Abstracts for presentation
PLENARY
Matthew Hickman
University of Bristol
An Evaluation of Opioid Substitution Treatment (OST) in prison on risk of mortality in period immediately after prison: does leaving prison on OST reduce the risk of death?
Garry Stillwell1, Hayley Jones2, Jenny Shaw3, Michael Farrell4, John Marsden1, Matthew Hickman2
1National Addiction Centre, Institute of Psychiatry, Kings College London.
2School of Social and Community Medicine, University of Bristol
3 Institute of Brain, Behaviour and Mental Health, University of Manchester
4National Drug and Alcohol Research Centre, University of New South Wales, Sydney Australia
Aims: International evidence has shown that the risk of death can be 4-12 times higher in the first month after prison release compared to later periods. We test whether leaving prison on OST compared to leaving drug free can reduce the risk of death in the period immediately after prison release for opioid dependent prisoners.
Methods: Prospective cohort of opioid dependent adult prisoners ≥18 recruited from 39 prisons in England from September 2010 to August 2013 followed up until September 2015. Information on the outcome (mortality), date of prison release, main exposure (release from prison on opioid substitution treatment- OST), confounders and other exposures (OST in the community) were obtained through record linkage.
Results: We recruited 15,141 incarcerations of which 8645 (57%) were released on OST – 162 people died in the first year and 24 in the first month after release. People released on OST were more likely to enter OST in the community compared to unexposed population (Risk Ratio 1.76 95%CI 1.7-1.8). In the first month the risk of mortality was 3.67 per 100 prison releases for the unexposed population vs 0.93 per 100 prison releases for people released on OST – an unadjusted HR (hazard ratio) of 0.25 (95%CI 0.10-0.64). After adjustment for treatment in the community, age and drug use confounders the HR was 0.3 (95%CI 0.1-0.9). Entering treatment in the community within 4 weeks of release reduced mortality risk by 0.36 (95%CI 0.14-0.98) attenuated to 0.48 (95%CI 0.18-1.3) after adjustment for OST prescribing on prison release.
Conclusions: Opioid dependent people leaving prison on OST had a mortality risk substantially lower than if they had left prison drug free – removing the excess risk of death in the first 4 weeks after release. Leaving prison on OST also increased the likelihood of entering drug treatment in the community.
PLENARY
Jane Smith
University of Exeter
The Community-based Prevention of Diabetes (ComPoD) trial and service evaluation of the voluntary sector-led Living Well, Taking Control (LWTC) diabetes programme
Smith JR1, Greaves C1, Jones M2, Kok M2, Thompson J3, Armstrong R1, Coleman S3, Solomon-Moore E4, Walsh A5, Sewell L6, Keable J5, Turton S6, Taylor R1, Abraham C1
1. University of Exeter Medical School
2. University of the West of England
3. University of Birmingham
4. University of Bristol
5. Westbank Healthy Living Centre
6. Health Exchange
Aims: To assess whether an existing community-based diabetes prevention programme delivered by voluntary sector providers is effective in modifying diabetes risk factors in adults with “pre-diabetes”.
Background: Type 2 diabetes is a growing public health challenge. NICE guidance recommends diabetes prevention in people at high risk via intensive lifestyle interventions promoting weight loss through diet and physical activity. However, there are few robustly evaluated ‘real-world’ diabetes prevention programmes in the UK.
Methods: ComPoD (www.isrctn.com/ISRCTN70221670) is a randomised, waiting list controlled trial of the LWTC programme conducted across two sites (Devon, West Midlands). Adults with pre-diabetes referred by GPs were randomised to receive LWTC immediately (intervention) or after 6 months (control). The trial supplements a wider parallel before-after service and process evaluation involving all LWTC programme participants. In line with guidance, LWTC comprises 4-6 weekly group sessions followed by regular support contacts and attendance at 5+ additional classes up to 12 months. Changes from baseline to 6 months in objective measures of weight, blood glucose and physical activity, and self-reported diet, health status and psychological well-being were assessed.
Results: Trial recruitment (n=314) was completed in June 2015, with 43% of participants male, a mean (SD) age of 61 (9.87) years, weight of 87.28 (15.14) kg and BMI of 31.83 (4.54) kg/m2. Amongst 191 overweight LWTC participants providing 6-month follow up data for the before-after evaluation by July 2015, there were significant positive changes in weight (1.77kg loss), blood glucose (1.85mmol reduction), healthy eating and depression (all p<0.01).
Conclusions: Initial findings on this innovative, replicable, real-world, voluntary-sector led programme are promising. However, 6-month comparative trial data due early 2016 will provide more robust evidence on programme effectiveness which will be timely in light of the proposed UK National Diabetes Prevention programme.
Abstracts for parallel presentation
A1
Mat Jones
University of the West of England
Association between Food for Life, a whole setting healthy and sustainable food programme, and primary school children’s consumption of fruit and vegetables
Jones, M1, Oxford L1, Pitt H2, Bray I1, Kimberlee R1, Orme J1
1. Public Health & Wellbeing Research Group, University of the West of England, Bristol
2. Sustainable Places Research Institute, Cardiff University
Aim: This study examined whetherYear 4 and 5 pupils consume more fruit and vegetables in schools engaged with the Food for Life (FFL) locally commissioned programme than pupils in schools not engaged with FFL.
Context: FFL is a whole school setting award programme organised around the themes of: food leadership and school food culture; food and catering quality; food education; and community and partnerships. Public health groups in local authorities have commissioned the FFL programme to support improvements in dietary health. National surveys find that children in England do not consume the recommended number of portions of fruit and vegetables, a recognised indicator of a healthy diet.
Research methods: The research design was a cross sectional study which compared schools engaged with FFL with schools which were not. FFL schools were individually matched by size and Free School Meal Eligibility (FSME) quintile with comparison schools in the same local authority area not engaged with programme activities. Year 4 and 5 pupils completed the Day in the Life Questionnaire, a validated 24-hour method of dietary assessment. In total 47 schools (FFL schools=24; Comparison schools =23) and 2411 pupils (FFL pupils =1265; Comparison pupils=1146) participated.
Results: After adjusting for FSME (school-level), gender and local authority, pupils in schools engaged with FFL were twice as likely to eat five or more portions of fruit and vegetables per day (OR=2.07, p=0.000, CI (1.54, 2.77), they were also about 60% more likely to eat more than the national average of 2.55 portions per day; (OR=1.66, p=0.000, CI (1.37, 2.00).
Conclusions: Limitations of the study include possible residual confounding by socio-economic factors, however it appears that school engagement with the locally commissioned FFL programme is associated with higher fruit and vegetable consumption.
A2
Isabel Oliver
Public Health England
The English National Study of Flooding and Health: first year results
Thomas David Waite1,2,3 Katerina Chaintarli3,9, Charles R Beck3,4,9, Angie Bone5, Richard Amlôt6, Sari Kovats7, Ben Armstrong7, Giovanni Leonardi5, G James Rubin8, Isabel Oliver3,4,9
1: Field Epidemiology Training Programme, Public Health England, Bristol, UK
2: European Programme for Interventional Epidemiology Training, Stockholm, Sweden
3: Field Epidemiology Service, Public Health England, Bristol, UK
4: School of Social and Community Medicine, University of Bristol, Bristol, UK
5: Centre for Radiation, Chemicals and Environmental Hazards, Public Health England, Chilton, UK
6: Emergency Response Department, Public Health England, Porton Down, UK
7: NIHR Health Protection Research Unit in Environmental Change and Health at the London School of Hygiene and Tropical Medicine, London, UK
8: NIHR Health Protection Research Unit in Emergency Preparedness and Response at King’s College London, London, UK
9:NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, Bristol, UK
Background: In winter 2013/14 there was widespread flooding in England. As part of Public Health England’s (PHE) incident recovery and evaluation, it was identified that the longer term impact of flooding on health, are poorly understood. In response to this PHE launched the National Study of Flooding and Health. This is a 10-year cohort study to examine the association between a range of exposures associated with flooding and three key mental health outcomes; anxiety, depression and post-traumatic stress disorder (PTSD).
Methods: We established a longitudinal open cohort study of people living in areas affected by the winter 2013/14 floods, with a cross sectional analysis at year one. We sent recruitment packs, including a questionnaire, by post to 8761 households. Responses were received from 2126 people living in 2014 different addresses (response rate of 23%).
Results: The prevalence of probable depression, anxiety and PTSD was highest amongst participants who reported floodwater in the liveable rooms of the house (probable depression 20.1%, probable anxiety 28.3%, probable PTSD 36.2%. After adjustment for a priori confounding factors, the odds of probable depression are nearly six times higher for flooded participants than for unaffected participants (aOR 5.91 95%CI (3.17-10.99)). The odds of depression amongst disrupted participants are also elevated. (1.56 (0.88-2.76))
The odds of probable anxiety and PTSD are more markedly elevated at 6.50 (3.77-11.24) and 7.19 (4.33-11.93) respectively for flooded participants and 1.61(0.94-2.77) and 2.06 (1.27-3.35) respectively for disrupted participants.
Conclusions: This is the first study to determine the impact of flooding on mental health a year after flooding. It has shown that flooding and, to a lesser extent, disruption from flooding can have a profound effect on mental health. Commissioners and providers should be aware of this impact. A proactive approach to identify people affected and support them medium term is needed.
A3
Frank de Vocht
University of Bristol
Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations
Muirhead C (lecturer) 1,4, Beyer F (Research Associate) 1,4, Michie S (Professor) 2,4, Brown J (Senior research Fellow) 2,4, Crane D (PhD student) 2,4, Garnett C (PhD student) 2,4, Hickman M (Professor) 3,4, Redmore J (BSc) 3,4, de Vocht F (Senior Lecturer) 3,4, Kaner E (Professor) 1,4
1. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
2. Research Department of Clinical, Educational and Health Psychology, UCL, London, UK.
3. School of Social and Community Medicine, University of Bristol, Bristol, UK.
4. NIHR School for Public Health Research
Aim: Conduct a systematic review of studies of digital alcohol interventions in community-dwelling populations.
Background: Face-to-face brief interventions delivered by health professionals to reduce hazardous and harmful alcohol consumption and/or alcohol-related problems have been used for decades. New developments now allow people to address consumption and alcohol-related problems through design and use of digital interventions.
Methodology: Randomised controlled trials in which community-dwelling individuals had been personally sought out or had been directed towards any digital intervention were identified from electronic databases (MEDLINE, PsycINFO Cochrane Library, and others), reference lists of identified papers, and from other searches. Studies of people seeking specialist treatment for their alcohol consumption, or in which the intervention was delivered in secondary or tertiary care were excluded.
Results: 55 trials reported in 53 papers met the inclusion criteria. Of these, the majority were conducted in North America (n=32) or mainland Europe (n=16), but 2 studies from the UK, 1 from Japan, and 4 from Australasia were also included. Follow-up times ranged from 1 to 24 months (median: 3 months). One and three studies were specific to females or males, respectively, and four others reported gender-specific results. Thirty-five studies considered teens, younger adults and/or students and the remaining studies were specific to adults. Based on the longest period of follow-up, the average difference in quantity of alcohol consumed between those randomised to a digital intervention and those randomised to a control condition was -23.6 g/week (95% CI -31.2, -16.0).
Conclusions: There is a sizeable recent literature on this topic. Alcohol consumption was significantly lower among those randomised to a digital intervention relative to controls; and equated to about 3 UK standard units per week. This was about 40% lower when restricted to teens/young adults/students, but the heterogeneity in effect size was lower than that in the main analysis.
A4
Chris Hyde
University of Exeter
Evaluation of school entry hearing screening: findings of an NIHR funded project
Chris Hyde, Professor of Public Health and Clinical Epidemiology, University of Exeter Medical School (UEMS), Heather Fortnum, Professor, University of Nottingham, Obioha C Ukoumunne, Associate Professor, UEMS, Rod Taylor, Professor, UEMS, Mara Ozolins, Research Fellow, University of Nottingham, Sam Errington, Research Fellow, University of Nottingham, Zhivko Zhelev, Research Fellow, UEMS, Clive Pritchard, Health economist, Optimity Matrix, Claire Benton Audiologist, Nottingham Audiology Services, Joanne Moody Audiologist, Cambridgeshire Community Services, Laura Cocking, Data Manager, Peninsula Clinical Trials Unit, Julian Watson, Parent representative, Sarah Roberts, Health economist, Optimity Matrix.
Aims: To evaluate the effectiveness and cost-effectiveness of school entry screening (SES) for hearing loss.
Background: The value of SES has been questioned since the introduction of Universal Newborn Hearing Screening in 2006 which now identifies around half the cases of permanent hearing loss at birth. In 2007 a report funded by the Health Technology Assessment Programme described a lack of good evidence.
Method: The project consisted of several studies, the component data from each refining and developing an existing SES economic model.
We compared the diagnostic accuracy of two screening tests; a pure-tone sweep test (PTS), and the Siemens HearCheckTM device (HC), with Pure Tone Audiometry (PTA), in children with sensorineural or permanent conductive hearing loss bilaterally (average 20-60dB HL) or unilaterally (≥20 dB HL), and children without identified hearing loss. Second data were collected for children aged 4-6 years from referrals to an audiology service with a school screen (Nottingham) and one without (Cambridge). We also investigated the practical implementation of the two screens by school nurses.
The model parameters of the decision analytic economic model included the yield and nature of hearing impairment detected in the systems with and without SES; the yield, consequences and costs of screen positive individuals in an SES system; and the costs of setting up an SES system.
Results: The economic model demonstrated, based on cost per quality adjusted life years, that SES is unlikely to be cost-effective and, using base case assumptions, is dominated by a no screening strategy. There are some scenarios when SES may be cost-effective
Conclusions: SES is also unlikely to be cost-effective when judged against the benchmarks normally used by NICE, relative to a system reliant on ad hoc referral when a suspicion of hearing impairment is raised. The results are dependent, however, on the Nottingham/Cambridge comparison.
B1
Rowan Brockman
University of Bristol
NAP SACC UK: adapting a US environmental intervention in UK nurseries to increase physical activity and healthy eating in 2-4 year olds.
Dr Rowan Brockman1, Professor Russell Jago2, Dr James White3, Professor Rona Campbell4,Professor William Hollingworth5,Dr Chris Metcalfe6, Dr Angeliki Papadaki7, Ms Sian Wells8, Professor Dianne Ward9, Professor Laurence Moore10, Dr Ruth Kipping11
1Research Assistant, School of Social and Community Medicine, University of Bristol, UK
2Professor of Pediatric Public Health, School for Policy Studies, University of Bristol, UK
3Lecturerin Public Health, School of Medicine, University of Cardiff, UK
4Professor of Public Health Research, School of Social and Community Medicine, University of Bristol, UK
5Professor of Health Economics, School of Social and Community Medicine, University of Bristol, UK
6Reader in Medical Statistics, School of Social and Community Medicine, University of Bristol, UK
7Lecturer in Nutrition, School for Policy Studies, University of Bristol, UK
8Trial Manager, School of Social and Community Medicine, University of Bristol, UK
9Professor of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
10Director, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
11Research Fellow, School of Social and Community Medicine, University of Bristol, UK
Aim: To adapt the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) to the UK and to develop the NAP SACC UK home component to involve parents.
Background: Most UK children attend formal childcare from age 3, therefore it is important that these settings promote healthy behaviours and reduce risk of obesity. NAP SACC works with nurseries to produce sustainable changes in the environment and improvements in children’s nutrition and physical activity. Randomised controlled trials in the USA have demonstrated the feasibility and acceptability of NAP SACC, and it has been adopted throughout the US. NAP SACC has not been assessed for feasibility or acceptability in the UK.
Methodology: A purposive sample of 16 nurseries in North Somerset and Cardiff were invited to participate in focus groups or telephone interviews to inform the development of NAP SACC UK. Health Visitors, Healthy Preschool Programme staff and Early Years’ staff in North Somerset and Cardiff participated in focus groups, which explored how NAP SACC could be adapted for the UK. Parents/carers with children aged 2-4 at participating nurseries took part in telephone interviews to discuss how NAPSACC could involve parents. All interview recordings were transcribed verbatim and anonymized. Meaningful content was coded using thematic analysis.
Results: 5 focus groups with childcare staff (n=17), 10 nursery manager interviews and 31 parent interviews were held. Staff were positive about the NAP SACC approach of self-assessment, use of action planning and staff workshops. There was concern over using Health Visitors due to lack of capacity/knowledge to deliver workshops. Parents suggested involving the whole family in the home component and linking up with healthy eating/physical activity themes in nurseries. Online tip-sharing forums for parents were also suggested.
Conclusions: This qualitative study provides useful insight from childcare staff and parents which will inform the development of the NAPSACC UK trial.
B2
Gemma Hobson
Devon County Council
Evaluation of a supported hospital discharge service for homeless patients in three Devon hospitals
Hobson, G., Senior Analyst in Public Health
Aim: This evaluation examined whether a supported hospital discharge service (Bay6) for homeless patients impacted secondary care utilisation and used qualitative research methods to explore staff views on the intervention.
Background: Several studies have demonstrated associations between structured discharge to suitable housing (accessibility and sustainability) and readmission levels to hospital.
Methodology: This was a mixed methods evaluation. Qualitative interviews were conducted with nine professionals, these were transcribed verbatim and analysed using Framework Analysis. Quantitative data was accessed on the secondary care usage of 104 Bay6 patients. Service usage for patients was measured six months before and after the intervention. The intervention was evaluated on an intention to treat basis, and thus included unsuccessful accommodation placements. The cost of care was calculated from Payment by Results tariffs figures from the Secondary Care Uses Service, with estimated costs used where the procedure was part of a block contract.
Results: The secondary care usage of a sample of 104 of Bay6 patients was analysed for usage volume and cost. In the six months after receiving the intervention the patients used £310,000 of secondary care, saving £88,000 (22%) compared to the six months preceding the intervention. Hospital clinical staff reported substantial saving in time that would have been spent chasing accommodation was redirected to patient medical care.
Conclusions: Despite some limitations, the evaluation found that the intervention was successful in reducing costs to secondary care based on a before and after comparison of secondary care usage for the clients. It demonstrated the potential to provide a service, that was well received by both patients and staff, which appears to be economically viable on an ‘invest to save’ basis. The findings could strengthen the evidence base which the acute trusts and wider partnership organisations need for planning successful hospital discharges for the vulnerably housed.
B3
Frank de Vocht
University of Bristol
The measurable impact of local alcohol licensing policies on population health in England; focussing on the southwest.
F. de Vocht (Senior Lecturer)1,2, Jon Heron (Senior Research Fellow)1,2, Colin Angus (Research Fellow) 1,3, John Mooney (Senior Lecturer)1,3, Alan Brennan (Professor)1,3, Karen Lock (Reader)1,4, Rona Campbell (Professor)1,2, Matthew Hickman (Professor)1,2
1 NIHR School for Public Health Research (SPHR).
2 School of Social and Community Medicine, University of Bristol, Bristol, UK
3 ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
4 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
Aim: Recent research has indicated that alcohol licensing policies implementation and enforcement in England may be related to population health gain. Results will be discussed specifically for local areas in the Southwest.
Background: Because alcohol policy in England is primarily determined at local government level, different local authorities have different strategies to reduce the impacts of alcohol consumption. Alcohol consumption in the Southwest is above national average. Local licensing policies, including cumulative impact zones (CIZs), can be important to regulate the physical availability of alcohol and modification of the commercial drinking environment. We hypothesized that, in addition to reduction of acute harms and antisocial behaviour, these policies may also have an effect on local population health.
Methodology: Home Office Alcohol & Late Night Refreshment Licensing data (2007-12) was linked to alcohol-related hospital admission from the Local Alcohol Profiles for England, population size and area deprivation. Cumulative policy and enforcement intensity was classified from ‘passive’ to ‘high’ based on presence of CIZ and/or successful challenges of new license applications. 2009-2015 age-standardised rates of alcohol-related conditions were analysed using mixed-effects log-rate models.
Results: Complete data were available for 319 of 326 Lower Tier Local Authority areas. Additional decrease in alcohol-related hospital admission rates in areas with the highest intensity policies compared to ‘passive’ areas was observed of 2% (95% CI: -3 to -2%) annually (P=0.006). Accounting for other population changes, this equated to a modest additional 5% reduction, or about 8 unique admissions per 100,000 people, in 2015 compared to what would have been expected had active policies not been in place.
Conclusions: Although these analyses do not directly prove causality, they indicate that alcohol licensing policies implementation and enforcement is related to measurable health gain. In addition to overall results, results will specifically be presented for local areas in the Southwest.
B4
Emma Bird
University of the West of England
A pilot controlled evaluation of a primary school-based health education intervention: Facts4Life
Bird, E L1; Oliver, B2; & Powell, J E3
1 Senior Lecturer in Public Health, University of the West of England
2 Academic Director Health and Social Sciences, University of the West of England
3Professor of Public Health Economics, University of the West of England
Aim: This pilot controlled evaluation aimed to explore the effects of a primary school-based health education intervention, Facts4Life, on changes in children’s health and illness-related attitudes.
Background: Evidence suggests that attitudes and behaviours established during childhood may continue on into adulthood and as such, it is important to promote health from an early age.
Methodology: A quasi-experimental study was conducted in 10 schools in Gloucestershire. Five schools received Facts4Life and 5 schools were allocated to a control group. The intervention was delivered by teachers during the Spring term 2015 (January – March). Children completed measures of health and illness-related attitudes approximately one week prior to the intervention period and again after the intervention period had ended. Mixed analysis of variance (MANOVA) models were used to identify any changes in outcome measures in the intervention and control groups from baseline to follow-up.
Results: 324 children completed baseline measures, with 295 (91% retention rate) completing measures at post-intervention. Children in the intervention group reported significant improvements from baseline to post-intervention responses to “When I feel unwell I need to take medicine to feel better” (p = 0.01, d = 0.54) and “When I am ill, I always need to see a doctor” (p = 0.01, d = 0.39). Children in the control group reported significant improvements from baseline to post-intervention response to “When I am ill, I always need to see a doctor” (p = 0.04, d = 0.21). Neither the intervention or control group showed changes from baseline to post-intervention on any other outcome variables.
Conclusions: Facts4Life is a promising intervention in that exposure was associated with significant changes in certain specific health and illness-related attitudes targeted by the intervention. Future, large scale studies should explore the effects of Facts4Life on health and illness-related attitudes and subsequent behaviour change over time.
C1
Sian Noble
University of Bristol
A cost-consequence analysis of an intervention to promote healthy physical and nutrition behaviours in primary schools: The Active For Life Year 5 (AFLY5) Study.
Moure Fernandez, A.1; Lawlor, D2; Kipping, R3; Wells, S4; Campbell R5; Peters, TJ6; Howe, L7; Gaunt DM8; Jago, R9 ; Noble, SM10
1 Research Assistant in Health Economics. Bristol Randomised Trials Collaboration; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
2 Professor of Epidemiology. MRC Integrative Epidemiology Unit at the University of Bristol and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
3 Research Fellow in Epidemiology and Public Health. School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
4 Research Associate. School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
5 Professor of Public Health Research. School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
6 Professor of Primary Care Health Services Research. School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
7 Senior Research Fellow in Epidemiology. School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
8 Research Assistant in Medical Statistics. Bristol Randomised Trials Collaboration; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
9 Professor of Paediatric Physical Activity and Public Health. School for Policy Studies, University of Bristol, Bristol, United Kingdom
10 Senior Lecturer in Health Economics. Bristol Randomised Trials Collaboration; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
Aim: To evaluate whether an intervention designed to increase fruit and vegetable consumption, levels of physical activity and reduce sedentary behaviour in Year 5 school children (the Active for Life Year 5 (AFLY5) randomised controlled trial), represents value-for-money.
Background: Interventions to improve diet and increase physical activity in children are an important research area. The AFLY5 intervention was neither effective in improving accelerometer assessed time spent in moderate to vigorous physical activity, sedentary time nor consumption of fruit and vegetables (the primary outcomes). It improved three of nine secondary outcomes. Scarce resources necessitate evaluating the cost-effectiveness of such interventions.
Methodology: Resources, including implementation staff/parental time, consumables, NHS visits, were collected contemporaneously with the trial using electronic time sheets and questionnaires. Resources were valued using salary scales, invoices and national reference costs. Two cost-consequence analyses were conducted. The primary analysis was from a combined school and provider perspective. The cost per pupil was estimated by multiplying the units of resources by their unit costs. A secondary analysis from parental-NHS perspectives was analysed using adjusted Ordinary Least Squares regressions. One-way deterministic sensitivity analyses explored methodological uncertainty.
Results: From a combined school-provider perspective, for the three secondary outcomes where the intervention was effective, it cost £18 per child to reduce self-reported: time spent on screen viewing at the weekend by 21 minutes, daily servings of snacks by 0.22 and consumption of high energy drinks by 0.26. From the parental-NHS perspectives the intervention cost an extra £79 (95%CI (-£128, £310) and £125 (95%CI (-£11, £886) per child respectively. Secondary analysis results have to be treated cautiously as based on 24% to 27% of observed data. Sensitivity analyses showed similar results.
Conclusions: Low intervention costs mean that if the AFLY5 intervention had been effective, cost would not have been a barrier to its implementation.
C2
Christy Burden
University of Bristol
From grief, guilt pain and stigma to hope and pride – a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth
Burden C a, Storey C c, Bradley S c, Ellis A d, Heazell A e, Downe S f, Cacciatore J g, Siassakos D h
a Academic Clinical Lecturer, Obstetrics and Gynaecology, University of Bristol
b Vice Chair, International Stillbirth Alliance
c Primary Care Librarian, North Bristol Trust
d Specialist Registrar, Obstetrics and Gynaecology, North Bristol Trust
e Senior Lecturer in Obstetrics and Gynaecology, NIHR Clinical Scientist, University of Manchester
f Professor in Midwifery Studies, University of Central Lancashire
g Associate Professor, Arizona State University
h Consultant Senior Lecturer, Obstetrics and Gynaecology, University of Bristol
Aim: Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance on bereavement care worldwide. The study was commissioned by the Lancet Stillbirth Series 2015.
Background: More than 2.7 million babies worldwide are stillborn each year, however, stillbirth is still not acknowledged as a serious public health issue on the global health agenda.
Methodology: Systematic review and meta-summary of quantitative, qualitative and mixed-methods studies. All languages and countries were included.
Results: 2619 abstracts were identified; 144 studies were included. Frequency effect sizes(FES%) were calculated for each theme (n= 23), as a measure of their prevalence in the literature
Themes ranged from negative psychological symptoms post bereavement (77·1) and in subsequent pregnancies (27·1), to disenfranchised (31·2) and incongruent grief (28·5). There was also impact on siblings (23·6) and on the wider family(2·8).
In studies from low/middle income countries, stigmatisation, rejection and abuse (13·2) were widespread. Themes prominent in studies of fathers were; grief suppression (18·1), employment difficulties, financial debt (5·6), and increased substance use (4·2). Others specific to mothers were; altered body image (3·5) and impact on quality of life (2·1). Some themes had mixed connotations; parental pride in the baby (5·6), motivation for engagement in healthcare improvement (4·2) and changed approaches to life and death, self-esteem, and own identity (25·7).
Conclusion/Recommendations: Stillbirth can have devastating psychological, physical and social costs, with ongoing effects on interpersonal relationships and parental relationships with subsequently born children. However, parents who experience the tragedy of stillbirth can develop resilience, new life-skills and capacities. The focus of the consequences may vary with parent gender and country. This review of the worldwide literature highlights the need for future investment and research into both stillbirth prevention and aftercare.
C3
Irina Holland
Somerset County Council
An analysis of NHS Health Checks alcohol screening data to inform the 2016 Dry January campaign in Somerset.
Holland, I. Public Health Information Specialist, Somerset County Council
Aim: To identify the type of resident who might drink at increasing risk levels, for targeting in the Dry January campaign in Somerset.
Background: Dry January is a national campaign to encourage people to give up alcohol for the month, promoted by Alcohol Concern.
The Public Health team has anonymised patient-level data from NHS Health Checks in Somerset post 2012. These Checks ask about lifestyle information including drinking behaviour using the AUDIT-C tool .
Methodology: Data from 2012-2014 was used, 34,929 records, including demographic factors (gender, age, ethnicity, deprivation) and lifestyle factors (smoking status, BMI, AUDIT-C). An AUDIT-C score of 5 or more indicates people who may be drinking at risky levels; the data was therefore split into those with AUDIT-C <5 and those with AUDIT-C ≥5.
Results: A greater proportion of males (31%) had scores ≥5 than females (17%) (x2(1)=1046.4, p<.0001). The proportion of people with an AUDIT-C score ≥5 decreased significantly with age (x2(7)=288.4, p<.0001) and this was true for both sexes. There was a slight but significant trend for deprivation, with those living in the most deprived quintile more likely to have an AUDIT-C score ≥5. A significantly higher proportion of smokers had AUDIT-C scores ≥5 than non-smokers (x2(1)=287.9, p<.0001). A significantly higher proportion of overweight and obese males (33%) had AUDIT-C ≥5 than those of normal/underweight (28%). This relationship was not seen in females. Although statistically significant these differences by BMI are not clinically meaningful.The number of people from BME groups was too small to draw conclusions about ethnicity.
Conclusions: The sample is large and gives insight into the lifestyle behaviours of people in Somerset who were motivated to take up an NHS Health Check. The data suggests that Dry January campaign messages should particularly target men aged 40-59 and smokers.
C4
Jaime Peters
University of Exeter
Evaluating the costs of strategies to identify individuals with maturity-onset diabetes of the young (MODY)
Jaime L Peters, Senior Research Fellow, University of Exeter, Rob Anderson, Associate Professor of Health Economics and Evaluation, University of Exeter, Beverley M Shields, Senior Lecturer in Medical Statistics, University of Exeter, Sophie King, Assistant Trial Manager, University of Plymouth, Michelle Hudson, Research Project Manager, University of Exeter, Maggie Shepherd, Honorary Clinical Professor, University of Exeter, Timothy J McDonald, Honorary Clinical Senior Lecturer, University of Exeter, Ewan R Pearson, Professor of Diabetic Medicine, University of Dundee, Andrew T Hattersley, Professor of Molecular Medicine, University of Exeter, Chris J Hyde, Professor of Public Health and Clinical Epidemiology
Aim: To evaluate and compare the NHS costs associated with different strategies to identify and change the treatment of individuals with maturity-onset diabetes of the young (MODY).
Background: Diabetes is a lifelong condition estimated to cost the NHS £10 billion each year. Individuals with mutations in HNF1A, HNF4A and GCK genes, the leading cause of MODY, are often misdiagnosed with type 1 diabetes, so receive more invasive and costly treatment than is appropriate. Identifying individuals with MODY and changing their treatment could lead to savings to the NHS.
Methodology: A decision analytic model was developed from the perspective of the NHS in England. The four test-treatment strategies, evaluated in a population of people diagnosed with diabetes when <30 years old, were: clinician-based referral for genetic testing, referral based on a clinical prediction model (online MODY probability calculator), referral based on biomarker testing of c-peptide and islet autoantibodies (GAD and IA2), and genetic testing of all individuals. These were compared to a strategy of no testing. Sensitivity analyses were conducted to identify parameters and assumptions that impacted the most on the model’s results.
Results: Strategies using the prediction model or biomarkers to refer individuals for genetic testing were estimated to save £100 per person with diabetes over their lifetime compared to no testing. Genetic testing for all individuals was the most costly strategy: £300 more per person compared to no testing. Sensitivity analyses indicated that the results were most sensitive to the estimated prevalence of MODY, the amount of family member testing and the long-term insulin needs of individuals.
Conclusions: Current evidence suggests that using the prediction model or biomarkers to inform genetic testing referral could be cost-saving to the NHS. Further evidence is required to inform data and assumptions, and to evaluate the use of these strategies sooner after diagnosis.
D1
Lisa Price
University of Exeter
Accumulation of Physical activity in primary school children: The Healthy Lifestyles Programme (HeLP)
Lisa Price, Lecturer, Sport and Health Sciences, University of Exeter
Jennifer Lloyd, Senior Research Fellow, University of Exeter Medical School
Katrina Wyatt, Assoc. Professor, University of Exeter Medical School
Melvyn Hillsdon, Assoc. Professor, Sport and Health Sciences, University of Exeter
Aim: This study aimed to assess how children accumulate their physical activity based on bout lengths.
Background: Current physical activity guidelines recommend that children achieve a minimum of 60 minutes moderate to vigorous physical activity per day; as a result the majority of studies choose to report total volume of physical activity. Detail concerning how activity is accumulated is often overlooked, yet the method of accumulation over the course of the week is likely to modify the relationships between PA and health.
Methodology: Baseline data from the Healthy Lifestyles programme (HeLP) was used in the present study. 870 children were randomised to receive a GeneActiv accelerometer. Children wore the monitor on their non-dominant hand for a period of 8 day. Data was analysed though the GGIR package in R.
Results: 830 (95.4%) children met the wear time criteria for inclusion. Median time in any activity (≥ Light intensity) reduced from 182.60 mins in 1 second burst to 62.2 mins, 30.42 and 18.99 minutes when accumulated in 1, 5 and 10 minute bouts. Similar results were seen for time in MVPA, with median time accumulated reducing from 51.47mins in 1 sec bursts to 4.33 mins in 1 minute bouts. Median recorded time for MVPA in 5 or 10 minutes bouts was zero. The mean time for children’s most active 5hour period was 11.13 am.
Conclusions: Children accumulate the majority of their activity in bouts shorter than 1 minute in length and rarely exceed bouts of 5 minutes in any intensity, with the most active periods occurring throughout the school day. The extent to which such short bursts of activity is beneficial for health is unknown. The present study highlights the need to examine physical activity beyond total volume to increase knowledge pertaining to the optimum dose of PA beneficial for health.
D2
Anna Taylor
University of Bristol
Railway suicide in England and Wales 2000-2013: a time-trends analysis
Anna K Taylor1, Kyla H Thomas2
1 Fourth Year Medical Student, University of Bristol
2 NIHR Clinical Lecturer, School of Social and Community Medicine, University of Bristol
Aim: To report the most recent trends in railway suicide in England and Wales and examine whether a 20% reduction in railway suicides by 2015 is likely to be achieved.
Background: Death by train is a highly lethal suicide method. In addition to the human lives lost, there are significant psychological and economic costs. The ‘Tackling Suicide on the Railways’ programme was launched in 2010 as a joint initiative among Network Rail, the Samaritans and British Transport Police. It aimed to achieve a 20% reduction in railway suicides by 2015 in Great Britain.
Methodology: Population data and suicide mortality data for England and Wales were obtained from the Office for National Statistics (ONS) and used to calculate age and gender specific rates for deaths registered from 2000 to 2013. Railway suicide data were obtained from the Rail Safety and Standards Board (RSSB) to enable comparison with ONS data.
Results: The railway was used in 4.1% of all suicides in England and Wales. RSSB data were similar to ONS data for most years. Suicides in all persons from all causes decreased from 2000 to 2007, with small increases between 2008 and 2013 due to an increase in male suicides. Railway suicide rates increased over the entire study period; the proportion of railway suicides in all persons increased from 3.5% to 4.9%. This trend was also mainly driven by increases in male suicides; female railway suicide rates remained consistent over the study period. The highest age specific railway suicide rates were observed in middle-aged men and women.
Conclusions: The continued rise in male railway suicide in England and Wales is concerning, particularly due to the high economic costs and psychological trauma associated with these deaths. The target of a 20% reduction in railway suicide by 2015 is unlikely to be achieved.
D3
Judi Kidger
University of Bristol
DrinkThink: Alcohol Screening and Brief Intervention for young people – an evaluation and intervention development study
Matt Hickman, Judi Kidger, Angela Beattie, Fiona Fox, Rona Campbell, Will Hollingworth, University of Bristol
Gordon Taylor, University of Bath
Eileen Kaner, University of Newcastle
In collaboration with Project 28 and BANES Public Health Team
Aim: to examine the feasibility and acceptability of delivering the DrinkThink Alcohol Screening and Brief intervention (ASBI) to young people within healthcare, social care, youth service and youth justice settings.
Background: Alcohol exposurethroughout adolescence is associated with numerous adverse health behaviours and outcomes. ASBI can be successful in reducing risky drinking among adults, but little is known about the feasibility or effectiveness of delivering such interventions to under 18s in community settings. Drinkthink equips health, youth, social care and youth justice agencies to deliver ASBI to young people with whom they work.
Methodology: Focus groups were conducted with professionals who had received training to deliver Drinkthink, and young people who had received the intervention. Topic guides covered staff perceptions of the training and experiences of delivering DrinkThink, and young people’s views on the value of the intervention. Discussions were recorded and transcribed. A thematic analysis was undertaken, in which relevant sections of text were coded and grouped together according to emerging themes.
Results: Staff participants were positive about the knowledge that the training conferred, but wanted more guidance on applying that knowledge in interactions with young people. DrinkThink materials were drawn on, but the intervention was rarely delivered in its entirety. Barriers to delivery included a perception that problematic drinking is not common among young people, difficulty in embedding the tool within the culture and aims of the agency, and practical issues such as time and working on the move. Young people reported that Drinkthink encouraged reflection on the negative consequences of their drinking patterns, and has led to them drinking less.
Conclusions: A revised version of the DrinkThink training for agencies should address social norms around alcohol, include discussion about how to incorporate the intervention into agency specific contexts and provide an electronic version of the tool.
D4
Angela Beattie - co-author Heide Busse presenting
University of Bristol
Evaluating youth mentoring for vulnerable young people: results from a feasibility study and pilot randomised control trial (RCT)
Beattie A1, Research Fellow, Busse H1, PhD student in Public Health, Kipping R1, Research Fellow, Gunnell D1,Professor of Epidemiology, Hickman M1,Professor in Public Health and Epidemiology, Macleod J1, Professor in Clinical Epidemiology and Primary Care, Hollingworth W1, Professor of Health Economics, Berridge D2, Professor of Child and Family Welfare, Metcalfe C1, Reader in Medical Statistics, Spiers S3, Breakthrough Manager, Campbell R1, Professor of Public Health Research, Principal Investigator for Breakthrough Mentoring study
1School of Social and Community Medicine, University of Bristol, Bristol
2School for Policy Studies, University of Bristol, Bristol
3South Gloucestershire Council, South Gloucestershire
Aim: To assess the feasibility and acceptability of conducting a definitive RCT of the effectiveness and cost effectiveness of the Breakthrough Mentoring programme targeted at secondary school students who are at risk of exclusion from school.
Background: Youth mentoring is used with vulnerable young people to help improve their health, well-being and educational attainment. There is growing interest in mentoring programmes by policy makers and practitioners. Much of the empirical research on mentoring originates from the United States and the evidence base for these programmes is weak with no UK RCT undertaken to assess their effectiveness and cost effectiveness.
Methods: Feasibility study, unblinded pilot RCT and process evaluation. 31 participants were approached and n=21 aged 12-16 years ( =14.10) were recruited, and randomised to receive weekly 2 hour mentoring sessions (n=11 intervention) for one academic year or care as usual (n=10 control). Qualitative interviews were conducted and analysed thematically. Quantitative data were analysed using descriptive analyses.
Results: Follow-up for 6&12 months was 100% and 86% for 18 months. The RCT was acceptable to students, parents and schools. Control group participants reported wanting a mentor and some were mildly upset at not achieving this. Intervention group participants indicated that having an adult mentor, unconnected with the school that they could talk to about their problems helped them to give voice to and deal with difficult feelings. The loss of the mentor relationship and the ending of the relationship were key negative experiences of the intervention.
Conclusions: It is feasible to recruit, randomise and retain vulnerable students at risk of exclusion from school to a pilot RCT for 6, 12 and 18 month follow-up. The need for a definitive RCT remains, as despite the large number of mentoring schemes in use in the UK the evidence base for their effectiveness is weak.
E1
Suzanne Audrey
University of Bristol
Healthy urban environments for children and young people: A systematic review of intervention studies
Audrey, S. Senior Research Fellow in Public Health
Aim: To examine evidence relating to changes to the urban environment and physical or mental health outcomes of children and young people.
Background: There is increasing interest in shaping urban environments to enable people to live healthier lives. Systematic review evidence from cross-sectional or longitudinal studies has identified components of the built environment associated with physical inactivity, active travel, dietary intake, obesity and mental health. However, robust intervention studies are required to provide evidence of effectiveness.
Methodology: The following databases were searched from inception to 29th October 2014: Embase; Geobase; Medline; PsycINFO; Transportation Research Information Services, and; ISI Web of Science & ISI Proceedings. Intervention studies (randomised controlled trial, controlled trial, controlled before and after, before and after, interrupted time series) were eligible if they: included a change to the built environment; reported outcomes in relation to children and young people’s physical or mental health; were undertaken in urban areas in high income countries, and; were published in English.
Results: 7,645 records were identified and checked, 113 full text studies assessed for eligibility, and 33 primary studies relating to 27 interventions included in the review. Interventions related to active travel, park and playground renovations, road traffic safety, and multi-component initiatives. Evidence for effectiveness was weak and at risk of bias because study designs were often opportunistic, non-randomised, used subjective outcome measures, and did not incorporate follow-up of study participants. There was some evidence of health benefits to children and young people from road safety and active travel interventions, with evidence of promise for a multi-component obesity prevention initiative.
Conclusions: Changes to the urban environment may improve the health of children and young people. Future studies should involve collaborations between researchers, policy makers and planners, and consider using randomised controlled study designs which incorporate objective outcome measures.
E2
Penny Marno
Swindon Borough Council
Evidence into practice: implementing the Football Fans in Training randomised controlled trial programme in England
Marno, P. Consultant in Public Health, Swindon Borough Council
Aim: This study examines whether implementing the Football Fans in Training programme1 (FFIT), developed and implemented in Scotland in a RCT, will deliver the same positive weight management and lifestyle outcomes in an English setting.
Background: Excess weight in adults, particularly in men, is significantly greater in Swindon than England2. Swindon has targets and a strategy to reduce obesity prevalence; however men have been difficult to engage.
Methodology: 30 men who met the programme criteria for weight (BMI 28kg/m2 or above) and age (35-65 years) attended course 1 from January to March 2015, delivered by Swindon Town Football Club in the Community Trust, working with Swindon Borough Council and Swindon Town FC. Training, materials and quality assurance were provided by a Scottish FFIT trainer. Both quantitative (e.g. weight, physical activity) and qualitative (e.g. participants perception of the programme) data were collected. Data were analysed at baseline, 3, 6 and 9 months so far.
Results: 28 out of 30 completed the course. At week 0 average weight and waist measurements were 108.3kg (95% CI103.4, 113.3) and 119.2cm (95% CI116, 122.5) respectively, reducing to 99.1kg (95% CI94.9, 103.3) and 109.1cm (95% CI105.7, 112.5) by 3 months. By month 9 these reductions had been maintained although there was no further significant decrease. Over the 3 months total weight loss was 256kg with individual loss ranging from 1.5% to 20%. There was a notable shift in perceptions of fitness and eating habits. Qualitative results suggested physical activity and well-being had both increased.
Conclusions: This study implemented an evidence based programme in a local football club in England giving similar results. It is an effective and practical way of reaching middle aged men by using a passion for football to make lifestyle change. Initial results from course 2 support this hypothesis.
E3
Micky Willmott
University of Bristol
Effectiveness of hand hygiene interventions in reducing illness absence amongst children in educational settings: A systematic review
Micky Willmott, Research Associate, School of Social and Community Medicine, University of Bristol
Alex Nicholson, Research Associate. School of Social and Community Medicine, University of Bristol
Heide Busse, PhD Student. School of Social and Community Medicine, University of Bristol
Georgie J. MacArthur, NIHR Postdoctoral Research Fellow. School of Social and Community Medicine, University of Bristol. Sara Brookes, Senior Lecturer in Medical Statistics. School of Social and Community Medicine, University of Bristol
Rona Campbell, Professor of Public Health Research. School of Social and Community Medicine, University of Bristol
Aim: This systematic review aimed to identify evidence of the effectiveness of hand hygiene interventions in reducing infectious illness and/or absence in educational settings for children aged 3 to 11 years and/or staff working with them.
Background: Educational settings are promising sites for preventing the spread of respiratory tract (RT) and gastrointestinal (GI) infections.
Methods: The review included RCTs of interventions with a hand hygiene component (any comparator) in educational settings for children aged 3 to 11 years in any country. Primary review outcomes were: RT or GI infection incidence or symptoms related to such infections; absenteeism rate; laboratory results of RT and/or GI infection. Two reviewers independently screened titles, abstracts, full papers and extracted study data. Study quality was assessed using the Cochrane Risk of Bias tool (v5.1). We aimed to undertake random effects meta-analyses (using RevMan 5.3) for each of the primary outcomes where studies were of sufficient quality and data were available.
Results: 18 cluster RCTs fitted review criteria. Individual study results suggest interventions may reduce children’s absence, RT infection incidence and symptoms, and laboratory-confirmed influenza-like illness. Evidence of impact on incidence of GI infection or symptoms was equivocal. Due to study heterogeneity, poor study design and generally low quality of reporting, co-authors agreed that it was not appropriate to present pooled estimates of the effect of interventions using meta-analyses.
Conclusion: Hand hygiene interventions amongst younger children in educational settings may reduce RT infection incidence and absence rates but evidence is limited. Barriers to hand hygiene in schools have been identified and taken alongside this review evidence, we argue that education interventions alone may be insufficient to achieve behaviour change and improve infection prevention and control. We make suggestions for school-based interventions and study designs which may improve evidence on this critical public health issue.
E4
Joanna Kesten
University of Bristol
Acceptability of low dead space detachable syringes among people who inject drugs and recommendations for their introduction: a qualitative study in the South West of England
Joanna M. Kesten,Qualitative Research Associate, University of Bristol, NIHR CLAHRC West and NIHR Health Protection Research Unit in Evaluation of Interventions
Rachel Ayres, Volunteer Manager, Engagement Team, Bristol Drugs Project
Jody Clark, Substance Misuse Project Officer, Bristol City Council
Barbara Coleman, Associate DPH, Bristol City Council
Matthew Hickman, Professor in Public Health and Epidemiology, University of Bristol, NIHR Health Protection Research Unit on Evaluation of Interventions
Jane Neale, Needle Exchange Manager, Bristol Drugs Project
Sabi Redwood, Senior Research Fellow in Ethnography / Qualitative Social Science, University of Bristol, NIHR CLAHRC West
Peter Vickerman, Professor in Infectious Disease Modelling, University of Bristol.
Aim: This study explored the acceptability of a new type of syringe among people who inject drugs (PWID) and staff who work with PWID.
Background: The prevalence of blood-borne viruses (BBV) among PWID is a significant public health concern. High dead space syringes (HDSS) traditionally have detachable needles, retain more fluid, including blood and increase the risk of transmitting BBV if shared compared to low dead space syringes (LDSS) with integral needles. Prior to the introduction of new LDSS with detachable needles it is important to understand their acceptability among PWID.
Methodology: Semi-structured interviews were performed with PWID and staff in Bath and Bristol. PWID were selected to reflect varying demographic characteristics, drug use and injecting preferences. Interviews explored experiences of different types of injecting equipment, facilitators and barriers of changing equipment and attitudes towards LDSS. Interviews were audio recorded, transcribed verbatim and analysed using the Framework Method.
Results/Findings : 23 PWID and 13 professionals/volunteers were interviewed. Three main themes emerged. The ‘Injection practice decision making’ theme was primarily informed by the ability to inject without problems. ‘Behaviour change’, the second theme, was considered if PWID experienced problems injecting and there was a benefit to changing in relation to optimised drug use. Change was disliked as injecting practices were bounded by habitual behaviour patterns. Finally the ‘Acceptability of LDSS’ theme was intertwined with the contents of the previous themes, in particular it was important that advice about new equipment from needle exchanges was trusted. LDSS features relevant to PWID included reduction in wasted drug and reduced risk of transferring infections.
Conclusions/Recommendations: Generally, changing injecting equipment is unappealing to PWID unless injecting is problematic. However, benefits of LDSS were viewed favourably. A gradual change in equipment alongside education from trusted needle exchange staff which empowers PWID is expected to enhance their acceptability.
F1
Rachel Kwiatkowska
Gloucestershire County Council
Is greater cycle lane density associated with increased cycling activity? An exploratory analysis of 12 neighbourhoods in Greater London.
Kwiatkowska R M1; Sadique Z2; Pliakas T2; Rutter H2; Glonti, K
1.Specialty Registrar in Public Health, Gloucestershire Hospitals NHS Foundation Trust
2.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine
Aim: To explore associations between neighbourhood built environment and cycling activity in Greater London.
Background: Cycling has significant health benefits and is a low-carbon mode of transportation. It is increasingly popular in London, where there has been substantial investment in cycling infrastructure.
Methods: The European SPOTLIGHT* project collected data from 12 neighbourhoods of differing residential density and socioeconomic level within Greater London. Objective measures of the built environment from Google Street View were linked to data on cycling behaviours from a survey of neighbourhood residents.
Multivariable logistic regression analysis was used to explore the association between cycle lane density and cycling behaviours, adjusting for confounders at the environmental and individual level.
Results: Out of 1,022 street segments within the 12 neighbourhoods 116 (11%) had a cycle lane. 123 (14.5%) of survey respondents reported cycling in the past 7 days.
Cycling activity did not differ significantly between neighbourhoods with high cycle lane density versus those with low cycle lane density on univariable analysis (OR 1.2, 95% CI 0.5-2.06). After adjusting for confounders, high cycle lane density was associated with lower odds of cycling (OR 0.51, 95% CI 0.39-0.67), as was high density of green/ water areas (OR 0.44, 95% CI 0.33-0.60) and parks/ recreation areas (OR 0.54, 95% CI 0.40-0.74). High density of local shops/ facilities was associated with higher odds of cycling (OR 1.35, 95% CI 1.03-1.75).
Neighbourhoods with low residential area density (RAD) and high socioeconomic status (SES) had significantly lower cycling activity compared with high RAD, high SES neighbourhoods (OR 0.49, 95% CI 0.28-0.87).
Conclusions: Our results indicate that greater prevalence of cycle lanes is not associated with higher rates of cycling in Greater London. Variation in cycling activity appears to be largely explained by differences in neighbourhood residential area density and land use mix, however further investigation is needed into other factors influencing cycling behaviours in London.
*Sustainable Prevention of Obesity through Integrated Strategies
F2
Robert Witton
Plymouth University Peninsula School of Dentistry
The association between tooth loss and deprivation in Plymouth children
Robert Witton1, Robert Nelder2, Sarah Macleod3
1 Director of Community-based Dentistry and Consultant in Dental Public Health, Plymouth University Peninsula Schools of Dentistry, Derriford Dental Education Facility, Plymouth Science Park, Plymouth PL6 8BU
2 Consultant in Public Health, Office of the Director of Public Health, Plymouth City Council, Windsor House, Plymouth, PL6 5UF
3 Senior Public Health Analyst, Office of the Director of Public Health, Plymouth City Council, Windsor House, Plymouth, PL6 5UF
Aims: To investigate the association between dental extractions under general anaesthesia (GA) and deprivation for Plymouth children aged 0-16 years in 2013-14.
Background: A third of five-year olds suffer from tooth decay in England. It is the most common cause of hospital admission among five to nine year olds costing the NHS £30million in 2012-13. There is no established methodology for geographical targeting of prevention strategies or what measures of dental disease to use.
Methodology: Data was extracted from Plymouth Community Healthcare’s database. Children's postcodes were used to determine in which of the 39 Plymouth neighbourhoods they lived. This enabled comparisons to be made across the city's neighbourhoods and IMD 2010 deprivation groupings.
Results/Findings: 861 Plymouth-resident children had a dental extraction in 2013/14. The range was from one to 16 teeth. The overall rate was 178.0 per 10,000 children. On a neighbourhood basis this ranged from 29.9 to 347.5 per 10,000. The highest neighbourhood rate was 11.6 times higher than the lowest.
The 39 Plymouth neighbourhoods have also been grouped into five categories based on the IMD 2010. Children living in the two most deprived groups accounted for over 60% of those having one or more teeth extracted. The rate of children having teeth extracted ranged from 95.2 per 10,000 in the least deprived group, to 254.7 per 10,000 in the most deprived. The rate in the highest group was 2.7 times higher than the rate in the lowest.
Conclusions/recommendations: There is evidence of oral health inequalities in Plymouth children undergoing GA for extraction of teeth. Analysing this routinely collected data may be an effective method of identifying geographical areas for targeting of oral health improvement. This may present a quicker, more focused and cost effective method of geographical targeting over traditional dental epidemiology surveys.
F3
Petra Manley
Bristol City Council
IMPACT-PC (Improved Management of Patients with Chlamydia and Gonorrhoea diagnosed in Primary Care Trial) - pilot feasibility study, Bristol 2015
Manley P1, Brangan E2,3, Muir P4, Pye K5, Horner P2, Horwood J2,3, Macleod J2
1South West Public Health Training Programme, Bristol City Council and University of Bristol
2University of Bristol, School of Social and Community Medicine
3NIHR Collaboration for Leadership in Applied Health Research and Care West
4Public Health England, South West Public Health Laboratory
5Bristol City Council, Avon Chlamydia Screening Office
Aim: To examine whether the proposed changes to management of Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) infections in Primary Care (PC) can be introduced successfully and whether GP practices and patients find this new management acceptable.
Background: Around half of CT and NG testing in England is amongst asymptomatic individuals attending PC for unrelated reasons. 5-10% of these tests are positive. GPs reported neither the training nor resources to manage these infections effectively and would welcome support. Based on the National Chlamydia Screening Programme model we developed a centralised nurse-led telephone-based service for CT/NG infections diagnosed in PC and conducted a pilot trial to examine its feasibility and acceptability to patients and practitioners.
Methodology: We recruited 11 practices. Eight were randomised to the intervention arm where practitioners could choose centralised management of CT/NG tests by specialist nurses where this was clinically appropriate. Patients in control practices received usual care. Clinicians in participating practices alongside patients who both consented and declined consent to study participation were interviewed about their experience of the study.
Results: 41% of practices we invited agreed to take part in the study. Interviews suggested that practitioners were positive about the intervention as offering several advantages for patients. However, practitioners encountered difficulties using our consenting mechanism and requested more feedback on the management of their patients outside the GP practice. 65% of patients who were asked for consent, agreed to take part. Patients interviewed found the intervention acceptable.
Conclusions: The study and the intervention were considered feasible and acceptable. We believe that this new CT/NG management pathway would both meet the expressed needs of GPs for additional support in this area, and improve outcomes for patients through timely case treatment and better partner management. We suggest that this pilot study leads into a definite RCT evaluating patient outcomes and potential benefits.
F4
Maya Gobin
Public Health England
MRSA and People Who Inject Drugs: Estimating burden and risk
Aim: This paper aim is to describe the burden of MRSA infection in the People Who Inject Drugs (PWID) in Bristol and to identify the risk factors for infection in this population.
Background: Bristol has one of the highest rates of community acquired MRSA in England. An increase in MRSA bacteraemia in PWID was detected in Bristol in 2014 and risk factors for infection were poorly understood. We use routine data sources to estimate the burden of disease in PWID in Bristol and possible risk factors.
Method: Laboratory and client data from Bristol Drug Services were merged to identify PWID aged between 16 and 70 years old with MRSA infection in Bristol from January 2006 to January 2015. The annual number, demographics of cases and information on injecting behaviour was summarised. The Post infection review (PIR) notes for 14 cases with serious MRSA bacteraemia resulting in prolonged hospital admission supplemented information on injecting behaviour.
Results: PWID accounted for 10.0% (129/1289) of all laboratory MRSA isolates, increasing from 1.1% in 2006 to 26.5% in 2014. Cases were predominantly male (100/129), White British (119/129) and aged between 22 and 59 years old (mean and median 38 years). Fifty five cases had a history of homelessness. Eighty four cases had a history of concurrent heroin and crack use. Twelve of the cases with a PIR were groin injectors and when asked none reported d their skin prior to injection.
Conclusions: MRSA infection is an important problem amongst PWID in Bristol and associated with poor outcomes. Interventions such as routine swabbing and de-colonisation, wound care advice and distribution of enhanced skin prep pack all targeted at groin injectors and people with concurrent heroin and crack cocaine may have a role to play in reducing infection. However, the evidence base for these approaches needs to be strengthened.