bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP12 Interventions to Promote Healthy Eating: A Systematic Review Of Regulatory Approaches
Authors: Hendry V , Monsivais P , Almiron-Roig E , Jebb S , Neelon S Benjamin , Griffin S , Ogilvie D 
Published: September 2013

BackgroundUnhealthy diets are a risk factor for many chronic diseases, accounting for around 40% excess cardiovascular and cancer mortality annually across the United Kingdom. Multifactorial strategies may help address this, and governments employ a variety of approaches to influence individual diets, the prevalence of obesity and population health. This systematic scoping review considers the effectiveness of regulatory interventions to change diet or diet-related behaviour.MethodsThe review includes regulation, rules and legislation (collectively, “regulation”) seeking to directly alter diet, dietary behaviour or nutrition by influencing (a) dietary behaviour (e.g. through regulating labelling, calorie display, marketing, food in schools, or built environments; or by using taxes or subsidies) or (b) the nutritional content of food (e.g. by specifying salt or trans fat levels). The review follows Cochrane and EPPI-Centre guidance and comprises a scoping review of regulatory interventions, and in-depth reviews on (1) school-based fruit and vegetable schemes and (2) control of trans fats. Medline, Embase, ISI WoK, EconLit, grey literature and bibliographic searches to the end of December 2012 identified 134 studies eligible for full text review. Studies were included if they had a recognisable research design.ResultsStudies of information labels (packaging or menus) and compliance with school food standards occurred most frequently. Six studies of school-based fruit and vegetable schemes provided moderate evidence of short-term increases in intake but weak evidence for any longer term behaviour changes. Thirteen studies examined trans fat controls through bans or labelling. These measures achieved good compliance if regulation was monitored, with evidence of food reformulation following both bans and labelling. Removing trans fats had minor effects on food availability, price or quality, although some ‘trans free’ foods commanded a price premium. The costs of removing trans fats were not reported.ConclusionRegulations with monitoring achieved compliance, but whether this affects food choices, dietary behaviour, nutrition, obesity prevalence or other health outcomes is unclear since those impacts have been under-evaluated. Regulation to influence dietary behaviour as well as the nutritional content of food can be used as a structural intervention to help create healthier living environments. Mandated labelling may risk exacerbating inequalities unless individual behaviour is also considered, and could be used to mislead consumers by providing a ‘healthy halo’ for unhealthy food. Understanding the effectiveness and costs of regulatory interventions will highlight where government-led action may be effective in promoting healthy diets in the population.
PP15 National Longitudinal Study of the Nutritional Habits of Adults with an Intellectual Disability - Analysis of Baseline Data
Authors: Hayes C B , Duffy P , Burke E , McCallion P , McCarron M 
Published: September 2013

BackgroundAdults with intellectual disability (ID) are known to have poor dietary habits and high rates of obesity. This population is thus at high risk for developing chronic conditions. Moreover, the process of de-institutionalisation is changing the way adults with ID are leading their lives and as this is a more recent phenomenon the effects of more independent living on dietary habits are largely unknown. This study provides a detailed account of the nutritional habits of older people (age 40+) with intellectual disability (ID) in Ireland.MethodsThe data was collected as part of the first wave of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS TILDA) on 753 persons with mild, moderate, severe and profound ID, to better understand their dietary habits. IDS-TILDA is a multi-wave national longitudinal study of older adults with ID. This analysis examined overall intake and variations in intake of food and beverages by age, gender, place of residence, level of ID and BMI. A multivariable analysis is currently being carried out.ResultsOverall, carbohydrate, dairy and meat intake were broadly in keeping with recommended guidelines although milk intake was poor (38% reporting never or rarely drinking milk). Fruit intake was also poor, (25% reporting eating two or more portions per day), although 50% of all participants reported drinking fruit juice daily. One-third of participants reported eating more than one portion of vegetables per day. Age and gender had little effect on nutritional habits. Preliminary analysis showed that those with mild/moderate ID were more likely eat more bread (p < 0.001), eat less meat (p < 0.05), vegetables (p < 0.05) and dairy products (p < 0.05) than those with severe or profound ID. They were also more likely to be obese (p < 0.05) and much more likely to live independently or with family (p < 0.001) reflecting greater autonomy in their food choices.ConclusionThe study demonstrated important differences in dietary habits between those with mild /moderate ID who were much more likely to live independently or with family compared to those with severe/profound ID who were more likely to be in residential care. It highlighted a number of areas where the dietary habits of older adults with ID could be improved. As the data provides detailed analysis on the dietary habits of a national sample of older people with ID for the first time, it will inform the development of nutritional policy advice for this group of people and their carers.
PP17 The Personal and Professional Impact of Stillbirth on Consultant Obstetricians
Authors: Nuzum D , Meaney S , O’Donoghue K 
Published: September 2013

BackgroundStillbirth remains amongst the most challenging areas in obstetric practice. In Ireland, consultant obstetricians are ultimately responsible for care provided to mothers following stillbirth. This study explores the impact of stillbirth on consultants working in an Irish tertiary maternity hospital (9,000 births per annum) where the stillbirth rate is 4.6/1000.MethodsSemi-structured qualitative interviews lasting 30-60 minutes were conducted in 2012 with a 50% sample of consultant obstetricians and gynaecologists (n = 8). The study explored how consultants care for parents following stillbirth and the impact of stillbirth on them personally and professionally. The data were analysed using Interpretative Phenomenological Analysis.ResultsThe human response and the weight of responsibility were the dominant personal and professional themes identified. The human response to stillbirth highlighted the personal impact stillbirth has on consultants and how in turn it shapes the care they provide. Stillbirth was deemed one of the most difficult experiences; described as amongst ‘the most devastating news’ with the exception of two who felt stillbirth was not the worst outcome. Most consultants stressed the importance of their ‘human response’ to parents following a stillbirth. All stated that bereaved parents should receive direct care from a consultant. The weight of professional responsibility revealed the sense of burden that consultants feel when a baby dies. The possibility of a medico-legal challenge was a significant factor; mostly for those who are primarily gynaecologists, resulting in the question “what have I missed?”. Consultants also felt that ‘expectations are high that outcomes are going to be good’ which adds to the weight of professional responsibilityConclusionDespite the impact and importance of stillbirth care, none of the obstetricians received any formal training in perinatal bereavement care yet all are required to care for families following the death of a baby. This study highlights a gap in training and the considerable impact of stillbirth on obstetricians professionally and personally. Medico-legal concerns following stillbirth potentially impact on the depth of care and warrants further research.
PP18 Spatial Profiling of General Practice Registration: Evidence From Southwark, London, UK
Authors: Lewis D J 
Published: September 2013

BackgroundGeneral Practices have a duty to serve their local community, and in doing so act as an advocate for further care, and as gatekeepers to the wider NHS. However, as reforms to the NHS erode the geographic basis for care commissioning via SHAs and PCTs, and with GP designed catchment areas largely unrepresentative of the distribution of patients served, particularly in urban areas, there is a need to better understand the characteristics of local enrolment.MethodsA set of “communities” are defined spatially for each of the 47 GP surgeries in the London Borough of Southwark, based upon a complete patient register. Each GP surgery has a set of communities that enclose the smallest geographic area (s) within which a given threshold of the GP surgery’s patients are served. Thus, a 50% threshold will enclose the smallest region (or set of regions) within which half of all that surgery’s patients reside. These, often complex, delineations are based upon the observed spatial distribution of patients, and offer a much finer grain insight into patterns of registration than might otherwise be possible with GP or area level data. These bespoke patient service communities allow for the comparison of a practice population against the resident population, and an analysis of how local communities sort and order themselves by care provider can be made.ResultsEvidence from Southwark suggests that patient ethnicity is a major factor in the sorting of population by GP surgeries, with some groups, notably African, Muslim and East Asian patients, being over twice as likely to use particular surgeries than might be expected given their proportion in the normal resident population. As GP service is a constrained system, concentrations in one location can lead to dispersions at others, and a distinct re-mapping of population between residence and service.ConclusionThis research uncovers the spatial dynamics that define patterns of GP registration, demonstrating that the characteristics of patient lists can differ depending on how a community is defined. Insights of this nature are key to a better understanding of how healthcare can be managed, commissioned and improved. They stress the need for robust spatial understandings of “local communities”, and highlight that the patient choice agenda is largely already in effect for dense, diverse urban environments. Improvements in care, particularly by GP-led groups, will come from a better understanding of patient and place.
PP19 Formative Evaluation of a Community-based NHS Health Check Service
Authors: Visram S 
Published: September 2013

BackgroundCardiovascular disease (CVD) is the leading cause of death in the UK. The national CVD prevention strategy centres on the NHS Health Check Programme, which involves offering a vascular risk assessment to those aged 40-74 years without established disease. It is estimated that the programme could prevent 9,500 cardiovascular events and 2,000 deaths each year, if there is universal uptake. Durham County Council commissioned a health check service to be delivered in the community by health trainers. Socioeconomic deprivation is associated with higher risk of CVD, yet response rates for screening programmes tend to be lower in deprived areas. The service targets those who would not usually access screening and offers them tailored lifestyle support, thereby addressing health inequalities.MethodsA mixed methods design was used to evaluate the implementation, acceptability and impact of this service, involving:i) Secondary analysis of monitoring data from all clients between January and June 2012 (n = 774). Descriptive and summary statistics were produced.ii) Interviews and focus groups with a purposive sample of staff and key stakeholders (n = 20). A thematic content approach was used to analyse all transcripts and field notes.iii) Summary data obtained from anonymous patient experience questionnaires (n = 181).ResultsWomen who accessed the service were more likely than men to be eligible for a health check (34% vs. 27%); yet eligible men were more likely to attend the health check (59.4% vs. 33.8%). More than half (57.6%) of clients were under the age of 50 and a similar proportion (60.5%) were from socioeconomically deprived areas. However, only 32.7% of those from the least affluent areas accepted the offer of a health check, in comparison with 44.4% from more affluent areas. More than half (57.4%) of the health checks resulted in a low CVD risk score, whereas 12.9% were high risk. Stakeholders perceived the service to be an effective way of engaging people from target communities in conversations about their health. It was felt that many clients would not have accessed support regarding their cardiovascular health from other providers. The vast majority (99%) of respondents to the patient experience questionnaire were satisfied with the service.DiscussionA community-based, health trainer-led service can add value by offering an alternative to health checks delivered in primary care settings. The service appears to be successful in engaging men and younger age groups. However, there is the potential for intervention-generated inequalities.
OP12 The Health Behaviours of Mothers in England: A Latent Class Analysis
Authors: Wardle H , Hall J , Graham H , Law C , McAloney K , Platt L 
Published: September 2013

BackgroundPromoting healthier lifestyles is at the heart of England’s public health strategy. The dominant focus has been on single health behaviours; however, most adults engage in multiple risk behaviours. Very few studies have investigated patterns among parents and children. This paper focuses on four health behaviours among mothers; part of a broader project examining multiple risk behaviours among parents and children.MethodsData from theHealth Survey for England(years 2006 and 2008) identified 4,218 mothers living with children under the age of 16. Latent Class Analysis classified mothers into groups with differing combinations of cigarette smoking, alcohol, fruit and vegetable consumption and physical activity engagement. Logistic regression identified the characteristics associated with membership of each group.ResultsSix mutually exclusive groups of mothers were identified. The first (31% of mothers) had average fruit, vegetable and alcohol consumption, average physical activity engagement and were non-smokers. This group had higher income levels than other mothers. The second group had lower levels of alcohol consumption, were non-smokers with lower physical activity levels. They were from lower income groups. The third group drank alcohol most regularly, were cigarette smokers and had lower physical activity engagement and fruit and vegetable consumption. These women were more likely to be single and to be in employment. The fourth group were frequent consumers of alcohol but had high levels of fruit and vegetable consumption and higher engagement in physical activity. They had higher levels of educational attainment than other mothers. The fifth group were either ex or current smokers, infrequent drinkers, average engagers in sports physical activity but had higher fruit and vegetable consumption. They were more likely to live in rented accommodation. The sixth group were current cigarette smokers with lower physical activity engagement, lower fruit and vegetable consumption and were infrequent drinkers. A higher proportion of this group lived in more deprived areas.DiscussionThis analysis shows for the first time for mothers in England, how risk behaviours cluster and the differential social patterning associated with the clusters. It indicates how targeted interventions aimed at different ‘risk’ groups may be appropriate. These implications will be discussed.
PP24 Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications to People with Dementia Living in Residential Care: A Systematic Review
Authors: Coon J Thompson , Abbott R , Rogers M , Whear R , Pearson S , Lang I , Cartmell N , Stein K 
Published: September 2013

BackgroundThe use of antipsychotic medications in dementia is associated with increased mortality. A significant proportion of long-term antipsychotic use is believed to be inappropriate. The Department of Health National Dementia Strategy recently targeted a two-thirds reduction in antipsychotic usage. The aim of this review is to explore qualitative and quantitative literature to identify interventions that have been used to reduce inappropriate prescribing of antipsychotics and the barriers and enablers to the implementation of these interventions.MethodsPotentially relevant papers were identified in the following ways i) electronic searches inMedline, PsycINFO, Embase, AMED, Social Policy and Practice including AgeInfo (OvidSp); CDSR, CENTRAL (Cochrane Library); CINAHL (EBSCOhost); British Nursing Index, AMED (NHS Evidence) and Science Citation Index and Social Science Citation Index (Web of Science) from inception to November 2012, ii) forward and backward citation chases, iii) hand searches of review papers identified in the search, iii) searching of relevant organisations’ websites. All comparative studies were included. Screening of articles for inclusion, data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary.ResultsEleven studies (involving staff and patients in 55 care homes) met the inclusion criteria. All reported quantitative data. Studies were conducted in the UK (n = 4), Canada (n = 2), USA (n = 2) Australia (n = 1) and Norway (n = 1). Studies were of varied design with associated quality issues. No papers in which barriers to the implementation of interventions had been studied were identified. All interventions were unique and involved the delivery of an education or training package (n = 5), the use of in-reach teams in which regular visits by psychiatrists, mental health nurses and psychologists enabled regular patient review in the care home (n = 4), audit followed by feedback and re-audit (n = 1) or regular review, education and the development of a behavioural management approach (n = 1). In all studies, the proportion of residents receiving antipsychotic medication was reduced following the intervention.ConclusionThere is some evidence to suggest that simple changes to the way patients are reviewed and monitored and/or enhanced education and training can reduce the prescription rates of antipsychotics for people with dementia living in residential care. In order to guide best practice in this area, further qualitative study is required to explore the barriers and enablers to successful implementation of these interventions. Large rigorous studies with extended post-intervention data collection are also necessary to ascertain the long term impact on prescribing practices.
PP31 Fertility Rates in Women with Inflammatory Bowel Disease Compared with the General Female Population: A United Kingdom Population-Based Cohort Study
Authors: Ban L , Tata I J , Fiaschi L , Card T 
Published: September 2013

BackgroundPrevious studies have raised concerns about reduced fertility in women diagnosed with inflammatory bowel disease (IBD). Our objectives were to compare estimates of age-specific fertility rates in women with and without IBD and to assess whether relative fertility was different before and after clinical diagnoses in comparison with the general female population.MethodsWe included all women aged 15 to 44 years between 1990 and 2010 from a large United Kingdom primary care database. Women with IBD were defined as those with a clinically diagnosed IBD in their medical records. Each woman was assigned an IBD diagnosis date corresponding to the date of the first record of IBD or the date of the first prescription of 5-aminosalicylic acid (excluding sulfasalazine) if this was before the first diagnostic recording. We estimated overall and age-specific fertility rates by 5-year age bands as the number of live births per 1000 person-years for all women with IBD and separately during the time before and after first clinical recognition, using Poisson regression to compare rates in women without IBD in the general population. Maternal smoking and socioeconomic status were added into the univariate model one at a time and variables that changed the magnitude of the fertility rate ratios by at least 10% were retained in the final model. We also calculated fertility rates for women with Crohn’s disease (CD) and ulcerative colitis (UC) separately.ResultsFertility rates were 46.2 (95% CI 44.6, 47.9) and 49.3 (49.2, 49.5) live births per 1000 person-years in 9,639 women with IBD and 2,131,864 without IBD, respectively (rate ratio [RR] 0.94 [0.90, 0.97]). Age-specific fertility rates showed that the lower fertility rates in women with IBD were restricted to the 15-24 and 35-44 year age groups. Fertility rates were low in women with IBD after diagnosis (RRs compared with women never clinically diagnosed with IBD 0.88 [0.84, 0.93], 0.91 [0.85, 0.98] and 0.85 [0.79, 0.93] for IBD overall, CD and UC respectively), but not before.ConclusionCompared with women in the general population, women with IBD have decreased fertility especially after they are clinically diagnosed. Gastroenterologists and obstetricians should be aware of women’s fertility plan and are advised to communicate this information to women with IBD.