bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP32 Are there Socio-Inequalities Associated With Type 2 Diabetes Care?
Authors: Christie A , Wilkinson J , Adams J , White M 
Published: September 2013

BackgroundThere has been increasing research interest in the adverse effects of public health interventions; notably concern that processes in the planning or delivery of an intervention may create or exacerbate the health differences between population groups. The aim of this study was to contribute to current understanding of ‘intervention-generated inequalities’ by examining the impact of secondary and tertiary preventive interventions for Type 2 diabetes by socio-economic status (SES). Previous research has shown that Type 2 diabetes places a disproportionate health burden on individuals from more disadvantaged backgrounds. It addition, managing the condition involves multiple processes and health professionals, all of which all could potentially exacerbate existing health inequalities.MethodsA secondary data analyses of patient level data collected by a hospital trust diabetes register from 1999 to 2007 was conducted to determine if receiving the same care was associated with differential health outcomes by SES. Two indicators of care were used: the number of recommended care processes (quality of care) and attendance at a hospital diabetes care clinic (shared care) each year. The Index of Multiple Deprivation 2004 was used as an indicator of patients’ SES. A series multilevel models were fitted with hbA1c, an indicator of patient’s diabetes control, as the dependent variable with interaction effects between SES and intervention indicators. Repeated measurements were nested within patients, nested within the general practice they registered with per year. Relevant socio-demographic, anthropometric, lifestyle, health and other intervention data controlled for in each model.ResultsThe initial descriptive analyses showed that high SES was statistically significantly receive greater quality of care and less likely to receive shared care than low SES patients. Overall, in both multilevel models high SES patients were more like more favourable hbA1c rates than low SES patients. However the interaction effects suggest that amongst patients receiving high quality of care, high SES patients were significantly more likely to have poorer HbA1c compared to low SES patients. In contrast amongst patients receiving shared care, high SES patients were more likely to have more favourable HbA1c rates than low SES patients.DiscussionThere was evidence that low SES patients received a poor quality of care but had greater access to specialist, secondary care. In addition, there was evidence to suggest that patients receiving the same care were associated with a differential impact on patients HbA1c. More complex analyses need to be conducted to determine the direction of these associations.
PP34 Interventions to Promote Informed Consent for Invasive Healthcare Procedures: A Cochrane Systematic Review and Meta-Analysis
Authors: Kelly M J , Kinnersley P , Phillips K , Savage K , Farrell E , Morgan B , Whistance R , Lewis V , Mann M , Stephens B L , Blazeby J , Elwyn G J , Edwards AGK 
Published: September 2013

BackgroundInformed consent is required before any surgery or invasive procedure is performed. Achieving ethically valid informed consent can be difficult: too little information may leave patients poorly informed and too much information may be overwhelming. As such interventions to promote information provision for informed consent are warranted. This study aimed to evaluate the impact of such interventions on a range of outcomes including patient knowledge, anxiety, and satisfaction.MethodsMedical databases were searched using keywords and subject headings (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO). Reference lists of included studies were searched. Randomised controlled trials (RCTs) of interventions to promote informed consent for patients undergoing surgical or invasive procedures were included. Studies were dual-assessed. Random effects meta-analyses were conducted for all outcomes with sufficient information. Standardised mean differences summarised the output. Narrative synthesis was also performed.Results65 RCTs were identified from 12 countries. In total 9,021 patients were randomised into these trials. Interventions employed various formats including written material, audio-visual tools and decision aids. Meta-analyses demonstrated statistically significant improvements in knowledge when measured immediately after interventions, shortly afterwards (between 24 hours and 15 days) and at a later date (15 days or more) (Immediate knowledge SMD 0.53 [95% CI 0.37, 0.69], I273%; Short-term knowledge SMD 0.68 [0.42, 0.93], I285%; Long-term knowledge SMD 0.78 [0.50, 1.06], I282%). Satisfaction with decision making also improved (SMD 2.25 [1.36, 3.15], I299% and decisional conflict was reduced (SMD -1.80 [-3.46, -0.14], I299%). No statistically significant differences were found for generalised anxiety, anxiety with the consent process or satisfaction with the consent process (generalised anxiety SMD -0.11 [-0.35, -0.01], I282%, anxiety with the consent process SMD 0.01 [-0.21, 0.23], I270%; satisfaction with the consent process SMD 0.12 [-0.09, 0.32], I276%).ConclusionInterventions to promote informed consent consistently improve patient knowledge, an important prerequisite for informed consent and this is achieved without any significant harmful effects. Such interventions can thus be considered effective at promoting informed consent for invasive healthcare procedures. Further studies are necessary to investigate all aspects of informed consent as a unified concept.
PP39 Research using Ankle Brachial Pressure Index Statistically Reassessed
Authors: Alnaji A , Law G R 
Published: September 2013

BackgroundAnkle Brachial Pressure Index (ABPI) is the ratio of ankle to brachial systolic blood pressure. It is widely used as a non-invasive, relatively simple method for the diagnosis of peripheral arterial diseases (PAD) in symptomatic patients. It is also widely used to estimate PAD prevalence. Furthermore, low ABPI – as an indicator of atherosclerosis – was also used to predict cardiovascular morbidity and mortality in many epidemiological studies. Several researchers think that ABPI is overvalued and its use in epidemiological studies had attracted some statistical pitfalls. This paper aims to investigate these pitfalls, and to suggest possible advance statistical solution for some of them.MethodsCritical review of literatureResultsThe use of ABPI was proposed by studies comparing ABPI with peripheral angiography and Doppler ultrasound. However, most of these studies either had small sample size (issues with representativeness and generalisability of the result), compared asymptomatic legs with symptomatic legs using independent sample t-test (inappropriate test as legs of the same patients are not independent), or chosen cases from old age group and controls from young age group (age is a potential confounder which might had distorted their results). There were no attempts to test for the potential association between ABPI and other variables such as gender, obesity, cholesterol level and physical activity. Nevertheless, several researchers tested the correlation between ABPI and brachial systolic blood pressure and claimed that ABPI is usually lower in patients with high brachial systolic blood pressure even in the absence of PAD. Some of these researchers used correlation coefficients, however, using Pearson correlation test is inappropriate as brachial pressure is mathematically coupled to the ABPI, thus a null hypothesis of zero correlation is erroneous and the conclusion based on it should be rendered invalid. Ordinary Least Square Linear Regression model will be unsuitable as well for the same reason. Bland-altman plot or Ordinary Least Product Regression would be more appropriate. Furthermore, most of the studies that used ABPI as a predictor of cardiovascular morbidity and mortality had introduced some major statistical flaws in their regression analysis such as collinearity, mathematical coupling and reversal paradox. Such statistical issues would have distorted those studies’ associations.ConclusionCaution should be taken when using ABPI in epidemiological studies. Covariate selection and adjustment for confounder should be done carefully in regressing analysis. Directed Acyclic Graph (DAG) is a good method for addressing these issues.
PP40 An Ethnic Minority Cohort of Young People – Feasibility of follow-up in Early Adulthood?
Authors: Enayat Z E , Read U M , Molaodi O , Cassidy A , Harding S 
Published: September 2013

BackgroundUnder-representation of ethnic minorities in cohort studies is common. The Determinants of (now) Adult Social well-being and Health (DASH) study examines how interaction of social and biological exposures influences ethnic differences in physical and mental health over the life course. It started 10 years ago with 6643 11-13y London schoolchildren, 80% ethnic minorities. A feasibility study examined best practice for follow-up of the cohort now aged 21-23y.Methods300 DASH participants, 50 for each major ethnic group (White British, Black African, Black Caribbean, Indian, Pakistani and Bangladeshi), were invited. They were offered assessments in different locations (GP surgeries, community pharmacies, clinical research facilities, homes, colleges) to collect a range of questionnaire and physical data (e.g. age appropriate mental health measures, 24 hour dietary data, accelerometry, blood biomarkers, arterial stiffness, bio-impedance). Consents were sought for DNA analysis, linkage of NHS records and to contact parents to participate in a generational study. Various retention and engagement initiatives were tried, including social media, a participant advisory group (PAG) and ‘Bring a DASH friend’ (BDF).Results<1% refused, 45% of participants were seen in a university setting, 19% in pharmacies, 28% in GP surgeries, and 7% in clinical research facilities. GP surgeries were keen to support DASH but busy environments compromised quality and pace of data collection. High street pharmacies proved ideal locations for satellite clinics. The primary influence on participants’ choice of location was proximity to home or convenience to stop en route from work. Item non-response for questionnaire-based measures and refusal rates for wearing monitors were low (<1%). Less than 5% refused to have bloods taken, with no ethnic bias. All were keen to get feedback on results, particularly cholesterol level, and consented to storage of bloods for DNA and for linkage of NHS records. 81% of the baseline cohort was traced using multiple measures. Three key initiatives worked best: PAG’s input on appropriateness of measures, retention and advocacy including use of social media; BDF due to continuing contact with school friends; and a community link worker to conduct advocacy activities in community-based spaces such as markets and places of worship, and to engage community champions. All participants agreed to contact with parents.ConclusionThese positive findings challenge conventional wisdom on underrepresentation of ethnic minorities in cohort studies. They also suggest effective mechanisms to enhance engagement with diverse communities and exploit the public health value of findings across ethnic groups.
PP48 The Tension between Innovation, Politics and Evidence Generation in Environmental Approaches to Tackling Obesity: Stakeholder Interview Study from the English Healthy Towns Initiative
Authors: Goodwin D , Cummins S , Sautkina E , Ogilvie D , Petticrew M , Jones A , Wheeler K , White M 
Published: September 2013

BackgroundIn 2008 Department of Health commissioned nine the ‘Healthy Towns’ (HT) in England to implement and evaluate community-based environmental interventions to prevent obesity. Healthy Towns were encouraged to test whole-town approaches to tackling the obesogenic environment, which included ‘innovative’ interventions. This research examines the role evidence played in the development and implementation of the HT programme at the national and local level, and the stimulation of innovative interventions.MethodsParticipants were purposively selected to represent successful HT bid and management teams and key national policy actors involved in the implementation of the HT programme and allocation of funds. During July and October 2010, twenty qualitative interviews with local programme stakeholders and national policy actors were conducted. The majority of interviews were face-to-face, with one conducted over the telephone. Interview transcripts were coded and thematically analysed. Initial analyses were guided by research questions regarding the nature and role of evidence in the development and implementation of the Healthy Towns programme and the capacity for evidence generation to inform future policy and practice.ResultsLocal anecdotal and observational evidence, rather than empirical evidence, was considered abundant and influential and was predominantly used to guide intervention development. While the programme was seen by stakeholders as an opportunity to pilot new and innovative approaches, the requirement to predict likely health impacts and adopt evidence-based practice was viewed as contradictory to this goal. These difficulties were exacerbated by political change and the impact of austerity measures during programme delivery. Overall stakeholders believed opportunities to add to the existing empirical evidence base were missed due to a lack of clarity and planning, particularly around timing, in local and national evaluations.DiscussionThe development of innovative population-level programmes to tackle obesity is beset by tensions and contradictions. Because of fear of failure, a strong emphasis on relying on existing evidence based practice and producing positive outcomes may have impeded the opportunity to implement truly innovative programmes. As determinants of obesity are complex and multi-factorial, governments should be realistic about the likely effects of single interventions and allow for the formative piloting of innovative projects that are not necessarily driven by targets.
OP15 Identifying the most effective public health nutrition policies: The views of policy-makers and thought-leaders across 14 EU countries
Authors: Lloyd-Williams F , Bromley H , Orton L , Taylor-Robinson D , O’Flaherty M , Moonan M , McGill R , Calder N , Anwar E , Castillo M Guzman , Rayner M , Capewell S 
Published: September 2013

BackgroundEuroHeart 2 is a European research programme led by the European Heart Network and European Society of Cardiology (http://www.ehnheart.org/euroheart-ii.html). One aspect of the project aimed to identify the most effective public health nutrition policies, in order to inform future evidence-based strategies to promote cardiovascular health. We interviewed senior policy-makers and thought-leaders in 14 diverse EU countries to elicit their views on a very wide range of possible nutrition strategies covering the entire public health policy spectrum aimed at improving approaches to public health nutrition.MethodsWe first mapped national nutrition policies across 30 European countries. We then identified contacted and recruited potential participants in 14 diverse countries. Policy-makers, thought-leaders and others active in the field of public health nutrition at the national level were interviewed. Questions were first developed and piloted with senior stakeholders in the UK. The interviews were conducted in English, either by person, telephone or Skype. The interviews typically lasted between 45 and 60 minutes. The interviews were transcribed and entered into NVIVO software. The Framework approach was used to analyse the transcripts.ResultsWe conducted 66 interviews in 14 countries across Europe. The interviews enabled more up to date and accurate information than was provided on websites or in reports. Responses revealed important differences between official lists of food policies and their actual implementation “on the ground”. European countries are at very different stages of addressing public health nutrition issues. Most are promoting dialogue, recommendations and guidelines (often considered an early part of the policy process). Voluntary reformulation of foods is also common, especially for salt, sugar and total fat. However, legislation regulation or fiscal interventions targeting salt, sugar, fat or fruit and vegetable consumption are still uncommon. Many interviewees expressed a preference for regulation and fiscal interventions and generally believed they were more effective, albeit politically more challenging. Conversely, information-based interventions were often seen as being more politically feasible.ConclusionPublic health nutrition policies in Europe represent a complex, dynamic and rapidly changing arena. Encouragingly, the majority of countries are engaged in activities intended to increase consumption of health food, and decrease the intake of junk food and sugary drinks. Exemplar countries demonstrating notable progress might include Finland, Norway, Iceland, Hungary, the UK and Portugal. However, most countries fall well short of optimal activities. Implementation of potentially powerful nutrition policies remains frustratingly patchy across Europe.
PP54 Ethnic differences in Upper Gastrointestinal Disease in Scotland
Authors: Brin G I , Ward H , Bansal N , Bhopal R , Bhala N 
Published: September 2013

BackgroundThere is a paucity of data assessing ethnic variations in upper gastrointestinal (GI) disease: we sought to study the incidence of upper GI diseases using adequate measure of ethnicity in Scotland.MethodsUsing the Scottish health and ethnicity linkage study (SHELS), linking NHS hospital admissions and mortality to the Scottish census 2001, we explored ethnic differences in incidence (2001-2010) of specific upper GI diseases (peptic ulcer disease, oesophagitis, gastritis, gallstones and pancreatitis) in Scotland. Risk ratios (RR) were calculated using Poisson regression with robust variance and multiplied by 100, by gender, adjusted for age and subsequently country of birth. The White Scottish population was the standard reference population (100). 95% confidence intervals (CI) were calculated to enable comparison and exclude 100 in the results below.ResultsThe total numbers of first events within the 9 years period of interest (over almost 29 million of Person-Year (PY) at risk) was 44,612 for peptic ulcer, 102,706 for oesophagitis, 141,235 for gastritis, 87,556 for gallstones and 17,177 for pancreatitis. Looking at risk ratios for all specific upper GI diseases and compared to respectively White Scottish men and women, other White British and other White had a lower risk of upper GI diseases even after adjustment for country of birth. White Irish had an increased risk of upper GI diseases but not significant after adjustment for country of birth. There were consistent ethnic variations in non–White minority ethnic group even after adjustment for country of birth. Chinese men and other South Asian (SA) men and women had a 1.5 to 1.7 fold increased risk of peptic ulcer disease. Pakistani and Bangladeshi had a 1.3 to 2 fold increased risk of oesophagitis whereas Chinese had a lower risk (RR 63.5 [95% CI 50.2, 80.2] for men, 67.4 [51.6, 88.1] for women). South Asian had a 1.2 to 1.5 fold increased risk of gastritis whereas it was lower for men of African origin (65.6 [49.3, 87.3]). Gallstones was more incident in Chinese men (140.2 [117.5, 167.2]) and Pakistani women (131.3 [115,4, 149.4]). The later also had an increased risk of pancreatitis (151.7 [123.3, 186.6]).ConclusionThis unique data allowing the comparison of specific upper GI diseases incidences between ethnic groups has shown major differences. Further exploration on risk factors and understanding of differences is needed to promote health equality.
PP56 Prevalence of Chronic Kidney Disease in Ethnic Minority Groupings: Findings from the Health Surveys for England 2003 and 2004
Authors: Aitken G , Moon G , Roderick P J 
Published: September 2013

BackgroundIn the UK, people from South Asian and Black communities have higher rates of Renal Replacement Therapy (RRT) compared to the White population. It is not clear why ethnic minorities have such high rates: possibilities include a higher prevalence of Chronic Kidney Disease (CKD) or a faster rate of progression to End Stage Renal Failure (ESRF). This study aimed to examine ethnic variation in the prevalence of CKD by a range of socio-economic, clinical and measurement characteristics.MethodsThe 2003 and 2004 Health Surveys for England were combined, totalling 9970 individuals aged over 16 with a valid serum creatinine value. Ethnicities were grouped into three categories; White, South Asian and Black. Prevalence of CKD stage 3–5 was calculated using the more accurate Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) estimating equation. Binomial logistic regression models (multivariate and stepwise selection) were used to determine the associations of ethnicity with CKD adjusted for socio-economic, health and clinical measurement factors.ResultsPrevalence of CKD stage 3–5 for White individuals was 7.6%, for South Asian was 2.8% and for Black was 4.9%. CKD prevalence increased consistently for White individuals by age grouping; the rate of increase was different for Black and South Asian individuals. Black and South Asian CKD prevalence was higher than Whites for those aged 35-54 and Black CKD prevalence was approximately double that of South Asian for ages 55-74. CKD 3–5 was strongly associated with nearly all covariates for White ethnicity, less so for South Asian and Black individuals. Odds Ratios for South Asian and Black were far higher than White for selected associated covariates. Adjustment for age and other covariates only produced only one statistically significant difference; an age-sex adjusted model confirming South Asian with lower risk of CKD compared to White (OR 0.64 [95% CI 0.44, 0.92]).ConclusionSouth Asian and Black ethnicities have lower CKD prevalence compared to White, but there is evidence of higher CKD prevalence in younger age groupings for South Asian/Black participants. Lack of statistical difference when adjusting for age and wide confidence intervals for minorities imply further research is needed with a larger sample size of ethnic minority groupings.