Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.31
M. Pothoulaki, G. Vojt, F. Mapp, C. Mercer, C. Estcourt, M. Woode-Owusu, J. Cassell, S. Wayal, M. Symonds, R. Nandwani, J. Saunders, P. Flowers
Background Partner notification (PN) is a key strategy for sexually transmitted infection (STI) management to reduce transmission and improve population health. It involves contacting sexual partners of people diagnosed with an STI and encouraging testing and treatment to prevent onward transmission, and re-infection. Current UK PN practice tends to conceptualise sexual partner types as ‘regular’ or ‘casual’. However these terms do not sufficiently capture diverse sexual behavioural patterns or STI transmission risk. Given this context, we explored the social relevance, understandings and meanings of contemporary sexual partner types, as a first step in aligning lived realities with clinical practice to improve PN outcomes. Methods We conducted eleven semi-structured focus groups (November 2016-August 2017), with members of the public (n=38) and sexual health clinic attendees diagnosed with an STI in the past six months (n=19) in England and Scotland. We recruited participants aged 18–65 years who identified as heterosexual or men who have sex with men (MSM), using purposive and convenience sampling. Data were digitally recorded, transcribed and analysed using thematic analysis in NVivo V.10. Results Findings from the 57 participants (male n=34; female n=23), suggested two key themes in understanding sexual partner types: 1) nature of emotional involvement with the partner(s) and 2) time/continuity of the relationship. Both tapped into participants’ relationship perspectives and shaped their understandings and use of partner terms. Interrelated subthemes involved: the different contexts, such as clinical consultations or everyday social interactions, which shaped the use of the terms ‘regular’ and ‘casual’ and associated interpretations; and the polysemy and ambiguity of the terms when they were used in combination with other words (e.g. casual sex; casual partner; casual regular) and alternate terms (e.g. random, one-off, serious relationship). There were no differences in the understandings of the terms between heterosexual and MSM participants. Conclusion This is the first empirical evidence that challenges and provides insight into the dichotomy of sexual partner types in contemporary clinical practice. There is a need for a new socially informed, interdisciplinary classification of sexual partner types to enable better recording and communication between patients, sex partners and healthcare professionals. Improved understanding of partner types will help healthcare professionals develop and tailor PN approaches which address social and cultural influences on the way people form sexual relationships and talk about sex. This will enable targeting of resources to achieve greatest benefit to individual and population health by detecting and preventing STI transmission.
{"title":"OP31 Towards understanding the ‘partner’ in partner notification for sexually transmitted infection healthcare: moving beyond the dichotomy of ‘regular’ and ‘casual’ partners","authors":"M. Pothoulaki, G. Vojt, F. Mapp, C. Mercer, C. Estcourt, M. Woode-Owusu, J. Cassell, S. Wayal, M. Symonds, R. Nandwani, J. Saunders, P. Flowers","doi":"10.1136/jech-2018-SSMabstracts.31","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.31","url":null,"abstract":"Background Partner notification (PN) is a key strategy for sexually transmitted infection (STI) management to reduce transmission and improve population health. It involves contacting sexual partners of people diagnosed with an STI and encouraging testing and treatment to prevent onward transmission, and re-infection. Current UK PN practice tends to conceptualise sexual partner types as ‘regular’ or ‘casual’. However these terms do not sufficiently capture diverse sexual behavioural patterns or STI transmission risk. Given this context, we explored the social relevance, understandings and meanings of contemporary sexual partner types, as a first step in aligning lived realities with clinical practice to improve PN outcomes. Methods We conducted eleven semi-structured focus groups (November 2016-August 2017), with members of the public (n=38) and sexual health clinic attendees diagnosed with an STI in the past six months (n=19) in England and Scotland. We recruited participants aged 18–65 years who identified as heterosexual or men who have sex with men (MSM), using purposive and convenience sampling. Data were digitally recorded, transcribed and analysed using thematic analysis in NVivo V.10. Results Findings from the 57 participants (male n=34; female n=23), suggested two key themes in understanding sexual partner types: 1) nature of emotional involvement with the partner(s) and 2) time/continuity of the relationship. Both tapped into participants’ relationship perspectives and shaped their understandings and use of partner terms. Interrelated subthemes involved: the different contexts, such as clinical consultations or everyday social interactions, which shaped the use of the terms ‘regular’ and ‘casual’ and associated interpretations; and the polysemy and ambiguity of the terms when they were used in combination with other words (e.g. casual sex; casual partner; casual regular) and alternate terms (e.g. random, one-off, serious relationship). There were no differences in the understandings of the terms between heterosexual and MSM participants. Conclusion This is the first empirical evidence that challenges and provides insight into the dichotomy of sexual partner types in contemporary clinical practice. There is a need for a new socially informed, interdisciplinary classification of sexual partner types to enable better recording and communication between patients, sex partners and healthcare professionals. Improved understanding of partner types will help healthcare professionals develop and tailor PN approaches which address social and cultural influences on the way people form sexual relationships and talk about sex. This will enable targeting of resources to achieve greatest benefit to individual and population health by detecting and preventing STI transmission.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"21 1","pages":"A15–A16"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81237243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.182
L. Westbury, C. Gale, C. Cooper, Emily Dennison
Background Falls are a major cause of disability and death among older people, particularly women. Cross-sectional surveys suggest that some risk factors associated with a history of falls may be sex-specific but whether risk factors for incident falls differ between the sexes is unclear. This study investigated risk factors for incident falls and whether they differ between men and women. Methods Participants were 3298 men and women (aged 60 years and over at Wave 4) who took part in the Waves 4–6 surveys of the English Longitudinal Study of Ageing. At Wave 4, they provided information on previous falls, sociodemographic, lifestyle, behavioural and medical factors, and had their physical and cognitive function assessed. Data on self-reported incident falls during the four-year follow-up period were collected at Waves 5 and 6. Relative risks (RR) for the association between baseline characteristics and incident falls were derived using sex-specific Poisson regression models with robust variance estimation. Factors associated with falling (p<0.20) were included in sex-specific mutually-adjusted models. Analyses were performed among men and women separately and relative risks were adjusted for previous falls before Wave 4. Results Overall, 633 (41.8%) men and 863 (48.4%) women experienced an incident fall between Waves 4 and 6. In mutually-adjusted models, older age was the only factor associated with increased risk of incident falls in both sexes. Some factors were only predictive of falls in one sex, namely more depressive symptoms (RR (95% CI) 1.03 (1.01, 1.06)), incontinence (1.11 (1.00,1.24)) and never having married in women (1.26 (1.03,1.53)), and greater comorbidity (1.05 (1.00,1.09)), higher levels of pain (1.11 (1.04,1.18)) and poorer balance (1.25 (1.05,1.49)) in men. Of these, only the relationships between pain, balance and comorbidity and falls risk differed significantly (p<0.05) by gender according to interaction tests. Conclusion Older age was associated with increased risk of incident falls in both sexes. However, associations regarding pain, balance and comorbidity differed by gender. Strengths of the study include the large sample size and the fact that it is representative of the community-dwelling English population aged 60 years and over. However, one potential weakness is that there was no definition in the questionnaire of what constituted a fall. This research will inform the development of interventions to reduce the risk of falls among older people.
{"title":"P59 Risk factors for incident falls in older men and women: findings from the english longitudinal study of ageing","authors":"L. Westbury, C. Gale, C. Cooper, Emily Dennison","doi":"10.1136/jech-2018-SSMabstracts.182","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.182","url":null,"abstract":"Background Falls are a major cause of disability and death among older people, particularly women. Cross-sectional surveys suggest that some risk factors associated with a history of falls may be sex-specific but whether risk factors for incident falls differ between the sexes is unclear. This study investigated risk factors for incident falls and whether they differ between men and women. Methods Participants were 3298 men and women (aged 60 years and over at Wave 4) who took part in the Waves 4–6 surveys of the English Longitudinal Study of Ageing. At Wave 4, they provided information on previous falls, sociodemographic, lifestyle, behavioural and medical factors, and had their physical and cognitive function assessed. Data on self-reported incident falls during the four-year follow-up period were collected at Waves 5 and 6. Relative risks (RR) for the association between baseline characteristics and incident falls were derived using sex-specific Poisson regression models with robust variance estimation. Factors associated with falling (p<0.20) were included in sex-specific mutually-adjusted models. Analyses were performed among men and women separately and relative risks were adjusted for previous falls before Wave 4. Results Overall, 633 (41.8%) men and 863 (48.4%) women experienced an incident fall between Waves 4 and 6. In mutually-adjusted models, older age was the only factor associated with increased risk of incident falls in both sexes. Some factors were only predictive of falls in one sex, namely more depressive symptoms (RR (95% CI) 1.03 (1.01, 1.06)), incontinence (1.11 (1.00,1.24)) and never having married in women (1.26 (1.03,1.53)), and greater comorbidity (1.05 (1.00,1.09)), higher levels of pain (1.11 (1.04,1.18)) and poorer balance (1.25 (1.05,1.49)) in men. Of these, only the relationships between pain, balance and comorbidity and falls risk differed significantly (p<0.05) by gender according to interaction tests. Conclusion Older age was associated with increased risk of incident falls in both sexes. However, associations regarding pain, balance and comorbidity differed by gender. Strengths of the study include the large sample size and the fact that it is representative of the community-dwelling English population aged 60 years and over. However, one potential weakness is that there was no definition in the questionnaire of what constituted a fall. This research will inform the development of interventions to reduce the risk of falls among older people.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"44 1","pages":"A86–A87"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79954686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.23
L. Ng Fat, S. Bell, A. Britton
Background Hazardous drinking among older adults is a growing concern, however there is limited research on the effect of chronic versus acute hazardous drinking among older people, and how the effects vary across life. This study among older adults, explores the association of positive AUDIT-C scores across life with objective biomarkers of cardio-metabolic health. Methods Analyses were undertaken among 4820 civil servants aged 59–83 years, within the prospective Whitehall II study, who answered the life-grid AUDIT-C inventory during the 2011–2012 survey and provided biological measurements (264 non-drinkers were excluded). Lifetime hazardous drinking groups were defined using a threshold of ≥5, at each decade of life from age 16 to 80+. These groups were as follows; never hazardous-drinker (reference), former hazardous-drinker1 (before age 50), former hazardous-drinker2 (after age 50), current hazardous-drinker (past hazardous-drinker sporadically), stable hazardous-drinker (hazardous-drinker in every decade). Similar groups were created for lifetime binge-drinking categories; never/former/current/stable binge-drinker (AUDIT-3 ≥2). Fully-adjusted linear regression was carried out on cardio-metabolic biomarkers including: waist circumference (WC, measured in cm), body mass index (BMI, kg/m2), total cholesterol (TC, mmol/L), systolic (SBP, mmHg) and diastolic (DBP, mmHg) blood pressure, gamma-glutamyl transferase (GGT), fatty-liver index scores (FLI) and lifetime hazardous/binge drinking as exposure, using STATA15. Covariates included sex, age, socio-economic position, ethnicity, smoking status, physical activity, BMI and fruit and vegetable consumption. Results Over half of the sample had been a hazardous-drinker at some point; Current hazardous-drinkers (21%), former hazardous-drinkers1 (
{"title":"OP23 Associations between lifetime hazardous drinking and associations between lifetime hazardous drinking and biomarkers of cardiometabolic health and liver function among older adults: findings from the whitehall II prospective cohort study","authors":"L. Ng Fat, S. Bell, A. Britton","doi":"10.1136/jech-2018-SSMabstracts.23","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.23","url":null,"abstract":"Background Hazardous drinking among older adults is a growing concern, however there is limited research on the effect of chronic versus acute hazardous drinking among older people, and how the effects vary across life. This study among older adults, explores the association of positive AUDIT-C scores across life with objective biomarkers of cardio-metabolic health. Methods Analyses were undertaken among 4820 civil servants aged 59–83 years, within the prospective Whitehall II study, who answered the life-grid AUDIT-C inventory during the 2011–2012 survey and provided biological measurements (264 non-drinkers were excluded). Lifetime hazardous drinking groups were defined using a threshold of ≥5, at each decade of life from age 16 to 80+. These groups were as follows; never hazardous-drinker (reference), former hazardous-drinker1 (before age 50), former hazardous-drinker2 (after age 50), current hazardous-drinker (past hazardous-drinker sporadically), stable hazardous-drinker (hazardous-drinker in every decade). Similar groups were created for lifetime binge-drinking categories; never/former/current/stable binge-drinker (AUDIT-3 ≥2). Fully-adjusted linear regression was carried out on cardio-metabolic biomarkers including: waist circumference (WC, measured in cm), body mass index (BMI, kg/m2), total cholesterol (TC, mmol/L), systolic (SBP, mmHg) and diastolic (DBP, mmHg) blood pressure, gamma-glutamyl transferase (GGT), fatty-liver index scores (FLI) and lifetime hazardous/binge drinking as exposure, using STATA15. Covariates included sex, age, socio-economic position, ethnicity, smoking status, physical activity, BMI and fruit and vegetable consumption. Results Over half of the sample had been a hazardous-drinker at some point; Current hazardous-drinkers (21%), former hazardous-drinkers1 (<age 50) (19%), former hazardous-drinkers2 (≥age 50) (11%) stable hazardous-drinker (5%). After adjusting for co-variates, hazardous-drinkers had a larger WC than never hazardous-drinkers (former hazardous-drinkers1 (&bgr;=1.17 [95% CI 0.25, 2.08]); (former hazardous-drinkers2 (1.88 [95% CI 0.77, 2.98]); current hazardous-drinkers (2.44 [1.55, 3.34]) and stable hazardous-drinkers (3.85 [2.23, 5.47])). A similar linear association along more current and frequent hazardous-drinking was also found with BMI. Current hazardous-drinkers had higher SBP (2.44 [1.19, 3.68]), log (GGT) (22.64 [18.27,27.02]) and FLI scores (4.05 [2.92, 5.18]) than never hazardous-drinkers, and so did stable hazardous-drinkers (sbp (2.78 [0.53, 5.04]), log(GGT) (17.94 [10.12, 25.75]), FLI (3.76, [1.75, 5.77])). Similar associations with waist, sbp, GGT, and FLI outcomes were found for lifetime binge-drinkers. Conclusion Hazardous-drinking is common among older adults and may increase cardio-metabolic risk factors, this may be compounded by persistent hazardous-drinking across life. Population reductions in hazardous-drinking is likely to have immediate improvements in elderly, but also lon","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"26 1","pages":"A11–A12"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78541829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.12
O. Robison, G. Inglis, J. Egan
Background There is a lack of public health evidence on the impacts of being a young carer, with most evidence based on studies involving already identified carers. Young carers tend to have poorer health, education and employment outcomes compared with their peers. They are also more likely to live in areas with higher deprivation levels, and with a lone parent or adult(s) with long-term health conditions, all of which are disproportionately present in Glasgow. From April this year, local authorities and health boards across Scotland will be required to offer a ‘young carers’ statement, as stipulated by the Carers Act (2016). Using data from a schools survey (age range 11–18) in Glasgow, the research aimed to take a population approach to young carer research, specifically to:Investigate the prevalence of young carersExplore differences in their health, wellbeing and future expectations. Methods Secondary analysis of the 2014 NHS Greater Glasgow & Clyde health and wellbeing secondary school survey was undertaken (n=11,215). Pupils with caring responsibilities were identified. Their outcomes in terms of physical and mental health, and post-school expectations were analysed, using three-stage complete case regression analysis in SPSS. Results Almost one in eight (12%) surveyed reported caring for someone in the household. Almost a third (30.9%) stated that no-one knew about it. Over half cared for someone with a disability, a third for someone with a long-term condition, almost a quarter for someone with a mental health problem, and just over a tenth for someone with a drug or alcohol problem. Over and above background factors and presence of illness in the household, young carers physical and mental health outcomes were significantly poorer, particularly for those caring for a person with mental health or addictions issues. They were significantly less likely to see themselves entering further or higher education. Discussion This research suggests that Glasgow could have many more young carers than previously thought, and provides clear evidence that young people’s outcomes are influenced by carer status. Possible explanations for under-identification include stigma, fear of intervention and not identifying with the ‘carer’ role. In April, the implementation of new Scottish legislation will place a duty on public services to identify and support young carers. This could present future service challenges, in particular, ensuring that young people feel comfortable enough to disclose their carer status, and that effective support measures contribute towards improving their health outcomes and future prospects.
{"title":"OP12 A population approach to the health and future prospects of young carers in glasgow","authors":"O. Robison, G. Inglis, J. Egan","doi":"10.1136/jech-2018-SSMabstracts.12","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.12","url":null,"abstract":"Background There is a lack of public health evidence on the impacts of being a young carer, with most evidence based on studies involving already identified carers. Young carers tend to have poorer health, education and employment outcomes compared with their peers. They are also more likely to live in areas with higher deprivation levels, and with a lone parent or adult(s) with long-term health conditions, all of which are disproportionately present in Glasgow. From April this year, local authorities and health boards across Scotland will be required to offer a ‘young carers’ statement, as stipulated by the Carers Act (2016). Using data from a schools survey (age range 11–18) in Glasgow, the research aimed to take a population approach to young carer research, specifically to:Investigate the prevalence of young carersExplore differences in their health, wellbeing and future expectations. Methods Secondary analysis of the 2014 NHS Greater Glasgow & Clyde health and wellbeing secondary school survey was undertaken (n=11,215). Pupils with caring responsibilities were identified. Their outcomes in terms of physical and mental health, and post-school expectations were analysed, using three-stage complete case regression analysis in SPSS. Results Almost one in eight (12%) surveyed reported caring for someone in the household. Almost a third (30.9%) stated that no-one knew about it. Over half cared for someone with a disability, a third for someone with a long-term condition, almost a quarter for someone with a mental health problem, and just over a tenth for someone with a drug or alcohol problem. Over and above background factors and presence of illness in the household, young carers physical and mental health outcomes were significantly poorer, particularly for those caring for a person with mental health or addictions issues. They were significantly less likely to see themselves entering further or higher education. Discussion This research suggests that Glasgow could have many more young carers than previously thought, and provides clear evidence that young people’s outcomes are influenced by carer status. Possible explanations for under-identification include stigma, fear of intervention and not identifying with the ‘carer’ role. In April, the implementation of new Scottish legislation will place a duty on public services to identify and support young carers. This could present future service challenges, in particular, ensuring that young people feel comfortable enough to disclose their carer status, and that effective support measures contribute towards improving their health outcomes and future prospects.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"27 1","pages":"A6"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75189640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.138
Kd Ferguson, J. Lewsey, M. McCann, D. Smith
Background Causal inference methods are increasingly popular in health research, with directed acyclic graphs (DAGs) being notably prominent. Theoretically, DAGs are powerful tools for minimising bias in quantitative analysis, however their transition into practice has been problematic. Lack of guidelines for generating the ‘right’ DAG for research questions have been cited as a central reason. This study presents a solution in the form of ‘evidence synthesis for constructing directed acyclic graphs’ (ESC-DAGs). The approach embeds DAGs in a procedural evidence synthesis method which focuses on how to derive and integrate DAGs from research evidence in a transparent and systematic fashion. Methods For studies meeting inclusion criteria: 1) Appraisal of study quality with split focus on the degree of explicit causal thinking employed and on more generic study quality issues such as study design, sample size, etc; 2) Mapping of conclusions for each study using causal inference theory to produce an ‘implied graph’; 3) Translation of implied graphs into DAGs through procedural application of four ‘causal criteria’ to each relationship in the implied graph (temporality, plausibility, recourse to theory, counterfactual thought experiment); 4) Integration of DAGs, starting with those with the highest appraisal scores until all DAGs are integrated. The output is an ‘integrated-DAG’. ESC-DAGs is demonstrated on the exposure-outcome relationship of parental influences on adolescent alcohol harm. Results 30 studies were included. Study appraisal produces a scale with scores ranging from 0 to 5 (median=2). The DAGs produced for individual studies are substantially less comprehensive than the integrated-DAG (covering between 5% and 40% of causal pathways). Over 90% of the implied graphs were changed during the translation process. The most common changes reflect a strong tendency in research to either mistakenly control for mediation or for unjustified control of parallel risk factors. Conclusion As a methodological contribution to an increasingly popular form of health research, ESC-DAGs has broad relevance to population health. Through its systematic treatment of research evidence, ESC-DAGs is a reproducible and transparent process that is suitable for use by researchers with only minimal training on the causal inference methods. Compared to how DAGs have been constructed elsewhere, those generated from ESC-DAGs are more comprehensive and have greater potential to reduce bias. In meeting the need for guidelines on generating DAGs in such a way, ESC-DAGs represents an important step towards realising the potential of DAGs to improve the practice of health research.
{"title":"P12 How to build the ‘right’ directed acyclic graph (DAG): a systematic, transparent and accessible method for evidence synthesis","authors":"Kd Ferguson, J. Lewsey, M. McCann, D. Smith","doi":"10.1136/jech-2018-SSMabstracts.138","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.138","url":null,"abstract":"Background Causal inference methods are increasingly popular in health research, with directed acyclic graphs (DAGs) being notably prominent. Theoretically, DAGs are powerful tools for minimising bias in quantitative analysis, however their transition into practice has been problematic. Lack of guidelines for generating the ‘right’ DAG for research questions have been cited as a central reason. This study presents a solution in the form of ‘evidence synthesis for constructing directed acyclic graphs’ (ESC-DAGs). The approach embeds DAGs in a procedural evidence synthesis method which focuses on how to derive and integrate DAGs from research evidence in a transparent and systematic fashion. Methods For studies meeting inclusion criteria: 1) Appraisal of study quality with split focus on the degree of explicit causal thinking employed and on more generic study quality issues such as study design, sample size, etc; 2) Mapping of conclusions for each study using causal inference theory to produce an ‘implied graph’; 3) Translation of implied graphs into DAGs through procedural application of four ‘causal criteria’ to each relationship in the implied graph (temporality, plausibility, recourse to theory, counterfactual thought experiment); 4) Integration of DAGs, starting with those with the highest appraisal scores until all DAGs are integrated. The output is an ‘integrated-DAG’. ESC-DAGs is demonstrated on the exposure-outcome relationship of parental influences on adolescent alcohol harm. Results 30 studies were included. Study appraisal produces a scale with scores ranging from 0 to 5 (median=2). The DAGs produced for individual studies are substantially less comprehensive than the integrated-DAG (covering between 5% and 40% of causal pathways). Over 90% of the implied graphs were changed during the translation process. The most common changes reflect a strong tendency in research to either mistakenly control for mediation or for unjustified control of parallel risk factors. Conclusion As a methodological contribution to an increasingly popular form of health research, ESC-DAGs has broad relevance to population health. Through its systematic treatment of research evidence, ESC-DAGs is a reproducible and transparent process that is suitable for use by researchers with only minimal training on the causal inference methods. Compared to how DAGs have been constructed elsewhere, those generated from ESC-DAGs are more comprehensive and have greater potential to reduce bias. In meeting the need for guidelines on generating DAGs in such a way, ESC-DAGs represents an important step towards realising the potential of DAGs to improve the practice of health research.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"59 1","pages":"A66"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79210546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.160
B. Evans, Alan Brown, J. Bulger, G. Fegan, S. Ford, K. Guy, S. Jones, L. Keen, N. Rees, H. Snooks
Background Research to improve prehospital treatment and care requires the participation of clinical and managerial staff from ambulance services to test interventions and collect research data. Researchers work closely with individuals and organisations with prehospital clinical, managerial and policy expertise to plan, deliver and disseminate research evidence. A recent trial involved assessing feasibility of paramedics administering Fascia Iliaca Compartment Block (FICB) in place of morphine to patients with suspected hip fracture. Participation in the trial was voluntary. We explored paramedics’ motivation for participating in research through the RAPID (Rapid Analgesia for Prehospital Hip Disruption) trial. Methods We held three focus groups with 11 RAPID trial paramedics serving one district hospital, audio-recorded with participants’ consent. We conducted thematic analysis of interview transcripts. Two researchers, one paramedic and one lay member were in the analysis team. Results Paramedics believed their participation in research had benefits for patients, for them individually and for the paramedic profession. Respondents said that being part of a research project provided an opportunity to increase their skills and provide improved patient care. In the RAPID trial, they understood the potential risks and benefits of different medications and management for patients with suspected hip fracture and welcomed the chance to identify improved pain management for a vulnerable population. They felt proud to be learning and using a procedure usually administered by clinical staff: ‘This is quite specialised, like, hang on, I’m doing a really top job here, dealing with anaesthetics…blunt needles… it’s like ‘up there’. It’s not our everyday thing.’ More generally, respondents identified how research potentially contributed towards widening the scope of paramedic practice by extending their role into clinically specialist areas. They suggested that many paramedics were unwilling to undertake tasks perceived to exceed their pay-grades and shunned the opportunity to learn new techniques which were not routine care. In comparison, these paramedics saw themselves as trail-blazers for the profession, proud to be acquiring extra clinical responsibilities and skills. They also valued the chance to contribute to the evidence base, providing knowledge about using alternative medication which they instinctively felt would cause fewer complications and benefit patient mortality and morbidity. Conclusion Paramedics who take part in research believe they contribute to personal and professional development and potentially improve patient care. Future research with paramedics refusing research participation could explore barriers and different views on skills development, which may also inform implementation of new evidence-based interventions.
{"title":"P34 Paramedic trail blazers – why do paramedics take part in prehospital research?","authors":"B. Evans, Alan Brown, J. Bulger, G. Fegan, S. Ford, K. Guy, S. Jones, L. Keen, N. Rees, H. Snooks","doi":"10.1136/jech-2018-SSMabstracts.160","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.160","url":null,"abstract":"Background Research to improve prehospital treatment and care requires the participation of clinical and managerial staff from ambulance services to test interventions and collect research data. Researchers work closely with individuals and organisations with prehospital clinical, managerial and policy expertise to plan, deliver and disseminate research evidence. A recent trial involved assessing feasibility of paramedics administering Fascia Iliaca Compartment Block (FICB) in place of morphine to patients with suspected hip fracture. Participation in the trial was voluntary. We explored paramedics’ motivation for participating in research through the RAPID (Rapid Analgesia for Prehospital Hip Disruption) trial. Methods We held three focus groups with 11 RAPID trial paramedics serving one district hospital, audio-recorded with participants’ consent. We conducted thematic analysis of interview transcripts. Two researchers, one paramedic and one lay member were in the analysis team. Results Paramedics believed their participation in research had benefits for patients, for them individually and for the paramedic profession. Respondents said that being part of a research project provided an opportunity to increase their skills and provide improved patient care. In the RAPID trial, they understood the potential risks and benefits of different medications and management for patients with suspected hip fracture and welcomed the chance to identify improved pain management for a vulnerable population. They felt proud to be learning and using a procedure usually administered by clinical staff: ‘This is quite specialised, like, hang on, I’m doing a really top job here, dealing with anaesthetics…blunt needles… it’s like ‘up there’. It’s not our everyday thing.’ More generally, respondents identified how research potentially contributed towards widening the scope of paramedic practice by extending their role into clinically specialist areas. They suggested that many paramedics were unwilling to undertake tasks perceived to exceed their pay-grades and shunned the opportunity to learn new techniques which were not routine care. In comparison, these paramedics saw themselves as trail-blazers for the profession, proud to be acquiring extra clinical responsibilities and skills. They also valued the chance to contribute to the evidence base, providing knowledge about using alternative medication which they instinctively felt would cause fewer complications and benefit patient mortality and morbidity. Conclusion Paramedics who take part in research believe they contribute to personal and professional development and potentially improve patient care. Future research with paramedics refusing research participation could explore barriers and different views on skills development, which may also inform implementation of new evidence-based interventions.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"38 1","pages":"A76"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73531422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.85
A. Burton, K. Walters, D. Osborn
Background The mortality gap for people with SMI from CVD is increasing. Studies have found a positive relationship between perceived social support and CVD outcomes in the general population; however there has been less research in people with SMI. Social support may influence CVD outcomes through encouraging participation in healthy lifestyle activities. Aims To assess whether higher social support as measured by the Medical Outcomes Study–Social Support Survey (MOS-SSS) is associated with greater attendance at primary care intervention appointments. Secondary outcomes included:adherence to CVD medications (Morisky Medication Adherence Scale (MMAS)),physical activity (International Physical Activity Questionnaire (IPAQ)),diet (Dietary Instrument for Nutrition Education (DINE))alcohol consumption (Alcohol Use Disorders Identification Test (AUDIT)),self–reported smoking behaviour Methods Longitudinal and cross sectional studies involving 326 patients with SMI and raised CVD risk factors. Participants were recruited from 76 GP practices in England to a clinical trial assessing the effectiveness of a behavioural intervention for reducing CVD risk in people with SMI against routine GP practice care. Secondary data analysis used random effects linear regression models for continuous outcomes, logistic regression for binary outcomes, and Poisson/negative binomial regression models for count outcomes. Results A weak association between social support and attendance at primary care intervention appointments was identified. As social support scores increased by one point, the appointment attendance rate increased by 0.5% (IRR=1.0053; 1.0001–1.0105, p=0.05). When sex, age, ethnicity, diagnosis and deprivation were entered into the model, this association decreased to 0.3% and was no longer significant (IRR=1.0032; 0.9980–1.0085, p=0.23). A strong association between social support and CVD medication adherence was identified. The odds of being in the moderate/high adherence group compared to the low adherence group increased by 3.9% with a one point increase on the MOS-SSS (OR=1.0385; 1.0176 to 1.0598, p<0.001). This association remained significant when sex, age, ethnicity, diagnosis and deprivation were included in the model (OR=1.0390; 1.0133–1.0648, p=0.003). No significant associations were identified between social support and physical activity, diet, alcohol or smoking. Conclusions Social support may be an important facilitator for attendance at appointments and adherence to CVD medications; however no association was found between social support and lifestyle behaviours. Harnessing positive social relationships in the delivery of interventions for reducing CVD risk in this population should be considered as a strategy for encouraging uptake.
背景:心血管疾病致重度精神分裂症患者的死亡率差距正在扩大。研究发现，在一般人群中，感知到的社会支持与心血管疾病结局之间存在正相关关系;然而，对重度精神分裂症患者的研究却很少。社会支持可以通过鼓励参与健康的生活方式活动来影响心血管疾病的结局。目的评估由医疗结果研究-社会支持调查(MOS-SSS)测量的较高的社会支持是否与较高的初级保健干预预约出勤率相关。次要结局包括:对心血管疾病药物的依从性(莫里斯基药物依从性量表(MMAS))、体育活动(国际体育活动问卷(IPAQ))、饮食(营养教育饮食工具(DINE))、饮酒(酒精使用障碍识别测试(AUDIT))、自我报告的吸烟行为。方法纵向和横断面研究涉及326例重度精神障碍患者和心血管疾病风险因素升高的患者。参与者从英格兰的76家全科医生诊所招募，参加一项临床试验，评估行为干预对降低重度精神障碍患者心血管疾病风险的有效性，而不是常规全科医生护理。辅助数据分析使用随机效应线性回归模型进行连续结果分析，使用逻辑回归模型进行二元结果分析，使用泊松/负二项回归模型进行计数结果分析。结果社会支持与参加初级保健干预预约之间存在弱关联。社会支持分数每增加1分，预约出勤率增加0.5% (IRR=1.0053;1.0001 - -1.0105, p = 0.05)。当将性别、年龄、种族、诊断和剥夺纳入模型时，这种关联降至0.3%，不再显著(IRR=1.0032;0.9980 - -1.0085, p = 0.23)。社会支持与心血管疾病药物依从性之间存在强烈关联。与低依从性组相比，中/高依从性组的几率增加了3.9%，MOS-SSS增加了1点(OR=1.0385;1.0176 ~ 1.0598, p<0.001)。当模型中包括性别、年龄、种族、诊断和剥夺时，这种关联仍然显著(OR=1.0390;1.0133 - -1.0648, p = 0.003)。没有发现社会支持与体育活动、饮食、饮酒或吸烟之间存在显著关联。结论社会支持可能是心血管疾病患者按时就诊和依从性药物治疗的重要促进因素;然而，没有发现社会支持和生活方式行为之间的联系。在这一人群中，利用积极的社会关系提供降低心血管疾病风险的干预措施，应被视为一种鼓励采用的策略。
{"title":"LB1 Is higher perceived social support related to greater participation in cardiovascular disease (CVD) risk reducing behaviours for people with severe mental illnesses (SMI)?","authors":"A. Burton, K. Walters, D. Osborn","doi":"10.1136/jech-2018-SSMabstracts.85","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.85","url":null,"abstract":"Background The mortality gap for people with SMI from CVD is increasing. Studies have found a positive relationship between perceived social support and CVD outcomes in the general population; however there has been less research in people with SMI. Social support may influence CVD outcomes through encouraging participation in healthy lifestyle activities. Aims To assess whether higher social support as measured by the Medical Outcomes Study–Social Support Survey (MOS-SSS) is associated with greater attendance at primary care intervention appointments. Secondary outcomes included:adherence to CVD medications (Morisky Medication Adherence Scale (MMAS)),physical activity (International Physical Activity Questionnaire (IPAQ)),diet (Dietary Instrument for Nutrition Education (DINE))alcohol consumption (Alcohol Use Disorders Identification Test (AUDIT)),self–reported smoking behaviour Methods Longitudinal and cross sectional studies involving 326 patients with SMI and raised CVD risk factors. Participants were recruited from 76 GP practices in England to a clinical trial assessing the effectiveness of a behavioural intervention for reducing CVD risk in people with SMI against routine GP practice care. Secondary data analysis used random effects linear regression models for continuous outcomes, logistic regression for binary outcomes, and Poisson/negative binomial regression models for count outcomes. Results A weak association between social support and attendance at primary care intervention appointments was identified. As social support scores increased by one point, the appointment attendance rate increased by 0.5% (IRR=1.0053; 1.0001–1.0105, p=0.05). When sex, age, ethnicity, diagnosis and deprivation were entered into the model, this association decreased to 0.3% and was no longer significant (IRR=1.0032; 0.9980–1.0085, p=0.23). A strong association between social support and CVD medication adherence was identified. The odds of being in the moderate/high adherence group compared to the low adherence group increased by 3.9% with a one point increase on the MOS-SSS (OR=1.0385; 1.0176 to 1.0598, p<0.001). This association remained significant when sex, age, ethnicity, diagnosis and deprivation were included in the model (OR=1.0390; 1.0133–1.0648, p=0.003). No significant associations were identified between social support and physical activity, diet, alcohol or smoking. Conclusions Social support may be an important facilitator for attendance at appointments and adherence to CVD medications; however no association was found between social support and lifestyle behaviours. Harnessing positive social relationships in the delivery of interventions for reducing CVD risk in this population should be considered as a strategy for encouraging uptake.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"13 1","pages":"A41–A42"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73651045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.122
E. Kelleher, Seán R Millar, F. Shiely, I. Perry, J. Harrington
Background Despite the increased global awareness of childhood obesity, a high proportion of parents and children continue to misclassify child weight status. The aim of this study was to determine parent and child misperception of child weight and identify the determinants influencing this misperception. Methods A cross-sectional study involving 1 075 children, aged 8–11 years, drawn from primary schools in Cork city and county in Ireland. Data were collected using child and parent self-administered questionnaires. Physical measurements were taken by trained researchers according to standard procedures. Univariate and multivariable logistic regression analysis was used to examine factors influencing parental and child perceptions regarding child weight. Results Almost one-quarter of parents of all children misclassified their child’s weight status. Forty four per cent of parents of overweight or obese children underestimated their child’s weight. In all children, factors associated with parental misperception of child weight included the child being female (OR=1.95; 95% CI 1.36 to 2.81, p<0.001), being overweight or obese (OR=2.84; 95% CI 1.95 to 4.15, p<0.001), child misclassification of own weight (OR=3.28; 95% CI 2.26 to 4.78, p<0.001) and parent reported child computer use (OR=1.64; 95% CI 1.12 to 2.39, p=0.01). In overweight or obese children, accuracy in parental perception of weight improved with increasing child age (OR=0.49; 95% CI 0.27 to 0.88, p=0.02). Of children who were overweight/obese, 76% (n=213) underestimated their weight. These children had increased odds of misperceiving their own weight status if their parents misclassified their child’s weight (OR=3.98; 95% CI 1.95 to 8.10, p<0.001). Conclusion Findings suggest that in an obesogenic society, where overweight and obesity has become the norm, the capacity of both parents and children to correctly classify child weight status is significantly impaired. Health care professionals should be aware of the frequent misperception of weight status, especially when dealing with parents of younger children and children who are overweight or obese.
尽管全球对儿童肥胖的认识有所提高，但很大比例的父母和儿童仍然对儿童体重状况进行错误分类。本研究的目的是确定父母和儿童对儿童体重的误解，并确定影响这种误解的决定因素。方法采用横断面研究方法，从爱尔兰科克市和郡的小学抽取1 075名8-11岁的儿童。数据通过儿童和家长自行填写的问卷收集。物理测量由训练有素的研究人员根据标准程序进行。采用单变量和多变量logistic回归分析来检验影响父母和儿童对儿童体重认知的因素。结果近四分之一的家长对孩子的体重状况进行了错误的分类。44%的超重或肥胖儿童的父母低估了孩子的体重。在所有儿童中，与父母对儿童体重误解相关的因素包括:儿童是女性(OR=1.95;95% CI 1.36 ~ 2.81, p<0.001)，超重或肥胖(or =2.84;95% CI 1.95 ~ 4.15, p<0.001)，儿童自身体重分类错误(OR=3.28;95% CI 2.26 ~ 4.78, p<0.001)和父母报告的儿童电脑使用情况(OR=1.64;95% CI 1.12 ~ 2.39, p=0.01)。在超重或肥胖儿童中，父母体重感知的准确性随着儿童年龄的增加而提高(or =0.49;95% CI 0.27 ~ 0.88, p=0.02)。在超重/肥胖儿童中，76% (n=213)低估了自己的体重。如果父母对孩子的体重分类错误，这些孩子误解自己体重状况的几率会增加(OR=3.98;95% CI 1.95 ~ 8.10, p<0.001)。结论在肥胖社会中，超重和肥胖已成为常态，父母和儿童对儿童体重状况的正确分类能力明显受损。卫生保健专业人员应该意识到经常对体重状况的误解，特别是在与年幼儿童和超重或肥胖儿童的父母打交道时。
{"title":"RF34 Parent and child misperception of child weight status: a cross-sectional analysis of the cork children’s lifestyle study (CCLaS)","authors":"E. Kelleher, Seán R Millar, F. Shiely, I. Perry, J. Harrington","doi":"10.1136/jech-2018-SSMabstracts.122","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.122","url":null,"abstract":"Background Despite the increased global awareness of childhood obesity, a high proportion of parents and children continue to misclassify child weight status. The aim of this study was to determine parent and child misperception of child weight and identify the determinants influencing this misperception. Methods A cross-sectional study involving 1 075 children, aged 8–11 years, drawn from primary schools in Cork city and county in Ireland. Data were collected using child and parent self-administered questionnaires. Physical measurements were taken by trained researchers according to standard procedures. Univariate and multivariable logistic regression analysis was used to examine factors influencing parental and child perceptions regarding child weight. Results Almost one-quarter of parents of all children misclassified their child’s weight status. Forty four per cent of parents of overweight or obese children underestimated their child’s weight. In all children, factors associated with parental misperception of child weight included the child being female (OR=1.95; 95% CI 1.36 to 2.81, p<0.001), being overweight or obese (OR=2.84; 95% CI 1.95 to 4.15, p<0.001), child misclassification of own weight (OR=3.28; 95% CI 2.26 to 4.78, p<0.001) and parent reported child computer use (OR=1.64; 95% CI 1.12 to 2.39, p=0.01). In overweight or obese children, accuracy in parental perception of weight improved with increasing child age (OR=0.49; 95% CI 0.27 to 0.88, p=0.02). Of children who were overweight/obese, 76% (n=213) underestimated their weight. These children had increased odds of misperceiving their own weight status if their parents misclassified their child’s weight (OR=3.98; 95% CI 1.95 to 8.10, p<0.001). Conclusion Findings suggest that in an obesogenic society, where overweight and obesity has become the norm, the capacity of both parents and children to correctly classify child weight status is significantly impaired. Health care professionals should be aware of the frequent misperception of weight status, especially when dealing with parents of younger children and children who are overweight or obese.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"21 1","pages":"A59"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78251598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.89
N. Ziauddeen, PJ Roderick, NS Macklon, NA Alwan
Background Short and long intervals between pregnancies have been associated with increased risk of adverse birth outcomes including low birth weight and stillbirth. Birthweight is an indicator of the in-utero environment and a key early life risk factor for long-term health outcomes such as obesity and cardiovascular disease. The World Health Organization recommended in 2005 waiting at least 24 months after a live birth before getting pregnant again. There are no UK guidelines on birth spacing. We aimed to investigate the association between duration of the inter-pregnancy interval between successive live birth pregnancies and risk of having a small-for-gestational age (SGA) or large-for-gestational age (LGA) baby. Methods A population-based cohort of prospectively collected routine healthcare data for antenatal care between January 2003 and September 2017 (total n=82 098 pregnancies) at University Hospital Southampton, Hampshire, UK was used. Records of women with their first two singleton live-birth pregnancies were analysed (n=15 922 women). Inter-pregnancy interval was defined as timing between a live birth and the next conception. SGA was defined as <10th percentile weight and LGA as >90th percentile weight for gestational age. Logistic regression was used to examine the association between risk of SGA or LGA and inter-pregnancy interval. The models were adjusted for maternal age, ethnicity, highest educational qualification, employment status, baseline maternal BMI, between pregnancy change in maternal BMI, smoking status at second pregnancy booking appointment and conception following infertility treatment. Sensitivity analyses was conducted adjusting for SGA or LGA in previous pregnancies. Results Twelve percent of first pregnancy and 7% of second pregnancy births were SGA. Seven percent of first pregnancy and 13% of second pregnancy births were LGA. Three percent of women each had SGA and LGA babies in both pregnancies. Compared to an interval of 24–35 months, there was a lower risk of SGA birth in second pregnancy with an interval of 12–23 months (adjusted OR 0.82, 95% CI 0.69 to 0.98, p=0.03). The association remained after adjusting for previous outcome of SGA in sensitivity analysis. No association was observed between risk of SGA with intervals of <12 or ≥36 months or LGA and inter-pregnancy interval. Conclusion An inter-pregnancy interval of 12–23 months was associated with lower risk of SGA, however the duration of the interval was not associated with LGA risk. In high-income countries with relatively healthy pregnant population, further research considering the potential advantages of shorter optimal interval between pregnancies than that recommended by WHO is needed. Acknowledgements David Cable (Electronic Patient Records Implementation and Service Manager) at University Hospital Southampton NHS Foundation Trust for support in accessing the data used in this study.
{"title":"LB5 Is the duration of the preceding inter-pregnancy interval associated with offspring’s size at birth? – analysis of a UK population-based cohort","authors":"N. Ziauddeen, PJ Roderick, NS Macklon, NA Alwan","doi":"10.1136/jech-2018-SSMabstracts.89","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.89","url":null,"abstract":"Background Short and long intervals between pregnancies have been associated with increased risk of adverse birth outcomes including low birth weight and stillbirth. Birthweight is an indicator of the in-utero environment and a key early life risk factor for long-term health outcomes such as obesity and cardiovascular disease. The World Health Organization recommended in 2005 waiting at least 24 months after a live birth before getting pregnant again. There are no UK guidelines on birth spacing. We aimed to investigate the association between duration of the inter-pregnancy interval between successive live birth pregnancies and risk of having a small-for-gestational age (SGA) or large-for-gestational age (LGA) baby. Methods A population-based cohort of prospectively collected routine healthcare data for antenatal care between January 2003 and September 2017 (total n=82 098 pregnancies) at University Hospital Southampton, Hampshire, UK was used. Records of women with their first two singleton live-birth pregnancies were analysed (n=15 922 women). Inter-pregnancy interval was defined as timing between a live birth and the next conception. SGA was defined as <10th percentile weight and LGA as >90th percentile weight for gestational age. Logistic regression was used to examine the association between risk of SGA or LGA and inter-pregnancy interval. The models were adjusted for maternal age, ethnicity, highest educational qualification, employment status, baseline maternal BMI, between pregnancy change in maternal BMI, smoking status at second pregnancy booking appointment and conception following infertility treatment. Sensitivity analyses was conducted adjusting for SGA or LGA in previous pregnancies. Results Twelve percent of first pregnancy and 7% of second pregnancy births were SGA. Seven percent of first pregnancy and 13% of second pregnancy births were LGA. Three percent of women each had SGA and LGA babies in both pregnancies. Compared to an interval of 24–35 months, there was a lower risk of SGA birth in second pregnancy with an interval of 12–23 months (adjusted OR 0.82, 95% CI 0.69 to 0.98, p=0.03). The association remained after adjusting for previous outcome of SGA in sensitivity analysis. No association was observed between risk of SGA with intervals of <12 or ≥36 months or LGA and inter-pregnancy interval. Conclusion An inter-pregnancy interval of 12–23 months was associated with lower risk of SGA, however the duration of the interval was not associated with LGA risk. In high-income countries with relatively healthy pregnant population, further research considering the potential advantages of shorter optimal interval between pregnancies than that recommended by WHO is needed. Acknowledgements David Cable (Electronic Patient Records Implementation and Service Manager) at University Hospital Southampton NHS Foundation Trust for support in accessing the data used in this study.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"37 1","pages":"A43–A44"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78666703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1136/jech-2018-SSMabstracts.78
C. Nightingale, B. Ram, E. Limb, A. Shankar, D. Procter, A. Cooper, A. Page, C. Clary, D. Lewis, S. Cummins, A. Ellaway, B. Giles-Corti, P. Whincup, A. Rudnicka, D. Cook, C. Owen
Background There has been increasing interest in whether the built environmentinfluences health behaviours, but robust longitudinal evidence is limited. We assessed the effect of moving into East Village (the former London 2012 Olympic Games Athletes Village), a neighbourhood built on active design principles, on levels of physical activity (PA) and adiposity among adults. Methods A cohort of 1278 adults (16+) seeking to move into social, intermediate (a mixture of shared ownership, shared equity, affordable rent), and market-rent East Village accommodation were recruited in 2013–2015, and followed up after two years. Objective measures of PA using accelerometry (ActiGraph GT3X+), body mass index (BMI) and bioelectrical impedance (fat mass %) were made. We examined change in levels of PA and adiposity, using multilevel models adjusting for sex, age group, ethnicity, housing sector (fixed effects) and household (random effect), comparing those who moved to East Village (intervention group) with those who lived outside East Village (control group). Effects by housing sector and weekdays versus weekends for PA were also examined. Results 877 adults (69%) were followed-up, half had moved to East Village. Moving to East Village was associated with a small increase in daily steps (151, 95% CI −233, 534), more so in the intermediate sector (399, 95% CI −211, 1009) than in the social and market-rent sectors, but effects were not statistically significant. There were no differences in time spent in moderate-to-vigorous PA (MVPA) or any appreciable weekday versus weekend effects. There was no evidence of differences in time spent in light PA or sedentary time both overall and by housing sector with the exception of the market-rent group in whom moving to East Village was associated with a decrease in light PA (−13.0 mins, 95% CI −24.7,–1.2 mins). There were no effects of moving to East Village on BMI or fat mass% overall or by housing sector. Conclusion At two-year follow-up, moving to East Village, a neighbourhood designed for healthy active living, did not have beneficial, consistent effects on objectively measured physical activity or adiposity of public health importance.
人们对建筑环境是否影响健康行为越来越感兴趣，但强有力的纵向证据有限。我们评估了搬进东村(前伦敦2012年奥运会运动员村)的影响，这是一个建立在积极设计原则基础上的社区，对成年人的身体活动水平(PA)和肥胖水平。方法在2013-2015年招募了1278名16岁以上的成年人，他们寻求搬进社会、中间(混合共有所有权、共有股权、可负担租金)和市场租金的东村住房，并在两年后进行了随访。采用加速度计(ActiGraph GT3X+)、体重指数(BMI)和生物电阻抗(脂肪质量%)对PA进行客观测量。我们检查了PA和肥胖水平的变化，使用多层模型调整性别、年龄组、种族、住房部门(固定效应)和家庭(随机效应)，比较了搬到东村的人(干预组)和住在东村以外的人(对照组)。还研究了住房部门和工作日与周末对PA的影响。结果随访877名成人(69%)，其中半数已迁入东村。搬到东村与每日步数的小幅增加有关(151,95% CI - 233,534)，在中间部门(399,95% CI - 211, 1009)比在社会和市场租金部门更重要，但影响没有统计学意义。在中度到剧烈的PA (MVPA)中花费的时间没有差异，也没有任何明显的工作日与周末的影响。除了市场租房组外，总体和住房部门在轻度PA或久坐时间上没有差异(- 13.0分钟，95% CI - 24.7， -1.2分钟)。搬到东村对BMI或总体脂肪量百分比或住房部门没有影响。在两年的随访中，搬到东村(一个为健康积极生活而设计的社区)对客观测量的身体活动或具有公共卫生重要性的肥胖没有有益的、一致的影响。
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