bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP60 Risk of Future Depression in People who Are Obese but Metabolically Healthy: The English Longitudinal Study of Ageing
Authors: Hamer M , Batty GD , Kivimaki M 
Published: September 2012

BackgroundThere is some evidence to suggest that obesity is a risk factor for the development of depression, although this is not a universal finding. This discordance might be ascribed to the existence of a ‘healthy obese phenotype’ – that is, obesity in the absence of the associated burden of cardio-metabolic risk factors. We examined whether the association of obesity with depressive symptoms is dependent on the individual’s metabolic health.MethodsParticipants were 3851 men and women (aged 63.0 ± 8.9 yrs, 45.1% men) from the English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Obesity was defined as body mass index ≥ 30 kg/m2. Based on blood pressure, HDL-cholesterol, triglycerides, glycated haemoglobin, and C-reactive protein, participants were classified as ‘metabolically healthy’ (0 or 1 metabolic abnormality) or ‘unhealthy’ (≥ 2 metabolic abnormalities). Depressive symptoms were assessed at baseline and at 2 years follow up using the 8-item Centre of Epidemiological Studies Depression (CES-D) scale.ResultsObesity prevalence was 27.5%, but 34.3% of this group was categorized as metabolically healthy at baseline. Relative to non-obese healthy participants, after adjustment for baseline CES-D score and other covariates, the metabolically unhealthy obese participants had elevated risk of depressive symptoms at follow-up (odds ratio [OR] = 1.50, 95% CI, 1.05 – 2.15), although the metabolically healthy obese did not (OR=1.38, 95% CI, 0.88 – 2.17). We repeated the main analysis after excluding 451 participants with existing depressive symptoms (CES-D≥4) at baseline. There were 238 incident cases of depression at follow up, and in comparison with healthy non-obese participants only the metabolically unhealthy obese participants had elevated odds of incident depression (OR=1.56, 95% CI, 1.09 – 2.22), but not their metabolically healthy obese counterparts (OR=1.45, 95% CI, 0.92 – 2.30) nor unhealthy non-obese participants (OR=1.38, 95% CI, 0.98 – 1.94). In further analysis we examined the associations between individual metabolic risk factors and depression. There was a dose-response association between the number of metabolic risk factors and risk of depression, although the risk only became significant in participants with more than one risk factor. Adverse triglycerides, impaired glycaemic control, and low grade inflammation were associated with depression at follow-up in models adjusted for age, sex and baseline CES-D score.ConclusionThe association between obesity and risk of depressive symptoms appears to be partly dependent on metabolic health, although further work is required to confirm these findings.
OP61 Is Maternal Iron Status Associated with offspring’s Blood Pressure and Adiposity? A Mendelian Randomization Study
Authors: Alwan NA , Lawlor DA , McArdle HJ , Greenwood DC , Cade JE 
Published: September 2012

BackgroundIron deficiency during pregnancy is a common problem. Experimental animal studies suggest that mothers deficient in iron during pregnancy are more likely to have offspring who become obese and have higher blood pressure. The use of random assortment of genes from parents to offspring can provide a method for assessing the causal impact of nutritional exposures, which is less likely to be influenced by confounding and reverse causality. The C282Y mutation in theHFEgene is robustly associated with iron stores, with those who carry the mutation having higher iron stores. Thus, this variant could be used as an instrumental variable to examine whether the association of maternal iron with offspring body mass index (BMI), waist circumference (WC) and blood pressure (BP) is causal.MethodsWe conducted a Mendelian randomization study to examine the association between maternal iron status with offspring adiposity and BP in adulthood. Instrumental variable (IV) analysis, using maternal C282Y as a genetic instrument for mother’s ferritin, was performed. IV analysis uses the proportion of the variation in maternal ferritin that is explained by C282Y to provide an unconfounded estimate of the relationship with offspring outcomes. The results were compared to the results of multivariable ordinary least squares (OLS) regression examining the same relationship. Male and female offspring of mothers from the UK Women Cohort Study (UKWCS) were approached, of whom 348 with mean age of 41 years completed the study. About half were offspring of C282Y carriers. Offspring’s BP, height and weight were measured at their local medical practice. Participants were also asked to self-measure their WC at home.ResultsMaternal C282Y was associated with maternal ferritin (mean difference per allele=84 g/l, 95% CI 31, 137, P=0.002). Using IV analyses, maternal ferritin was not associated with offspring’s BP, BMI or WC. The first stage F statistic for the strength of the instrument was 10 ( Kleibergen-PaaprkLM P-value=0.009). Maternal ferritin was associated with offspring diastolic BP, WC and BMI in univariable, but not in multivariable OLS analysis. There was no strong statistical evidence of a difference between the OLS and the IV models coefficients for any of the outcomes considered.ConclusionWe found no association between maternal iron status and offspring’s BP and adiposity using both multivariable OLS and IV modeling with maternal C282Y mutation as the instrument. Further exploration of this relationship is needed in larger studies that have genetic variation assessed in both mother and offspring.
OP73 Exploring Impacts of Survey Non-Response using Record-Linkage of Scottish Health Survey Data (2003 to 2008)
Authors: Gray L , McCartney G , White IR , Given L , Katikireddi SV , Leyland AH 
Published: September 2012

BackgroundInference on population health is commonly derived from health survey data, based on the assumption that they are representative of the target communities. Departure from representativeness may weaken external validity leading to biased estimates, with important implications for public health evidence, particularly in relation to prevalence and quantity estimates such as population alcohol consumption. A key aspect determining the extent to which surveys are representative is the level of participant response. Inverse probability weights based on a limited range of demographic variables are usually applied in an attempt to correct for non-response. We aimed to investigate whether weighted estimates of all-cause mortality and mortality from alcohol-related conditions derived from the 2003 Scottish Health Survey (SHeS) – with household response of 67% – reflect those in the population of Scotland.MethodsBaseline observations from SHeS were individually record-linked to mortality data for the 91% of respondents consenting to linkage, and directly age-standardised survey-weighted mortality rates were calculated for the 3117 men and 3980 women aged 20 years and older at interview. Equivalent mortality rates were calculated for the whole of Scotland in the same age group using population estimates and mortality data contemporaneous with the linked survey data.ResultsThere were 201 (6.4%) male deaths and 215 (5.4%) female deaths in the 2003 SHeS by the end of 2008. Among men, all-cause mortality was markedly lower in the SHeS sample (918 per 100,000 person-years [95% CI:850–987]) than in the Scottish population (1361 [95% CI:1357–1365]). Figures for women were also highly significantly different (739 [95% CI:682–795] for the SHeS and 928 [95% CI:925–931] for the Scottish population). Alcohol-related mortality was lower in the SHeS sample (38 [95% CI:18–57] in men and 11 [95% CI:0–22] in women) relative to the Scottish population (57 [95% CI:56–58] in men [non-significant] and 25 [95% CI:24–25] in women [significant]).ConclusionRespondents to the 2003 SHeS differ from the population they are intended to represent, with much lower than expected all-cause mortality in both sexes; alcohol-related mortality rates were somewhat lower than expected suggesting lower alcohol consumption among survey respondents which, if genuine, would lead to inherent underestimation of population consumption levels. Importantly, differences existed despite the application of conventional weighting and age-standardisation methods. Consideration should be given to the levels of resource allocated for increasing survey response and the further development of survey methodology to address the resultant systematic bias in health survey data arising from non-response.
OP74 Measuring Sexual Behaviour Comes of Age: A Comparison of Outcomes in the 2010 Health Survey for England with the National Survey of Sexual Attitudes and Lifestyles
Authors: Mercer CH , Robinson C , Craig R , Nardone A , Johnson AM 
Published: September 2012

BackgroundThe Health Survey for England (HSE) is a general health survey administered annually to a probability sample of people living in England. In 2010, the HSE included, for the first time, questions about sexual health, which previously were considered too sensitive for a general health survey. This paper compares the reporting of sexual behaviours by people aged 16–44 in HSE–2010 with data collected by the second British National Survey of Sexual Attitudes and Lifestyles (Natsal–2), Britain’s most recent, dedicated national probability survey of sexual behaviour.MethodsIn HSE–2010, 8,420 people aged 16–69 were interviewed, of whom 2,911 were aged 16–44. Natsal–2 interviewed 12,110 people aged 16–44 in 1999/2001. HSE–2010 used pen-and-paper self-completion questionnaires for the sexual health questions, while Natsal–2 used computer-assisted personal-interviews including computer-assisted self-interview for the more sensitive questions, including those on sexual health. HSE–2010 used the same question wording developed and piloted for Natsal.ResultsCollecting sexual behaviour data was acceptable to HSE–2010 participants with low item non-response (5–10%), albeit slightly higher than in Natsal–2 (<5%). Reported age at first heterosexual intercourse was comparable in the two surveys: median ages of 17 (men) and 16 (women) among those aged 16–24. However, for some very sensitive questions there were lower levels of reporting in HSE–2010 than in Natsal–2: while the proportion reporting same-sex in the last 5 years was similar (2–3%), reporting ofeverhaving same-sex was lower in HSE–2010 for men (2%vs.5% in Natsal–2). Similarly, the mean number of opposite-sex partners reported in HSE–2010 was a little lower than in Natsal–2, particularly among men: 9.5vs.12.7, respectively, in contrast to 5.4vs.6.5, respectively, among women. Men in HSE–2010 were also slightly less likely to report being diagnosed with sexually transmitted infection(s) than in Natsal–2: 8.7%vs.11.1%, respectively; but this was reported by similar proportions of women: 12% in both surveys.ConclusionThe inclusion of questions on sexual behaviour in HSE–2010 has demonstrated the feasibility and utility of measuring sexual behaviour in general health surveys, albeit in less detail than in a survey focused on sexual behaviour such as Natsal. General health surveys such as the HSE provide a useful vehicle for monitoring sexual risk behaviour more frequently than is possible with decennial Natsal surveys. Health surveys should not shy away from also measuring sexual behaviour, especially in light of the associations between health status and sexual health outcomes of satisfaction, function and behaviour.
OP77 Type a Behaviour Pattern and Coronary Heart Disease: Philip Morris’ “Crown Jewel”
Authors: Petticrew M , Lee K , McKee M 
Published: September 2012

BackgroundThe Type A Behaviour Pattern (TABP) – characterised as individuals who are highly competitive, time-conscious and aggressive - has been the subject of research for over fifty years. The concept was developed in the 1950s by U.S. cardiologists Meyer Friedman and Ray Rosenman who argued that TABP was a risk factor for coronary heart disease (CHD), notably among white middle-class males. The theory was initially supported by findings from the Western Collaborative Group study (WCGS) and the Framingham study. However, subsequent studies found no consistent evidence that TABP predicts CHD onset or outcome. This pattern of early positive findings followed by negative findings (a “decline effect”) has long been a puzzle for TABP researchers. Despite this, the concept of Type A behaviour has continued to enjoy public appeal, fostered through popular books by Friedman and Rosenman which describe “how to recognise the deadly Type A pattern in your own personality”. TABP has also remained the subject of contemporary public health research, and it features in discussions on the psychosocial causes of health inequalities. We analysed tobacco industry documents to show that Philip Morris and RJ Reynolds were major funders of TABP research, with selected positive findings used to counter concerns regarding tobacco and health.MethodsThe Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) was systematically searched from 1959 to 2011 to identify relevant documents. The names of key individuals were identified through retrieved documents using a snowballing technique.ResultsOur document analysis suggests that, in the case of TABP, the decline effects described above may be explained by the influence of tobacco industry funding. Phillip Morris channeled significant funds for TABP research through Duke and Yale Universities, including part-funding the Framingham study. It also funded a 10-year clinical trial of the effectiveness of counselling to reduce TABP, which it referred to as its “Crown Jewel”, and funded Meyer Friedman’s Institute to a total of almost US$11million. A history of the relationship between TABP research and the Tobacco Industry will be presented.ConclusionIt has not previously been shown that research into TABP was strongly influenced by the Tobacco Industry. This analysis extends further our understanding of the extent to which the tobacco industry has shaped major themes in contemporary public health research. Our findings also help explain the inconsistencies in the findings of epidemiological studies into TABP and mortality.
OP78 Scientists, Competing Interests, and the Media: A Content Analysis of UK Newspaper Reporting in H1N1 Influenza
Authors: Chan KNK , O’Neill S , Mandeville KL 
Published: September 2012

BackgroundConcerns were raised about the competing interests amongst scientists on advisory committees during the 2009/10 H1N1 influenza pandemic, particularly given the substantial public expenditure on antiviral drugs and vaccines. The media is known to strongly influence public demand for new drugs and policy decisions, and many scientists commented on the use of pharmaceutical products/emerging health risks during the 2009 H1N1 pandemic in the UK media. This study assessed competing interests for the scientists promoting or rejecting the use of antivirals and/or vaccines in newspaper articles during the early pandemic.MethodsWe performed a retrospective content analysis of United Kingdom national newspaper articles on H1N1 influenza published during the period when the government decided its policy on antiviral/vaccine provision (20 April and 5 July 2009). Two reviewers coded 436 articles independently and identified those scientists promoting or rejecting the use of antivirals/vaccine according to a pre-specified protocol. Competing interests for these named scientists were then identified through a systematic search for potential or previously declared interests.ResultsOne in two scientists commenting on the use of antiviral/vaccines in H1N1 influenza had undisclosed competing interests. Potential competing interests were identified in 6 of the 9 scientists (66.7%) promoting vaccine use; 6 of the 10 scientists (60%) promoting antivirals; and 1 of 4 scientists (25%) rejecting antiviral use. The nature of these competing interests ranged from study funding to directorships of pharmaceutical companies. Only three articles made clear that the scientist concerned had a link with pharmaceutical companies.ConclusionThis study showed substantial competing interests amongst scientists commenting on the use of antivirals and/or vaccines in H1N1 influenza during the period the UK government was deciding its pharmaceutical policy. Since commentaries in the media provide an alternative route for external pressure on health policy decisions, scientists should declare any potential competing interests for media interviews as for journal articles.
OP83 Does Lunch Type Have an Impact on Dietary Quality over the Whole Day in English Primary School Children?
Authors: Evans CEL , Mandl V 
Published: September 2012

BackgroundNutrient standards were introduced by the Government to all English primary schools in 2008. By restricting some products and increasing the quantity and quality of others, the standards resulted in a healthier school meal profile. Despite attention to improve the quality of school meals, packed lunches have changed little in recent years and are not covered by similar regulations. There are few published studies that compare weight, body mass index (BMI), energy and nutrient intake over the whole day according to lunch type.MethodsA dietary assessment tool named CADET was used to assess the diet of 2355 children aged 6 to 8 years attending primary schools across England. Regression analysis which took into account the clustering of children within schools was used to report anthropometric, dietary and nutritional characteristics over one 24 hour period. Nutrient and anthropometric results from children having a packed lunch were compared with children having a school meal. Results were also compared to the reference nutrient intakes (RNIs) and the National Diet and Nutrition Survey (NDNS) in children.ResultsNo significant differences in weight, standardised BMI, or daily energy consumption were seen between children in the packed lunch group compared to the school meal group. However, there were nutritional differences, reported here as mean difference and 95% confidence interval (95% CI). The packed lunch group consumed higher daily amounts of carbohydrates (8.1 g, 95% CI 2.2 to 14.0g, P< 0.01), sugar (9.8g, 95% CI 5.4 to 14.3, P< 0.01) and sodium (92.1mg, 95% CI 22 to 162mg, P< 0.01). Conversely, the school meal group consumed higher intakes of protein (3.3g, 95% CI 1.6 to 5g, P< 0.01), fibre (0.8g, 95% CI 0.3 to 1.3g, P<0.01) and zinc (0.2mg, 95% CI 0.05 to 0.5mg, P<0.01). Neither group met the recommended amounts for zinc, fibre or starch and indicated lower levels of sodium and higher levels of fat than the NDNS. Differences found in nutrient intake were independent of measures of child deprivation and ethnicity.ConclusionChildren taking a packed lunch to school have a less nutritious diet on average over the whole day in terms of sugar, sodium and fibre. A good quality lunch is therefore an important factor for overall dietary quality in children. Policies to encourage parents and children to include nutritious foods such as fruit, vegetables and low fat starchy foods are needed to narrow the gap between school meals and packed lunches.
PS04 Validity of Cancer Diagnosis in a Primary Care Database Compared with Linked Cancer Registrations in England. Population-Based Cohort Study
Authors: Dregan A , Murray-Thomas T , Moller H , Gulliford M 
Published: September 2012

BackgroundElectronic health records from primary care are increasingly utilised as a resource for epidemiological research in cancer. The present study aimed to evaluate the validity of cancer diagnoses recorded in a primary care database compared with cancer registry data in England.MethodsEligible cancer codes were reviewed and agreed by two epidemiologists with experience in cancer and primary care. The eligible cohort comprised 42,556 participants, registered with English general practices in the General Practice Research Database (GPRD) that consented to cancer registry linkage, who presented with haematuria, haemoptysis, dysphagia or rectal bleeding or were diagnosed with cancer of the lung, urinary tract, oesophagus/stomach, or colon/rectum between 2002 and 2006. Cancer registry (CR) records were linked through a unique identifier by a third party. Cancer registry and primary care records were compared for cancer diagnosis, date of cancer diagnosis and death.ResultsThere were 5,429 cancer diagnoses in GPRD and 5,710 in the CR, with 5,216 (91% of CR total) diagnosed in both sources. There were 494 (9%) diagnosed in CR but not in GPRD and 213 (4%) that were diagnosed in GPRD but not CR. The predictive value of a GPRD cancer diagnosis was 96% for lung cancer, 92% for urinary tract cancer, 96% for gastro-oesophageal cancer and 98% for colorectal cancer. ‘False negative’ primary care records were sometimes accounted for by registration end dates being shortly before cancer diagnosis dates. The median (interquartile range) difference in date of cancer diagnosis (CR minus GPRD) was -11 (-30 to 6) days. Death records were consistent for the two sources for 3,337/3,397 (99%) of cases.ConclusionRecording of cancer diagnosis and mortality in primary care electronic records is generally consistent with cancer registrations in England. Linkage studies must pay careful attention to selection of codes to define eligibility and timing of diagnoses in relation to beginning and end of record.
PS07 Trends in Blood Pressure in England: Good Treatment or Good Luck?
Authors: DeWilde SJ , Carey IM , Shah SM , Harris T , Rudnicka AR , Whincup PH , Cook DG 
Published: September 2012

BackgroundFor 30 years, adult blood pressure (BP) has declined in many developed countries. This is likely to have contributed to declining cardiovascular disease mortality. However, the reasons for this, particularly the impact of increased antihypertensive treatment, have been little studied. Diagnostic criteria have changed, meaning that more patients are treated at lower levels of BP than previously; and treatment intensity is greater. Accounting for the effects of treatment on BP trends is complex and open to misinterpretation.MethodsUsing the Health Survey for England we examined BP measures and treatment in white subjects aged 18+ years over two periods, 1994–2002 and 2003–2009. To examine trends independent of anti-hypertensive treatment, untreated BP was estimated from the recorded BP on treatment. To do this, a model was derived using published data on the effect of anti-hypertensives used singly and in combination at differing pre-treatment BP levels. BP untreated with statins was similarly estimated.ResultsAmong an average 9,147 subjects per year, mean systolic BP (SBP) in men declined by 0.55 mmHg annually (95% CI 0.46 to 0.64) between 1995–2002; 0.34 mmHg annually (95% CI 0.21 to 0.46) between 2003–2009. Similar trends occurred in women. The decline was greater in older groups, but present in young, largely untreated groups, although the trend was greatly reduced in young men by 2009. Trends in estimated SBP adjusting for the influence of treatment, where present, exhibited only slightly lower declines; for men: 0.47 mmHg annually (95% CI 0.37 to 0.57) between 1995–2002; 0.27 mmHg annually (95% CI 0.13 to 0.41) between 2003–2009. Statin therapy had little additional effect. Diastolic blood pressure showed similar but weaker trends.ConclusionFor 15 years, BP declined in English adults. The overall decline in SBP of nearly 5 mmHg over the study period is likely to be of clinical significance in reducing CVD events. For an individual aged 40–49 a 5 mmHg reduction in SBP, as seen here, would be expected to reduce the risk of stroke by 23% and of IHD by 16%. It is therefore of concern that, in recent years, the decline has essentially ceased in the youngest age groups, particularly in younger men. The effect of treatment was modest; less than 25% of the male SBP decline is attributable to it. Other explanations for this fall, occurring whilst obesity has increased, need further exploration, but reduced salt intake is a likely candidate.