bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS25 Discontinuation of Antiepileptic Drugs in Pregnancy: A UK Population Based Study in the Health Improvement Network (THIN)
Authors: Man S , Petersen I , Thompson M , Nazareth I 
Published: September 2012

BackgroundSince the thalidomide tragedy in the 1960s, many women are concerned with the use of drugs in pregnancy. Antiepileptic drugs (AEDs) are commonly used to treat epilepsy and bipolar disorders in women of child bearing age. However, some AEDs are associated with an increased risk of major congenital malformations. Untreated epilepsy and bipolar disorders in pregnancy may lead to devastating consequences for both mother and child. This leaves women and health care professionals with a dilemma as whether to continue AED medication in pregnancy. Using data from THIN, a UK primary care database, we examined pregnancy as a determinant for ceasing AED treatment.MethodsA cohort study of pregnant women receiving AEDs in UK primary care was conducted. We identified women who were prescribed AEDs in the three months before pregnancy. Time to last consecutive AED prescription in pregnancy was estimated whereby discontinuation of therapy was defined by a gap of more than three months between prescriptions. We identified a control group of twice as many non-pregnant women receiving AEDs. These women were randomly selected, but stratified within five year age bands and matched on indication for AEDs as for the pregnant women Cox’s regression was used to compare the likelihood of discontinuing AEDs between pregnant and non-pregnant women.ResultsIn total, 934 women were prescribed AEDs three months before pregnancy. Pregnant women with epilepsy were twice as likely to cease AEDs compared to non-pregnant women (Hazard Ratio (HR):2.00, 95% confidence interval (CI:1.62–2.47). Of 745 women with epilepsy, 601 (80.7%) continued treatment into pregnancy and 465 (62.4%) to the end of the second trimester. Of 1,490 non-pregnant women with epilepsy, 1,242 (83.4%) and 1,071 (71.9%) continued for comparable time periods.Pregnant women with bipolar disorder or depression were three times as likely to cease AEDs compared to non-pregnant women (HR:3.07, 95% CI:2.04–4.62). Of 54 pregnant women with bipolar disorder, 27 (50.0%) continued into pregnancy, and only 8 (14.8%) to the end of the second trimester. In 108 non-pregnant women with bipolar disorder, 82 (75.9%) and 58 (53.7%) continued for comparable periods.ConclusionPregnancy is a determinant for the discontinuation of AEDs during pregnancy, especially in women with bipolar disorder or depression despite the potentially severe consequences associated with not treating the underlying illness in pregnancy.
PS27 Serum Bilirubin and Risk of Cardiovascular Events and Death in a Statin-Treated Population: A Cohort Study
Authors: Horsfall LJ , Petersen I , Nazareth I 
Published: September 2012

BackgroundSerum bilirubin is an endogenous antioxidant with a strong genetic component that may be a marker for future cardiovascular disease (CVD) risk. We examined the relationship between serum bilirubin levels recorded prior to statin prescription, primarily as test for liver function, and the diagnosis or death from CVD. We also examined whether bilirubin levels increased following statin prescription independently of liver enzymes, which has been shown in animal models and could contribute to the purported health benefits of statins in addition to cholesterol reduction.MethodsAll patients with liver function tests three months prior to first statin treatment between January 1st 2000 and December 31st 2010 and no history of liver disease or CVD were extracted from The Health Improvement Network (THIN) primary care database. Restricted cubic spline Poisson regressions were fitted on bilirubin levels and adjusted for traditional cardiovascular risk factors to estimate incidence rate ratios.ResultsIn total 130,052 patients met the inclusion criteria and after a median follow-up of 43 months, there were 5,938 coronary heart disease (CHD) events, 2,438 stroke events, and 5,185 deaths from any cause. In men, the incidence of CHD in the lowest decile category of bilirubin (1–6 µmol/L) was 176 per 10,000 person years (PYs) compared with 139 per 10,000 PYs in the highest decile (19–40 µmol/L). The result for stroke was 72 versus 52 per 10,000 PYs and for death 139 versus 92 per 10,000 PYs. Similar differences were seen for women. The adjusted associations with bilirubin were L-shaped with a negative relationship up to around 10–15 µmol/L. The models predicted that, compared to patients with the median bilirubin level (10 µmol/L), those with a similar CVD risk profile but a bilirubin level of 5 µmol/L had a 19% (95% CI: 11–27%) higher rates of CHD, a 22% (95% CI: 10–36%) higher rates of stroke, and a 26% (95% CI: 17–35%) higher rate of death. A dose-dependent increase in mean bilirubin level was seen following atorvastatin prescription but not for simvastatin.ConclusionLow bilirubin prior to statin prescription is an independent risk factor for CVD and death. Further work is needed to examine whether pleotrpic effects of statins can be explained by alterations in bilirubin production and/or elimination.
PS39 Alcohol and Harm to Others in Russia: Longitudinal Analysis of Couple Drinking and Subsequent Divorce
Authors: Keenan K , Grundy E , Kenward MG , Leon DA 
Published: September 2012

BackgroundIn Russia male drinking patterns have serious negative health effects; however the impact of alcohol on divorce is relatively unexplored. In other settings heavy drinking and discrepant drinking within couples increases the probability of marital breakdown. Longitudinal data, rather than cross-sectional, is preferable to establish the direction of any causal link.MethodsThe association between married couple drinking patterns and subsequent divorce was investigated in a national population-based panel study in Russia. Follow-up data on 4,266 married couples was extracted from 14 consecutive annual rounds (1994–2009) of the Russian Longitudinal Monitoring Survey. The overall follow-up rate of couples was 90%, and loss to follow-up was unrelated to drinking behaviour. At interview couples provided information about family relationships, drinking habits in the last 30 days and socio-demographic variables. Discrete time hazard models were fitted using pooled logistic regression to estimate the probability of divorce among married couples as a function of the previous round’s drinking patterns and other covariates.ResultsIncreased odds of divorce were associated with greater frequency of husband drinking (P<0.001) and greater frequency of wife drinking (P<0.001), and remained significant after mutual adjustment. Wife’s hazardous drinking was also associated with a higher risk of divorce (OR 1.45, 95% CI 1.06–1.92) after adjustment for husband’s drinking. Husbands who were abstainers also had raised odds of divorce compared to moderate drinkers (OR 1.36, CI 1.01–1.84). There was a significant positive relationship between husband’s maximum daily volume of ethanol from vodka and divorce, after adjustment for frequency. After testing for interaction between husband’s and wife’s drinking, there was no evidence that couples with discrepant drinking frequencies had increased risk of divorce.ConclusionThis study adds to the very sparse literature investigating the association of drinking with divorce using longitudinal data. The results suggest that in Russia heavy and frequent drinking of both husbands and wives put couples at greater risk of future divorce. The thresholds where frequency and volume adversely affect marital stability are higher in husbands, than in wives. Male abstainers have a higher degree of marital dysfunction, lending support to the idea that many Russian male abstainers are ex-drinkers. More research is needed to understand the causal pathways from drinking to marital breakdown in Russia, and the overall population-level impact of drinking on partnerships.
PS41 Characteristics Associated with Statin Prescribing for Primary Prevention of Cardiovascular Disease Among People with Diabetes
Authors: Jones NRV , Wild SH 
Published: September 2012

BackgroundDiabetes is a risk factor for cardiovascular disease (CVD) and guidelines recommend that people with diabetes ought to have their blood lipid levels monitored and, if necessary, controlled to ensure that they are at a safe level to prevent avoidable morbidity and mortality resulting from CVD. Guidelines are not necessarily followed and the differences in treatment which this leads to could give rise to health inequalities according to socio-economic status, sex, or other patient characteristics. This study investigated the association between patient characteristics and statin prescribing in people who were eligible to receive a statin for primary prevention of CVD according to the contemporary Scottish Intercollegiate Guideline Network guidelines (SIGN 55).MethodsData from the Scottish Care Information – Diabetes Collaboration dataset for the period 2000–2007 were used. This dataset contains socio-demographic and prescribing data for 203,528 people, which is almost every person with diagnosed diabetes in Scotland. The analyses were based on people over 40 years of age, with complete data, with no history of CVD, and with total serum cholesterol exceeding 5mmol/l.Logistic regression was used to calculate odds ratios (OR) for ever having a record of a statin prescription by age, sex, socio-economic status (defined using quintiles of the Scottish Index of Multiple Deprivation, SIMD, where Q1 reflects the most deprived and Q5 the most affluent), smoking habits, body mass index, diastolic blood pressure, and type of diabetes.ResultsOf 83,666 people identified as eligible for statin treatment as defined by SIGN 55 guidelines, 29% had no record of a statin prescription. In both men and women, the OR for having a statin prescribed when compared to Q1 from multi-variate models were ORmen0.93 ORwomen0.91 for Q2, ORmen0.77 ORwomen0.77 for Q3, and ORmen0.71 ORwomen0.71 for Q4. Current and former smokers, overweight and obese people, and people with high blood pressure or treated hypertension had greater odds of statin prescription, whereas underweight people and women with type one diabetes had reduced odds of being prescribed a statin than each comparison group.ConclusionAlmost one third of people with diagnosed diabetes have no record of having ever received a statin prescription as recommended by SIGN 55. The odds of having a record of treatment were higher among more deprived people even after adjusting for potential confounding factors.
PS43 What is Important to the Quality of Life of People with Multiple Myeloma? Implications for the Design Of Quality of Life Questionnaires
Authors: Osborne TR , Ramsenthaler C , Higginson IJ 
Published: September 2012

BackgroundMultiple myeloma is an incurable cancer, although recent treatment advances have improved expected survival from months to years in some cases. Increasing survival has elevated the importance of understanding and measuring patients’ quality of life (QOL) in research and clinical settings. A number of QOL questionnaires exist for use in myeloma, yet there is a paucity of research to understand what issues are important to QOL from the patients’ perspective.This study explores the issues important to the QOL of people with myeloma, and how QOL is affected by the disease and its treatment. Implications for the design of QOL questionnaires are discussed.MethodsIn-depth qualitative interviews with 20 myeloma patients to identify issues important to QOL and explore the impact of disease and treatment. Participants recruited from King’s College Hospital and St. Christopher’s Hospice, London. Purposive sampling by age, gender, performance status and disease stage. Thematic content analysis of interview transcripts was conducted.ResultsMany participants started by discussing the importance of physical function and independence. There appeared to be a dominant role for participatory function in determining QOL – family life, leisure pursuits and other social activities were often identified as important. Physical symptoms such as pain or fatigue were frequently said to be affecting QOL, but often this was through their affect on social and participatory function. Sometimes symptoms were reported, but they did not affect QOL because functional and participatory aspects were maintained. Issues that prevented social engagement or participation were often therefore most deleterious to QOL – such as reduced mobility; susceptibility to infection; and fear of low-trauma fractures. Participants also often discussed the importance of quality, accessible healthcare – particularly good communication and receiving the right amount of information from professionals.ConclusionThese results support the broad consensus that quality of life is multidimensional, involving physical, psychological and social domains. The presence of symptomsper sedid not necessarily impair QOL in this group. QOL questionnaires for use in myeloma should perhaps focus less on the presence, absence or severity of a symptom, but consider how much of a problem the symptom is in terms of its broader impact on function. This is particularly important when tools are applied in clinical practice, when the wider burden of symptoms is perhaps of greater interest. Tools for use in myeloma clinical practice should also consider items about the quality of healthcare – since this appears important to patients’ QOL.
PS45 Addressing Child Poverty – The Role of the NHS Workforce
Authors: Egan JA 
Published: September 2012

BackgroundGlasgow, like other UK cities, faces the challenge of addressing high child poverty levels - 52% of children, in some parts of the city, live in poverty. Within NHS Greater Glasgow and Clyde, the Healthier, Wealthier Children (HWC) project was set up to create referral pathways between the NHS and money advice services to support pregnant women and families at risk of child poverty. The 15 month project, launched in October 2010, was funded by the Scottish Government.The evaluation, being undertaken by the Glasgow Centre for Population Health, will conclude in April 2012. This paper aims to describe the HWC evaluation findings with a focus on two key objectives: development of the NHS workforce role and mainstreaming child poverty action within this role.MethodsA mixed methods approach to the HWC evaluation included capturing and describing the changes in the NHS workforce roles through documentary analysis, an NHS workforce survey and outcomes from money advice services.ResultsAn HWC website was set up to provide staff materials, case studies and practical recommendations on child poverty work as an NHS workforce resource. Other ongoing work includes creating midwife/patient web-based scenarios to be used as a national resource.Although not part of the existing NHS performance framework (i.e. HEAT targets), there is evidence that HWC work is being embedded. Most referrals to advice services were made by health visitors (51%) and midwives (29%). The majority of both workforces (81/84; 96%) intend to continue referring post-HWC. Moreover, health visitors ranked clients’ money worries as a priority above three national HEAT targets.To date, 2,516 referrals were made to money advice services which resulted in uptake of 54% (n=1,347) among pregnant women and families with young children. More than seven out of 10 people accessing advice services were eligible for Healthy Start vouchers (benefits related) which can be exchanged for milk, fresh fruit and vegetables. There was a total recorded annual gain of just over £2.7 million and £328,000 in one-off lump sums. Other reported client outcomes included immigration advice, addressing fuel poverty and onward homelessness referrals.ConclusionThis paper will suggest that HWC has resulted in positive outcomes towards mitigating the impact of child poverty. Midwives and health visitors have played an active role and there is scope to develop this work across the wider Early Years workforces.
PS48 Processes Of Change: What Are The Specific Pathways And Project Components That Have A Positive Impact On The Well-Being Of Participants In A ‘Well London’ Project?
Authors: Derges J , Draper A , Clow A , Lynch R , Jain S 
Published: September 2012

BackgroundThis paper presents follow-up data from a qualitative study of a Big Lottery funded ‘Well London’ project; an initiative set up to improve the health and well-being of Londoners living in areas historically marked by social, economic and environmental deprivation. The project introduced a series of health interventions: healthy eating, physical activity, and mental health and well-being, across a total of 20 areas within London. An evaluation of the interventions was conducted through a series of in depth semi-structured interviews with residents in 3 of the areas. Participants were interviewed twice: initially at the start of the interventions and again twelve months later. The interviews explored which of the project components acted positively on participant’s sense of well-being and lead to changes in health behaviour. The methodology used, placed emphasis on the opinions and reflections of study participants and responds to Popay’s call for research to be centred not only on theoretical concerns, but also to be attentive to ‘lay’ theories of health.MethodsTwo sets of 60 semi-structured interviews, taking place a year apart were conducted across three locations identified as Census Lower Super Output Areas (LSOAs). These measured changes in health behaviour and residents’ perceptions of ‘well-being’ that arose following the Well London interventions. Residents were interviewed about their experiences and perceptions of the neighbourhood; also their health and views of the Well London interventions. Residents who had not taken part in the project interventions were also selected and interviewed, for comparison.ResultsThe study found that the project objectives succeeded where there were at least one of the following present; a) high levels of individual motivation; b) the involvement of external agencies in the form of key worker and/or agency support; c) where residents were involved in the organisation and dissemination of the projects, often as volunteers; and d) where the environment was made accessible, safe and conducive to a sense of belonging and ‘community ownership’.ConclusionThe findings indicate that the Well London project increased perceptions of well-being in populations defined by inner city social disadvantage. However, the pathways to change are complex and not easily generalized. Success is dependent on multiple interacting interpersonal, social and contextual factors, as well as the actual type of interventions themselves.
PS49 Food For Thought! The Role Of Dietary Choices On Cognitive Behaviour
Authors: Cadar D , Pikhart H , Mishra G , Stephen AM , Kuh D , Richards M 
Published: September 2012

BackgroundCognitive decline indicates the first sign of dementia and a major public health impact associated with ageing. Evidence suggests that dietary patterns are associated with cerebrovascular and cardiovascular risk factors.MethodsTo examine the association between dietary choices and 20 years cognitive decline from 43 to 60+.; 1018 study members from the MRC National Survey of Health and Development regularly followed up since birth in 1946 were included in the study.Cognitive functioning was measured at 43 and 60+ years using two tests: verbal memory (maximum words recalled 45) and visual search (maximum letter searched: 600).Dietary data was obtained using a 5 days diet diary at age 36 and 43y. An overall score representing level of healthy food choice was derived, by summing scores from five separate criteria: 1. consumption of breakfast (0 no consumption to 2 all days); 2.type of milk (from 0 whole to 3 skim milk); 3. type of bread (from 0 white to 4 wholemeal); 4. number of daily portions of fruit and vegetables (from 0 none to 5 portions/day) and percentages of energy from daily intakes (0-more than 45% energy to 5 -less than 30% energy). A total score was derived and further classified as 0 low or 1 higher choice, subject to median split at each age. A cumulative midlife score was further derived as 0 low choice at either age or 1 higher choice at least at one age or both. The confounding variables were father’s social class, childhood cognition, education, adult social class and depression.ResultsThere was a cross sectional positive association between a higher choice of diet and verbal memory scores at age 43y compared to a lower choice 1.83 (95% CI 1.12 to 2.54). This association was maintained after adjusting for all covariates. There was also a significant association between a midlife cumulative healthier choice of diet and a slower verbal memory from 43 to 60+ in a fully adjusted model 0.69 (1.10 to 1.27) compared to midlife lower choice. There was no association between dietary choice and visual search or visual search decline.ConclusionOur results suggest that a healthy dietary option based on high intake of fruit and vegetables, complex carbohydrates and cereals made in early midlife is protective of verbal memory decline from mid to later life. Public health interventions based on healthy diets and the prevention of nutritional deficiencies should be considered an important line of defence against cognitive decline and dementia.
Androgen Receptor on the Move: Boarding the Microtubule Expressway to the Nucleus
Authors: Thadani-Mulero Maria , Nanus David M. , Giannakakou Paraskevi 
Published: September 2012

Abstract
Recent studies have shown that the microtubule-stabilizing drug paclitaxel, which is commonly used for the treatment of prostate cancer, inhibits signaling from the androgen receptor by inhibiting its nuclear accumulation downstream of microtubule stabilization. This mechanism is independent of paclitaxel-induced mitotic arrest and could provide an alternative mechanism of drug action that can explain its clinical activity. In this review, we highlight the importance of signaling and trafficking pathways that depend on intact and dynamic microtubules, and, as such, they represent downstream targets of microtubule inhibitors. We showcase prostate cancer, which is driven by the activity of the androgen receptor, as recent reports have revealed a connection between the microtubule-dependent trafficking of the androgen receptor and the clinical efficacy of taxanes. Identification and further elucidation of microtubule-dependent tumor-specific pathways will help us better understand the molecular basis of clinical taxane resistance as well as to identify individual patients more likely to respond to treatment. Cancer Res; 72(18); 4611–5. ©2012 AACR.