Anne Matthews

MENSTRUAL BLOOD-LOSS WITH INTRAUTERINE DEVICES

The effect of three intrauterine contraceptive devices (I.U.D.)-Lippes D, Dalkon Shield, and Copper 7-on menstrual blood-loss has been studied serially by objective methods in 279 women. All the women had a minimum of two cycles following delivery, abortion, cessation of lactation, or previous pill or I.U.D. use. All pads and tampons used for two further menstrual cycles before and for 12 cycles after I.U.D. insertion were collected, and the blood-loss was measured by extracting the haemoglobin by conversion to alkaline haematin. Mean menstrual blood-loss increased with all three devices. The amount of loss, the percentage of women losing more than 80 ml, the decline in haemoglobin concentration, and the incidence of anaemia during the 12 cycles following insertion were all greater among users of the Lippes Loop than of the Copper 7 with generally intermediate values for Dalkon Shield users. The mean increases in blood-loss were: for parous women fitted with the Lippes Loop, 48 ml, with the Dalkon Shield, 34 ml, and with the Copper 7, 18 ml; for nulliparae fitted with the small size of Dalkon Shield, 27 ml, and, with the Copper 7, 19 ml.

A systematic review of the influence of the retail food environment around schools on obesity-related outcomes

The high prevalence of childhood obesity has led to questions about the influence of ‘obesogenic’ environments on childrens health. Public health interventions targeting the retail food environment around schools have been proposed, but it is unclear if they are evidence based. This systematic review investigates associations between food outlets near schools and childrens food purchases, consumption and body weight. We conducted a keyword search in 10 databases. Inclusion criteria required papers to be peer reviewed, to measure retailing around schools and to measure obesity‐related outcomes among schoolchildren. Thirty papers were included. This review found very little evidence for an effect of the retail food environment surrounding schools on food purchases and consumption, but some evidence of an effect on body weight. Given the general lack of evidence for association with the mediating variables of food purchases and consumption, and the observational nature of the included studies, it is possible that the effect on body weight is a result of residual confounding. Most of the included studies did not consider individual childrens journeys through the food environment, suggesting that predominant exposure measures may not account for what individual children actually experience. These findings suggest that future interventions targeting the food environment around schools need careful evaluation.

Evaluating the Feasibility of Measuring Travel to School Using a Wearable Camera

Background The school journey is often studied in relation to health outcomes in children and adolescents. Self-report is the most common measurement tool. Purpose To investigate the error on self-reported journey duration in adolescents, using a wearable digital camera (Microsoft SenseCam). Methods During March–May 2011, participants (n=17; aged 13–15 years) from four schools wore wearable cameras to and from school for 1 week. The device automatically records time-stamped, first-person point-of-view images, without any action from the wearer. Participants also completed a researcher-administered self-report travel survey over the same period. Analysis took place in November 2011. Within- and between-subjects correlation coefficients and Bland-Altman 95% limits of agreement were derived, accounting for the multiple observations per individual. Results Self-report data were collected for 150 journey stages and SenseCam data for 135 (90%) of these. The within-subjects correlation coefficient for journey duration was 0.89 (95% CI=0.84, 0.93). The between-subjects correlation coefficient was 0.92 (95% CI=0.79, 0.97). The mean difference (bias) between methods at the whole sample level was small (10 seconds per journey, 95% CI= −33, 53). The wide limits of agreement (±501 seconds, 95% CI= −491, 511) reveal large random error. Conclusions Compared to direct observation from images, self-reported journey duration is accurate at the mean group level but imprecise at the level of the individual participant.

How many foods in the UK carry health and nutrition claims, and are they healthier than those that do not?

Objective The present study aimed to measure the prevalence of different types of health and nutrition claims on foods and non-alcoholic beverages in a UK sample and to assess the nutritional quality of such products carrying health or nutrition claims. Design A survey of health and nutrition claims on food packaging using a newly defined taxonomy of claims and internationally agreed definitions of claim types. Setting A national UK food retailer: Tesco. Subjects Three hundred and eighty-two products randomly sampled from those available through the retailer’s website. Results Of the products, 32 % (95 % CI 28, 37 %) carried either a health or nutrition claim; 15 % (95 % CI 11, 18 %) of products carried at least one health claim and 29 % (95 % CI 25, 34 %) carried at least one nutrition claim. When adjusted for product category, products carrying health claims tended to be lower in total fat and saturated fat than those that did not, but there was no significant difference in sugar or sodium levels. Products carrying health claims had slightly higher fibre levels than products without. Results were similar for comparisons between products that carry nutrition claims and those that do not. Conclusions Health and nutrition claims appear frequently on food and beverage products in the UK. The nutrient profile of products carrying claims is marginally healthier than for similar products without claims, suggesting that claims may have some but limited informational value. The implication of these findings for guiding policy is unclear; future research should investigate the ‘clinical relevance’ of these differences in nutritional quality.

“Don’t wait for them to come to you, you go to them”. A qualitative study of recruitment approaches in community based walking programmes in the UK

BackgroundThis study aimed to examine the experiences of walking promotion professionals on the range and effectiveness of recruitment strategies used within community based walking programmes within the United Kingdom.MethodsTwo researchers recruited and conducted semi-structured interviews with managers and project co-ordinators of community based walking programmes, across the UK, using a purposive sampling frame. Twenty eight interviews were conducted, with community projects targeting participants by age, physical activity status, socio-demographic characteristics (i.e. ethnic group) or by health status. Three case studies were also conducted with programmes aiming to recruit priority groups and also demonstrating innovative recruitment methods. Data analysis adopted an approach using analytic induction.ResultsTwo types of programmes were identified: those with explicit health aims and those without. Programme aims which required targeting of specific groups adopted more specific recruitment methods. The selection of recruitment method was dependent on the respondent’s awareness of ‘what works’ and the resource capacity at their disposal. Word of mouth was perceived to be the most effective means of recruitment but using this approach took time and effort to build relationships with target groups, usually through a third party. Perceived effectiveness of recruitment was assessed by number of participants rather than numbers of the right participants. Some programmes, particularly those targeting younger adult participants, recruited using new social communication media. Where adopted, social marketing recruitment strategies tended to promote the ‘social’ rather than the ‘health’ benefits of walking.ConclusionsEffective walking programme recruitment seems to require trained, strategic, labour intensive, word-of-mouth communication, often in partnerships, in order to understand needs and develop trust and motivation within disengaged sedentary communities. Walking promotion professionals require better training and resources to deliver appropriate recruitment strategies to reach priority groups.

Exploring the opportunities for food and drink purchasing and consumption by teenagers during their journeys between home and school: a feasibility study using a novel method

OBJECTIVE To investigate the feasibility and acceptability of using wearable cameras as a method to capture the opportunities for food and drink purchasing/consumption that young people encounter on their regular journeys to and from school. DESIGN A qualitative study using multiple data-collection methods including wearable cameras, global positioning system units, individual interviews, food and drink purchase and consumption diaries completed by participants over four days, and an audit of food outlets located within an 800 m Euclidean buffer zone around each school. SETTING A community setting. SUBJECTS Twenty-two students (fourteen girls and eight boys) aged 13-15 years recruited from four secondary schools in two counties of England. RESULTS Wearable cameras offered a feasible and acceptable method for collecting food purchase and consumption data when used alongside traditional methods of data collection in a small number of teenagers. We found evidence of participants making deliberate choices about whether or not to purchase/consume food and drink on their journeys. These choices were influenced by priorities over money, friends, journey length, travel mode and ease of access to opportunities for purchase/consumption. Most food and drink items were purchased/consumed within an 800 m Euclidean buffer around school, with items commonly selected being high in energy, fat and sugar. Wearable camera images combined with interviews helped identify unreported items and misreporting errors. CONCLUSIONS Wearable camera images prompt detailed discussion and generate contextually specific information which could offer new insights and understanding around eating behaviour patterns. The feasibility of scaling up the use of these methods requires further empirical work.

Associations between Food Outlets around Schools and BMI among Primary Students in England: A Cross-Classified Multi-Level Analysis

Introduction Researchers and policy-makers are interested in the influence that food retailing around schools may have on child obesity risk. Most previous research comes from North America, uses data aggregated at the school-level and focuses on associations between fast food outlets and school obesity rates. This study examines associations between food retailing and BMI among a large sample of primary school students in Berkshire, England. By controlling for individual, school and home characteristics and stratifying results across the primary school years, we aimed to identify if the food environment around schools had an effect on BMI, independent of socio-economic variables. Methods We measured the densities of fast food outlets and food stores found within schoolchildren’s home and school environments using Geographic Information Systems (GIS) and data from local councils. We linked these data to measures from the 2010/11 National Child Measurement Programme and used a cross-classified multi-level approach to examine associations between food retailing and BMI z-scores. Analyses were stratified among Reception (aged 4-5) and Year 6 (aged 10-11) students to measure associations across the primary school years. Results Our multilevel model had three levels to account for individual (n = 16,956), home neighbourhood (n = 664) and school (n = 268) factors. After controlling for confounders, there were no significant associations between retailing near schools and student BMI, but significant positive associations between fast food outlets in home neighbourhood and BMI z-scores. Year 6 students living in areas with the highest density of fast food outlets had an average BMI z-score that was 0.12 (95% CI: 0.04, 0.20) higher than those living in areas with none. Discussion We found little evidence to suggest that food retailing around schools influences student BMI. There is some evidence to suggest that fast food outlet densities in a child’s home neighbourhood may have an effect on BMI, particularly among girls, but more research is needed to inform effective policies targeting the effects of the retail environment on child obesity.

An education programme influencing health professionals to recommend exercise to their type 2 diabetes patients – understanding the processes: a case study from Oxfordshire, UK

BackgroundIncreasing levels of physical activity decreases the risk of premature mortality associated with chronic diseases e.g., coronary heart disease, type 2 diabetes, stroke. Despite this, most adults in England do not meet physical activity guidelines. Physical activity advice and signposting offered to at-risk patients by primary care providers is recommended. However, exercise medicine education is sparse, leading to poor practitioner knowledge of the risk reduction evidence and strategies to implement effective patient behaviour change. The ‘Generation Games’ intervention seeks physical activity increase in the 50+ population of Oxfordshire. It offers a Health Professional Education Programme (HPEP) providing exercise medicine education, and promotion of Generation Games to which health professionals can signpost patients. There is a poor evidence base concerning how such education translates into patient exercise behaviour change.MethodsThe research aimed to create more understanding of how an education programme can influence health professionals to recommend Generation Games to and increase exercise behaviour in type 2 diabetes patients. A case study method facilitated examination of the routines and cultures studied – the experience of Diabetes nurses was used as an example of best practice engagement with the HPEP. Observation, interviews and documentation were employed to triangulate data. Data analysis refined and developed themes within key theoretical frameworks.ResultsFirstly, there is a lack of knowledge about physical activity risk reduction benefits and a belief that efforts to motivate patients to increase their physical activity are ineffective, thus creating barriers to engagement with the HPEP. Secondly, practice nurses tasked with delivering lifestyle advice to diabetes patients – themselves suffering a motivational interviewing skill deficit – find ingrained physical activity behaviours extremely challenging, and therefore highly value the HPEP for providing helpful tools. Thirdly, patients who hear of Generation Games from a health professional may have mismatched expectations of how their exercise behaviour can change.ConclusionsExercise medicine education has the potential to improve patient care and services. Before initiatives like the HPEP can succeed, primary care practice requires a more supportive exercise medicine culture. Also necessary is adequate resourcing of patient-centred behaviour change advice, training, encouragement and monitoring services.

Influence of the retail food environment around schools on obesity-related outcomes: a systematic review

Abstract Background Soaring childhood obesity rates have led to questions about the influence of obesogenic environments on childrens health. Public health interventions that target the retail food environment around schools have been proposed, but whether these interventions are evidence based is unclear. Methods We examined associations between the retail food environment near schools and food purchasing, consumption, and bodyweight of students. We catalogued and critiqued the methods and results of studies analysing these associations and sought to assess the quality of evidence within the publications. We undertook a keyword search of several databases and sources of grey literature, including Medline, Embase, Web of Science, and the Cochrane Public Health Group specialised register. Inclusion criteria required studies to be published in a peer-reviewed journal between January, 1981, and October, 2012, provide at least one measurement of food retailing surrounding schools, and include outcome data for school children aged 5–18 years. Two researchers independently reviewed papers and blindly assessed the quality of the study using a modified checklist that covered study design and reporting. Methodological heterogeneity precluded meta-analysis, so we used a semiquantitative method in which we categorised papers according to their outcomes and identified whether or not the outcome was significantly (p Findings 21 studies met our inclusion criteria. All followed a cross-sectional study design. 19 described the food environment with geographical-system-information-based measures (eg, the density or proximity of food outlets within a buffer zone around the school) and two characterised the food environment using qualitative data. Outcome measures varied considerably. Only one study examined effects on food purchasing behaviour. Far more common were studies examining effects on the consumption of fruit and vegetables and of foods high in fat, sugar, or salt, or the effects on bodyweight. The one study that examined the associations between food outlets and food purchases showed a significant correlation between the proximity of fast food outlets and the number of fast food purchases. Five papers assessed associations between food outlets around schools and the consumption of fruits and vegetables. 34 relations were assessed, half of which showed a positive correlation. Only one of these results was significant (p Interpretation This review of the scientific literature found very little evidence for an effect of the retail food environment surrounding schools on food purchases and consumption patterns, but some evidence of an effect on bodyweight. Given the general lack of evidence for association with the mediating variables of food purchasing and food consumption, and the observational nature of the studies included in this review, it is possible that this finding is a result of residual confounding. The methods for the studies varied, but many contained worrying limitations; for example, most studies measured exposure at the level of the school and only one study considered childrens actual journeys through the food environment. Better studies are required to inform effective public health policies. Funding British Heart Foundation, NHS Berkshire.