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A1 – DAVID EVANS, UWE
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Prince Consort Hall
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11.30 – 11.50
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Background:
Since the 1970s the overlapping concepts of community
development, engagement, involvement and participation have
become a central concern of the international public health
movement. Stimulated by the Declaration of Alma Ata, the
Ottawa Charter and ‘Health for All’, the public health
system in the UK has demonstrated an increasing rhetorical
commitment to participatory approaches. However, it is less
clear that participatory approaches have been regularly
pursued by UK NHS public health units in practice. This
literature has not previously been systematically reviewed
or synthesised.
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Aims:
The central review question is ‘what has been the impact of
participatory approaches by UK NHS public health units on
health and social outcomes?’
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Methods:
This systematic review builds on the emerging methodology of
qualitative systematic reviews which has been used in
previous systematic reviews by the lead investigator. We
systematically searched 14 online databases using a search
strategy based on four word groups: population=community
(+variations); intervention=participation (+variations);
setting=public health department (+variations); outcome
(+variations). Inclusion and exclusion criteria were applied
including UK setting.
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Results:
The initial search yielded 5,451 references which were
reduced to 2,155 once duplicates had been removed. Eight
papers covering seven studies met the inclusion criteria,
had data extracted and were fully analysed. The literature
found was largely qualitative and focused on process rather
than outcomes.
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Conclusions:
Despite the strong rhetorical commitment to participatory
approaches in the specialist public health field, there is
very limited evidence for the application and impact of
participatory approaches by UK public health units.
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B1 – SARAH GUNN, UNIVERSITY OF BRISTOL
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Ashcombe Suite
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11.30 – 11.50
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Background:
Following the successful development and implementation of
the peer-led ASSIST programme, which was shown to be
effective in reducing adolescent smoking levels1,
the Department of Health are funding a two-year study to
test the feasibility of a similar peer-led intervention to
encourage increased physical activity and healthy eating
amongst adolescents.
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1. Campbell et al. An
informal school-based peer-led intervention for smoking
prevention in adolescence (ASSIST): a cluster randomised
trial. Lancet 2008 May 10;371(9624):1595-602.
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Aims:
To develop a training programme for ‘peer supporters’ that
would enable them, in everyday situations, to encourage
physical activity and healthy eating amongst their peers.
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Methods:
Influential students are identified by other members of
their year group through a peer nomination questionnaire,
and invited to attend a two-day, out-of-school training
programme run by health promotion specialists and youth
workers. The trained ‘peer supporters’ are then asked to
pass on the information they have learned, and to model new
behaviour, to encourage healthy eating and physical activity
amongst students in their year. They are supported in this
role through four school-based follow-up sessions.
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Results and
conclusions:
The study is at the pilot stage. The purpose of this
presentation is to describe the development and
implementation of the training programme and identify some
preliminary successes and challenges.
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C1 – KATE THOMAS, UNIVERSITY OF BRISTOL
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Grove Suite
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11.30 – 11.50
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Background:
Increasing life expectancy has provoked public health
concern about the prospects of a growing number of people
experiencing problems with locomotor function in old age.
Socio-economic influences over a lifetime impact on health
and may contribute to poor physical functioning in the
elderly.
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Aims:
To examine the impact of childhood and adult socioeconomic
factors on locomotor function in old age using the "get up
and go" timed walk and "flamingo balance" tests, in the Boyd
Orr (n=405) and Caerphilly (n=1,089) prospective cohorts.
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Methods:
Walking times were log transformed because of a skewed
distribution and linear regression models investigated
associations of socioeconomic circumstances, adjusting for
age, sex and clinic location. The back-transformed
regression coefficients represent percentage change in walk
time. The flamingo test was dichotomised at the lowest 20%
of performers (cut-point <5 seconds); logistic regression
was used.
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Results:
There were rapid reductions in walking speed and balance
time with increasing age. Each one-year increase in age was
associated with a 1.7% increase in walk time and a 14%
increased odds of poor balance. Participants with low
social class in childhood but high social class in adulthood
had walking times that were 2% slower (95% CI: -4%, 8%) than
people who had a high social class in both periods;
participants who moved from a high childhood social class to
a low adulthood social class had walking times that were 6%
slower (95% CI: -1%, 14%); participants who had a low social
class in both periods had walking times that were 10% slower
(95% CI: 4%, 16%); (P for trend <0.001). Achieving higher
education was associated with 5% faster (95% CI: -7%, -2%)
walking times; the association remained after adjusting for
health behaviours and diseases but was partly attenuated
after adjustment for adult social class (2% reduction; 95%
CI: -5%, 1%).
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- Conclusion:
Accumulating lifetime socioeconomic disadvantage is
associated with worse physical performance in old age.
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D1 – ANDERS WALLENSTEN, HPA SW
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Clarence Suite
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11.30 – 11.50
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Background:
Highly pathogenic avian
influenza (HPAI) A/H5N1 is a zoonotic disease which is often
fatal in humans. Wild birds may carry the disease, but it is
not known to what extent contact with infected wild birds
result in transmission to humans. On January 10th
2008 HPAI A/H5N1 was isolated from carcasses of mute swans
collected at Abbotsbury Swannery, Dorset. This signalled the
start of a two month outbreak in which ten mute swans and
one Canada goose tested positive for the disease. The Health
Protection Agency investigated if any humans were affected.
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Aims:
To investigate if any
transmission of HPAI A/H5N1 to humans from wild birds had
occurred.
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Methods:
People who had reported sick
or dead wild birds to the Veterinary Laboratories Agency
that tested positive for HPAI A/H5N1 were contacted and
interviewed about their exposure. They were also asked to
name others potentially exposed. Those that had been within
one metre of infected birds without protective equipment
were considered exposed. The exposed were assessed for the
need for oseltamivir treatment and asked daily about
symptoms during the HPAI A/H5N1 incubation period. Samples
for serology were collected and analyzed 30 days after
exposure.
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Results:
Thirteen exposed persons
were identified of which seven had manually handled infected
swans. Seven were given post prophylactic oseltamivir
treatment. None of the exposed developed overt disease and
follow-up serology was negative for the ten who accepted
testing.
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Conclusions:
We found no evidence of
transmission of HPAI A/H5N1 in people that had contact with
infected birds.
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A2 – LYNNE EAGLE, UWE
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Prince Consort Hall
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11.50 – 12.10
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Background:
Message framing refers to
the way communications should be framed, for example either
emphasising the advantages of doing a certain action or the
negative consequences of not taking action.
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Aims:
It is known that the
effectiveness of messages framed in either positive or
negative terms is dependent on several factors. The aim is
to systematically review the effectiveness of different
types of interventions or targeted behaviours using various
types of message framing.
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Method:
A systematic review using
major electronic databases was conducted (e.g. EBSCO and
EBSCO Medical (including Medline) databases for relevant
studies and our own collection of papers and books.
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Results:
Positively framed messages
appear to be stronger for preventative behaviour and health
affirming messages. Factors potentially impacting on
communication effectiveness include whether new behaviour is
being promoted or whether ceasing current behaviour is
targeted. In low involvement conditions positive messages
are more effective, whereas the reverse is true for
high-involvement conditions. Negative message framing, often
relying on fear appeals, has been found to be more effective
for illness-detecting behaviour. However, if the message
conflicts with pre-existing knowledge, attitudes, beliefs
and perceived social norms interventions are not only
ineffective but harden resolve to continue with existing
behaviours. There is evidence that message framing effects
vary across cultures, although this remains a significantly
under-researched area.
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Conclusions:
There is a clear need to
provide guidance to those planning interventions in order to
maximise potential effectiveness of intervention
communications.
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B2 – NORMA DAYKIN, UWE
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Ashcombe Suite
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11.50 – 12.10
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Background:
Concerns have been raised
about the role of alcohol in media output aimed at young
people, in particular, it has been suggested that media
representations have contributed to a culture in which
excessive weekend alcohol consumption by young people is
celebrated and encouraged. The study was funded by the
Department of Health and the Home Office, working together
on the Alcohol Harm Reduction Campaign.
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Aim:
The study sought to
investigate the volume and nature of comments about alcohol
in weekend output from a sample of radio stations in
England.
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Methods:
Alcohol references from 1200
hours of radio output in England were examined. The sample
included commercial and non commercial stations across a
number of regions and music genres. The research explored
the volume and nature of alcohol related comments using
quantitative methods. Discourse analysis was used to explore
the role that these comments play in radio output.
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Results:
Variations in the volume and
nature of comments about alcohol were found, influenced by
broadcast sector, music genre and seasonal factors. Hence
the volume of comments is lower on BBC stations than on
commercial stations as well as on stations that focus on
hip-hop and Black music as opposed to other genres.
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The majority of comments by
presenters support drinking in the context of weekend
partying and socialising, one of five key themes identified.
A proportion (13%) of comments, appear to encourage
excessive drinking and while not all presenters encourage
drinking, very few presenters directly challenge comments
from listeners about excessive drinking.
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Conclusions:
Conventions of radio broadcasting may shape presenters’
responses to alcohol talk. Hence presenters are not solely
responsible for representations of alcohol. For example,
comments about alcohol contribute to identity and branding
of radio output as well as helping to forge connections
between presenters and listeners. However, some presenters
achieve these goals without mentioning alcohol.
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C2 – IAIN LANG, EXETER UNIVERSITY
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Total burden of exposure
to environmental toxicants in
relation to ethnicity: findings from the National
Health and Nutrition Examination Survey (NHANES)
2001-2004
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Grove Suite
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11.50 – 12.10
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Background:
Some environmental
toxicants, such as pesticides, have long been known to be
concentrated in particular social and ethnic groups, and
often considered a result of occupational or geographical
risks. Recently established high throughput analysis
techniques enable the estimation of population-level
concentrations toxicants present at low doses, including
pesticides, phthalates, and phenols, but analyses have
tended to focus on single toxicants or classes of toxicants.
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Aims: To assess the overall burden of toxicant
exposure in a national population according to ethnic
background.
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Methods:
Data on 11, 039 adults in the US National Health And
Nutrition Examination Survey (NHANES) 2001-2004 were used to
estimate body burdens of 225 toxicants. Ethnicity was
self-reported as Hispanic Black, Hispanic White,
Non-Hispanic Black, Non-Hispanic White, and other
background. Differences in the normalized concentrations of
each toxicant in relation to ethnicity were assessed using
fully adjusted linear regression models.
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Results:
Concentrations of 26 of the 225 toxicants assessed (11.5 %)
were associated with ethnic background. The greatest
differences in relation to ethnicity were for the
organochloride pesticides
DDT,
DDE, and HCH in which Mexican and Black respondents had mean
concentrations 3.94 (95% CI 2.41 to 6.48) and 3.96 (95% CI
3.08 to 5.09) times higher than Non-Hispanic White
respondents. Associations for a number of volatile organic
compounds and phthalates were also determined.
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Conclusions:
These findings are the first to demonstrate the extent to
which overall burden of toxicant exposure in the US general
population is determined by ethnic background. There is an
urgent need for policy to address ethic inequalities in
exposure to harmful toxicants.
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D2 – LINDA MATTHEWS
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An Audit of Rubella
Susceptibility Rates in the Cwm Taf (South) NHS
Trust Over a Four Year Period
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Clarence Suite
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11.50 – 12.10
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Background:
Rubella is an insignificant
childhood disease that has devastating results in pregnancy.
Immunisation using Rubella single vaccine was replaced by
Measles, Mumps and Rubella vaccine (MMR) in 1988. Adverse
publicity (1998) caused a fall in uptake of MMR. Anecdotal
evidence suggests that rubella susceptibility levels in
pregnancy have subsequently increased.
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Aims:
Using data collected in one
NHS Trust area in Wales: To determine the rate of rubella
susceptibility in antenatal women by age group, in first and
subsequent pregnancies and to compare with National figures.
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Methods:
A retrospective analysis
(2005 – 2007) of the results of rubella immunity in
ante-natal screening tests was carried out. Information
given on the request forms was also examined. Analysis was
also planned prospectively for another 3 years from 2008 to
2010. To date 3 years retrospective and one year prospective
have been analysed.
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Results:
The number and percentage of
all women who are susceptible to rubella (as defined by an
antibody level of <10 IU/ml) has risen over the period
2005-2008. The susceptibility rate in the most vulnerable
group, namely women in their first pregnancy have increased
from 6.6% to 9.5% in this four year period. Data will
presented by age group, first pregnancy and ethnicity.
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Conclusions:
Poor uptake in the MMR
Immunisation programme has been associated with an increase
in rubella susceptibility rates particularly in the under
twenties. The reduction in uptake of MMR may result in the
re-emergence of rubella and cases of congenital rubella.
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A3 – AMANDA OWEN-SMITH, UNIVERSITY OF BRISTOL
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Prince Consort Hall
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12.10 – 12.30
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Background:
Despite global policy moves towards more explicit forms of
healthcare rationing, there has been no empirical research
of patients’ views on this issue, and little relating to the
views of clinicians.
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Aims:
To understand whether patients currently receiving
healthcare want to know about financial limitations, and how
clinical professionals make judgments about how much
information to disclose.
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Methods:
Qualitative interview research with 31 patients (with morbid
obesity and breast cancer) and 21 professionals involved in
the provision of their care.
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Results:
Nearly all patients wanted to know about healthcare
rationing, although their accounts showed that this could be
extremely distressing, and many felt this was not the right
approach for all patients. Clinical professionals tended to
be committed to explicitness in theory, but in practice
ethical and pragmatic concerns meant that implicit
approaches were often adopted. Clinicians adopted a number
of techniques for deciding on the appropriate level of
disclosure, and commonly
waited for patients to ask specifically about these issues
(which they rarely did).
However, patients disliked discriminatory patterns of
disclosure, and many simply did not know they needed to ask
to be told about all treatment options available.
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Conclusions:
Despite most patients saying they were firmly in favour of
explicit rationing, the potentially devastating effects of
this approach means that some individual elicitation of
preferences is necessary. However, clinicians’ current
elicitation techniques, such as they exist, are
unsatisfactory, and this evidence suggests that disclosure
practices are likely to be socially patterned.
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B3 – JUDI KIDGER, UNIVERSITY OF BRISTOL
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Ashcombe Suite
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12.10 – 12.30
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Background:
In Britain, 12% of 11-16 year olds have a diagnosable mental
disorder, with many more experiencing symptoms of emotional
distress. There is increasing academic and political
interest in how schools can better support student emotional
health, but little is known about what is currently being
done, and what students and staff would like to see
introduced.
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Aim:
To examine emotional health provision across English
secondary schools, and to explore student and staff
perceptions of what schools can do to support teenagers’
emotional health.
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Methods:
A postal survey of a random sample of 296 secondary schools
across England. In-depth
semi-structured student focus groups (27 groups, 154
students aged 12-14) and staff interviews (12 interviews, 15
individuals) in a sub-sample of eight schools.
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Results:
The majority of schools spent little curriculum time on
emotional health, with several key topics such as depression
and help seeking neglected. Students and staff wanted more
coverage, with experts rather than teachers delivering
lessons. Most schools provided support for students
experiencing emotional distress, but the type and quality
varied a great deal. Students wanted an increase in
confidential, accessible help sources, but also needed to be
better informed about existing services. Staff and students
emphasised whole-school approaches to emotional health, in
which teacher-student relationships, bullying, and other
aspects of the environment could be addressed.
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Conclusions:
Current emotional health provision is variable but often
lacking. Clearer guidance at policy level, rigorous
evaluation of current interventions, and more training for
teachers is necessary to improve the support provided.
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C3 – BRUCE BOLAM, GOSW
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Do high levels of universal
immunisation coverage control area-level deprivation
effects on the incidence of vaccine-preventable
disease?
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Grove Suite
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12.10 – 12.30
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Background:
The State of
Victoria, Australia, has achieved over 90% immunisation
coverage among the three principle childhood cohorts of 1, 2
and 6 years of age. With an incidence of 5.5 per 100,000
person-years, invasive pneumococcal disease (IPD) is the
commonest reliably diagnosed vaccine-preventable disease
(VPD). 7-valent pneumococcal vaccination of children under
one year of age was introduced during 2005.
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Aim:
To describe the relationship between area-level deprivation
and IPD incidence pre- and post-introduction of universal
pneumococcal vaccination.
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Methods:
An observational ecological
study using postcode to link Victorian Dept. of Human
Services IPD notification data and pneumococcal vaccine
coverage data from the Australian Childhood Immunisation
Register to an area-based measure of social deprivation, the
Australian Bureau of Statistic’s
Index of
Relative Socio-Economic Advantage/Disadvantage (IRSAD), for
children aged 0-4
years during 2002-4 and 2006-7.
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Results:
There were 40.7 IPD
cases per 100,000 children aged 0-4 years in 2002-4, with a
non-significant trend to higher incidence with higher
area-level deprivation (IPD & IRSAD r=0.54, regression line
of best fit -1.06, 95%CI = -3.38, 1.26). There was almost
100% vaccine coverage all deprivation quintiles in 2006-07.
There was an incidence of 11.4 IPD cases per 100,000
children aged 0-4 years in 2006-07, with a non-significant
relationship between IPD incidence and area-level
deprivation (IPD & IRSAD r=0.42, regression line of best fit
-0.16, 95%CI = -1.01, 0.70.
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Conclusions:
There is limited
observational data to suggest that high universal levels of
IPD immunisation may have helped control any area-level
deprivation effect in the commonest reliably diagnosed VPD
in Victoria.
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D3 – MARK KEALY, HPA
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Clarence Suite
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12.10 – 12.30
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Background:
Current guidelines for tuberculosis control contain little
guidance on Tuberculosis in the workplace. This report
describes how one such outbreak of infection was managed.
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Aim:
to describe an outbreak of tuberculous infection at a
utility call centre, and how its management may point the
way for controlling similar outbreaks of tuberculosis.
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Methods:
Following notification of a smear positive case of
tuberculosis in a young man, known to have infected one
close contact, a wide ring of work contacts were identified.
These were examined using the principles in the BTS and NICE
guidance with a mixture of Mantoux testing and Chest X-ray
depending on age. Those with a ‘positive’ Mantoux were
tested using the ‘Quantiferon Gold’ immunoassay to determine
whether they had infection with Mycobacterium tuberculosis.
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Results:
A total of 52 Chest X-rays were performed on those people
over the age of 35, none of these had features suggestive of
early tuberculosis, 84 Mantoux tests were performed on those
under 35, 45 of these had ‘positive’ Mantoux tests and of
these 12 were positive on Quantiferon testing. All were
started on prophylactic antituberculous treatment for latent
infection. One was found to have a pleural effusion and
diagnosed as having pulmonary tuberculosis.
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Conclusions:
This outbreak involved screening 136 contacts and resulted
in finding a total of 12 cases of latent tuberculosis by
Quantiferon testing and 1 case of clinical tuberculosis. In
future guidance should suggest that a careful risk
assessment needs to be undertaken for workplace contacts.
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A4 – SUSAN HAMILTON, UNIVERSITY
OF BRISTOL
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Prince Consort Hall
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12.30 – 12.50
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Background:
There is evidence that news
reporting of suicides can lead to ‘copycat’ events,
particularly when coverage is repeated, the method is
described and readily available. Clifton Suspension Bridge
has attracted publicity as a location for suicides in the UK
and has been the site of 6-8 suicides per year since the
1970s. There is limited evidence from the UK on associations
between reporting and suicides, and few studies assess the
impact of quality and prominence of reporting.
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Aim:
To assess the evidence for
clustering in time of deaths from the Suspension Bridge
between 1974 - 2007. To describe changes in the quality and
prominence of local news reports, and assess the
contribution of these to any clustering.
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Methods:
Details of suicides from the
Suspension Bridge were obtained from the coroner’s office.
The BBC and ITV provided copies of all local TV news
broadcasts. Local newspapers were scanned for reports around
the time of the death or inquest. All media items were rated
for quality and prominence.
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Results:
Initial results indicate
that the prominence of news reports concerning Suspension
Bridge suicide has declined considerably over time. There
has been no TV reporting since 1996. However, many of the
recommendations to improve the quality of reporting in
existing guidelines are not being implemented. Evidence of
clustering, and changes in the quality of news reports will
be discussed.
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Conclusions:
While there has been some improvement in local media
reporting of Suspension Bridge suicides, much remains to be
done. Implications for public health professionals working
with the media will be discussed.
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B4 – EMILY KLINEBERG, UNIVERSITY OF BRISTOL
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Ashcombe Suite
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12.30 – 12.50
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Background:
There are an estimated 25,000 presentations of adolescent
self-harm to hospitals in England and Wales annually. Recent
school-based surveys report that 7% of 16 year olds
self-harmed in the past year and only 13% of those episodes
led to hospital presentation. Support from friends and
family is sought more frequently than help from services,
yet self-harm often remains hidden.
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Aim:
To explore attitudes to disclosing self-harm and seeking
help with an adolescent community-based sample.
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Methods:
Individual interviews were conducted with a purposive sample
of 15-16 year olds (n=30) from four East London secondary
schools, selected on the basis of gender and experience of
self-harm.
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Results:
Young people who had self-harmed reported difficulty
verbalising feelings. Some used self-harm to communicate
distress, however many expressed reluctance about
disclosure. This stemmed from attitudes about self-harm
being personal or unproblematic, along with expectations of
negative responses from others.
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A range of informal and
service-based sources of help was mentioned, with
reservations about trusting others and handling of
confidential information. There was limited understanding
about service accessibility and whether professionals would
help with personal problems, or simply attend to physical
harm.
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Conclusions:
There was no consensus about help sources or knowledge of
potential gatekeepers. There is a need to reduce stigma
about mental health, to increase awareness of appropriate
responses to self-harm along with the nature and
accessibility of services. Development of school-based
interventions could address these issues, providing
information for both young people who self-harm and others
who may be approached for support.
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C4 – JULIE MYTTON, NHS BRISTOL
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Grove Suite
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12.30 – 12.50
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Background:
The developing fetus
receives vitamin D from their mother during the last
trimester of pregnancy. Babies with vitamin D deficiency are
at risk of hypocalcaemic fits. A case series of vitamin D
deficient patients in primary care in Bristol in 2006 found
a high proportion of women of childbearing age, especially
in the Black African ethnic group.
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Aims:
To estimate the proportion
of Caucasian and Black African women in Bristol with vitamin
D deficiency during pregnancy.
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Methods:
Women were recruited to the
study when attending routine antenatal appointments with
midwives linked to 4 primary care centres in north Bristol.
Blood for Vitamin D analysis was taken at the same time as
other routinely collected samples.
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Results:
97 Caucasian women and 82
Black African women were recruited between March and
September 2008. Excluding 26 women reporting any vitamin D
supplementation, 61.5% Caucasian women and 95.5% Black
African women had less than the ‘adequate’ level of total
vitamin D (<75nmol/l). 8.8% Caucasian women and 66.7% Black
African women had ‘severely deficient’ levels of vitamin D
(<25nmol/l). The mean difference in vitamin D between these
groups (40.9nmol/l [95% CI 32.6, 49.1]) was greater than
chance (p<0.001).
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Conclusions:
Black African women in this
sample were highly likely to have babies born deficient in
vitamin D and therefore at risk of hypocalcaemic fits. A
proportion of pregnant Caucasian women were also found to be
deficient. Deficiency is entirely preventable yet current
vitamin D policy does not meet the needs of women or their
infants.
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D4 – ADA BENNETT, HPA SW
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Clarence Suite
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12.30 – 12.50
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Background:
Increases in the number of the people living with HIV, and
advances in treatment, have led to changes in its management
from an acute, complication-management based model of care
to a multiagency, community based model. National guidelines
recommend that services are organised through Managed
Clinical Networks which are not well established in the
South West.
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Aim:
To describe the epidemiology of HIV and current service
provision in the South West, in relation to the national
guidelines.
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Methods:
A descriptive epidemiology, with trend analysis of local
data, was carried out. A systematic review using AMED, BNI,
EMBASE, HMIC, PsycINFO, MEDLINE from PubMed, CINAHL, HEALTH
BUSINESS ELITE and a further search of guideline documents
related to HIV was carried out. A questionnaire was
developed and sent to commissioners. Interviews were carried
out with key providers and the voluntary sector.
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Results:
The data shows that the number of people with HIV in the
South West has almost doubled in the last five years from
1,296 in 2003 to 2,365 in 2007. Although clinical networks
exist in the region, these do not have a commissioning
function. Results of the questionnaires will be ready by the
end of April 2009.
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Conclusions:
Initial findings indicate a need to commission HIV services
in the context of wider sexual health strategies. The full
conclusions of the study will be available in May 2009.
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A5 – JAMES HAWKINS, UNIVERSITY OF
BRISTOL
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Prince Consort Hall
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2.00 – 2.20
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Background:
NHS performance indicators focus on successful smoking
cessation at 4 weeks, based on evidence that 15% of
abstainers will continue to be abstinent at one year.
However there is little evidence examining abstinence and
relapse rates beyond one year of cessation. This paper looks
at the success of smoking cessation after one year of
abstinence and factors influencing long-term relapse in a
British population.
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Methods:
Smoking relapse is studied using a sub-sample of individuals
in the annual British Household Panel Survey (BHPS),
1991-2006, who reported not being a smoker in at least two
consecutive surveys after previously reporting being a
smoker (n=1 914). A panel probit regression was used to
examine the association between relapse and length of
abstinence, socio-economic and health variables.
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Results:
Follow up was available on individuals for a median of 5
years. 29.5% (27.5%-31.6%; 95% CI) of the sample reported
relapse during follow up. Increased length of abstinence,
cohabiting, marriage, increased age, having a degree and
increased GP visits were significantly associated with a
lower risk of relapse. While higher relapse rates were
significantly associated with mental health problems,
diabetes, financial worries and divorce.
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Conclusions:
A significant proportion of smokers relapse after more than
one year of abstinence, suggesting that NHS indicators
focussing on 4 week quit rates may be misleading. This study
also sheds light on factors associated with long-term
relapse. This can form the basis for targeting particular
individuals in public health interventions aimed at
prolonging abstinence.
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B5 – LISA PATEL, NHS BRISTOL
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Ashcombe Suite
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2.00 – 2.20
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Background:
Angiotensin-II receptor antagonists (AIIRAs) are widely used
for the treatment of primary hypertension.
There are seven AIIRAs
currently licensed in the UK, candesartan, eprosartan,
irbesartan, losartan, olmesartan, telmisartan and valsartan.
They all differ slightly in their chemical structures and
pharmacokinetic and pharmacodynamic profiles, suggesting
that they may also differ in their clinical effectiveness.
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Aim:
To determine which AIIRA is the most effective at reducing
systolic blood pressure (SBP) and diastolic blood pressure
(DBP) in adults with uncomplicated primary hypertension.
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Methods:
A systematic review and meta-analysis for each AIIRA
pairwise comparison were conducted. Medline, Embase and
Cochrane (1994-2007) were searched for randomised controlled
trials comparing the effects of two or more AIIRAs as
monotherapy on clinic BP in adults with primary
hypertension.
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Results:
Thirty-seven studies reporting on a total of 11,537
participants met the inclusion criteria. Losartan reduced BP
less than all six other AIIRAs, although this was only
statistically significant for candesartan, irbesartan,
olmesartan and telmisartan. Against these four the mean
difference in BP after treatment ranged from 2.14-3.20mmHg
for SBP, and from 1.24-2.63mmHg for DBP. Valsartan reduced
BP less than the other five AIIRAs (excluding losartan),
although this was only statistically significant for
irbesartan and telmisartan. Against these two the mean
difference in BP after treatment ranged from 2.30-2.60 mmHg
for SBP and from 1.27-1.62 mmHg for DBP.
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Conclusions:
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Losartan was found to be the
least effective AIIRA at reducing BP, followed by
valsartan. It was not possible to rank the remaining five
AIIRAs in order of effectiveness.
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C5 – LUKE HOUNSOME, SWPHO
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Grove Suite
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2.00 – 2.20
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Background:
The South West Public Health Observatory is instrumental in
the establishment of a web-based ‘hub’ of resources for
those working in the field of Skin Cancers. It is therefore
essential to have as good an understanding as possible of
the statistics relating to the incidence of malignant
melanoma.
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Aim:
Determine the trends in incidence of Malignant Melanoma by
age bands, and investigate regional variations. Analyse
rates of incidence in conjunction with a selection possible
explanatory factors e.g. ethnicity, deprivation, UV
exposure and latitude.
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Methods:
Incidence rates at Local Authority geography have
been extracted from the National Cancer Intelligence Service
(NCIS) databases. Incidence rates will be analysed using
multiple regression so that the effect of a number of
explanatory factors can be explored. Time trends in
age-specific incidence rates for Government Office Regions
have been assessed to identify any age differentials in the
incidence of Malignant Melanoma. Rate ratios are used to
determine the age groups which have seen the largest
relative increases.
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Results:
Detailed results have yet to be produced. Initial results
show a continuing increase in incidence of Malignant
Melanoma, and a higher incidence in the South West and South
East of England. The rate of increase appears to be larger
in the people aged 55 and over.
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Conclusions:
Factors affecting incidence and mortality of any condition
are complex and require careful analysis. It appears they
are affected by changing temporal and social trends in
exposure to UV radiation. Knowledge of the factors which
most affect Malignant Melanoma will allow good service
planning and targeted interventions.
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D5 – JULIAN ELSTON, PenTAG / DEVON PCT
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Clarence Suite
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2.00 – 2.20
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Background
: UK policy makers have come under increasing pressure to
screen young, competitive athletes for cardiovascular
disease (CVD), in order to prevent sudden cardiac death
(SCD). However, the harms and benefits of screening have not
been fully explored at a population level.
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Aim:
To assess the population health implications of screening
young, competitive athletes annually in the UK.
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Method:
Using data from three key studies, we imputed incidence
rates for the period before and after screening, and
calculated the attributable risk and population attributable
risk (and their fractions) of competition on athletes and
screened athletes as well as the number needed to screen to
prevent one SCD (NNS). We used false negative and positive
test rates to calculate the prevalence of CVD and the
sensitivity and specificity of the screening test.
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Using these parameters, we
developed a decision-tree model to estimate the annual
number of SCDs in 12-35 year-olds in the UK, the expected
number of screening and diagnostic tests, the number of
athletes disqualified from competitive sport, the number of
SCDs prevented, and the ratio of disqualifications per SCD.
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Results:
Competitive athletics contributed to 81.9% (62.4–91.6%) of
SCD in athletes, but only 26.6% (-20.3–55.8%) in the
population. After screening, this fell to 62.6% (25.6–80.0%)
and 7.2% (-10.7–22.4%), respectively. The NNS was 38,151
(20,534 – 267,380). In the UK, 1,520,021 young athletes
would be screened, with 140,361 referred for diagnosis. Of
196 SCDs per year, 40 would be prevented. For each SCD
prevented 791 athletes would be disqualified.
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Conclusions:
The impact of screening young athletes on SCD is small. Any
benefits would be achieved at the expense of significant
harms.
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A6 – LOUISE HURST, NHS WILTSHIRE
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Prince Consort Hall
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2.20 – 2.40
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Background:
There is widespread recognition of the importance of the
workplace as a setting for public health action with
increasing evidence of both health and business benefits.
Whilst current policy supports workplace health promotion
for the NHS and its partners, the extent of Trusts’
engagement with this agenda and the evidence base for what
works is less clearly understood.
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Aim:
To examine the extent and nature of current workplace
wellness activities of NHS Trusts in London (as both
employers and service providers to other employers), to
identify examples of good practice and to explore the
underlying factors that facilitate success.
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Methods:
An online questionnaire was developed, piloted and
disseminated to all NHS Trusts in London (response rate
70%). Trusts with high levels of activity were identified
(n=5) and participated in semi-structured focus groups to
explore enabling factors for activity.
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Results:
Coverage of health issues in terms of policy and activity
was varied both between individual trusts and types of trust
(Primary Care, Mental Health, Acute, Ambulance), with more
emphasis on topics related to traditional health and safety
approaches, smoking and active travel. Many activities
provided were not underpinned by Trust policy and only 10%
of Trusts monitored employee health by grade. Examples of
good practice included some common features: effective
inter-organisational partnerships, programmes based on
identified need and senior management engagement.
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Conclusions:
This presentation will describe the methodology and
limitations of this research, summarise the results and make
recommendations for workplace wellness activities in the
context of the broader evidence.
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B6 – SIMON EVANS, UWE
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Ashcombe Suite
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2.20 – 2.40
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Background:
The Gloucestershire
Partnerships for Older People Project (POPP) was one of 29
prevention projects funded by the Department of Health. The
project, titled ‘Gloucestershire Care Homes – Part of our
Community’ was awarded £2.5 million to be spent between
April 2007 and March 2009. A research team from the
University of the West of England, Bristol, (UWE) was
commissioned to carry out a local evaluation.
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Aims: The UWE evaluation aimed to (i) explore the
implications of the project for joint working and cultural
change; (ii) assess the impact of specific interventions;
and (iii) conduct an economic appraisal of the project.
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Methods:
Qualitative and quantitative
methods were used including economic analysis,
questionnaires, in depth interviews and documentary
analysis. An innovative feature of the project design was
the recruitment of older people as ‘community researchers’.
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Results: Performance data showed that most of the
project targets were achieved, including the provision of
training in dementia care, activity provision and nutrition.
Significant savings were identified as a result of reduced
emergency bed day use and care home medication reviews.
Stakeholder interviews suggested improved understanding and
partnership working between statutory and independent sector
agencies. A range of challenges were identified in terms of
changing public perceptions of care homes and increasing the
involvement of older people in service development.
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Conclusions: The Gloucestershire POPP was a complex
and ambitious project which achieved many of its aims,
including a reduction in the costs of hospital admissions,
through a range of preventative interventions. As a result,
key elements of the project have been shown to be
sustainable and have been commissioned beyond the life of
the project.
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C6 – ALEXANDER IVES, SWPHO
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Grove Suite
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2.20 – 2.40
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Aim:
To compare trends of lung
cancer incidence in the most and least deprived populations
of the South West region and how this differs by sex.
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Methods:
The SWPHO cancer registry
database was used to identify lung cancer cases diagnosed
between 1985 and 2006 in the South West region. National
deprivation quintiles were used, where deprivation was based
on the income domain of Indices of Multiple Deprivation
2007. The postcode of residence of each patient was used to
assign the relevant deprivation quintile. Three year rolling
directly age-standardised rates (standardised to the
European population) was calculated for the least and most
deprived quintiles.
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Results:
Female lung cancer incidence
in the South West significantly increased between 1985-1987
and 2004-2006 in the most deprived group (p < 0.01), but not
in the most affluent group (p = 0.10). The incidence rate of
the most deprived group in 1985-1987 was 100% higher than
that of the least deprived (38.0 vs.18.9 per 100,000) while
rates are 160% higher in 2004-2006 (49.3 vs.18.7 per
100,000). In contrast, male lung cancer incidence in the
South West decreased in both affluent and deprived groups
and the difference between the least and most deprived
quintiles (deprivation gap) remained relatively constant
over time.
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Conclusion:
Female incidence increased
in the most deprived group (30%) but not in the most
affluent group, increasing the deprivation gap in females
over the past 20 years. Smoking prevention is the key to
reducing lung cancer. Large health gains will be achieved by
focusing on smoking prevention activities for females in
these areas.
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D6 – RICHARD MARTIN, UNIVERSITY OF BRISTOL
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What is the value of screening
for prostate cancer?
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Clarence Suite
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2.20 – 2.40
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Background:
Screening by serum prostate specific antigen (PSA) testing
is intuitively appealing because it identifies cancers
localized to the prostate gland and hence potentially
curable. However,
screening is contentious and the NHS is awaiting evidence
that the
prospect of benefit from a routine screening programme
outweighs the potential for harm..
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Aim:
to i)
review the evidence for prostate cancer screening; and ii)
to describe our population-based cluster randomized
controlled trial of prostate cancer screening.
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Methods:
i) Literature review; ii)
Population-based cluster randomized controlled trial of
prostate cancer screening, involving over 400,000 men in 600
general practices across the UK (the Comparison Arm for
ProtecT (CAP) trial).
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Results:
No robust randomised trials of screening for prostate cancer
have yet been published. There are studies underway in
Europe (ERSPC) and the USA (PLCO). In the absence of trial
findings, some evidence is available from ecological studies
and case-control/cohort studies, but these are often
difficult to interpret. It was suggested that the
decline in prostate cancer
mortality during the 1990s in several countries was due to
the increased use of PSA testing. However, the
pattern of change in mortality was inconsistent between and
within countries, and falls in mortality were found in
countries without widespread screening (such as the UK) as
well as those with it (such as the US). In a study
comparing cohorts of men from Seattle-Puget Sound (where
there was rapid uptake of PSA screening and prostate cancer
treatment) and Connecticut (where testing was uncommon), no
differences in mortality were found, even with 11 years of
follow-up. Other factors are
likely to have contributed to the secular decrease in
mortality from prostate cancer, including improved treatment
of clinically detected disease.
Recruitment to
the CAP trial was conducted between 2001-2008 and follow-up
for primary (10 year prostate cancer mortality) and
secondary (15 year prostate cancer mortality, morbidity and
cost-effectiveness) outcomes is underway.
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Conclusions:
The current evidence does not support screening for prostate
cancer outside randomised controlled trials investigating
its effects.
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