ORCID Profile
0000-0003-2741-0467
Current Organisation
University of Tasmania
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-02-2009
DOI: 10.1161/CIRCULATIONAHA.108.812172
Abstract: Background— We examined whether population-level hospitalization rates for heart failure (HF) and subsequent survival have continued to improve since the turn of the century. We also examined trends in the prescribing of evidence-based pharmacological treatment for HF. Methods and Results— All patients in Scotland hospitalized with a first episode of HF between 1986 and 2003 were followed up until death or the end of 2004. Prescriptions of evidence-based treatments issued from 1997 to 2003 by a s le of primary care practices were also examined. A total of 116 556 in iduals (52.6% women) had a first hospital discharge for HF. Age-adjusted first hospitalization rates for HF (per 100 000 95% CI in parentheses) rose from 124 (119 to 129) in 1986 to 162 (157 to 168) in 1994 and then fell to 105 (101 to 109) in 2003 in men in women, they rose from 128 (123 to 132) in 1986 to 160 (155 to 165) in 1993, falling to 101 (97 to 105) in 2003. Case-fatality rates fell steadily over the period. Adjusted 30-day case-fatality rates fell after discharge (adjusted odds [2003 versus 1986] 0.59 [95% CI 0.45 to 0.63] in men and 0.77 [95% CI 0.67 to 0.88] in women). Adjusted 1- and 5-year survival improved similarly. Median survival increased from 1.33 to 2.34 years in men and from 1.32 to 1.79 years in women. Age-adjusted prescribing rates for angiotensin-converting enzyme inhibitors, β-blockers, and spironolactone increased from 1997 to 2003 (all P .0001 for trend). Conclusions— After rising between 1986 and 1994, rates of first hospitalization for HF declined. Case-fatality rates also fell. Prescribing rates for HF therapies increased from 1997 to 2003. These findings suggest that improvements in the prevention and treatment of HF may have had progressive, sustained effects on outcomes at the population level however, prognosis remains poor in HF.
Publisher: BMJ
Date: 11-2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
DOI: 10.1161/CIRCHEARTFAILURE.108.794008
Abstract: Background— Diabetes and heart failure frequently coexist. Our aim was to assess the association between diabetes and short- and long-term outcomes in all patients admitted to the hospital for the first time with heart failure in Scotland between 1986 and 2003. Methods and Results— A total of 116 556 patients were studied, of whom 13% (n=15 161) had a diagnosis of diabetes. At 30 days, diabetes was associated with a lower case fatality. By 1 year, the association between diabetes and better outcome was reversed, and diabetes was a significant independent predictor of higher case fatality. The longer term risk of death associated with diabetes was greatest in younger patients. In patients aged 65 years or younger, the hazard ratio for mortality at 5 years associated with diabetes was 1.41 (95% CI, 1.31 to 1.52) for men and 1.64 (1.50 to 1.79) for women. The risk associated with diabetes was less in patients aged 75 years or older: a hazard ratio in men 1.16 (1.10 to 1.22) and in women 1.15 (1.10 to 1.20). In the younger age group the risk associated with diabetes was significantly greater in women than in men ( P =0.005 for diabetes-sex interaction). Diabetes was also a significant independent predictor of heart failure readmission, and again the risk was greatest in younger women. Conclusions— Although diabetes was associated with a lower case fatality at 30 days, by 1 year it was a significant independent predictor of higher case fatality. The risk associated with diabetes was greatest in young patients, and in young patients the risk was greatest in women.
Publisher: BMJ
Date: 06-2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2009
DOI: 10.1161/CIRCOUTCOMES.108.825968
Abstract: Background— Temporal trends in stroke incidence are unclear. We aimed to examine age- and sex-specific temporal trends in incidence of fatal and nonfatal hospitalized stroke in Scotland from 1986 to 2005. Methods and Results— Mean age at the time of first stroke was 70.8 (SD, 12.9) years in men and 76.4 (12.9) years in women. Between 1986 and 2005, rates fell in men from 235 (95% CI, 229 to 242) to 149 (144 to 154) and in women from 299 (292 to 306) to 182 (177 to 188). Poisson modeling showed that temporal trends were influenced by age with declines in incidence of hospitalized stroke starting later in younger than older age groups. In both men and women aged under 55 years, the overall incidence rate of stroke was significantly higher in 2005 than in 1986. Conclusions— We report in a whole country that the overall incidence of stroke declined steadily and substantially between 1986 and 2005, with a relative reduction in the risk of stroke of 31% in men and 42% in women. Reductions in rates of both hospitalized and nonhospitalized fatal stroke contributed to this overall decline. The increase in incident stroke rates in young people is of concern.
Publisher: Wiley
Date: 06-2001
DOI: 10.1016/S1388-9842(00)00141-0
Abstract: The prognostic impact of heart failure relative to that of 'high-profile' disease states such as cancer, within the whole population, is unknown. All patients with a first admission to any Scottish hospital in 1991 for heart failure, myocardial infarction or the four most common types of cancer specific to men and women were identified. Five-year survival rates and associated loss of expected life-years were then compared. In 1991, 16224 men had an initial hospitalisation for heart failure (n=3241), myocardial infarction (n=6932) or cancer of the lung, large bowel, prostate or bladder (n=6051). Similarly, 14842 women were admitted for heart failure (n=3606), myocardial infarction (n=4916), or cancer of the breast, lung, large bowel or ovary (n=6320). With the exception of lung cancer, heart failure was associated with the poorest 5-year survival rate (approximately 25% for both sexes). On an adjusted basis, heart failure was associated with worse long-term survival than bowel cancer in men (adjusted odds ratio, 0.89 95% CI, 0.82-0.97 P<0.01) and breast cancer in women (odds ratio, 0.59 95% CI, 0.55-0.64 P<0.001). The overall population rate of expected life-years lost due to heart failure in men was 6.7 years/1000 and for women 5.1 years/1000. With the notable exception of lung cancer, heart failure is as 'malignant' as many common types of cancer and is associated with a comparable number of expected life-years lost.
Publisher: Elsevier BV
Date: 09-2001
DOI: 10.1016/S0735-1097(01)01465-6
Abstract: We tested the hypotheses that the effect of gender on short-term case fatality following a first admission for acute myocardial infarction (AMI) varies with age, and that this effect is offset by differences in the proportion of men and women who survive to reach hospital. Evidence is conflicting regarding the effect of gender on prognosis after AMI. All 201,114 first AMIs between 1986 and 1995 were studied. Both 30-day and 1-year case fatality were analyzed for the 117,749 patients hospitalized and for all first AMIs, including deaths before hospitalization. The effect of gender and its interaction with age on survival was examined using multivariate modeling. Gender-based differences in survival varied according to age in hospitalized patients, with younger women having higher 30-day case fatality than men (e.g., <55 years, women 6.5% vs. 4.8% men, p < 0.0001). When deaths from first AMI before hospitalization were included in 30-day case fatality, women were less likely to die (adjusted odds ratio 0.9, confidence interval 0.89 to 0.93). Gender was not an independent predictor of one-year survival (p = 0.16). Female gender increases the probability of surviving to reach hospital, and this outweighs the excess risk of death occurring in younger women following hospitalization. Overall, men have a higher 30-day case fatality than women. Women do not fare worse than men after AMI when age and other factors are taken into account. However, men are more likely to die before hospitalization.
Publisher: Oxford University Press (OUP)
Date: 12-2011
Abstract: Non-cardiac chest pain (NCCP) is considered a benign condition. We investigate case-fatality following an incident hospitalization for NCCP and determine whether previous psychiatric hospitalization is associated with short-term mortality. This was a population-based retrospective cohort study of 159 888 patients discharged from hospital in Scotland (1991-2006) following a first NCCP hospitalization, using routinely collected morbidity and mortality data. All-cause and cardiovascular disease (CVD) mortality at 1 year following hospitalization was examined. A total of 3514 (4.4%) men and 3136 (3.9%) women with a first NCCP hospitalization had a psychiatric hospitalization in the 10 years preceding incident NCCP hospitalization. Those with a previous psychiatric hospitalization were younger and more socioeconomically deprived (SED). Overall, crude case fatality at 1 year was 4.4% in men and 3.7% in women. This was higher in patients with a previous psychiatric hospitalization compared with those without (overall: men 6.3 vs. 4.3% women: 5.3 vs. 3.6%), in all age groups and all SED quintiles. Following adjustment (year of NCCP hospitalization, SED, co-morbid diabetes, and hypertension), the hazard of all-cause and CVD-specific death at 1 year was higher in men and women with a previous psychiatric hospitalization than without, with effect modification according to age group. Non-cardiac chest pain is not an entirely benign condition. In iduals with a hospital discharge diagnosis of NCCP who have a previous psychiatric hospitalization have a greater risk of death, all-cause, and CVD-specific, at 1 year, than those without. A NCCP hospitalization is an opportunity to engage, and where appropriate, intervene to modify cardiovascular risk in this difficult-to-reach and high-risk group.
Publisher: Informa UK Limited
Date: 14-12-2016
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.JEMERMED.2011.02.022
Abstract: The potential health benefits of mobile phone use have not been widely studied, except for telemedicine-type applications. This study seeks to determine whether initial contact with emergency services via a mobile phone in life-threatening situations is associated with potential health benefits when compared to contact via a landline. A record-linkage study was carried out in which data from all emergency dispatches for immediately life-threatening events from a United Kingdom county ambulance service were linked to the Patient Admission System at two major local hospitals. Mortality (at the scene, at the emergency department [ED], and during hospitalization) transfer to the ED admission (inpatient care, and intensive care unit) and length of stay were analyzed for calls classified as Code Red (immediately life-threatening) by initial exposure (mobile phone vs. landline), while controlling for potential confounding variables. Of 354,199 ambulances dispatched to attend emergency incidents, 66% transported patients to the hospital while 2% stood down due to death at the scene. Mobile phone compared to landline reporting of emergencies resulted in significant reductions in the risk of death at the scene (odds ratio [OR] 0.77), but not for death in the ED or during inpatient admission. The risk of being transferred to the ED and subsequent inpatient admission were significantly lower with reporting from mobile phones compared to landline (OR 0.93 and OR 0.82, respectively). In this study, evidence of statistical association was demonstrated between the use of mobile phones to alert ambulance services in life-threatening situations and improved outcomes for patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
DOI: 10.1161/STROKEAHA.108.542787
Abstract: Background and Purpose— The aim of this study was to examine the effect of sex across different age groups and over time for stroke incidence, 30-day case-fatality, and mortality. Methods— All first hospitalizations for stroke in Scotland (1986 to 2005) were identified using linked morbidity and mortality data. Age-specific rate ratios (RRs) for comparing women with men for both incidence and mortality were modeled with adjustment for study year and socioeconomic deprivation. Logistic regression was used to model 30-day case-fatality. Results— Women had a lower incidence of first hospitalization than men and size of effect varied with age (55 to 64 years, RR=0.65, 95% CI 0.63 to 0.66 ≥85 years, RR=0.94, 95% CI 0.91 to 0.96). Women aged 55 to 84 years had lower mortality than men and again size of effect varied with age (65 to 74 years, RR=0.79, 95% CI 0.76 to 0.81) 75 to 84 years, RR=0.94, 95% CI 0.92 to 0.95). Conversely, women aged ≥85 years had 15% higher stroke mortality than men (RR=1.15, 95% CI 1.12 to 1.18). Adjusted risk of death within 30 days was significantly higher in women than men, and this difference increased over the 20-year period in all age groups (adjusted OR in 55 to 64 year olds 1.23, 95% CI 1.14 to 1.33 in 1986 and 1.51, 95% CI 1.39 to 1.63 in 2005). Conclusions— We observed lower rates of incidence and mortality in younger women than men. However, higher numbers of older women in the population mean that the absolute burden of stroke is greater in women. Short-term case-fatality is greater in women of all ages and, worryingly, these differences have increased from 1986 to 2005.
Publisher: Springer Science and Business Media LLC
Date: 02-07-2010
Abstract: Preventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative s les may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD). The primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible in iduals. The programme employed two approaches to engaging with the community: a) a social marketing c aign and b) a community development project adopting primarily face-to-face canvassing. In iduals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches. Various reasons were identified for low uptake of risk screening amongst in iduals living in areas of high SED in response to the social marketing c aign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement (2) issues of understanding (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention. Socio-economically disadvantaged in iduals can be hard-to-reach engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.
Publisher: BMJ
Date: 12-2006
Publisher: Wiley
Date: 18-12-2009
Abstract: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist and present major challenges to healthcare providers. The epidemiology, consultation rate, and treatment of patients with HF and COPD in primary care are ill-defined. This was an analysis of cross-sectional data from 61 primary care practices (377 439 patients) participating in the Scottish Continuous Morbidity Recording scheme. The prevalence of COPD in patients with HF increased from 19.8% in 1999 to 23.8% in 2004. In 2004, the prevalence was similar in men and women (24.8% vs. 22.9%, P = 0.09), increased with age up to 75 years, and increased with greater socioeconomic deprivation (most deprived 31.3% vs. least deprived 18.6%, P = 0.01). Contact rates for HF or COPD in those with both conditions were greater than disease-specific contact rates in patients with either condition alone. Although overall beta-blocker prescribing increased over time the adjusted odds of beta-blocker prescription in patients with COPD was low and failed to improve [odds ratio 0.30 (0.28-0.32), P < 0.001]. In 2004, only 18% of in iduals with HF and COPD were prescribed beta-blockers vs. 41% in those without COPD. Chronic obstructive pulmonary disease is a frequent comorbidity in patients with HF and represents a significant healthcare burden to primary care. Although beta-blocker prescribing in the community has increased, less than a fifth of patients with HF and COPD received beta-blockers.
Publisher: BMJ
Date: 02-07-2010
Abstract: Randomised trials indicate that organised inpatient (stroke unit) care has an important impact on patient outcomes with an absolute risk difference (ARD) of 3% for survival and 5% for returning home. However, it is unclear what impact this complex intervention actually has in routine practice. A comprehensive national dataset was used to study the impact of stroke unit implementation. The Scottish linked discharge database was used to identify all patients admitted to hospital with an incident stroke. Analyses compared case fatality and discharge home (adjusted for age, sex, deprivation and comorbidity) for hospitals with or without a stroke unit during four consecutive study periods: 1986-1990, 1991-1995, 1996-2000 and 2001-2005. During the study period, the percentage of admissions to hospitals that had a stroke unit increased from 0% to 87%, the 6 month case fatality decreased from 45% to 29% and discharges home increased from 46% to 59%. Adjusted ORs (95% CI) for case fatality (stroke unit versus no unit) in each study period were as follows: not calculable (no units before 1991), 0.83 (0.78-0.89), 0.90 (0.86-0.94) and 0.87 (0.82-0.91). These equate to an ARD of 3.0% over the whole study period. Equivalent data for discharge home indicated an increased odds of discharge home: not calculable, 1.23 (1.15-1.31), 1.15 (1.10-1.21) and 1.17 (1.11-1.23) with an overall ARD of 5%. These results indicate a positive impact of a policy of stroke unit care on case fatality and discharge home. The estimated impact, after adjusting for case mix, appears very similar to that calculated using clinical trial data.
Publisher: Springer Science and Business Media LLC
Date: 05-06-2018
Publisher: Springer Science and Business Media LLC
Date: 29-03-2011
Publisher: Oxford University Press (OUP)
Date: 02-2001
Publisher: Elsevier BV
Date: 2018
Publisher: BMJ
Date: 15-07-2004
Publisher: Springer Science and Business Media LLC
Date: 09-04-2010
Publisher: Oxford University Press (OUP)
Date: 07-02-2012
DOI: 10.1093/HER/CYS005
Abstract: Secondary prevention programmes can be effective in reducing morbidity and mortality from coronary heart disease (CHD). In particular, UK guidelines, including those from the Department of Health, emphasize physical activity. However, the effects of secondary prevention programmes with an exercise component are moderate and uptake is highly variable. In order to explore patients' experiences of a pre-exercise screening and health coaching programme (involving one-to-one consultations to support exercise behaviour change), semi-structured telephone interviews were undertaken with 84 CHD patients recruited from primary care. The interviews focused on patients' experiences of the intervention including referral and any recommendations for improvement. A thematic analysis of transcribed interviews showed that the majority of patients were positive about referral. However, patients also identified a number of barriers to attending and completing the programme, including a belief they were sufficiently active already, the existence of other health problems, feeling unsupported in community-based exercise classes and competing demands. Our findings highlight important issues around the choice of an appropriate point of intervention for programmes of this kind as well as the importance of appropriate patient selection, suggesting that the effectiveness of health coaching may be under-reported as a result of including patients who are not yet ready to change their behaviours.
Publisher: Oxford University Press (OUP)
Date: 09-02-2012
DOI: 10.1002/BJS.8686
Abstract: This study examined trends for all first hospital admissions for peripheral artery disease (PAD) in Scotland from 1991 to 2007 using the Scottish Morbidity Record. First admissions to hospital for PAD were defined as an admission to hospital (inpatient and day-case) with a principal diagnosis of PAD, with no previous admission to hospital (principal or secondary diagnosis) for PAD in the previous 10 years. From 1991 to 2007, 41 593 in iduals were admitted to hospital in Scotland for the first time for PAD. Some 23 016 (55·3 per cent) were men (mean(s.d.) age 65·7(11·7) years) and 18 577 were women (aged 70·4(12·8) years). For both sexes the population rate of first admissions to hospital for PAD declined over the study interval: from 66·7 per 100 000 in 1991-1993 to 39·7 per 100 000 in 2006-2007 among men, and from 43·5 to 29·1 per 100 000 respectively among women. After adjustment, the decline was estimated to be 42 per cent in men and 27 per cent in women (rate ratio for 2007 versus 1991: 0·58 (95 per cent confidence interval 0·55 to 0·62) in men and 0·73 (0·68 to 0·78) in women). The intervention rate fell from 80·8 to 74·4 per cent in men and from 77·9 to 64·9 per cent in women. The proportion of hospital admissions as an emergency or transfer increased, from 23·9 to 40·7 per cent among men and from 30·0 to 49·5 per cent among women. First hospital admission for PAD in Scotland declined steadily and substantially between 1991 and 2007, with an increase in the proportion that was unplanned.
Publisher: Elsevier BV
Date: 03-2002
DOI: 10.1016/S0167-5273(01)00626-X
Abstract: Although atrial fibrillation (AF) is an important cause of cardiovascular morbidity and mortality there is a paucity of data describing hospitalisation rates and case-fatality associated with this common arrhythmia. This study examines recent trends in first-ever hospitalisations for AF in Scotland. Using the linked Scottish Morbidity Record Scheme, we identified all 22968 patients admitted to Scottish hospitals for the first time with a principal diagnosis of AF between 1986 and 1995. For each calendar year we calculated short (30-day) and medium (31 day to 2 years) case-fatality rates. Adjusting for each patient's age, sex, deprivation status, concurrent diagnoses and prior hospitalisation status, we examined whether case-fatality rates had significantly improved during this 10-year period. Between 1986 and 1995 the number of men hospitalised for the first time with AF increased by 926 (125%) to 1730 per annum and the number of women and by 875 (105%) to 1712 (both P<0.001). Hospitalisation rates increased from 0.31 to 0.70/1000 men and from 0.32 to 0.65/1000 women (both P<0.001). By the end of this period the proportion of men had increased from 48 to 50%. In both sexes, the median age of patients rose--in men from 66 to 68 years and in women from 74 to 75 years (both P<0.01). Despite the increasing age of patients and greater comorbidity, short-term (30-day) case-fatality declined from 4.0 to 3.1% in men (P<0.001) and 4.1 to 3.8% (P<0.01) in women. Similarly, medium-term (31-day to 2-year) case-fatality fell from 25 to 22% in men and 27 to 25% (both P<0.001) in women. Adjusting for the age, sex, extent of deprivation, secondary diagnoses and prior hospitalisation of hospitalised patients, we found that the risk of short-term case-fatality in the 1995 male and female cohort significantly declined by 21% (P<0.05) and 24% (P<0.05), respectively, in comparison to the 1986 cohort. The adjusted risk of case-fatality in the medium term also declined significantly in men by 30% (P<0.05) over this period and by 20% (P<0.05) in women relative to 1986. The number of first-ever hospitalisations for AF has increased twofold during the 10-year period 1986-1995. Although the age of patients has progressively increased during this period, short and medium case-fatality rates have declined, especially in men. This may partly reflect better treatment of AF. However, changing admission thresholds and other factors could also have led to an apparent improvement in prognosis. Nevertheless, medium-term case fatality remains substantial after a first ever admission to hospital with AF.
Publisher: Springer Science and Business Media LLC
Date: 16-01-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-09-2000
DOI: 10.1161/01.CIR.102.10.1126
Abstract: Background —Contemporary survival in unselected patients with heart failure and the population impact of newer therapies have not been widely studied. Therefore, we have documented case-fatality rates (CFRs) over a recent 10-year period. Methods and Results —In Scotland, all hospitalizations and deaths are captured on a single database. We have studied case fatality in all patients admitted with a principal diagnosis of heart failure from 1986 to 1995. A total of 66 547 patients (47% male) were studied. Median age was 72 years in men and 78 years in women. Crude CFRs at 30 days and at 1, 5, and 10 years were 19.9%, 44.5%, 76.5%, and 87.6%, respectively. Median survival was 1.47 years in men and 1.39 years in women (2.47 and 2.36 years, respectively, in those surviving 30 days). Age had a powerful effect on survival, and sex, comorbidity, and deprivation had modest effects. One-year CF was 24.2% in those aged years and 58.1% in those aged years. After adjustment, 30-day CFRs fell between 1986 and 1995, by 26% (95% CI 15 to 35, P .0001) in men and 17% (95% CI 6 to 26, P .0001) in women. Longer term CFRs fell by 18% (95% CI 13 to 24, P .0001) in men and 15% (95% CI 10 to 20, P .0001) in women. Median survival increased from 1.23 to 1.64 years. Conclusions —Heart failure CF is much higher in the general population than in clinical trials, especially in the elderly. Although survival has increased significantly over the last decade, there is still much room for improvement.
Publisher: Emerald
Date: 02-02-2015
Abstract: – The Australian Dietary Guidelines support good health and disease prevention. Children with healthy eating habits established early in life have been shown to continue these habits into adulthood compared with those children who have poor eating habits in their younger years. The nutritional intake of many Australian children is not in accordance with the national guidelines. The reasons children make the food choices they do are unclear from the literature. The paper aims to discuss these issues. – This study used participatory action research methods to explore why primary school-aged children make the food choices that they do. A non-government primary school requested assistance in encouraging their children to make healthier choices from the school canteen menu. The authors gathered opinions from the children in two different ways a group discussion during class and a “discovery day” that involved four class grades. The authors identified children’s food preferences and food availability in canteens. The authors explored how the children perceived healthy foods, the importance of a healthy food environment and what criteria children use to decide what foods to buy. – Children’s food preferences were mostly for unhealthy foods, and these were readily available in the canteen. The perception about what foods were healthy was limited. Despite being asked to develop a “healthy” menu, the majority of choices made by the children were not healthy. Children described unhealthy choices as preferable because of taste of the food, if it was sugary, if it was quick to eat, available and cheap, the relationship of food and weather, the connection to health conditions and peer dominance. – This study suggests that children make their food choices based on simple concepts. The challenge lies around producing healthy options in collaboration with the school community that match the children’s food choice criteria. – This paper provides a modern and inspiring whole school approach based on equity and empowerment of the children. Discovering why children make food choices from the children’s perspective will help to present healthy options that will be more appealing for children. The methodology used to uncover why children make their food choices has also provided valuable insight into a study design that could be used to address other childhood research questions. The methodology offers an educative experience while gathering rich information directly from the children. This information can be used by the school to support children to have more control over their health and to develop behaviours to increase their health for the rest of their lives.
Publisher: BMJ
Date: 08-2006
Publisher: Elsevier BV
Date: 10-2001
Publisher: BMJ
Date: 05-2008
Abstract: To examine the long-term outcome of patients evaluated in a rapid assessment chest pain clinic (RACPC): are "low-risk" patients safely reassured? Retrospective cohort study. Staff grade-led RACPC in an urban teaching hospital. 3378 patients (51% male), attending the RACPC between April 1996 and February 2000. Death, coronary mortality, morbidity and revascularisation over a median follow-up of 6 years. Coronary standardised mortality ratio (SMR). 2036 (60.3%) patients were categorised as "low risk", 957 (28.3%) as having "stable coronary artery disease" and 214 (6.3%) as being an "acute coronary syndrome". During the study, 3.6% of patients in the low risk category, 11.9% in the stable coronary artery disease category and 24.6% in the acute coronary syndrome category died from coronary artery disease or had a myocardial infarction. 5.5%, 18.2% and 18.4%, respectively, died from any cause. Compared to the local population (coronary SMR = 100), our "low risk/non-coronary chest pain" cohort had a coronary SMR of 51 (95% CI 31 to 83), the "stable coronary artery disease" cohort 240 (187 to 308) and the "acute coronary syndrome" cohort 780 (509 to 1196). The RACPC was effective at triaging patients with chest pain. Patients identified as at "low risk" were unlikely to have an adverse coronary outcome and were appropriately reassured.
Publisher: Oxford University Press (OUP)
Date: 15-04-2001
Publisher: Elsevier BV
Date: 11-2004
Publisher: Oxford University Press (OUP)
Date: 15-11-2000
Publisher: BMJ
Date: 05-2006
Publisher: BMJ
Date: 10-2004
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.IJCARD.2012.05.099
Abstract: Angina and intermittent claudication impair function and mobility and reduce health-related quality of life. Both symptoms have similar etiology, yet the physical and psychological impacts of these symptoms are rarely studied in community-based cohorts or in in iduals with isolated symptoms. The 2003 Scottish Health Survey was a cross-sectional survey which enrolled a random s le of in iduals aged 16-95 years living in Scotland. The Rose Angina Questionnaire, the Edinburgh Claudication Questionnaire, the Short Form-12 (SF-12) and the General Health Questionnaire were completed. Self-assessed general health was reported. Survey results were linked to national death records and mortality at five years was calculated. Subjects with isolated angina or intermittent claudication and neither symptom were compared (22 participants with both symptoms were excluded) 7403 participants (aged ≥ 16 years) were included. Participants with angina (n=205 60 ± 15 years 45% male) rated their general health worse and were more likely to have a potential mental-health problem than those with intermittent claudication (n=173 61 ± 15 years 41% male). Mean (standard deviation) physical and mental component scores on the SF-12 were higher for participants with intermittent claudication relative to those with angina (physical component score: 42.3 (10.6) vs. 35.0 (11.7), p<0.001 mental component score: 52.3 (8.5) vs. 46.5 (11.7), p=0.001). There was an observed absolute difference in five-year mortality of 4.8% (angina 12.3%, 95% CI 8.5-17.6 intermittent claudication 7.5%, 95% CI 4.4-12.6) although not statistically significant (p=0.16). Both intermittent claudication and angina adversely impact general and mental health and survival, even in a relatively young, community-based cohort.
Publisher: Oxford University Press (OUP)
Date: 23-09-2006
Abstract: To examine the long-term cardiovascular consequences of obesity and project the cardiovascular consequences of the recent increase in prevalence of obesity. Between 1972 and 1976, 15 402 in iduals aged 45-64, living in two towns in the west of Scotland underwent comprehensive cardiovascular screening. We analysed all deaths and hospitalizations for cardiovascular reasons occurring over the subsequent 20 years according to baseline body mass index (BMI) category. Compared with normal weight in iduals (BMI 18.5-24.9), obesity (BMI > or =30) was associated with an increased adjusted risk of coronary heart disease (hazard ratio for death or hospital admission: 1.60, 95% CI 1.45-1.78), heart failure (2.09, 1.68-2.59), stroke (1.41, 1.21-1.65), venous thrombo-embolism (2.29, 1.60-3.30), and atrial fibrillation (1.75, 1.17-2.65). Obesity was associated with nine additional cardiovascular deaths and 36 additional cardiovascular hospital admissions for every 100 affected middle-aged men over the subsequent 20 years (seven deaths and 28 admissions in women). Assuming no change in cardiovascular risk profile and outcomes related to obesity, the increase in prevalence in 1998, when compared with 1972, is projected to lead to an additional four cardiovascular deaths and 14 admissions per 100 middle-aged men and women over the next 20 years. Obesity is associated with an increase in a broad range of fatal and non-fatal cardiovascular events. Consideration of only coronary, only fatal, and only first events greatly underestimates the cardiovascular consequences of obesity.
Publisher: BMJ
Date: 05-2007
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