Pub Date : 2019-07-29DOI: 10.1136/jech-2019-212257
H. Coo, L. Fabrigar, G. Davies, Renée Fitzpatrick, M. Flavin
Background A high maternal prepregnancy body mass index has been associated with lower offspring IQ, but it is unclear if the relationship is causal. To explore this, our objectives were to compare maternal and paternal estimates and to assess whether certain factors mediate the association. Methods We analysed data from the Avon Longitudinal Study of Parents and Children, which initially recruited 14 541 women residing in Avon, UK, with an expected date of delivery in 1991–1992. Data were collected during and after pregnancy by questionnaire, medical record abstraction and clinical assessment. At approximately 8 years of age, psychologists administered an abbreviated form of the Wechsler Intelligence Scale for Children-III. We fit multivariable logistic regression models to estimate parental prepregnancy obesity and overweight–offspring IQ associations. Counterfactually defined indirect (mediated) effects of maternal prepregnancy obesity on offspring IQ were estimated through path analysis. Results Among 4324 mother–father–child triads and using normal weight as the referent, we observed consistently stronger associations for maternal prepregnancy obesity and offspring performance IQ (eg, adjusted β (95% CI)=−3.4 (−5.7 to −1.2) vs −0.97 (−2.9 to 0.96) for paternal obesity). The indirect effects of maternal obesity on offspring IQ through pathways involving gestational weight gain and duration of breastfeeding were small but significant. Conclusion Our findings are consistent with a weak biologic effect of maternal adiposity in pregnancy on offspring performance IQ. Given the growing prevalence of obesity worldwide, more evidence is needed to resolve the correlation versus causation debate in this area.
{"title":"Are observed associations between a high maternal prepregnancy body mass index and offspring IQ likely to be causal?","authors":"H. Coo, L. Fabrigar, G. Davies, Renée Fitzpatrick, M. Flavin","doi":"10.1136/jech-2019-212257","DOIUrl":"https://doi.org/10.1136/jech-2019-212257","url":null,"abstract":"Background A high maternal prepregnancy body mass index has been associated with lower offspring IQ, but it is unclear if the relationship is causal. To explore this, our objectives were to compare maternal and paternal estimates and to assess whether certain factors mediate the association. Methods We analysed data from the Avon Longitudinal Study of Parents and Children, which initially recruited 14 541 women residing in Avon, UK, with an expected date of delivery in 1991–1992. Data were collected during and after pregnancy by questionnaire, medical record abstraction and clinical assessment. At approximately 8 years of age, psychologists administered an abbreviated form of the Wechsler Intelligence Scale for Children-III. We fit multivariable logistic regression models to estimate parental prepregnancy obesity and overweight–offspring IQ associations. Counterfactually defined indirect (mediated) effects of maternal prepregnancy obesity on offspring IQ were estimated through path analysis. Results Among 4324 mother–father–child triads and using normal weight as the referent, we observed consistently stronger associations for maternal prepregnancy obesity and offspring performance IQ (eg, adjusted β (95% CI)=−3.4 (−5.7 to −1.2) vs −0.97 (−2.9 to 0.96) for paternal obesity). The indirect effects of maternal obesity on offspring IQ through pathways involving gestational weight gain and duration of breastfeeding were small but significant. Conclusion Our findings are consistent with a weak biologic effect of maternal adiposity in pregnancy on offspring performance IQ. Given the growing prevalence of obesity worldwide, more evidence is needed to resolve the correlation versus causation debate in this area.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"49 1","pages":"920 - 928"},"PeriodicalIF":0.0,"publicationDate":"2019-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78641762","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 : 2019-07-17DOI: 10.1136/jech-2019-212436
Kim Nathan, O. Robertson, Polly Atatoa Carr, P. Howden-Chapman, N. Pierse
Background Findings regarding early residential mobility and increased risk for socioemotional and behavioural (SEB) difficulties in preschool children are mixed, with some studies finding no evidence of an association once known covariates are controlled for. Our aim was to investigate residential mobility and SEB difficulties in a population cohort of New Zealand (NZ) children. Methods Data from the Integrated Data Infrastructure were examined for 313 164 children born in NZ since 2004 who had completed the Before School Check at 4 years of age. Residential mobility was determined from address data. SEB difficulty scores were obtained from the Strengths and Difficulties Questionnaire administered as part of the Before School Check. Results The prevalence of residential mobility was 69%; 12% of children had moved ≥4 times. A linear association between residential mobility and increased SEB difficulties was found (B=0.58), which remained robust when controlling for several known covariates. Moves >10 km and moving to areas of higher socioeconomic deprivation were associated with increased SEB difficulties (B=0.08 and B=0.09, respectively), while residential mobility before 2 years of age was not. Children exposed to greater residential mobility were 8% more likely to obtain SEB difficulties scores of clinical concern than children exposed to fewer moves (adjusted OR 1.08). Conclusion This study found a linear association between residential mobility and increased SEB difficulties in young children. This result highlights the need to consider residential mobility as a risk factor for SEB difficulties in the preschool years.
{"title":"Residential mobility and socioemotional and behavioural difficulties in a preschool population cohort of New Zealand children","authors":"Kim Nathan, O. Robertson, Polly Atatoa Carr, P. Howden-Chapman, N. Pierse","doi":"10.1136/jech-2019-212436","DOIUrl":"https://doi.org/10.1136/jech-2019-212436","url":null,"abstract":"Background Findings regarding early residential mobility and increased risk for socioemotional and behavioural (SEB) difficulties in preschool children are mixed, with some studies finding no evidence of an association once known covariates are controlled for. Our aim was to investigate residential mobility and SEB difficulties in a population cohort of New Zealand (NZ) children. Methods Data from the Integrated Data Infrastructure were examined for 313 164 children born in NZ since 2004 who had completed the Before School Check at 4 years of age. Residential mobility was determined from address data. SEB difficulty scores were obtained from the Strengths and Difficulties Questionnaire administered as part of the Before School Check. Results The prevalence of residential mobility was 69%; 12% of children had moved ≥4 times. A linear association between residential mobility and increased SEB difficulties was found (B=0.58), which remained robust when controlling for several known covariates. Moves >10 km and moving to areas of higher socioeconomic deprivation were associated with increased SEB difficulties (B=0.08 and B=0.09, respectively), while residential mobility before 2 years of age was not. Children exposed to greater residential mobility were 8% more likely to obtain SEB difficulties scores of clinical concern than children exposed to fewer moves (adjusted OR 1.08). Conclusion This study found a linear association between residential mobility and increased SEB difficulties in young children. This result highlights the need to consider residential mobility as a risk factor for SEB difficulties in the preschool years.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"126 1","pages":"947 - 953"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88167363","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 : 2019-07-17DOI: 10.1136/jech-2019-212225
L. Cambon, F. Alla
Population health interventions (PHIs) are generally complex; their results depend on their interaction with the context of their implementation. Moreover, the distinction between intervention and context is arbitrary: we need rather to consider an ‘interventional system’, including both interventional and contextual components. Evaluation must go beyond effectiveness and must include two key research questions: a viability analysis, to verify that the intervention can be routinised in a real-life context; and a theory-based evaluation, to analyse mechanisms and to understand what produces effects among components and their interactions with each other and with the context. PHI research is a question not only of the object but also of perspectives. This means doing research differently, making use of interdisciplinarity and involving stakeholders. Such an approach may contribute to the development, transfer, implementation and scaling-up of innovative interventions.
{"title":"Current challenges in population health intervention research","authors":"L. Cambon, F. Alla","doi":"10.1136/jech-2019-212225","DOIUrl":"https://doi.org/10.1136/jech-2019-212225","url":null,"abstract":"Population health interventions (PHIs) are generally complex; their results depend on their interaction with the context of their implementation. Moreover, the distinction between intervention and context is arbitrary: we need rather to consider an ‘interventional system’, including both interventional and contextual components. Evaluation must go beyond effectiveness and must include two key research questions: a viability analysis, to verify that the intervention can be routinised in a real-life context; and a theory-based evaluation, to analyse mechanisms and to understand what produces effects among components and their interactions with each other and with the context. PHI research is a question not only of the object but also of perspectives. This means doing research differently, making use of interdisciplinarity and involving stakeholders. Such an approach may contribute to the development, transfer, implementation and scaling-up of innovative interventions.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"9 1","pages":"990 - 992"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74273187","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 : 2019-07-17DOI: 10.1136/jech-2018-211588
Francisco Perales, Alice Campbell
Background Research documents substantial adolescent health disparities by sexual orientation, but studies are confined to a small number of countries—chiefly the USA. We provide first-time evidence of associations between sexual orientation and adolescent health/well-being in a new country—Australia. We also add to knowledge by examining health/well-being outcomes not previously analysed in national samples, considering adolescents reporting no sexual attractions, and rank-ordering sexual-orientation health disparities by magnitude. Methods Data from an Australian national probability sample of 14/15 years old (Longitudinal Study of Australian Children, n=3318) and regression models adjusted for confounding and for multiple comparisons were used to examine the associations between sexual attraction and 30 outcomes spanning multiple domains of health/well-being—including socio-emotional functioning, health-related quality of life, depressive symptoms, health-related behaviours, social support, self-harm, suicidality, victimisation, self-concept, school belonging and global health/well-being assessments. Results Lesbian, gay, bisexual and questioning adolescents displayed significantly worse health/well-being than their heterosexual peers in all outcomes (p<0.05). The magnitude of the disparities ranged between 0.13 and 0.75 SD, and was largest in the domains of self-harm, suicidality, peer problems and emotional problems. There were fewer differences between the heterosexual and no-attraction groups. Worse outcomes were observed among both-sex-attracted adolescents compared with same-sex-attracted adolescents, and sexual-minority girls compared with sexual-minority boys. Conclusions Consistent with the minority stress model and recent international scholarship, sexual-minority status is an important risk factor for poor adolescent health/well-being across domains in Australia. Interventions aimed at addressing sexual-orientation health disparities within Australian adolescent populations are urgently required.
{"title":"Early roots of sexual-orientation health disparities: associations between sexual attraction, health and well-being in a national sample of Australian adolescents","authors":"Francisco Perales, Alice Campbell","doi":"10.1136/jech-2018-211588","DOIUrl":"https://doi.org/10.1136/jech-2018-211588","url":null,"abstract":"Background Research documents substantial adolescent health disparities by sexual orientation, but studies are confined to a small number of countries—chiefly the USA. We provide first-time evidence of associations between sexual orientation and adolescent health/well-being in a new country—Australia. We also add to knowledge by examining health/well-being outcomes not previously analysed in national samples, considering adolescents reporting no sexual attractions, and rank-ordering sexual-orientation health disparities by magnitude. Methods Data from an Australian national probability sample of 14/15 years old (Longitudinal Study of Australian Children, n=3318) and regression models adjusted for confounding and for multiple comparisons were used to examine the associations between sexual attraction and 30 outcomes spanning multiple domains of health/well-being—including socio-emotional functioning, health-related quality of life, depressive symptoms, health-related behaviours, social support, self-harm, suicidality, victimisation, self-concept, school belonging and global health/well-being assessments. Results Lesbian, gay, bisexual and questioning adolescents displayed significantly worse health/well-being than their heterosexual peers in all outcomes (p<0.05). The magnitude of the disparities ranged between 0.13 and 0.75 SD, and was largest in the domains of self-harm, suicidality, peer problems and emotional problems. There were fewer differences between the heterosexual and no-attraction groups. Worse outcomes were observed among both-sex-attracted adolescents compared with same-sex-attracted adolescents, and sexual-minority girls compared with sexual-minority boys. Conclusions Consistent with the minority stress model and recent international scholarship, sexual-minority status is an important risk factor for poor adolescent health/well-being across domains in Australia. Interventions aimed at addressing sexual-orientation health disparities within Australian adolescent populations are urgently required.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"45 1","pages":"954 - 962"},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74418849","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.29
C. Ellis-Smith, IJ Higginson, Cj Evans
Background Detection and management of physical symptoms and psychosocial concerns for people with dementia is essential to reduce suffering. Measures used in routine care can support assessment and change care processes to improve outcomes. We aimed to develop and conduct a feasibility and process evaluation of the mechanisms of action (MOA), acceptability and implementation requirements of the Integrated Palliative Care Outcome Scale for Dementia (IPOS-Dem) to improve comprehensive assessment and management of symptoms and concerns of residents with dementia in care homes. Methods A mixed methods interventional design informed by the MRC framework and underpinned by a theoretical model of expected MOA. Study conducted in three care homes involving residents with dementia, family, care staff and health professionals. IPOS-Dem V1 was developed from the validated IPOS through a scoping review of symptoms and concerns common in dementia. Two sequential phases followed. Phase one comprised focus groups/semi-structured interviews and cognitive interviews to evaluate content validity, comprehensibility and acceptability; and refinements to IPOS-Dem made. Phase two employed an embedded mixed methods design to evaluate MOA, feasibility and implementation requirements. Residents received IPOS-Dem as part of routine care for 12 weeks. Qualitative data included focus groups, semi-structured interviews and observations. Quantitative data comprised IPOS-Dem scores. Directed content analysis and descriptive statistics was used for qualitative and quantitative data analysis respectively, analysed separately and then integrated on key areas to inform a final theoretical model. Results Phase one: 26 family, care staff and health professionals participated in focus groups/interviews, and 10 care staff in cognitive interviews. Five additional items were identified as important for content validity. Refinements to improve acceptability and comprehensibility included use of lay terms and item descriptors. Phase two: 32 residents received IPOS-Dem and 18 family, care staff and health professionals participated in focus groups, interviews and observations. Key MOA were improved collaborative assessment resulting in improved detection of symptoms and concerns; comprehensive ‘picture of the person’ which supported systematic record-keeping and monitoring, and facilitated communication between care staff, family, and health professionals. IPOS-Dem was perceived as easy to use and providing value to care, with the proportion of missing data decreasing from 2.1% at baseline to 1.1% at 12 weeks. Conclusion IPOS-Dem is an acceptable and feasible measure to improve comprehensive assessment and management of symptoms and concerns in residents with dementia. A theoretical model of likely MOA and implementation requirements is presented. Further psychometric testing and effectiveness trial is required. Funders Cicely Saunders International, Atlantic Philanthropies. This research
{"title":"OP29 A measure to improve assessment and management of symptoms and concerns of people with dementia in care homes: development and mixed methods evaluation","authors":"C. Ellis-Smith, IJ Higginson, Cj Evans","doi":"10.1136/jech-2018-SSMabstracts.29","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.29","url":null,"abstract":"Background Detection and management of physical symptoms and psychosocial concerns for people with dementia is essential to reduce suffering. Measures used in routine care can support assessment and change care processes to improve outcomes. We aimed to develop and conduct a feasibility and process evaluation of the mechanisms of action (MOA), acceptability and implementation requirements of the Integrated Palliative Care Outcome Scale for Dementia (IPOS-Dem) to improve comprehensive assessment and management of symptoms and concerns of residents with dementia in care homes. Methods A mixed methods interventional design informed by the MRC framework and underpinned by a theoretical model of expected MOA. Study conducted in three care homes involving residents with dementia, family, care staff and health professionals. IPOS-Dem V1 was developed from the validated IPOS through a scoping review of symptoms and concerns common in dementia. Two sequential phases followed. Phase one comprised focus groups/semi-structured interviews and cognitive interviews to evaluate content validity, comprehensibility and acceptability; and refinements to IPOS-Dem made. Phase two employed an embedded mixed methods design to evaluate MOA, feasibility and implementation requirements. Residents received IPOS-Dem as part of routine care for 12 weeks. Qualitative data included focus groups, semi-structured interviews and observations. Quantitative data comprised IPOS-Dem scores. Directed content analysis and descriptive statistics was used for qualitative and quantitative data analysis respectively, analysed separately and then integrated on key areas to inform a final theoretical model. Results Phase one: 26 family, care staff and health professionals participated in focus groups/interviews, and 10 care staff in cognitive interviews. Five additional items were identified as important for content validity. Refinements to improve acceptability and comprehensibility included use of lay terms and item descriptors. Phase two: 32 residents received IPOS-Dem and 18 family, care staff and health professionals participated in focus groups, interviews and observations. Key MOA were improved collaborative assessment resulting in improved detection of symptoms and concerns; comprehensive ‘picture of the person’ which supported systematic record-keeping and monitoring, and facilitated communication between care staff, family, and health professionals. IPOS-Dem was perceived as easy to use and providing value to care, with the proportion of missing data decreasing from 2.1% at baseline to 1.1% at 12 weeks. Conclusion IPOS-Dem is an acceptable and feasible measure to improve comprehensive assessment and management of symptoms and concerns in residents with dementia. A theoretical model of likely MOA and implementation requirements is presented. Further psychometric testing and effectiveness trial is required. Funders Cicely Saunders International, Atlantic Philanthropies. This research","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"28 1","pages":"A14–A15"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78911323","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.26
L. Bentley, Q. Liao, Benjamin Barr, Cameron Mustard
Background In most countries policy makers are seeking to raise the age at which people become eligible for state pensions due to population aging. Aging societies are also characterised by an increase in the number of people are living with chronic conditions and multi-morbidity which can affect employment later in life. This study examines the prevalence of multi-morbidity by age, birth-cohort, and socioeconomic status before assessing the impact that this has on employment status for workers approaching retirement age. It presents a comparative analysis of the UK and Canada and discusses the different policies that each have adopted regarding older workers with chronic conditions. Methods We estimate the prevalence of multi-morbidity (composed of 6 broad categories of disease) for those aged between 50 and 64, by sex, educational level, and by two birth cohorts: the silent generation (pre-1946) and the baby boomers (1946–1964), using the Health Survey for England and the Canadian Community Health Survey. The prevalence of each condition and the changes in specific comorbidities between the generations were estimated. Finally, the association between multi-morbidity on the employment status (in employment or not) is assessed. Each of the analyses uses logistic regression models. Results Prevalence of multi-morbidities has increased between generations, particularly for the lower educated in England and higher educated groups in Canada. As the number of conditions increased the probability of being in employment decreased. While employment rates are similar for people with no-conditions in the UK and Canada there was a more negative impact of having more than one condition in the UK. For example, silent generation women with a low education in the England with 3+ conditions were much less likely to be employed than women with no health conditions (odds ratio of 0.095 (0.071–0.128), whilst the effect was lower for low educated silent generation women in Canada 0.318 (0.235–0.431)). The consequences of multi-morbidity for employment was found to be similar between generations. The increase in multi-morbidities may have led to reduced employment prospects particularly amongst the less educated groups in England. Conclusion Many countries are facing the challenge of an aging population. The effect of multi-morbidity on employment for older workers has been understudied even though it presents a set of challenges which risk exacerbating existing social inequalities because they are concentrated among less advantaged groups and associated with reduced employment prospects. The research presented here suggests that different policy approaches might be effective in ameliorating these inequalities.
{"title":"OP26 Temporal trends in multi-morbidity and how it impacts employment among older adults in canada and england: understanding generational and social inequalities","authors":"L. Bentley, Q. Liao, Benjamin Barr, Cameron Mustard","doi":"10.1136/jech-2018-SSMabstracts.26","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.26","url":null,"abstract":"Background In most countries policy makers are seeking to raise the age at which people become eligible for state pensions due to population aging. Aging societies are also characterised by an increase in the number of people are living with chronic conditions and multi-morbidity which can affect employment later in life. This study examines the prevalence of multi-morbidity by age, birth-cohort, and socioeconomic status before assessing the impact that this has on employment status for workers approaching retirement age. It presents a comparative analysis of the UK and Canada and discusses the different policies that each have adopted regarding older workers with chronic conditions. Methods We estimate the prevalence of multi-morbidity (composed of 6 broad categories of disease) for those aged between 50 and 64, by sex, educational level, and by two birth cohorts: the silent generation (pre-1946) and the baby boomers (1946–1964), using the Health Survey for England and the Canadian Community Health Survey. The prevalence of each condition and the changes in specific comorbidities between the generations were estimated. Finally, the association between multi-morbidity on the employment status (in employment or not) is assessed. Each of the analyses uses logistic regression models. Results Prevalence of multi-morbidities has increased between generations, particularly for the lower educated in England and higher educated groups in Canada. As the number of conditions increased the probability of being in employment decreased. While employment rates are similar for people with no-conditions in the UK and Canada there was a more negative impact of having more than one condition in the UK. For example, silent generation women with a low education in the England with 3+ conditions were much less likely to be employed than women with no health conditions (odds ratio of 0.095 (0.071–0.128), whilst the effect was lower for low educated silent generation women in Canada 0.318 (0.235–0.431)). The consequences of multi-morbidity for employment was found to be similar between generations. The increase in multi-morbidities may have led to reduced employment prospects particularly amongst the less educated groups in England. Conclusion Many countries are facing the challenge of an aging population. The effect of multi-morbidity on employment for older workers has been understudied even though it presents a set of challenges which risk exacerbating existing social inequalities because they are concentrated among less advantaged groups and associated with reduced employment prospects. The research presented here suggests that different policy approaches might be effective in ameliorating these inequalities.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"20 1","pages":"A13"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87379232","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.52
JM Wagnild, H. Ball, T. Pollard
Background Despite increasing interest in the impact of sedentary behaviour on health, little is known about sedentary behaviour during pregnancy. Given the association between sedentary behaviour and risk of type 2 diabetes, it is particularly important to understand the prevalence and correlates of sedentary behaviour during pregnancy in women at risk of gestational diabetes. The aims of this mixed methods study were to 1) quantify objectively measured sedentary time during pregnancy in women at risk of gestational diabetes, 2) quantitatively examine the correlates of objectively measured sedentary time, and 3) explore the place of sedentary behavior and physical activity in these pregnant women’s lives using qualitative data. Methods Pregnant women (n=192) recruited from two hospitals in the North East of England who had a risk factor for gestational diabetes continuously wore activPAL accelerometers for seven days during the second trimester, and a subsample of participants (n=18) took part in a semi-structured interview in the third trimester. Multiple linear regression analyses were applied to accelerometry data and thematic analysis was conducted with interview data using NVivo11. Results On average, women spent 9.57 hours per day (SD=1.62) engaged in sedentary behaviour, which accounted for 71.7% of waking hours. In multivariate linear regression models, the only statistically significant predictor of sedentary time was Index of Multiple Deprivation. Time spent sedentary was 9.29 hours (95% CI 9.00 to 9.57) for the most deprived tertile, 10.26 hours (95% CI 9.74 to 10.78) for the middle tertile, and 9.81 hours (95% CI 9.29 to 10.33) for the least deprived tertile. The key overarching theme that emerged from the interview data was that there was a social expectation that the participants should slow down and sit down simply due to their pregnancy status, which often conflicted with participants’ own perspectives that their roles in everyday life were incompatible with ‘sitting around.’ Conclusion These findings indicate that sedentary time during pregnancy may be socially patterned such that those residing in the most deprived areas spend significantly less time sedentary than those in less deprived areas. Furthermore, the reported strong social expectation for pregnant women to slow down and halt their everyday lives is a challenge for interventions to reduce sedentary time and increase physical activity during pregnancy.
尽管人们对久坐行为对健康的影响越来越感兴趣，但对怀孕期间的久坐行为知之甚少。鉴于久坐行为与2型糖尿病风险之间的联系，了解怀孕期间有妊娠糖尿病风险的妇女久坐行为的患病率及其相关性尤为重要。本混合方法研究的目的是:1)量化有妊娠期糖尿病风险妇女怀孕期间客观测量的久坐时间;2)定量检查客观测量的久坐时间的相关性;3)使用定性数据探讨久坐行为和身体活动在这些孕妇生活中的地位。方法从英格兰东北部两家医院招募有妊娠糖尿病危险因素的孕妇(n=192)，在妊娠中期连续佩戴活动pal加速计7天，并在妊娠晚期参加半结构化访谈的子样本(n=18)。加速度测量数据采用多元线性回归分析，访谈数据采用NVivo11进行专题分析。结果:女性平均每天花9.57小时(SD=1.62)从事久坐行为，占醒着时间的71.7%。在多元线性回归模型中，唯一具有统计学意义的久坐时间预测因子是多重剥夺指数。最贫困的五分之一的久坐时间为9.29小时(95% CI 9.00 ~ 9.57)，中等贫困五分之一的久坐时间为10.26小时(95% CI 9.74 ~ 10.78)，最贫困五分之一的久坐时间为9.81小时(95% CI 9.29 ~ 10.33)。从访谈数据中得出的一个重要主题是，社会期望参与者仅仅因为怀孕就应该慢下来坐下，这往往与参与者自己的观点相冲突，即他们在日常生活中的角色与“坐着”不相容。这些发现表明，怀孕期间久坐的时间可能与社会模式有关，因此生活在最贫困地区的孕妇久坐的时间明显少于生活在较贫困地区的孕妇。此外，据报道，社会对孕妇放慢和停止日常生活的强烈期望，对减少怀孕期间久坐时间和增加身体活动的干预措施构成了挑战。
{"title":"OP52 The prevalence and correlates of objectively measured sedentary time in pregnant women at risk of gestational diabetes in the UK: a mixed methods study","authors":"JM Wagnild, H. Ball, T. Pollard","doi":"10.1136/jech-2018-SSMabstracts.52","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.52","url":null,"abstract":"Background Despite increasing interest in the impact of sedentary behaviour on health, little is known about sedentary behaviour during pregnancy. Given the association between sedentary behaviour and risk of type 2 diabetes, it is particularly important to understand the prevalence and correlates of sedentary behaviour during pregnancy in women at risk of gestational diabetes. The aims of this mixed methods study were to 1) quantify objectively measured sedentary time during pregnancy in women at risk of gestational diabetes, 2) quantitatively examine the correlates of objectively measured sedentary time, and 3) explore the place of sedentary behavior and physical activity in these pregnant women’s lives using qualitative data. Methods Pregnant women (n=192) recruited from two hospitals in the North East of England who had a risk factor for gestational diabetes continuously wore activPAL accelerometers for seven days during the second trimester, and a subsample of participants (n=18) took part in a semi-structured interview in the third trimester. Multiple linear regression analyses were applied to accelerometry data and thematic analysis was conducted with interview data using NVivo11. Results On average, women spent 9.57 hours per day (SD=1.62) engaged in sedentary behaviour, which accounted for 71.7% of waking hours. In multivariate linear regression models, the only statistically significant predictor of sedentary time was Index of Multiple Deprivation. Time spent sedentary was 9.29 hours (95% CI 9.00 to 9.57) for the most deprived tertile, 10.26 hours (95% CI 9.74 to 10.78) for the middle tertile, and 9.81 hours (95% CI 9.29 to 10.33) for the least deprived tertile. The key overarching theme that emerged from the interview data was that there was a social expectation that the participants should slow down and sit down simply due to their pregnancy status, which often conflicted with participants’ own perspectives that their roles in everyday life were incompatible with ‘sitting around.’ Conclusion These findings indicate that sedentary time during pregnancy may be socially patterned such that those residing in the most deprived areas spend significantly less time sedentary than those in less deprived areas. Furthermore, the reported strong social expectation for pregnant women to slow down and halt their everyday lives is a challenge for interventions to reduce sedentary time and increase physical activity during pregnancy.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"1 1","pages":"A26"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90109097","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.176
K. Levin, E. Crighton
Background Step-Down Intermediate Care (IC) was developed in Glasgow City and implemented in November 2014. IC units act as a bridging service between hospital and home, for those deemed medically fit for discharge, but who would otherwise spend some time delayed in hospital, usually due to a lack of appropriate care, support or accommodation in the community. The aim of this study was to measure the effect of IC on days delayed. Methods Rate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6 month phase-in period, using segmented linear regression with 23-month (January 2013–November 2014) pre- and 13-month (June 2015–June 2016) post- intervention periods. Rate of delayed days for residents of Inverclyde and West Dunbartonshire (I&WD)- areas with similar high levels of deprivation, within NHS GGC, but with no IC in place – were used as a comparison group, as in April 2015 a national target was set to reduce delays. Results Between January 2013 and November 2014 rate of days delayed in hospital increased by 41%. Rate of days delayed in I&WD was approximately half that of Glasgow at the start of the study period, however these also increased in the pre intervention period, by 33%. Rates reduced in both areas between November 2014 and June 2015. After accounting for secular changes pre-intervention, Glasgow City saw a level change of −57.66 (-60.85, –54.48) days per 1000 population with no significant change in trend, 0.35 (-0.19, 0.88). However, following adjustment for changes in I&WD, and therefore a factoring out of the new national target, the impact of IC in Glasgow City was found to be a level change of −12.56 (-17.65, –7.47) and a trend change of −0.38 (−0.73, –0.04). This is equivalent to a predicted reduction due to IC of −7.28 days delayed per 1000 popn, in June 2016, and a relative reduction of 18%. Rate of days delayed in Glasgow City continued to increase over time after the introduction of IC, though at a slower rate than if IC had not existed. Conclusion The introduction of a national target resulted in a reduction of delayed days. After factoring out this reduction, IC was responsible for a further reduction in delayed days of 18%. The rate of days delayed continued to increase over time after the introduction of IC, though at a slower rate.
{"title":"P52 The effect of step-down intermediate care on days lost to delayed discharge from hospital: a controlled interrupted time series analysis","authors":"K. Levin, E. Crighton","doi":"10.1136/jech-2018-SSMabstracts.176","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.176","url":null,"abstract":"Background Step-Down Intermediate Care (IC) was developed in Glasgow City and implemented in November 2014. IC units act as a bridging service between hospital and home, for those deemed medically fit for discharge, but who would otherwise spend some time delayed in hospital, usually due to a lack of appropriate care, support or accommodation in the community. The aim of this study was to measure the effect of IC on days delayed. Methods Rate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6 month phase-in period, using segmented linear regression with 23-month (January 2013–November 2014) pre- and 13-month (June 2015–June 2016) post- intervention periods. Rate of delayed days for residents of Inverclyde and West Dunbartonshire (I&WD)- areas with similar high levels of deprivation, within NHS GGC, but with no IC in place – were used as a comparison group, as in April 2015 a national target was set to reduce delays. Results Between January 2013 and November 2014 rate of days delayed in hospital increased by 41%. Rate of days delayed in I&WD was approximately half that of Glasgow at the start of the study period, however these also increased in the pre intervention period, by 33%. Rates reduced in both areas between November 2014 and June 2015. After accounting for secular changes pre-intervention, Glasgow City saw a level change of −57.66 (-60.85, –54.48) days per 1000 population with no significant change in trend, 0.35 (-0.19, 0.88). However, following adjustment for changes in I&WD, and therefore a factoring out of the new national target, the impact of IC in Glasgow City was found to be a level change of −12.56 (-17.65, –7.47) and a trend change of −0.38 (−0.73, –0.04). This is equivalent to a predicted reduction due to IC of −7.28 days delayed per 1000 popn, in June 2016, and a relative reduction of 18%. Rate of days delayed in Glasgow City continued to increase over time after the introduction of IC, though at a slower rate than if IC had not existed. Conclusion The introduction of a national target resulted in a reduction of delayed days. After factoring out this reduction, IC was responsible for a further reduction in delayed days of 18%. The rate of days delayed continued to increase over time after the introduction of IC, though at a slower rate.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"21 1","pages":"A83–A84"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90212363","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.156
L. Long, V. Joshi, L. Tang, R. Taylor, A. Zwisler
Background Today, many more people are surviving sudden cardiovascular events and living longer with cardiovascular disease, thanks to advances in preventive strategies and advanced treatment. Hence, rehabilitation and palliative care interventions have become an important focus for improving the lives of patients living with cardiovascular diseases. Drawing on ‘review of reviews’ and rapid review methodology, as well as evidence gap maps, we worked with non-academic stakeholders at the Danish Heart Foundation (DHF) to co-produce a contemporary overview to uniquely bring together the evidence for the efficacy of rehabilitation and palliative care across a wide spectrum of cardiovascular diseases. The overview summarises the current evidence but also identifies where gaps in the evidence exist. Methods End user feedback was sought on the protocol and at key points in the overview process. Six bibliographic databases were searched for systematic reviews. Only articles published after 2009 were included. Quality of SRs was assessed using the R-AMSTAR tool. A narrative synthesis was performed and a summary of the most recent systematic review(s)/meta-analyses for efficacy of rehabilitation for each of the included CVD conditions presented using accessible graphic visualisations of data (infographics). Results The overview finds that the evidence for rehabilitation in coronary heart disease and heart failure is well established as well as supervised exercise training in intermittent claudication. Improved access to rehabilitation is needed for these indications. There is a dearth of studies on the efficacy of dietary and smoking interventions in CVD indications. Also, further research is needed on palliative care interventions for heart failure and other life-threatening cardiovascular diseases. Conclusion A pragmatic, flexible approach to conducting this overview, together with meaningful involvement of end users, facilitated completion of a comprehensive overview to deadline (six months), identified gaps in the evidence, improved accessibility of findings and ensured relevance to real world settings. Limitations included no attempt to search for individual randomised controlled trials (RCTs), to perform updates or undertake de novo SRs. We only focused on the effectiveness of rehabilitation and palliative interventions for CVD relative to control and did not consider the relative effectiveness of different components of interventions (for example, type, duration, frequency of exercise training) or settings. The overview highlights the need to prioritise high quality studies that establish the effectiveness of rehabilitation in cardiovascular indications where there is currently little or no evidence.
{"title":"P30 Rapid overviews for pragmatic transfer of knowledge from research to practice","authors":"L. Long, V. Joshi, L. Tang, R. Taylor, A. Zwisler","doi":"10.1136/jech-2018-SSMabstracts.156","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.156","url":null,"abstract":"Background Today, many more people are surviving sudden cardiovascular events and living longer with cardiovascular disease, thanks to advances in preventive strategies and advanced treatment. Hence, rehabilitation and palliative care interventions have become an important focus for improving the lives of patients living with cardiovascular diseases. Drawing on ‘review of reviews’ and rapid review methodology, as well as evidence gap maps, we worked with non-academic stakeholders at the Danish Heart Foundation (DHF) to co-produce a contemporary overview to uniquely bring together the evidence for the efficacy of rehabilitation and palliative care across a wide spectrum of cardiovascular diseases. The overview summarises the current evidence but also identifies where gaps in the evidence exist. Methods End user feedback was sought on the protocol and at key points in the overview process. Six bibliographic databases were searched for systematic reviews. Only articles published after 2009 were included. Quality of SRs was assessed using the R-AMSTAR tool. A narrative synthesis was performed and a summary of the most recent systematic review(s)/meta-analyses for efficacy of rehabilitation for each of the included CVD conditions presented using accessible graphic visualisations of data (infographics). Results The overview finds that the evidence for rehabilitation in coronary heart disease and heart failure is well established as well as supervised exercise training in intermittent claudication. Improved access to rehabilitation is needed for these indications. There is a dearth of studies on the efficacy of dietary and smoking interventions in CVD indications. Also, further research is needed on palliative care interventions for heart failure and other life-threatening cardiovascular diseases. Conclusion A pragmatic, flexible approach to conducting this overview, together with meaningful involvement of end users, facilitated completion of a comprehensive overview to deadline (six months), identified gaps in the evidence, improved accessibility of findings and ensured relevance to real world settings. Limitations included no attempt to search for individual randomised controlled trials (RCTs), to perform updates or undertake de novo SRs. We only focused on the effectiveness of rehabilitation and palliative interventions for CVD relative to control and did not consider the relative effectiveness of different components of interventions (for example, type, duration, frequency of exercise training) or settings. The overview highlights the need to prioritise high quality studies that establish the effectiveness of rehabilitation in cardiovascular indications where there is currently little or no evidence.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"47 1","pages":"A74"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87798521","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.68
L. Macdonald, J. Olsen, N. Shortt, A. Ellaway
Background Recent research on the determinants of health-related behaviours, such as smoking, heavy drinking and poor diet, has begun to focus on physical environmental factors, such as the retail environment, and associations with area level deprivation. This study utilises an innovative application of spatial cluster analysis to examine the socio-spatial patterning of various categories of outlets, selling potentially health-damaging goods/services (alcohol, fast food, tobacco and gambling) within Glasgow. This novel application advances existing methods for quantifying spatial access to retail outlets as it is not restricted by pre-defined boundaries. Methods Outlet address data was obtained from Glasgow City Council for 2012 (tobacco, fast food), and 2013 (alcohol, gambling) and mapped using GIS software. SaTScan, a well-established cluster analysis tool, was used to detect spatial clusters of outlets and ascertain their statistical significance (at the 5% level). Analysis was performed for all categories of outlets combined (to examine co-location), and individually for alcohol, fast food, tobacco, and gambling outlets. Software provided output for clusters centroids, size (radius) and statistical significance. Clusters were assigned a Scottish Index of Multiple Deprivation 2012 Income score; quintiles of income deprivation were calculated from 1 (most deprived) to 5 (least deprived) and compared for numbers of clusters. Results Across the city, there were 28 areas where all four types of outlets were co-located; and for individual outlets, there were 20 alcohol outlet clusters, 16 fast food outlet clusters, 15 tobacco outlet clusters and 5 gambling outlet clusters. Co-occurrence clusters were more common in deprived areas, with ten clusters in the more deprived quintile compared to one in the most affluent quintile. In terms of individual categories of outlet, poorer areas contained the largest number of alcohol, fast food, tobacco and gambling outlet clusters. Co-location of individual types of outlets in similar geographical areas was also evident, for example: located in the central business district, other retail, office, service hubs, and also deprived areas in the ‘east end’. Conclusion The study makes use of a robust technique to detect clusters and adds to evidence that deprived areas have increased access to potentially health damaging goods/services. Such research can inform interventions to tackle the co-occurrence of health behaviours, and findings could aid authorities to develop policy/planning regulations appropriate for areas in greatest need.
{"title":"OP69 Do ‘environmental bads’ such as alcohol, fast food, tobacco, and gambling outlets cluster and co-locate in more deprived areas in glasgow city, scotland?","authors":"L. Macdonald, J. Olsen, N. Shortt, A. Ellaway","doi":"10.1136/jech-2018-SSMabstracts.68","DOIUrl":"https://doi.org/10.1136/jech-2018-SSMabstracts.68","url":null,"abstract":"Background Recent research on the determinants of health-related behaviours, such as smoking, heavy drinking and poor diet, has begun to focus on physical environmental factors, such as the retail environment, and associations with area level deprivation. This study utilises an innovative application of spatial cluster analysis to examine the socio-spatial patterning of various categories of outlets, selling potentially health-damaging goods/services (alcohol, fast food, tobacco and gambling) within Glasgow. This novel application advances existing methods for quantifying spatial access to retail outlets as it is not restricted by pre-defined boundaries. Methods Outlet address data was obtained from Glasgow City Council for 2012 (tobacco, fast food), and 2013 (alcohol, gambling) and mapped using GIS software. SaTScan, a well-established cluster analysis tool, was used to detect spatial clusters of outlets and ascertain their statistical significance (at the 5% level). Analysis was performed for all categories of outlets combined (to examine co-location), and individually for alcohol, fast food, tobacco, and gambling outlets. Software provided output for clusters centroids, size (radius) and statistical significance. Clusters were assigned a Scottish Index of Multiple Deprivation 2012 Income score; quintiles of income deprivation were calculated from 1 (most deprived) to 5 (least deprived) and compared for numbers of clusters. Results Across the city, there were 28 areas where all four types of outlets were co-located; and for individual outlets, there were 20 alcohol outlet clusters, 16 fast food outlet clusters, 15 tobacco outlet clusters and 5 gambling outlet clusters. Co-occurrence clusters were more common in deprived areas, with ten clusters in the more deprived quintile compared to one in the most affluent quintile. In terms of individual categories of outlet, poorer areas contained the largest number of alcohol, fast food, tobacco and gambling outlet clusters. Co-location of individual types of outlets in similar geographical areas was also evident, for example: located in the central business district, other retail, office, service hubs, and also deprived areas in the ‘east end’. Conclusion The study makes use of a robust technique to detect clusters and adds to evidence that deprived areas have increased access to potentially health damaging goods/services. Such research can inform interventions to tackle the co-occurrence of health behaviours, and findings could aid authorities to develop policy/planning regulations appropriate for areas in greatest need.","PeriodicalId":15778,"journal":{"name":"Journal of Epidemiology & Community Health","volume":"42 1","pages":"A33"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80046630","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}
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