Publications by authors named "Elizabeth Webb"

78 Publications

Inter-rater agreement of scores to assess quality of care in public sector primary health care facilities - A pattern of performance.

Eval Program Plann 2021 Sep 17;89:102004. Epub 2021 Sep 17.

School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, 31 Bophelo Road, Gezina, Pretoria, 0001, South Africa.

Purpose: To determine if the scores obtained from the Ideal Clinic Assessment Tool (ICAT) used to assess the quality of care in public Primary Health Care facilities in South Africa showed inter-rater agreement between self-assessments, district peer reviews and cross-district peer reviews. The ICAT scores obtained in the three types of reviews were paired as follows: self-assessments/district peer reviews, self-assessment/cross-district peer reviews and district/cross-district peer reviews. The global scores and averages of the Vital elements for the three paired reviews for 587 facilities across the country were compared using Bland-Altman plots.

Results: The Bland-Altman plots showed no inter-rater agreement between the global scores and averages of the Vital elements for the facilities in any of the paired reviews (n = 1 761 reviews). Similarly, there was no inter-rater agreement between the global scores of the three paired reviews in any of the nine provinces in the country.

Conclusion: There is still a need to continue to conduct both district and cross-district reviews despite the substantial cost of doing so. Further studies are required to determine what factors contributed to the disagreement in scores between the different types of reviews despite the preparatory training of reviewers.
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http://dx.doi.org/10.1016/j.evalprogplan.2021.102004DOI Listing
September 2021

Attitudes and beliefs of South African primary healthcare practitioners on initiating insulin in people with type 2 diabetes: Findings from the Tshwane Insulin Project (TIP).

Prim Care Diabetes 2021 Oct 22;15(5):865-870. Epub 2021 Jun 22.

Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag X323, Arcadia, 0007, City of Tshwane, South Africa. Electronic address:

Aims: To investigate the attitudes and beliefs of primary healthcare practitioners (HCPs) towards initiating insulin therapy for people with type 2 diabetes (T2D) in South Africa.

Methods: A cross-sectional survey was conducted amongst HCPs from 23 clinics. The nurses' questionnaire was administered by research nurses while doctors completed an online version about their attitudes, beliefs and perceived barriers to initiating insulin.

Results: Of the 73 HCPs surveyed, 68% were nurses and 84% were women. Only 24% of HCPs believed that most patients would eventually need to initiate insulin regardless of their adherence to treatment regimens and 86% preferred to delay insulin therapy. Doctors were reluctant to initiate insulin, citing patient-related reasons such as low socio-economic level (41%), inability to refrigerate insulin (77%) and inability to self-monitor blood glucose (55%). Doctors mentioned that patient behaviour including not adhering to treatment regimen and appointments (91%) and reluctance to start insulin therapy (82%) influenced their prescription practices. Doctors mentioned that health system factors, including the pressure to see patients quickly (68%) and lack of continuity of care (64%) were barriers to initiating insulin.

Conclusions: Optimising insulin therapy in primary care requires health system changes including promoting person-centred care and continuing training for HCPs.
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http://dx.doi.org/10.1016/j.pcd.2021.06.005DOI Listing
October 2021

Suboptimal control for patients with type 2 diabetes in the Central Chronic Medicine Dispensing programme in South Africa.

Afr J Prim Health Care Fam Med 2021 Mar 24;13(1):e1-e7. Epub 2021 Mar 24.

School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria.

Background: In South Africa, the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme allows stable patients with non-communicable diseases, including type 2 diabetes mellitus (T2DM), to collect their medication from a pick-up location near their home, thus avoiding long waiting times and travel expenses. The CCMDD programme aims at improving patient retention and adherence through better access to medicines, resulting in better health outcomes.

Aim: We assessed whether patients with T2DM enrolled in CCMDD achieved the recommended targets for glycaemic, blood pressure (BP) and lipid control.

Setting: City of Tshwane, South Africa.

Methods: We reviewed the records of 198 T2DM patients enrolled in CCMDD and assessed their control of haemoglobin A1c (HbA1c), BP and lipids.

Results: Most of the records reviewed belonged to women (64.7%), African (89.9%), hypertensive (82.7%) and to patients exclusively on oral antidiabetic agents (98.5%). Patients were, on average, 57.7 (s.d. = 12.1) years old and had participated in the CCMDD programme for, on average, 2 years. The mean HbA1c was 8% (s.d. = 2). Glycaemic control was achieved by only 29.2% of patients, and 49% of patients had HbA1c between 7% and 9%. Ninety-three patients (66%) had achieved the total cholesterol target, 57.4% achieved BP targets and 6.9% had achieved the low-density lipoprotein cholesterol target.

Conclusion: A small group of patients achieved the targets for glycaemic, BP and lipid control. Despite improved accessibility to medication, the CCMDD is not synonymous of improved clinical outcomes. Future research should ascertain the factors associated with suboptimal control for these patients.
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http://dx.doi.org/10.4102/phcfm.v13i1.2648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063568PMC
March 2021

Reliability of the breathing pattern assessment tool for in-person or remote assessment in people with asthma.

Clin Exp Allergy 2021 Sep 8;51(9):1218-1220. Epub 2021 Mar 8.

Department of Physiotherapy, Alfred Health, Melbourne, Vic., Australia.

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http://dx.doi.org/10.1111/cea.13856DOI Listing
September 2021

Application of the Modified Incremental Step Test for Pulmonary Rehabilitation.

Phys Ther 2021 05;101(5)

Physiotherapy, Alfred Health, Melbourne, Australia.

Objective: A Modified Incremental Step Test (MIST) performed in the home may facilitate entirely home-based pulmonary rehabilitation programs. The aims of this study were to investigate the reliability and responsiveness, and the utility of the MIST for exercise prescription in people with stable chronic lung disease.

Methods: The MIST was undertaken at the center and home in random order, before and after pulmonary rehabilitation, with 2 tests at each time point. Reliability was assessed using intraclass correlation coefficient. Responsiveness was evaluated as effect size. The minimal important difference was appraised using distribution and anchor-based methods. In a substudy, physiological responses to MIST were measured by a portable metabolic system, followed by a constant step rate test at 60% of peak oxygen uptake (VO2peak), to evaluate utility for exercise prescription.

Results: Forty-six participants were recruited (29% of eligible candidates). There was excellent reliability for number of steps recorded in home- and center-based settings (intraclass correlation coefficient = 0.954, 95% CI = 0.915-0.976). A small-moderate effect size was demonstrated following pulmonary rehabilitation (0.34), and the minimal detectable change was 7 steps. All participants in the substudy achieved 60% of VO2peak and achieved steady state by the fourth minute, with 60% of VO2peak corresponding to a mean 37% (95% CI = 29-44) of the MIST final level.

Conclusions: The MIST is reliable and responsive to pulmonary rehabilitation in people with stable chronic respiratory disease. It provides new opportunities to assess exercise capacity, prescribe exercise training, and reassess exercise program outcomes in environments where established field walking tests are not feasible.

Impact: Pulmonary rehabilitation is a highly effective treatment that is underutilized worldwide. Home-based pulmonary rehabilitation may improve access for patients and deliver equivalent clinical outcomes but is limited by the availability of a robust exercise test that can be used at home to assess exercise capacity and prescribe training intensity. This study tested the clinimetric properties of the MIST and demonstrated a new way to assess exercise capacity, prescribe exercise training of an appropriate intensity, and reassess exercise capacity in environments where established field walking tests are not feasible.
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http://dx.doi.org/10.1093/ptj/pzab044DOI Listing
May 2021

Compression Therapy to Prevent Recurrent Cellulitis of the Leg. Reply.

N Engl J Med 2020 11;383(19):1891-1892

University of Canberra, Canberra, ACT, Australia.

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http://dx.doi.org/10.1056/NEJMc2029458DOI Listing
November 2020

The clinical outcomes of patients with diabetes and hypertension in a peri-urban area, Johannesburg, South Africa.

Prim Care Diabetes 2021 04 27;15(2):212-217. Epub 2020 Aug 27.

Biostatistics Research Unit, South African Medical Research Council SAMRC, 1 Soutpansberg, Hatfield, Pretoria, South Africa.

Aim: To describe the clinical outcomes of patients with type 2 diabetes (DM2) and hypertension (HT) who received treatment and care at a specialized primary healthcare facility.

Methods: A cross-sectional study was conducted and data retrieved from 349 patient's records. The clinical outcomes were linked to individual risk factors and demographic profiles. Patients with HT who had at least four blood pressure (BP) measurements and patients with DM2 who had at least two HbA1c measurements in a 12-month period were included.

Results: More females had controlled HT than males. There was no sex difference observed for the control of DM2. Patients with HT visited the clinic for a median period of 96 days (IQR 35-257). Among 59.1% (n = 159) patients who achieved at least one controlled BP measurement, 64.2% (n = 102) had a controlled BP at the last visit. Patients with DM2 visited the clinic for a median period of 851 days (IQR 449.5-1254). From a total of 34 patients (43.5%) who achieved at least one controlled HbA1c measurement, 55.9% (n = 19) had a controlled HbA1c at the last visit.

Conclusion: Despite the difference in patient profiles, more than half of the patients who received specialised DM2 and HT care managed to achieve BP and HbA1c control.
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http://dx.doi.org/10.1016/j.pcd.2020.08.010DOI Listing
April 2021

Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP).

Diabetes Res Clin Pract 2020 Oct 11;168:108366. Epub 2020 Aug 11.

Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa. Electronic address:

Aims: To determine factors associated with 'hypothetical willingness' to start insulin among people with Type 2 diabetes (T2DM).

Methods: A quantitative cross-sectional study with insulin-naïve T2DM patients at 23 primary care facilities in the Tshwane Metropolitan Municipality. Data collected included demographic and clinical data, willingness to start insulin, attitudes and barriers to insulin therapy. Factors associated with unwillingness to start insulin therapy were explored using a multivariable logistic regression model.

Results: Of 468 T2DM study patients (mean age 57.2, SD = 11.3 years), more than half (51.9%) expressed unwillingness to starting insulin therapy. Unwillingness was associated with negative attitudes (OR = 1.32, 95% CI = 1.12-1.55, p = 0.001) and reluctance (OR = 1.41, 95% CI = 1.27-1.57, p < 0.001) rather than age, sex, education or diabetes duration. The strongest reasons for patient unwillingness were injection anxieties, fear of needles, insufficient knowledge of insulin, feeling unable to cope with insulin and concerns about out-of-pocket costs.

Conclusions: The prospect of insulin therapy disturbs patients' sense of self and their psychological wellbeing. The high prevalence of psychological insulin resistance among these T2DM patients needs to be addressed for effective diabetes management.
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http://dx.doi.org/10.1016/j.diabres.2020.108366DOI Listing
October 2020

Compression Therapy to Prevent Recurrent Cellulitis of the Leg.

N Engl J Med 2020 08;383(7):630-639

From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia.

Background: Chronic edema of the leg is a risk factor for cellulitis. Daily use of compression garments on the leg has been recommended to prevent the recurrence of cellulitis, but there is limited evidence from trials regarding its effectiveness.

Methods: In this single-center, randomized, nonblinded trial, we assigned participants with chronic edema of the leg and recurrent cellulitis, in a 1:1 ratio, to receive leg compression therapy plus education on cellulitis prevention (compression group) or education alone (control group). Follow-up occurred every 6 months for up to 3 years or until 45 episodes of cellulitis had occurred in the trial. The primary outcome was the recurrence of cellulitis. Participants in the control group who had an episode of cellulitis crossed over to the compression group. Secondary outcomes included cellulitis-related hospital admission and quality-of-life assessments.

Results: A total of 183 patients were screened, and 84 were enrolled; 41 participants were assigned to the compression group, and 43 to the control group. At the time of a planned interim analysis, when 23 episodes of cellulitis had occurred, 6 participants (15%) in the compression group and 17 (40%) in the control group had had an episode of cellulitis (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.59; P = 0.002; relative risk [post hoc analysis], 0.37; 95% CI, 0.16 to 0.84; P = 0.02), and the trial was stopped for efficacy. A total of 3 participants (7%) in the compression group and 6 (14%) in the control group were hospitalized for cellulitis (hazard ratio, 0.38; 95% CI, 0.09 to 1.59). Most quality-of-life outcomes did not differ between the two groups. No adverse events occurred during the trial.

Conclusions: In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment. (Funded by Calvary Public Hospital Bruce; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000412336.).
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http://dx.doi.org/10.1056/NEJMoa1917197DOI Listing
August 2020

Review and analysis of the potential for glyphosate to interact with the estrogen, androgen and thyroid pathways.

Pest Manag Sci 2020 Sep 17;76(9):2886-2906. Epub 2020 Jul 17.

Global Regulatory Science, Bayer Crop Science, Chesterfield, MO, USA.

Glyphosate was recently evaluated for its potential to interact with the estrogen, androgen and thyroid (EAT) hormone pathways, including steroidogenesis, under the United States Environmental Protection Agency's (USEPA) Endocrine Disruptor Screening Program (EDSP), then by Germany, the rapporteur Member State who led the European Annex 1 renewal for glyphosate, and then by the European Food Protection Agency (EFSA) also as part of the Annex 1 renewal for glyphosate. Under the EDSP, 11 Tier 1 assays were run following the USEPA's validated 890-series test guidelines and included five in vitro and six in vivo assays to evaluate the EAT pathways. Steroidogenesis was evaluated as part of the estrogen and androgen pathways. An up-to-date critical review has been conducted that considered results from the EDSP Tier 1 battery, guideline regulatory studies and an in-depth analysis of the literature studies that informed an endocrine assessment. A strength of this evaluation was that it included data across multiple levels of biological organization, and mammalian and nonmammalian test systems. There was strong agreement across the in vitro and in vivo Tier 1 battery, guideline studies and relevant literature studies, demonstrating that glyphosate does not interact with EAT pathways including steroidogenesis. Based on an analysis of the comprehensive toxicology database for glyphosate and the literature, this review has concluded that glyphosate does not have endocrine-disrupting properties through estrogen, androgen, thyroid and steroidogenic modes of action. © 2020 Society of Chemical Industry.
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http://dx.doi.org/10.1002/ps.5983DOI Listing
September 2020

Acceptability of a Computer-Tailored Safer Sex Intervention for Heterosexually Active African Americans Attending an STI Clinic.

J Prim Prev 2020 06;41(3):211-227

, Louisville, KY, USA.

Since African Americans are disproportionately affected by HIV/AIDS, interventions that increase correct and consistent condom use are urgently needed. We report baseline acceptability data from a randomized controlled trial (RCT) testing the Tailored Information Program for Safer Sex, a computer-tailored intervention designed to increase correct and consistent condom use among low income, heterosexually active African Americans attending an urban sexually transmitted infection (STI) clinic. We enrolled 274 participants at baseline in an RCT-147 in the intervention group. The intervention had high acceptability, with a mean acceptability of 4.35 on a 5-point scale. We conducted a multiple regression analysis examining demographic, structural, and sexual risk characteristics that revealed only sex to be significantly (p < .01) associated with intervention acceptability. While women were more likely than men to find the intervention acceptable, overall the results indicated broad acceptability of this intervention to the target audience. eHealth interventions are a viable option for HIV prevention among African Americans visiting a publicly-funded STI clinic. We discuss implications of these results for the future application of such programs.
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http://dx.doi.org/10.1007/s10935-020-00585-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234923PMC
June 2020

The ability of primary healthcare clinics to provide quality diabetes care: An audit.

Afr J Prim Health Care Fam Med 2019 Oct 17;11(1):e1-e6. Epub 2019 Oct 17.

School of Health Systems and Public Health, University of Pretoria, Pretoria.

Background: In South Africa, much of diabetes care takes place at primary healthcare (PHC) facilities where screening for diabetic complications is often low. Clinics require access to equipment, resources and a functional health system to do effective screening, but what is unknown is whether these components are in place.

Aim: The aim of this study was to assess the capacity of primary care clinics in one district to provide quality diabetes care.

Setting: This study was conducted at the Tshwane district in South Africa.

Methods: An audit was done in 12 PHC clinics. A self-developed audit tool based on national and clinical guidelines was developed and completed using observation and interviewing the clinic manager and pharmacist or pharmacy assistant.

Results: Scales, height rods, glucometers and blood pressure machines were available. Monofilaments were unknown and calibration of equipment was rare. The Essential Drug List was the only guideline consistently available. All sites reported consistent access to medication, glucose strips and urine dipsticks. All sites made use of the chronic disease register, and only 25% used an appointment system. No diabetes-specific structured care form was in use. All facilities had registered and enrolled nurses and access to doctors. Availability of educational material was generally poor.

Conclusion: The capacity to deliver quality care is compromised by the poor availability of guidelines, educational material and the absence of monofilaments. These are modifiable risk factors that could be resolved by the clinic managers and staff development educators. However, patient records and health information systems need attention at policy level.
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http://dx.doi.org/10.4102/phcfm.v11i1.2094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852325PMC
October 2019

Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic oedema: a randomised controlled trial protocol.

BMJ Open 2019 08 15;9(8):e029225. Epub 2019 Aug 15.

Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.

Introduction: Cellulitis represents a significant burden to patients' quality of life (QOL) and cost to the healthcare system, especially due to its recurrent nature. Chronic oedema is a strong risk factor for both an initial episode of cellulitis and cellulitis recurrence. Expert consensus advises compression therapy to prevent cellulitis recurrence in individuals with chronic oedema, however, there is little supporting evidence. This research aims to determine if the management of chronic oedema using compression therapy effectively delays the recurrence of lower limb cellulitis.

Methods And Analysis: A randomised controlled trial with cross-over will be used to assess the impact of compression therapy on clinical outcomes (time to next episode of cellulitis, rate of cellulitis-related hospital presentations, QOL and leg volume). Using concealed allocation, 162 participants will be randomised into the intervention (compression) or control (no compression) group. Randomisation will be stratified by prophylactic antibiotic use. Participants will be followed up at 6 monthly intervals for up to 3 years or until 45 episodes of cellulitis occur across the cohort. Following an episode of recurrent cellulitis, control group participants will cross-over to the intervention group. Survival analysis will be undertaken to assess the primary outcome measure of time to cellulitis recurrence. The hypotheses are that compression therapy to control lower limb chronic oedema will delay recurrent lower limb cellulitis, reduce the rate of associated hospitalisations, minimise affected limb volume and improve the QOL of this population.

Ethics And Dissemination: Ethics approval has been obtained from the ethics committees of all relevant institutions. Results will be disseminated through relevant peer-reviewed journal articles and conference presentations.

Trial Registration Number: ACTRN12617000412336; Pre-results. The ICTOC trial is currently in progress. Participant recruitment started in May 2017 and is expected to continue until December 2019.
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http://dx.doi.org/10.1136/bmjopen-2019-029225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701661PMC
August 2019

Long work hours, weekend working and depressive symptoms in men and women: findings from a UK population-based study.

J Epidemiol Community Health 2019 05 25;73(5):465-474. Epub 2019 Feb 25.

Research Department of Epidemiology and Public Health, University College London, London, UK.

Background: Globalised and 24/7 business operations have fuelled demands for people to work long hours and weekends. Research on the mental health effects of these intensive temporal work patterns is sparse, contradictory or has not considered gender differences. Our objective was to examine the relationship between these work patterns and depressive symptoms in a large nationally representative sample of working men and women in the UK.

Method: The current study analysed data from Understanding Society, the UK Household Longitudinal Study, of 11 215 men and 12 188 women in employment or self-employment at the time of the study. Ordinary least squares regression models, adjusted for potential confounders and psychosocial work factors, were used to estimate depressive symptoms across categories of work hours and weekend work patterns.

Results: Relative to a standard 35-40 hours/week, working 55 hours/week or more related to more depressive symptoms among women (ß=0.75, 95% CI 0.12 to 1.39), but not for men (ß=0.24, 95% CI -0.10 to 0.58). Compared with not working weekends, working most or all weekends related to more depressive symptoms for both men (ß=0.34, 95% CI 0.08 to 0.61) and women (ß=0.50, 95% CI 0.20 to 0.79); however, working some weekends only related to more depressive symptoms for men (ß=0.33, 95% CI 0.11 to 0.55), not women (ß=0.17, 95% CI -0.09 to 0.42).

Conclusion: Increased depressive symptoms were independently linked to working extra-long hours for women, whereas increased depressive symptoms were associated with working weekends for both genders, suggesting these work patterns may contribute to worse mental health.
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http://dx.doi.org/10.1136/jech-2018-211309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581113PMC
May 2019

Associations of Public Transportation Use With Cardiometabolic Health: A Systematic Review and Meta-Analysis.

Am J Epidemiol 2019 04;188(4):785-795

Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.

Public transportation provides an opportunity to incorporate physical activity into journeys, but potential health impacts have not been systematically examined. We searched the literature for articles on public transportation and health published through December 2017 using Google (Google Inc., Mountain View, California), 5 medical databases, and 1 transportation-related database. We identified longitudinal studies which examined associations between public transportation and cardiometabolic health (including adiposity, type 2 diabetes mellitus, and cardiovascular disease). We assessed study quality using the Newcastle-Ottawa Scale for cohort studies and performed meta-analyses where possible. Ten studies were identified, 7 investigating use of public transportation and 3 examining proximity to public transportation. Seven studies used individual-level data on changes in body mass index (BMI; weight (kg)/height (m)2), with objective outcomes being measured in 6 studies. Study follow-up ranged from 1 year to 10 years, and 3 studies adjusted for nontransportation physical activity. We found a consistent association between use of public transportation and lower BMI. Meta-analysis of data from 5 comparable studies found that switching from automobile use to public transportation was associated with lower BMI (-0.30 units, 95% confidence interval: -0.47, -0.14). Few studies have investigated associations between public transportation use and nonadiposity outcomes. These findings suggest that sustainable urban design which promotes public transportation use may produce modest reductions in population BMI.
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http://dx.doi.org/10.1093/aje/kwz012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438807PMC
April 2019

Shared negative experiences of long-acting reversible contraception and their influence on contraceptive decision-making: a multi-methods study.

Contraception 2019 04 24;99(4):228-232. Epub 2019 Jan 24.

University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Family Planning and Contraceptive Research, 5841 S. Maryland Ave. - MC2050, Chicago, IL 60637.. Electronic address:

Objectives: We explored how negative stories about long-acting reversible contraception (LARC) - defined as a firsthand negative experience with LARC shared directly with the study participant - were involved in participants' decisions about whether to use LARC following abortion, and how counseling affected the influence of negative LARC stories on contraceptive choices.

Study Design: We performed a multi-methods study, embedded within a trial examining the impact of a theory-based counseling intervention on LARC uptake post-abortion. Participants completed a baseline survey to determine the influence of negative LARC stories. We subsequently invited respondents who reported having heard negative LARC stories to participate in a semi-structured qualitative interview. We analyzed quantitative data with univariate statistics. We analyzed qualitative data using thematic content analysis.

Results: Among the 60 participants, 16 (27%) reported having heard negative LARC stories. Two of the 16 (13%) planned to initiate LARC prior to counseling, compared to 18 of 44 women (41%) who had not heard negative LARC stories (p=0.06). Prior to counseling, 69% of participants with negative LARC stories reported that these stories made them less likely to use LARC. In qualitative interviews with 9 women, we identified several key themes: (1) negative LARC stories deterred LARC use; (2) friends and family were valued informants; (3) potential side effects were important to LARC decision-making; and (4) positive and negative features of the counseling encounter influenced the effect of negative LARC stories.

Conclusions: Negative LARC stories are common among women presenting for abortion at our institution and may influence patient uptake of these methods. Implications This study uses a multi-methods approach to examine the influence of negative stories about long-acting reversible contraception (LARC) on decision-making about LARC. These findings can help providers elicit patients' needs in contraception counseling and generate hypotheses for future counseling research.
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http://dx.doi.org/10.1016/j.contraception.2019.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441367PMC
April 2019

Marriage and physical capability at mid to later life in England and the USA.

PLoS One 2019 23;14(1):e0209388. Epub 2019 Jan 23.

The Health Foundation, London, United Kingdom.

Background: Married people have lower rates of mortality and report better physical and mental health at older ages, compared to their unmarried counterparts. However, there is limited evidence on the association between marriage and physical capability, the ability to carry out the tasks of daily living, which is predictive of future mortality and social care use. We investigate the association between marital status and physical capability at mid to later life in England and the United States.

Methods: We examine the association between marriage and physical capability at mid to later life in England and the USA using two performance-based measures of physical capability: grip strength and walking speed. Multiple linear regression was carried out on Wave 4 (2008) of the English Longitudinal Study of Ageing (ELSA) and Waves 8 and 9 (2006 and 2008) of the US Health and Retirement Study (HRS).

Results: In age adjusted models married men and women had better physical capability than their unmarried counterparts. Much of the marriage advantage was explained by the greater wealth of married people. However, remarried men were found to have stronger grip strength and widowed and never married men had a slower walking speed than men in their first marriage, which was not explained by wealth, demographic and socioeconomic characteristics, health behaviours, chronic disease or depressive symptoms. There were no differences in the association between England and the USA.

Conclusions: Marriage may be an important factor in maintaining physical capability in both England and the USA, particularly because of the greater wealth which married people have accrued by the time they reach older ages. The grip strength advantage for remarried men may be due to unobserved selective factors into remarriage.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209388PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343866PMC
September 2019

Informal caregiving patterns and trajectories of psychological distress in the UK Household Longitudinal Study.

Psychol Med 2019 07 12;49(10):1652-1660. Epub 2018 Sep 12.

Research Department of Epidemiology and Public Health,University College London,London WC1E 6BT,UK.

Background: Approximately seven million people in the UK are engaged in informal caregiving. Informal caregivers are at risk of poorer mental and physical health. However, less is known about how the relationship between the informal caregiving and psychological distress changes over time. The aim of this study was to investigate longitudinal associations between the informal caregiving and psychological distress amongst UK men and women aged 16+.

Methods: Data were analysed from the UK Household Longitudinal Study (UKHLS, n = 9368), a nationally representative study of UK households. Longitudinal linear mixed modelling was used to estimate associations between the longitudinal patterns of informal caregiving (non-caregiver/one episode of 1-2 years/intermittent caregiving/3+ years caregiving) and trajectories of psychological distress across seven waves of UKHLS data.

Results: Informal caregiving was not associated with psychological distress for men. Women engaged in long-term (⩾3 years) or intermittent caregiving had higher levels of psychological distress at the point of initiation, compared with women who were not caregivers throughout the study period (3+ years caregiver: regression coefficient 0.48, 95% confidence interval (CI) 0.07-0.89; intermittent caregiver: regression coefficient 0.47, 95% CI 0.02-0.92). Trajectories of psychological distress changed little over time, suggesting a plateau effect for these caregiving women.

Conclusions: Women engaged in long-term or repeated shorter episodes of informal caregiving reported more symptoms of psychological distress than non-caregiving women. Given the increased risk of reporting psychological distress and the increasing importance of the informal care sector, the risk of poorer mental health of informal caregivers should be a priority for public health.
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http://dx.doi.org/10.1017/S0033291718002222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601356PMC
July 2019

Effect of sedative agent selection on morbidity, mortality and length of stay in patients with increase in intracranial pressure.

World J Emerg Med 2018 ;9(4):256-261

Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University Shreveport, Louisiana 71115, USA.

Background: To identify the effects of sedative agent selection on morbidity, mortality, and length of stay in patients with suspected increase in intracranial pressure. Recent trends and developments have resulted in changes to medications that were previously utilized as pharmacological adjuncts in the sedation and intubation of patients with suspected increases in intracranial pressure. Medications that were previously considered contraindicated are now being used with increasing regularity without demonstrated safety and effectiveness. The primary objective of this study is to evaluate and compare the use of Ketamine as an induction agent for patients with increased intracranial pressure. The secondary objective was to evaluate and compare the use of Etomidate, Midazolam, and Ketamine in patients with increased intracranial pressure.

Methods: We conducted a retrospective chart review of patients transported to our facility with evidence of intracranial hypertension that were intubated before trauma center arrival. Patients were identified during a 22-month period from January 2014 to October 2015. Goals were to evaluate the impact of sedative agent selection on morbidity, mortality, and length of stay.

Results: During the review 148 patients were identified as meeting inclusion criteria, 52 were excluded due to incomplete data. Of those the patients primarily received; Etomidate, Ketamine, and Midazolam. Patients in the Ketamine group were found to have a lower mortality rate after injury stratification.

Conclusion: Patients with intracranial hypertension should not be excluded from receiving Ketamine during intubation out of concern for worsening outcomes.
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http://dx.doi.org/10.5847/wjem.j.1920-8642.2018.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117539PMC
January 2018

Safety of multicomponent meningococcal group B vaccine (4CMenB) in routine infant immunisation in the UK: a prospective surveillance study.

Lancet Child Adolesc Health 2018 06 25;2(6):395-403. Epub 2018 Apr 25.

Division of Bacteriology, National Institute for Biological Standards and Control, Hertfordshire, UK.

Background: Safety data for the multicomponent meningococcal group B vaccine (4CMenB) has so far been limited to experience from clinical trials and isolated local outbreaks. Since the UK is the first country to implement a nationwide routine immunisation programme with 4CMenB (at age 8 weeks, 16 weeks, and then 1 year), we aimed to assess the safety of 4CMenB in this setting.

Methods: In this prospective surveillance study, we assessed suspected adverse reactions of 4CMenB in children up to age 18 months reported in the UK Yellow Card Scheme and primary care records extracted from the Clinical Practice Research Datalink (CPRD). We proactively assessed reports of fever, local reactions, Kawasaki disease, seizures, and sudden death, and compared the number of spontaneous reports with the expected number of events based on background incidence and the number of children vaccinated. We also identified any unexpected adverse reactions and estimated compliance with subsequent doses of routine vaccinations.

Findings: From Sept 1, 2015, to May 31, 2017, approximately 1·29 million children aged 2-18 months received about a combined 3 million doses of 4CMenB. 902 reports of suspected adverse reactions were received through the UK Yellow Card Scheme, of which 366 (41%) were related to local reactions and 364 (40%) related to fever. The only unexpected finding was that 160 reports of local reactions described a persistent nodule at the site of injection, usually without other local symptoms. There were 55 (6%) reports of seizures, with an age-adjusted observed-to-expected ratio of 0·13 (95% CI 0·10-0·17). Ecological analyses found similar rates of seizures within 7 days of routine immunisation in the periods before and after 4CMenB introduction, with incidence rate ratios of 1·30 (95% CI 0·56-3·00) at age 2 months, 1·53 (0·49-4·74) at age 4 months, and 1·26 (0·69-2·32) at age 12 months. Of the 902 reports, three (<1%) were of Kawasaki disease (observed-to-expected ratio 1·40, 95% CI 0·29-4·08) and three (<1%) of sudden infant death syndrome within 3 days of vaccination in children aged 2-4 months (0·44, 0·12-1·14). Analysis of routine immunisations recorded in CPRD found that 11 602 (95·1%) of 12 199 children had received the second dose of 4CMenB by 26 weeks of age, 1793 (84·7%) of 2117 had received the third dose by 62 weeks of age, and 4CMenB introduction had not reduced compliance with doses of other routine vaccinations.

Interpretation: We found no significant safety concerns after widespread use of 4CMenB in UK infants, and the vaccine appears to have been well accepted by parents. However, it is important to continue monitoring the safety and long-term effect of the immunisation programme in the UK to further characterise the reported suspected adverse reactions.

Funding: None.
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http://dx.doi.org/10.1016/S2352-4642(18)30103-2DOI Listing
June 2018

Informal caregiving and markers of adiposity in the UK Household Longitudinal Study.

PLoS One 2018 19;13(7):e0200777. Epub 2018 Jul 19.

Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.

Objectives: The aim was to investigate associations between caregiving and adiposity using a representative UK longitudinal study. We also investigated whether associations differed by age, gender and caregiving characteristics.

Methods: Data on 9,421 participants aged 16+ from three waves (2009-2012) of the UK Household Longitudinal Study were used. Body mass index, waist circumference and percentage body fat were assessed. Caregiving and caregiving characteristics (hours per week, number of people cared for, co-resident caregiving and combining working and caregiving) was available from the prior wave. Gender-stratified associations between caregiving/caregiving characteristics with adiposity were tested. Covariates included caregiver's health, socioeconomic position, parenthood and partnerships.

Results: Caregiving was associated with higher adiposity for women but not men. Younger women caregivers had particularly higher levels of adiposity. Men combining part-time paid work with caregiving had higher levels of adiposity than men working full-time and not caregiving. Women aged 16-44 or 65+ had particularly high levels of adiposity when combining full-time work and caregiving, compared to full-time work alone.

Conclusion: The health of caregivers should be a public health priority, particularly for younger women and those combining paid work with caregiving responsibilities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200777PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053187PMC
January 2019

Associations of increases in public transport use with physical activity and adiposity in older adults.

Int J Behav Nutr Phys Act 2018 04 2;15(1):31. Epub 2018 Apr 2.

Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.

Background: We investigated predictors of two increases in older people's public transport use: initiating public transport use among non-users; and increasing public transport use amongst users. We also investigated associations of these changes with physical activity, Body Mass Index (BMI) and waist circumference.

Methods: Data come from the 2008 and 2012 English Longitudinal Study of Ageing (ELSA). Logistic regression assessed predictors of increases in public transport use among adults aged ≥50 years. Gender-stratified logistic and linear models assessed associations of increases in public transport use with changes in physical activity and adiposity.

Results: Those becoming eligible for a free older person's bus pass were more likely to both initiate and increase public transport use (e.g. for initiating public transport use Adjusted Odds Ratio (AORs) 1.77, 95% Confidence Interval 1.35; 2.33). Retiring from paid work was also associated with both initiating and increasing public transport use e.g. AOR 1.57 (1.29; 1.91) for initiating use. Women who increased public transport use had mean BMI 2.03 kg/m lower (- 2.84, - 1.21) at follow up than those who did not, although this was attenuated after adjusting for BMI at baseline (- 0.40 kg/m, - 0.82, 0.01). After adjustment for baseline physical activity those initiating public transport use were more likely to undertake at least some physical activity in 2012 (e.g. AOR for women 1.67, 1.03; 2.72).

Conclusions: Both initiating and increasing public transport use were associated with increased physical activity and may be associated with lower adiposity among women. These findings strengthen the case for considering public transport provision as an effective means of promoting healthier ageing.
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http://dx.doi.org/10.1186/s12966-018-0660-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879764PMC
April 2018

Authors' reply.

Maturitas 2018 06 13;112:95. Epub 2018 Mar 13.

Department of Epidemiology & Public Health, University College London, United Kingdom.

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http://dx.doi.org/10.1016/j.maturitas.2018.03.002DOI Listing
June 2018

Informal caregiving and metabolic markers in the UK Household Longitudinal Study.

Maturitas 2018 Mar 9;109:97-103. Epub 2018 Jan 9.

Department of Gerontology, University of Southampton, Southampton, SO17 1BJ, UK. Electronic address:

Objectives: Informal caregiving is associated with poorer mental and physical health. Little research has yet focused on objectively measured health risk factors, such as metabolic markers. The aim of this study was to investigate whether informal caregiving was associated with markers of metabolism in a large, representative UK longitudinal study. We also investigated whether more intensive caregiving, as indicated by more caregiving hours, was associated with a less favourable metabolic profile.

Study Design/outcome Measures: Using data on 9408 participants aged 16+ from the UK Household Longitudinal Study, we explored the relationship between caregiving and metabolic markers (blood pressure, total and high density lipoprotein cholesterol, glycated haemoglobin and triglycerides). We additionally investigated the importance of caregiving intensity (number of hours spent caregiving per week). Associations between caregiving/caregiving intensity and metabolic markers were tested using gender-stratified linear regression models adjusted for age, household income, education, social class, chronic illness, number of dependent children in the household, body mass index and partnership status.

Results: Men who were informal caregivers had higher total cholesterol levels than non-caregivers (3.25% higher, 95% CI: 0.07, 6.53). Women caregivers also had higher total cholesterol levels and women providing intensive care (over 20 h per week) had higher triglyceride levels (19.91% higher, 95% CI: 7.22, 34.10) and lower levels of high density lipoprotein cholesterol (8.46% lower, 95% CI: 14.51, 1.99); however, associations for women were attenuated in our final models.

Conclusions: Informal caregiving is associated with less favourable lipid profiles. This may be one mechanism through which informal caregiving is associated with increased disease risk. The health of informal caregivers should be a priority for public health.
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http://dx.doi.org/10.1016/j.maturitas.2018.01.002DOI Listing
March 2018

MOBILE-izing Adolescent Sexual and Reproductive Health Care: A Pilot Study Using a Mobile Health Unit in Chicago.

J Sch Health 2018 03;88(3):208-216

Ellen H. Block Professor of Health Justice, 5841 South Maryland Avenue, MC 2050, Chicago, IL 60637.

Background: Adolescents experience numerous barriers to obtaining sexual and reproductive health care (SRHC). Mobile Health Units (MHUs) can remove some barriers by traveling to the community. This pilot study developed Mobile SRHC through an iterative process on an existing MHU and evaluated it among adolescents and providers.

Methods: Mobile SRHC was developed through a mixed-method, multiphase study. Three key informant interviews with MHU providers, an adolescent needs assessment survey, and a Youth Model Development Session informed model development. Emergency contraception (EC), oral contraceptive pills (OCPs), and depot-medroxyprogesterone acetate (DMPA) were sequentially incorporated into MHU services. Administrative data assessed method distribution and surveys assessed patient satisfaction.

Results: Key informants held positive attitudes toward implementing Mobile SRHC into their practice. Needs assessment surveys (N = 103) indicated a majority was interested in learning about sexual health (66.0%) and obtaining birth control (54.4%) on an MHU. Over 3 months, 123 adolescents participated in Mobile SRHC. Seven packs and 9 prescriptions of EC, 8 3-month packs and 10 prescriptions of OCPs, and 5 injections and 5 prescriptions of DMPA were distributed. Ninety-two percent of adolescent participants reported they would recommend Mobile SRHC to friends.

Conclusions: Mobile SRHC is a feasible approach for reproductive health care among adolescents.
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http://dx.doi.org/10.1111/josh.12598DOI Listing
March 2018

Does public transport use prevent declines in walking speed among older adults living in England? A prospective cohort study.

BMJ Open 2017 Sep 28;7(9):e017702. Epub 2017 Sep 28.

CMIST and Department of Social Statistics, University of Manchester, London, UK.

Objectives: Although there is some evidence that public transport use confers public health benefits, the evidence is limited by cross-sectional study designs and health-related confounding factors. This study examines the effect of public transport use on changes in walking speed among older adults living in England, comparing frequent users of public transport to their peers who did not use public transport because of structural barriers (poor public transport infrastructure) or through choice.

Design: Prospective cohort study.

Setting: England, UK.

Participants: Older adults aged ≥60 years eligible for the walking speed test. 6246 individuals at wave 2 (2004-2005); 5909 individuals at wave 3 (2006-2007); 7321 individuals at wave 4 (2008-2009); 7535 individuals at wave 5 (2010-2011) and 7664 individuals at wave 6 (2012-2013) of the English Longitudinal Study of Ageing.

Main Outcome Measure: The walking speed was estimated from the time taken to walk 2.4 m. Fixed effects models and growth curve models were used to examine the associations between public transport use and walking speed.

Results: Older adults who did not use public transport through choice or because of structural reasons had slower walking speeds (-0.02 m/s (95% CI -0.03 to -0.003) and -0.02 m/s (95% CI -0.03 to -0.01), respectively) and took an extra 0.07 s to walk 2.4 m compared with their peers who used public transport frequently. The age-related trajectories of decline in walking speed were slower for frequent users of public transport compared with non-users.

Conclusions: Frequent use of public transport may prevent age-related decline in physical capability by promoting physical activity and lower limb muscle strength among older adults. The association between public transport use and slower decline in walking speed among older adults is unlikely to be confounded by health-related selection factors. Improving access to good quality public transport could improve the health of older adults.
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http://dx.doi.org/10.1136/bmjopen-2017-017702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652510PMC
September 2017

The role of sports clubs in helping older people to stay active and prevent frailty: a longitudinal mediation analysis.

Int J Behav Nutr Phys Act 2017 07 14;14(1):95. Epub 2017 Jul 14.

Institute for Health and Human Development, University of East London, Water Lane, London, E15 4LZ, UK.

Background: Frailty is a common syndrome in older adults characterised by increased vulnerability to adverse health outcomes as a result of decline in functional and physiological measures. Frailty predicts a range of poor health and social outcomes and is associated with increased risk of hospital admission. The health benefits of sport and physical activity and the health risks of inactivity are well known. However, less is known about the role of sports clubs and physical activity in preventing and managing frailty in older adults. The objective of this study is to examine the role of membership of sports clubs in promoting physical activity and reducing levels of frailty in older adults.

Methods: We used data from waves 1 to 7 of the English Longitudinal Study of Ageing (ELSA). Survey items on physical activity were combined to produce a measure of moderate or vigorous physical activity for each wave. Frailty was measured using an index of accumulated deficits. A total of sixty deficits, including symptoms, disabilities and diseases were recorded through self-report and tests. Direct and indirect relationships between sports club membership, levels of physical activity and frailty were examined using a cross-lagged panel model.

Results: We found evidence for an indirect relationship between sports club membership and frailty, mediated by physical activity. This finding was observed when examining time-specific indirect pathways and the total of all indirect pathways across seven waves of survey data (Est = -0.097 [95% CI = -0.124,-0.070], p = <0.001).

Conclusions: These analyses provide evidence to suggest that sports clubs may be useful in preventing and managing frailty in older adults, both directly and indirectly through increased physical activity levels. Sports clubs accessible to older people may improve health in this demographic by increasing activity levels and reducing frailty and associated comorbidities. There is a need for investment in these organisations to provide opportunities for older people to achieve the levels of physical activity necessary to prevent health problems associated with inactivity.
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http://dx.doi.org/10.1186/s12966-017-0552-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512788PMC
July 2017

Crossing the road in time: Inequalities in older people's walking speeds.

J Transp Health 2017 Jun;5:77-83

Research Department of Epidemiology and Public Health, University College London, London UK.

Pedestrian crossings in the UK and US require people to walk at 1.2 m/s to cross the road in time; however a large proportion of older people do not walk this fast, potentially discouraging walking or putting older people at risk of injury. We use longitudinal data to investigate changes in walking speed, and ability to cross the road in time, at older ages. 31,015 walking speed measurements were taken from 10,249 men and women aged 60+ years in waves 1-7 of the English Longitudinal Study of Ageing (2002-2014). Growth curve analyses were used to model how walking speed changes with increasing age, and predicted probabilities of being able to cross the road in time were estimated. 10% of measured walking speeds were fast enough to cross the road in time. Walking speed declined with age (-5.7×10m/s/yr (95% CI -7.6×10, -3.9×10)), and the decline accelerated with increasing age (-0.3 ×10m/s/yr (-0.4 ×10, -0.3 ×10)). Female, less wealthy and less healthy older people had slower walking speeds. For instance, predicted probability of crossing the road in time at age 60 was 14.8% (10.1, 18.5) and 2.7% (1.5, 3.8) for the richest and poorest men and 8.4% (6.0, 1.1) and 1.5% (0.9, 2.2) for the richest and poorest women, and at age 80 they were 7.1% (3.6, 10.5) and 1.0% (0.3, 1.7) for the richest and poorest men and 3.7% (1.6, 5.9) and 0.5% (0.1, 0.9) for the richest and poorest women. Most older people do not walk fast enough to cross the road in time. Even the majority of the wealthiest and healthiest people aged 60 years and older do not walk fast enough to cross pedestrian crossings in the allocated time. Crossing times should be increased to allow for older peoples' slower walking speeds or other policies considered to improve walkability, and to help avoid injuries and social isolation.
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http://dx.doi.org/10.1016/j.jth.2017.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485874PMC
June 2017

A cluster-randomized trial to estimate the effect of mobile screening and treatment feedback on HbA1c and diabetes-related complications in Tshwane primary health care clinics, South Africa.

Prim Care Diabetes 2017 12 6;11(6):546-554. Epub 2017 Jul 6.

Department of Internal Medicine, University of Pretoria, South Africa. Electronic address:

Aim And Objectives: Our study had two primary objectives. The first was to evaluate the effect of an expert review with an individualised patient management plan on change in HbA1c. The second was to determine whether a mobile screening unit would increase the proportion of patients screened for glycaemic and lipid control, as well as diabetic complications as compared to the standard guideline-driven clinic care.

Methods: We conducted a cluster-randomised trial and enrolled 599 diabetic patients from twelve primary health care clinics in the Tshwane district of South Africa. The study was carried out in three phases: Phase 1 was a historical twelve-month record review to determine baseline characteristics; Phase 2 was the provision of the intervention (active screening for metabolic control and diabetes-related complications and health education targeting health care workers and diabetic patients) compared to the control group (routine care with similar education given to health care workers and diabetic patients) with a follow-up which included a clinical assessment. Phase 3 was a repeat of the record review to assess post-intervention changes following the proposed individualised patient management plan in the intervention clinics, and self-initiated by the health care professionals in the control clinics, based on training and results-sharing.

Results: No significant changes in the HbA1c between the intervention and control clinics after one year were observed. The mean Hba1c changed from 8.68 to 8.53% (intervention) and from 8.95 to 8.76% (control) (p=0.92). Significant differences were observed in screening for diabetic complications when active screening was done by a dedicated team. The increase observed was more than 60% in all indicators monitored. Significant changes were also seen in the control clinics for two measured outcome variables (HbA1c test ordered from 15% to 25% (p=0.02) and serum-creatinine test ordered increased from 11% to 19% (p<0.001)). There was no significant difference in the proportion of actions taken, or not taken, between the control and interventions arms (p=0.83). The proposed changed patient management plans by the expert review team were implemented in only 29% of patients in the intervention arm.

Conclusions: A comprehensive programme that integrates clinical evaluations, active screening and an individualised patient management plan did not lead to significant improvement in the HbA1c levels. However, screening for glycaemic and lipid control, as well as diabetic complications, improved dramatically with a dedicated team. The lower than expected rate of uptake of the specialists-proposed patient management, with the resulting non-significant change in glycaemic control, needs further investigation.
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http://dx.doi.org/10.1016/j.pcd.2017.05.010DOI Listing
December 2017

Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank.

Lancet Public Health 2016 Dec;1(2):e46-e55

Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK.

Background: Insufficient physical activity is a determinant of obesity and cardiovascular disease. Active travel to work has declined in high-income countries in recent decades. We aimed to determine which socioeconomic and demographic characteristics predicted switching to or from active commuting, whether switching from passive to active commuting (or the reverse) independently predicts change in objectively measured body-mass index (BMI), and to ascertain whether any association is attenuated by socioeconomic, demographic, or behavioural factors.

Methods: This study used longitudinal data from UK Biobank. Baseline data collection occurred at 22 centres between March, 2006, and July, 2010, with a repeat assessment at one centre (Stockport) between August, 2012, and June, 2013, for a subset of these participants. Height and weight were objectively measured at both timepoints. We included individuals present at both timepoints with complete data in the analytic sample. Participants were aged 40-69 years and commuted from home to a workplace on a regular basis at both baseline and follow-up. Two exposures were investigated: transition from car commuting to active or public transport commuting and transition from active or public transport to car commuting. Change in BMI between baseline and repeat assessment was the outcome of interest, assessed with bivariate and multivariate logistic regression models.

Findings: 502 656 individuals provided baseline data, with 20 346 participating in the repeat assessment after a median of 4·4 years (IQR 3·7-4·9). 5861 individuals were present at both timepoints and had complete data for all analytic variables. Individuals who transitioned from car commuting at baseline to active or public transportation modes at follow-up had a decrease in BMI of -0·30 kg/m (95% CI -0·47 to -0·13; p=0·0005). Conversely, individuals who transitioned from active commuting at baseline to car commuting at follow-up had a BMI increase of 0·32 kg/m (0·13 to 0·50; p=0·008). These effects were not attenuated by adjustment for hypothesised confounders. Change in household income emerged as a determinant of commute mode transitions.

Interpretation: Incorporation of increased levels of physical activity as part of the commute to work could reduce obesity among middle-aged adults in the UK.

Funding: UK Medical Research Council.
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http://dx.doi.org/10.1016/S2468-2667(16)30006-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341146PMC
December 2016
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