bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP59 Predictors of Depressive Symptoms After Stroke: Longitudinal data Analysis of the Stroke Outcomes Study 2 (SOS2)
Authors: Munyombwe T , West R M , Hill K M 
Published: September 2013

BackgroundThere is a lack of studies that model patient-specific recovery patterns in depressive symptoms after stroke. Patient- specific recovery patterns provide insight into how patients progress overtime, critical time periods and time varying factors that influence these recovery patterns. This study used a multilevel modelling approach to indentify trajectories of depressive symptoms after stroke and investigated the effect of socio-demographic factors and baseline stroke severity on recovery patterns after stroke.Data Secondary data analysis of 592 stroke patients who participated in a stroke outcomes study (SOS2) was conducted. The General health questionnaire (GHQ) 28 depressive and anxiety subscales were assessed at multiple time points over a year (3, 6, 13, 26 and 52 weeks). Average recovery trajectories for anxiety and depression subscales were characterised using multilevel modelling approach. Random intercept and random slopes models were preferred based on change in deviance. The predictors were age, sex, marital status, education, ethnicity and presence of hemianopia, occupation, house ownership, smoking, baseline stroke severity measured by Barthel index and River mead mobility index.ResultsThe mean age of the sample was 70.34 (SD 11.89) and 253(43%) were female. The average anxiety and depressive trajectories showed that most change occurred in the initial-13 week period. Female gender (B = 1.029; SE = 0.288), younger age (B = -0.035; SE = 0.015), presence of hemianopia (B = 1.251: SE = 0.497), increased baseline stroke severity (B = -0.073; SE = 0.029), living in a council/tenant house (B = 1.026; SE = 0.315) were associated with increased anxiety symptoms.ConclusionMultilevel modelling has indicated that most change in depressive symptoms after stroke occurs in the initial 13 week period. Gender, place of residence, age, presence of hemianopia and baseline stroke severity are significant predictors of depressive symptoms after stroke
PP60 Probable Airflow Obstruction in Adults: Data from the Health Survey for England 2010
Authors: Scholes S , Moody A , Hawkins N , Mindell J 
Published: September 2013

BackgroundIn the UK, chronic obstructive pulmonary disease (COPD) causes approximately 25,000 deaths annually. Around three million people are estimated to have COPD, of whom fewer than one-third have been diagnosed. Using spirometry, fixed thresholds (FT) and lower limit of normal (LLN) criteria define airflow obstruction (AO) differently. FTs use cut-offs for lung function measurements regardless of age, sex, height and ethnicity; LLN criteria use cut-offs (e.g. 5th centile) based on normalised values for a healthy person of a given age, sex, height and ethnic group. Although FTs are widely used, LLN criteria are recommended in epidemiological studies as FTs overestimate AO in the elderly due to age-related changes in lung function.MethodsThe Health Survey for England 2010 focused on respiratory health and included spirometry (without bronchodilators) in a nationally representative random general population sample. For participants aged ≥45years without asthma (n = 1635), we estimated the prevalence of self-reported doctor-diagnosed COPD. Using the Global Lungs Initiative 2012 multi-ethnic reference equations, prevalence rates of probable AO were estimated using four definitions:FT: FEV1/FVC<0.70FT + : FEV1/FVC<0.70andFEV1<80% predictedLLN: FEV1/FVCLLN + : FEV1/FVC and FEV1These definitions areoverlapping. We estimated the prevalence of COPD within each probable AO group. Potential risk factors for COPD or for probable AO were analysed using logistic regression (five separate outcomes).Results5% of participants reported doctor-diagnosed COPD. The prevalence of probable AO was 24% (FT), 12% (FT +), 14% (LLN) and 7% (LLN +). 17% of participants in the FT + group reported COPD compared with 24% of participants in the LLN + group. Pack-years smoked and respiratory symptoms significantly increased the odds of COPD and of AO after adjustments for age, sex, socioeconomic status and exposure to passive smoking. Compared with never regular smokers, those with 50 + pack-years had 5.8 (95% CI 2.6, 13.0) times higher odds of reporting diagnosed COPD, and 5.5 (3.0, 10.3) and 6.8 (3.2, 14.8) times higher odds of probable AO by FT + and LLN + criteria, respectively. Participants with respiratory symptoms had 2.5 (1.1, 5.7), 2.0 (1.0, 4.0) and 2.8 (1.3, 5.7) times higher odds of COPD/AO respectively than those without respiratory symptoms. Participants meeting LLN probable AO criteria had higher odds of diagnosed COPD: FT 2.0 (1.2, 3.5); FT + 40 (2.2, 7.1); LLN 4.2 (2.4, 7.3); LLN + 5.7 (3.0, 10.8).ConclusionAs post-bronchodilator spirometry was not used in HSE 2010, our results may overestimate thetrueprevalence of AO, but this large population survey confirms that substantial underdiagnosis of COPD remains likely. LLN criteria appear to identify fewer, more severely affected individuals than FT criteria.
PP61 Neighbourhoods and Ethnic Differences in Biological ‘Wear and Tear’
Authors: Molaodi O R , Leyland A H , Ellaway A , Kearns A , Harding S 
Published: September 2013

BackgroundWe recently showed that ethnic minorities tend to live in deprived neighbourhoods with a high density of fast food outlets and less green space. We examine whether these neighbourhood characteristics were associated with ethnic differences in biological ‘wear and tear’. The hypothesis is that ethnic minorities may experience early physiological deterioration as a result of persistent high level coping with chronic neighbourhood stressors.MethodsIndividual level data from the Health Surveys for England (1999 and 2004) were combined with area level data on neighbourhood food and physical activity environments, deprivation and ethnic density. A summary biological risk score, allostatic load – AL, was created from nine biological indicators of elevated risk; serum levels of C-reactive protein, fibrinogen, glycated haemoglobin, total and high-density lipoprotein cholesterol, BMI, waist, and systolic and diastolic blood pressure. Multi-level models examined ethnic differences in AL, as a continuous (0–9) and dichotomous (> = 4) score, in relation to neighbourhood and individual level characteristics.DiscussionBlack Caribbeans, Pakistani and Bangladeshis had a higher probability of a mean and high risk AL score than Whites, increasing with age, and more clearly delineated among women than men. Individual and area deprivation were related to AL but did not explain ethnic differences in AL. The density of fast food outlets, supermarkets, physical activity facilities, or ethnic density was not associated with AL.ConclusionLiving in deprived neighbourhoods was associated with greater biological wear and tear, independent of individual socio-economic circumstances, but did not explain the worse physiological profiles of some ethnic groups.
PP66 Positively Living Positively Working - Lifestyle Behaviours in a Working and Non-Working Population
Authors: McCarthy V J C , Perry I J , Greiner B A 
Published: September 2013

BackgroundThe difference between a working and a non-working middle to older aged population and their lifestyle behaviours has not been investigated previously. Furthermore, the association between positive job characteristics for current older workers and the co-occurrence of positive lifestyle behaviours (PLBs) is scarcely known.MethodsWe carried out a cross-sectional study on a sample of 2,047 males and females aged between 50-69 years. Data were collected on socio-demographic factors, and on PLBs (five or more portions of fruit and vegetables a day, ex/non-smoker, light alcohol intake and high/moderate physical activity). Just over half the sample were current workers (n= 1,025). Job characteristics were determined using the Copenhagen Psychosocial Questionnaire, specifically looking at demands and resources at work. Descriptive statistics were used to examine PLBs for the complete sample (workers and non-workers). Multinomial logistic regression was used to investigate job characteristics and the co-occurrence of PLBs for workers only.ResultsThe average PLBs were higher for the worker than the non-worker across most socio-demographic factors. Non-workers, with low levels of education, had lower mean PLBs. Workers with medium or high demands were significantly more likely to have 2 (OR 2.84 [95% CI 1.15, 7.02], p=0.02), 3 (3.54 [1.43, 8.75], p=0.01) and 4 (4.99 [1.90, 13.11], p<0.01). PLBs versus none, in comparison to those with low demands. In addition workers with medium/high possibility for development were more likely to have 2 (2.95 [1.19, 7.29], p=0.02), and 3 (2.81 [1.14, 6.93], p=0.03) PLBs versus 0 in comparison to those with low possibility for development.DiscussionWorkers and non-workers differ with regard PLBs however, within workers, those with higher demands in work also have more PLBs. This is counter-intuitive, but may be the result of looking at the modern workplace with a modern tool. These findings can help inform health promotion initiatives in our communities and workplaces.
PP68 Prevalence and Risk Factors of Poor Sleep in a Community-Dwelling Older Population: Findings from the Hertfordshire Cohort Study
Authors: Denison H J , Jameson K A , Baird J , Dennison E M , Edwards M H , Patel H P , Cooper C , Sayer A Aihie 
Published: September 2013

BackgroundPoor sleep is associated with morbidity and mortality, and research indicates that poor sleep quality is common in older people. The aim of this investigation was to determine the prevalence and risk factors of poor sleep in a community-dwelling older population.MethodsThe target population was 591 men and women aged 71-80 years from the Hertfordshire Cohort Study. 443 (75.0%) agreed to participate. Sleep was assessed using the validated Pittsburgh Sleep Quality Index (PSQI) in a self-administered questionnaire. The response rate was 91.7% (n = 406). The PSQI assesses a variety of factors related to sleep quality, including estimates of duration and latency and the frequency of specific sleep disturbances. A PSQI score of >5 indicates poor sleep quality.Results153 (41%) participants had a PSQI score of > 5. The majority (97.3%) reported at least one symptom of disturbed sleep occurring at least once in the past month. The most commonly reported reason for disturbed sleep was getting up to use the bathroom, with 240 (60.3%) participants reporting that this woke them at least 3 times a week. 52 (13.1%) participants reported having taken medication to help them sleep at least once in the past month.Smoking was associated with sleep duration in men but not women, with men who had ever smoked sleeping 35 minutes less compared to those who had never smoked (95% CI 16, 54, p < 0.001). Self-rated general health was also associated with sleep duration in men but not women, with men who rated their general health as fair/bad/very bad sleeping 46 minutes less than those who rated their health as good/very good (95% CI 21, 71, p < 0.001). Women, but not men, with great or some difficulty making ends meet financially were more likely to have a PSQI score >5 compared to those who easily made ends meet (OR 4.0, 95% CI 1.5, 11.0, p = 0.007). In both men and women, worse self-rated general health was significantly associated with a PSQI score of >5 [OR (95% CI) for fair/bad/very bad health compared to good/very good health: 5.0 (2.3, 11.0), p < 0.001 for men, 2.8 (1.4, 5.8), p = 0.005 for women]. Age, BMI, weight and height were not associated with either sleep duration or poor sleep (PSQI > 5).ConclusionThere was a high prevalence of poor sleep in this population. These findings reinforce the need for sleep assessment to be included in routine medical examinations of older people, especially in those with poorer general health.
PP69 Occupational Sedentary Time, Socioeconomic Position, and Obesity
Authors: Coombs N , Stamatakis E 
Published: September 2013

BackgroundHigher status occupations are associated with higher levels of occupational sedentary time, yet lower levels of obesity compared to lower social class groups. We hypothesised that leisure-time physical activity and sedentary time explain this paradox: when not at work individuals in higher status occupations spend more time physically active and less time sedentary, offsetting their sedentary jobs. This study examines if the positive association between occupational sedentary time and obesity persists after adjustment for leisure-time physical activity and leisure-time sedentary time.MethodsThe sample comprised of 4282 economically active participants from the 2008 Health Survey for England (mean age 43.4 ± 13.2, 2160 women). Respondents reported sedentary time at work (sitting/standing), TV viewing, leisure-time non-TV sitting and moderate to vigorous physical activity (MVPA). Logistic regression models were run for obesity (BMI> = 30) with occupational sedentary time, TV time, non-TV leisure-time sitting, and leisure-time MVPA as main exposures. Covariates included age, sex, indicators of socioeconomic position (occupational social class, household income quartile, highest educational qualification and area deprivation quintile) smoking status, frequency of alcohol consumption, and frequency of fruit and vegetable consumption. The complex sample design was taken into account and non-response weights applied.ResultsOccupational sedentary time was associated with obesity after adjusting for TV time and leisure-time MVPA (OR 1.08 per hour [95% CI 1.04, 1.12]). Leisure-time non-TV sitting was not associated with obesity. TV time was positively associated with obesity (1.2 [1.14, 1.27]), and leisure-time MVPA was negatively associated with obesity (0.8 [0.7, 0.9]).ConclusionThe associations between occupational sedentary time and obesity were independent of leisure-time sedentary behaviour and MVPA. Sedentary occupations are associated with obesity regardless of occupational social class, TV viewing and leisure-time MVPA. Lower levels of obesity among higher social class groups, despite higher levels of occupational sedentary time, cannot be explained by leisure-time sedentary and physical activity behaviours.
PP73 Evaluation of a Regional Health Trainer Programme; Reaching the Parts others do not Reach
Authors: Lees K , Rahman E , Parkes J 
Published: September 2013

BackgroundThe NHS South Central Health Trainers Programme includes 7 Health Trainer (HT) services in the South Central area (n = 73 staff). The programme aims to engage the ‘hard to reach’, deliver sustained improvements to the health of the people through behavioural change, provide access to and encouraging the appropriate use and take up of NHS and other local services, and increase capacity and capability of the community.MethodsWe conducted an analysis on the HT dataset that reported service activity over time; service users demographics; assessment process, health gains, and the HT profile data (April 2006 - March 2012). Data were described, using descriptive statistics and compared to national, regional or local comparators. The findings were evaluated against overall aims of the service.ResultsThe HT Service saw 9,959 people (2006-2012). The number of people seen increased year by year. 59% (n = 5822) seen by the HT service were women. 74% (n = 7338) stated ethnicity as White British. Over 15% of HT service users are from an ethnic minority other than White British, which is higher compared to the SE population. The majority of people seen lived in the two most deprived quintiles (over 90%), suggesting HTs are targeting people living in the most deprived communities. 10% of people seeing HT were not registered with a GP, and are therefore a ‘hard to reach’ group, for the NHS. Just over half (n = 5113) of people seen had their primary issue recorded, the most common issue of those recorded, was diet (56% 2865/5113).HTs recorded agreed behavioural goals with just over 4/10 of their service users. Over three quarters of those who agreed behavioural goals made a full or partial behavioural change. HTs signposted 34% of service users to other services, which included a wide range of NHS and other local services. Much of the data regarding service users’ health behaviours and health outcomes was missing. Robust data is vital in order to monitor evaluate and improve the service. The service should review data fields to ensure usefulness, ensure staff capacity training and motivation for data entry.ConclusionHealth Trainers are a valuable workforce engaging with more deprived populations and data suggests that they have a positive effect on lifestyle behavioural change. However data is incomplete and of only moderate quality. Better recording with high quality robust data would facilitate evaluation of the service, and enable estimates of effectiveness and sustainability to be demonstrated.
PP76 Exploring Barriers and Solutions to take up of Interventions to Address Fuel Poverty: A Health Impact Assessment of Fuel Poverty Policy in England
Authors: Ogilvie F , Earwicker R , Petrokofsky C , Wynne P , Jenkins S , Coates H 
Published: September 2013

BackgroundFuel poverty – whereby households are unable to keep warm at reasonable cost – is an on-going problem within the UK. There are known health impacts of living in cold homes, and a number of free or subsidised interventions are available to help address fuel poverty. There is however concern that such interventions are not being taken up by those in greatest need. A Health Impact Assessment (HIA) was therefore conducted to explore barriers and solutions to take up of interventions to address fuel poverty in England, in order to make policy recommendations to the Department of Energy and Climate Change (DECC).MethodsIn line with the HIA steps of screening; scoping; profiling; evidence gathering and appraisal; and making recommendations; we formed a steering group of staff from the Department of Health and DECC to set the scope of the HIA. We used data from the 2010 English Housing Survey to explore the socio-demographic profile of fuel poor households, and reviewed the evidence on the health impacts of fuel poverty on different population sub-groups. We conducted a literature review to explore barriers and potential solutions to take up of fuel poverty interventions, and used the findings from the HIA to develop policy recommendations.ResultsWhile there are known health impacts of outdoor and indoor cold, the relationship between fuel poverty and health is complex, with a lack of evidence for specific impacts on population sub-groups such as those with disabilities and the elderly. Barriers to take up of existing fuel poverty interventions include lack of perception of need; lack of knowledge about options and their benefits; difficulty accessing further information; and unwillingness or inability to take action. A number of initiatives have tried to promote take up of interventions, however none have been robustly evaluated, meaning little is known about which are most effective.ConclusionThe findings from the HIA led to policy recommendations for improving the understanding of the relationship between fuel poverty and health, including the relationship between fuel poverty and excess winter deaths; improving the match between fuel poor households and those who are eligible for interventions to address fuel poverty; collecting data on the characteristics of households that do not take up interventions they are eligible for; addressing the known barriers to take up of interventions to address fuel poverty; evaluating the effectiveness of programmes that aim to address low take up of interventions; and ensuring on-going cross-government working.
PP77 Changes Ahead – Again! Lessons Learned from a Study Exploring Receptivity to Policy Changes in NHS Commissioning
Authors: McCafferty S , Bate A , Finch T , McGovern T 
Published: September 2013

BackgroundIn the National Health Service (NHS) in England commissioning is the process of prioritising resources to ensure that health and care services are provided effectively to meet the needs of the population. Commissioning policy has been subject to extensive tremendous reforms and recent years have witnessed the introduction and termination of the ‘World Class Commissioning’ (WCC) initiative, the White Paper ‘Equity and Excellence: Liberating the NHS’ and the subsequent transfer of commissioning responsibility from primary care trusts (PCTs) to clinical commissioning groups (CCGs). The impact of these reforms and how receptive organisations are to these policy changes is not fully understood. This research utilised the opportunity of the changing policy landscape as a natural experiment to explore the receptivity of a commissioning organisation to these changes.MethodsA case study approach was adopted within one PCT following its evolution to CCG. A series of in-depth interviews were conducted across three time points (n = 11, total 34), to understand organisational responses to changes in commissioning policy. Thematic analysis and a constant comparative approach were used to identify themes.ResultsThis research identified the key factors influencing the organisation’s ability to deliver policy objectives, in terms of key relationships structures and processes. Four key factors were identified. These were: policy, change agenda and locale, culture, and system management. Sub themes within these factors were also identified, particularly of note were: the level of commitment generated through the policy, the clarity of goals, historical working practices and perceptions of power.ConclusionThese results have significant implications for emerging CCGs and provide guidance for future policy development. Previous commissioning policy initiatives have failed to adequately manage and address issues within the broader NHS system. Further continual reorganisation was found to be particularly disruptive. Results suggest that commissioning organisations are likely to be more receptive to future commissioning policies which are coherent, feasible and generate buy-in from key stakeholders. During this time of extended policy change transitions need to be carefully managed to avoid loss of valuable expertise.