Showing papers by "Peymane Adab published in 2014"

Preventing childhood obesity, phase II feasibility study focusing on South Asians: BEACHeS.

Abstract: Objective: To assess feasibility and acceptability of a multifaceted, culturally appropriate intervention for preventing obesity in South Asian children, and to obtain data to inform sample size for a definitive trial. Design: Phase II feasibility study of a complex intervention. Setting: 8 primary schools in inner city Birmingham, UK, within populations that are predominantly South Asian. Participants: 1090 children aged 6–8 years took part in the intervention. 571 (85.9% from South Asian background) underwent baseline measures. 85.5% (n=488) were followed up 2 years later. Interventions: The 1-year intervention consisted of school-based and family-based activities, targeting dietary and physical activity behaviours. The intervention was modified and refined throughout the period of delivery. Main outcome measures: Acceptability and feasibility of the intervention and of measurements required to assess outcomes in a definitive trial. The difference in body mass index (BMI) z-score between arms was used to inform sample size calculations for a definitive trial. Results: Some intervention components (increasing school physical activity opportunities, family cooking skills workshops, signposting of local leisure facilities and attending day event at a football club) were feasible and acceptable. Other components were acceptable, but not feasible. Promoting walking groups was neither acceptable nor feasible. At follow-up, children in the intervention compared with the control group were less likely to be obese (OR 0.41; 0.19 to 0.89), and had lower adjusted BMI z-score (−0.15 kg/m 2 ;9 5% CI−0.27 to −0.03). Conclusions: The feasibility study informed components for an intervention programme. The favourable direction of outcome for weight status in the intervention group supports the need for a definitive trial. A cluster randomised controlled trial is now underway to assess the clinical and costeffectiveness of the intervention.

Cost-effectiveness of a community-based physical activity programme for adults (Be Active) in the UK: an economic analysis within a natural experiment

Abstract: Objective To determine the cost-effectiveness of a physical activity programme (Be Active) aimed at city-dwelling adults living in Birmingham, UK. Methods Very little is known about the cost-effectiveness of public health programmes to improve city-wide physical activity rates. This paper presents a cost-effectiveness analysis that compares a physical activity intervention (Be Active) with no intervention (usual care) using an economic model to quantify the reduction in disease risk over a lifetime. Metabolic equivalent minutes achieved per week, quality-adjusted life years (QALYs) gained and healthcare costs were all included as the main outcome measures in the model. A cost-benefit analysis was also conducted using ‘willingness-to-pay’ as a measure of value. Results Under base-case assumptions—that is, assuming that the benefits of increased physical activity are sustained over 5 years, participation in the Be Active programme increased quality-adjusted life expectancy by 0.06 years, at an expected discounted cost of £3552, and thus the cost-effectiveness of Be Active is £400 per QALY. When the start-up costs of the programme are removed from the economic model, the cost-effectiveness is further improved to £16 per QALY. The societal value placed on the Be Active programme was greater than the operation cost therefore the Be Active physical activity intervention results in a net benefit to society. Conclusions Participation in Be Active appeared to be cost-effective and cost-beneficial. These results support the use of Be Active as part of a public health programme to improve physical activity levels within the Birmingham-wide population.

Family and Neighborhood Correlates of Overweight and Obesogenic Behaviors Among Chinese Children

Abstract: Background The prevalence of childhood obesity is increasing rapidly in China. However, research on its modifiable environmental determinants to inform preventive interventions is limited.

Process evaluation design in a cluster randomised controlled childhood obesity prevention trial: the WAVES study

Abstract: The implementation of a complex intervention is heavily influenced by individual context. Variation in implementation and tailoring of the intervention to the particular context will occur, even in a trial setting. It is recognised that in trials, evaluating the process of implementation of a complex intervention is important, yet process evaluation methods are rarely reported. The WAVES study is a cluster randomised controlled trial to evaluate the effectiveness of an obesity prevention intervention programme targeting children aged 6-7 years, delivered by teachers in primary schools across the West Midlands, UK. The intervention promoted activities encouraging physical activity and healthy eating. This paper presents the methods used to assess implementation of the intervention. Previous literature was used to identify the dimensions of intervention process and implementation to be assessed, including adherence, exposure, quality of delivery, participant responsiveness, context, and programme differentiation. Multiple methods and tools were developed to capture information on all these dimensions. These included observations, logbooks, qualitative evaluation, questionnaires and research team reflection. Data collection posed several challenges, predominantly when relying on teachers to complete paperwork, which they saw as burdensome on top of their teaching responsibilities. However, the use of multiple methods helped to ensure data on each dimension, where possible, was collected using more than one method. This also allowed for triangulation of the findings when several data sources on any one dimension were available. We have reported a comprehensive approach to the assessment of the implementation and processes of a complex childhood obesity prevention intervention within a cluster randomised controlled trial. These approaches can be transferred and adapted for use in other complex intervention trials. ISRCTN97000586

Breastfeeding practice, oral contraceptive use and risk of rheumatoid arthritis among Chinese women: the Guangzhou Biobank Cohort Study

Abstract: OBJECTIVE: Hormonal and reproductive factors are implicated in the aetiology of RA but results of previous studies have been mixed. The aim of this cross-sectional study was to assess the relationships between RA use of oral contraceptives (OCs) and history of breastfeeding in a population of older women from South China. METHODS: We used baseline data from 7349 women >/= 50 years of age in the Guangzhou Biobank Cohort. Questionnaires were used to obtain socio-demographic lifestyle and obstetric history data including parity OC use and breastfeeding practices. The main outcome was RA. Women were asked about history of RA and were examined to assess joint swelling. RF levels were measured. The presence of RA was defined in two ways: (i) as reporting physician-diagnosed RA or pain and swelling in at least three joints (including the wrist) and (ii) also having at least one of the following: positive RF morning stiffness or objective swelling of the small joints of the hands. RESULTS: Compared with those who had never breastfed breastfeeding was associated with half the risk of RA. The risk was lower with increasing duration of breastfeeding [adjusted odds ratio (OR) 0.54 (95% CI 0.29 1.01) for breastfeeding at least 36 months; P for trend = 0.04]. OC use had no relationship with RA. CONCLUSION: Breastfeeding (especially longer duration) but not OC use is associated with a lower risk of RA. This has potentially important implications for future RA disease burden given the declining rates of breastfeeding and the one-child policy in China. Further research is needed to explain the biological mechanism.

TargetCOPD: a pragmatic randomised controlled trial of targeted case finding for COPD versus routine practice in primary care: protocol

Abstract: Many people with clinically significant chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. There are a number of small studies which have examined possible methods of case finding through primary care, but no large RCTs that have adequately assessed the most cost-effective approach. In this study, using a cluster randomised controlled trial (RCT) in 56 general practices in the West Midlands, we plan to investigate the effectiveness and cost-effectiveness of a Targeted approach to case finding for COPD compared with routine practice. Using an individual patient RCT nested in the Targeted arm, we plan also to compare the effectiveness and cost-effectiveness of Active case finding using a postal questionnaire (with supplementary opportunistic questionnaires), and Opportunistic-only case finding during routine surgery consultations. All ever-smoking patients aged 40-79 years, without a current diagnosis of COPD and registered with participating practices will be eligible. Patients in the Targeted arm who report positive respiratory symptoms (chronic cough or phlegm, wheeze or dyspnoea) using a brief questionnaire will be invited for further spirometric assessment to ascertain whether they have COPD or not. Post-bronchodilator spirometry will be conducted to ATS standards using an Easy One spirometer by trained research assistants. The primary outcomes will be new cases of COPD and cost per new case identified, comparing targeted case finding with routine care, and two types of targeted case finding (active versus opportunistic). A multilevel logistic regression model will be used to model the probability of detecting a new case of COPD for each treatment arm, with clustering of patients (by practice and household) accounted for using a multi-level structure. A trial-based analysis will be undertaken using costs and outcomes collected during the trial. Secondary outcomes include the feasibility, efficiency, long-term cost-effectiveness, patient and primary care staff views of each approach. This will be the largest RCT of its kind, and should inform how best to identify undiagnosed patients with COPD in the UK and other similar healthcare systems. Sensitivity analyses will help local policy-makers decide which sub-groups of the population to target first. Current controlled trials ISRCTN14930255

Are school physical activity characteristics associated with weight status in primary school children? A multilevel cross-sectional analysis of routine surveillance data

Abstract: Background The school environment potentially influences the development of childhood obesity. Changes to schooling could be used as an intervention to reduce obesity but the features of the school environment that influence obesity are unknown. Aim To estimate the interschool variation in body mass index (BMI) z-scores in primary school children and examine the individual and school physical activity characteristics contributing to this. Methods Cross-sectional analysis and multilevel modelling at individual and school level, with BMI SD scores (z-scores) as the outcome. Individual and school data were obtained for 11 118 reception year children (age 4–5) and 10 151 year 6 children (age 10–11) from 296 primary schools in Birmingham. Data sources were the UK National Child Measurement Programme and the annual National School Sport Survey in 2006/7. Results In reception year children, 4.2% of the variation in BMI z-scores is attributed to differences between schools. Individual characteristics explained 24% of this between-school variation and certain school physical activity characteristics (the time schools devote to physical education) explained a further 28%. In year 6 children, only 0.9% of the variation in BMI z-scores was between-school variation. BMI z-scores were significantly higher in year 6 than reception year children, with the largest increases between year groups in the South Asian and African-Caribbean ethnic groups. Deprivation was positively associated with BMI z-scores. Conclusions In addition to the association between individual characteristics and BMI z-score, there is a small but significant association between school characteristics and BMI z-score, which is in part explained by the time schools devote to physical education. This modest school effect has the potential to have a substantial impact on children’s weight status at a population level.

Hypoxemia and glycemic control in type 2 diabetes mellitus with extreme obesity.

Abstract: Context: Obstructive sleep apnea (OSA) has been shown to be associated with type 2 diabetes mellitus (DM). Studies on healthy individuals found that OSA is associated with lower insulin sensitivity. We hypothesized that nocturnal hypoxemia from OSA is associated with poorer glycemia in severely obese DM individuals. Design and Setting: This was a retrospective observational study of 122 non-DM, 126 non–insulin-treated DM, and 35 insulin-treated DM patients. Data were collected on demographic characteristics, body mass index, and comorbidities. An overnight sleep study was performed in all patients, and OSA was defined as an apnea-hypopnea index of ≥5 events/h. Results: There were more males (P = .003) and a lower proportion of white Europeans (P = .010) among DM patients. The prevalence of OSA was 80.1% in DM and 63.1% in non-DM individuals (P = .001). DM individuals also had lower oxygen saturation (O2) (P = .0106), greater percentage of time spent under 90% oxygen saturation (%TST<90%) (P = .0067), and ...

Perceptions of Local Parents and School Staff on Childhood Obesity Prevention Interventions in Iran

Abstract: Background and Objectives: Childhood obesity is an increasing public health problem in Iran, and there is no evidence for effective prevention strategies to date. The aim of this qualitative study was to identify and prioritise perceived potential interventions by parents and school staff to help inform the development of an obesity prevention intervention for Iranian school children. Materials and Methods: Focus groups were held with the parents of primary school aged children and school staff working in primary schools in Tehran city. Additionally, three interviews were held with two physical education teachers and one school nurse. The participants were asked about the causes of obesity and what activities they believed would help children to maintain healthy weight. Then they were asked to prioritise the activities that would have the greatest impact on children to maintain their healthy weight. Thematic analysis was used to analyse the data. Parents were selected from a range of socio-economic backgrounds to include two groups from each of high, medium, and low socio-economic districts of Tehran. Eleven focus groups were held with a total of 85 participants. Results: Public policy interventions included the provision of valid nutrition information, physical activity promotion, and accessibility to healthy foods. School-based interventions included improving physical education, providing organised physical activity, provision of good quality education for children, parents and school staff, improving school shops, and using rewards and competitions. The findings suggest that close liaison should be established between the school, the family, and the broader community. Conclusions: This study provided important contextual data on where the emphasis should be placed in developing the childhood obesity prevention interventions for the school children in Tehran. The findings further highlight the importance of involving a wide range of stakeholders, and including multiple components to maximise the chances of success.

Comparison of characteristics of COPD patients with an established diagnosis, with those newly identified through case-finding – The Birmingham COPD cohort study

Abstract: Introduction There is increasing effort to identify people with undiagnosed COPD. However there is insufficient data on the profile of such patients to determine whether their characteristics and trajectory differ from those with established disease. Aim We compare the clinical characteristics of patients identified from a primary care COPD case-finding trial, with established cases on practice registers. Methods Interim baseline data from a primary care cohort of COPD patients from 71 UK practices were used. Patients with established COPD, as well as newly identified cases were invited. Baseline assessment includes spirometry, anthropometry, exercise capacity as well as questionnaires to obtain socio-demographic, occupational, lifestyle and health data Results 1,071 patients with spirometry confirmed COPD (LLN criteria) were included; 89 identified through case-finding. Compared with established cases, the newly identified were more likely to be female (47 vs 37%), younger (mean age 63.2 vs 68.9) and current smokers (42.0 vs 31.3%). They had less severe obstruction (55.1% vs 17.2% GOLD stage I), lower CAT score (mean 15.4 vs 20.2) and fewer comorbidities (10.1 vs 15.6% had ≥3 comorbidities). Restricting analyses to 812 with moderate/severe disease (GS II-III), newly identified patients still had lower CAT (p=0.04), fewer exacerbations (p≤0.01) and lower BODE (p≤0.01). All analyses adjusted for age, sex, smoking and disease severity. Conclusions Patients identified through case finding have milder disease. Longitudinal studies are needed to assess prognosis and longer term benefits of early diagnosis.

COPD and work absenteeism: Birmingham COPD cohort

Abstract: Introduction Around 5% of UK sickness absence (absenteeism) is due to COPD. However we know little about which factors are related to absenteeism in COPD patients to inform future interventions. Aims and objectives To carry out a cross-sectional analysis to assess factors associated with absenteeism in a primary care COPD cohort Methods Interim baseline data from a primary care cohort of COPD patients was used. We examine the associations between absenteeism and sociodemographic, clinical and occupational characteristics. Results Of 1700 COPD patients, 16.7% (n=283) were in work, of which ∼49% (n=139) reported absenteeism (> 1 day over 12m). Patients with absenteeism were more likely to be female (57.0% vs 44.4%), slightly younger (mean age 59.2 vs. 61.1) and to have ever smoked (47.8% vs. 42.1%) compared to those without. They were also more likely to report dyspnoea (p for trend 3). However there were no significant associations with disease severity (GOLD stage). Using a logistic regression model including income level in addition to all the above covariates, increasing number of exacerbations (p for trend > 0.01) remained the only factor independently associated with self-reported absenteeism. Conclusions This is the first UK primary care study to assess associations between COPD and absenteeism. Interventions to reduce COPD exacerbations should be a focus in trials aimed at improving work productivity.