Peymane Adab

Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial

Objective To assess the effectiveness of a range of weight management programmes in terms of weight loss. Design Eight arm randomised controlled trial. Setting Primary care trust in Birmingham, England. Participants 740 obese or overweight men and women with a comorbid disorder identified from general practice records. Interventions Weight loss programmes of 12 weeks’ duration: Weight Watchers; Slimming World; Rosemary Conley; group based, dietetics led programme; general practice one to one counselling; pharmacy led one to one counselling; choice of any of the six programmes. The comparator group was provided with 12 vouchers enabling free entrance to a local leisure (fitness) centre. Main outcome measures The primary outcome was weight loss at programme end (12 weeks). Secondary outcomes were weight loss at one year, self reported physical activity, and percentage weight loss at programme end and one year. Results Follow-up data were available for 658 (88.9%) participants at programme end and 522 (70.5%) at one year. All programmes achieved significant weight loss from baseline to programme end (range 1.37 kg (general practice) to 4.43 kg (Weight Watchers)), and all except general practice and pharmacy provision resulted in significant weight loss at one year. At one year, only the Weight Watchers group had significantly greater weight loss than did the comparator group (2.5 (95% confidence interval 0.8 to 4.2) kg greater loss,). The commercial programmes achieved significantly greater weight loss than did the primary care programmes at programme end (mean difference 2.3 (1.3 to 3.4) kg). The primary care programmes were the most costly to provide. Participants allocated to the choice arm did not have better outcomes than those randomly allocated to a programme. Conclusions Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective. Trial registration Current Controlled Trials ISRCTN25072883.

Passive smoking exposure and risk of COPD among adults in China: the Guangzhou Biobank Cohort Study

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in China, where the population is also exposed to high levels of passive smoking, yet little information exists on the effects of such exposure on COPD. We examined the relation between passive smoking and COPD and respiratory symptoms in an adult Chinese population. METHODS We used baseline data from the Guangzhou Biobank Cohort Study. Of 20 430 men and women over the age of 50 recruited in 2003-06, 15,379 never smokers (6497 with valid spirometry) were included in this cross-sectional analysis. We measured passive smoking exposure at home and work by two self-reported measures (density and duration of exposure). Diagnosis of COPD was based on spirometry and defined according to the GOLD guidelines. FINDINGS There was an association between risk of COPD and self-reported exposure to passive smoking at home and work (adjusted odds ratio 1.48, 95% CI 1.18-1.85 for high level exposure; equivalent to 40 h a week for more than 5 years). There were significant associations between reported respiratory symptoms and increasing passive smoking exposure (1.16, 1.07-1.25 for any symptom). INTERPRETATION Exposure to passive smoking is associated with an increased prevalence of COPD and respiratory symptoms. If this association is causal, we estimate that 1.9 million excess deaths from COPD among never smokers could be attributable to passive smoking in the current population in China. Our findings provide strong evidence for urgent measures against passive smoking in China.

Performance league tables: the NHS deserves better

League tables are frequently used to depict comparative performance in sport and commerce. However, extension of their use to rank services provided by healthcare agencies has attracted resistance, criticism, and anxiety. In this article we discuss the benefits and drawbacks of league tables and suggest that an alternative technique, based on statistical process control, could be introduced in their place. We believe that this technique would have the dual advantage of being less threatening to providers of health services and would be more easily understood and correctly interpreted by patients, auditors, and commissioners of services. ### Summary points League tables are an established technique for displaying the comparative ranking of organisations in terms of their performance League tables provoke anxiety and concern among health service providers for several reasons, including concerns over adjustment for case mix and the role of chance in determining their rank Control charts, used for monitoring and control of variation in the manufacturing industry, overcome these problems by displaying performance without ranking and helping to differentiate between random variation and that due to special causes League tables are useful for comparing quality or outputs from different systems, whereas control charts are more useful for comparison of units within a single system, such as the NHS Control charts avoid stigmatising “poor performers” and promote the use of a systems approach to quality improvement For many years league tables have been used to rank the quality of goods or services provided by competing organisations. They are commonly published in the popular press and magazines, specialist journals, and the internet. These tables range from those that simply rank crude performance on indicators to those that report sophisticated comparisons of summary adjusted statistics (such as those with uncertainty intervals around the rank). The public is prepared to pay intermediaries, such as financial advisers, …

Does smoking status influence the prognosis of bladder cancer? A systematic review.

Objectives To summarize, in a systematic review, the evidence for the effect of stopping smoking on recurrence, cancer‐specific and all cause‐mortality among smokers with newly diagnosed bladder cancer.

Age of menarche and the metabolic syndrome in China.

Objectives: In western populations, young age of menarche is associated with increased cardiovascular risk. Little is known about the potential impact of menarche on the metabolic syndrome (as a proxy for cardiovascular risk) in rapidly economically developing populations where age of menarche is falling. We sought to determine the relation between age of menarche and the metabolic syndrome in a rapidly developing Chinese population. Methods: We carried out a retrospective historical cohort study of 7349 women from the Guangzhou Biobank Cohort Study, China, enrolled in 2003–2004. Cardiovascular risk factors were obtained from physical examination; age of menarche was obtained from self-report. The main outcome measure was the metabolic syndrome and its components. Results: Adjusted for age, education, and number of pregnancies, young age of menarche (<12.5 years) compared with age of menarche ≥14.5 years was associated with a higher risk of the metabolic syndrome (odds ratio = 1.49; 95% confidence interval = 1.22–1.82), central obesity (1.35; 1.10–1.65), raised blood pressure (1.34; 1.09–1.65), raised fasting glucose (1.40; 1.15–1.71), and higher triglyceride levels (1.36; 1.12–1.67). Further adjustment by waist circumference attenuated these effects, but the odds ratios remained elevated. Conclusions: Earlier age of menarche experienced by younger women in China today, now 12.5 years on average in urban populations, may contribute to an increase in the metabolic syndrome and thereby an increase in cardiovascular disease as these women age. These results further highlight the importance of childhood antecedents of adulthood disease.

Prior TB, Smoking, and Airflow Obstruction: A Cross-Sectional Analysis of the Guangzhou Biobank Cohort Study

BACKGROUND Prior pulmonary TB has been shown to be associated with a higher risk of airflow obstruction, which is the hallmark of COPD, but whether smoking modifies this relationship is unclear. We investigated the relationships between prior TB, smoking, and airflow obstruction in a Chinese population sample. METHODS Participants in the Guangzhou Biobank Cohort Study underwent spirometry, chest radiography, and a structured interview on lifestyle and exposures. Prior TB was defined as the presence of radiologic evidence suggestive of inactive TB. Airflow obstruction was based on spirometric criteria. RESULTS The prevalence of prior TB in this sample (N = 8,066, mean age: 61.9 years) was 24.2%. After controlling for sex, age, and smoking exposure, prior TB remained independently associated with an increased risk of airflow obstruction (odds ratio = 1.37; 95% CI, 1.13-1.67). Further adjustment for exposure to passive smoking, biomass fuel, and dust did not alter the relationship. Smoking did not modify the relationship between prior TB and airflow obstruction. CONCLUSIONS Prior TB is an independent risk factor for airflow obstruction, which may partly explain the higher prevalence of COPD in China. Clinicians should be aware of this long-term risk in individuals with prior TB, irrespective of smoking status, particularly in patients from countries with a high TB burden.

Relationship between walking levels and perceptions of the local neighbourhood environment

Objective: To explore the relationship between frequency of walking trips, perceptions of the local environment and individual travel preferences in children. Design: Cross-sectional questionnaire-based study. Setting: Six primary schools in Birmingham, UK, range of socioeconomic classifications. Participants: 473 children aged 9–11 years (82% response rate), including 250 (52.9%) boys and 160 (33.8%) from ethnic minority populations. Outcome measures: The primary outcome measure was level of walking (high or low) based on self-reported walking frequency in the past week. Secondary outcome measures included child perceptions of seven aspects of the local environment and individual travel preference. All outcomes were measured through questionnaires administered at school in the presence of a researcher. Results: 198 (41.9%) children were classified as high walkers and 275 (58.1%) as low walkers. After adjusting for confounding factors, high walkers were more likely to perceive heavy traffic surrounding their homes (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.03 to 2.33), unsafe streets (OR 1.88, 95% CI 1.27 to 2.80) and prefer healthier modes of travel (OR 1.67, 95% CI 2.56 to 1.08). High walkers were less likely to worry about strangers (OR 0.66, 95% CI 0.45 to 1.02) and less likely to report no parks or sports grounds nearby (OR 0.66, 95% CI 0.42 to 1.02). Children from ethnic minority groups walked significantly less than white children (mean number of walking trips 16.8 and 21.9, respectively, p<0.001). Conclusions: Certain environmental perceptions are related to walking levels in children. Awareness of these may help in the development of future interventions, and also enable healthcare professionals to encourage walking by providing case-specific and appropriate advice.

Parity and the metabolic syndrome in older Chinese women: the Guangzhou Biobank Cohort Study

Objective  To examine whether parity or gravidity contributes to the development of the metabolic syndrome (MS).

Original ResearchCOPDPrior TB, Smoking, and Airflow Obstruction: A Cross-Sectional Analysis of the Guangzhou Biobank Cohort Study

BACKGROUND Prior pulmonary TB has been shown to be associated with a higher risk of airflow obstruction, which is the hallmark of COPD, but whether smoking modifies this relationship is unclear. We investigated the relationships between prior TB, smoking, and airflow obstruction in a Chinese population sample. METHODS Participants in the Guangzhou Biobank Cohort Study underwent spirometry, chest radiography, and a structured interview on lifestyle and exposures. Prior TB was defined as the presence of radiologic evidence suggestive of inactive TB. Airflow obstruction was based on spirometric criteria. RESULTS The prevalence of prior TB in this sample (N = 8,066, mean age: 61.9 years) was 24.2%. After controlling for sex, age, and smoking exposure, prior TB remained independently associated with an increased risk of airflow obstruction (odds ratio = 1.37; 95% CI, 1.13-1.67). Further adjustment for exposure to passive smoking, biomass fuel, and dust did not alter the relationship. Smoking did not modify the relationship between prior TB and airflow obstruction. CONCLUSIONS Prior TB is an independent risk factor for airflow obstruction, which may partly explain the higher prevalence of COPD in China. Clinicians should be aware of this long-term risk in individuals with prior TB, irrespective of smoking status, particularly in patients from countries with a high TB burden.

Case finding for chronic obstructive pulmonary disease: a model for optimising a targeted approach

Objectives Case finding is proposed as an important component of the forthcoming English National Clinical Strategy for chronic obstructive pulmonary disease (COPD) because of accepted widespread underdiagnosis worldwide. However the best method of identification is not known. The extent of undiagnosed clinically significant COPD in England is described and the effectiveness of an active compared with an opportunistic approach to case finding is evaluated. Methods A cross-sectional analysis was carried out using using Health Survey for England (HSE) 1995–1996 data supplemented with published literature. A model comparing an active approach (mailed questionnaires plus opportunistic identification) with an opportunistic-only approach of case finding among ever smokers aged 40–79 years was evaluated. There were 20 496 participants aged ≥30 years with valid lung function measurements. The main outcome measure was undiagnosed clinically significant COPD (any respiratory symptom with both forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.7 and FEV1 <80% predicted). Results 971 (4.7%) had clinically significant COPD, of whom 840 (86.5%) did not report a previous diagnosis. Undiagnosed cases were more likely to be female, and smoked less. 25.3% had severe disease (FEV1 <50% predicted), 38.5% Medical Research Council (MRC) grade 3 dyspnoea and 44.1% were current smokers. The active case-finding strategy can potentially identify 70% more new cases than opportunistic identification alone (3.8 vs 2.2 per 100 targeted). Treating these new cases could reduce hospitalisations by at least 3300 per year in England and deaths by 2885 over 3 years. Conclusions There is important undiagnosed clinically significant COPD in the population, and the addition of a systematic case-finding approach may be more effective in identifying these cases. The cost-effectiveness of this approach needs to be tested empirically in a prospective study.