bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS36 Probation and NHS Working Together to Reduce Health Inequalities: Great Expectations or a Tale of Two Services
Authors: Parkes J , Roderick P , Panozzo S 
Published: September 2012

BackgroundOffenders within the community are considered a socially excluded population experiencing poorer health than the general population and difficulties in accessing health care. There is little research focused on Community based offenders supervised by Probation. This study explored probation staff’s knowledge, perceptions and attitudes to offender health needs and access to health services.MethodsUsing information derived from qualitative research with probation staff and following a pilot, a national on-line questionnaire survey was conducted of probation staff involved in the management of offenders from a geographically representative sample of Probation Trusts in England and Wales. The questionnaire covered: offender health issues, enablers and barriers to health service access, and the NHS/CJS partnership. Models of good/innovative practice were sought.ResultsSixteen Probation Trusts participated and 611/2810 (22%) responses were obtained. 72% were female, 58% had 6–15 years of experience in probation service. The main offender health issues were substance misuse, mental health (MH), learning disabilities and chronic disease, with alcohol misuse the most important. Provision of easily accessible mental health (for mild –moderate severity) and alcohol treatment services were considered to be inadequate (often/occasional lack of adequate provision 65% alcohol treatment vs 42% drug treatment vs 90% MH).The main barrier reported was poor communication between probation and the NHS in particular with Primary Care services. It was felt that many offenders had not registered with a GP and that there was little joint working, understanding and education between primary care and probation. In addition the chaotic lifestyle of offenders lead to them having difficulties in negotiating health services and having appropriate health seeking behaviours, often accessing health services at a point of crisis (A&E). Responsiveness of health services was perceived to be lacking. Provision of in-house services (particularly mental health) was considered to be very useful where available.Suggested improvements included undertaking health needs assessments to inform joint strategic planning, focus on improvement of alcohol treatment provision; joint education sessions for GPs and Offender Managers, exploration of in-house mental health services; increased access to health trainers, and greater health focus in probation staff training.ConclusionProbation staff participants were very supportive of improving health of offenders. This study identified some key barriers to addressing the health needs of offenders and their access to services, with practical solutions identified by participants providing implications for policy within the ‘new’ NHS, health service commissioning, and future research.
PS37 Does the Route to Diagnosis Affect Outcomes for Oesophago-Gastric Cancer Patients
Authors: Palser T , Cromwell D , Hardwick R , Riley S , Greenaway K , Meulen J van der 
Published: September 2012

BackgroundThe UK Cancer Reform strategy aims to improve early diagnosis but there is little evidence on how the route to diagnosis and affects outcomes for patients with oesophago-gastric (O-G) cancer. We investigated the relationship between the route to diagnosis, patient characteristics, treatment intent and one-year survival among O-G cancer patientsMethodsThe study was undertaken in 142 English NHS trusts and 30 cancer networks, with data being prospectively collected on patients diagnosed with O-G cancer between October 2007 and June 2009. Route to diagnosis was defined as general practitioner (GP) referral - urgent or non-urgent, hospital consultant referral, or after an emergency admission. The association between patients’ route of diagnosis, treatment intent and survival was estimated using logistic regression.ResultsAmong 14,102 cancer patients, 66.3% were diagnosed after a general practitioner (GP) referral, 16.4% after an emergency admission, and 17.4% after hospital consultant referral. Of the 9,351 GP referrals, 68.8% were urgent. Compared to urgent GP referrals, a markedly lower proportion of patients diagnosed after emergency admission had a curative treatment plan (36% v 16%; adjusted odds ratio (OR) = 0.62, 95% CI: 0.52 to 0.74) and a lower proportion of survived one year (43% v 27%; OR=0.78; 0.68 to 0.89). Urgency of GP referral did not affect treatment intent or survival. Routes to diagnosis varied across the 30 cancer networks, with the proportion of patients diagnosed after emergency admission ranging from 8.7% to 32.3%.ConclusionOutcomes for cancer patients are worse if diagnosed after emergency admission. Networks should examine the causes of large regional variations to reduce rates of diagnosis after emergency admission.
PS38 Sarcopenic Obesity and Risk of All-Cause and Cardiovascular Mortality in Older Men
Authors: Atkins JL , Whincup PH , Morris RW , Wannamethee SG 
Published: September 2012

BackgroundSarcopenic obesity refers to the age-associated loss of muscle mass coupled with high adiposity levels. Although it is known that both obesity and low muscle mass are associated with increased mortality, few studies to date have examined the combined effects of sarcopenia and obesity on all-cause or cardiovascular mortality. We examined the relationship between sarcopenic obesity and all-cause and cardiovascular mortality in older men.Methods4,252 men from the British Regional Heart Study, aged 60–79 years in 1998–2000, were followed prospectively until 2011 for mortality. At baseline, midarm muscle circumference (MAMC) measurement was used to provide information on muscle mass and measurement of bioelectrical impedance analysis (BIA) to provide fat free mass index. Obesity was assessed by measurement of body mass index (BMI), waist circumference (WC), and BIA (providing fat mass, FM, index). Participants were classified as either normal, sarcopenic, obese, or sarcopenic obese using varying measures of adiposity and muscle mass, since no consensus definition for sarcopenic obesity exists. Associations between the four sarcopenic obesity groups and mortality rates (all-cause and cardiovascular) were examined using Cox regression, adjusting for age, smoking, alcohol intake, social class and physical activity.ResultsThere were 1,456 deaths during follow-up (mean=10.1years), 578 (40%) of which were cardiovascular. Obesity (assessed by BMI, WC and FM index) was not significantly associated with all-cause mortality, but BMI and WC were significantly associated with cardiovascular mortality (p<0.05). Low muscle mass (MAMC only) was significantly associated with all-cause mortality (p<0.001) but not with cardiovascular mortality. Sarcopenic obese men (MAMC ≤24.95cm; WC>102cm) had the greatest relative risk of all-cause mortality (RR: 1.66, 95% CI:1.23–2.25). Risks of all-cause mortality were also increased among men who were sarcopenic only (RR: 1.25, 95% CI:1.09–1.43) and obese only (RR:1.44, 95% CI:1.25–1.64) compared with normal men. Similar, though weaker, relationships were seen using MAMC and BMI to define sarcopenic obesity, but not when using combined BIA measures. Sarcopenic obese men had a less marked excess cardiovascular mortality risk (RR: 1.20, 95% CI:0.69–2.08), compared with obese men (RR: 1.35, 95% CI:1.09–1.67).ConclusionSarcopenic obese older men are at an increased risk of all-cause mortality compared with those with only sarcopenia or obesity or normal body composition. MAMC and WC appeared to be the best markers of muscle mass and obesity for predicting all-cause mortality, compared with BMI and BIA measures. The added effect of sarcopenia and obesity, however, did not have a synergistic effect on cardiovascular mortality. Efforts to promote healthy ageing in the elderly should focus on both preventing obesity and maintaining muscle mass.
PS42 Inequalities in Child Obesity: Where Do These Occur and is the Gap Widening?
Authors: Dinsdale H , Ridler C 
Published: September 2012

BackgroundChild obesity is an important public health problem. Of particular concern are the considerable inequalities in obesity prevalence between socioeconomic and ethnic groups. The Department of Health’s recently publishedCall to Action on Obesitymakes a commitment to achieving a sustained downward trend in the level of excess weight in children and states that it is vital that action on obesity reduces health inequalities.MethodsThis analysis uses data collected by the National Child Measurement Programme (NCMP). The NCMP is an annual programme that measures the height and weight of children aged 4–5 years (Reception) and 10–11 years (Year 6) in schools in England. Approximately one million children are measured every year.The NCMP collects information on ethnicity and place of residence for each child. Five years of good quality data are now available (2006/07, 2007/08, 2008/09, 2009/10, 2010/11) and these have been analysed in detail by the National Obesity Observatory to examine how patterns of child obesity prevalence vary by demographic and socioeconomic group.ResultsObesity prevalence among children who live in the most deprived areas of England is approximately twice that of children living in the least deprived areas. NCMP data suggest that health inequalities among boys in Reception and girls in Year 6 are widening. Health inequalities do not seem to be widening or narrowing for girls in Reception or boys in Year 6 but substantial health inequalities do persist among these groups.When all years of NCMP measurements are considered the Bangladeshi ethnic group seems to have shown the greatest increases over time. Children in the ‘White Other’ ethnic group appear to be experiencing a decrease in obesity prevalence.ConclusionIn order to achieve a reduction in obesity prevalence among children a particular focus on deprived groups may be required. This would help tackle persistent health inequalities. Children from the Bangladeshi ethnic group may benefit from particular attention, given the evidence that obesity prevalence is increasing for these children at a greater rate than for other ethnic groups.
PS56 Risk Of Intentional Self-Harm In Young People With Selected Mental And Chronic Physical Conditions In England
Authors: Seminog O , Goldacre M 
Published: September 2012

BackgroundSelf-harm is a well recognised act of psychological distress in some young people. Children and young adults with chronic disease are known to have an increased risk of psychological distress, but their risk of intentional self-harm is not well documented in England. We aimed to determine the risk of intentional self-harm in an English population aged 10–24 years with a range of psychological disorders, namely schizophrenia, bipolar disorder, anorexia/bulimia, depression and in those with chronic medical conditions, including diabetes mellitus, asthma and epilepsy.MethodsWe used a dataset of English national linked Hospital Episode Statistics for 1999 – 2011. We identified all the records of people who were admitted to the National Health Service (NHS) hospitals with these conditions. Each condition-specific cohort was constructed by identifying the first admission for the “exposure” condition in people aged 10 to 24 years, and we analysed the dataset for any subsequent admission for intentional self-harm. The rate of self-harm in each exposure cohort was compared with that in a reference cohort comprising people admitted for a wide range of minor medical and surgical conditions; and expressed as a rate ratio (RR) with 95% confidence intervals (CI).ResultsThe RR (95% CI) for intentional self-harm was significantly and substantially high in people with schizophrenia 5.93 (5.7 to 6.17), bipolar disorder 7.93 (7.26 to 8.64), anorexia/bulimia 5.29 (4.97 to 5.63), and depression 10.25 (9.95 to 10.57). It was also significantly high, though much less so, in people with diabetes 1.60 (1.52 to 1.68), asthma 1.52 (1.48 to 1.56) and epilepsy 1.88 (1.80 to 1.96). These rates remained elevated after we excluded the cases of self-harm in the first year following hospitalisation with each exposure condition.ConclusionChildren and young adults with the psychiatric conditions studied are at substantially increased risk of intentional self-harm. People with the chronic medical diseases studied were also at increased risk, although not nearly as high as that associated with the psychiatric disorders. The elevated risks were maintained more than a year after admission, and are likely to be associated with the disorder rather than the fact of hospital admission. Self-harm is important not only for the distress of the act itself, but it is also recognised as a predictor for eventual suicide. Our findings suggest that current suicide prevention programmes should consider targeting these risk groups as a priority.
Prediction of Graupel Density in a Bulk Microphysics Scheme
Authors: Milbrandt Jason A. , Morrison Hugh 
Published: September 2012

AbstractA method to predict the bulk density of graupel ρg has been added to the two-moment Milbrandt–Yau bulk microphysics scheme. The simulation of graupel using the modified scheme is illustrated through idealized simulations of a mesoscale convective system using a 2D kinematic model with a prescribed flow field and different peak updraft speeds. To examine the relative impact of the various approaches to represent rimed ice, simulations were run for various graupel-only and graupel-plus-hail configurations.Because of the direct feedback of ρg to terminal fall speeds, the modified scheme produces a much different spatial distribution of graupel, with more mass concentrated in the convective region resulting in changes to the surface precipitation at all locations. With a strong updraft, the model can now produce solid precipitation at the surface in the convective region without a separate hail category. It is shown that a single rimed-ice category is capable of representing a realistically wide range of graupel characteristics in various atmospheric conditions without the need for a priori parameter settings.Sensitivity tests were conducted to examine various aspects of the scheme that affect the simulated ρg. Specific parameterizations pertaining to other hydrometeor categories now have a direct impact on the simulation of graupel, including the assumed aerosol distribution for droplet nucleation, which affects the drop sizes of both cloud and rain, and the mass–size relation for snow, which affects its density and hence the embryo density of graupel converted from snow due to riming.
Greek foreign policy towards the Armenian Question: a historical survey
Authors: Hassiotis I. K. 
Published: September 2012

To Richard Clogg, a small token of auld acquaintanceThe historical factors that have influenced the course of Greek–Armenian political relations from the mid-nineteenth century up to the dissolution of the Soviet Union (and the subsequent official recognition by Greece of the independent Republic of Armenia in 1991) are explored. In addition, those factors that have caused – and may well cause again, at least in the foreseeable future – the Greek and Armenian positions either to converge or to diverge are identified.
Gaps in the prevention of perinatal transmission of hepatitis B virus between recommendations and routine practices in a highly endemic region: a provincial population-based study in China
Authors: Hu Yali , Zhang Shu , Luo Chao , Liu Qilan , Zhou Yi-Hua 
Published: September 2012

Abstract

Background
Hepatitis B virus (HBV) infection is endemic in China; perinatal transmission is the main source of chronic HBV infection. Simultaneous administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine is highly effective to prevent perinatal transmission of HBV; however, the effectiveness also depends on full adherence to the recommended protocols in daily practice. In the present investigation, we aimed to identify gaps in immunoprophylaxis of perinatal transmission of HBV between recommendations and routine practices in Jiangsu Province, China.

Methods
Totally 626 children from 6 cities and 8 rural areas across Jiangsu Province, China, born from February 2003 to December 2004, were enrolled; 298 were born to mothers with positive hepatitis B surface antigen (HBsAg) and 328 were born to HBsAg-negative mothers. Immunoprophylactic measures against hepatitis B were retrospectively reviewed for about half of the children by checking medical records or vaccination cards and the vaccine status was validated for most of children.

Results
Of 298 children born to HBV carrier mothers, 11 (3.7%) were HBsAg positive, while none of 328 children born to non-carrier mothers was HBsAg positive (P < 0.01). The rates of anti-HBs ≥ 10 mIU/ml in children of carrier and non-carrier mothers were 69.5% and 69.2% respectively (P = 0.95). The hepatitis B vaccine coverage in two groups was 100% and 99.4% respectively (P = 0.50), but 15.1% of HBV-exposed infants did not receive the timely birth dose. Prenatal HBsAg screening was performed only in 156 (52.3%) of the carrier mothers. Consequently, only 112 (37.6%) of HBV-exposed infants received HBIG after birth. Furthermore, of the 11 HBV-infected children, only one received both HBIG and hepatitis B vaccine timely, seven missed HBIG, two received delayed vaccination, and one missed HBIG and received delayed vaccination.

Conclusions
There are substantial gaps in the prevention of perinatal HBV infection between the recommendations and routine practices in China, which highlights the importance of full adherence to the recommendations to eliminate perinatal HBV infection in the endemic regions.
Association of pre-transplant statin use with delayed graft function in kidney transplant recipients
Authors: Reiling Janske , Johnson David W , Kruger Peter S , Pillans Peter , Wall Daryl R 
Published: September 2012

Abstract

Background
Administration of HMG-CoA reductase inhibitors (statins), prior to ischemia or prior to reperfusion has been shown to decrease ischemia-reperfusion renal injury in animal studies. It is unknown whether this protective effect is applicable to renal transplantation in humans. The aim of this study was to determine the relationship between prior statin use in renal transplant recipients and the subsequent risk of delayed graft function.

Methods
All patients who underwent deceased or living donor renal transplantation at the Princess Alexandra Hospital between 1 July 2008 and 1 August 2010 were included in this retrospective, observational cohort study. Graft function was classified as immediate graft function (IGF), dialysis-requiring (D-DGF) and non-dialysis-requiring (ND-DGF) delayed graft function. The independent predictors of graft function were evaluated by multivariable logistic regression, adjusting for donor characteristics, recipient characteristics, HLA mismatch and ischaemic times.

Results
Overall, of the 266 renal transplant recipients, 21% exhibited D-DGF, 39% had ND-DGF and 40% had IGF. Statin use prior to renal transplantation was not significantly associated with the risk of D-DGF (adjusted odds ratio [OR] 1.05, 95% CI 0.96 – 1.15, P = 0.28). This finding was not altered when D-DGF and ND-DGF were pooled together (OR 0.98; 95% CI 0.89-1.06, p = 0.56).

Conclusions
The present study did not show a significant, independent association between prior statin use in kidney transplant recipients and the occurrence of delayed graft function.
Efficacy of applying self-assessment of larviciding operation, Chabahar, Iran
Authors: Ranjbar Mansour , Gorgij Khodadad , Mohammadi Mahdi , Haghdoost Ali Akbar , Ansari-Moghaddam Alireza , Nikpour Fatemeh , Salehi Masoud , Sakeni Mohammad , Hasanzahi Abdolghafar , Olanratmanee Phanthip , Kittayapong Pattamaporn 
Published: September 2012

Abstract

Background
Appropriate supervision, along with availability of an effective system for monitoring and evaluation, is a crucial requirement to guarantee sufficient coverage and quality of malaria vector control procedures. This study evaluated the efficacy of self-assessment practice as a possible innovative method towards achieving high coverage and excellent quality of larviciding operation in Iran.

Methods
The research was conducted on the randomly selected rural health centre of Kanmbel Soliman with 10 staff and 30 villages, in three main steps: (i) assessment of effectiveness of larviciding operations in the study areas before intervention through external assessment by a research team; (ii) self-assessment of larviciding operations (intervention) by staff every quarter for three rounds; and, (iii) determining the effectiveness of applying self-assessment of larviciding operations in the study areas. Two toolkits were used for self-assessment and external evaluation. The impact of self-assessment of larviciding operations was measured by two indicators: percentage of missed breeding habitats and cleaned breeding habitats among randomly selected breeding sites. Moreover, the correlation coefficients were measured between self-assessment measures and scores from external evaluation. The correlation coefficient and Mann Whitney test were used to analyse data.

Results
Following the utilization of self-assessment, the percentage of missed breeding habitats decreased significantly from 14.23% to 1.91% (P <0.001). Additionally, the percentage of cleaned breeding habitats among randomly selected breeding sites increased from 66.89% to 95.28% (P <0.001). The external evaluation also showed significant effects of self-assessment in performance of vector control; the maximum effect of intervention were seen in an action plan for monitoring and evaluation of larviciding operations at field level, geographical reconnaissance for the registration of breeding habitats and worker skills related to larviciding.
Before intervention, the results of self-assessment practice were compatible with external evaluation in 76.3% of 139 reviewed reports of self-assessment. After intervention, the findings of self-assessment and external evaluation were similar in the vast majority of reviewed reports (95%).

Conclusion
The self-assessment tool seems to be valid and reliable in improving effectiveness of larviciding operations. Furthermore, the result of self-assessment is more compatible with external evaluation results if it would be applied frequently. Therefore, it can be used as an alternative assessment technique in the evaluation of larviciding operations in addition to traditional assessment methods.