Slieve Donard Hotel - qub.ac.uk

Annual Meeting

Slieve Donard Hotel Newcastle, County Down

24 November 2017

@CoE_NI #coeawd17 1 | P a g e

Friday 24th November 2017 Grand Ballroom, Slieve Donard Hotel, Newcastle

08:30 Registration Annex

09:15 Welcome Grand Ballroom

Professor Frank Kee

09:20 Dr Hugh Campbell Grand Ballroom

10:20 Professor Alicia O’Cathain

University of Sheffield Grand Ballroom

“How should we develop new ways to improve health”

11:20 Refreshments & Poster Viewing Annex & Grand Ballroom

11:50 Dr Denise O’Hagan Grand Ballroom On behalf of the Faculty of Public Health in NI (FiNI)

‘Interested in joining the Faculty of Public Health?’

12:00 Stand and Deliver Grand Ballroom

12:10 Room 101 Grand Ballroom

12:50 LUNCH & Poster Viewing Oak Restaurant / Annex


Friday 24th November 2017 Grand Ballroom, Slieve Donard Hotel, Newcastle

14:00 Mrs Joanne Morgan, Mrs Jenny Hanna, Professor Lindsay Prior Grand Ballroom Community Development and Health Network / Centre of Excellence for Public Health NI

“Community -based Interventions to Improve People’s Health”

14:15 Mr Matt Bird Grand Ballroom Relationology International

‘Choose Relationships Choose Health’

15:15 Refreshments Annex

15:35 Dr Zoe Williams Grand Ballroom ‘Trust me I’m a Doctor’, BBC

‘Walking the Walk, and Talking the Talk’

15:50 10 UP Grand Ballroom

16:50 Prizes & Closing Remarks Grand Ballroom

18:30 for 19:00 Dinner Oak Restaurant


Poster Presentations 1 Andrew Kunzmann Detecting oesophageal cancer earlier (p8)

2 Haydee Jordao The impact of a tailored dietary intervention coupled with oral

rehabilitation on the nutritional status of older patients (p8)

3 Mark O’Doherty Social capital, deprivation and self-rated health: does reporting heterogeneity play a role? Results from the English Longitudinal Study

of Ageing (p9)

4 Ashlene Crowe Improving communication for individuals with a rare condition (p9)

5 Aideen Johnson School-based physical activity interventions and wellbeing in children:

A systematic review and intervention complexity assessment (p10)

6 Jenny Hanna Community-based interventions to improve people’s health (p11)

7 Blanaid Hicks Androgen deprivation therapy and the risk of anaemia in men with

prostate cancer (p11)

8 Niamh O’Kane How do we talk about physical activity on Twitter? A content and sentiment analysis (p12)

9 Kim Tu Tran Thi The influence of proton pump inhibitors and histamine-2 receptor antagonists on liver cancer risk: a nested case-control study (p13)

10 Conor Cunningham The ‘Walk with Me’ Study: developing a peer-led, multi-component

physical activity intervention in older adults (p13)

11 Eileen Morgan Official statistics on cancer in Northern Ireland. Latest results from the

N. Ireland Cancer Registry (p14)

12 Ciara Rooney When do women opt-in to postpartum weight management? Findings

from the Supporting Mums (SMS) pilot intervention (p14)

13 Nga Nguyen Economic evaluations of Trastuzumab in the treatment of HER2-positive early stage breast cancer: a systematic review (p15)

14 Chris Jenkins An evidence-based approach to the evaluation and planning of breast

cancer services in Vietnam (p16)

15 Andrea McGrattan The development and pilot testing of tailored Mediterranean lifestyle

education to encourage dietary behaviour change in patients with Mild Cognitive Impairment (p16)

16 Charlene Treanor Baseline results from a feasibility study of an intervention programme to reduce cognitive impairment due to cancer treatment (p17)

17 Jason Wilson Association of objective sedentary behaviour and self-related health in

English older adults (p17)

18 Katie Brown Genomic and bioinformatic interrogation of rare diseases: translating

multi-omic research into clinical progress (p18)

19 Leonie Heron The economic cost of physical inactivity and sedentary behaviour (p18)


Poster Presentations cont…

20 Shannon Montgomery Investigating the role of social networks for physical activity and sedentary behaviour in adolescents: a social network analysis (p19)

21 Rachael O’Neill Investigation of retinal measures as a biomarker of chronic

kidney disease in the Northern Ireland Cohort for Longitudinal

Ageing (NICOLA) (p19)

22 Danielle Logan Biomarkers of nutritional well-being in older people (p20)

23 Blain Murphy An Ode to MGUS (Monoclonal gammopathy of undetermined significance) (p21)

24 Katie Mohan Accuracy of medical screeners versus non-medical screeners for

diagnosing diabetic eye disease in Vietnam (p22)

25 Leigh-Ann McCrum The Impact of Oral Health Status on Food Choice amongst the Older

Adult Population (p23)

26 Ethna McFerran Can Ireland’s colorectal screening programme save more lives, save

money and live within existing colonoscopy capacity limits? Findings

from the MISCAN micro-simulation model (p24)

27 Jinnan Zang Evaluation of novel early renal indicators in diabetes (p24)

28 Hannah McKenna Alcohol consumption amongst the over 50 population of Northern

Ireland: initial NICOLA findings (p25)

29 Sara Wallace Factors affecting dietary change and micronutrient bioavailability in older patients: impact of oral health status (p25)

30 Raymond Henderson Economic burden of colorectal cancer across Europe: a population-based

cost analysis (p26)

31 Chiara Magliacane Youth conflict-related trauma through generations: an ethnography on

the relationship between health and society in post-conflict Northern Ireland (p27)

32 Roisin O’Neill Effect of a peer support intervention to encourage adoption and maintenance of a Mediterranean diet in established community groups:

a cluster randomised trial (p27)

33 Neil Heron Stroke prevention rehabilitation intervention trial of exercise (SPRITE) – a randomised feasibility study (p28)

34 Olujoke Afolashade Fakoya Using theory and knowledge synthesis to improve approaches to reduce loneliness and social isolation (p29)

35 Lina Wang A multi-state Markov model integrating socioeconomic status and

health-related determinants to estimate recovery from functional

disability (p30)


Poster Presentations cont…

36 Nicole Blackburn The musculoskeletal consequences of latissmus dorsi breast reconstruction in women following mastectomy for breast cancer (p30)

37 Anne Devlin Why is work-limiting disability in Northern Ireland so high? (p31)

38 Aideen Maguire Cousin marriage and the mental health of progeny: a population-wide

data-linkage study (p32)

39 Jianjun Tang Inactive individuals require twice financial incentives as much as active

individuals to increase physical activity: a discrete choice modelling approach (p32)

40 Kishan Patel Exploring the effect of socioeconomic status on the risk of all-cause mortality between migrants and the majority settled population of

Finland for the years 2001-2014 (p33)


Stand and Deliver 1 Ashlene Crowe Improving communication for individuals with a rare condition (p9)

2 Kim Tu Tran Thi The influence of proton pump inhibitors and histamine-2 receptor

antagonists on liver cancer risk: a nested case-control study (p13)

3 Nga Nguyen Economic evaluations of Trastuzumab in the treatment of HER2-positive early stage breast cancer: a systematic review (p15)

4 Katie Brown Genomic and bioinformatics interrogation of rare diseases: translating

multi-omic research into clinical progress (p18)

5 Rachael O’Neill Investigation of retinal measures as a biomarker of chronic kidney

disease in the Northern Ireland Cohort for Longitudinal Ageing (NICOLA) (p19)

6 Katie Mohan Accuracy of medical screeners versus non-medical screeners for diagnosing diabetic eye disease in Vietnam (p22) 7 Leonie Heron The economic cost of physical inactivity and sedentary behaviour (p18)

8 Olujoke Afolashade Fakoya Using theory and knowledge synthesis to improve approaches to reduce

loneliness and social isolation (p29)

9 Danielle Logan Biomarkers of nutritional well-being in older people (p20)

10 Haydee Jordao The impact of a tailored dietary intervention coupled with oral

rehabilitation on the nutritional status of older patients (p8)

11 Chris Jenkins An evidence-based approach to the evaluation and planning of breast cancer services in Vietnam (p16)


Dr Zoe Williams Dr Zoe Williams – Medical Doctor/GP, Media Personality, Fitness and Physical Activity Expert, Motivational Speaker and Gladiator Amazon!

DOCTOR: Zoe graduated from Medical school in 2007, with recognition for high achievement. She has gained experience in many specialist fields within medicine including A&E, Cardiology, Respiratory and Acute medicine, Surgery, Dermatology, Oncology, Obstetrics and Gynaecology. She currently practices as an NHS General Practitioner in London. Her specialist interests include preventative medicine, sports medicine and tackling chronic health thorough lifestyle measures such as healthy eating and physical activity. She is clinical lead of Public Health England’s GP clinical champion network and also leads on work to promote physical activity and healthy lifestyle with The Royal College of General Practitioners. MEDIA: Zoe is resident doctor on ITV’s popular daytime show ‘This Morning’. She has presented across the BBC network, including BBC News broadcast, ‘Horizons’ and ‘Trust Me I’m a Doctor’.

She specializes in debunking the confusing world of medicine, in a fun and entertaining way. As a GP she is fluent in all subjects relating to health, and is respected within the medical world as an expert in the fields of physical activity, obesity and lifestyle. FITNESS: Zoe is a fitness expert. She has competed in numerous sports at high level including Athletics and Premiership level Rugby Union. In 2009 Zoe teamed up with professional rugby player, Spencer Davey, to develop the first ever celebrity run Bootcamp in the North-East of England, ‘Naturally Fit’. GLADIATORS: Zoe was selected from thousands of athletes to be ‘Amazon’ on Sky 1’s Gladiators. She was able to demonstrate her athleticism and strength and remains undefeated. Sportsgirls and Fit4Life: Zoe’s passion in life is to help people achieve and maintain good health through exercise and physical activity. This is nevermore true than with children. In 2009 she founded the organisation ‘Sportsgirls’, which aims to increase the physical activity of teenage girls by inspiring, educating and motivating they to be healthier and more active. In 2013 workshops were also developed for boys and the organisation was renamed Fit4Life. Writer/Consultant: Zoe has written for numerous publications on the topics of health, fitness and diet and has consulted for various nutrition and sports brands. Zoe’s unique combination of skills and achievements combined with her likeable, outgoing, down-to earth personality, make her an authentic and credible asset. Her ambition is to continue to combine her dedication to medicine, her passions for health and fitness and her career in media and she is always delighted to hear about new opportunities.

Mr Matt Bird

Matt Bird is an international speaker, author and

broadcaster. He has spoken in 30 countries to more than a

million people. He has authored 10 books including

one that won a ‘book of the

year’ prize and he writes for The Times newspaper.

Matt is the founder of Relationology International a unique approach to increasing business growth through the power of stakeholder relationships

www.relationology.co.uk. His charitable work building relational capital in

communities, has received commendations from successive British Governments most recently with Cinnamon Network www.cinnamonnetwork.com

Professor Alicia O’Cathain Alicia O’Cathain is Professor of Health Services Research at the School of Health

and Related Research at the University of Sheffield, UK. She leads research in

developing and evaluating complex interventions for long term conditions, evaluating new health services, and emergency and urgent care. She has

written extensively on combining qualitative and

quantitative methods in

research studies, recently focusing on how best to use

qualitative research with randomised controlled trials.

Her current research focuses on how to develop complex

interventions to improve

health.

http://www.relationology.co.uk/

http://www.cinnamonnetwork.com/


1 Detecting oesophageal cancer earlier

Dr Andrew Kunzmann A Thrift, Ú McMenamin, J Busby, C Cardwell, M Canadas Garre, L Smyth, AJ McKnight, L Murray & H Coleman Introduction

Oesophageal cancer often has a very poor prognosis due to late clinical presentation and a lack of cost-effective screening options. A recent UK report

based on consultations with patients, researchers and clinicians identified the

top priority for oesophageal research as “to identify high-risk people from the general population in whom to target Barrett’s oesophagus screening”.

Method

My work will assess ways to identify individuals at high-risk of oesophageal cancer to target endoscopy screening. To do this I will use data from the UK

Biobank which contains data on over 500,000 participants with information from

questionnaires, blood tests, genotyping and subsequent cancers. We will assess how well the following methods distinguish between individuals who went on to

develop oesophageal cancer and individuals who remained cancer free: 1) questionnaire assessing established risk-factors for oesophageal cancer

that would be largely available to general practitioners, such as age,

sex, smoking status, alcohol intake, BMI and regular heartburn 2) A panel of biomarkers from blood samples

3) A panel of genes selected from the entire genome

Future results/conclusions If these are sufficiently predictive, these could be used to develop a

questionnaire app or computer program to be used by GPs. Patients considered

to be at high-risk of oesophageal cancer could be sent for blood or gene tests to reassess risk of oesophageal cancer. If blood or gene tests indicate that a

patient is at high-risk of oesophageal cancer, these patients could be sent for endoscopy screening which may detect oesophageal cancer at an early, or even

pre-cancerous stage which improves the likely success of treatments.

Research is directed at policy makers: We will be publishing this work in a peer-reviewed journal and consulting with prominent gastroenterologists.

Keywords: Oesophageal cancer; Early diagnosis; Biomarkers; Genotypes

2 The impact of a tailored dietary intervention coupled with oral

rehabilitation on the nutritional status of older patients

Miss Haydee Jordão

H Jordão, G Mc Kenna, U McMenamin, A Kunzmann, L Murray, H Coleman Background Poor oral health, and specifically periodontitis, has been identified in patients with digestive cancers and many systemic diseases. Despite several studies, controversy remains as to whether oral health status is independently associated with these outcomes, due to confounding by smoking, alcohol and poor nutrition, and therefore further research is required. Aim To investigate the association between oral health status and gastrointestinal cancer risk. Method Data from the large, prospective UK Biobank, which includes n=475,766 participants, were analysed. Oral health problems (defined as painful gums, bleeding gums, and/or having loose teeth) were self-reported by questionnaire. Linkage to cancer registries enabled identification of gastrointestinal cancer cases. Cox proportional hazard models were applied to estimate the relationship between gastrointestinal cancer risk and oral health problems, adjusting for confounders. Results During an average 6 years of follow-up, n=4,069 gastrointestinal cancer cases were detected, of which 13% reported oral health problems. Overall, there was no association between oral health problems and risk of gastrointestinal cancer (HR 0.97, 95%CI 0.88-1.07). In site-specific analysis, no associations were identified between oral health problems and risk of oesophageal, gastric, pancreatic or colorectal cancers. However, an increased risk of hepatobiliary cancers was observed in those with oral health problems (HR 1.31, 95%CI 0.95-1.80), which became a significant 50% increased risk in analysis restricted to ever smokers, overweight individuals, and those consuming <5 fruit and vegetables portions per day. Conclusion Overall there was no association between poor oral health and gastrointestinal cancer risk, however there were suggestions of an increased risk of hepatobiliary cancer. For general population (old, young, male, female), researchers and I particularly would like to expand to Angolan decision makers. Angola has a high rate of hepatobiliary cancer and expensive dental service. As consequence of the study result shows a possible association between oral health and hepatobiliary cancer, maybe decision makers can work in affordable price for dental care of the population.

Keywords: Oral health, periodontitis, gastrointestinal cancer, digestive cancer


3 Social capital, deprivation and self-rated health: does reporting

heterogeneity play a role? Results from the English Longitudinal Study

of Ageing

Dr Mark G O’Doherty D French, A Steptoe, F Kee Introduction Self-rated health (SRH) is commonly assessed in large surveys, though responses can be influenced by different individuals’ perceptions of and beliefs about health. Therefore, instead of providing evidence of ‘true’ health disparities across groups, findings may actually reflect reporting heterogeneity. Method Using data from participants aged 50 years and older from the English Longitudinal Study of Ageing (ELSA) Wave 3 (2006/07; participation rate =73%), associations between three dimensions of social capital (local area & trust, social support and social networks), deprivation and SRH were examined using the vignette methodology in 2341 individuals who completed both the self-report and at least one of the 18 vignettes. Analysis employed a hierarchical probit model (HOPIT). Results Individuals expressing low local area & trust social capital (beta= -0.276, p<0.001) and those with poor social networks (beta= -0.280, p<0.001) were more likely to report poor SRH in HOPIT models accounting for reporting heterogeneity, but unadjusted ordered probit analyses still correctly show a negative relationship between low local area & trust social capital (beta= -0.243, p<0.001) and those with poor social networks (beta= -0.210, p<0.01), though they somewhat tend to underestimate its strength. Neither social support nor deprivation appeared to have any effect on SRH regardless of reporting heterogeneity. Conclusion Anchoring vignettes offer a relatively uncomplicated and cost-effective way of identifying and correcting for reporting heterogeneity to improve comparative validity of self-report measures of health. This analysis underlines the need for caution when using unadjusted self-reported measures to study the effects of social capital on health. Who - Policy makers (e.g. Commissioner for Older People for Northern Ireland, Eddie Lynch) and third sector organisations (e.g. Age NI) These results may be more indicative of ‘true’ health disparities or may be the result of diverging ‘attitudes’ between social capital groupings. Overall, policy solutions require an overarching approach by addressing the social determinants of health that are inclusive of all sectors of the community. High quality research is required to identify how best to tackle health inequalities and policy solutions for each group might be quite different. Keywords Social capital; self-rated health; ageing; vignettes; health disparities; deprivation

4 Improving communication for individuals with a rare condition

Ms Ashlene Crowe AJ McKnight, H McAneney Introduction A rare disease is defined as occurring in less than 1 in 2,000 people, but cumulatively, rare diseases are common and represent a significant public health concern, with one in 17 people in the UK being affected by a rare condition. The problems encountered because of the low number of instances of rare diseases include a lack of accurate diagnosis, no clarity about which specialists they should be referred to post-diagnosis, a lack of coordinated approach, medical professionals who have not heard of the disease and thus do not know how to treat or manage the symptoms, or even there being no treatments available. Thus improving communication mechanisms both within and around the healthcare system is of vital importance to individuals living and working with rare diseases. Method Surveys amongst people with a rare disease, medical professionals, families and advocacy/support groups have been, and will continue to be, carried out. This is to establish what communication for them is like within the healthcare system and how they access or engage with medical practitioners and similarly how they access information to do with their disease. The DELPHI model will be used to identify the priorities for improving communication for people with rare disease in Northern Ireland. Stage one will draw on the information from the surveys to identify the priorities and stage two will be the ordering of these priorities by participants in a series of workshops. Results From the survey data there were 60 priorities identified which have been grouped under 4 headings: Sources of Information, Medical Care, Rare Disease Community, and Public Awareness. Conclusion There is a huge amount of progress which needs to be made in order to improve how someone with a rare condition receives information, treatment, and ultimately holistic care to help them deal with the life-changing event of discovering that you have a rare disease. Who in particular is this research being directed to: This research is part of a local co-production strategy and will be used by advocacy groups for people with rare diseases, and by the Northern Ireland Stakeholder Implementation Group in order to best meet commitments provided in the Northern Ireland Rare Disease Implementation Plan 2015. Keywords: Rare disease, communication, co-developed, co-production 1 UK Strategy for Rare Diseases, 2013, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/260562/UK_Strategy_for_Rare_Diseases.pdf 2 European Commission. European Commission Regulation (EC) No 141/2000 of the European Parliament and the Council of 16 December 1999 on orphan medicinal products, Official Journal of the European Communities, L18 (1), 2000 3 NI Implementation Plan for Rare Diseases, 2015, https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/ni-rare-diseases- implementation- plan-oct-2015.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/260562/UK_S

https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/ni-rare-diseases-

https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/ni-rare-diseases-


5 School-based physical activity interventions and wellbeing in children:

A systematic review and intervention complexity assessment

Mrs Aideen Johnson P Connolly, M Tully Introduction Schools play an important role in determining the level of physical activity (PA) of children and adolescents (Dale, Corbin, & Dale, 2000) and a number of recent systematic reviews have examined the types of school-based PA interventions which positively impact upon aspects of physical health, PA behaviours and fitness. However, there is a growing body of evidence to suggest that PA can also have a positive impact on other aspects of wellbeing which are seen as essential to the present and future development of a child, including for example mental health, psychological wellbeing and educational outcomes. Whilst research in this area continues to grow, reviews to date have primarily focused on associations with and efficacy of PA interventions for a limited range of wellbeing outcomes, with little consideration of the constituent parts or complexity of interventions that lead to positive outcomes. Method Given the gap in the current literature, this proposed review, registered with the Campbell Collaboration, aims to summarise the evidence for school-based PA interventions and a broader range of wellbeing outcomes. The review will adopt a systematic and thorough approach to searching, using a pearl harvesting method developed by Robert Sandieson (Western University, Ontario) to develop a comprehensive search strategy and will include both objective and subjective measures of PA. Furthermore, the ‘Intervention Complexity Assessment Tool for Systematic Reviews’ (Lewin et al. 2013) will be used as a method of disaggregating the component parts of the interventions. Conclusions It is hoped that using these methods to search and code relevant publications will enable

a more effective comparison and interpretation of the review findings. Who in particular is this research being directed to? This research will be particularly relevant to key stakeholders within the education sector including for example DENI, EA, school principals and teachers. It will also be relevant to those within the public health sector. Keywords School-based physical activity, wellbeing


6 Community-based interventions to improve people’s health

Mrs Jenny Hanna L Prior, J Morgan, F Kennon Introduction The Community Development and Health Network (CDHN) is a regional community and voluntary sector organisation. CDHN is a membership organisation, providing support for members to use community development as a means to improve health and wellbeing and reduce inequality. CDHN works build understanding, to influence practice and policy, of how community development influences health and inequality.

Method Traditional commissioning and procurement arrangements have focused on output data to measure the success of a community based interventions. Increasingly there are moves to measure outcomes; changes in health, attitudes, behaviours. However, there remains a gap; funders often look for output and outcome data in isolation, with little consideration of relationships, context and routines in which the programme has taken place. This means that key information to aid understanding about why certain outcomes, intended and unintended occurred is often missing. CDHN developed a reflective case story template, to enable community based projects to capture this

information. Using this information CDHN sought to explore what factors are important in sustaining projects and have a positive influence on health and wellbeing. Results Community development practitioners, who participated in a CDHN training programme were asked to complete a case story, using the template. During the four years training programme 60 narratives were gathered. These 60 were reviewed and 10 were chosen for further in-depth data collection on project progression, completion and impact. Out of the 10 reviewed narratives 3 were reviewed using PIAGEK software. Of the 10 projects reviewed eight had ended and two were on going. There were two reasons for projects ending; natural end of the funding cycle, or change in staff.

Conclusion Of the three projects reviewed using PIAGEK it was found that all interventions depended on a support network, organisational process and agreed outcomes. The relationship between these factors and embeddedness in a community appears to influence the sustainability and health and wellbeing impact of a project. The findings indicate that those projects and interventions which are embedded within communities are more likely to be sustainable and have a positive impact on health and wellbeing.

7 Androgen deprivation therapy and the risk of anaemia in men with

prostate cancer

Dr Blanaid Hicks A Klil-Drori, H Yin, L Campeau, L Azoulay Introduction The use of androgen deprivation therapy in prostate cancer may be associated with an increased risk of Anaemia, but the evidence remains limited. This study aimed to determine if androgen deprivation is associated with increased risk of anaemia in patients newly diagnosed with prostate cancer. Methods This was a population-based cohort study using the United Kingdom Clinical Practice Research Datalink linked to the Hospital Episode Statistics repository. The cohort consisted of 10,364 men newly diagnosed with non-metastatic prostate cancer between April 1, 1998 and September 30, 2015. We used time-dependent Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for Anaemia (hemoglobin <130 g/l) associated with current and past use of androgen deprivation therapy, compared with non- use. Results There were 3,651 incident anaemia events during 31,574 person-years of follow-up (rate: 11.6/100 person-years). Current androgen deprivation therapy use was associated with a nearly 3-fold increased hazard of anaemia, compared with non-use (23.5 vs 5.9 per 100 person-years, respectively; HR: 2.90, 95% CI: 2.67, 3.16). The HR was elevated in the first 6 months of use (HR: 2.20, 95% CI: 1.95, 2.48) and continued to be elevated with longer durations of use. Past androgen deprivation therapy use was associated with a lower estimate (HR: 1.27, 95% CI: 1.12, 1.43), which returned closer to the null ≥25 months after treatment discontinuation (HR: 0.95, 95% CI: 0.79, 1.15). Conclusions The use of androgen deprivation therapy is associated with increased risk of anaemia, which reverses upon treatment discontinuation. Target Audience: This study is aimed at a clinical audience. A better awareness of ADT-induced anemia is important in the clinical setting. In cases of mild anemia, a better awareness of this association may help reduce the use of unnecessary diagnostic tests, such as colonoscopy, to investigate the possible causes of anemia, enhancing the quality of life of patients by limiting unnecessary testing. This study has been published in a relevant clinical journal and will be presented at relevant conferences to facilitate the dissemination of results to the targeted clinical audience. Keywords: Androgen deprivation therapy, prostate cancer, anaemia, pharmacoepidemiology


8 How do we talk about physical activity on Twitter? A content and

sentiment analysis

Miss Niamh O’Kane M McKinley, A Gough, O Ajao, F Kee, R Hunter Introduction The ever-growing popularity of social media has encouraged physical activity (PA) practitioners and researchers to embrace these new platforms for promoting PA. However, we need to better understand how we communicate about PA on social media platforms and how users interact with it. Contributors to the PA conversation on Twitter are wide reaching; encompassing the general public, for-profit organisations and public health bodies and professionals. This study aims to identify themes in content and sentiment across the PA conversation on Twitter and assess the sources of information, to provide PA researchers and practitioners with an insight into the social media environment and how information is shared within it. Methods Tweets containing the term “physical activity” were collected from Twitter continuously over a 7-day period in May 2017, producing 7,525 tweets. Sentiment scores were assigned to tweets using the Wordnet extension for RapidMiner Studio. A coding framework was developed and content analysis was manually performed on a 1% sample to identify frequency of main themes; including informational, promotional, and personal. Results The majority of PA tweets expressed weak positive (67.1%), weak negative (12.3%) and neutral sentiment (13.7%), with the minority exhibiting strong positive (5.5%) and strong negative (1.4%) sentiment. Preliminary content analysis identified 63.5% of PA tweets as informational, with 8.1% of tweets promoting products or services, and 28.4% identified as personal tweets, for example general commentary and reporting behaviour. Within all informational physical activity tweets, 63.8% contained information in the

tweet itself rather than linking to external information. Conclusion Tweets about PA were predominately positive and used to convey information within the tweet. The findings of this study will provide PA researchers with a better understanding of how PA is discussed on Twitter, and further analysis of the data may help inform how we use social media as an intervention tool for lifestyle behaviour change and PA promotion.


9 The influence of proton pump inhibitors and histamine-2 receptor

antagonists on liver cancer risk: a nested case-control study

Miss Kim Tu Tran Thi C Cardwell, H Coleman Background Proton pump inhibitors (PPIs) is one of the most widely prescribed medication in use of acid suppression, peptic ulcers, dyspepsia. However, prolonged PPIs using is associated with overgrowth of bacteria in stomach and small intestine, resulting the production of N-nitrosamines that might be carcinogenic. Long term PPIs treatment is related to hypergastrinemia which has shown related to carcinogenicity and shorter survival. In observational studies, PPIs has found associated with gastrointestinal cancer and periampullary cancer, but no study has been conducted in liver cancer. Only an experimental study conducted in rats suggests omeprazole a promoter of liver tumor. Association between PPIs/H2 antagonist and liver cancer has not been determined, whereby biological mechanism suggests its association. Thus, we examine this relationship in a case-control study within the Primary Care Clinical Informatics Unit data. Method A case-control study was conducted by using data from The Primary Care Clinical Informatics Unit database (PCCIU). Cases were patients with liver cancer and controls were matched with cases on age, gender, and GP practice. One year prior the index date was excluded. Cases or controls were excluded if either the year of diagnosis before 1999 or the duration of medication exposure is less than three years. Conditional logistic regression was calculated to compare odd ratio of liver cancer between PPIs/ H2RA user to non-users. Results Our preliminary result showed that ever use of PPIs increased risk of liver cancer (OR 1.72, 95% CI 1.28-2.30). No dose relationship was observed in both terms of cumulative prescription or defined daily dose. Among five subgroup analysis, only omeprazole and pantoprazole significantly associated with liver cancer risk. H2RA showed no association with liver cancer in this study. Conclusion PPIs was associated with risk of live cancer. H2 antagonist, however, was not associated with liver cancer risk in this study. Keywords: Proton pump inhibitors, Histamine-2 receptor antagonists, liver cancer, risk. Target Audience: This study is of interest to general practitioners and gastroenterologists.

10 The ‘Walk with Me’ study: developing a peer-led, multi-component

physical activity intervention in older adults

Dr Conor Cunningham McMullan I, Simpson L, Cupples M, Hardeman W, Black M, Farrell D, Hunter R, Kee F, Laventure B, Morgan J, Murphy M, McDonough S, Totten C, Tudor-Locke C, Wright A, Tully M Introduction Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those from lower socio-economic position, are also the most inactive. Increasing physical activity levels, particularly among those most inactive, is a public health priority. Peer-led physical activity interventions may offer a model to increase physical activity in the older adult population. This study aims to develop and test the feasibility of a peer-led, multicomponent physical activity intervention in socio-economically disadvantaged community dwelling older adults. Method The UK Medical Research Council framework for developing and evaluating complex interventions will be used to design and test the feasibility of a RCT of a multicomponent peer-led physical activity intervention. Data will be collected at baseline, immediately after the intervention and 6 months after baseline measures. The feasibility RCT will provide information on recruitment of peer mentors and participants and attrition rates, intervention fidelity, and data on the variability in objective physical activity measurements. The feasibility trail will also assess the acceptability of the intervention and identify potential resources needed to undertake a definitive trial should the trial prove feasible. Results Data analyses will be descriptive and include an evaluation of eligibility, recruitment and retention rates. The findings will be used to estimate the sample size required for a definitive trial. A detailed process evaluation using qualitative and quantitative methods will be conducted with a variety of stakeholders to identify areas of success and necessary improvements. Conclusion The ‘Walk with Me’ feasibility RCT will provide the information necessary to inform the design and delivery of a fully-powered trial should the ‘Walk with Me’ intervention prove feasible. Who in particular is this research being directed to ie. If policy makers who? And how will you ensure they hear about it. Public Health policy makers, local older people’s charities and community groups. Findings from the research will be presented at local and international conferences, via peer reviewed publications and on-line through the NIHR website. We work closely with project partners who include Health Trusts, the Public Health Agency, local older people’s charities and community groups. Output from the research will be disseminated to each project partner whilst emphasising the strengths and novelty of the research for each group. Keywords: Randomised controlled trial, Physical activity, Peers, Older adults, Feasibility study


11 Official statistics on cancer in Northern Ireland. Latest results from the

N. Ireland Cancer Registry

Dr Eileen Morgan NI Cancer Registry Introduction The N. Ireland Cancer Registry (NICR) is the producer of official statistics on the incidence, prevalence, survival and mortality of cancer in N. Ireland in order to provide evidence to help inform decision making about cancer services. The most up-to-date statistics are released in March each year. Method: The NICR is a population-based registry which collects patient information on their disease and the services they receive. New cases of cancer are registered from pathology reports, hospital administration records, and death certificates by Tumour Verification Officers. GP or hospital charts may also be accessed if the above sources do not yield a reliable registration. Registrations are validated and quality-checked according to internationally recognised standards. Age-standardised incidence rates by sex, year and age at diagnosis are calculated. Standardised incidence ratios are also calculated to compare incidence in smaller geographic units to national incidence rates. The lifetime risk of developing cancer up to the age of 75 is calculated and prevalence figures are also calculated. Six-month, 1-year and 5-year net survival estimates are calculated. Results: During 2011-2015 there were 4,557 male and 4,516 female patients diagnosed each year with cancer (excluding Non-Melanoma Skin Cancer) in Northern Ireland. The odds of developing cancer before age 75 are 1 in 3.6. At the end of 2015, there were 58,586 people living with a cancer diagnosis. The most common cancers diagnosed among males were prostate (25% of all cancer in males), colorectal (15%) and lung (15%) while the most common cancers among women were breast (30% of all cancer in females), lung (12%) and colorectal (12%). Since 2006, the number of cancer cases (excluding NMSC) has increased among men from 3,786 to 4,650 and from 3,681 to 4,606 among women. After adjusting for age, there was a steady increase in incidence rates in males in 1999-2009, followed by a decrease from 2009-2015 by an average of 0.8% per year. In contrast, since 1993 female incidence rates have shown a steady increase by an average of 1.0% per year from 1993 to 2015. Five-year net survival for patients diagnosed during 2005-2009 for all cancers (excluding NMSC) was 54% (95% CI 53.7%, 55.1%). Survival has improved compared to patients diagnosed in 1993-1999 (42.2%; 95% CI 41.6%, 42.8%), though gains in lung cancer survival were slight. Conclusion: The number of cancer cases is increasing in recent years, largely due to the ageing population. Survival is higher in patients with an early stage at diagnosis highlighting the importance of being symptom aware and seeking advice. Keywords: Cancer · Statistics · Registry **These statistics are available at: http://www.qub.ac.uk/research-centres/nicr/CancerInformation/official-statistics/ or via email through: [email protected]. The NICR frequently provides data for assembly questions and for researchers (both local and international).

The N. Ireland Cancer Registry is funded by the Public Health Agency. This work uses data provided by patients and collected by the NHS as part of their care and support.

12 When do women opt-in to postpartum weight management? Findings

from the Supporting Mums (SMS) pilot intervention

Dr Ciara Rooney C McGirr, A Anderson, C Baba, C Cardwell, S Dombrowski, C Free, P Hoddinott, V Holmes, F Kee, E McIntosh, I Young, J Woodside, M McKinley Introduction There is no consensus on the optimum time to engage women in postpartum weight management. Women are likely to differ in their readiness to engage with weight management for a myriad of reasons. Based on this, and the fact that many women gain weight between 1 and 2 years postpartum, the SMS postpartum weight management pilot randomised controlled trial (RCT) employed a generous window of time for opt-in (6 weeks - two years postpartum). This allowed us to explore if opting-in was clustered around a specific postpartum stage or was spread out over a wider time frame. Methods The study aimed to recruit 100 overweight/obese (BMI > 25 kg/m2) postpartum (6 weeks-2 years from birth) women using community based approaches. Results One-hundred women (32.5 + 4.3 years) were recruited. Mean BMI was 31.4 + 4.6 kg/m2. Almost a third (34%) of women had an infant aged 3-6 months postpartum. Some women were ready to engage with the intervention very early in the postpartum stage (13% of women had an infant aged 1-3 months). Overall, 69% of women in the study had an infant aged up to 1 year old and 31% had an infant aged between 1 and 2 years when they signed up to the study. Conclusion This study supports the idea that women may feel ready to opt-in to postpartum weight management interventions at different stages in the postpartum period. (NIHR PHR Project: 14/67/20) Keywords postpartum, opt-in, weight management, pilot study Who is this research being directed to? The findings of this work will be of interest to other groups in the field of public health (academic & non-academic) carrying out interventions in postpartum women. The final findings of the SMS study will be communicated through dissemination at conferences, presentations, peer-reviewed publications and reports.

http://www.qub.ac.uk/research-centres/nicr/CancerInformation/official-statistics/

http://www.qub.ac.uk/research-centres/nicr/CancerInformation/official-statistics/

mailto:[email protected]


13 Economic evaluations of Trastuzumab in the treatment of HER2-

positive early stage breast cancer: a systematic review

Miss Nga Nguyen D Kelleher, S McIntosh, M Donnelly, C O’Neill

Introduction Breast cancer is a global issue with significant impact on patients’ health and has caused huge economic burden. Trastuzumab (Herceptin, Genetech) is a recombinant humanized monoclonal antibody used in the treatment of early stage breast cancer with overexpress

human epidermal growth factor receptor 2 (HER2). In the context of limited healthcare resources and significant cost of Trastuzumab, one of the major issues that should be taken into account is cost-effectiveness of this treatment. Many studies have been conducted in order to evaluate the cost-effectiveness of Trastuzumab in different settings, supporting the decision makers in budget allocation and reimbursement policies imposing. However, the substantial heterogeneity could be seen in a variety of research, in terms of early stage breast cancer definition, cost per unit of health outcome or effect (cost/QALY, cost/LYG), modelling method (type of model, model assumptions, states, transition probability, discount rate, cost analysis), time horizon, study perspectives… The above mentioned issues make it difficult for decision makers to utilize the large amount of evidences in making decisions routinely. Therefore, this systematic review aims at identifying the possible key drivers to different outcomes of the economic evaluations (EEs) of Trastuzumab in the treatment of HER2-positive early stage breast cancer and critically assessing the quality of these studies. Method This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidance recommendations. Details of the protocol for this systematic review were registered on PROSPERO (International prospective register of systematic reviews). The systematic review search strategy was first built on the NICE Clinical Guidelines for “breast cancer” term and CADTH - Canadian Agency for Drugs and Technologies in Health Guidelines for “economics evaluation” term; then it was optimized with the help from a Specialist Medical Librarian. The search strategy was run in September 2017 in 10 databases including MEDLINE, EMBASE, Web of Science, SCOPUS, Center for Reviews and Dissemination (CRD) database - the National Health Service Economic Evaluation Database NHS EED, Econlit – EBSCO, CINAHL Plus, Cochrane Library of Systematic Reviews (CDSR), International Guidelines Library (GIN) and Cost effectiveness analysis (CEA) registry. This review has been initiated with 5453 papers and now undergoing 2-stage screening process. First, after removing the duplicates, all remaining records were screened by two independent reviewers, on title and abstract for inclusion by eligibility criteria according to the designated PICOS criteria. Second, the authors will independently review the full

text materials and refine studies that meet all inclusion criteria for further assessment

and extraction. Data extraction will be based on 34-item checklist adopted from Wijnen et al. (2016). The risk of bias assessment will be conducted using the ‘Drummond checklist’ (BMJ checklist) and the ‘Evers checklist’ (CHEC-extended checklist) for full EEs conducted alongside single effectiveness studies; or the ISPOR checklist for model-based EEs. Result The outcome of this review will be the potential key drivers to the heterogeneity around cost effectiveness estimates in different settings, the quality assessment of economic evaluations of Trastuzumab in the treatment of HER2-positive early stage breast cancer and whether the uncertainty around cost effectiveness estimates related to identifiable

characteristics of the country such as its income level, ethnic profile or healthcare system funding model. Who is this research directed to? This research aims at the policy makers, healthcare professionals and other researchers in the area of health economics and breast cancer. Keywords Early stage breast cancer, economic evaluations, HER2 positive, Trastuzumab, systematic review.

QR code for the systematic review protocol on PROSPERO:


14 An Evidence-Based Approach to the Evaluation and Planning of Breast

Cancer Services in Vietnam

Mr Chris Jenkins T Thu Ngan; L Lohfled; M Donnelly; L Murray; H Van Minh Introduction The incidence of breast cancer has increased consistently in Vietnam over the past two decades. Despite this, there has been a lack of studies on what breast cancer services exist, and how they function, across different levels of the Vietnamese health system. Our project sought to examine the accessibility, affordability, and appropriateness of breast cancer services (early detection, diagnosis and treatment) across the country. Methodology The project used a mixed-methods approach, collecting data through self-administered questionnaires (n=69) and in-depth interviews (n=23) with health professionals working at facilities across all four levels of the Vietnamese health system (National, Provincial, District, & Commune). Our study was located across three provinces, representing the northern, central, and southern regions of the country. Results Screening Activities o Screening outreach activities in the community are ad hoc and sporadic. Screening is often

conducted by staff from National and Provincial hospitals (clinical breast examination and sometimes ultrasound) with administrative and organizational support from the Commune health station

o There are no stand-alone screening campaigns for breast cancer. Screening activities are conducted in combination with cervical screening and/or other women’s reproductive health services

o Facility-based opportunistic screening is limited o Male doctors performing clinical breast examinations represent a barrier for many women

seeking services Definitive Diagnosis and Treatment o Performed only at central upper levels of the health system o Referral processes are complex o The health insurance system is complex and does not cover full costs of treatment o Limited radiotherapy capacity across upper levels of the health system Conclusions There is scope for strengthening the primary levels of the Vietnamese health system to detect breast cancer. Increased autonomy and support for Commune health stations to conduct screening activities, the systematic incorporation of opportunistic screening, and the extension of breast cancer specific training for commune and district level health care staff are potential areas for strengthening. Numerous barriers additionally exist for women seeking definitive diagnosis and treatment for breast cancer across all three provinces we investigated. Keywords: Breast cancer; Vietnam; health systems; global health

15 The development and pilot testing of tailored Mediterranean lifestyle

education to encourage dietary behaviour change in patients with mild

cognitive impairment

Miss Andrea McGrattan A McGrattan, CT McEvoy, B McGuinness, MC McKinley, JV Woodside Background As our population grows older, there is an increased risk of having complex co-morbidities, ill-health and frailty. One of the major contributors to ill health in this population is cognitive decline. Mild Cognitive Impairment (MCI) is a transitional stage between the expected decline of normal ageing and that of dementia, with estimations that 46% of people with MCI develop dementia within three years from diagnosis. Accumulating evidence suggests that adherence to a traditional Mediterranean diet (MD) is neuroprotective, but few clinical trials have been conducted. There is a need to test the efficacy of MD behaviour change on cognition, but also to understand how best to achieve behaviour change towards a MD, particularly in non-Mediterranean and high-risk populations. We have developed a MD educational resource for MCI patients in accordance with the Medical Research Council framework for developing complex interventions (Craig et al., 2008), based on a systematic literature review and informed by qualitative work with the target group. Methods THINK-MED is a 12 month, three-arm, pilot randomised controlled trial aiming to recruit 60 MCI participants via memory clinics. Eligible participants will have low adherence to a MD characterised by a Mediterranean Diet Score (MDS) of ≤4 and be willing to make changes to their diet. Participants will be randomised into 1 of 3 groups: (1) THINK-MED educational resource on one occasion at baseline (n=20); (2) THINK-MED educational resource staged over 5 months with telephone support from a dietitian (n=20), or (3) standard care control group (n=20). Results Outcome assessments will be taken at baseline, 6 months and 12 months. The primary outcome is dietary behaviour change aiming to increase MDS by ≥3 points at month 6 (adoption of MD) and month 12 (maintenance of MD). Secondary outcomes include a comprehensive cognitive assessment using a validated neuropsychological test battery (Cantab Cognitive Battery, Cambridge Cognition Ltd.), anthropometrics, muscle strength, blood pressure and a fasting blood sample for analysis of biomarkers of MD adherence and vascular risk factors. Questionnaires will gather information on quality of life, physical activity, depression, instrumental activities of daily living and MD dietary knowledge and behaviour change. A detailed process evaluation using qualitative and quantitative methods will be conducted proceeding the pilot study to inform the development of a definitive trial. Recruitment for this pilot study is ongoing with participant follow-up due to complete late 2018. Conclusion: This pilot study aims to determine the acceptability and feasibility of a tailored, Mediterranean Lifestyle Education Intervention, THINK-MED to encourage dietary behaviour change in MCI patients. Ultimately, this study will inform the development of a definitive trial to further evaluate the effect of this intervention among this population group. Keywords: Mediterranean diet, lifestyle, MCI, behaviour change


16 Baseline results from a feasibility study of an intervention programme

to reduce cognitive impairment due to cancer treatment

Dr Charlene Treanor V Coyle, P Passmore, F Kee, M Donnelly

Introduction Cancer-related cognitive impairment affects up to 75% of cancer patients which warrants intervention. Method A single-arm, before- and after- study was undertaken to assess the feasibility of an intervention to reduce cognitive impairment. Early-stage (I-III) breast and colorectal cancer patients underwent a neuropsychological assessment before their first cycle of chemotherapy and will undergo the same assessment after their last chemotherapy cycle. Patients with cognitive decline (using predefined criteria) will be invited to participate in an intervention. Tests include the Trail Making Test, Hopkin’s Verbal Learning Test (HVLT), Controlled Oral Word Assessment, Digit Span and Stroop Test. Results Thirty-eight percent of participants approached underwent baseline assessment (n=15). Assessments took, on average, 55 minutes to complete. On average, participants were 57 years old, spent 18 years in education and had no comorbidities. Participants were predominantly female (n=12), had breast cancer (n=10), were married (n=12) and were not working (n=8). Most scores were within the normal range when compared to normative values. However, impairment was detected for some individuals. For example, one participant indicated significant/severe impairment on both parts of the Trail Making Test. Six participants performed in the 25th percentile on the Digit Span Forward or Backward test. Five and six participants, respectively, scored at least one standard deviation below normal performance on at least one trial of the HVLT and Stroop test. Conclusion Some participants demonstrate some impairment in executive functioning, learning and memory prior to receipt of chemotherapy. Participants are currently being followed up. Who in particular is this research being directed to This research is targeted towards health-care professionals involved in the care of patients with cancer. We will ensure that this research will reach cancer health-care professionals by dissemination at relevant UK and international conferences e.g. National Cancer Intelligence Network annual Cancer Outcomes conference and International Psycho-Oncology Society. The findings of this review will also be relevant to cancer patients and their families. Keywords cancer-related cognitive impairment; effectiveness of interventions; feasibility

17 Association of objective sedentary behaviour and self-related health in

English older adults

Dr Jason J Wilson NE Blackburn, R O’Reilly, MA Tully

Introduction Reducing sedentary behaviour has been proposed as an important approach to improving public health. Self-rated health is generally accepted as a valid measure of health status in population studies, with lower ratings associated with increased age, morbidity and mortality. However, previous research has not explored the association between objectively measured sedentary behaviour and self-rated health in older adults. Therefore, this study aimed to explore the association between sedentary behaviour and self-rated health in English older adults using data collected from the Health Survey for England (2008). Method A sub-sample of older adults (≥65 years) from the 2008 Health Survey for England wore an ActiGraph GT3X accelerometer for 7 days. Self-rated health was measured using the General Health Questionnaire. Analysis of Covariance was used to compare the average daily sedentary behaviour time between three groups of self-rated health (very good/good; fair; bad/very bad), using Tukey post-hoc tests. Covariates used included sex, BMI, total household income and average daily moderate-to-vigorous physical activity (MVPA) time. Results Older adults spent 614±83.46 mins/day in sedentary behaviour with 36.5% rating their health as either fair or bad/very bad. After adjustment, significant associations between sedentary behaviour and self-rated health were found (p=0.002; adjusted r2=0.13). Individuals rating their health as very good/good spent significantly less time in sedentary behaviour than those with fair health (p=0.0004). Conclusion This study suggests sedentary behaviour could be a novel and important variable to consider alongside more established correlates of self-rated health such as mortality, morbidity and social status. Future longitudinal research could help determine how changes in sedentary behaviour influence self-rated health as individuals’ age. Who in particular is this research being directed to? Researchers exploring novel correlates of sedentary behaviour and health in older adults. How will they hear about it? We have prepared a manuscript to be submitted to PLOS One and we will also present our findings at a relevant public health conference. Key words: Sedentary behaviour, aging, self-rated health, correlates


18 Genomic and bioinformatic interrogation of rare diseases: translating

multi-omic research into clinical progress

Ms Katie Brown AJ McKnight, H McAneney Background

Internationally rare diseases affect approximately 350 million people and 3 million people in the UK alone. Rare diseases pose a significant burden both at the

individual level and for public health, due to the often chronic and fatal nature of

the conditions. In addition, a lack of defined diagnosis and treatment pathways further decreases the patient’s quality of life. The 100,000 genomes project is a UK

based project which is attempting to sequence the genomes of patients with rare diseases and their families, as well as some cancers. This genomics based project is

possible due to the advent of next generation sequencing (NGS) technology. As 80% of these rare diseases have a genetic basis this information will be used to

improve diagnosis, infer prognosis, identify causality and perhaps even identify novel therapeutic approaches. However, a lack of somatic mutations in many

diseases has increased our awareness that the study of genomic variation alone is

insufficient to describe causality in many diseases. Therefore, other ‘omic’ approaches have also been increasing in the study of human disease, including

epigenomics (the study of modifications associated with disease not due to sequence level variation). This study aims to identify multi-omic diagnostic

biomarkers which could be of substantial benefit for individuals affected by rare disease and their healthcare professionals who may be struggling to provide a

diagnosis and therefore treatment.

Method

This project will utilise multi-omic approaches to analyse data from the 100,000 genomes project. A range of renal, respiratory, eye, cardiac, neurological,

dermatological rare diseases will be included in the study. Bioinformatic identification of candidate genes will be followed by whole genome methylation

sequencing, an epigenomic approach, attempting to identify statistically significant differential methylation associated with rare diseases when compared to healthy

controls.

Keywords

Rare diseases, The 100,000 Genomes Project, Genomics, Epigenomics, Multi-omics

19 The economic cost of physical inactivity and sedentary behaviour

Miss Leonie Heron M Tully, F Kee, C O’Neill Background Adults in the United Kingdom are highly inactive and have high levels of sedentary behaviour. Both physical inactivity and sedentary behaviour are independent risk factors for several chronic conditions including cardiovascular disease, diabetes, certain types of cancer, and mental illness. These diseases place a considerable burden on the healthcare service. Economic burden of disease analyses may be critical in providing a financial argument for highlighting the need for a government-wide initiatives to address physical inactivity and sedentary behaviour. The economic cost of physical inactivity in the UK has been previously estimated, but no analysis has been performed for sedentary behaviour. Furthermore, health-behaviour interventions should be routinely analysed for cost-effectiveness in order to identify the most efficient solutions to this public health burden. Methods In the economic burden of disease analysis, the diseases will be identified with physical inactivity or sedentary behaviour as a risk factor, and the number of deaths and disability-adjusted life years (DALYs) which they cause will also be identified. Population attributable fractions (PAFs) will be calculated for each disease and subsequently applied to NHS data to calculate how much physical inactivity and sedentary behaviour cost the NHS. The cost to the wider economy will be estimated either using the friction cost approach (FCA), the human capital approach (HCA), or the value of a statistical life (VSL) approach. Keywords Burden of disease, Cost-effectiveness analysis, physical inactivity, sedentary behaviour, United Kingdom

References Dee, A. et al. (2015) ‘Overweight and obesity on the island of Ireland: an estimation of costs’, BMJ Open, 5(3), pp. e006189–e006189. doi: 10.1136/bmjopen-2014-006189. Ding, D. et al. (2016) ‘The economic burden of physical inactivity: a global analysis of major non-communicable diseases’, The Lancet, 388(10051), pp. 1311–1324. doi: 10.1016/S0140-6736(16)30383-X.


20 Investigating the role of social networks for physical activity and

sedentary behaviour in adolescents: a social network analysis

Ms Shannon Montgomery J Badham, M Donnelly, L Dunne, J Davison, R Hunter Introduction There has been little research investigating the association between peer and individual physical activity behaviour, and the underpinning mechanisms are underexplored. During adolescence, peer influence becomes stronger while parental and familial influence weakens, especially with regard to engagement in health behaviours. Better understanding of how peer social networks are associated with physical activity behaviour and the identification of important network structures and characteristics will help inform the development of socially-activated physical activity behaviour change interventions for adolescents. Therefore, the aim of this study was to investigate the association between physical activity behaviour and peer networks in adolescents. Methods This study involves secondary analysis of a population-wide, cross-sectional survey (Wellbeing in Schools Survey) on health and well-being involving post-primary school pupils (1603 respondents; aged 13-14 years old; 88 schools) in Northern Ireland. A sub-sample of 23 schools with at least 80% complete network data and ranging in demographic characteristics was selected for analysis. Friendships were measured using social network techniques and physical activity was measured using the Physical Activity Questionnaire for Children (PAQ-C). Social network analysis involved network visualisations and deriving network descriptives to investigate network structure and characteristics in relation to socio-demographic characteristics and physical activity behaviour using UCINET6 (version 6.620) software. Logistic regression was conducted to investigate the association between network properties and physical activity behaviour while controlling for key socio-demographic characteristics. Results: Of the 23 schools included in the analysis, 30% were single sex and 83% high socioeconomic status. 17% of the schools were from the most deprived areas. Preliminary results show distinct clustering of participants by gender and an association between network parameters and physical activity levels. Conclusions: Among adolescents of age 13-14 years, there is evidence of an association between friendship ties and physical activity levels, which differs by gender. Future behaviour change interventions for adolescents should consider and utilise these inherent network structures and characteristics within the intervention design and evaluation. Who is this research directed to? : Physical activity researchers interested in intervention design Keywords: social networks, social network analysis, physical activity, adolescents

21 Investigation of retinal measures as a biomarker of chronic kidney

disease in the Northern Ireland Cohort for Longitudinal Ageing

(NICOLA)

Miss Rachael O’Neill G McKay, AP Maxwell Introduction Chronic kidney disease (CKD) is an important public health concern and a major challenge for health care systems, as management and treatment costs continue to grow. CKD is a major risk multiplier in patients with diabetes, hypertension and heart disease, all of which are key causes of death and disability in older people. Microvascular (blood vessels <0.3mm in diameter) damage has been shown to play a major role in the onset and development of CKD. The estimated glomerular filtration rate (eGFR) decreases with ageing and several studies have shown reduced eGFR in association with poorer physical function and activity. Increased CKD prevalence rates in the elderly is an ongoing concern and is likely to increase further as a consequence of ageing populations globally. Retinal screening offers a direct and noninvasive visualisation of microvascular changes. This study will investigate retinal microvascular parameters and renal function to identify any associations with CKD in an ageing population. This may offer future clinical utility for vascular health outcomes through development of appropriate preventive and therapeutic measures and identification of individuals at increased risk of microvascular-associated conditions, particularly with improved accessibility of imaging technologies in public and private health sectors. Methodology We will measure retinal microvascular parameters from digital fundus images and renal function data from the Northern Ireland Cohort for Longitudinal Ageing (NICOLA) which includes approximately 4000 participants aged >50 years. Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE) is a semi-automated computer-assisted program that will measure retinal microvascular parameters (arteriolar and venular calibre, fractal dimension, tortuosity, branching angles) from the retinal

images for statistical comparisons. Serum Creatinine and eGFR associated values will be assessed in the context of CKD definitions (eGFR <60 mL/min/1.73m2). Variation in retinal microvascular parameters will be assessed in the context of renal function and CKD status. Keywords Chronic Kidney Disease, Retinal Imaging, Microvasculature, Retinal Parameters


22 Biomarkers of nutritional well-being in older people

Ms Danielle Logan JV Woodside, G McKenna

Introduction It is vitally important to identify older adults who are failing to meet nutritional

intake guidelines. However, conducting a full nutritional assessment is currently a complex and invasive process. Hence, there is a necessity within the

healthcare system for a non-invasive, timely and cost-effective method

(Yoshizawa et al., 2013). Biomarker analysis may aid nutritional assessment and saliva has been suggested as a potential non-invasive biological fluid which

could be used for the assessment of nutritional biomarkers. Therefore, the project aim is to identify potential nutritional biomarkers in the oral environment

of older adults.

Methods

1. To undertake a systematic review of nutritional biomarkers available within the saliva of older adults. A scoping exercise has been conducted between

May and October 2017, following an initial literature review about the use of saliva in determining oral and systemic diseases and nutritional status.

2. To collect saliva samples from older adults and identify biomarker targets.

Following ethical approval, saliva samples may be collected in the Centre for Dentistry from older adults of varying nutritional and chronic disease states.

Blood samples will also be taken to measure nutritional status. 3. To test commercially available salivary sensors on specific nutritional

biomarker targets relevant to the oral environment of older adults.

Results

At this stage the results are in relation to part one of the methods. The scoping exercise has identified eleven potential salivary biomarkers of nutritional status.

These include four proteins; albumin, ferritin, prealbumin and transferrin, three minerals; calcium, phosphorus, potassium, one enzyme; amylase, two vitamins;

vitamin C and D and total antioxidant capacity. The outcomes of the scoping

exercise will form the basis of a systematic review and they will also help to develop the study design.

Conclusion

The current results identified eleven potential nutritional biomarkers in saliva

which need to be investigated in a systematic review. Further research will be

conducted to see whether nutritional biomarkers are detectable in saliva of

older adults and thus if they can be used to assess nutritional status.

Who this research is directed to and how will they hear about it This research may be of importance to a number of stakeholders within the

healthcare sector involved with nutritional assessment, such as doctors, GPs,

nurses, pharmacists, community practitioners and perhaps dentists. Hence, older adults who are failing to meet nutritional recommendations may benefit,

as nutritional deficiencies may be detected quicker, earlier and non-invasively. Findings will be published in peer reviewed journals and presented at suitable

conferences and events specific to healthcare professionals.

References

Yoshizawa, J.M., Schafer, C.A., Schafer, J.J., Farrell, J.J., Paster, B.J. and Wong, D.T.W. (2013), "Salivary Biomarkers: Toward Future Clinical and Diagnostic

Utilities", Clinical Microbiology Reviews, vol. 26, no. 4, pp. 781-791.

Keywords

Biomarkers, Saliva, Oral health, Well-being, Nutritional status, Older people


23 An Ode to MGUS (Monoclonal gammopathy of undetermined

significance)

Mr Blain Murphy CM McShane, M Donnelly, O Santin, C Treanor, J Quinn, L Gribben, LA Anderson Objectives Living with a premalignant condition can elicit negative psychosocial effects including increased anxiety and fear of progression to cancer. A qualitative study was undertaken to explore patient experiences of monoclonal gammopathy of undermined significance (MGUS), the common precursor to multiple myeloma. Methods Two focus groups and six telephone interviews were conducted with MGUS patients (n=14) identified via local nurse-led haematology telephone clinics. Interviews were transcribed verbatim and the data was subjected to thematic analysis. Results Four key themes emerged: 1) interaction with health services; 2) information; 3) impact on patient’s lives and 4) unmet needs. Patients reported heightened anxiety and worry at diagnosis and follow-up potentially influenced by uncertainty about the condition, lack of information at diagnosis and an absence of social support. Ongoing surveillance was viewed as beneficial but “scary”. Nurse-led telephone clinics were universally praised by patients for removing the clinical environment, which some perceived as a “cancer place”, and were considered more convenient in terms of time and travel. Conclusions MGUS patients may experience heightened anxiety and worry at diagnosis and follow-up. Improving doctor-patient communication, providing written information and implementing telephone clinics could help patients living with MGUS.

Impact This research is relevant to individuals with MGUS and healthcare professionals who deal with MGUS on a daily basis (haematology consultants/clinicians, nurses and general practitioners). Keywords Monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma, quality of life, qualitative, precancer, patient experience.

An Ode to MGUS (Monoclonal gammopathy of

undetermined significance) By Blain Murphy

MGUS, the blood condition

Is part of the addition Of M-Protein to the blood

Which hits you with a thud!

Your lack of knowledge leaves you clueless Your future is now hueless

The diagnosis was opportunist But is your worry foolish?

You fear the nurses answer When you ask if it is cancer? When you tell your friends

What is the dividend?

For there is no equivalence Of monoclonal gammopathy of undetermined significance


24 Accuracy of medical screeners versus non-medical screeners for

diagnosing diabetic eye disease in Vietnam

Ms Katie Mohan N Congdon, T Peto, L Lohfeld

Background

Diabetes mellitus (DM) is a global epidemic, affecting 415 million people and is expected to rise to 642 million by 2040. (1) One of the most common

microvascular complications of DM is diabetic eye disease (DR) (2,3). If left

untreated, DR can lead to visual impairment and is now the leading cause of blindness among the working population. (2) Previously, diabetes was

considered a disease of the affluent, however, due to cultural and economic transitions, there has been a steady increase in the number of people with

diabetes in both developed and developing countries. (4,5). In the world today approximately 70% of DM is in low and middle income countries and there has

been a 64% increase in blindness from DR between 1990 and 2010, virtually all

of which was due to rising rates in developing countries. Diabetic screening programs operate worldwide and early detection through these screening

programs is vital to prevent sight threatening complications (4,6). Sight loss can have severe implications on peoples social, physical and mental well-being and

screening for DR together with appropriate treatment can ensure that good

quality of life is maintained.(7–9) Screening programs have shown to be clinically effective and the NHS Diabetic Eye Screening Program in the UK is

considered to be the gold standard.

Methods Consecutive patients diagnosed with type 1 or type 2 diabetes and undergoing

evaluation for possible diabetic eye disease at Ho Chi Minh City Eye Hospital will

be examined. Trained staff from Northern Ireland (NI) will deliver training to graders in Vietnam and experienced non-medical graders in NI will grade all

retinal images serving as a reference standard. Sensitivity and specificity (with 95% confidence intervals), positive and negative predictive values, area under

the receiving operating characteristic (ROC) curve and kappa statistic will be

used to compare the accuracy of ophthalmologists, optometrists and non-medical graders from Vietnam with the reference standard.

Significance of this Research

Integrating a diabetic screening program in Vietnam which is highly efficient

and cost effective may reduce the workload for ophthalmologists, allowing them to focus on delivering treatment. It will potentially allow patients to have

greater access to screening appointments and may subsequently reduce the incidence and prevent the progression of sight threating diabetic eye disease.

This project has the potential to transform the delivery of diabetic eye screening

programs in Vietnam and other LMIC settings. The use of non-medical graders is particularly important in low resource settings where there are limited

medically trained professionals.

Keywords Diabetes mellitus; Diabetic Eye Disease; Visual impairment; Diabetic Screening

Programs; Medical graders; Non-medical graders

Bibliography 1. International Diabetes Federation (IDF). IDF Diabetes Atlas 7th edition

[Internet]. idf.org. 2015. Available from: http://www.diabetesatlas.org/ 2. Graham-Rowe E, Lorencatto F, Lawrenson JG, Burr J, Grimshaw JM, Ivers NM, et

al. Barriers and enablers to diabetic retinopathy screening attendance: Protocol for a systematic review. Syst Rev [Internet]. 2016;5(1):134. Available from: http://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0309-2

3. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet [Internet]. 2010;376(9735):124–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20580421

4. Khue NT. Diabetes in Vietnam. Vol. 81, Annals of Global Health. 2015. p. 870–3. 5. Congdon N, Zheng Y, He M. The worldwide epidemic of diabetic retinopathy.

Indian J Ophthalmol [Internet]. 2012;60(5):428. Available from: http://www.ijo.in/text.asp?2012/60/5/428/100542

6. Echouffo-Tcheugui JB, Ali MK, Roglic G, Hayward RA, Narayan KM. Screening intervals for diabetic retinopathy and incidence of visual loss: A systematic review. Diabet Med. 2013;30(11):1272–92.

7. Peto T, Tadros C. Screening for diabetic retinopathy and diabetic macular edema in the united kingdom. Curr Diab Rep. 2012;12(4):338–45.

8. Ahola AJ, Saraheimo M, Forsblom C, Hietala K, Sintonen H, Groop P-H. Health-related quality of life in patients with type 1 diabetes--association with diabetic complications (the FinnDiane Study). Nephrol Dial Transplant. 2010;25(6):1903–8.

9. Davidov E, Breitscheidel L, Clouth J, Reips M, Happich M. Diabetic retinopathy and health-related quality of life. Graefe’s Arch Clin Exp Ophthalmol. 2009;247(2):267–72.


25 The impact of oral health status on food choice amongst the older

adult population

Ms Leigh-Ann McCrum S Watson, L McGowan, J Woodside, G McKenna

Introduction

Links between poor oral health status and a reduced nutritional status are well established amongst the older adult population (65 years+). This may be

because there is an increased risk of nutritionally-dense foods including fruit,

vegetables or fibre-based foods being avoided due to the reduced biting and chewing performance that is associated with a poor dentition status. Qualitative

research exploring the impact of oral health/dentition status on food choice and consuming a healthy balanced diet is severely lacking amongst older adults.

Consequently, there is an evident need to investigate the role of oral health alongside other factors that influence food choice amongst the older adult

population.

Method

Focus groups (n=4) with community-dwelling older adults were conducted with 8 men and 13 women with a mean age of 72 years (ranging between 65-84

years). Participants were asked about the main factors that influence their food

choice, whether or not they feel their food choices had changed over the past 10/20 years and a number of questions relating to eating a healthy diet. Focus

groups were recorded and transcribed verbatim. These transcripts were then analysed using thematic analysis.

Results

Whilst not all participants reported to have mastication difficulties due to tooth

loss, for those that did, 3 key themes emerged around the role of oral health status on food choice; the dental practice, avoided food due to oral health

status and coping strategies for avoided food. Other factors that strongly influenced food choice among participants included social influences, physical

health, health information, support and cognition and product-based reasons.

Regarding the dental practice, participants primarily discussed both their positive and negative experiences with the dentist and their current oral health

status such as whether they were dentate, partially dentate or edentate. Avoided foods among those that were either partially dentate or edentate

included specific hard to bite or difficult to tare foods such as apples, corn on

the cob or raw vegetables. Nuts and seeds-based products were often too hard

for participants to eat and had a tendency to become lodged. Certain meats

(particularly steak and bacon) proved to be too tough for participant’s to eat as well. Comping strategies for foods that had to be avoided due to their reduced

dentition status included softening foods by cooking and/or changing texture, altering food particle size e.g by chopping, mincing, or grating, moving to other

side of mouth or by food substitution e.g opting for softer fruit and more tender

meats. Additional coping mechanisms included simple denture care such as rinsing mouth after food consumption, approaching certain food with caution

and by making modifications to how food is chewed.

Conclusion This qualitative research demonstrates that poor dentition status may be

considered a barrier for food choice and consuming a healthy balanced diet

within this sample of older adults. Further research is needed to explore if these findings are consistent with the wider older adult population.

Who is this research being directed to?

Clinical practice, dentists, those working within the public health sector, older

adults

Keywords older adults; oral health; dentition status; food choice; nutritional status.


26 Can Ireland’s colorectal screening programme save more lives, save

money and live within existing colonoscopy capacity limits? Findings

from the MISCAN micro-simulation model

Ms Ethna McFerran JF O’Mahony, F Kee

Background Ireland’s colorectal cancer screening programme, ‘BowelScreen,’ currently offers

biennial faecal immunochemical testing (FIT) for 60-69 year-olds, using a test

positivity cut-off of 225ng/ml of haemoglobin. FIT can be adjusted by varying positivity cut-off which alters the screening sensitivity and specificity. The

choice of FIT has implications for the number of cancers detected and the colonoscopy capacity required for screening triage and subsequent surveillance.

Existing literature indicates that screening programmes using a lower cut-off of 50ng/ml would cost less and be more effective, but may require more

colonoscopy capacity for positive screen findings. Ireland’s current colonoscopy

capacity has been a binding constraint on ‘BowelScreen’ and the current screening age range is shorter than initially planned due to this limitation. The

objective of this study was to determine if a more effective, less costly screening strategy exists within BowelScreen’s current colonoscopy capacity by

considering alternative FIT cut-off levels.

Methods

The MISCAN cancer screening model was used to simulate 144 strategies varying screening intervals, age ranges and FIT cut-offs. Outputs estimated net

costs, quality-adjusted life-years (QALYs) and number of colonoscopies required.

Results A combination of reduction in FIT cut-off to 50ng Hb/ml, extending the

screening interval to 3 years and reducing the start age to 55, saves 20% more QALYs, reduces costs by 7%, and yields a 17% reduction in colonoscopy

requirements.

Conclusion

Simple changes to Bowel-Screen could save lives, reduce costs and relieve pressure on colonoscopy capacity. The extent of the potential improvements

depends in part on the acceptability of lengthening the screening interval.

27 Evaluation of novel early renal indicators in diabetes

Miss Jinnan Zang GJ McKay, DA Simpson, AP Maxwell Background Diabetes is a major global health concern and those with the condition are at increased risk of developing microvascular complications such as diabetic kidney disease (DKD). DKD is the most common cause of end stage renal disease and early detection is critical for improved clinical management. Diagnosis of DKD with current biomarkers is problematic and earlier identification would offer improved clinical utility. Renal impairment is difficult to visualise non-invasively so we sought to identify early biomarkers of DKD in urine, which in essence reflects a liquid biopsy. MicroRNAs (miRNAs) are single-stranded RNA molecules, which are important post-transcriptional regulators of gene expression in many chronic conditions. miRNAs are relatively stable and quantifiable in urinary exosomes, offering potential as biomarkers for early diagnosis and identification of disease pathways. Methods We conducted a pilot case-control study to identify miRNAs associated with DKD from urine samples collected from 11 age and gender matched samples. Cases had type 2 diabetes (T2D), an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 and proteinuria. Controls had T2D, eGFR > 60 ml/min/1.73m2 and no proteinuria. Customised panels (Exiqon) evaluated 87 miRNA expression profiles previously reported in urine. Results We identified 2 miRNAs that had the lowest degree of variation and highest stability values to enable sample normalisation (200b-3p and 20a-5p) and control for the amount of RNA extracted. We identified 5 miRNAs significantly higher (p<0.05; 21-5p, 24-3p, 30e-5p, 126-3p and 378a-3p) and 1 miRNA (125b-5p) significantly lower in those with DKD. Conclusion The results from this pilot study suggest urinary exosome miRNA profiling may identify potential indicators of DKD. Candidate miRNAs are currently undergoing replication and validation within a larger cohort. Who in particular is this research being directed at and how will you ensure they hear about it: The data generated will explore the clinical utility of novel biomarker discovery for the early identification and risk stratification of DKD. Results will be published in peer review journals and presented at suitable public health fora to inform the evidence base for targeting miRNAs as biomarkers for the early diagnosis of DKD Keywords Biomarkers, diabetic kidney disease, microRNA, urine, exosomes


28 Alcohol consumption amongst the over 50 population of Northern

Ireland: initial NICOLA findings

Miss Hannah McKenna M Donnelly, DPJ O’Reilly

Introduction Alcohol misuse is a threat to older adult health and quality of life. Large representative aging studies such as The English Longitudinal Study of Aging (ELSA) and The Irish Longitudinal Study on Aging (TILDA) have measured alcohol consumption. My work presents the first estimates for the Northern Irish population based on initial Wave 1 (cross-sectional) analyses from The Northern Irish Cohort for the Longitudinal Study of Aging (NICOLA), describing the prevalence and nature of alcohol consumption among people aged 50 and older. Method Simple random selection from a health-card registration database identified 8500 non-institutionalised respondents aged ≥50. A beverage-specific quantity-frequency self-report questionnaire measured alcohol intake. NICOLA participants were categorised as alcohol abstainers, non-hazardous drinkers (1-14 units/week) and hazardous drinkers (˃14 units/week) according to UK guidelines (see poster). Results 3148 (38.2%) of respondents reported being alcohol abstinent. 3570 (43.3%) disclosed non-hazardous alcohol intake at ≤14 units weekly. 1529 (18.5%) of NICOLA participants reported hazardous alcohol consumption, over 14 units weekly. Hazardous alcohol consumption was highest for those aged 50-64 (23.8%), compared to 16.6% (65-74) and 6.7% (≥75 years). 27.7% of male respondents drank over 14 units weekly compared to 10.4% of women. Hazardous drinking was higher for the employed category (23.7%) over retired (14.7%) or economically inactive (19.4%), and for those reporting tertiary (22.4%) and secondary (19.2%) educational attainment over primary (12.5%) or no educational attainment (12.6%). Conclusion Alcohol misuse is a challenge for policy makers due to our ‘aging’ population. Indeed, publications addressing recent governmental policy changes acknowledged that there may be no suitable level of alcohol consumption for older adults due to the aging process, medication interactions and life events such as bereavement or retirement from work. These findings are comparable with those reported by TILDA and ELSA. Who in particular is this research being directed to? The data provides a basis for informing appropriately targeted public health programmes and responses within Northern Ireland. Keywords older adults, Northern Ireland, alcohol consumption, hazardous drinking.

29 Factors affecting dietary change and micronutrient bioavailability in

older patients: impact of oral health status

Ms Sara (Meg) Wallace JV Woodside, G McKenna Introduction Amongst older patients eating habits and nutritional status are of huge importance, as poor-quality diets have been implicated in the development of a number of systemic diseases, including cardiovascular disease. Nutritional intake and status is influenced by a variety of factors, including socio-economic status, income, education and oral health status. As natural teeth are lost, older patients often develop eating habits based around softer, more manageable foods, which are often lacking in essential vitamins, minerals and fibre. Nutrients consumed within the diet differ in their bioavailability. Understanding nutrient bioavailability helps optimise diets and set appropriate dietary and nutrient recommendations. The first step in making a nutrient bioavailable is to liberate it from the food matrix and turn it into a chemical form that can bind to and enter the gut cells or pass between them. Nutrients are rendered bioavailable by the processes of chewing (mastication)and the initial enzymatic digestion of the food in the mouth. However, no previous research has investigated the links between oral health status (including numbers of remaining natural teeth), chewing ability and nutrient bioavailability. Methods Data from the NICOLA study, a longitudinal cohort of ageing with large amounts of data collected on dietary intake, will be used to examine factors affecting diet in older people, including oral health. Data from an ongoing study of advice to promote dietary change to a Mediterranean diet in already existing community groups will be used to examine factors associated with ability to change diet and consumption of certain foods, including oral health. In partially and fully edentate older patients, and comparing to younger patients were possible, the relationship between oral health status, chewing ability and nutrient bioavailability for a range of foods will be examined. Who is it directed to This research is directed to a variety of stakeholders; older adults themselves who should be equipped with the information and resources necessary to live and eat healthily, health professionals including pharmacists, GPs and dentists who should be aware of the factors that may affect nutritional status in this age group and how it can be optimised, as well as the family members and other support networks utilised by older adults, who need to be made aware of the signs of poor nutritional status and the resources available to help prevent this. This research could be used to better develop and inform dietary interventions for this age group, dietary recommendations, and educational material. Key Words Nutrition; Ageing; Nutrient bioavailability; Dietary change; Oral health; Older adults


30 Economic burden of colorectal cancer across Europe: a population-

based cost analysis

Mr Raymond Henderson D French, R Sullivan, M Lawler Introduction Our objective is to determine the 2015 annual economic impact of colorectal cancer (CRC) for the 28 countries in the European Union, Iceland, Norway, Serbia, Switzerland, and Turkey (hereafter referred to as the 33 European countries). In 2009, the healthcare cost of CRC for the 27-member countries of the European Union (EU-27) was over €5.5 billion, constituting 0.4% of total health care expenditures, the cost of which increases to over €13 billion when aggregated with the macroeconomic effects of mortality, morbidity, and informal care costs. Representing 165,301 deaths (11.2% of all cancer deaths) in 2015 across the 33 European countries, CRC is a considerable health burden. Methods CRC-related costs were assessed for the 33 European countries. Aggregate financial data on healthcare resource use, mortality, morbidity and informal care costs were derived from international and national sources, and used to assess country-specific CRC expenditure. CRC health care costs were assessed from financial data on primary, outpatient, emergency, and inpatient care, as well as pharmaceuticals. Costs associated with CRC for informal care, and lost income due to morbidity and loss of life, were also assessed. Countries were examined for variances in CRC-related health care costs both per case and per capita. These dependent variables were plotted against the following independent variables by using ordinary least squares (OLS) univariate and multivariate regression analyses: gross domestic product (GDP/capita), total health care expenditure (THE/capita), WHO’s healthcare system ranking (HSR) index, CRC incidence (crude rate), CRC mortality, CRC-specific disability-adjusted-life-years) (DALYs/100,000), and mortality-to-incidence ratio (MIR). The p-value of an explanatory variable was deemed significant if <0.05. Results In 2015 the economic impact of CRC cost the 33 European countries €16.4 billion, with €7.2 billion (44%) attributed to healthcare resource use. The healthcare costs of CRC were approximately €12 per citizen, diverging significantly from €2 per person in Cyprus to €37 per person in Austria. Productivity losses due to loss of life cost €3.7 billion (22%), lost working days due to illness costs €3.4 billion (21%), and informal care cost €2.1 billion (13%). The results of the OLS regression showed a strong positive correlation between CRC-related healthcare costs and GDP (CRC costs/capita, p<0·001 and CRC costs/case, p<0·001), THE (CRC costs/capita, p<0.001 and CRC costs/case, p<0.01), and WHO's HSR index (CRC costs/case, p<0.05). Results of the multivariate regression predicted a €0.66 increase in CRC costs/case for every €1 increase in GDP/capita (purchasing power parity adjusted). Discussion Comparing the EU-27 of 2009 to the EU-27 of 2015 there has been a €1.8 billion increase to €14.9 billion in the economic burden of CRC. Primary care, A&E care, pharmaceuticals and morbidity have increased in cost, while outpatient care, hospital care, mortality, and informal care have decreased. The largest changes are a €1.9 billion increase in morbidity costs, a €1.3 billion increase in

pharmaceutical expenditure, and a €0.9 billion decrease in informal care costs. It is likely that more expensive targeted therapies are extending lifespan of CRC patients, reducing toxicity, thereby producing less adverse effects, possibly decreasing the need for informal care, but this would require further investigation. These results will add significant policy and public health intelligence for implementing value-based CRC care and prioritizing the distribution of public research funds. Who in particular is this research being directed? This study will have an impact with CRC policymakers, CRC public health makers, and help allocate CRC research funding. Academic dissemination will occur through publication in high-impact journals and attendance at conferences Keywords: Colorectal cancer; cost of illness; Europe


31 Youth conflict-related trauma through generations: an ethnography on

the relationship between health and society in post-conflict Northern

Ireland.

Ms Chiara Magliacane E Chatzipanagiotidou, F Magowan Background This project aims to analyse the relationship between the post-conflict Northern Irish environment and youth trauma in deprived areas. Using an anthropological perspective and methodology, the study wants to investigate the possible contribution that a socio-cultural perspective can give to the current research on the field, with a special focus on the role of transgenerational trauma. The recognition of the role that socio-economic determinants have on health is usually a challenge for social researchers. In post-conflict Northern Ireland, the overall lack of research about connections between the social context and youth trauma opens the way to the present project. Anthropological studies on social implications of mental disorders have achieved impressive results in many societies; they show how conditions of sufferance and poverty are not intrinsically given, but are the products of historical processes and events (Farmer 2003: 130). The continuum of violence (Scheper-Hughes and Bourgois 2004) and the politics of victimhood (Fassin and Rechtman 2009) sustains a culture of silence and fear in deprived areas (Taussig 2004); this implies the need of investigating the structural and symbolic violence (Farmer 2004; Bourdieu and Wacquant 2004) that lies behind the diffusion of mental suffering. The project would refer to these concepts from Medical Anthropology in order to look at connections between trauma and social, political and economic structures. Accordingly, the study will consider factors such as poverty, unemployment, social inequality and gender and class perspectives. At the same time, the project will problematise categories such as youth and trauma. 'Trauma' is currently debated within the social sciences since the 'invention' of the Post-Traumatic Stress Disorder (PTSD) in 1980 (Summerfield, 2001). Current critics made to its clinical conception (Good, DelVecchio-Good and Grayman 2015; Young 1995) show how trauma has been mainly analysed as a memory of the past. On the contrary, medical anthropological research focuses on wider perspectives on society and its structures; this would be a new and original approach to the study of youth trauma considering that, at this stage, there is no research of this kind regarding Northern Ireland. Methods Qualitative interviews, participant observation. Expected Impact: Local Northern Ireland organizations, i.e. specific charities that provide mental health support. Ongoing and present connections will ensure they will hear about this research. Keywords: Trauma, youth, post-conflict, Northern Ireland, structural violence, PTSD, health inequalities, violence, social inequalities.

32 Effect of a peer support intervention to encourage adoption and

maintenance of a Mediterranean diet in established community

groups: a cluster randomised trial

Dr Roisin O’Neill L McGowan, CT McEvoy, F Kee, CC Patterson, ME Cupples, MC McKinley, JV Woodside Introduction Peer support offers a potential alternative, low cost social support approach to encouraging lifestyle behaviour change. Research suggests that leveraging existing social networks in established groups can enhance the effectiveness of peer support strategies and further encourage behaviour change. This study is an extension of the Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED); its aim is to explore the effect of the PS intervention when compared to a minimal education intervention in already established community groups. Methods Recruited groups were randomised to receive either a PS intervention or a minimal MD intervention of education materials (control). Peer supporters were trained to deliver the intervention; this consisted of 11 group-based sessions delivered over 12 months. Control groups were provided with written educational literature focusing on the MD. Outcomes were assessed at baseline, 3, 6 and 12 months. The primary outcome assessed change in habitual Mediterranean Diet Score (MDS) at 6 months from baseline (adoption). Results N=2 groups were randomised to the PS intervention and n=2 to the minimal education intervention, with n=8 participants per group. At 6 months, MDS increased by 2.6±2.7 in the PS intervention and 3.3±2.2 in the education group, from baseline; the between group difference was non-significant after adjusting for baseline scores (-0.9 (95%CI -

2.9, 1.2)) (p=0.39). Conclusion Both the PS and Education groups increased MDS scores at 6 months. Exploration of qualitative and quantitative data will help us to evaluate these findings further. This will inform a future large-scale RCT where the efficacy and cost-effectiveness of the peer support MD intervention will be tested. Keywords: Peer Support; Mediterranean diet; Behaviour Change; Intervention


33 Stroke prevention rehabilitation intervention trial of exercise (SPRITE)

- a randomised feasibility study

Dr Neil Heron F Kee, J Mant, ME Cupples, M Tully, M Donnelly Background

The value of cardiac rehabilitation (CR) after a transient ischaemic attack (TIA) or minor stroke is untested despite these conditions sharing similar pathology

and risk factors to coronary heart disease. We aimed to evaluate the feasibility

of conducting a trial of an adapted home-based CR programme (‘The Healthy Brain Rehabilitation Manual’) for patients following a TIA/minor stroke, including

eliciting participants’ views about the programme and identifying the key behaviour change techniques (BCTs).

Methods

Clinicians were asked to identify patients attending the Ulster Hospital, Belfast

within 4 weeks of a first TIA or minor stroke. Those who agreed to participate underwent assessments of physical fitness, cardiovascular risk, quality of life

and mental health, before random allocation to: Group (1) standard/usual care; (2) rehabilitation manual or (3) manual plus pedometer. The intervention, ‘The

Healthy Brain Rehabilitation Manual’, was developed following the MRC

guidelines for developing complex health service interventions, including undertaking 2 systematic reviews of the literature and a qualitative appraisal

with service users, including patients, carers, health professionals and academics.

All study participants received telephone support at 1 and 4 weeks,

reassessment at 6 weeks and an invitation to a focus group exploring views

regarding the study. Two trained review authors independently assessed the manual to identify the BCTs used.

Results

Approximately 54% (15/28) (10 men, 5 women; 9 TIA, 6 minor stroke; mean

age 69 years) consented and completed the study. Mean time to enrolment from TIA/stroke was 20.5 days. Participants completed all assessment measures

except VO2max testing, which all declined. The manual and telephone contact were viewed positively as credible sources of advice. Pedometers were valued

highly, particularly for goal-setting. Overall, 36 individual BCTs were used - the

commonest BCTs were centred around setting goals and planning as well as

social support.

Conclusion

Recruitment and retention rates suggest that a trial to evaluate the effectiveness of a novel home-based CR programme, implemented within 4

weeks of a first TIA/minor stroke is feasible. The commonest BCTs used within

the manual revolve around goals, planning and social support, in keeping with UK national guidelines. The findings from this feasibility work have been used to

further refine the programme and inform the design of a pilot study, which is currently ongoing. The pilot study is assessing how best to deliver the

intervention, GP-delivery versus stroke nurse delivery and the pilot study results will be available in early 2018.

Target audience: Care of the elderly medical staff, General Practitioners, public health workers, sport and exercise medicine and rehabilitation medical

staff, charities working in cardiovascular/stroke disorders, policy makers.

Keywords: TIA, minor stroke, secondary cardiovascular prevention, cardiac

rehabilitation, SPRITE, ‘The Healthy Brain Rehabilitation Manual’, ‘The Heart Manual’.

Related publications

June, 2015 Heron, N; Kee, F; Donnelly, M; Cupples, ME. Systematic review of rehabilitation programmes

initiated within 90 days of a transient ischaemic attack or ‘minor’ stroke: a protocol. BMJ Open, 2015; 5: e007849. doi:10.1136/bmjopen-2015- 007849.

November, 2015. Heron, N; Kee, F; Tully, MA; Donnelly, M; Cupples, ME. Systematic review of the use of behaviour change techniques (BCTs) in home-based cardiac rehabilitation programmes for patients with cardiovascular disease – protocol. Systematic reviews. 2015, 4:164. DOI: 10.1186/s13643-015-0149-5. URL:

http://www.systematicreviewsjournal.com/content/4/1/164 May, 2016 Heron, N; Kee, F; Cardwell, C; Tully, MA; Donnelly, M; Cupples, ME. Behaviour change techniques in

home-based cardiac rehabilitation programmes for patients with cardiovascular disease: systematic review.

British Journal of General Practice (BJGP), 2016 Oct;66(651):e747-57. doi: 10.3399/bjgp16X686617. Epub 2016 Aug 1. September, 2016 Cupples, ME; Heron, N. What to do after cardiac rehabilitation programs: the role of the general

practitioner in cardiovascular prevention. Monaldi Archives for Chest Disease, Cardiac Series 2016; volume 86; 755.

December, 2016 Heron N, Kee F, Cardwell C, Tully MA, Donnelly M, Cupples ME. Secondary prevention lifestyle interventions initiated within 90 days after TIA or 'minor' stroke: a systematic review and meta-analysis of rehabilitation programmes. British Journal of General Practice. 2016 Dec 5. pii: bjgpjan-2017-67-654-heron-fl-oa-p.

December, 2016 Heron, N. Optimising secondary prevention in the acute period following a TIA of ischaemic origin. BMJ Open Sport & Exercise Medicine Jan 2017, 2 (1) e000161; DOI: 10.1136/bmjsem-2016-000161

November, 2017 Heron, N; Kee, F; Mant, J; Tully, MA; Reilly, P; Cupples, ME; Donnelly, M. Stroke Prevention

Rehabilitation Intervention Trial of Exercise (SPRITE) - A Randomised Feasibility Study. Provisionally accepted for publication in BMC Cardiovascular Disorders, Nov, 2017.

http://www.systematicreviewsjournal.com/content/4/1/164

http://bmjopensem.bmj.com/content/2/1/e000161

http://bmjopensem.bmj.com/content/2/1/e000161


34 Using theory and knowledge synthesis to improve approaches to reduce

loneliness and social isolation

Ms Olujoke Afolashade Fakoya N McCorry, M Donnelly

Background

Loneliness and social isolation are among the most significant public health issues facing our ageing society. They can impact considerably on an

individual’s quality of life and their utilisation of health and social services1,2.

Loneliness is part of the human condition that affects all ages though older people are more vulnerable to experiencing loneliness3 - 10% of adults over the

age of 65 in the United Kingdom living in a chronic state of loneliness4. Circumstances and events such as geographical mobility and reduced inter-

generational living along with cultural and psychological factors influence loneliness4. Age UK (2015) identified a lack of evidence underpinning existing

interventions and approaches to loneliness and social isolation. Service

providers are under increasing demand to provide initiatives to tackle loneliness, even in the absence of empirical evidence to support their innovation. There is

a need to close the gap between our understanding about what constitutes a ‘loneliness intervention’ in the academic literature and the delivery of

interventions.

Aims

To use realist principles to synthesise and evaluate interventions designed to reduce loneliness and social isolation. This analytical task will endeavour to

uncover which aspects of given interventions worked, for whom, and in what circumstances. The synthesis may be used to provide evidence-based

1 Age UK, 2011. Loneliness and Isolation: Evidence Review. [pdf] Available at: <https://www.ageuk.org.uk/documents/en-gb/for-professionals/evidence_review_loneliness_and_isolation.pdf?dtrk=true> [Accessed 15 November 2017]. 2 NHS National Institute for Health Research. Interventions for loneliness and social isolation. [pdf] Available at: <https://www.york.ac.uk/media/crd/Loneliness%20and%20social%20isolation.pdf> [Accessed 15 November 2017]. 3 Bernard, S., 2013. Loneliness and social isolation among older people in North Yorkshire. [pdf] Available at: <https://www.york.ac.uk/inst/spru/research/pdf/lonely.pdf> [Accessed 15 November 2017]. 4 Age UK, 2017. Later life in the United Kingdom. [pdf] Available at: <https://www.ageuk.org.uk/Documents/EN-GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true> [Accessed 15 November 2017.

recommendations regarding ways in which loneliness interventions could be

improved.

Methods

To conduct a review of reviews of interventions aimed at reducing loneliness and/or social isolation and to identify the categories by which these

interventions have been grouped and the rationale for these categories. This

information will be used to identify the parameters for a realist review. The realist review will include constructing programme theories, gathering evidence

and configuring elements of theory and evidence together in CMO (Context, Mechanism and Outcome) configurations. The results from the realist review

will be applied to existing services using an evidence-based approach to improve the quality of the interventions.

Results An analysis of how loneliness interventions are categorised will be produced.

The realist review will produce an evidence-based programme theory which will identify how given interventions or programmes are working, and in which

circumstances and contexts.

Conclusion

This research will help to identify gaps in current interventions aimed at reducing loneliness and social isolation. Consequently, the results may help to

improve the service provision and delivery of these interventions and, ultimately, improve the psychological and physical health and well-being of

older people.


35 A multi-state Markov model integrating socioeconomic status and

health-related determinants to estimate recovery from functional

disability

Ms Lina Wang F Kee, V O’Neill

Aims and Purpose The aim of this research is to develop a multi-state model which will combine

both socioeconomic and behavioural risk factors, in order to establish the key

covariates driving the sojourn time in and recovery from functional disability.

Background As the population ages, policy makers need to learn more about the

determinants of healthy aging, but most cross sectional surveys provide a poor basis for this. Longitudinal studies provide the only means for studying the

processes of individual life course development and dynamics, and the effects

of earlier characteristics and exposures on later outcomes. This research is particularly acute in Northern Ireland, as the province currently has the highest

disability claimant rates in the UK (DSDNI, 2013).

Data

Cross-national comparisons will be made by making use of longitudinal data on ageing research studies.

Methods

Multi-state models are often used to model the flow of movement of individuals through various health states. By combining multi-state models with causal

inference methods we will extend these transition estimates to population

average effects, crucially allowing the assessment of the effect of hypothetical interventions on the population. As such, the research findings will aid

organisations, health care service providers and government to be more readily able to anticipate and be responsive to the changing populations needs.

36 The musculoskeletal consequences of latissmus dorsi breast

reconstruction in women following mastectomy for breast cancer

Dr Nicole Blackburn JG McVeigh, EM McCaughan, RD Kennedy, SA McIntosh, Wilson IM Introduction Current evidence suggests that patients who have latissimus dorsi (LD) breast reconstruction following mastectomy for breast cancer can experience long-term decreased shoulder movement and decreased shoulder strength. However, as there is no standardised assessment or follow-up period within the literature, findings are conflicting. This research aimed to investigate the impact on daily living of LD breast reconstruction in women following mastectomy for breast cancer. Methods Both qualitative and quantitative methods of enquiry were used. A focus group study explored the musculoskeletal consequences of breast reconstruction using the LD muscle as perceived by the women (n=15) and their healthcare professionals (n=11). Dyad interviews were also conducted in order to determine the impact of surgery on function and activities of daily living (ADL) from the woman’s perspective and that of her significant other (n=8). A questionnaire survey was administered to all women in Northern Ireland who had undergone LD breast reconstruction within a 15 year period (n=159). In order to determine both the physical and psychosocial impact of LD breast reconstruction, a range of outcome measures were included in order to evaluate respondents’ pain, function, quality of life (QoL) and psychological status. Results The qualitative studies highlighted a lack of preparedness and unrealistic expectations regarding functional recovery among women and their significant others’. Post-surgery it was apparent that women weighed up reduced shoulder function against survival, demonstrating resilience in their approach to coping with this adaptive way of living. The healthcare professionals had different levels of awareness of the musculoskeletal impact of surgery, with inconsistencies in the support provided between sites apparent across studies. The survey identified low to moderate effect on the outcomes assessed among the women (n=159), however, node removal significantly impacted certain aspects of QoL (p<0.05) and disability (p=0.04). Conclusions and Implications Breast reconstruction using the LD had an impact on shoulder function and some ADL, which impacted not only on the women but also family and significant others. The functional impact was greater in the immediate postoperative period with the severity varying among patients. However, patients demonstrated resilience in how they coped with the impact of surgery and the findings of this research indicate that most women return to their normal activities; albeit in a different way. This work identified that women and their significant other require further information to clarify expectation regarding recovery. The work has also highlighted the changing priorities of women throughout their journey from diagnosis into long-term recovery.


37 Why is work-limiting disability in Northern Ireland so high?

Ms Anne Devlin D McVicar, D French

Introduction Northern Ireland has historically high levels of economic inactivity compared to

the other UK constituent countries. The biggest component of which is inactivity on the grounds of illness or disability. Economic inactivity is consistently

included within the Stormont Executive’s Programme for Government (PfG) as

an area which should be targeted for improvement. Northern Ireland also has significantly higher rates of disability related benefit claiming. The Employment

Support Allowance and Incapacity Benefit claimant rate in Northern Ireland is nearly double that of the rate in England. And significantly greater than

Scotland and Wales as well. These disability rates do not correlate with regional health outcomes across the UK.

As such, increasing our knowledge base on the determinants of inactivity, in this case on the grounds of disability, is imperative so that policymakers can

make informed decisions as they try to meet PfG targets for decreasing economic inactivity.

Method This study will be the first to examine work disability in NI and is possible

because of the data available from the first wave of the NICOLA (Northern Ireland Cohort of Longitudinal Aging) study. This study will compare those who

are work disabled in NI with those in England using the ELSA survey. We initially use an ordinary least squares (OLS) regression with work-limiting

disability as the dependent variable, it is these results which are presented

below.

Given the issues associated with using self-reported health measures we plan to carry out an instrumental variable model using objective health measures to

solve for possible endogeneity. We also intend to included local labour factors

within our model to account for the effect it can have on disability rates.

Results Initial results from the OLS regression with work-limiting on the left hand side

find a statistically significant Northern Ireland dummy of 0.07 when we control

for age and education we find this increase which we would expect given a

younger and better educated sample in Northern Ireland. When we include self-

reported health in our regression model the Northern Ireland coefficient falls to 0.035 and falls again to 0.028 when we include a variable that measures

whether or not the respondent has visited the GP in the last 4 weeks. This GP measure is used in the absence of subjective health measures. Interestingly,

using activity limited disability as the dependant variable gives much larger

coefficients. Running the same regression as before the NI differential is 0.28.

Conclusion These preliminary results would suggest one of two things 1) health is indeed

worse in Northern Ireland, although existing data on health outcomes would suggest this is not true or 2) the results are biased downwards by endogeneity

and something else we have not accounted for is determining the rates of work-

disability in Northern Ireland. For more conducive findings we need to include objective health measures and local labour market factors, given the literature

which points to the strength of the labour market affecting disability rates.

Audience

This work is designed to be policy relevant and is aimed at those policymakers who work in areas such as economic inactivity.

Keywords

Disability; work; ageing; health; disability benefits, Northern Ireland.


38 Cousin marriage and the mental health of progeny: a population-wide

data-linkage study

Dr Aideen Maguire F Tseliou, DPJ O’Reilly Introduction Consanguineous marriage (marriage between second cousin or first cousin relatives) is common throughout the world, with approximately 1 in 10 children worldwide the progeny of consanguineous parents, despite concerns over the genetic implications of such a partnership. The literature on consanguinity and the impact this has on the mental health of children is scarce, even though many of the factors associated with consanguineous unions are also associated with mental health outcomes. This study aimed to determine if children of consanguineous parents are at an increased risk of common mood disorder or psychoses. Method Data from the Child Health System Dataset on all individuals born in Northern Ireland (NI) between 1971-1986 were linked to nation-wide administrative data sources on prescription medication data and death records within the secure environment of the Honest Broker Service. Degree of parental consanguinity (second cousin or first cousin relatives) was determined from questions asked of the parents within two weeks of the child’s birth during routine health visitor house calls. Potential mental ill-health was determined by receipt of psychotropic medication during the study period 2010-2014. Results Of the 363,960 individuals, alive and resident in NI in 2014 with full data on all variables, 609 (0.2%) were born to consanguineous parents. Over a third (35.8%) of children of first cousin parents were in receipt of antidepressant and/or anxiolytic medication and 8.5% were in receipt of antipsychotic medication. Multi-level logistic regression models showed that children of first cousin parents were over three times as likely to be in receipt of medications for common mood disorders (antidepressant and/or anxiolytic

medication OR=3.01, 95% CI 1.24, 7.31) and over twice as likely to be receipt of antipsychotic medication (OR=2.13, 95% CI 1.29, 3.51), compared to children of non-related parents after full adjustment for factors known to be associated with poor mental health. Conclusion This study clearly shows that a child of consanguineous parents is at an increased risk of common mood disorder and psychoses. This is an issue of increasing global relevance due to increased migration from countries where consanguineous marriage is common.

39 Inactive individuals require twice financial incentives as much as active

individuals to increase physical activity: a discrete choice modelling

approach

Dr Jianjun Tang A Longo, G Hutchinson, RF Hunter, F Kee Introduction Although the use of financial incentives in encouraging healthier behaviours has received significant recent attention, previous studies have not shown significant effects of financial incentives for increasing physical activities in workplace settings. One reason may be that the effects of financial incentives employed have been insufficient or group-specific. The purpose of the study is to investigate whether inactive individuals require larger financial incentives to increase their physical activity than active individuals. Methods A web-based questionnaire was disseminated to and completed by 673 office-based participants from a physical activity promotion scheme. Discrete choice modelling was applied to predict participants’ willingness-to-accept financial incentives for increasing walking or cycling and doing moderate and vigorous recreational activities. All respondents have completed baseline physical activity measurement by wearing a pedometer for 7 consecutive days, which was used to categorize participants as active (≥10,000 steps per day), moderate-active (≥5,000 and <10,000 steps per day), and inactive (<5,000 steps per day). Results Participants from the inactive group required a mean of £5.45/hour [95% CI: £4.39, £6.51] to walk or cycle to and from places, in contrast to their counterparts from the moderate-active group (£3.31/hour; [95% CI: £2.32, £4.29]) and active group (£3.19/hour; [95% CI: £1.69, £4.68]). Similarly, inactive participants asked for £3.24 [95% CI: £2.30, £4.17] and £4.79 [95% CI: £3.25, £6.33] for increasing 60 minutes of moderate and vigorous physical activity, respectively, which were significantly higher than the moderate-active group (£0.92 [95% CI: £0.15, £1.68] and £3.51 [95% CI: £2.24, £4.78], respectively) and active group (£1.82 [95% CI: £0.73, £2.90] and £1.84 [95% CI: £-0.04, £3.72], respectively) would require. Conclusion Compared to moderate-active and active participants, inactive participants require significantly larger financial incentives to increase their physical activities. Who in particular is this research being directed to? How will you ensure they hear about it This work is of particular interest to researchers from disciplines such as public health and behavioural economists, and those involved in changing behaviou in practice, for example, public health practitioners and policymakers. Dissemination activities include study e-zines and presentations to local stakeholders, a workshop, conferences and academic publications. Keywords: Discrete Choice modelling, Physical Activity, Financial Incentives


40 Exploring the effect of socioeconomic status on the risk of all-cause

mortality between migrants and the majority settled population of

Finland for the years 2001-2014

Mr Kishan Patel A Kouvonen, A Koskinen, L Kokkinen, M Donnelly, DPJ O’Reilly, A Vaananen Background Research comparing the health of migrants to the health of the settled population in their new countries has yielded mixed results. The aim of this record-linkage study was to analyse the effect that socio-economic status has on the risk of mortality between different migrant groups and the settled majority population. Methods A random sample of 1,058,381 working age people (age range 18 to 64 years) living in Finland in 2000 were drawn from the Finnish Population Register, and linked to mortality data from 2001 to 2014 obtained from the National Death Register. Cox proportional hazard models were used to investigate the association between migrant status and all-cause mortality. Results After adjustment for age, sex, marital status, social class and individual income, the risk of mortality was reduced for both low and high-income migrants when compared to the majority Finnish population (0.46 (95% CI 0.37-0.52) and 0.81 (95% CI 0.66-0.91) respectively). Low-income migrants from Africa, the Middle East and Asia had the lowest mortality risk of any group studied (0.41(95% CI 0.34-0.49)). Conclusion Migrants seem to display a survival advantage when compared to the settled majority. We suggest that social class, and indeed mobility between social classes, may be the largest factor in this phenomenon.

Key words Administrative research, migrants, migration, mortality, register data, record-linkage, social class Importance This comparison of mortality risk between social classes is an innovative use of Finnish data, and will provide important knowledge for policy makers. We aim to disseminate the findings through publication, and presentations targeted at both academic and non-academic audiences.


And Finally…..

On behalf of our funders and partners, thank you for joining us today. The last 10yrs has forged many special relationships both professionally and personally and we hope you will continue to carry the CoE baton into the future, and build upon what we have achieved. Here’s to 20UP

~ For those departing - safe home ~ For those staying for dinner - enjoy the evening ahead ~ And to those whom we will not see for a while – have a happy Christmas and hopefully we will meet in the New Year


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