and smoking restrictions in homes and cars pre- and post-legislation.MethodsWe conducted a repeat cross-sectional survey of 10,867 schoolchildren in 304 primary schools in Scotland, Wales and Northern Ireland. Children provided saliva for cotinine assay, completing questionnaires before and 12-months after legislation, including the Family Affluence Scale (a measure of socioeconomic status), and reports of smoking restrictions in homes and cars. Multinomial regression analyses assessed differences between survey years in SHS exposure and private smoking restrictions, with interaction terms to assess SES patterning in changes.ResultsSHS exposure was highest, and private smoking restrictions least frequent, among lower SES children pre- and post-legislation in all countries. Proportions of samples containing <0.1ng/ml (i.e. undetectable) cotinine increased significantly (RR=1.63; 95%CI=1.45 to 1.83), from 31.0% to 41.0%. Although across the SES spectrum, there was no evidence of displacement of smoking into the home, socioeconomic inequality in the likelihood of samples containing detectable levels of cotinine increased (RR=1.10; 95%CI=1.05 to 1.16). Among children from the poorest and most affluent families respectively, 96.9% and 38.2% of post-legislation samples contained detectable cotinine. Socioeconomic gradients at higher exposure levels remained unchanged. Among children from the poorest families, 1 in 3 samples contained greater cotinine concentrations than Scottish bar worker’s samples prior to legislation (3ng/ml). Smoking restrictions in homes and cars increased. However, little more than half (55.1%) of children, and only 19.3% of children of smokers, lived in smoke-free homes following legislation. Significant socioeconomic patterning remained, with 26.3% and 72.0% of children from the poorest and most affluent families respectively living in a smoke-free home.ConclusionUrgent action is needed to reduce inequalities in SHS exposure. Such action should include emphasis on reducing smoking in cars and homes.