bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS14 A Systematic Review of Evidence on Malignant Spinal Metastases: Technologies for Identifying Patients at High Risk of Vertebral Fracture and Spinal Cord Compression
Authors: Suttcliffe P , Connock M , Shyangdan D , Court R , Kandala N , Clarke A 
Published: September 2012

BackgroundSpinal metastases are common and can lead to significant morbidity and reduction in quality of life towards the end of life due to spinal cord compression (SCC). Between 5% and 20% of patients with spinal metastases develop metastatic spinal cord compression (MSCC) during the course of their disease. Understanding early diagnosis of spinal metastases and prediction of collapse of the metastatic vertebrae is important.MethodsA systematic review was undertaken to identify patients at high risk of vertebral fracture and SCC. Thirteen electronic bibliographic databases were searched. A quality assessment instrument was used to assess bias in six domains: study population, attrition, prognostic factor measurement, outcome measurement, confounding measurement and account, and analysis.Results2,425 potentially relevant articles were identified, of which 31 met the inclusion criteria. Seventeen studies reported retrospective data, 10 were prospective studies, and three were other study designs. There was one systematic review. There were no randomised controlled trials. There were approximately 7,900 participants (4 studies did not provide this information) in the included studies and 5,782 participants were analysed (3 studies did not provide this information). The sample sizes ranged from 41 to 859. Cancers reported were: lung alone (n=3); prostate alone (n=6); breast alone (n=7); mixed cancers (n=13); and unclear (n=1). Ninety-three prognostic factors were identified as potentially significant in predicting risk of SCC or collapse. Many of the included studies provided limited information about patient population and selection criteria and they varied in methodological quality, rigour and transparency. Several studies with mixed case populations identified type of cancer (e.g. breast, lung or prostate cancer) as a significant factor in predicting SCC, but determining the risk differential is difficult because of residual bias in studies.ConclusionPerhaps not surprisingly, the overall findings from this systematic review showed that the more spinal metastases present and the longer a patient is at risk, the greater the chance of development of SCC and collapse. Other prognostic factors include total burden of metastatic disease and immediate symptomatology suggestive of spinal column involvement. Current clinical consensus favours magnetic resonance imaging and computed tomography for investigation of SCC and vertebral fracture, but this important area is clearly under-researched.
PS17 Commissioning Care for People with Long Term Conditions
Authors: Porter AM , Smith JA , Shaw S , Mays N 
Published: September 2012

BackgroundThe landscape of health care commissioning is being reshaped in England, as clinical commissioning groups prepare to take on the role now held by Primary Care Trusts (PCTs). Long term conditions are likely to remain a priority area, with concerns about increasing prevalence driving a shift towards care delivered in the community and early intervention to avoid hospitalisation. We report on a NIHR-funded study which used action research in three NHS local health communities to examine in detail the practice of PCT commissioning of care for people with long term conditions.MethodsThe study was undertaken in three contrasting PCT areas (Somerset, Wirral and Calderdale), and focused on diabetes and another locally selected condition in each site. The design combined a largely ethnographic approach with action research, allowing for responsive intervention to meet local commissioners’ needs. Formal data collection over a 15 month period to January 2012 consisted of 104 semi structured interviews, observation of 27 meetings, and analysis of over 300 documents. A thematic framework was developed to guide analysis in terms of processes, resources and outcomes of commissioning.ResultsFindings highlighted the complex nature of health care commissioning, far removed from the ‘commissioning cycle’ which sets out a formal, sequential model emphasising contracting. Instead, commissioning developments took place over a number of years through an incremental process of review and revision where negotiation and relationships were prominent. Providers often played a significant role in identifying needs and designing new models of care. The sheer scale of labour involved in commissioning was striking. Greatest success with shifting models of care towards nationally recommended good practice came where there was a combination of effective prioritisation of developments, persistence and pragmatic bounding of tasks within a wider strategic framework. Measuring the impact of commissioning practice on clinical outcomes was challenging.ConclusionTo fulfill national policy towards remodelling care for people with long term conditions, NHS commissioners are engaged in labour-intensive, steadily paced and incremental work with providers. Planned reforms to commissioning in England raise questions about whether this approach can continue in the face of straitened budgets for management support, an increased emphasis on provider competition and disruptions to established relationships between commissioners and providers.
PS28 Impact of Number and Type of Comorbidity on Depression Prevalence and Health Care Costs. Population-Based Cohort Study
Authors: Bhattarai N , Charlton J , Rudisill C , Gulliford M C 
Published: September 2012

BackgroundThe degree to which the number of comorbidities and the presence of depression impact health care use and costs has been unexplored employing actual resource use data representing a general population. We aimed to evaluate the impact of number and type of comorbidities on depression prevalence, health care utilisation and health care costs.MethodsCohort study and included in the study were 300,020 participants aged 30 years of age registered with the UK General Practice Research Database. We used the UK General Practice Research Database to examine participants’ diagnoses and resource use in primary and secondary care from 2005 to 2009. Healthcare unit costs and the costs of each individual prescription item were analysed.ResultsIn participants with no comorbidity, the age-standardised prevalence of depression was 7% in men and 14% in women. The likelihood of having depression increased in participants with single comorbidities including diabetes mellitus (men 13%, women 22%), CHD (men 15%, women 24%), stroke (men 14%, women 26%) or colorectal cancer (men 10%, women 21%). Patients with concurrent diabetes, CHD and stroke had a very high prevalence of depression (men 23%, women 49%) with women being more likely to suffer depression. Patients with a single comorbidity were 1.63 (95% confidence interval 1.59 to 1.66) times more likely to be depressed than those without comorbidity while those with two and three comorbidities were 1.96 (1.89 to 2.03) and 2.35 (2.03 to 2.59) times more likely. Depression increased the total costs of resources utilised per year in all participants across both genders, all age groups and across all comorbidities analysed in this study. Individuals with depression had higher total annual health care costs (males = £1014, females=£1212) than those without comorbidity or depression (males = £380, females = £517). Those with diabetes alone had £1144 for males and £1393 for females but £ 2534 for males and £ 3017 for females when depression was present alongside diabetes. When patients had diabetes, CHD and had suffered a stroke these patients’ costs were £1541 for males and £1879 for females without depression and £3420 for males and £4072 for females with depression. Depression increased the associated cost of any comorbidity.ConclusionThe prevalence of depression appears to be more strongly determined by the number of comorbidities rather than the precise nature of the comorbid diagnoses. Additional costs of health care utilisation are considerably higher when depression is associated with single or multiple comorbidities.
PS29 Youth Exposure to Online Alcohol Advertising in The UK: An Analysis of Social Media Websites
Authors: Winpenny E , Marteau TM , Nolte E 
Published: September 2012

BackgroundThere is increasing evidence that youth exposure to alcohol marketing is a risk factor for underage drinking. In 2011, online marketing became the largest channel for marketing for the first time, overtaking television. However, there is little understanding of the level of exposure of young people to online alcohol marketing.MethodsWe obtained data on the top 3 social media sites in the UK for each month from December 2010 to May 2011, based on unique user figures, by gender and age (6–14, 15–24). We analysed the reach (the proportion of available internet users who used the site in each month) and impressions (the number of individual pages viewed on the site in each month) of the overall top three social media sites, Facebook, YouTube and Twitter in each demographic. Using data from the top 10 TV channels in the UK we identified 5 drinks brands, which had the highest TV advertising exposure to children (4–15) during this 6 month period. During February and March 2012, we examined each of these brands across the 3 social media sites. We analysed the brand presence and page content on each site and assessed the use and effectiveness of age restrictions.ResultsFacebook was the most-used social media site, with an average reach across the observation period ranging from 39% in males aged 6–14 to 91% among females aged 15–24. The average impressions per month varied between 697 million and 2,717 million. YouTube had a similar average reach (41–81%) while Twitter had a considerably lower usage in the age groups studied. All 5 of the alcohol brands studied maintained a brand website, facebook page and twitter page, while 3 of the 5 also hosted a YouTube channel. Features such as the ‘like’ button on facebook and the use of competitions and games enable spread of brand engagement through the network.Age restrictions to alcohol brand content varied across the sites. Facebook users under the age of 18 years were not able to access ‘official’ alcohol brand pages, although most user-generated content and some brand-generated applications were still accessible. By contrast, YouTube and Twitter did not maintain age-restriction with users of all ages able to view and interact with brand content.ConclusionSocial media sites are heavily used by children and young adults. Their exposure through these sites to alcohol marketing warrants intervention.
PS31 Patterns of Partnership Smoking During Pregnancy
Authors: Prady SL , Graham H , Pickett KE 
Published: September 2012

BackgroundPartner’s smoking status is an important predictor of maternal smoking in pregnancy; however there are few UK-wide surveys which look at these effects. We investigated partnership smoking, quitting and cutting down during pregnancy in the UK’s Millennium Cohort Study.MethodsWe used multinomial logistic and linear regression to investigate retrospective self-reported smoking status and reductions in cigarettes smoked of mothers and their partners. All analyses were weighted for the complex sampling design and non-response, both unadjusted and adjusted for socio-demographic status.ResultsSeventy-six percent of women had respondent partners, 22% were couples who both smoked around the time of the pregnancy (unweighted N=2,954). Of these smoking couples, 37% of women quit during their pregnancy, 41% cut down, and 23% smoked the same amount (persistent smokers), respective percentages for partners were 16%, 25% and 56%. Compared to women who quit, women who cut down were more likely to have a partner who was a persistent smoker (RRR 7.6, 95% CI 4.9 to 11.7), or a cut-down smoker (5.7, 3.8 to 8.5). Compared to persistent smokers, those who cut down were slightly heavier smokers (women mean difference 1.1 cigarettes/day, partners 2.0). Women who cut down reduced average consumption to 6.3 a day (mean reduction 9.3, 95% CI 9.0 to 9.8) and partners to 10.1 (8.7, 8.1 to 9.3). There was no difference in the effect of partners’ persistent smoking on the risk of women cutting down or persistent smoking (P=0.38), but partner cutting down was a significantly larger predictor of women cutting down compared to women continuing to smoke (P=0.02). After reduction, women whose partners cut down smoked an average of 2.2 more cigarettes more than those whose partners quit (P=0.043). There was no evidence of variation in reduction for those who had partners who quit and those who were persistent smokers (d=0.87, P=0.42).Resultswere robust to adjustment for socio-demographics; fully adjusted results will be presented.ConclusionMost women cut down and this was associated with partner cutdown, however this strategy was limited as partners were more likely to be persistent smokers. Significant reductions in the maternal number smoked were achieved, but the influence of partner smoking (whether persistent or cut down) may limit reduction. Cutting down as a strategy has questionable impact on in-utero exposure and may put at infants at risk for environmental tobacco smoke exposure postpartum. For maximum effect, partner and targeted couples interventions are warranted.
PS51 Could More Than Three Million Older People Be At Risk Of Alcohol-Related Harm? A Cross-Sectional Analysis Of Age-Specific Drinking Guidelines
Authors: Knott C , Scholes S , Shelton NJ 
Published: September 2012

BackgroundTo determine the effect of recently proposed age-specific alcohol consumption guidelines upon the estimated proportion and number of older individuals potentially at risk of alcohol-related harm. Nationally representative cross-sectional population data from Health Survey for England (HSE).MethodsRandom sample of the general population living in private households in England. For reliable comparison of adult alcohol consumption by age and sex across a five-year period, data were extracted from HSE 2003 and 2008 for all participants aged 16 or over. The sample included those who drank in the previous week, never drinkers, non-drinkers and adults who reported not having consumed alcohol in the week prior to interview. Excluded from the sample were those for whom data on drinking behaviour or unit alcohol consumption were missing (around one per cent of the total available sample). The sample from HSE 2003 thus comprised 14,718 participants, while the 2008 sample comprised data on 14,939 individuals.ResultsThe total number of individuals aged 65 or over classified as drinking in excess of daily recommended limits would have increased to over three million in 2008 under age-specific guidelines proposed by the Royal College of Psychiatrists, equating to an at-risk population of 809,000 individuals greater than found within the 16–24 age group during the same year. Proposed revisions to existing binge drinking classifications defined almost 1,200,000 people aged 65 or over as hazardous consumers of alcohol in 2008, equating to a rise of 258% by comparison with existing definitions.ConclusionThe introduction of new age-specific drinking guidelines put forward by the Royal College of Psychiatrists would increase the elderly population drinking in excess of daily recommended limits by more than two-fold, and increase by more than three-fold the number of binge drinkers. However, there remains at present a dearth of evidence sufficient for guiding age-specific revisions to existing and already problematic alcohol consumption thresholds. Nevertheless, vigilance regarding heavy late-life drinking remains important in light of older people’s heightened sensitivity to the effects of alcohol and the rising number within the sub-population potentially at risk of alcohol-related harm.
PS52 Are There Gender Differences In The Social Patterning Of Binge Drinking In The Czech Republic, Russia, Poland And Lithuania? A Cross-Sectional Study
Authors: Asher L , Pikhart H , Bobak M 
Published: September 2012

BackgroundBinge drinking may have played a central role in mortality fluctuations in the former Soviet Union (fSU). In Eastern Europe, binge drinking is more common in men than women and in men of lower socio-economic position (SEP). Yet intersections of these factors have rarely been addressed with sufficient power to detect social patterns in binge drinking amongst women. The aim of this study was to determine whether there are gender differences in the social patterning of binge drinking in the Czech Republic, Russia, Poland and Lithuania.MethodsCross-sectional baseline data from the HAPIEE (Health, Alcohol and Psychosocial factors in Eastern Europe) study was used. The participants were men and women aged 45–69 years randomly selected from population registers in the Czech Republic, Russia, Poland and Lithuania. Logistic regression was used to examine the association between social factors (education, employment status, household amenities and deprivation) and binge drinking (>100g (men) and >60g (women) ethanol per occasion ≥1x/month) in each gender and country separately. Amenities score was derived from 18 (Lithuania) or 12 (other countries) individual questions on household items. ‘Few amenities’ was defined as a score in the lowest quartile for the participant’s country.Tests for interaction between gender and each variable were carried out. Tests for interaction between country and each variable were also completed. Pooled data (all countries) was interpreted where there was no evidence of country heterogeneity.ResultsThere were 34,069 participants with complete data. Amongst men in all countries, all markers of low SEP were associated with increased odds of binge drinking (e.g. OR 1.22, 95% CI 1.10–1.35 for few amenities, fully adjusted model). In women, few amenities (OR 0.81, 0.70–0.94, fully adjusted model), and to a lesser extent low education level, were associated with decreased odds of binge drinking. The associations between social factors, gender and binge drinking were homogenous between countries (few amenities test for country heterogeneity p=0.72 men, p=0.51 women) with the exceptions of education and deprivation in women.ConclusionIn Russia and Eastern Europe binge drinking in men and women is socially patterned, but in contrasting ways. Men with lower SEP may binge drink due to social instability and poor coping mechanisms. Women with higher SEP may binge drink due to greater resources and exposure to, and adoption of, male drinking patterns through employment or higher education. Policy to tackle binge drinking should take into account its gender-specific social determinants.
PS53 Effect Of Geographical Access To Health Facilities On Child Mortality In Rural Ethiopia: A Community Based Cross Sectional Study
Authors: Okwaraji Y , Cousens C , Berhane Y , Mulholland K , Edmond K 
Published: September 2012

BackgroundThere have been few studies which have examined associations between access to health care and child health outcomes in remote populations most in need of health services. This study assessed the effect of travel time and distance to health facilities on mortality in children under five years in a remote area of rural north-western Ethiopia.MethodsThis study involved a randomly selected cross sectional survey of 2,058 households. Data were collected during home visits to all resident women of reproductive age (15–49 years). A geographic information system (GIS) was used to map all households and the only health centre in the district. The analysis was restricted to 2,206 rural children who were under the age of five years during the five years before the survey. Data were analysed using random effects Poisson regression.Results90.4% (1,996/2,206) of children lived more than 1.5 hours walk from the health centre. Children who lived >1.5hrs from the health centre had a two–three fold greater risk of death than children who lived<1.5 hours from the health centre (children with travel time 1.5–<2.5hrs adjusted relative risk [adjRR] 2.3[0.95–5.6], travel time 2.5–<3.5hrs adjRR 3.1[1.3–7.4] and travel time 3.5–<6.5hrs adjRR 2.5[1.1–6.2]).ConclusionDistance to a health centre had a marked influence on under five mortality in a poor, rural, remote area of Ethiopia. This study provides important information for policy makers on the likely impact of new health centres and their most effective location in remote areas.
PS54 Biomarkers Associated With Mortality In A Community Based Population With Cardiovascular Risk Factors: Data From The Screening To Prevent Heart Failure (STOP HF) Study
Authors: Conlon CM , Kelleher CC , Dawkins I , McDonald L , Ledwidge M , McDonald K 
Published: September 2012

BackgroundThe STOP HF cohort is an ongoing longitudinal study of 1,040 individuals with cardiovascular risk factors and no known ventricular dysfunction at baseline. The study is located in South Dublin and the Southeast of Ireland. This is an analysis of the deaths reported at the interim analysis conducted in January 2012 (mean follow-up, 4 years, range 3.5–7.0 years).MethodsUnivariable analyses compared the profiles of survivors to those deceased. Logistic regression identified the foremost associates of death. Cox’s proportional hazard models estimated the risk of death over time, considering the presence of certain factors.ResultsBetween January 2005 and April 2008 1,040 individuals were recruited into the STOP HF study (Mean age 65, 49% male, hyperlipidemia 53%, hypertension 47%, CAD 16%, MI 8%, arrhythmia 8%, diabetes 12%, smoker 14%). At the interim analyses 64 deaths were reported, (6.1% of the cohort). Univariable analyses indicated those deceased were older (65 vs. 71 years, p<0.0001) with lower diastolic blood-pressure (p<0.005) and a 17% greater prevalence of diabetes (p<0.0001). Those deceased had biomarker levels more frequently ≥75th percentile for gender in BNP (p<0.005), hsCRP (p<0.0001), Urea (p<0.005), Creatinine (p<0.0001) and ALP (p<0.05) and were more likely to be taking ACE inhibitor (p<0.02) and anti-diabetic therapy (p<0.0001). The final multivariable model identified age (ExpB=1.07, OR 1.03–1.11, p<0.0001), diabetes (ExpB=3.44, OR 1.96–7.00, P=0.001), BNP (ExpB=1.00, OR 1.000–1.007, p=0.075) and hsCRP (ExpB=1.07, OR 1.04–1.11, p<0.000) as associates of mortality (model χ2(4, N=1041)=50.240, p<0.001). Controlling for age, cox’s proportional hazard models indicated that those with diabetes had a 3 times higher risk of death (ExpB=3.117, OR 1.801–5.304, p<0.0001); those with a hsCRP level ≥75th percentile for gender were almost 3.5 times more likely to die (ExpB=3.439, OR 1.995–5.498, p<0.0001) and those with ALP ≥75th percentile for gender were also more likely to die durin the follow-up period (ExpB=1.919, OR 1.096–3.359).ConclusionDiabetes is associated with in excess of a 3 times increase in the likelihood of death over 4 years follow-up in this population, while other morbid conditions such as coronary disease and atrial fibrillation show no significant association. Despite aggressive cardiovascular risk management through primary and secondary prevention strategies, those with diabetes continue to have a poor prognostic outlook. Observation of biomarkers such as hsCRP and ALP may be of added value in monitoring cohorts with existing cardiovascular risk factors and identifying those that may be sub-clinically manifesting heightened risk of mortality in this setting.