bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP63 Body Size and Body Composition: A Comparison between Children in India and in the UK through Infancy and Early Childhood
Authors: D’Angelo S , Crozier S R , Chittaranjan Y , Joglekar C , Lubree H , Fall C H , Inskip H M 
Published: September 2013

BackgroundIndian children have been shown to be smaller in all body measurements compared with white Caucasian British children at birth, one and four years, but they show a particular pattern of smallness, with relative sparing of subcutaneous fat– the so-called ‘thin-fat’ phenotype. Recently, Indian children at age 6 years were found to have a higher body fat percentage from DXA measurements than white British children, despite a lower BMI. However, no study has compared Indian anthropometric measurements at birth and at multiple ages through early childhood to 6 years with a large (> 500) population sample of British children, using the same measurement protocols throughout.MethodsWe used data from 631 liveborn, singleton children from the Pune Maternal Nutrition Study (PMNS) and 3012 liveborn, singleton, white British children from the Southampton Women’s Survey (SWS), which included anthropometric measurements at birth and 1, 2, 3 and 6 years. t-tests and Mann-Whitney U-tests were used to compare the means and medians of the two populations. Birth measurements were adjusted for gestational age and sex, using linear regression, while the measurements at the other ages were adjusted only for sex. Southampton measurements were used as a reference and standard deviation (SD) scores were generated: Pune SD score = (Pune observation-Southampton mean)/ (Southampton SD).ResultsAt all ages and for all anthropometric measurements considered, Pune children were smaller than those in Southampton. At all ages after birth, the largest difference was found in head circumference, followed by mid-upper arm circumference and weight. At birth and through infancy and childhood, subscapular skinfold thickness was always the most spared measurement, indicating that the body composition of Pune children was characterised by fat preservation at all ages.ConclusionThis study suggests that the previously described ‘thin-fat phenotype’ characterises Indian babies not only at birth but also through infancy and childhood up to 6 years of age. Compared with the Southampton children, they are smaller but have greater preservation of subcutaneous fat, and this pattern is sustained to age 6 years. It is well known that adult Indians have a higher percentage body fat than those from European populations, but this propensity is established before birth and does not alter through early life.
OP71 The Funding Pressures Facing the NHS from 2010/11 to 2021/22
Authors: Roberts A D , Marshal L M , Charlesworth A 
Published: September 2013

BackgroundSpending on the UK National Health Service (NHS) has risen by an average of 4% a year in real terms since its introduction in 1948. This growth has now halted due to reductions in public spending. The English NHS is therefore targeting efficiency savings of £15–20 billion by 2014–15 to meet rising pressures. This research looks beyond 2014–15 to estimate the financial challenge facing the NHS in England in 2021–22, examining the potential impact of various policies in managing these pressures.MethodsTo estimate funding pressures facing the English NHS, healthcare activity was broken down by type: acute, maternity, mental illness, general practice, and prescribing. A least-squares approach was used to model determinants of demand for each type in the base year. Results were applied to projections of population, mortality and chronic conditions, with estimated cost then applied. The cost of projected healthcare activity was compared to potential scenarios for government funding of the English NHS, with the gap representing the required efficiency gain by 2021–22. The effect of three key factors on closing this gap was examined: pay restraint, management of chronic conditions demand, and increased acute sector productivity.ResultsFunding pressures on acute NHS services in England are estimated to rise by 3% a year due to combined effects of population change and rising hospital admissions for chronic conditions. If pay rises with recent trend, total acute sector pressure will rise by 4% a year. If spending remains flat in real terms, the funding gap will reach £44–54 billion in 2021–22. If the current efficiency challenge is met in 2014–15, this reduces to £28–34 billion. Closing this gap will require a combination of measures: releasing all savings related to productivity gains made prior to 2015–16 (£6bn), preventing increases in the probability of being admitted to hospital with a chronic condition (£6bn), and restricting pay growth to rising with inflation (£8bn). The remaining £8bn gap will require further productivity gains of 1% a year between 2015–16 and 2021–22.ConclusionThe current austerity experienced by the English NHS is likely to extend beyond the 4-year period to 2014–15 that is currently the focus of planned efficiency savings. If funding pressures increase with recent trends, further savings of 4% a year will be needed between 2015–16 and 2021–22 to meet rising demands on healthcare. This will require unprecedented sustained increases in health service productivity to avoid cuts to services or falls in quality.
OP88 What Factors Drive Unhealthy Diet? Novel Analysis of Food Frequency Questionnaire Data using Canonical Correspondence Analysis
Authors: Goffe L A , Rushton S P , White M 
Published: September 2013

BackgroundDiet is a major contributor to obesity, but the processes that influence intake remain unclear. Understanding the factors driving food consumption at the population scale requires detailed knowledge of the relationships between dietary patterns and socio-demographic factors. Objectively measuring diet is problematic, but food frequency questionnaires (FFQ) are an established, if imperfect, method for population studies. Such data is inherently multifactorial and various methods have been used to reduce dimensionality. We aimed to evaluate the role of socio-demographic factors in determining different dietary patterns using novel methods.MethodsData were from a survey of dietary habits of 5044 adults in Newcastle-upon-Tyne, 2001–2002. This included the European Prospective Investigation of Cancer (EPIC) 134 item FFQ and socio-demographic data. We used canonical correspondence analysis (CCA), an extension of correspondence analysis that constrains the ordination to relate FFQ responses to relevant socio-demographic variables. Ordination methods summarise continuous trends according to socio-demographic variables, creating ‘components’ to describe trends in multivariate data. Results can be displayed graphically using scatter plots, showing the position of each food item and arrows, varying in length and direction, to show the strength of influence of each demographic variable.ResultsTwo main axes emerged from the FFQ data, describing dietary patterns. The first axis related to the level of processing; highly processed food items generally scoring low and raw ingredients scoring high. The second axis related to a Mediterranean diet; relevant items (e.g. pasta, rice, fruits and vegetables, cheese, yoghourt and wine) scored high, whereas those related to a traditional British diet (i.e. ‘meat and two veg’) scored low. Food consumption is highly individual but by constraining the ordination with reported age, dietary knowledge, educational attainment, socio-economic status and receipt of welfare benefits, it was possible to show their relationship to eating habits. These correlates accounted for 5.8% of variation, age exerting the strongest influence. Older people showed a strong preference for a British, low-processed food diet. University education was associated with consumption of a low-processed Mediterranean diet, whereas those living in deprived areas were associated with a highly-processed traditional British diet.DiscussionCCA provides a robust, descriptive and conceptually superior method for dietary pattern analysis using FFQ data. Results confirm findings of qualitative research, suggesting that diet is strongly culturally patterned among specific, identifiable population subgroups. Such work is limited by cross-sectional data, but CCA may enable better tailoring and targeting of interventions for those at greatest risk from an unhealthy diet.
OP92 Improving the Effectiveness of Multidisciplinary Team Meetings for Patients with Chronic Diseases: Assessing the Predictors of Decision Implementation
Authors: Raine R , Xanthopoulou P , Wallace I , Nic a’ Bháird C , Barber J , Clarke A , Lanceley A , Ardron D , Harris M , Blazeby J , Ferlie E , Gibbs S , King M , Livingston G , Michie S , Prentice A 
Published: September 2013

BackgroundDepartment of Health policy states that health care for chronic diseases should be delivered through multidisciplinary team meetings (MDMs). It is known that multidisciplinary teams should include certain features (for example commitment to leadership) to be effective. But additional factors need to be considered: e.g. the context in which MDMs operate, group decision processes, and patient related factors such as their preferences and socio-demographic characteristics. There is, therefore, a need for research on MDMs to identify factors that promote effective MDM decision-making in terms of decision implementation. We report on a study, unique in its size and scope, making its results applicable across the NHS.MethodsWe undertook an observational study of 370 MDMs in 12 different teams (gynaecological, skin and haematological cancers, mental health, heart failure and memory clinics) in the North Thames area. Analyses used random effects logistic regression models, allowing for MDM clustering, to investigate the influence of MDM and patient related factors on decision implementation. Decision implementation and patient demographics were ascertained from medical records. The MDM characteristics examined were Team Climate Score, disease type, team skill-mix (Adjusted Teachman’s Index and number of professional categories represented), and whether defined co-morbidities and patient preferences were considered. The patient characteristics examined were age, gender and Index of Multiple Deprivation (IMD) score.ResultsWe will present descriptive analyses on 6053 discussions of 3184 patients. For example, discussions on 17% of patients led to no decision. Decision implementation ranged from 67% (Mental Health) to 79% (Memory Clinics). Reasons for non-implementation will be presented.We will present the results of logistic regression on the patient and MDM related factors associated with decision implementation, including the extent to which patient related factors, for example their socio-economic circumstances, were associated with implementation. We will also describe the patient and MDM related factors associated with patient preferences being taken into account.ConclusionWe address recent calls for empirical research on MDM decision-making in routine practice to understand how and under what conditions MDMs produce effective decisions, as well as methods to effectively obtain and consider patient preferences. As the largest study of its kind in this area, and the first to examine and compare MDMs for different chronic diseases, this study enables identification of factors associated with good outcomes that are generalisable across healthcare.
OP95 Public Involvement in Health and Social Care Research: Exploring Areas of Consensus and Conflict
Authors: Snape D A , Jacoby A , Gradinger F , Gibson A , Newman J , Popay J 
Published: September 2013

BackgroundPublic involvement (PI) in research, promoted by the UK Department of Health, has gained considerable momentum. Despite this, examination of the actual impacts of this involvement or how such impacts might be measured effectively remains limited. Evidence about the impact of PI is essential to ensure integrity, avoid harmful effects and to justify resources. In light of this, the overall aim of this MRC multi-phase study was to advance understanding of the impacts of PI, to contribute to more robust assessment of these impacts and to improve standards of PI practice. The Delphi process described here formed part of the multi-phase study.MethodsA modified Delphi approach integrated qualitative and quantitative research methods. Three workshops were conducted to generate qualitative data around PI values and normative debates; and to generate items for a subsequent two-round Delphi survey.Criticalconsensus andclearconsensus criterion were pre-determined at 70% and 60% respectively. Through open questions participants were able to make additional comments and to generate potential solutions to identified problems. Written responses were analysed thematically. Workshop and Delphi study participants were drawn from diverse settings including universities, health and charitable organisations. Participants included members of the public, academic, clinical and user-researchers, research funders and managers, self-selected as having some clear previous experience of PI in research; 42 participated in the workshops and 231 completed both rounds of the Delphi survey.ResultsCritical consensus was reached across the different stakeholder groups that the public: have unique knowledge and expertise complimentary to that of researchers which should be valued equally (90%); can influence how research is used (85%); should be involved in publicly funded research, and are entitled to say what and how research is undertaken (80%); and that the public perspective, when considered at all stages, ensures more ethical research (70%). However, it was also agreed that assessing how PI influences a research project is methodologically problematic. Qualitative analysis highlighted the multi-dimensional nature of ‘PI process’ considerations. Researchers were sometimes seen as lacking understanding of the ‘added value’ of PI. The current PI Policy imperative was perceived by many as encouraging ‘tokenism’. Participants felt that a ‘fit for purpose’ approach, reflecting study and social contexts, was a more appropriate way of assuring effective PI than dependence on pre-conceived models.ConclusionHost organisations, including academic institutions, need to strengthen infrastructure to ensure that systems promote and facilitate PI better.
PL03 Associations between Birth Characteristics and Eating Disorders Across the Life Course: Findings from two Million Males and Females Born in Sweden 1975-1998
Authors: Goodman A , Heshmati A , Malki N , Koupil I 
Published: September 2013

BackgroundRecent years have seen considerable interest in the developmental origins of eating disorders (ED) but results have been conflicting, perhaps reflecting low power in many studies. Limited power has also prevented robust comparisons of associations with ED subtypes or the use of within-family designs to address the potential for confounding.MethodsWe used total population data to create a cohort of 2,011,908 males and females, born 1975-1998 in Sweden to Swedish-born mothers. Birth characteristics included twin/triplet status; gestational age; birthweight; birth length; premature rupture of the membranes; delivery method; Apgar score at 5 minutes; birth traumas; mother’s smoking during pregnancy; and mother’s weight gain during pregnancy. We adjusted for multiple family and social characteristics, and conducted within-family analyses to test for confounding at the maternal/family level. Our outcomes were hospitalisation for anorexia, bulimia or eating disorder not-otherwise-specified (EDNOS)’ after age 12, with follow-up period until end 2010.ResultsAnorexia was independently predicted by multiple birth (AOR 1.33 [95% CI 1.15, 1.53] for twin/triplet vs. singleton) and lower gestational age (HR 0.96 [0.95, 0.98] per extra week of gestation). Gestational age showed a clear dose-response pattern. These associations were largely specific to anorexia, and were only seen in the cohort members affected; within-family analyses revealed that the maternal siblings of twins or preterm individuals showed no increased risk, and provided no evidence of residual maternal-level confounding. Higher birthweight for gestational age showed a strong, positive dose-response association with bulimia (HR 1.15 [1.09, 1.22]) per sex-standardised standard deviation increase). Again, this association was specific to bulimia and within-family analyses provided no evidence of residual confounding. By contrast, although mother’s smoking predicted anorexia, this did seem likely to reflect maternal-level confounding. Other birth characteristics showed little or no association with any ED outcome, except a trend towards increased bulimia and EDNOS among mothers who gained excessive weight during pregnancy.ConclusionThese findings are consistent with a causal role of earlier gestational age upon anorexia and higher birthweight upon bulimia. Further research is needed to elucidate the mechanisms, but the dose-response nature of these associations indicates that they do not simply reflect pathological responses at the extremes of the distribution. The strong association with multiple births is noteworthy as many of the largest population-based studies of ED prevalence have been conducted in twins: our findings suggest the possibility that such studies substantially overestimate ED prevalence.
The Parity-Associated Microenvironmental Niche in the Omental Fat Band Is Refractory to Ovarian Cancer Metastasis
Authors: Cohen Courtney A. , Shea Amanda A. , Heffron C. Lynn , Schmelz Eva M. , Roberts Paul C. 
Published: September 2013

Abstract
Ovarian cancer is an insidious and aggressive disease of older women, typically undiscovered before peritoneal metastasis due to its asymptomatic nature and lack of early detection tools. Epidemiologic studies suggest that child-bearing (parity) is associated with decreased ovarian cancer risk, although the molecular mechanisms responsible for this phenomenon have not been delineated. Ovarian cancer preferentially metastasizes to the omental fat band (OFB), a secondary lymphoid organ that aids in filtration of the peritoneal serous fluid (PSF) and helps combat peritoneal infections. In the present study, we assessed how parity and age impact the immune compositional profile in the OFB of mice, both in the homeostatic state and as a consequence of peritoneal implantation of ovarian cancer. Using fluorescence-activated cell sorting analysis and quantitative real-time PCR, we found that parity was associated with a significant reduction in omental monocytic subsets and B1-B lymphocytes, correlating with reduced homeostatic expression levels of key chemoattractants and polarization factors (Ccl1, Ccl2, Arg1, and Cxcl13). Of note, parous animals exhibited significantly reduced tumor burden following intraperitoneal implantation compared with nulliparous animals. This was associated with a reduction in tumor-associated neutrophils and macrophages, as well as in the expression levels of their chemoattractants (Cxcl1 and Cxcl5) in the OFB and PSF. These findings define a preexisting “parity-associated microenvironmental niche” in the OFB that is refractory to metastatic tumor seeding and outgrowth. Future studies designed to manipulate this niche may provide a novel means to mitigate peritoneal dissemination of ovarian cancer. Cancer Prev Res; 6(11); 1182–93. ©2013 AACR.
Effect of Copy Number Variants on Outcomes for Infants With Single Ventricle Heart Defects
Authors: Carey Abigail S. , Liang Li , Edwards Jonathan , Brandt Tracy , Mei Hui , Sharp Andrew J. , Hsu Daphne T. , Newburger Jane W. , Ohye Richard G. , Chung Wendy K. , Russell Mark W. , Rosenfeld Jill A. , Shaffer Lisa G. , Parides Michael K. , Edelmann Lisa , Gelb Bruce D. 
Published: September 2013

Background—
Human genomes harbor copy number variants (CNVs), which are regions of DNA gains or losses. Although pathogenic CNVs are associated with congenital heart disease (CHD), their effect on clinical outcomes is unknown. This study sought to determine whether pathogenic CNVs among infants with single ventricle physiology were associated with inferior neurocognitive and somatic growth outcomes.

Methods and Results—

Genomic DNAs from 223 subjects of 2 National Heart, Lung, and Blood Institute–sponsored randomized clinical trials in infants with single ventricle CHD and 270 controls from The Cancer Genome Atlas project were analyzed for rare CNVs >300 kb using array comparative genomic hybridization. Neurocognitive and growth outcomes at 14 months from the CHD trials were compared among subjects with and without pathogenic CNVs. Putatively pathogenic CNVs, comprising 25 duplications and 6 deletions, had a prevalence of 13.9%, significantly greater than the 4.4% rate of such CNVs among controls. CNVs associated with genomic disorders were found in 13 cases but not in controls. Several CNVs likely to be causative of single ventricle CHD were observed, including aberrations altering the dosage of
GATA4
,
MYH11
, and
GJA5
. Subjects with pathogenic CNVs had worse linear growth, and those with CNVs associated with known genomic disorders had the poorest neurocognitive and growth outcomes. A minority of children with pathogenic CNVs were noted to be dysmorphic on clinical genetics examination.

Conclusions—
Pathogenic CNVs seem to contribute to the cause of single ventricle forms of CHD in ≥10% of cases and are clinically subtle but adversely affect outcomes in children harboring them.
Effectiveness and Safety of Digoxin Among Contemporary Adults With Incident Systolic Heart Failure
Authors: Freeman James V. , Yang Jingrong , Sung Sue Hee , Hlatky Mark A. , Go Alan S. 
Published: September 2013

Background—
Clinical guidelines recommend digoxin for patients with symptomatic systolic heart failure (HF) receiving optimal medical therapy, but this recommendation is based on limited, older trial data. We evaluated the effectiveness and safety of digoxin in a contemporary cohort of patients with incident systolic HF.

Methods and Results—
We identified adults with incident systolic HF between 2006 and 2008 within Kaiser Permanente Northern California who had no prior digoxin use. We used multivariable extended Cox regression to examine the association between new digoxin use and risks of death and HF hospitalization, controlling for medical history, laboratory results, medications, HF disease severity, and the propensity for digoxin use. We also conducted analyses stratified by sex and concurrent β-blocker use. Among 2891 newly diagnosed patients with systolic HF, 529 (18%) received digoxin. During a median 2.5 years of follow-up, incident digoxin use was associated with higher rates of death (14.2 versus 11.3 per 100 person-years) and HF hospitalization (28.2 versus 24.4 per 100 person-years). In multivariable analysis, incident digoxin use was associated with higher mortality (hazard ratio, 1.72; 95% confidence interval, 1.25–2.36) but no significant difference in the risk of HF hospitalization (hazard ratio, 1.05; 95% confidence interval, 0.82–1.34). Results were similar in analyses stratified by sex and β-blocker use.

Conclusions—
Digoxin use in patients with incident systolic HF was independently associated with a higher risk of death but no difference in HF hospitalization.